Indications of Ketorolac - Term Paper Example

Drug Monograph- Ketorolac (Toradol) Table of Contents I. Drug 3 II. Therapeutic Category 3 III. Indications 3 IV. Dosage 4 V. Contraindications 5 VI. Drug-Drug Interactions 6 VII. Pregnancy Risk Category 6 VIII. Sound-Alike/Look-Alike Drugs 7 IX. Potential Adverse Effects, Frequency 7 X. Prescription Refill Limitations 8 References 9 I. Drug Name Ketorolac Generic names are ketorolac trometamol, ketorolac tromethamine as synonym. Toradol brand (Roche Australia, n.d.). The chemical structure of the drug is as follows (RxList, 2012): Image source: RxList, 2012 II. Therapeutic Category Ketorolac belongs to that class of medications known as NSAIDs, for non-steroidal anti-inflammatory drug (Roche Laboratories, 2008): TORADOL (ketorolac tromethamine) is a member of the pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drugs (NSAIDs). The chemical name for ketorolac tromethamine is (±)-5-benzoyl-2,3-dihydro-1H-pyrrolizine-1-carboxylic acid, compound with 2-amino-2-(hydroxymethyl)-1,3-propanediol (1:1) (RxList, 2012). III. Indications For the treatment of pain that is of moderate to severe intensity. The prescription is often made for pain that attends an operation or other medical procedures that cause pain. As an NSAID, it is not addictive, meaning that in opposition to narcotics, no physical or psychological dependence develops. Used in combination with narcotics at times, in order to boost the pain-relieving powers of the ketorolac. Ketorolac is to be used for pain management of short duration only, not to exceed five days for all administration routes of the drug (WebMD, 2012; Mayo Foundation for Medical Education and Research, 2012; The American Society of Health-System Pharmacists, 2012; US National Library of Medicine, 2010; FADavis, n.d.; Selleck Chemicals, 2011; MediResource, 2012; MedicineNet, 2012; NetDoctor, 2012; Drugs.com, 2012; RxList, 2012; MedIndia, 2012). Ketorolac belongs to the same class of drugs as ibuprofen as well as naproxen, but the consensus is that ketorolac has greater power in the reduction of pain from inflammation as well as from other causes. This makes ketorolac singular among other NSAIDs, with regard to the degree of effect and with regard to the kinds of pain that it can relieve or treat. It works by effecting the blockage of those enzymes responsible for the production of prostaglandins in the body, those chemicals that the body generates that in turn results in fever and inflammation (MedicineNet, 2012). IV. Dosage The first dose can be via the veins, or via the muscles, administered via injections (US National Library of Medicine, 2010). The typical subsequent dose is 10 mg for every four to six hours in the presence of pain, depending on the requirement for pain relief. The recommended maximum daily dose is 40 mg, to be taken preferably with meals, in order to reduce risks of stomachs getting upset from the medication (MediResource, 2012). Some dosage prescriptions are age and weight dependent, as well as dependent on the presence of some other conditions, such as impairment of the urine function (Roche Laboratories, 2008): Transition from IV or IM dosing of ketorolac tromethamine (single- or multiple-dose) to multiple-dose TORADOLORAL: Patients age 17 to 64: 20 mg PO once followed by 10 mg q4-6 hours prn not >40 mg/day Patients age ≥65, renally impaired, and/or weight40 mg/day (Roche Laboratories, 2008) V. Contraindications Ketorolac is contraindicated for patients taking probenicid (US National Library of Medicine, 2010); ketorolac tromethamine, pentoxifylline (Roche Laboratories, 2008); and in the following: Patients with peptic ulcer; patients who have had asthma from taking aspirin and other NSAIDs; as analgesic for prophylactic purposes prior to surgery that is major; in bypass surgery chronic pain management; delivery and labor for pregnant women; nursing moms; patients that are bleeding, or at an elevated risk of bleeding; patients taking aspirin and other NSAIDs. It is also contraindicated in patients whose urine functions are impaired (Roche Laboratories, 2008): Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state. (Roche Laboratories, 2008) The drug is also contraindicated in patients on blood thinners, or else that doctors are to be very cautious when administering ketorolac together with blood thinning agents such as heparin (Roche Laboratories, 2008): Patients on therapeutic doses of anticoagulants (e.g., heparin or dicumarol derivatives) have an increased risk of bleeding complications if given TORADOL concurrently; therefore, physicians should administer such concomitant therapy only extremely cautiously. The concurrent use of TORADOL and therapy that affects hemostasis, including prophylactic low-dose heparin (2500 to 5000 units q12h), warfarin and dextrans have not been studied extensively, but may also be associated with an increased risk of bleeding. Until data from such studies are available, physicians should carefully weigh the benefits against the risks and use such concomitant