Ketorolac

INTRODUCTION

Indications

Short-term management of pain (not to exceed 5 days total for all routes combined).

Action

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia. Also has antipyretic and anti-inflammatory properties. Therapeutic Effects: Decreased pain.

Adverse Reactions/Side Effects

CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache. Resp: asthma, dyspnea. CV: edema, pallor, vasodilation. GI: GI BLEEDING, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea. GU: oliguria, renal toxicity, urinary frequency. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, pruritus, purpura, sweating, urticaria. Hemat: prolonged bleeding time. Local: injection site pain. Neuro: paresthesia. Misc: allergic reactions, including, anaphylaxis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools. Report these signs to the physician immediately.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for exfoliation, dermatitis, and other severe skin reactions that might indicate serious hypersensitivity reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis). Notify physician immediately if these reactions occur.

• Assess pain and other variables (range of motion, muscle strength) to document whether this drug is successful in helping manage the patient's pain and decreasing impairments.

• Assess signs of paresthesia, including numbness and tingling. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). NSAIDs can increase BP in certain patients.

• Be alert for signs of prolonged bleeding time such as bleeding gums, nosebleeds, and unusual or excessive bruising. Report these signs to the physician.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess symptoms of bronchospasm and asthma, including wheezing, coughing, dyspnea, and tightness in chest. Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendices I, J, K).

• Monitor signs of kidney toxicity, including blood or pus in urine, increased urinary frequency, decreased urine output, weight gain from fluid retention, and fatigue. Report these signs to the physician.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor and report euphoria, abnormal thinking, or other psychic disturbances.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.