Ketorolac Flashcards

1
Q

What is the trade name of Ketorolac?

A

Toradol

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2
Q

What is the drug classification of Ketorolac?

A

Non-steroidal anti-inflammatory drug (NSAID)

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3
Q

What is Ketorolac a derivative of and its uses?

A
  • 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
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4
Q

What is the MOA of Ketorolac?

A
  • 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
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5
Q

When is the onset of action of Ketorolac?

A

10 minutes

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6
Q

When is the peak effect of Ketorolac?

A

2-3 hours

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7
Q

What is the e 1/2 t of Ketorolac?

A

5 hours

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8
Q

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

A

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

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9
Q

How is Ketorolac metabolized and eliminated?

A
  • metabolized by the liver, principally by flucoronic acid conjugation
  • eliminated by the kidneys (60% unchanged)
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10
Q

Is ketorolac protein bound?

A

99% protein bound!

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11
Q

What are the common side effects of Ketorolac?

A
  • 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
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12
Q

What are the contraindications to administration of Ketorolac?

A
  • 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
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13
Q

What are some drug interactions with Ketorolac?

A
  • 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
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14
Q

What is the oral dose of Ketorolac?

A

10mg q4-6hr

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15
Q

What is the IV/IM dose of Ketorolac?

A

30-60mg; then 15-30mg q6hrs

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16
Q

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

A

120mg; do NOT exceed 5 days of use

17
Q

When should you use smaller doses of Ketorolac?

A
  • elderly
  • prostaglandin dependent renal failure patients
  • renal insufficiency
  • may see elevated liver enzymes in liver failure/impairment patients
18
Q

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

A

IS REVERSIBLE

19
Q

What is the Vd of KEtorolac?

A

very small

20
Q

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

A

anaphylactoid and asthma reaction

21
Q

What is unique about Ketorolac vs the other NSAIDS?

A

it is the ONLY available IV NSAID

22
Q

What is an advantage of Ketorolac vs opioids?

A

NO ventilatory or cardiac depression

23
Q

What is the DOA of Ketorolac?

A

6-8hours