Lip smacking or involuntary face, tongue, or limb movements — hold the next dose and notify the provider (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 works two ways. It stimulates upper GI motility, which speeds gastric emptying and raises lower esophageal sphincter tone. It also blocks dopamine receptors in the chemoreceptor trigger zone (CTZ), which reduces nausea. That same dopamine blockade causes its main dangers: extrapyramidal symptoms (EPS), neuroleptic malignant syndrome (NMS), and a black box warning for tardive dyskinesia, which may be irreversible. The nurse times doses before meals, limits duration, and watches closely for abnormal movements.
Key points to remember
- Increases gastric emptying and lower esophageal sphincter tone; blocks dopamine in the CTZ.
- Give 30 minutes before meals and at bedtime.
- EPS: restlessness, tremor, acute muscle spasms (dystonia), and parkinsonism.
- Black box warning: tardive dyskinesia (lip smacking, involuntary face, tongue, or limb movements). Risk rises with high doses and with use longer than 12 weeks, and it may be irreversible.
- NMS: high fever, severe rigidity, altered mental status, and autonomic instability.
- Contraindicated in GI obstruction, perforation, or hemorrhage and in seizure disorders; avoid in Parkinson's disease.
- Causes drowsiness, which alcohol and other CNS depressants make worse.
Nursing priorities
- Before the first dose, check for signs of GI obstruction, perforation, or bleeding and ask about seizures, because these are contraindications.
- Give each dose 30 minutes before meals and at bedtime as ordered, because that is when it works best.
- Assess every shift for involuntary movements, restlessness, tremor, and rigidity, because early detection of EPS or tardive dyskinesia allows the drug to be stopped.
- Track how long the client has been on therapy and flag use nearing 12 weeks, because tardive dyskinesia risk rises with longer use.
- Evaluate response: less nausea and improved gastric emptying.
- Teach slow position changes and caution with driving, because the drug causes drowsiness.
Worked example
- Cue: A client with diabetic gastroparesis who has taken metoclopramide for several weeks develops lip smacking and repetitive tongue movements.
- Meaning: These movements suggest tardive dyskinesia, the black box adverse effect, which may be permanent.
- Action: Hold the next dose, notify the provider, and document the movements.
- Evaluation: The provider discontinues the drug, and the client can state which movements to report in the future.
Patient teaching
- Take it 30 minutes before meals and at bedtime.
- Call right away if you notice movements you cannot control, such as lip smacking, face or tongue movements, or feeling unable to sit still.
- This medicine is for short-term use. Do not take it longer than prescribed.
- Avoid alcohol and other drugs that make you sleepy, rise slowly, and do not drive until you know how it affects you.
Common mistakes
- Giving the dose after meals instead of 30 minutes before.
- Writing off restlessness as anxiety. In a client on metoclopramide, restlessness can be EPS.
- Forgetting the duration limit. Tardive dyskinesia risk climbs with use beyond 12 weeks and may not reverse.
- Giving it for vomiting caused by a bowel obstruction, where it is contraindicated.
Red flags: report now
- Lip smacking or involuntary face, tongue, or limb movements — hold the next dose and notify the provider (tardive dyskinesia).
- Acute muscle spasm, tremor, or marked restlessness — notify the provider (EPS).
- High fever, severe rigidity, and confusion — stop the drug and notify the provider immediately (NMS).
- Suspected bowel obstruction, perforation, or active GI bleeding — hold and notify the provider.
References
Clinical references for this topic
