DRUG STUDY Generic Name ketorolac Trade Name Toradol Classification Dose Route Time/frequency nonsteroidal anti60 mg IVP

Q 6 hrs PRN inflammatory agents, nonopioid analgesics Duration Normal dosage range 6 hrs or longer 60 mg q 6 hr (not to exceed 120 mg/day) 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 Nursing Implications (what to focus on) Contraindications/warnings/interactions Concurrent use with aspirin may effectiveness, adverse GI effects with aspirin , other NSAIDs , potassium 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. Lab value alterations caused by medicine Evaluate liver function tests, especially AST and ALT, periodically in patients receiving prolonged therapy. May cause levels. May cause prolonged bleeding time that may persist for 24-48 hr following discontinuation of 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.

Peak 1-2 hrs

Onset 10 min

Why is your patient getting this medication Severe back pain

Mechanism of action and indications (Why med ordered) Inhibits prostaglandin synthesis, producing peripherally mediated analgesia, Also has antipyretic and antiinflammatory properties.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) adverse GI effects with alcohol. Chronic use with acetaminophen may risk of adverse renal reactions (Tylenol). May effectiveness of antihypertensives (Norvasc, Lopressor).

Nursing Process- Assessment (Pre-administration 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 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.