Ketorolac 15mg IV  or  Ibuprofen 600mg PO Q6hrs PRN if the patient can tolerate oral medications
Avoid high dose NSAIDS in patients with renal failure or insufficiency.
Ketorolac 15 mg has similar effects to the traditional 30 mg dosage. 
Morphine or  other Opioids may be needed if severe pain
Avoid high dose NSAIDS in patients with renal failure or insufficiency.
Ketorolac 15 mg has similar effects to the traditional 30 mg dosage. 
Metoclopramide
Ondansetron
Consider Tamsulosin 0.4mg PO QHS (discontinued after successful expulsion; average 1-2 weeks)
See EBQ:Alpha-blockers for ureteral stone expulsion discussion of evidence
76% vs 48% passage rates in tamsulosin vs no treatment, respectively
Only patients with stones ≥ 5 mm benefited
Review of 55 RTCs, with NNT of 4
Tamsulosin number needed to harm (orthostatic hypotension)= 19 (give at night, to reduce side effect rate)
Use of IV fluids to "flush out" stone has NOT been shown to improve clinical outcomes
See EBQ:Alpha-blockers for ureteral stone expulsion discussion of evidence
76% vs 48% passage rates in tamsulosin vs no treatment, respectively
Only patients with stones ≥ 5 mm benefited
Review of 55 RTCs, with NNT of 4
Tamsulosin number needed to harm (orthostatic hypotension)= 19 (give at night, to reduce side effect rate)
Only patients with stones ≥ 5 mm benefited
Review of 55 RTCs, with NNT of 4
Urolithiasis
Nephrolithiasis is most common misdiagnosis given to patients with rupturing AAA
Pyelonephritis
Vascular
Acute cystitis
Abdominal aortic aneurysm
Interstitial cystitis
Renal artery embolism