Drugs for the Control of Pain

A. Opiod

Opioid
Morphine

Opioids are a class of drugs that include the

B. Nonopiod
illegal drug heroin, synthetic opioids such as
fentanyl, and pain relievers available legally
by prescription.

Ketorolac
 Protein Binding: Premature infants: 20%; Adults: 35%.
BRAND NAME Morphoine (mor-feen)
Metabolism and Excretion: Mostly metabolized by the liver. Active metabolites
GENERIC NAME: Astramorph
excreted PF, AVINza, Doloral, Duramorph PF, Embeda,
renally.
Epimorph, Infumorph, Kadian, M-Eslon, Morphine H.P,
Half-life: M.O.S, M.O.S.-S.R,
Premature MS20Contin,
neonates: 10– Statex7.6 hr; Infants 1– 3
hr; Neonates:
mo: 6.2 hr; Children 6 mo– 2.5 yr: 2.9 hr; Children 3– 6 yr: 1– 2
CLASSIFICATIONS: hr; Children 6– 19 yr with sickle cell disease: 1.3 hr; Adults: 2– 4 hr.

Therapeutic: opioid analgesics

TIME/ACTION
Pharmacologic: PROFILE (analgesia)
opioid agonists
ROUTE ONSET PEAK DURATION
SCHEDULE: II
PO unknown 60 min 4 – 5 hr
PREGNANCY
PO-ER CATERGORY:
unknown C 3 – 4 hr 8 – 24 hr
IM 10 – 30 min 30 – 60 min 4 – 5 hr
Subcut
INDICATIONS: 20 min 50 – 90 min
Severe pain (the 20 mg/mL oral 4 solution
– 5 hr concentration should
Rect unknown 20 – 60 min 3 – 7 hr
IV rapid only be used20inminopioid-tolerant 4patients).
– 5 hr Management of
Epidural moderate to1 severe
6 – 30 min hr chronic pain
up in patients
to 24 hr requiring use of a
IT continuous unknown
rapid (min) around-the-clock opioid analgesic
up to 24 hr for an extended
period of time (extended/sustained-release). Pulmonary edema.
Pain associated with MI.
CONTRAINDICATIONS/PRECAUTIONS:
ACTION: Binds to opiate receptors in the CNS. Alters the perception of
Contraindicated in: Hypersensitivity; Some products
and response to painful stimuli contain tartrazine,generalized
while producing bisul-fites,
or
CNSalcohol and should be avoided in patients with known
depression.
hypersensitivity; Acute, mild, intermittent, or postoperative
THERAPEUTIC EFFECTS: pain (extended/sustained-release);
De-crease Significant
in severity of pain. Addition respiratory
of naltrexone in Embeda
depression
product (extended/sustained-release);
is designed to prevent abuse or Acute
misuseorbysevere
altering the
bronchial asthma
formulation. (extended/sustained-release);
Naltrexone has no effect unless the Paralytic
capsule isileus
(extended/sustained-release).
crushed or chewed.

PHARMACOKINETICS:
Use Cautiously in: Head trauma;qintracranial pressure; Severe renal, hepatic, or
pulmonary disease; Hypothyroidism; Seizure disorder; Adrenal
Absorption: Variably absorbed (about 30%) following oral administration.
insufficiency; His-tory of substance abuse; Undiagnosed
More reliably absorbed from rectal, subcut, and IM sites.
abdominal pain; Prostatic hyperplasia; Patients undergoing
Following epidural administra-tion, systemic absorption and
procedures that rapidly ppain (cordotomy, radiation); long-
absorption into the intrathecal space via the meninges occurs.
acting agents should be discontinued 24 hr before and replaced
with short-acting agents; Geri: Geriatric or debilitated patients
Distribution: Widely distributed.OB,
(dosepsuggested); Crosses the placenta;
Lactation: enters breast
Avoid chronic milk
use; has in
been
small amounts.
used during labor but may cause respiratory depression in the
newborn; Pedi: Neonates and infants 3 mo (more susceptible to
respiratory de-pression); Pedi: Neonates (oral solution contains
sodium benzoate which can cause potentially fatal gasping
syndrome).
ADVERSE REACTIONS/SIDE EFFECTS:
PO (Children 1 mo): Prompt-release tablets and solution—
0.2– 0.5 mg/kg/ dose q 4– 6 hr as needed. Controlled-release
CNS: confusion,
tablet— 0.3– 0.6sedation, dizziness,
mg/kg/dose q 12 hr. dysphoria, euphoria,
floating feeling, hallucinations, headache, unusual
dreams. IM, IV, Subcut (Adults $50 kg): Usual starting dose for
EENT: blurred
moderate vision,pain
to severe diplopia, miosis. patients— 4– 10 mg q
in opioid-naive
Resp:
3– 4RESPIRATORY
hr. MI— 8– 15 mg,DEPRESSION.
for very severe pain additional smaller
CV:doseshypotension,
may be givenbradycardia.
every 3– 4 hr.
GI: constipation, nausea, vomiting.
GU: IV,
IM, Subcut
urinary (Adults and Children 50 kg): Usual starting
retention.
dose for moder-ate to severe pain in opioid-naive patients—
Derm: flushing, itching, sweating.
0.05– 0.2 mg/kg q 3– 4 hr, maxi-mum: 15 mg/dose.
Misc: physical dependence, psychological dependence,tolerance.
IM, IV, Subcut (Neonates): 0.05 mg/kg q 4– 8 hr, maximum
INTERACTIONS: dose: 0.1 mg/kg. Use preservative-free formulation.

