Metoclopramide

Question 1

Indications for metoclopramide

Answer 1

Nausea and vomiting
After surgery, radio/chemotherapy, uraemia, migraines, opiates
Gastroparesis

Question 2

What is the other effect of metoclopramide

Answer 2

Gastrokinetic agent- used in gastroparesis

Question 3

Contraindications for metoclopramide

Answer 3

Phaeochromocytoma
Parkinsons
Antipsychotic patients
Bowel obstruction or perforation
Depression
Infants, epilepsy, prolactinoma

Question 4

Side effects of metoclopramide

Answer 4

Restlessness/akathisia
Extrapyramidal side effects including oculogyric crisis
Raised prolactin and lactation
Constipation, depression
Agranulocytosis, tardive dyskinesia
Neuroleptic malignant syndrome

Question 5

Which drugs interact with metoclopramide?

Answer 5

Antipsychotics
Parkinsons meds
Anticholinergics
SSRIs
Methaemoglobinaemia drugs
Increases effect of alcohol

Question 6

Effect of renal impairment on dose

Answer 6

Use half dose, or quarter if CCr

Question 7

What is an oculogyric crisis?

Answer 7

Prolonged involuntary upward rolling of eyes, can be caused by antipsychotics/metoclopramide/some neuro disorders

Type of dystonia

Question 8

What are extrapyramidal side effects?

Answer 8

Drug induced movement disorders- can be acute or tardive- usually caused by antipsychotics

Dystonia, pseudoparkinsonism, tardive dyskinesia

Question 9

How does metaclopramide work?

Answer 9

Antagonises dopamine D2 receptors in medulla oblongata - antiemetic
Some serotonin agonist effect

Question 10

What is neuroleptic malignant syndrome?

Answer 10

Emergency caused by dopamine blockade- cramps/tremors, autonomic instability, delirium/coma, rhabdomyolysis, hyperthermia, sweat shock

Question 11

What is the treatment and dose in acute dystonia?

Answer 11

Procyclidine 5mg IM