Ketorolac
Brand names: Toradol
Class: 🤕 NSAIDs & Analgesics
The NP-board angle on ketorolac is short-course severe acute pain and the strict duration limit. It is a parenteral and oral NSAID with potency comparable to low-dose opioids for post-operative pain, renal colic, and migraine in the emergency department. Mechanism is COX-1/COX-2 inhibition. The board pearl is the 5-day combined IV/PO maximum — GI bleeding and acute kidney injury rise sharply beyond that. Avoid in CKD, heart failure, peptic ulcer disease, third-trimester pregnancy, and active bleeding. Stop before surgery. Ketorolac is not a chronic NSAID and is not an outpatient maintenance analgesic. On the exam, the trigger phrase is severe acute pain with a need to limit opioids — give it, time-box it, and stop.
✅ Indications
Moderate-severe acute pain (post-op, renal colic, migraine in ED).
⚙️ Mechanism of Action
Non-selective COX inhibitor — potent analgesia.
📏 Dosing
IV/IM: 15–30 mg q6h. PO: 10 mg q4–6h. MAX 5 DAYS TOTAL.
🚫 Contraindications
Active peptic ulcer/GI bleed, AKI or CKD, <30 mL/min CrCl, perioperative CABG, labor/delivery, breastfeeding.
⚠️ Adverse Effects
GI bleed (HIGH), AKI (HIGH), bleeding, HTN; same NSAID cautions amplified.
🔬 Monitoring
Creatinine, BP, GI symptoms.
💎 Board Pearls
- ⏱️ 5-DAY MAX — total duration across all routes (IV + PO). NEVER prolong.
- 🚫 Contraindicated in CKD (avoid if CrCl <30).
- 💊 Useful migraine abortive in ED when oral meds not tolerated.
Practice Questions
Which statement about ketorolac (Toradol) therapy should NOT be followed when counseling an adult patient?
Related Drugs in This Class
- Ibuprofen — Motrin, Advil
- Naproxen — Aleve, Naprosyn
- Acetaminophen — Tylenol, APAP, Paracetamol
Sources
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