Drug-Drug: UseIV, Subcut

Drug-Natural Products:
ROUTE/DOSAGE:
NURSING IMPLICATIONS:
Assessment
 Assess type,MS
and 20 min (peak)
of 25– 50%formulation.
patient’s pain rating on a numerical or visual analogue scale or the pa-tient reports
satisfactory pain Rect (Adults
can be safelymoderate
side effects are minimal.
with (Adults):
extreme cautionContinuous
in patientsinfusion—
receiving0.8–
MAO10 mg/hr;
inhibitors
may be preceded by a bolus of 15 mg (infusion rates
within 14 days prior (may result in unpredictable, severe vary
greatly; up to 400dose
reactions—pinitial mg/hr
ofhave been used).
morphine to 25% of usual dose).qCNS
depression with alcohol, sedative/hyp-notics, clomipramine,
IV, Subcut (Children 1 mo): Continuous infusion,
barbiturates, tricyclic antidepressants, and antihista-mines.
postoperative pain— 0.01– 0.04 mg/kg/hr. Continuous infusion,
Administration of partial-antagonist opioid analgesics may
sickle cell or cancer pain— 0.02– 2.6 mg/kg/hr.
precipitate opioid withdrawal in physically dependent patients.
Buprenorphine,
IV (Neonates): nalbuphine,
Continuousbutorphanol,
infusion— 0.01–or pentazocine
0.03 mg/kg/hr.
maypanalgesia. Mayqthe anticoagulant effect of warfarin.
Cimetidinepmetabolism and mayqeffects.
Epidural (Adults): Intermittent injection— 5 mg/day (initially);
if relief is not obtained at 60 min, 1– 2 mg increments may be
made; (totaluse
Concomitant dose
of not to exceedvalerian,
kava-kava, 10 mg/day.
or Continuous
chamo-mile canqCNS
infusion— 2– 4 mg/24 hr; mayqby 1– 2 mg/day (up to 30
depression.
mg/day).
Larger doses may be required during chronic therapy.
Epidural (Children 1 mo): 0.03– 0.05 mg/kg, maximum dose:
PO, Rect (Adults $50 kg): Usual starting dose for moderate to
0.1 mg/kg or 5 mg/24 hr. Use preservative-free formulation.
severe pain in opioid-naive patients— 30 mg q 3– 4 hr initially or
onceIT24-hr opioid
(Adults): requirement
0.2– is determined, convert
1 mg. Use preservative-free to controlled-,
formulation.
extended-, or sustained-release morphine by administering total
daily oral morphine dose every 24 hr (as Kadian or Avinza), 50% of
the total daily oral morphine dose every 12 hr (as Kadian, MS
Contin), or 33% of the total daily oral morphine dose every 8 hr (as
Contin).
location, and See equianal-gesic
intensity of pain priorchart,
to andAppendix B. Avinza
1 hr following dose IM,
PO, subcut,
shouldfollowing
not exceed 1600 mg/day because
IV administration. of fu-maric
When titrating opioidacid in increases
doses,
should be administered until there is either a 50% reduc-tion in the
PO, relief.
and Children
When titrating 50 kg): Usual
doses of short-acting startingadose
mor-phine, fordose
repeat
administered
to se-vere pain in opioid-naive patients— 0.3 mg/kg q and
at the time of the peak if previous dose is ineffective 3–
4 hr initially.
 Patients on a continuous infusion should have additional bolus doses provided
Implementationevery 15– 30 min, as needed, for breakthrough pain. The bolus dose is usually
set to the amount of drug infused each hour by continuous infusion.
Patients
 High taking
Alert: Do sustained-release
not confuse Avinzamorphine(morphinemay require
sulfate) withadditional short-acting
Invanz (ertapenem) or
opioid (raloxifene).
Evista doses for breakthrough
Do not confuse pain.
MS Doses
Contin of short-acting
(morphine opioids
sulfate) should be
with Oxycon-tin
(oxycodone).
equivalent to 10– 20% of 24 hr total and given every 2 hr as needed. morphine
Do not confuse morphine (non-concentrated oral liquid) with
 (concentrated
An equianalgesic oral liquid).
chart (see Appendix B) should be used when changing routes
 High Alert: Do not
or when changing from confuseonemorphine
opioid to with hydromorphone— errors have re-sulted in
another.
death. Other errors associated with morphine include overdose and infusion pump
 High Alert: Assess level of consciousness, BP, pulse, and respirations before
miscalculations, especially in children. Consider patients’ previous an-algesic use and
and periodically during administration. If respiratory rate is 10/min, assess
