Is there something comparable to Toradol that can be given IV for pain? - page 3

Toradol is one of my favorite pain relief meds, if only it didn't harm the kidneys! Is there something comparable to Toradol that can be given IV for pain (usually post-op) either in place of a... Read More

  1. by   RN Rotten Nurse
    Quote from MD Terminator
    The main reason people use an anti-emetic drug in combination with a pain medication IS sedation. I think the practice was originally started because people thought if you nocked them out, they wouldn't be in pain. Then came about some flawed studies (since proven wrong) that the pain releiving props of the medication was enhanced by using one of these drugs.

    Its the same thing as the ER giving a patient Haldol for pain. NONE of these drugs are indicated for pain, and therefore SHOULD NOT be used for pain. Yes, I know about off-label useage, but I promise you... come into my hospital and give one of these drugs for pain (instead of choosing a proper method... you understand, don'tcha?) and you will be brought in front of our medical ethics review board. Just ask our residents who were using Haldol and Ativan for abdominal pain.

    -Dave

    Whatever...........! I found in my former life (when i worked in a recovery room) that when I would get a patient that would be crying and writhing in pain (acting a bit hysterical.....) after trying morphine, demerol, and toradol, that often a shot of good old Ativan would do the trick. If it works dont knock it. I have also taken care of a man with Chrons that said the only thing that worked for his abdominal pain was Ativan. Why would someone be brought in front of the medical ethics review board for a giving a drug that works?!
  2. by   Tenesma
    Quote from RN Rotten Nurse
    Whatever...........! I found in my former life (when i worked in a recovery room) that when I would get a patient that would be crying and writhing in pain (acting a bit hysterical.....) after trying morphine, demerol, and toradol, that often a shot of good old Ativan would do the trick. If it works dont knock it. I have also taken care of a man with Chrons that said the only thing that worked for his abdominal pain was Ativan. Why would someone be brought in front of the medical ethics review board for a giving a drug that works?!

    you are going to get a lot of flak for your statement, so i will try to soften the situation

    1) while you are ABSOLUTELY right that Ativan will calm somebody down - it has to do with the fact that you are providing sedation, and in all truth, you are not providing pain relief... you may feel that the same goal has been achieved (ie: the patient isn't complaining anymore), but what you are not realizing is that a patient who is in pain will have a huge sympathetic outflow and release of catecholamines - which in turn can be quite harmful to the body (in fact, somebody with a bad heart can infarct for this exact reason).
    So while the patient may look peaceful - the untreated pain will hurt the patient.

    2) now there are certain situations where patients with primarily pre-existing anxieties or depression will have a lower threshold for pain, and that by mitigating the anxiety component of pain - you are actually improving their pain score.... that is entirely possible...

    3) patient with Crohn's or any other chronic illness - remember benzodiazepines are extremely addictive, and there is a higher correlation between psychiatric/mental disease (including anxiety disorders/addiction disorders/depressive disorders) and Crohns (when compared to the normal population).... So would I give ativan to that patient? sure... but that doesn't mean much in the context of the original postings...
  3. by   Dave ARNP
    All you're going to do is nock a patient out.
    Ativan is a decent drug to use when a patients anxiety is making their pain worse, or when their pain is causing anxiety... but you will NOT use it by itself.

    If you had thoroughly read my post which you quoted, you would have understood that I was referring to Haldol when speaking of ER docs being reviewed. Haldol has no effect on pain. It may calm the patient, but it will NOT help the pain.

    I give ALOT of Ativan during the course of mananging a patients pain. It works extremely well. However it's cruel to use it as monotherapy. Think ICU when you have a patient paralyzed, but still in extreme pain. They may be outwardly calm, but on the inside they're a trainwreck.

