GENERIC NAME: ketorolac BRAND NAME: Toradol DRUG CLASS: nonsteroidal antiinflammatory drugs (NSAIDs)

MECHANISM OF ACTION: interferes with prostaglandin biosynthesis by inhibiting cyclooxygenase pathway of arachidonic acid metabolism; also acts as a potent inhibitor of platelet aggragation. AVAILABILITY  Tablets: 10 m  Injection: 15 and 30 mg/ml  Ophthalmic solutions: 0.4%, 0.5% STORAGE Tablets should be stored at 15 -30 C (59-86 F). Injectable solution should be stored at 15-30 C (59 to 86 F) and protected from light. INDICATIONS  Moderately severe pain  Ocular itching caused by seasonal allergic conjunctivitis  Post-operative ocular inflammation r/t cataract extraction  To reduce ocular pain, burning, or stinging after corneal refractive surgery DOSAGES  Usual Adult Dose for Pain:  In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose.  Parenteral:  Single dose administration: --IM: Patients less than 65 years of age: one dose of 60 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): one dose of 30 mg. --IV: Patients less than 65 years of age: one dose of 30 mg. Patients who are renally impaired, and/or less than 50 kg (110 pounds): One dose of 15 mg.  Multiple dose administration: --Patients less than 65 years of age: 30 mg IM or IV every 6 hours as needed. The maximum daily dose should not exceed 120 mg. --Patients who are renally impaired, and/or less than 50 kg (110 pounds): 15 mg IM or IV every 6 hours as needed. The maximum dose should not exceed 60 mg.  Oral: --10 mg orally 4 times a day as needed. The maximum daily dose should not exceed 40 mg.

--Patients less than 50 kg: The maximum daily dose should not exceed 40 mg. Usual Geriatric Dose for P ain:  In adults, the use of oral ketorolac is only indicated as continuation therapy to IV or IM dosing of ketorolac. The manufacturer recommends that the oral formulation should not be given as an initial dose. Parenteral:  Single dose administration: --IM: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): one dose of 30 mg. --IV: Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): One dose of 15 mg .  Multiple dose administration: --Patients greater than or equal to 65 years of age, renally impaired, and/or less than 50 kg (110 pounds): 15 mg IM or IV every 6 hours as needed. The maximum dose should not exceed 60 mg.  Oral: --10 mg orally 4 times a d ay as needed. The maximum daily dose should not exceed 40 mg. Usual Pediatric Dose for Pain:  2 to 16 years: --IM dosing: a single dose of 1 mg/kg up to a maximum of 30 mg. --IV dosing: a single dose of 0.5 m g/kg up to a maximum of 15 mg.  Greater than or equal to 3 years: 0.6 mg/kg IV once post surgery.

SIDE EFFECTS  Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ketorolac and seek medical attention or call your doctor at once if you have any of these serious side effects: o chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance; o black, bloody, or tarry stools; o coughing up blood or vomit that looks like coffee grounds; o swelling or rapid weight gain; o urinating less than usual or not at all; o nausea, stomach pain, low fever, loss of appetite, dark urine, clay colored stools, jaundice (yellowing of the skin or eyes); o fever, sore throat, and headache with a s evere blistering, peeling, and red skin rash; o the first sign of any mouth sores or skin rash, no matter how mild; o pale skin, easy bruising, severe tingling, numbness, pain, muscle weakness; or o fever, headache, neck stiffness, chills, increased sensitivity to light, purple spots on the skin, and/or seizure (convulsions).
 Less serious side effects may include: o upset stomach, mild nausea or vomiting, diarrhea, constipation; o mild heartburn, stomach pain, bloating, gas; o dizziness, headache, drowsiness;

sweating; or ringing in your ears.

ADVERSE REACTIONS  CNS- drowsiness, headache, dizziness  CV- hypertension  EENT- tinnitus  GI- n/v, diarrhea, constipation, flatulence, dyspepsia, epigastric pain, stomatitis  SKIN- rash, pruritus, diaphoresis,  OTHER- excessive thirst, edema, injection site pain CONTRAINDICATIONS Do not use this medication if you are allergic to ketorolac, aspirin, or other NSAIDs, or if you have:  Severe kidney disease;  Bleeding or blood clotting disorder;  Closed head injury or bleeding in your brain;  Stomach ulcer or a history of stomach or intestinal bleeding; or  If you are breast-feeding a baby.  Labor and delivery  Peptic ulcer disease NURSING RESPONDIBILISTIES  Monitor for adverse reactions, especially prolonged bleeding time and CNS reactions  Check IM injection site for hematoma or bleeding  Monitor fluid intake and output  Inform patient that drug is meant only for short - term pain management  Advise patient to minimize GI upset by eating small frequent servings of healthy foods  Instruct patient to avoid aspirin products and herbs during therapy  Teach patient how to use eye drops, if prescribed  Caution female patient not to take drug if shes breastfeeding  Advise patient to avoid driving and other hazardous activities until he knows how drug affects concentration and allertness