Ketorolac

Question 1

What is the trade name of Ketorolac?

Answer 1

Toradol

Question 2

What is the drug classification of Ketorolac?

Answer 2

Non-steroidal anti-inflammatory drug (NSAID)

Question 3

What is Ketorolac a derivative of and its uses?

Answer 3

• 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

Question 4

What is the MOA of Ketorolac?

Answer 4

• 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

Question 5

When is the onset of action of Ketorolac?

Answer 5

10 minutes

Question 6

When is the peak effect of Ketorolac?

Answer 6

2-3 hours

Question 7

What is the e 1/2 t of Ketorolac?

Answer 7

5 hours

Question 8

When is Ketorolac’s e 1/2t prolonged? by how much approx?

Answer 8

30%-50% prolonged in the elderly (6-8 hours) so cut the dose in HALF!

Question 9

How is Ketorolac metabolized and eliminated?

Answer 9

• metabolized by the liver, principally by flucoronic acid conjugation
• eliminated by the kidneys (60% unchanged)

Question 10

Is ketorolac protein bound?

Answer 10

99% protein bound!

Question 11

What are the common side effects of Ketorolac?

Answer 11

• 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

Question 12

What are the contraindications to administration of Ketorolac?

Answer 12

• 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

Question 13

What are some drug interactions with Ketorolac?

Answer 13

• 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

Question 14

What is the oral dose of Ketorolac?

Answer 14

10mg q4-6hr

Question 15

What is the IV/IM dose of Ketorolac?

Answer 15

30-60mg; then 15-30mg q6hrs

Question 16

What is the maximum daily dose of Ketorolac? maximum days of use?

Answer 16

120mg; do NOT exceed 5 days of use

Question 17

When should you use smaller doses of Ketorolac?

Answer 17

• elderly
• prostaglandin dependent renal failure patients
• renal insufficiency
• may see elevated liver enzymes in liver failure/impairment patients

Question 18

What is important to remember about Ketorolac (NSAIDS) vs. ASA?

Answer 18

IS REVERSIBLE

Question 19

What is the Vd of KEtorolac?

Answer 19

very small

Question 20

What reactions can occur if Ketorolac is given to aspirin-sensitive patients?

Answer 20

anaphylactoid and asthma reaction

Question 21

What is unique about Ketorolac vs the other NSAIDS?

Answer 21

it is the ONLY available IV NSAID

Question 22

What is an advantage of Ketorolac vs opioids?

Answer 22

NO ventilatory or cardiac depression

Question 23

What is the DOA of Ketorolac?

Answer 23

6-8hours