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Clinical Medications Worksheets

Generic Name Metoclopramide Peak Unknown Trade Name Reglan Onset 30-60 min Classification Antiemetics Duration 1-2 hr Dose 5 mg Route PO Time/frequency 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

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 5hydroxytryptamine (5-HT) receptors in the peripheral nervous system in animals.

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 systemdepressant 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. A d v i s e p a t i e n t t o n o t i f y h e a l t h c a r e p r o f e s s

Nursing Process- Assessment (Pre-administration assessment) Assess for nausea, vomiting, abdominal distention, and bowel sounds. Assess patient for extrapyramidal side effects. Monitor for tardive dyskinesia. Monitor for neuroleptic malignant syndrome. Assess patient for signs of depression periodically throughout therapy.

Assessment Why would you hold or not give this med? Extrapyramidal side effects, hypersensitivity, adverse side effects.

Evaluation Check after giving Decreased symptoms of esophageal reflux.