Application Paper PowerPoint

1. Toradol for Postoperative
Patients
Candice Bretz
MSNE 5356
Lamar University

2. Toradol (ketorolac)
• Ketorolac is a non-steroidal anti-inflammatory (NSAID) that is used for
short-term treatment of postoperative pain.
• It has analgesic and anti-inflammatory mechanisms of action (Wilson,
Ripsch, &White, 2016).

3. Pathophysiology Condition
• There are two categories of pain: acute or chronic pain.
• Pain is treated based on the type of pain.
• Pain is transmitted through specialized nerve fibers from the spinal cord to
the brain.
• The transmission of pain is called nociception.
• Nociception is divided into four categories: transduction, transmission,
perception, and modulation (Foy, 2017).

4. Intended Drug Response
• Ketorolac inhibits the synthesis of prostaglandins and is a nonselective
cyclo-oxygenase (COX) inhibitor (Vadivelu et al., 2015).
• Ketorolac alleviates mild to moderate postoperative pain (Nezafati, Khiavi,
Mirinejhad, Ammadi, & Ghanizadeh, 2017).
• It provides a high level of analgesia and reduces the consumption of opioids
(Siribumrungwong, Cheewakidakarn,Tangtrakulwanich, & Nimmaanrat,
2015).

5. Potential Reactions
• Ketorolac should not be administered concurrently with any other NSAID or
anticoagulant.
• Gastrointestinal bleeding risk is increased when used in combination with an
anticoagulant.
• Angiotensin II receptor antagonists, angiotensin converting enzyme (ACE)
inhibitors, and diuretics use should be limited with ketorolac due to
increased renal impairment (M. , personal communication, November 11,
2017).

6. Side Effects
• Ketorolac can cause gastrointestinal bleeding, peptic ulcers, renal
impairment, and platelet aggregation (M., personal communication,
November 11, 2017).

7. Pharmacokinetics
• Ketorolac is rapidly absorbed but has decreased absorption in the presence of food.
• The bioavailability is between 80% and 100% if administered orally, intravenously,
or intramuscularly.
• The onset of action begins within 10 minutes and the peak action is between 75 and
150 minutes.
• The half-life is five to six hours and the medication is mostly metabolized by the
liver and excreted in urine (Vadivelu et al., 2015).

8. Drug Binding Issues
• Ketorolac administered in conjunction with aspirin reduces the protein
binding of ketorolac.
• Clearance of free ketorolac isn’t affected by the concurrent administration
of aspirin (Food and DrugAdministration, 2013).

9. Improving Communication
• Nurses play an important role in obtaining a health history and current
prescriptions.
• Nurses, surgeons, anesthesiologists, and primary care physicians need to
collaborate regarding a patient’s care to provide safe care to patients.
• Primary care physicians and surgeons need to have better documentation
regarding a patient’s medication condition and medications prescribed.
• An accurate health history can lead to decreased adverse effects to patients (M. ,
personal communication, November 11, 2017).

10. Application to Practice Setting
• The addition of ketorolac to a patient’s postoperative pain regimen has
opioid-sparing effects and increases the analgesic action.
• Ketorolac decreases the adverse side effects seen with opioids.
• The use of ketorolac in the postoperative patient improves patient
outcomes and patient satisfaction (Min et al., 2012).

11. References
• Food and DrugAdministration. (2013).Toradol. Retrieved
from
https://www.accessdata.fda.gov/drugsatfda_docs/label/201
3/019645s019lbl.pdf
• Foy, M. (2017). Principles of pharmacology in pain
management. InV.A. Arcangelo, A.M. Peterson, C.Wilbur, &
J.A. Reinhold (Eds), Pharmacotherapeutics for advanced
practice (pp. 93-109). Philadelphia, PA:Wolters Kluwer.
• Leggett, M. (2017, November 11). Personal interview.
• Min,T.J., Kim.W.Y., Jeong,W.J., Choi, J.H., Lee,Y.S., Kim,
J.H., & Park,Y.C. (2012). Effect of ketamine on intravenous
patient-controlled analgesia using hydromorphone and
ketorolac after the nuss surgery in pediatric patients. Korean
Journal of Anesthesiology, 62(2), 142-147.
doi:10.4097/kjae.2012.62.2.142
• Nezafati, S., Khiavi, R.H., Mirinejhad, S.S.,Ammadi, D.A.,
Ghanizadeh, M. (2017). Comparison of pain relief from
different intravenous doses of ketorolac after reduction of
mandibular fractures. Journal of Clinical Diagnostic
Research, 11(9), 6-10). doi:10.7860/JCDR/2017/30946.10558
• Siribumrungwong, K., Cheewakidakarn, J.,
Tangtrakulwanich, B., & Nimmaanrat, S. (2015).
Comparing parecoxib and ketorolac as
preemptive analgesia in patients undergoing
posterior lumbar spinal fusion: A prospective
randomized double-blinded placebo-controlled
trial. BMC Musculoskeletal Disorders, 16(59), 1-8.
doi:10.1186/s12891-015-0522-5
• Vadivelu, N., Gowda, A., Urman, R., Jolly, S.,
Kodumundi,V., Maria, M.,…Pergolizzi, J. (2015).
Ketorolac tromethamine routes and clinical
implications. Pain Practice, 15(2), 175-193.
doi:10.1111/papr.12198
• Wilson, N., Ripsch, M., &White, F. (2016). Impact
of opioid and nonopioid drugs on postsurgical
pain management in the rat. Pain Research and
Treatment, 2016, 1-8. doi:10.1155/2016/8364762