current requirements, but clarify doses that greatly exceed normal range. Have second
level of sedation.
practitioner Physical
independently stimulation
check may dose
original order, be sufficient to prevent
calcu-lations, significant
and infusion pump
hypoventila-tion.
settings. Use only preservative-free formulations for neonates, and for epidural50%.
Subsequent doses may need to be decreased by 25– and
Initial drowsiness
intrathecal routes in allwill diminish with continued use.Geri: Assess geriatric
patients.
patients therapeutic
 Explain frequently; value
older ofadults are more
medication priorsensitive to the effects
to administration of opioid
to enhance the
analgesicseffect.
analgesic and may experience side effects and respiratory complications more
 Regularly
frequently.administered
Pedi: Assess doses pediatric
may be more patient frequently;
effective than prnchildren are more
administration. An-
algesic is more effective if given before pain becomes severe.
sensitive to the effects of opioid analgesics and may experience respiratory
 Coadministration with nonopioid
complications, excitability analgesics may
and restlessness morehave additive analgesic effects and
frequently.
 may permit lower
Prolonged use maydoses. lead to physical and psychological dependence and
 When transferring
tolerance. from other
This should opioids orpatient
not prevent other forms
from ofreceiving
morphineadequate
to extended-re-lease
analgesia.
tablets, administer a total daily dose of oral morphine equivalent to previous daily
Most patients who receive morphine for pain do not develop psychological
dose (see Appendix B) and divided every 8 hr (MS Contin), every 12 hr (Em-beda,
dependence. Pro-gressively higher doses may be required to relieve pain with
Kadian, MS Contin), every 24 hr (Kadian or Avinza).
long-term therapy.
 Morphine should be discontinued gradually to prevent withdrawal symptoms after
 Assess
long-term bowel
use. function routinely. Institute prevention of constipation with in-
 creased
PO: Doses intake of administered
may be fluids and bulk with and
foodwith laxatives
or milk to minimize
to minimize constipating
GI irritation.
 ef-fects.
Administer Administer
oral solutionstimulant laxatives
with properly routinely
calibrated if opioid
measuring usemay
device; exceeds 2– 3
be di-luted
days,
in un-less
a glass contraindicated.
of fruit juice just prior to administration to improve taste. Verify correct
 dose
Lab Test
(mg) Considerations:
and correct volume Mayqplasma
(mL) prior toamylase and lipase
administration. Use levels.
an oral syringe when
 using 20 mg/mL
Toxicity concentration
and Overdose: If anof opioid
oral solution.
antagonist is required to reverse respira-
 Swallow
tory depression or coma, naloxone is the not
extended-release tablets whole; do break, crush,
antidote. Dilutedissolve,
the 0.4-mgor chew (could
ampule of
result in rapid release and absorption of a potentially toxic
naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by directdose).
 Embeda, Kadian,2 and
IV push every min.Avinza capsulesand
For children mayadults
be opened and the
weighing 40 pellets sprinkled
kg, dilute 0.1 mgonto
of
applesauce immediately prior to administration. Patients should rinse mouth and
nal-oxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and
swallow to assure ingestion of entire dose. Pellets should not be chewed, crushed, or
administer 0.5 mcg/kg every 2 min. Titrate dose to avoid withdrawal, seizures,
dissolved. Kadian capsules may also be opened and sprinkled on ap-proximately 10
and
mL ofsevere
waterpain.
and flushed while swirling through a pre-wetted 16 French gastrostomy
tube fitted with a funnel at the port end. Additional water should be used to transfer
and flush any remaining pellets. Kadian should not be administered via a nasogastric
Potential Nursing Diagnoses
tube.
 Rect: MS Contin and Oramorph SR have been administered rectally.
Acute pain (Indications)
 IM, Subcut: Use IM route for repeated doses, because morphine is irritating to subcut
tissues. Chronic pain (Indications)
Risk for injury (Side Effects)
 IV Administration


