86. Metoclopramide Flashcards Preview

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Flashcards in 86. Metoclopramide Deck (11)

Metoclopramide - Mechanism

D2 receptor antagonist. Increased resting tone, contractility, LES tone, motility. Does not influence colon
transport time.


Metoclopramide - Clinical Use

Diabetic and postsurgery gastroparesis, antiemetic


Metoclopramide - Adverse effects

Increased parkinsonian effects, tardive dyskinesia. Restlessness, drowsiness, fatigue, depression, diarrhea.
Drug interaction with digoxin and diabetic agents. Contraindicated in patients with small bowel
obstruction or Parkinson disease (due to D2-receptor blockade).


• What is the mechanism of action of metoclopramide?

It is a dopamine receptor antagonist (specifically the D2 receptor)


• A man with HF and diabetes is receiving a D2 receptor antagonist for gastroparesis. What two types of drugs may cause interactions?

Digoxin and diabetic agents (this is metoclopramide)


• Metoclopramide is contraindicated in patients with what serious gastrointestinal disorder?

Small bowel obstruction; it is prokinetic and thus will worsen the discomfort of these patients


• On what parts of the gastrointestinal tract does metoclopramide act?

Lower esophageal sphincter (increases tone and contractility), stomach, small bowel (increases motility) (no effect on colon)


• Give at least two clinical uses of metoclopramide.

Diabetic gastroparesis, postsurgical gastroparesis, antiemesis


• A Parkinson disease patient with profuse vomiting asks for metoclopramide. Why does the doctor disagree with this choice?

Metoclopramide, a D2 receptor antagonist, can cross-react with and block D1 receptors, exacerbating parkinsonian symptoms


• A diabetic man is given a drug that causes restlessness, drowsiness, and nausea. Does this drug impact colon transit time?

No, as this is metoclopramide


• A 74-y/o woman has hypovolemia due to gastroenteritis. As the resident, would you start with ondansetron or metoclopramide for her nausea?

Ondansetron (metoclopramide is useful in GI-based nausea but has a greater risk of adverse effects in the elderly)

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