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Classification: Prokinetic Drug, Antiemetic Drug

Action: Dopamine antagonist that acts by increasing receptor sensitivity and response of upper GIT tissues to acetylcholine. This cause contraction of gastric smooth muscles, relaxation of the pyloric sphincter and duodenal bulb and increased peristalsis without stimulating gastric, biliary and pancreatic secretions. It also produces sedation and induces release of prolactin.

Indication: Gastrointestinal (GI) motility disturbances. Nausea and vomiting of central and peripheral origin associated with surgery, metabolic diseases, malignant disease, infectious diseases and drug induced. Radiological procedures of GIT. Control of post-operative vomiting and to assist in intestinal intubation.

Adverse Reactions: Sedation, restlessness, lassitude, fatigue, diarrhea, insomia, headache, dizziness, nausea, extrapyramidal effects, tardive dyskinesia, parkinsonism, drowsiness, and bowel upsets. Somnolence, nervousness, dystonic reactions. Increased pituitary prolactin release gynecomastia, galactorrhea and menstrual disorders.

Nursing Considerations

Assessment

  • Assess patient’s GI complaints: nausea, vomiting, anorexia, constipation, abdominal distention before and after administration
  • Frequently monitor blood pressure of patients taking IV form of drug
  • Monitor for possible drug induced adverse reactions:
    • CNS: restlessness, anxiety, drowsiness, fatigue, fever, lassitude, insomnia, seizures, suicide ideation, headache, dizziness, dystonic reactions, sedation
    • CV: transient hypertension
    • GI: nausea, bowel disturbance
    • Hematologic: agranulocytosis, neutropenia
    • Skin: rash
    • Others: prolactin secretions, loss of libido
  • Monitor for and immediately report¬†occurrence¬†of extrapyramidal symptoms and tardive dyskinesia especially in elderly patients: rigidity, grimacing, shuffling gait, tremors, rhythmic involuntary movements of tongue, mouth, jaw, feet and hands. Some effects may be irreversible.
  • Assess mental status during treatment: depression, anxiety and irritability
  • Assess patient’s and family’s knowledge of drug therapy

Planning

  • Oral route
    • Give 30 minutes – 1 hour before meals for better absorption and at bedtime
    • Use gum, hard candy, frequent rinsing of mouth for dryness of oral cavity
  • IV route
    • Give IV undiluted if dose is < 10mg; give over 2 minutes
    • Dilute more than 10mg in 50 mL or more D5W, NaCl, Ringer’s, LR and give over 15 minutes or more
    • Give diphenhydramine IV for EPS
    • Discard open ampules

Implementation

Patient/family education

  • Teach patient how to recognize and to report drug induced adverse reactions
  • Tell patient to avoid driving and other hazardous activities for at least 2 hours or until stabilized on this medication
  • Advise patient to avoid alcohol and other CNS depressants that enhance sedating properties of this drug

Evaluation

  • Patient responds positively to drug manifested by improved clinical condition
  • Patient maintains normal fluid and electrolyte status
  • Patient does not experience injury related to drug induced adverse reactions
  • Patient and family state understanding of drug therapy