IV: Solution is colorless; do not administer discolored solution.
BRAND NAME: Ketorolac (kee-toe-role-ak)

Direct IV: Diluent: Dilute with at least 5 mL of sterile water or 0.9% NaCl for
injection. Concentration: 0.5– 5 mg/mL. Rate: High Alert: Administer 2.5–15 mg
GENERIC NAME: over 5 min. RapidToradol
administration may lead to increased respiratory de-pression,
hypotension, and circulatory collapse.
CLASSIFICATIONS:
 Continuous Infusion: Diluent: May be added to D5W, D10W, 0.9% NaCl, 0.45%
NaCl, Ringer’s or LR, dextrose/saline solution, or dextrose/Ringer’s or LR.
Concentration: nonsteroidal
Therapeutic: 0.1– 1 mg/mLanti-inflammatory
or greater for continuous
agents,infusion.
nonopioidRate: Ad-minister
analgesics
via infusion pump to control the rate. Dose should be titrated to ensure adequate pain
relief without excessive
Pharmacologic: pyrrozilinesedation, respiratory
carboxylic acid depression, or hypo-tension. May be
administered via patient-controlled analgesia (PCA) pump.
 Y-Site Incompatibility: alemtuzumab, amphotericin B cholesteryl, amphoteri-cin B
PREGNANCY CATERGORY: C (oral, nasal spray [ 30 wk gestation]), D (nasal spray
colloidal, amphotericin B lipid complex, amphotericin B liposome, azathio-prine,
[$30 wk gestation)
dantrolene, diazoxide, doxorubicin liposome, folic acid, ganciclovir, in-domethacin,
micafungin, pentamidine, pentobarbital, phenytoin, sargramostim, trastuzumab.
INDICATIONS: Short-term
 Epidural: Administer management
undiluted. of pain
If a lidocaine (not is
test dose to administered,
exceed 5 days total
flush for
catheter
with 0.9% NaCl allandroutes combined).
wait 15 min before administration of DepoDur Do not use an in-
line filter. Do not admix or administer other medications in epidural space for 48 hr
ACTION: Inhibits
after administration. prostaglandin
Administer withinsynthesis,
4 hr after producing
removingperipherally
from vial. Store in
mediated
refrigerator; do not freeze. analgesia. Also has antipyretic and anti-inflammatory
properties.
Patient/Family Teaching
THERAPEUTIC EFFECTS: De-creased pain.
 Instruct patient how and when to ask for pain medication.
PHARMACOKINETICS:
 May cause drowsiness or dizziness. Caution patient to call for assistance when am-
bulating or smoking and to avoid driving or other activities requiring alertness un-til
Absorption: Rapidlyisand
response to medication completely absorbed following all routes of
known.
 Advise patient toadministra-tion.
change positions slowly to minimize orthostatic hypotension.
 Caution patient to avoid concurrent use of alcohol or other CNS depressants with this
Distribution:
medication. Enters breast milk in low concentrations.
 Encourage patients who are immobilized or on prolonged bedrest to turn, cough, and
Protein breathe
Binding: 99%.2 hr to prevent atelectasis.
deeply every
 Home Care Issues: High Alert: Explain to patient and family how and when to
Metabolism and Excretion:
administer morphine Primarily
and how metabolized by the liver.
to care for infusion Ketorolac
equipment and its Pedi: Teach
properly.
parents or caregivers how to accurately measure liquid medication and to 6%
metabolites are excreted primarily by the kidneys (92%); use only the
measuring deviceexcreted in feces.
dispensed with the medication.
 Emphasize the importance of aggressive prevention of constipation with the use of
Half-life:
morphine 4.5 hr (range 3.8 – 6.3 hr;qin geriatric patients and patients with
impaired renal function).
Evaluation/Desired Outcomes
TIME/ACTION PROFILE (analgesic effect)
 Decrease
ROUTEin severityONSET of pain without
PEAKa significant alteration in level of conscious-ness
DURATION
or respiratory status.
 Decrease in symptoms of pulmonary edema. 4 – 6 hr or
PO unknown 2 – 3 hr longer
IM, IV 10 min 1 – 2 hr 6 hr or longer
6 – 8 hr or
 CONTRAINDICATIONS/PRECAUTIONS:
INTERACTIONS:
