**Question:** Which of the following statements is true of ketorolac?

A. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID)
B. Ketorolac is a selective COX-2 inhibitor
C. Ketorolac is an opioid analgesic
D. Ketorolac is a synthetic analogue of salicylic acid

**Core Concept:**
Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that belongs to the group of selective COX-2 inhibitors. Nonsteroidal anti-inflammatory drugs are a class of medications used to relieve pain, inflammation, and fever by inhibiting the production of prostaglandins, which are hormone-like substances involved in pain, inflammation, and fever responses. Ketorolac is specifically a selective COX-2 inhibitor, meaning it preferentially targets the cyclooxygenase-2 (COX-2) enzyme, which is primarily involved in inflammation, while leaving the COX-1 enzyme responsible for maintaining the protective lining of the stomach intact.

**Why the Correct Answer is Right:**
Ketorolac is a selective COX-2 inhibitor, which makes it an effective analgesic (pain reliever) and anti-inflammatory agent with minimal side effects on the stomach lining compared to non-selective NSAIDs. As a selective COX-2 inhibitor, ketorolac effectively reduces the production of prostaglandins responsible for inflammation, pain, and fever.

**Why Each Wrong Option is Incorrect:**

A. Ketorolac is not an opioid analgesic (pain reliever). Opioids target different pain pathways and have different mechanisms of action compared to NSAIDs like ketorolac.

B. Ketorolac is not a selective COX-2 inhibitor; it is a selective COX-2 inhibitor, not a nonselective inhibitor. Selective COX-2 inhibitors minimize gastrointestinal side effects associated with nonselective NSAIDs.

C. Ketorolac is not an opioid analgesic, which is a different class of pain relievers that act on different pain pathways.

D. Ketorolac is not a synthetic analogue of salicylic acid (which is a component of aspirin). Ketorolac is a selective COX-2 inhibitor and has a different chemical structure from salicylic acid.

**Clinical Pearl:**

Selective COX-2 inhibitors like ketorolac are beneficial in pain and inflammation management, particularly in patients with a history of gastrointestinal complications with nonselective NSAIDs. By targeting COX-2, they minimize the risk of gastrointestinal side effects while still providing pain relief and anti-inflammatory effects.