Report involuntary movements of the face, tongue, lips, or limbs (tardive dyskinesia).
Before you read
Test yourself first: 1 question
Question 1 of 1
A client with GERD is taking ranitidine. The nurse explains that this medication relieves symptoms by which mechanism?
Answer: B. Ranitidine is a histamine-2 (H2) receptor antagonist that decreases gastric acid secretion by blocking histamine at the parietal cell H2 receptors. It does not neutralize existing acid (that is what antacids do), coat the ulcer (sucralfate), or increase lower esophageal sphincter tone (metoclopramide). Understanding that H2 blockers reduce acid production guides correct timing and teaching.
Keep the streak going with more questions like these, each with a full rationale.
What is metoclopramide?
It is used for diabetic gastroparesis, GERD, and nausea/vomiting. Memory aid: it 'moves' the gut but its dopamine blockade causes extrapyramidal and tardive dyskinesia risk.
Key points to remember
- Increases gastric emptying and lower esophageal sphincter tone while blocking dopamine in the CTZ.
- Causes extrapyramidal symptoms (restlessness, dystonia, parkinsonism) and a black box warning for tardive dyskinesia.
- Tardive dyskinesia risk rises with high doses and use longer than 12 weeks and may be irreversible.
- Can precipitate neuroleptic malignant syndrome (high fever, rigidity, altered mental status, autonomic instability).
- Contraindicated in GI obstruction, perforation, hemorrhage, and seizure disorders.
- Best given 30 minutes before meals and at bedtime.
Nursing priorities
- Administer 30 minutes before meals and at bedtime as ordered.
- Assess regularly for involuntary movements, restlessness, and muscle rigidity.
- Limit total duration to 12 weeks or less to reduce tardive dyskinesia risk.
- Monitor for relief of nausea and improved gastric emptying.
- Hold and notify the provider if bowel obstruction or perforation is suspected.
Patient teaching
- Report any uncontrollable movements of the face or body right away.
- Avoid alcohol and other CNS depressants, which increase drowsiness.
- Do not take longer than prescribed; this drug is for short-term use.
- Rise slowly and use caution driving until you know how it affects you.
Red flags: report now
- Report involuntary movements of the face, tongue, lips, or limbs (tardive dyskinesia).
- Report acute muscle spasms, tremor, or restlessness (extrapyramidal symptoms).
- Report high fever, severe rigidity, and confusion (neuroleptic malignant syndrome) immediately.
- Never use with known mechanical GI obstruction, perforation, or active GI bleeding.
References
Clinical references for this topic
