A review of ketorolac as a potential therapeutic agent

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Journal name: World Journal of Pharmaceutical Research
Original article title: A review of ketorolac as a potential therapeutic agent
The WJPR includes peer-reviewed publications such as scientific research papers, reports, review articles, company news, thesis reports and case studies in areas of Biology, Pharmaceutical industries and Chemical technology while incorporating ancient fields of knowledge such combining Ayurveda with scientific data.
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Original source:

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Author:

Bande Shaila, Bade Vaishnavi and Nilesh Y. Jadhav


World Journal of Pharmaceutical Research:

(An ISO 9001:2015 Certified International Journal)

Full text available for: A review of ketorolac as a potential therapeutic agent

Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research

Doi: 10.20959/wjpr20241-30761

Copyright (license): WJPR: All rights reserved


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Summary of article contents:

Introduction

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) primarily used to manage moderate-to-severe acute pain. Known for its rapid action when administered through intramuscular (IM) or intravenous (IV) routes, it serves as an effective option for individuals unable to take oral medications. This drug, marketed under various brand names such as Toradol, has garnered attention for its versatility in treating not only pain but also inflammation and cancer-related symptoms. However, its use is tempered by potential side effects such as gastrointestinal bleeding, renal complications, and contraindications in specific populations like pregnant or nursing women.

Mechanism of Action and Pharmacokinetics

One of the pivotal aspects of ketorolac is its mechanism of action, which involves the non-selective inhibition of cyclooxygenase (COX) enzymes (COX-1 and COX-2), leading to a decrease in prostaglandin synthesis. This inhibition plays a critical role in attenuating inflammation and pain. The pharmacokinetic profile of ketorolac indicates an 80% bioavailability following oral administration, with peak plasma concentrations occurring between 30 to 60 minutes post-administration. It is predominantly metabolized in the liver and excreted via the kidneys, and its half-life varies between the R and S enantiomers, aiding in its analgesic effectiveness.

Safety Profile and Side Effects

Despite its efficacy, the safety profile of ketorolac warrants careful consideration. Common side effects include headaches, nausea, dyspepsia, and abdominal discomfort. Serious adverse events, although rare, can include gastrointestinal bleeding, renal failure, and anaphylactic reactions. Due to its potential to suppress prostaglandin synthesis, ketorolac is categorized with caution in specific populations, particularly pregnant women due to risks associated with fetal and maternal health. Moreover, the safe use in lactating women remains under scrutiny, given the drug's excretion in breast milk and the potential impacts on nursing infants.

Clinical Applications in Pain Management

Ketorolac has garnered considerable interest for its role in multimodal analgesia, particularly in postoperative settings. It has been shown to reduce the reliance on opioids, consequently lessening the associated side effects of opioid therapy, such as nausea and constipation. Clinical studies demonstrate that ketorolac significantly improves postoperative pain management outcomes when compared to placebo, suggesting its utility in enhancing patient satisfaction and recovery times. Additionally, it has shown promise in specific contexts, such as managing migraine pain and enhancing the analgesic efficacy of local anesthetics in orthopedic procedures.

Conclusion

In conclusion, ketorolac remains a valuable therapeutic agent in the realm of pain management, particularly for acute pain scenarios. Its dual role as an analgesic and anti-inflammatory drug, combined with a rapid onset of action, makes it suitable for various clinical applications. However, its use must be balanced with the consideration of potential side effects and safety concerns, particularly in sensitive populations. Ongoing research and clinical evaluations will continue to clarify its role in pain management and explore its benefits in multimodal analgesic regimens.

FAQ section (important questions/answers):

What is ketorolac and how is it used?

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) used primarily to manage acute pain. It can be administered orally, intramuscularly, intravenously, or topically as eye drops.

What are the common side effects of ketorolac?

Common side effects include dizziness, nausea, abdominal pain, and sleepiness. Serious side effects can occur, including gastrointestinal bleeding, kidney failure, heart failure, and anaphylaxis.

What is the mechanism of action for ketorolac?

