Intranasal ketorolac protocol and directions for ketorolac solution preparation
*To prepare nasal ketorolac solution:
Take ketorolac tromethamine (60 mg/2 mL) and preservative free normal saline (2.75 mL).Mix in an emptied Nasocort AQ® spray bottle.Prime with 5 sprays before use, then each spray actuates 1.26 mg of solution.Instruct patient and medical personnel to tilt head down while spraying and sniff gently to avoid swallowing solution.
†Clinical and objective evaluation with spirometry performed before each dose and as needed.
If there is no reaction 3 hours after the 325 mg dose of aspirin, this is a negative challenge.
Reactions can be:
- Naso-ocular alone- Naso-ocular and a 15% or more decline in FEV1 (Classic reaction)- Lower respiratory reaction only (FEV1 declines by >20%)- Laryngospasm with or without a, b, c (flat or notched inspiratory curve)- Systemic reaction: hives, flush, gastric pain, hypotension
Aspirin desensitization:
After a reaction has been treated and resolved, repeat provoking dose.If no reaction, continue to escalate the doses as above.At 325 mg of aspirin, desensitization is always completed.