Toradol

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.

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).

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

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...

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.

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.

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

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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/druginfo/uspdi/202686.html

Tenesma, thanks for the book references. I was about to do a search for a list of some good ones.