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| No. 20 | 
Feb 24, 2004, 10:19 PM
Its my undertanding that Toradol interfears with the clotting of blood, and in fact potentiates drugs such as coumadin, heperin, lovonox...etc. So why would this drug be prescribed soon before or after a major surgery? That does not make sense to me....   | | Advertisement Sponsored Links | | | | No. 21 |
Feb 25, 2004, 12:18 AM
I'll post below a snippet from a page which I will use to answer your question.
Current dosing recommendations vary according to patient population, risk category, and weight. In general, the physician will use LMWH before general surgery or after surgery for orthopedic surgery. Low-molecular-weight heparin can also be combined with warfarin until a therapeutic international normalized ratio (INR) is achieved. The physician will start warfarin on the day of or the day after surgery, depending on the type of surgery. He may use LMWH alone if the patient is at higher risk for bleeding, can't achieve a consistent warfarin level, or can't safely regulate the warfarin dosing. Note that there may be an increased risk of bleeding if the patient is receiving ketorolac (Toradol) while on LMWH (especially enoxaparin).
Here is the link. http://www.nursingcenter.com/prodev/....asp?tid=53590
Answer your question?
-Dave
| | No. 22 |
Feb 25, 2004, 03:21 PM
Originally Posted by Anniekins Its my undertanding that Toradol interfears with the clotting of blood, and in fact potentiates drugs such as coumadin, heperin, lovonox...etc. So why would this drug be prescribed soon before or after a major surgery? That does not make sense to me....
Most of our surgery patients have between 25 and 100cc blood loss in surgery, they are at a low risk for continued bleeding. Besides that they come back to the floor with drains so we can assess them frequently for bleeding that may not show up on the dressing. Toradol works but if your patient has lost a lot of blood or is at an increased risk of bleeding don't use it.
| | No. 23 |
Feb 25, 2004, 05:55 PM
Never see toradol used in abd transplant, due to bleeding/renal issues. Use Dilaudid or MSO4 PCA until po, then Dilaudid, Morphine, or Percocet. Long term chronic pain issues, I've seen addressed w/ Methadone. Very few people complain of feeling "loopy", but many of our population has past history of substance use/abuse, so pain control remains the focus.
| | No. 24 |
Feb 28, 2004, 03:26 PM
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  | | No. 25 |
Feb 28, 2004, 04:36 PM
uh oh...we just learned LAST WEEK in my pharmacology class that phenergan is given with pain meds to potentiate their effects 
i'm sooo glad i found this site | | No. 26 |
Feb 28, 2004, 05:25 PM
Originally Posted by 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?!
| | No. 27 |
Feb 28, 2004, 05:40 PM
Originally Posted by 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...
| | No. 28 |
Feb 28, 2004, 05:47 PM
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 Originally Posted by 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?! | | No. 29 |
Feb 28, 2004, 05:53 PM
Originally Posted by 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.
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