Ketorolac Flashcards
What is the trade name of Ketorolac?
Toradol
What is the drug classification of Ketorolac?
Non-steroidal anti-inflammatory drug (NSAID)
What is Ketorolac a derivative of and its uses?
- Derivative of Pyrrole acetic acid used to treat moderate to severe pain, gout, ankylosing spondylitis, OA, and for post-surgical analgesia
- useful in supplementing opioids by potentiating their anti-nocioceptice action
What is the MOA of Ketorolac?
- Reduces inflammatory response by inhibiting cyclooxygenase (COX) 1 AND 2, which decreases the synthesis of eicosanoids
- also inhibits prostaglandin synthesis by decreasing the activity of COX
- blocks conversion of arachidonic acid to prostaglandins
- decreases production and release of prostaglandins
- Analgesic, antipyretic, anti-inflammatory
When is the onset of action of Ketorolac?
10 minutes
When is the peak effect of Ketorolac?
2-3 hours
What is the e 1/2 t of Ketorolac?
5 hours
When is Ketorolac’s e 1/2t prolonged? by how much approx?
30%-50% prolonged in the elderly (6-8 hours) so cut the dose in HALF!
How is Ketorolac metabolized and eliminated?
- metabolized by the liver, principally by flucoronic acid conjugation
- eliminated by the kidneys (60% unchanged)
Is ketorolac protein bound?
99% protein bound!
What are the common side effects of Ketorolac?
- Prolongs bleeding time and decreases platelet aggregation
- Bronchospasm in asthma/ aspirin sensitivity
- GI bleeding/PUD/Dyspepsia (inhibits prostaglandin production that maintains normal gastric and duodenal mucosa)
- Peripheral edema
- nausea
- sedation
- ARF
- Anaphylaxis
- Stevens-Johnson Syndrome
- Ulceration/ perforation
What are the contraindications to administration of Ketorolac?
- GI or intracranial bleeding
- Urticaria
- Coagulation defects
- Asthma
- Labor and Delivery: d/t may inhibit uterine contractions and affect fetal circulation
- 3rd trimester pregnancy
- cross tolerance with ASA and other anti-coags
What are some drug interactions with Ketorolac?
- increases plasma lithium [ ]
- increased risk of bleeding if given with oral anticoags
- May increase Warfarin lvls
- Displaces other highly protein bound drugs
- Probencid increases the level of Ketorolac
What is the oral dose of Ketorolac?
10mg q4-6hr
What is the IV/IM dose of Ketorolac?
30-60mg; then 15-30mg q6hrs
What is the maximum daily dose of Ketorolac? maximum days of use?
120mg; do NOT exceed 5 days of use
When should you use smaller doses of Ketorolac?
- elderly
- prostaglandin dependent renal failure patients
- renal insufficiency
- may see elevated liver enzymes in liver failure/impairment patients
What is important to remember about Ketorolac (NSAIDS) vs. ASA?
IS REVERSIBLE
What is the Vd of KEtorolac?
very small
What reactions can occur if Ketorolac is given to aspirin-sensitive patients?
anaphylactoid and asthma reaction
What is unique about Ketorolac vs the other NSAIDS?
it is the ONLY available IV NSAID
What is an advantage of Ketorolac vs opioids?
NO ventilatory or cardiac depression
What is the DOA of Ketorolac?
6-8hours
