Which feature distinguishes ketorolac from most other NSAIDs and dictates its prescribing restrictions?

• A It has strong anti-inflammatory activity but weak analgesic activity, limiting use to rheumatoid arthritis
• B It undergoes exclusively biliary excretion, making it safe in renal impairment
• C It is a selective COX-2 inhibitor suitable for long-term osteoarthritis therapy
• D It is a potent analgesic comparable to low-dose opioids, but parenteral or oral use must not exceed five days because of gastrointestinal bleeding and renal risks ✓

Explanation

Ketorolac is unusual among NSAIDs in having analgesic potency comparable to modest opioid doses, which led to its use for postoperative pain, but its toxicity profile mandates strict limits: treatment should not exceed five days, with gastrointestinal haemorrhage and renal impairment being the chief concerns. It is a non-selective COX inhibitor, not a coxib, and it is renally excreted, so it is avoided in significant kidney disease.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.