Teaching has been adequate when a client being treated with acetylsalicylic acid states:
1. “I can crush the pills before I swallow them.”
A. “I can crush the pills before I swallow them.”
B. “I should take the pills with antacids.”
C. “Taking the pills on an empty stomach will help absorption.”
D. “If the pills smell like vinegar, I should throw them out.”
Correct Answer: D. “If the pills smell like vinegar, I should throw them out.”
Any aspirin should be discarded if a vinegar odor is noticed. Aspirin reacts slowly with water to give salicylic acid and acetic acid. The green line shows the ester bond that is broken during the hydrolysis reaction. So, when you open an old bottle of aspirin it is common to smell the vinegar. This means that at least some of the aspirin has degraded.
Option A: Crushing is not recommended for sustained-release preparations. Aspirin absorption from the gastrointestinal (GI) tract depends on the formulation state. When consumed as a liquid preparation, it is rapidly absorbed as opposed to tablets. Its hydrolysis yields salicylic acid. Salicylic acid has a narrow therapeutic window. If maintained within that narrow range, it provides the appropriate anti-inflammatory effect.
Option B: Antacids impair absorption. Aspirins absorption is pH sensitive at the level of the small intestine. Absorption is higher through the small intestine than the stomach for the same pH range. At pH 3.5 or 6.5, aspirin’s intestinal absorption is greater than the gastric absorption of the compound. The stomach does not absorb aspirin at pH 6.5.
Option C: Taking the medication on an empty stomach will increase GI irritation. Aspirin increases the risk of GI bleeding in patients who already suffer from peptic ulcer disease or gastritis. The risk of bleeding is still present even without these conditions if there is concomitant consumption of alcohol or if the patient is on warfarin.