Snapshot A 56-year-old woman with a past medical history of hypertension and 3 cesarean sections presents to the emergency room for abdominal pain, abdominal distention, and nausea. In the emergency room, she has 2 episodes of nonbloody nonbilious emesis. An abdominal radiograph shows dilated loops of small bowel, suggestive of a small bowel obstruction. A nasogastric tube is inserted for gastric decompression. She requests an anti-emetic and reports that metoclopramide has helped significantly in the past. Her physician however chooses to avoid metoclopramide as it is pro-kinetic and not a good choice in small bowel obstruction. Introduction Drugs metoclopramide Mechanism of action dopamine (D2) receptor antagonist, which increases upper gastrointestinal motility, contractility, and lower esophageal sphincter tone, causing increased gastric emptying pro-kinetic Clinical use diabetic gastroparesis post-surgical gastroparesis anti-emesis gastro-esophageal reflux disease (GERD) Adverse effects extrapyramidal symptoms tardive dyskinesia parkinsonism dystonia akathisia treat immediately with diphenhydramine and benztropine restlessness drowsiness fatigue diarrhea contraindications small bowel obstruction Parkinson disease