Clinical Medications Worksheets
Generic Name Trade Name Classification
Metoclopramide Reglan Antiemetics
Peak Onset Duration
Unknown 30-60 min 1-2 hr
Why is your patient getting this medication
Management of esophageal reflux
Mechanism of action and indications
(Why med ordered)
Metoclopramide inhibits gastric smooth muscle relaxation
produced by dopamine, therefore increasing cholinergic response
of the gastrointestinal smooth muscle. It accelerates intestinal
transit and gastric emptying by preventing relaxation of gastric
body and increasing the phasic activity of antrum. Simultaneously,
this action is accompanied by relaxation of the upper small
intestine, resulting in an improved coordination between the body
and antrum of the stomach and the upper small intestine.
Metoclopramide also decreases reflux into the esophagus by
increasing the resting pressure of the lower esophageal sphincter
and improves acid clearance from the esophagus by increasing
amplitude of esophageal peristaltic contractions.
Metoclopramide's dopamine antagonist action raises the threshold
of activity in the chemoreceptor trigger zone and decreases the
input from afferent visceral nerves. Studies have also shown that
high doses of metoclopramide can antagonize 5-
hydroxytryptamine (5-HT) receptors in the peripheral nervous
system in animals.
Dose Route Time/frequency
5 mg PO Q ac & q hs
Normal dosage range
10-15 mg 30 min before meals and at bedtime (not to exceed 0.5
mg/kg/day). A single dose of 20 mg may be given preventively.
Some patients may respond to doses as small as 5 mg.
For IV meds, compatibility with IV drips and/or solutions
N/A
Nursing Implications (what to focus on)
Contraindications/warnings/interactions
Hypersensitivity. Possible GI obstruction or hemorrhage. History
of seizure disorders. Pheochromocytoma. Parkinson’s disease. Use
caution with history of depression. History of depression, diabetes,
geriatric patients are more susceptible to over sedation and
extrapyramidal reactions.
Common side effects
Drowsiness, extrapyramidal reactions, restlessness.
NEUROLEPTIC MALIGNANT SYNDROME
Interactions with other patient drugs, OTC or herbal
medicines (ask patient specifically)
Keppra, gabapentin, Lamictal: Central nervous system- and/or
respiratory-depressant effects may be additively or synergistically
increased in patients taking multiple drugs that cause these effects,
especially in elderly or debilitated patients.
Seroquel: Coadministration of metoclopramide with
phenothiazines or other neuroleptic agents may increase the risk
of severe extrapyramidal reactions. The mechanism is additive
antidopaminergic effects. In addition, central nervous system-
depressant effects may be additively or synergistically increased
in patients taking multiple drugs that cause these effects,
especially in elderly or debilitated patients.
Lab value alterations caused by medicine
May alter hepatic function test results. May cause increased serum
prolactin and aldosterone concentrations.
Be sure to teach the patient the following about this medication
Take as directed, may cause drowsiness, avoid driving. Do not
drink alcohol and other CNS depressants. Instruct patient to take
metoclopramide exactly as directed. If a dose is missed, take as
soon as remembered if not almost time for next dose. Advise
patient to avoid concurrent use of alcohol and other CNS
depressants while taking this medication.
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Nursing Process- Assessment Assessment Evaluation
(Pre-administration assessment) Why would you hold or not give this med? Check after giving
Assess for nausea, vomiting, abdominal distention, Extrapyramidal side effects, hypersensitivity, Decreased symptoms of
and bowel sounds. Assess patient for extrapyramidal adverse side effects. esophageal reflux.
side effects. Monitor for tardive dyskinesia.
Monitor for neuroleptic malignant syndrome. Assess
patient for signs of depression periodically
throughout therapy.