Contraindicated in: Hypersensitivity; Cross-sensitivity with other NSAIDs
Drug-Drug:
may ex- Probenecidqlevels and the risk of
ist; Preoperative adverse
use; Activereactions;
or historyconcurrent
of peptic
ulcer disease or use is contraindicated.qrisk of bleeding
GI bleeding; whenalcohol
Known used withintolerance
(injection only); pentoxifylline; con-current use is contraindicated.
Perioperative pain from Concurrent
coronary
artery bypass graft (CABG) use with aspirin maypeffectiveness.q surgery; adverse GI effects with a
Cerebrovascular
spirin, other NSAIDs, potassium supplements,
bleeding; Advanced renal impairment or cortico-steroids,
at risk for renal
failure due to volume depletion;or Concurrent
alcohol. Maypeffectiveness of diuretics oruse antihypertensives.of
May Chronic
pentoxifylline or probenecid; OB: qserum lithium
use in 3rdlevels andqrisk of toxicity.qrisk of toxicity
from methotrexate.
trimester may cause constriction of ductusqrisk of bleeding
arte-riosus. May with cefotetan,
cefoperazone,
inhibit labor andqmaternal valproic
bleeding at acid, clopidogrel, ti-clopidine, tirofiban,
delivery.
eptifibatide, thrombolytic agents, or anticoagulants.q risk of
adverse hematologic reactions with antineoplastics or radiation
Use Cautiously in: therapy. Mayqrisk
Cardiovascular of nephrotoxicity
disease or risk factorsfromforcyclosporine.
cardiovascular dis-
ease (mayqrisk of serious cardiovascular thrombotic events,
Drug-Natural Products: Bleeding
myocardial riskinfarction,
with arnica,andchamomile, clove, dong
stroke, especially withquai,
prolonged
feverfew, garlic, ginger, ginkgo, Panax ginseng.
use); Heart failure; Coagulation disorders; Mild-to-moderate
renal impairment (dosage reduction may be required); Hepatic
ROUTE/DOSAGE: impairment;
Oral therapy isPedi: Safety
indicated only not established of
as a continuation in parenteral
neonates; Geri:
therapy.
ppears onTotal duration
Beers list;qof therapy
risk of GIby all routesLactation:
bleeding; should not eLactation.
xceed 5 days.
ADVERSE REACTIONS/SIDE EFFECTS:
PO (Adults 65 yr): 20 mg initially, followed by 10 mg q 4 – 6
hr (not to exceed 40 mg/day).
PO
CNS:(Adults $65 yr, 50
STROKE, kg, or withabnormal
drowsiness, renal impairment):
thinking, 10 mg
dizziness,
q 4 – 6 hr (not to exceed
euphoria, 40 mg/day).
headache.
PO (Children 2– 16 yr, 50 kg): nasal
1 mg/kg as a single(spray),
dose. No data
EENT: qlacrimation (spray), discomfort
available for multiple doses.
throat irritation (spray).
Resp: asthma, dyspnea.
IM (Adults 65 yr): Single dose— 60 mg. Multiple dosing— 30
CV: MYOCARDIAL
mg q 6 hr (not to exceed 120 INFARCTION,
mg/day). edema, pallor,
vasodilation.
IM (Adults $65 yr, 50 kg, or with renal impairment): Single
GI: 30
dose— GImg.
BLEEDING, abnormal
Multiple dosing— taste,
15 mg q 6 diarrhea, dry mouth,
hr (not to exceed 60
mg/day). dyspepsia, GI pain,qliver enzymes, nausea.
GU:(Children
IM oliguria,
2– renal
16 yr,toxicity, urinary
50 kg): Single frequency.
dose— 0.4 – 1 mg/kg
(maximum: 30 mg/ dose). Multiple
Derm: EXFOLIATIVE dosing— STEVENS-JOHNSON
DERMATITIS, 0.5 mg/kg q 6 hr .
SYNDROME, TOXIC EPIDERMAL NECROLYSIS,
IV (Adults 65 yr):pur-pura,
pruritus, Single dose— 30 mg.urticaria.
sweating, Multiple dosing— 30 mg q 6
hr (not to exceed 120 mg/day).
Hemat: prolonged bleeding time
IV (Adults $65 yr, 50 kg, or with renal impairment): Single dose—
Local: injection site pain.
15 mg. Multiple dosing— 15 mg q 6 hr (not to exceed 60 mg/day).
Neuro: paresthesia.
IV (Children 2– 16 yr, 50 kg): Single dose— 0.4 – 1 mg/kg
Misc: allergic
(maximum: reactions
15 mg/ dose). including, anaphylaxis.
Multiple dosing— 0.5 mg/kg q 6 hr.
Intranasal (Adults 65 yr): 1 spray in each nostril q 6 – 8 hr (not to
exceed 4 sprays in each nostril/day).
Intranasal (Adults $65 yr, 50 kg, or with renal impairment): 1
spray in only one nostril q 6 – 8 hr (not to exceed 4 sprays in
one nostril/day).
NURSING IMPLICATIONS