Ketorolac works by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), reducing prostaglandin synthesis, which helps manage pain and inflammation.

What precautions should be taken when using ketorolac?

Patients should avoid ketorolac if pregnant, nursing, or with certain health conditions like kidney disease. Monitoring is essential due to potential serious side effects.

How does ketorolac contribute to multimodal analgesia?

Ketorolac enhances pain management by providing effective analgesia, allowing for reduced opioid use, mitigating opioid-related side effects, and improving overall patient recovery.

In which forms is ketorolac available for administration?

Ketorolac is available in several forms, including oral tablets, intramuscular, intravenous (IV) injections, and topical eye drops, allowing for flexible administration based on patient needs.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “A review of ketorolac as a potential therapeutic agent”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Pain:
Pain refers to the physical suffering or discomfort caused by illness or injury. In the context of ketorolac, its effectiveness as an analgesic aims to alleviate acute pain, enhancing patient comfort and improving quality of life during treatment. Understanding pain management is critical in healthcare, particularly in surgical or post-operative settings.

2) Drug:
Drugs are substances used for medical treatment, which can include non-steroidal anti-inflammatory drugs like ketorolac. The review emphasizes the importance of understanding various drugs' pharmacodynamics and pharmacokinetics to optimize their use in clinical settings, enhancing treatment effectiveness and minimizing adverse effects.

3) Shaila (Saila):
Shaila refers to Bande Shaila, the lead author of the review article discussing ketorolac. Her contribution to the study of this drug is significant for enhancing the understanding of its pharmacological effects, as well as its applications in acute pain management, contributing to ongoing clinical knowledge in pharmacology.

4) Study (Studying):
The study refers to the detailed review and investigation into the properties and efficacy of ketorolac as a therapeutic agent for pain management. This study contributes valuable information to the field of pharmacology, further guiding best practices and treatment protocols in pain management.

5) Cancer:
Cancer refers to a group of diseases characterized by uncontrolled cell growth. The review mentions ketorolac's use in cancer treatment, emphasizing its role in managing pain for cancer patients. This connection underscores the necessity of effective analgesics in palliative care and the overall quality of life for those with severe illnesses.

6) Bleeding:
The bleeding indicates a significant concern in clinical settings, particularly when using medications like ketorolac. The review discusses the risks of gastrointestinal bleeding, underlining the importance of careful monitoring and patient selection when prescribing NSAIDs to avoid serious complications.

7) Activity:
Activity in this context refers to the pharmacological efficacy of ketorolac. Understanding the activity of drugs in terms of their mechanism of action, therapeutic effects, and contraindications helps healthcare providers make informed decisions about pain management strategies and enhances patient outcomes after surgeries.

8) Nausea:
Nausea is the sensation of having an urge to vomit, commonly experienced as a side effect of various medications. In the context of ketorolac, addressing potential side effects, including nausea, is important to ensure patient adherence to treatment and minimize discomfort during recovery from pain or surgical procedures.

9) Life:
Life in this context refers to the essential quality of existence and well-being of patients. Effective pain management with medications like ketorolac is crucial for improving the quality of life for individuals suffering from acute pain, facilitating a quicker return to normal activities and overall health.

10) Inflammation:
Inflammation is the body's response to injury or infection, often causing redness, swelling, and pain. Ketorolac, as a non-steroidal anti-inflammatory drug (NSAID), works by inhibiting inflammatory processes, thereby helping to reduce pain and swelling in various conditions, which is a foundational aspect of effective pain management.

11) Vomiting:
Vomiting is the act of expelling contents from the stomach through the mouth, often linked to various medical conditions or medications. Monitoring for vomiting as a side effect in patients taking ketorolac is crucial for optimizing patient care and minimizing adverse effects associated with its use.

12) Quality:
The quality emphasizes the importance of evaluating the standards of treatment and care provided to patients. Specifically, the quality of analgesia from ketorolac administration can significantly impact patient satisfaction and recovery rates, highlighting the need for ongoing assessments in clinical research.

