Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Ketorolac is a member of a class of drugs called
nonsteroidal antiinflammatory drugs (NSAIDs) that is used for treating
inflammation and pain. Other drugs in this class include ibuprofen (Motrin) and
naproxen (Naprosyn, Aleve), but ketorolac is more effective than other NSAIDs in
reducing pain from both inflammatory and non-inflammatory causes. Ketorolac
reduces the production of prostaglandins, chemicals that cells of the immune
system make that cause the redness, fever, and pain of inflammation and that
also are believed to be important in the production of non-inflammatory pain. It
does this by blocking the enzymes that cells use to make prostaglandins
(cyclooxygenase 1 and 2). As a result, pain as well as inflammation and its
signs and symptoms - redness, swelling, fever, and pain - are reduced. The FDA
approved ketorolac in November 1989.
GENERIC AVAILABLE: Yes
PRESCRIPTION: Yes
PREPARATIONS: Tablets: 10 mg; Injection: 15 and 30 mg/ml.
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.
PRESCRIBED FOR: Ketorolac is used for short-term management (up to 5 days) of
moderately severe acute pain that otherwise would require narcotics. It most
often is used after surgery.
DOSING: Treatment should be started with ketorolac injection. Tablets are
used only if treatment is continued after patients begin to eat and drink. The
total duration of therapy should not exceed 5 days because of the potential for
gastrointestinal bleeding and other side effects. The recommended adult
intravenous single dose is 15 to 60 mg. Multiple intravenous doses of 15 or 30
mg every 6 hours, not to exceed 60 or 120 mg a day, also may be used. Following
intravenous therapy, the recommended dose is one or two tablets initially
followed by 1 tablet every 4-6 hours, not to exceed 40 mg daily. The smaller
dose is used for patients with poor kidney function or those older than 65
years.
DRUG INTERACTIONS:Probenecid
(Benemid) should not be combined with ketorolac because
it reduces the elimination of ketorolac by the kidneys. This may lead to
increased levels of ketorolac in the body and increased side effects from
ketorolac.
Ketorolac may increase the blood levels of lithium (Eskalith) by reducing the
elimination of lithium by the kidneys. Increased levels of lithium may lead to
lithium toxicity.
Individuals taking oral blood thinners or anticoagulants [for example, warfarin
(Coumadin)
should avoid ketorolac because ketorolac also thins the blood, and excessive
blood thinning may lead to bleeding.
PREGNANCY: There are no adequate studies in
pregnant women. Ketorolac should
be used during pregnancy only if the potential benefit justifies the potential
risk to the fetus. NSAIDs may cause cardiovascular side effects during late
pregnancy.
NURSING MOTHERS: Ketorolac should not be used by nursing mothers because it
is excreted in breast-milk.
SIDE EFFECTS: Common side effects from ketorolac include rash,
ringing in the
ears, headaches,
dizziness, drowsiness, abdominal pain, nausea, diarrhea,
constipation,
heartburn, and fluid retention. NSAIDs reduce the ability of blood
to clot and therefore increase bleeding after an injury. Ketorolac may cause
ulcers and bleeding in the stomach and intestines, particularly with use for
more than five days. Sometimes, stomach ulceration and intestinal bleeding can
occur without any abdominal pain. Black tarry stools, weakness, and dizziness
upon standing may be the only signs of the bleeding. NSAIDs reduce the flow of
blood to the kidneys and impair function of the kidneys. The impairment is most
likely to occur in patients with preexisting impairment of kidney function or
congestive heart failure, and use of NSAIDs in these patients should be done
cautiously. Liver failure has also been associated with ketorolac. People who
are allergic to aspirin and other NSAIDs should not use ketorolac. Individuals
with asthma or nasal polyps are more likely to experience allergic reactions to
NSAIDs.
The anterior cruciate ligament helps to prevent the top and bottom of the knee from sliding back and forth. Symptoms and signs of a torn ACL include knee pain and swelling. Treatment of a torn ACL depends upon the health of the patient and the patient's expectations and willingness to undertake extensive physical therapy. Rehabilitation after surgical repair of an ACL tear may take more than nine months.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
Normally, the bladder gently fills with urine and you slowly become aware of
the need to urinate. This feeling is your cue to start looking for a
bathroom.
But in people who have bladder spasms, the sensation occurs suddenly and
often severely. A spasm itself is the sudden, involuntary squeezing of a
muscle. A bladder spasm, or "detrusor contraction," occurs when the
bladder muscle squeezes suddenly without warning, causing an urgent need to
release urine. The spasm can force urine from the bladder, causing leakage.
When this happens, the condition is called urge incontinence or overactive bladder.
People who have had such spasms describe them as a cramping pain and
sometimes as a burning sensation. Some women with severe bladder spasms
compared the muscle contractions to severe menstrual cramps and even labor
pains experienced during childbirth.
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