DRUG STUDY

Brand Name: Toradol

Generic Name: Ketorolac Tromethamine

Classification: Nonsteroidal anti-inflammatory drug

Action: Inhibits COX-1 and COX-2 enzymes, resulting in decreased prostaglandin synthesis;
reduces prostaglandin levels in aqueous humor.

Indication: Ketorolac is indicate to relieve moderately severe pain, usually pain that occurs after
an operation or other painful procedure

Route/ Dosage/ Interval: 30 mg IVTT Q6

Half Life: 5 - 9 hours

Absorption: metabolized in the liver

Drug Interaction: May decrease effects of antihypertensives (e.g amlodipine, lisinopril), diuretics
(e.g furosemide, HCTZ). Aspirin, NSAIDs, other salicylates may increase risk of GI side effects,
bleeding. May increase risk of bleeding with heparin, oral anticoagulants (e.g. Warfarin). May
increase concentration, risk of toxicity of lithium. May increase effect of apixaban, dabigatran,
edoxaban, rivaroxaban. Bile acid sequestrants (e.g.cholestyramine) may decrease
absorption/effect. May increase nephrotoxic effect of cyclosporine.
Excretion: Around 92% of a dose is excreted in urine as 60% as unchanged ketorolac and 40% as
metabolites.
Adverse Effect: Peptic ulcer, GI bleeding, gastritis, severe hepatic reaction (cholestasis, jaundice)
occur rarely. Nephrotoxicity (glomerular nephritis, interstitial nephritis, nephrotic syndrome)
may occur in patients with preexisting renal impairment. Acute hypersensitivity reaction (fever,
chills, joint pain) occurs rarely.

Precaution/ Contraindication: Hypersensitivity to ketorolac, aspirin, or other NSAIDs.

Intracranial bleeding, hemorrhagic diathesis, incomplete hemostasis, high risk of bleeding;
concomitant use of aspirin, NSAIDs, probenecid, or pentoxifylline, labor and delivery, advanced
renal impairement or risk of renal failure, active or history of peptic ulcer disease, chronic
inflammation of GI tract, recent or history of GI bleeding/ulceration. Perioperative pain in setting
of CABG surgery.
Nursing Responsibilities:

1. Baseline Assessment: Assess onset, type, location, duration of pain. Obtain baseline
renal/hepatic function tests.
2. Intervention/Evaluation: Monitor renal function, LFT, urinary output. Monitor daily
pattern of bowel activity, stool, consistency. Observe for occult blood loss. Assess for
therapeutic response: relief of pain, stiffness, swelling; increased joint mobility; reduced
joint tenderness; improved grip strength. Monitor for bleeding (may also occur with
opthalmic route due to systemic absorption).
3. Patient/Family Teaching: Avoid aspirin, alcohol. Report abdominal pain, bloody stools, or
vomiting blood. If GI upset occurs, take with food, milk.