A client has been on metoclopramide 10 mg QID for 14 weeks f… | MyMerci
Medical EmergenciesPA
Question
A client has been on metoclopramide 10 mg QID for 14 weeks for diabetic gastroparesis and reports new repetitive lip-smacking and tongue protrusions. Which is the nurse's priority action?
1Hold metoclopramide and notify the provider — tardive dyskinesia is a serious adverse effect carrying a boxed warning; risk increases beyond 12 weeks✓ Correct answer
2Continue therapy and add benztropine
3Increase the dose for better symptom control
4Reassure the client and observe for 1 month
Explanation
Correct (2): Metoclopramide carries a boxed warning for tardive dyskinesia — irreversible involuntary movements; risk rises with duration >12 weeks, elderly, and women. Stop the drug and notify the provider. (1) Benztropine treats acute dystonia, not TD; continuing increases harm. (3) Higher dose worsens. (4) Delay risks permanent TD.
In-depth explanation
Memory Tip Metoclopramide = "Met-OFF after 12 weeks" — boxed warning. Tardive dyskinesia ≠ Acute dystonia (benztropine works). Pediatric/elderly need lowest dose, shortest duration.
Clinical scenario
Scenario 62-year-old female on metoclopramide 10 mg PO QID × 14 weeks for diabetic gastroparesis. New lip-smacking, tongue protrusion, involuntary facial movements.
Key concepts
Metoclopramide — D2 antagonist prokinetic for gastroparesis, GERD, and antiemetic.