13) Maharashtra (Maharastra, Maha-rashtra):
Maharashtra is a state in India where the authors of the review article are affiliated. Regional studies such as those from Maharashtra provide valuable insights into local healthcare practices and drug usage trends, contributing to a broader understanding of medication efficacy across different populations.

14) Performance:
Performance refers to how well a drug or treatment achieves its intended effects. The performance of ketorolac, particularly in pain relief and anti-inflammatory actions, is critical in clinical settings to ensure optimal patient outcomes and effectively manage acute pain postoperatively.

15) Measurement:
Measurements refer to the quantification of various clinical parameters, including the effects of a drug. Accurate measurements are crucial in pharmacology for assessing the effectiveness, side effects, and overall safety of medications like ketorolac, aiding in evidence-based practice.

16) Ahmednagar:
Ahmednagar is a city in Maharashtra, India, associated with the institutions involved in the study of ketorolac. The geographical context contributes to understanding the local healthcare landscape and the need for suitable pain management solutions in that specific region, addressing community health requirements.

17) Toxicity:
Toxicity refers to the degree to which a substance can harm humans or animals. Understanding the toxicity of ketorolac is essential for healthcare providers to minimize adverse effects and ensure patient safety, particularly concerning long-term and high-dose use in various populations.

18) Mandal:
Mandal likely refers to Seva Shikshan Prasarak Mandal, the educational institution associated with the authors. The role of institutions in facilitating research and education in pharmacology is pivotal for advancing knowledge about medication efficacy and promoting evidence-based practices in clinical settings.

19) Seva (Sheva):
Seva translates to 'service' in Hindi, reflecting the mission of organizations like Seva Shikshan Prasarak Mandal to provide education and contribute to healthcare. The institutional commitment to serving communities plays a crucial role in advancing medical research and improving health outcomes.

20) Post:
The post refers to the period after a specific event, commonly used in medical contexts regarding post-operative care. Highlighting the importance of managing pain effectively in the post-operative period serves to enhance recovery, patient comfort, and overall treatment outcomes.

21) Pharmacological:
Pharmacological refers to the branch of medicine that deals with the uses, effects, and mechanisms of action of drugs. Understanding the pharmacological profile of ketorolac is vital for using this NSAID effectively in pain management, ensuring optimal therapeutic outcomes, and minimizing potential side effects.

22) Biodegradable:
Biodegradable materials can break down naturally through biological processes. In the context of pharmaceuticals, biodegradable drug delivery systems may enhance the targeted release of medications like ketorolac, offering innovative approaches to improve therapeutic effects while minimizing adverse reactions.

23) Pharmacology:
Pharmacology is the study of drugs and their interactions with biological systems. This field is integral for understanding the therapeutic effects and potential side effects of medications such as ketorolac, guiding evidence-based practices in clinical settings and improving patient outcomes.

24) Depression:
Depression refers to a mood disorder characterized by persistent sadness and loss of interest. The connection between pain management and mental health is critical, as effective use of analgesics like ketorolac may help alleviate pain and, consequently, improve the overall psychological well-being of patients.

25) Medicine:
Medicines encompass a wide range of substances used to treat or manage health conditions. The review emphasizes the importance of evaluating various types of medicines, like ketorolac, for their therapeutic effectiveness and safety in managing acute pain and inflammation.

26) Pregnant:
Pregnant refers to the state of carrying a developing fetus. The review mentions that ketorolac use is cautioned against in pregnancy, particularly in later stages, due to potential hazards; understanding these risks is vital in ensuring safe medication practices for pregnant individuals.

27) Account:
Account pertains to the consideration and documentation of specific factors, such as side effects and responses to medications like ketorolac. Accurate patient accounts of symptoms and medication effects are essential for healthcare providers to tailor effective pain management strategies.

28) Surface:
Surface can refer to the outer layer of an object or tissue. In pharmacology, understanding the surface properties of drug formulations, including solubility and permeability, is crucial for enhancing drug absorption and effectiveness, especially in topical or injectable medications.

