Browse the corpus

Ketorolac, a nonsteroidal anti-inflammatory drug, is an option for the management of acute moderate-to-severe pain. Ketorolac is available in various forms, including oral, nasal spray, IV, or IM administration. Widely employed in postoperative scenarios for pain control, ketorolac is particularly effective when combined with opioids, leading to a significant reduction in opioid requirements. This synergistic approach not only mitigates the need for opioids but also diminishes the occurrence of adverse effects such as vomiting and decreased gastrointestinal motility. In pediatric cases, ketorolac demonstrates effectiveness comparable to major opioid analgesics. This educational activity discusses the indications, actions, and contraindications associated with ketorolac, emphasizing its role as a valuable agent in treating acute pain. The activity further highlights essential aspects, including the mechanism of action, adverse event profile, and critical factors for monitoring and managing toxicity, providing crucial insights for interprofessional team members involved in treating patients with acute moderate-to-severe pain. Objectives: Identify appropriate indications for ketorolac use. Implement appropriate dosing strategies and treatment regimens for ketorolac based on patient-specific factors. Select the optimal patients for ketorolac use, considering individual patient characteristics and comorbidities. Improve collaboration with other healthcare professionals to ensure appropriate pain management strategies incorporating ketorolac. Access free multiple choice questions on this topic.

High quantities or prolonged use of ketorolac can lead to hepatotoxicity and nephrotoxicity.[29] In addition, ketorolac can cause multiple skin disorders, such as toxic epidermal necrolysis. Anaphylactic shock has been characterized due to ketorolac overdose.[30] Arterial blood gas analysis reveals high anion gap metabolic acidosis. Management of overdose is usually supportive care and discontinuation of ketorolac. There is no specific antidote for ketorolac. Hemodialysis is not helpful due to high plasma protein binding.[31]

In light of the present opioid epidemic in the United States, seeking alternative pain reduction methods that either reduce or prevent the need for administering opioids is essential. Higher-risk populations for opioid misuse include young males, individuals with a history of abuse, and individuals with significant mental health histories.[32] Clinicians should make a deliberate effort to identify patients in these populations and, as a whole, decrease their opioid prescribing practices where possible. The recent general trend of emergency room prescription practices shows a decrease in opioid prescriptions, but much room remains for improvement.[33] Ketorolac has demonstrated effectiveness equal to that of morphine when used postoperatively. The drug has significant potential to be helpful in emergency room settings for moderate-to-severe pain, for which opioids are often regularly prescribed. When considering opioids for acute pain, a multimodal approach can be beneficial to decrease opioid administration to the extent possible. An interprofessional team can also be helpful in correctly identifying individuals who might benefit from alternative pain management medications or interventions and coordinating or assisting in implementing these alternate strategies. Given ketorolac's relatively high toxicity profile, the oral form is recommended for administration only after IV or IM dosage; fluid inter-professional collaboration is ideally maintained to reduce adverse outcomes and ensure the right individuals receive this medication. Healthcare providers are first and foremost responsible for identifying individuals who could benefit from non-opioid pain medications, both in the emergency department and in the postoperative setting. Recommendations include utilizing pharmacists in this process, as their expertise is in medication pharmacokinetics and proper dosing. Pharmacists can also ensure that adverse drug-to-drug interactions are detected and addressed and help decide which patients are ideal for ketorolac.

Healthcare providers are first and foremost responsible for identifying individuals who could benefit from non-opioid pain medications, both in the emergency department and in the postoperative setting. Recommendations include utilizing pharmacists in this process, as their expertise is in medication pharmacokinetics and proper dosing. Pharmacists can also ensure that adverse drug-to-drug interactions are detected and addressed and help decide which patients are ideal for ketorolac. Nurses play a vital role, given that they typically spend more time with patients and are responsible for administering ketorolac in its oral, IV, and IM forms. They assist in monitoring for toxicity, as well. Nurses can also liaise between the ordering provider and the patient, informing clinicians of any adverse effects and advocating for patients who might be appropriate candidates for ketorolac. Nurses and pharmacists are responsible for reporting any concerns or issues to the rest of the healthcare team. Pharmacists must counsel patients on proper use, perform medication reconciliation, and contact the prescriber should they note any red flags, including potential drug interactions or adverse events.