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Updated: Dec 17 2021


  • 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
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