therapy in these patients only extremely cautiously. Patients receiving therapy that affects hemostasis should be monitored closely. VI. Drug-Drug Interactions Drug-drug interactions are described as follows, and relates to ketorolac use with alcohol, other NSAIDs, acetaminophen, diuretics, lithium, anti-high blood pressure medications, kidney medications, and others (FADavis, n.d.): 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. May effectiveness of diuretics or antihypertensives. May serum lithium levels and risk of toxicity. risk of toxicity from methotrexate. risk of bleeding with cefotetan, cefoperazone, valproic acid, clopidogrel, ticlopidine, tirofiban, eptifibatide, thrombolytic agents, or anticoagulants. risk of adverse hematologic reactions with antineoplastics or radiation therapy. May risk of nephrotoxicity from cyclosporine. Probenecid ketorolac blood levels and the risk of adverse reactions (concurrent use should be avoided). (FADavis, n.d.) VII. Pregnancy Risk Category The FDA has tagged ketorolac with a pregnancy risk category of C (Drugs.com, 2012b). It is contraindicated in pregnant and nursing mothers, as well as during baby delivery and labor (Roche Laboratories, 2008) VIII. Sound-Alike/Look-Alike Drugs Sound-alike and look-alike data are available. Ketorolac sounds like Ketalar, a branded drug, and can cause confusion. Toradol sounds like or looks like the following medications: “Foradil®, Inderal®, TEGretol®, Torecan®, traMADol, tromethamine” (Lexi-Comp, 2012). IX. Potential Adverse Effects, Frequency Data on adverse effects overlap with contraindications in some of the literature on ketorolac. Adverse effects are generally said to occur anywhere from 1 percent to 10 percent of the population takng ketorolac, and these adverse effects include the following (Roche Laboratories, 2008): Table Source: Roche Laboratories, 2008 Other adverse effects that occur very rarely include change in weight; skin sensitivity to light; heart failure; fever and sepsis; hallucinations and vertigo; increased urination; psychosis and coma; depression and pneumonia; death; infertility; myocardial infarction; conjunctivitis; anorexia; too much thirst; jaundice; elevation of appetite; and various bodily infections (Roche Laboratories). X. Prescription Refill Limitations The limits are set by the maximum number of days for which ketorolac is prescribed for use, which is not to exceed five days (WebMD, 2012; Mayo Foundation for Medical Education and Research, 2012; The American Society of Health-System Pharmacists, 2012; US National Library of Medicine, 2010; FADavis, n.d.; Selleck Chemicals, 2011; MediResource, 2012; MedicineNet, 2012; NetDoctor, 2012; Drugs.com, 2012; RxList, 2012). References American Society of Health-System Pharmacists (2012). Ketorolac. Medline Plus. Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a693001.html Drugs.com (2012). Toradol. Drug Information Online Drugs.com. Retrieved from http://www.drugs.com/toradol.html Drugs.com (2012b). Ketorolac Pregnancy and Breastfeeding Warnings. Drug Information Online Drugs.com. Retrieved from http://www.drugs.com/pregnancy/ketorolac.html FADavis (n.d.). ketorolac. Davis’s Drug Guide for Nurses. Retrieved from http://resources.fadavis.com/wade/Drug_Monographs/display_monograph.cfm?monograph=ketorolac&title=Ketorolac%20%28Toradol%29 Lexi-Comp (2012). Ketorolac (Systemic). Pediatric Care Online. Retrieved from https://www.pediatriccareonline.org/pco/ub/view/Pediatric-Drug-Lookup/154105/0/ketorolac__systemic_?amod=aapea&login=true&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token Mayo Foundation for Medical Education and Research (2012). Ketorolac. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/drug-information/DR601483 MedicineNet (2012). Ketorolac- injection, Toradol. MedicineNet.com. Retrieved from http://www.medicinenet.com/ketorolac-injection/article.htm MedIndia (2012). Ketorolac. MedIndia.net. Retrieved from http://www.medindia.net/doctors/drug_information/ketorolac.htm MediResource (2012). Toradol (ketorolac). CHealth. Retrieved from http://chealth.canoe.ca/drug_info_details.asp?brand_name_id=1009&rot=4 NetDoctor (2012). Toradol (ketorolac trometamol). Netdoctor.co.uk. Retrieved from http://www.netdoctor.co.uk/aches-and-pains/medicines/toradol.html Roche Australia (n.d.). Ketorolac. Toradol PI 120203. Retrieved from http://www.roche-australia.com/fmfiles/re7229005/downloads/anti-inflammatory/toradol-pi.pdf Roche Laboratories (2008). Toradol (ketorolac tromethamine). Daily Med. Retrieved from http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=9090 RxList (2012). Toradol. RxList.com. Retrieved from http://www.rxlist.com/toradol-drug.htm Selleck Chemicals (2011). Ketorolac (Toradol). SelleckChem.com. Retrieved from http://www.selleckchem.com/products/Ketorolac-Tromethamine%28Toradol%29.html US National Library of Medicine (2010). Ketorolac. PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000918/ WebMD (2012). Drug- Ketorolac. eMedicineHealth. 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