DTP Fentanyl

Question 1

Fentanyl Drug class

Answer 1

Narcotic analgesic

Question 2

Fentanyl Pharmacology

Answer 2

• Synthetic narcotic analgesic
• Acts on the CNS
• Binds with the opioid receptors

Question 3

Fentanyl Metabolism

Answer 3

Hepatic metabolism and renal excretion

Question 4

Fentanyl Indications

Answer 4

• Significant pain

- Morphine KSAR

Question 5

Fentanyl Contraindications

Answer 5

• KSAR or hypersensitivity to fentanyl

Question 5

Contraindications for Fentanyl NAS administration

Answer 5

• GCS <14
• Suspected nasal or mid fractures
• Blood or mucous obstructing the nasal passage

Question 6

Fentanyl Precautions

Answer 6

• Elderly pts
• Hypotension
• Respiratory tract burns
• Respiratory depression and/or failure
• Known addiction to narcotics
• Patients taking MAOIs

Question 7

Fentanyl Side Effects

Answer 7

• Drowsiness
• Pin point pupils
• Bradycardia
• Hypotension
• Respiratory depression
• Muscular rigidity (particularly muscles of respiration)
• Nausea
• Vomiting

Question 8

Fentanyl Presentation

Answer 8

100 mcg/2 mL

Question 9

Fentanyl Onset

Question 10

Fentanyl Duration

Answer 10

30-60min

Question 11

Fentanyl Half-life

Answer 11

2-3hrs

Question 12

Fentanyl Schedule

Answer 12

S8 - controlled drug

Question 13

Fentanyl Special notes

Answer 13

• Fentanyl is a rapid onset synthetic narcotic that may potentiate respiratory depression and haemodynamic instability, particularly when administered intravenously in the setting of CNS depression or hypovolaemia.

Question 15

Fentanyl IM Adult >70yo dose for Significant Pain

Answer 15

25-50mcg, repeat up to 50mcg

@10min, TMD 100mcg

Question 16

Fentanyl IM dose Adult

Answer 16

25-100mcg, repeat up to 50mcg @10min, TMD 200mcg

Question 17

Fentanyl IV dose Adult >70yo dose for Significant Pain

Answer 17

25mcg, repeat @5min, Total Max dose 100mcg

Question 17

Fentanyl Paediatric dose for Significant Pain

Answer 17

> 1y = 1.5mcg/kg NAS
1mcg/kg @ 10mins
Total Max 100mcg

<1 = medical consult

NAS administration is ≤ 0.5 mL per nostril, although volumes up to 1 mL per nostril may be considered appropriate

Question 18

Special notes of Fentanyl and Midazolam administration

Answer 18

• Address any adverse side effects such as hypotension when administering fentanyl and midazolam to maintain sedation
• Fentanyl addition will reduce midazolam requirements, provide analgesia and ultimately decrease the risk of hypotension.
• Under no circumstances are fentanyl and midazolam to be mixed in the one syringe.

Question 19

Fentanyl IV dose for Adult

Answer 19

25mcg, repeat @5min, Total Max dose 200mcg

Question 20

Special notes of Fentanyl doses above 200mcg

Answer 20

• For doses above 200 mcg, IV access must be obtained and fentanyl administered via that route.
• If intravenous access is not able to be obtained and greater than 200 mcg is required, paramedics must seek medical consultation and approval via the QAS on-call medical officer consultation line.

Question 21

Special notes of Fentanyl administration of hypotensive patient

Answer 21

• When administered to hypotensive patient, ACPs must call for ICP backup where available.
• In the setting of the hypotensive adult patient (SBP