NURS 1566 Clinical Form 3: Clinical Medications Worksheets (You will need to make additional copies of these forms)

Generic Name ketorolac Trade Name Toradol Classification Dose Route Time/frequency nonsteroidal anti30 mg IVP Q 6 hrs PRN inflammatory agents, nonopioid analgesics Duration Normal dosage range 6 hrs or longer 30 mg q 6 hr (not to exceed 120 mg/day)

Peak 1-2 hrs

Onset 10 min

Why is your patient getting this medication Severe back pain

For IV meds, compatibility with IV drips and/or solutions 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. Coadministration with opioid analgesics may have additive analgesic effects and may permit lower opioid doses. Y-Site Compatibility: dexmedetomidine, fentanyl, hydromorphone, morphine, remifentanil, sufentanil Y-Site Incompatibility: azithromycin, fenoldopam Mechanism of action and indications Nursing Implications (what to focus on) (Why med ordered) Contraindications/warnings/interactions Inhibits prostaglandin synthesis, producing Concurrent use with aspirin may effectiveness, adverse peripherally mediated analgesia, Also has antipyretic GI effects with aspirin , other NSAIDs , potassium and anti-inflammatory properties. supplements , corticosteroids , or alcohol. Chronic use with acetaminophen may risk of adverse renal reactions, bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax ginseng. Common side effects Drowsiness, GI BLEEDING, EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, anaphylaxis. Interactions with other patient drugs, OTC or Lab value alterations caused by medicine herbal medicines (ask patient specifically) Evaluate liver function tests, especially AST and ALT, adverse GI effects with alcohol. Chronic use with periodically in patients receiving prolonged therapy. May acetaminophen may risk of adverse renal reactions cause levels. May cause prolonged bleeding time that (Tylenol). May effectiveness of antihypertensives may persist for 24-48 hr following discontinuation of (Norvasc, Lopressor). therapy. May cause BUN, serum creatinine, or potassium concentrations. Be sure to teach the patient the following about this medication Instruct patient on how and when to ask for 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. 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. Nursing Process- Assessment (Pre-administration assessment) Patients who have asthma, aspirininduced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. Assessment Why would you hold or not give this med? Occurrence of unwanted or dangerous side effects. Evaluation Check after giving Decrease in severity of pain. Patients who do not respond to one NSAID may respond to another.