Drug Study Ketorolac

DRUG STUDY Brand Name: Toradol Generic Name: Ketorolac Dosage, Route & Frequency Recommended PAIN Adult: IV Loading Dose 30 mg (15 mg <50 kg) Geriatric: IV Loading Dose 15 mg IM 30 mg loading dose, then 15 mg q6h PO 5–10 mg q6h prn (max: 40 mg/d) max duration all routes 5 d Prescribed 30mg IVTT now Drug Action It inhibits synthesis of prostaglandins and is a peripherally acting analgesic. Ketorolac does not have any known effects on opiate receptors. Therapeutic Effects: Decreased pain. Peak: 45–60 min. Distribution: Distributed into breast milk. Metabolism: Metabolized in liver. Elimination: Excreted in urine. Half-Life: 4–6 h. Drug-Drug & Drug-Food Interactions Drug: May increase methotrexate levels and toxicity; may increase lithium levels and toxicity. Herbal: Feverfew, garlic, ginger, ginkgo increased bleeding potential. Drug Classification: NSAID, ANALGESIC; ANTIPYRETIC Indications Contraindications Short-term management of pain; ocular itching due to seasonal allergic conjunctivitis, reduction of post-operative pain and photophobia after refractive surgery. Hypersensitivity to ketorolac; individuals with complete or partial syndrome of nasal polyps, angioedema, and bronchospastic reaction to aspirin or other NSAIDs; during labor and delivery; patients with severe renal impairment or at risk for renal failure due to volume depletion; patients with risk of bleeding; active peptic ulcer disease; pre- or intraoperatively; intrathecal or epidural administration; in combination with other NSAIDs; lactation. Side Effects (By System) CNS: Drowsiness, dizziness, headache. GI: Nausea, dyspepsia, GI pain, hemorrhage. Other: Edema, sweating, pain at injection site. Adverse Reactions (By System) Body as a Whole: fever, infections, sepsis CV: congestive heart failure, palpitation, pallor, tachycardia, syncope Derm: alopecia, photosensitivity, urticaria GI: anorexia, dry mouth, eructation, esophagitis, excessive thirst, gastritis, glossitis, hematemesis, hepatitis, increased appetite, jaundice, melena, rectal bleeding Hemic and Lymphatic: ecchymosis,eosinophilia, epistaxis, leukopenia, thrombocytopenia Metabolic and Nutritional: weight change Nervous System: abnormal dreams, abnormal thinking, anxiety, asthenia, confusion, depression, euphoria, extrapyramidal symptoms,hallucinations, hyperkinesis, inability to concentrate, insomnia, nervousness,paresthesia, somnolence, stupor, tremors, vertigo, malaise Reproductive, female: infertility Respiratory: asthma, cough, dyspnea, pulmonary edema, rhinitis Special Senses: abnormal taste, abnormal vision, blurred vision, hearing loss Urogenital: cystitis, dysuria, hematuria, increased urinary frequency, interstitial nephritis,oliguria/polyuria, proteinuria, renal failure, urinary retention Responsibilities in the Nursing Process (ADPIE) Assessment ● Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. ● Assess for rash periodically during therapy. May cause StevensJohnson syndrome or toxic epidermal necrolysis. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia. ● Monitor BP during initiation and periodically during therapy. May cause fluid retention and edema leading to new onset or worsening hypertension. ● Pain: Assess pain (note type, location, and intensity) prior to and 1– 2 hr following administration. ● Lab Test Considerations: Evaluate liver function tests, especially AST and ALT, periodically in patients receiving prolonged therapy. May cause increased levels. ● May cause prolonged bleeding time that may persist for 24– 48 hr following discontinuation of therapy. ● May cause increased BUN, serum creatinine, or potassium concentrations. Responsibilities in the Nursing Process (ADPIE) Patient/Family Teaching ● Instruct patient on how and when to ask for and take pain medication. ● Instruct patient to take medication exactly as directed. Take missed doses as soon as remembered if not almost time for next dose. Do not double doses. Do not take more than prescribed or for longer than 5 days. ● May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known. ● Caution patient to avoid the concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. ● Advise patient to inform health care professional of medication regimen prior to treatment or surgery. ● Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs. Evaluation/Desired Outcomes ● Decrease in severity of pain. Patients who do not respond to one NSAID may respond to another. Implementation ● Do not confuse Toradol (ketorolac) with tramadol (Ultram). ● Administration in higher-than-recommended doses does not provide increased effectiveness but may cause increased side effects. Duration of ketorolac therapy, by all routes combined, should not exceed 5 days. Use lowest effective dose for shortest period of time to minimize risk of cardiovascular thrombotic events. ● IV Push: Administer undiluted. Concentration: 15– 30 mg/mL. Rate: Administer over at least 15 Sec ● Solution Compatibility: D5W, D5/0.9% NaCl, 0.9% NaCl, LR, Plasma-Lyte A, Ringer’s injection