    -Dave

    Quote from RN Rotten Nurse
    Whatever...........! I found in my former life (when i worked in a recovery room) that when I would get a patient that would be crying and writhing in pain (acting a bit hysterical.....) after trying morphine, demerol, and toradol, that often a shot of good old Ativan would do the trick. If it works dont knock it. I have also taken care of a man with Chrons that said the only thing that worked for his abdominal pain was Ativan. Why would someone be brought in front of the medical ethics review board for a giving a drug that works?!
  4. by   Nursekatydid
    Quote from Tenesma
    a few issues with toradol post-operatively:
    1) platelet function: it interferes with platelet aggregation - it has nothing to do with heparin or other LMWH.2) bone healing: it interferes with bone healing by inhibiting osteoclastic activity

    I give/write for it post-operatively frequently!!! however, I would not give it to patients who had fine bony work (ie: ankle fusion), nor would i give it to somebody where hematoma formation would be dangerous: burn patients after excision and grafting, plastic surgery patients (breasts, abdominoplasty, facial, etc.), strong hx of GI bleeds, etc...

    dont forget that toradol is a very powerful drug: 30mg IVis equi-analgesic to 10mg of IV Morphine... nothing to laugh at
    The above statement about Toradol having nothing to do with LMWH or Heparin is NOT true. Toradol taken wiht an oral anticoagulant can actually INCREASE the effect of an LMWH or Heparin, therefore greater risk for bleeding.
  5. by   Tenesma
    nursekatydid: how does toradol increase the effect of heparin or a LMWH??? while both drugs play a role in coagulation they are involved in two distinct pathways?

    toradol: inhibits platelet aggregation, inhibits platelet thromboxane production
    fragmin/lovenox: increases anti-factor Xa
    heparin: catalyst for atIII

    the two classes of drugs have NOTHING to do with each other... HOWEVER< they both interfere with hemostasis, so should a patient be on both drugs they would be at a higher risk of bleeding (and thus have a longer bleeding time)...

    there are many studies looking at interactions between toradol and LMWH/heparin, and none so far have found any interaction whatsoever...
    your point that toradol augments the effect of LMWH is therefore wrong.
  6. by   bellehill
    Quote from Tenesma
    a few issues with toradol post-operatively:
    1) platelet function: it interferes with platelet aggregation - it has nothing to do with heparin or other LMWH.

    2) bone healing: it interferes with bone healing by inhibiting osteoclastic activity

    I give/write for it post-operatively frequently!!! however, I would not give it to patients who had fine bony work (ie: ankle fusion)...

    dont forget that toradol is a very powerful drug: 30mg IVis equi-analgesic to 10mg of IV Morphine... nothing to laugh at
    Thanks for the info on the fusion surgery, that is what I needed to know! Didn't realize Toradol was so powerful, no wonder it works.
  7. by   Nursekatydid
    Tanesma,
    I got that information directly from Saunders Nursing Drug Handbook (2003 edition, pgs.633-635.)
    Toradol effects the platelets and heparin affects the coagulation cascade. When both parts of coagulation are interfered with, then bleeding can be a problem.
  8. by   Tenesma
    Quote from Nursekatydid
    Tanesma,
    I got that information directly from Saunders Nursing Drug Handbook (2003 edition, pgs.633-635.)
    Toradol effects the platelets and heparin affects the coagulation cascade. When both parts of coagulation are interfered with, then bleeding can be a problem.

    you have to be careful how you describe things.... and I wouldn't reference a Nursing Drug Handbook when discussing the intricacies of pharmacology. There is a huge difference between saying "toradol increases the effects of heparin" compared to "toradol and heparin are additive in their contribution to bleeding" (which is what your last sentence, correctly, is alluding to).
  9. by   Dave ARNP
    Quote from Tenesma
    you have to be careful how you describe things.... and I wouldn't reference a Nursing Drug Handbook when discussing the intricacies of pharmacology.
    Perhaps you can suggest a book that you feel is adquate?
    Mind you, as nurses we have to have a book which will keep us very well informed. We're not only responsible for giving the medication, but making sure the medication and the doseage that the DOCTOR ordered isn't high enough to kill T-Rex.

