USMLE

Metoclopramide

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GI Drugs
  1. Ondansetron
  2. Sucralfate
  3. Docusate (Stool Softener)
  4. Bulk Forming Laxatives (Psyllium, Methylcellulose)
  5. Stimulant Laxatives (Senna, Bisacodyl)
  6. Bismuth Subsalicylate
  7. Antidiarrheals (Loperamide, Diphenoxylate-Atropine)
  8. Antacids
  9. Metoclopramide
  10. Misoprostol
  11. Proton Pump Inhibitors (PPIs)
  12. Orlistat
  13. Octreotide

Summary

Metoclopramide is a medication used to treat nausea and vomiting, gastroparesis, and gastroesophageal reflux or GERD. Side effects of metoclopramide include extrapyramidal symptoms or EPS, which classically include tardive dyskinesia, a syndrome characterized by uncontrollable lip smacking and tongue rolling.

Key Points

  • Metoclopramide (Reglan)
    • Mechanism
      • Dopamine antagonist
        • Block dopamine receptors in the chemoreceptor trigger zone (CTZ)
      • Direct-acting anticholinergic
    • Clinical Use
      • Nausea/Vomiting
        • Chemotherapy
        • Postoperative Recovery
      • Gastroparesis
        • Also called delayed gastric emptying
        • Metoclopramide increases gastric motility
      • Gastroesophageal Reflux Disease (GERD)
    • Side Effects and Adverse Reactions
      • Extrapyramidal Symptoms (EPS)
        • Tardive Dyskinesia
        • Pseudoparkinsonism
        • Akathisia
        • Dystonia
      • Sedation
        • Avoid alcohol and other CNS depressants
      • Anticholinergic Effects
        • Dry mouth, urinary retention, constipation, etc.
        • Expected side effects
      • Hypotension
        • Instruct patient to rise slowly to prevent dizziness and falls
      • Headache