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

Gldngrl · Feb 29, 2004

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.
-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.

fab4fan · Feb 29, 2004

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.

Home Health Columnist / Guide · Feb 29, 2004

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/criteria/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

Gump · Mar 1, 2004

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

Michael35 · Dec 17, 2004

For the people who think putting your title after your name is special, multiple titles I am more impressed by. Phenergan doesnt help with pain?, next time assess it by asking your patient before and after- I will bet they say YES it is better. Yes, Phenergan will also cause sedation, which also is nice after painful surgery. Comfort is always nice for our patients, do we need a journal,study, or expert opinion from someone with impressive initials after there name to tell us this?

Michael35 · Dec 17, 2004

For the people who think putting your title after your name is special, multiple titles I am more impressed by. Phenergan doesnt help with pain?, next time assess it by asking your patient before and after- I will bet they say YES it is better. Yes, Phenergan will also cause sedation, which also is nice after painful surgery. Comfort is always nice for our patients, do we need a journal,study, or expert opinion from someone with impressive initials after there name to tell us this?

mwbeah · Dec 21, 2004

Phenergan is not a drug to treat pain, here is its mechanism of action:

Mechanism of Action:

The predominant action of promethazine is antagonism of H1-receptors. Although promethazine is classified as a phenothiazine, its ability to antagonize dopamine is approximately one-tenth that of chlorpromazine. For this reason, promethazine is not used as a neuroleptic.

Like other H1-antagonists, promethazine does not prevent the release of histamine, as do cromolyn and nedocromil, but competes with free histamine for binding at H1-receptor sites. Histamine receptors in the GI tract, uterus, large blood vessels, and bronchial muscle are blocked. The relief of motion sickness and nausea/vomiting appear to be related to central anticholinergic actions and may implicate activity on the medullary chemoreceptor trigger zone.

Please post responsibly and with caution this agent does not relieve pain, it acts at histamine receptors. Phenergan is used for sedation and anti-emesis. I ask that when posting, persons should have a working knowledge of the agents they speak of.

mwbeah

vwgirl · Dec 21, 2004

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

The head of our OB department puts his post-op c-sections on round the clock Phenergan in addition to their Morphine PCA; they are all so snowed that they could not complain of pain even if they wanted to, which is what I think he is trying to accomplish. (This is the man who responds to all phone calls with, "Why you calling me with this stupid stuff?") But if my patients are too sedated to open their eyes or move in the bed, I hold the Phenergan.

Nightcrawler, BSN, RN · Dec 21, 2004

I did a clinical rotation through a local ER where the attending doc would routinely order ativan and toradol together, esp for chest pain. I even heard that he was trying to find a way to market the combination as tordivan...... The patient that I saw it used on came in with a c/o chest pain and elevated bp. The meds were given, the bp came down, the pain went away and the patient went to sleep......

Michael35 · Dec 21, 2004

I am impressed by the knowledge, but I cant help but wonder if all this knowledge actually impeads patient care? I like my patients to leave my unit comfortable and happy as can be. Phenergan helps in some cases no matter what your PDR says. It is important to also have narcotic on board, dont start with phenergan as your pain reliever. When in doubt ask the patient. Merry Christmas, Michael :rolleyes:

mwbeah · Dec 22, 2004

Michael, your posts speak for themself. You obviously don't care enough for your patients to ensure they have the appropriate agents to address the appropriate patient needs. Making a patient "sleepy" doesn't address the patient's pain. Additionally, opioids are a great tool but they themself, if used over time can lead to a hyperalgesia.

If you want to understand the how to manage pain appropriately start with this link www.pain.com

Mike

aimeee, BSN, RN · Dec 25, 2004

moderator's note: please remember to keep your comments focused on the subject of pain control. one can remain respectful even when disagreeing.

a tense and anxious patient hurts more than a relaxed patient, all other things being equal. therefore, i would expect that a patient with an anxiolytic or sedating agent would find relief from pain medication faster than one who had only the pain medication. if a patient has been under-medicated and is already "wound up", then it often takes a smaller total amount of pain medication to bring the pain back under control if given in conjunction with something to help them relax.

it is not unusual for opioids to cause nausea in the narcotic naive, so prophylactic doses of an agent to prevent nausea make perfect sense. too often, the phenergan is only ordered after the patient has gotten sick and the brain has already formed an association between being nauseated and the opioid.