29) Repair:
Repair refers to the process of restoring something to its original condition. In the context of medicine, it may relate to tissue repair mechanisms that can be influenced by medications, where effective pain control from drugs like ketorolac can facilitate smoother healing after injuries or surgeries.

30) Visit:
Visit refers to an interaction between a patient and a healthcare provider. Ensuring clear communication and monitoring during visits is crucial for evaluating treatment efficacy with medications like ketorolac, guiding adjustments to improve patient outcomes in pain management.

31) Water:
Water is a critical component in pharmacology for various reasons, including acting as a solvent for drug delivery. The solubility and distribution of ketorolac in the body can be influenced by hydration status, impacting drug efficacy and absorption.

32) Field:
The field refers to a specific area of study or industry. In pharmacology, 'the field' involves constant research and exploration of drug effectiveness and safety profiles, including the ongoing development and application of analgesics like ketorolac in various treatment scenarios.

33) Death:
Death in a medical context refers to the cessation of life, often associated with serious health complications. Understanding the risks associated with medications like ketorolac, including severe side effects that could lead to hospitalization or fatality, is crucial for patient safety in clinical practice.

34) Blood:
Blood is the fluid that circulates in the circulatory system, delivering necessary substances to cells. Monitoring blood parameters is important when administering drugs like ketorolac due to potential side effects like bleeding, particularly in patients with coagulopathy or undergoing surgical procedures.

35) Rich (Rch):
Rich in this context may describe the abundance of certain factors, such as growth factors in blood derivatives. Understanding what substances are rich or deficient in certain treatments can help guide the development of effective drug therapies and enhance their therapeutic potential.

36) Salt (Salty):
Salt in pharmaceuticals can describe various salt forms that drugs take to enhance their stability and solubility. Ketorolac is provided as a tromethamine salt, impacting its bioavailability and overall pharmacokinetic properties crucial for effective pain management.

37) Veterinary medicine:
Veterinary medicine focuses on the prevention, diagnosis, and treatment of diseases in animals. The application of ketorolac in veterinary contexts highlights its potential in managing pain and inflammation in animals, emphasizing the role of pharmacology in diverse fields of healthcare.

38) Surrounding:
Surrounding can refer to the environment or context in which something exists. In pharmacology, understanding the surrounding factors, such as patient demographics and existing health conditions, helps tailor drug therapies like ketorolac to enhance safety and efficacy across diverse populations.

39) Vaishnavi (Vaisnavi):
Vaishnavi refers to another author, Bade Vaishnavi, involved in the study of ketorolac. The collaboration of multiple researchers enhances the comprehensive evaluation of drug efficacy and safety, contributing significantly to advancements in clinical pharmacology and patient care.

40) Knowledge:
Knowledge in this context refers to the understanding and insights gained from scientific research and clinical practices. Expanding knowledge about medications like ketorolac is essential for healthcare providers to ensure safe and effective pain management tailored to patient needs.

41) Suffering:
Suffering relates to enduring pain or distress, often experienced by patients with acute conditions. Effective use of analgesics like ketorolac aims to alleviate suffering, emphasizing the role of proper pain management strategies in enhancing patient quality of life and emotional well-being.

42) Swelling:
Swelling is a physiological response to injury or inflammation, characterized by an accumulation of fluid in tissues. Ketorolac’s anti-inflammatory properties help reduce swelling, directly impacting pain relief and recovery, highlighting the importance of managing inflammation during treatment.

43) Relative:
Relative refers to a comparative aspect, especially in evaluating treatment effectiveness. In pharmacology, assessing relative effectiveness of medications like ketorolac against other analgesics or treatment modalities is crucial for determining the best approaches to pain management.

44) Entering:
Entering signifies the process of patients engaging in healthcare systems or protocols. Monitoring patients upon entering treatment plans with medications like ketorolac is essential for assessing initial pain levels and tailoring ongoing pain management strategies accordingly.

45) Raising:
Raising can refer to the act of elevating certain parameters, such as raising awareness about drug efficacy and safety among healthcare professionals. Enhanced understanding of ketorolac’s use can improve clinical practice and patient outcomes in pain management.

