# A client is prescribed sucralfate 1 g PO QID and ciprofloxacin 500 mg PO BID. Which administration schedule should the nurse implement?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391805&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client is prescribed sucralfate 1 g PO QID and ciprofloxacin 500 mg PO BID. Which administration schedule should the nurse implement?

## Option

1. Administer sucralfate with the first bite of each meal and at bedtime; give ciprofloxacin immediately after meals to reduce nausea.
2. Advise the client to use sucralfate solely when heartburn or reflux occurs, as it provides immediate relief and does not require routine dosing.
3. Give sucralfate on an empty stomach 1 hour before meals and bedtime; separate ciprofloxacin by at least 2 hours from sucralfate to prevent binding **✔ Correct answer**
4. If the client has difficulty swallowing, crush sucralfate and mix it with ciprofloxacin oral suspension to administer both medications together as a single dose.

**Correct answer: 3**

## Explanation

Correct (2): Sucralfate is taken on an empty stomach 1 hour before meals and at bedtime to form a protective barrier over the ulcer. It binds many drugs (fluoroquinolones, levothyroxine, phenytoin, digoxin, warfarin) → separate by ≥2 hours. (1) Binding reduces both efficacy. (3) Crushing is unnecessary. (4) Scheduled, not PRN.

## In-depth explanation

Memory Tip Sucralfate = "Suck-up-the-acid, separate 2 hours from other drugs." Also causes constipation (aluminum content).

## Clinical scenario

Scenario 50-year-old male with duodenal ulcer on sucralfate 1 g PO QID + ciprofloxacin 500 mg PO BID for cellulitis. Discussion at medication reconciliation.

## Key concepts

- **Sucralfate** — Aluminum sucrose octasulfate; forms gel barrier over ulcers; binds many drugs.
- **Empty stomach administration** — 1 hour before meals and HS to maximize ulcer surface coverage.
- **Drug binding separation** — At least 2 hours separation from interacting drugs (fluoroquinolones, levothyroxine).

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