Prokinetic for Extrinsic Duodenal Compression — SCE Palliative Medicine MCQ
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Correct answer: B — Metoclopramide 10 mg SC TDS before meals – dopamine antagonist with prokinetic action to enhance gastric emptying
Explanation lettering: E = shown as A · D = shown as B · B = shown as C · A = shown as D · C = shown as E
Metoclopramide (Option D) is uniquely suited here, combining central anti‑emetic action with prokinetic effects, directly addressing delayed gastric emptying from extrinsic duodenal compression. UK palliative care guidelines clearly recommend metoclopramide for gastric stasis and delayed gastric emptying, specifying 10 mg TDS orally or SC or CSCI 30 mg/24 h, and note that MHRA limitations do not apply in palliative care. Cyclizine (Option B) is an anticholinergic that would counteract prokinetic action and is warned against co‑prescription. Granisetron and ondansetron (Options A, E) are effective in chemo‑induced nausea but lack motility effects. Prochlorperazine (Option C) also lacks prokinetic properties. Therefore, metoclopramide is the only mechanistically and guideline‑supported choice.
Reference: NHS England NW Palliative Care Pain & Symptom Control Guidelines 2020; North West Coast Palliative Care Clinical Practice Summary 2022; NHS Scotland Right Decisions: Nausea and Vomiting guideline, https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/symptom-management/nausea-and-vomiting/