46) Dealing:
Dealing pertains to how healthcare practitioners manage patient care, especially concerning pain relief strategies. Effective dealing with issues related to medication side effects, such as those caused by ketorolac, ensures optimal patient safety and adherence to pain management therapies.

47) Burning (Burn, Burned, Burnt):
Burning refers to a sensation often associated with irritation or discomfort. When administering ketorolac, monitoring for burning sensations at the injection site or related to gastrointestinal effects is essential to manage potential side effects and enhance patient comfort.

48) Family:
Family in this context refers to the immediate support structure around a patient. Understanding the impact of pain and its management, including medications like ketorolac, on a patient's family dynamics emphasizes the need for holistic patient care strategies.

49) Reason:
Reason refers to the justification or rationale for choosing specific treatment modalities. Evaluating the reasons behind selecting ketorolac for pain management is essential for crafting appropriate therapeutic strategies that align with patient needs and clinical outcomes.

50) Debate:
Debate signifies ongoing discussions regarding the best approaches to pain management, particularly concerning the use of specific drugs. The efficacy and safety of ketorolac versus alternative treatments often provoke debates among healthcare professionals, influencing clinical decision-making.

51) Doubt:
Doubt indicates uncertainty regarding a drug's effects or outcomes. Addressing doubts surrounding ketorolac's efficacy or potential side effects is critical in advancing patient care, as well as ensuring that clinicians feel confident in prescribing appropriate treatments.

52) Kappa:
Kappa denotes a statistical measure often used to evaluate agreement between observers or assess variability in clinical studies. In ketorolac research, kappa could be used to measure the consistency of pain assessment scores, reinforcing reliability in clinical findings.

53) Edema (Oedema):
Edema refers to swelling caused by excess fluid trapped in tissues. The review notes that ketorolac’s anti-inflammatory action can reduce edema, thereby impacting pain levels and enhancing recovery, particularly important in surgical or injury contexts.

54) Table:
Table signifies a method of presenting data in a structured way for analysis. In medical literature, tables summarizing the efficacy, safety, and pharmacological properties of ketorolac assist researchers and healthcare professionals in making informed decisions during treatment.

55) Venu:
Venu refers to another author associated with the article, contributing to the research on ketorolac. Each author’s perspective and expertise enrich the reviewed article, promoting a comprehensive analysis of drug efficacy and application in pharmacological practice.

56) Food:
Food can influence drug absorption and metabolism. In the context of ketorolac, understanding food interactions helps in providing appropriate dietary advice to patients, ensuring optimal drug efficacy and minimizing side effects related to food intake.

57) Line:
Line may refer to a sequence or guideline established for medication prescription and management. In health protocols concerning ketorolac, establishing clear lines of treatment enhances adherence to best practices, contributing to better patient outcomes and safety.

58) Milk:
Milk relates to nutrition and may impact the absorption of certain medications. In the context of ketorolac, understanding how dairy products influence its pharmacokinetics is essential for advising patients on dietary practices to enhance treatment effectiveness.

59) Coma:
Coma refers to a state of prolonged unconsciousness, often indicating severe medical complications. In discussions about ketorolac's side effects, understanding the risk of overdose leading to coma emphasizes the importance of appropriate dosing and monitoring in patient care.

60) Pir:
Peer refers to colleagues or other professionals within the same field. In scientific research, peer evaluations and collaborations enhance the credibility and accuracy of findings, particularly in studying the effects and applications of drugs like ketorolac.

61) Male:
Male denotes a gender classification that can affect pharmacological responses. Understanding gender differences in drug metabolism and efficacy is crucial when considering the administration of medications like ketorolac, to ensure balanced and applicable treatment for all patients.

62) Rat:
Rats are often used in preclinical studies to assess drug efficacy and safety. Research on ketorolac utilizing rat models provides valuable insights into its pharmacokinetics and potential effects, contributing to the broader understanding of its use in humans.

Other Science Concepts:

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