    :hatparty:
    -Dave
  10. by   Tenesma
    don't get me wrong i think the Nursing Drug Handbook is a great resource for a quick check to look up a med or a dose... but when the finer points are being discussed it is often in error or vague or nebulous or misleading.

    MicroMedex is a great resource online if your hospital provides access to it - i still think that the classic resoucre is Goodman & Gillman's Pharm book as well as Stoeltings Pharmacology - and if you want to be even more cutting edge you can look it up on pubmed online (that is free and available to everybody)... or even better, have a discussion (like we are doing now) about the drug with people who are a bit more familiar with it...

    i am not trying to be condescending - just want to help guide and provide information, and i apologize if it comes across as rude...
  11. by   Gldngrl
    Quote from MD Terminator
    Perhaps you can suggest a book that you feel is adquate?
    Mind you, as nurses we have to have a book which will keep us very well informed. We're not only responsible for giving the medication, but making sure the medication and the doseage that the DOCTOR ordered isn't high enough to kill T-Rex.

    :hatparty:
    -Dave
    I don't believe that posting inflammatory statements are a benefit to either the nursing or medical professions. Both physicians and nurses make errors and as I've posted before, there needs to be a team effort to ensure quality care. This includes mutual respect and listening to what is being said, instead of reacting defensively because of a difference in education and knowledge.
  12. by   fab4fan
    I don't think that was inflammatory (heh, and here we are, talking about an anti-inflammatory drug). I was wondering pretty much the same thing. You take it on faith that what is in the drug handbook is true.
  13. by   NRSKarenRN
    lovenox (enoxaparin) + toradol


    other medicines-although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. in these cases, your doctor may want to change the dose, or other precautions may be necessary. when you are using enoxaparin, it is especially important that your health care professional know if you are taking any of the following:
    • nonsteroidal anti-inflammatory drugs (nsaids) including: e. low molecular weight heparins (lmwh) [clinical significance level - severe (first databank)]
      the combined use of lmwh and platelet inhibitors such as ketorolac may produce an additive prolongation of bleeding time and an increased risk of bleeding. the prolonged bleeding risk may persist for several days following discontinuation of platelet inhibitors. drugs that affect hemostasis should be discontinued prior to initiating therapy with lmwh. the manufacturer recommends that lmwh and ndaids like ketorolac shuld not be administered concurrently. if coadministration of lmwh and p;atelet inhibitors cannot be avoided, patients should be monitored closely for bleeding complications. concomitant administration of platelet inhibitors and lmwh is not recommended and will be reviewed.
      http://www.hhsc.state.tx.us/hcf/vdp/.../ketorola.html
    ---------



    other medicines--although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. in these cases, your doctor may want to change the dose, or other precautions may be necessary. when you are using enoxaparin, it is especially important that your health care professional know if you are taking any of the following:
    • nonsteroidal anti-inflammatory drugs (nsaids) including:
    • ketorolac tromethamine (e.g., toradol)-use of this drug when receiving spinal or epidural anesthesia can lead to long term neurological problems

    drugs affecting platelet aggregation or affect blood clotting ability such as:
    • aspirin or
    • dipyridamole (e.g., sk-dipyridamole) or
    • divalproex (e.g., depakote) or
    • inflammation or pain medicine, except narcotics, or
    • plicamycin (e.g., mithracin) or
    • salicylates (e.g., choline salicylate (arthropan), magnesium salicylate (doan's), salsalate (disalcid), or
    • sulfinpyrazone (e.g., anturane) or
    • thrombolytic agents (e.g. alteplase (activase), anistreplase (eminase), streptokinase (streptase), urokinase (abbokinase) or
    • ticlopidine (e.g., ticlid)
    • valproic acid (e.g., depakene)-using any of these medicines together with enoxaparin may increase the risk of bleeding
    http://www.nlm.nih.gov/medlineplus/d...di/202686.html
    Last edit by NRSKarenRN on Feb 29, '04

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