 May cause drowsiness or dizziness. Advise patient to avoid driving or other activi-ties
Assessment
requiring alertness until response to the medication is known.
 Caution patientwho
 Patients to avoid the concurrent
have asthma, use ofallergy,
aspirin-induced alcohol,andaspirin, NSAIDs,
nasal polyps are atacetamin-
increased
ophen, or other OTC medications without consulting health care professional.
risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and
 Advise urticaria.
patient to inform health care professional of medication regimen prior to
 Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome or
treatment or surgery.
 Advise toxic
patientepidermal necrolysis.
to consult Discontinue
health care therapy
professional if severe
if rash, or visual
itching, if accompanied with
distur-bances,
fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions,
tinnitus, weight gain, edema, black stools, persistent headache, or influ-enza-like
conjunctivitis, hepatitis and/or eosino-philia.
syndrome (chills, fever, muscle aches, pain) occurs.
 Pain: Assess pain (note type, location, and intensity) prior to and 1 – 2 hr follow-ing
 Intranasal:
administration.Instruct patient on correct technique for administration, need to
open a new
Lab bottle every 24 hr, and
Test Considerations: the 5 day
Evaluate limit
liver for use.
function tests, especially AST and ALT,
periodically in patients receiving prolonged therapy. May causeqlevels.
 May cause prolonged bleeding time that may persist for 24 – 48 hr following dis-
Evaluation/Desired Outcomes
continuation of therapy.
 May causeqBUN, serum creatinine, or potassium concentrations.
 Decrease in severity of pain. Patients who do not respond to one NSAID may
re-spond to another.
Potential Nursing Diagnoses

Acute pain (Indications)

Implementation

 Do not confuse Toradol (ketorolac) with tramadol (Ultram).

 Administration in higher-than-recommended doses does not provide increased
effectiveness but may cause increased side effects. Duration of ketorolac ther-apy, by
all routes combined, should not exceed 5 days. Use lowest effective dose for shortest
period of time.
 Coadministration with opioid analgesics may have additive analgesic effects and may
permit lower opioid doses.
 PO: Ketorolac therapy should always be given initially by the IM or IV route. Use
oral therapy only as a continuation of parenteral therapy.

IV Administration

 Direct IV: Administer undiluted. Concentration: 15 – 30 mg/mL. Rate: Ad-minister

over at least 15 sec.

Patient/Family Teaching

 Instruct patient on how and when to ask for and take pain medication.
 Instruct patient to take medication exactly as directed. Take missed doses as soon as
remembered if not almost time for next dose. Do not double doses. Do not take more
than prescribed or for longer than 5 days.
 Nonopioid
Analgesic for
Moderate Pain

Simple or non-opioid analgesics are a diverse

group of drugs that include anti-inflammatory
drugs (non-steroidal anti-inflammatory drugs
or NSAIDs) and paracetamol