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Module 8
According to Bullock and Manias (2017), metoclopramide is a medication used to treat the
symptoms of sluggish stomach emptying (gastroparesis) in diabetic patients. The generic
name of metoclopramide is Reglan, and it is in a class of medications called prokinetic
agents. It acts by stimulating stomach and intestinal motions or contractions. It alleviates
symptoms such as nausea, vomiting, heartburn, a sense of fullness after meals, and appetite
loss.
The nursing consideration for the administration of metoclopramide is firstly, nurses need to
assess for extrapyramidal symptoms and tardive dyskinesia (more likely in aged patients).
Secondly, they need to assess for gastrointestinal complaints, such as nausea, vomiting and
constipation. Metoclopramide is generally administered orally in a tablet or solution
form. The dosage of the tablets and solutions is generally 5 to 10 mg. In oral administration,
for better absorption allow 30 minutes to one hour before eating and sleeping (Burcham &
Rosenthal, 2022). However, it can be administered intramuscularly or intravenously in
severely nauseous patients, with the latter route taking effect much more quickly. Parenteral
metoclopramide is also generally 5 mg. Rectal administration is also an option, as is an
intraperitoneal injection in patients undergoing peritoneal dialysis. In patients with kidney
failure, it is generally recommended that metoclopramide maintenance doses be reduced to
avoid drug accumulation. (Bullock & Manias, 2017).
Reference:
Bullock, S., Manias, E., 2016, Fundamentals of pharmacology (8th Ed.), Pearson
Burchum, J.R., Rosenthal, L.D., 2022, Lehne's pharmacology for nursing care (11th Ed.),
Elsevier
Module 9
Metoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries
and veins). Metoprolol is used to treat angina and hypertension. Metoprolol is also used to
lower your risk of death or needing to be hospitalized for heart failure.
Mechanism of action
Metoprolol is a beta-1-adrenergic receptor inhibitor specific to cardiac cells with negligible
effect on beta-2 receptors. This inhibition decreases cardiac output by producing negative
chronotropic and inotropic effects without presenting activity towards membrane stabilization
nor intrinsic sympathomimetics. Administration of metoprolol in normal subjects is widely
reported to produce a dose dependent reduction on heart rate and cardiac output. This effect is
generated due to a decreased cardiac excitability, cardia output, and myocardial oxygen
demand. In the case of arrhythmias, metoprolol produces its effect by reducing the slope of
the pacemaker potential as well as suppressing the rate of atrioventricular conduction
(Gabriel Khan & Rowlands, 2000)
Therapeutic effect
Metoprolol is used alone or together with other medicines to treat high blood pressure
(hypertension). So, it works by relaxing blood vessels and slowing heart rate to improve
blood flow and decrease blood pressure.
Reference:
Gabriel Khan, M., & Rowlands, D. (2015). Cardiac drug therapy, (8th edition.). Humana
Press
Module 10
Amiodarone is known as an anti-arrhythmic drug, and it is in a class of medications called

antiarrhythmics. It is used to restore normal heart rhythm and maintain a regular, steady
heartbeat (MIMS, 2022). Amiodarone should only be used if you have a life-threatening
arrhythmia or irregular heart rate. This medication has the risk of serious side effects such as:
 Amiodarone could impair sinus beat formation and conduction and may induce
significant bradycardia.
 It causes blood vessels to dilate leading to hypotension
 It can also cause serious lung or liver problems (MIMS, 2022).
Nursing Consideration
According to MIMS (2022), while administering amiodarone, the vital considerations that
nurses need to follow are they should monitor blood pressure and apical pulse prior to
administration. Similarly, nurses need to ensure the use of cardiac monitor on patients
receiving amiodarone therapy. And baseline chest x-ray and pulmonary function test is
recommended before beginning PO therapy.
MIMS Australia. (2022). Amiodarone. In MIMS Online. https://www.mimsonline.com.au
Module 11
NSW Health (20220 has classed Diazepam as a scheduled 4 medication. Medicines in
Appendix D of the Regulation in a hospital ward or nursing home must be stored apart from
all other goods (other than drugs of addiction) in a separate room, safe, cupboard or other
receptacle securely attached to a part of the premises and kept securely locked when not in
immediate use because storage is an important aspect of the total drug control system.
Diazepam injection is chemically stable as 5-mg doses in disposable glass syringes for 90
days when stored at 4 degrees C or 30 degrees C. However, refrigeration is recommended.
Diazepam should be stored at room temperature (15–30 °C). The solution for parenteral
injection should be protected from light and kept from freezing. The oral forms should be
stored in air-tight containers and protected from light. When ambient storage temperatures
are 30 degrees C or less, ambulances carrying lorazepam and diazepam should be restocked
every 30 to 60 days. When drug storage temperatures exceed 30 degrees C, more frequent
stocking or refrigeration is required.
NSW Health (2022). Schedule 4 Appendix D drugs - Prescribed restricted substances.
https://www.health.nsw.gov.au/pharmaceutical/Pages/sch4d.aspx

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Module 8

Amiodarone is known as an anti-arrhythmic drug, and it is in a class of medications called

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