Fentanyl

Question 1

Pharmacology

Answer 1

A synthetic opioid analgesic.
Actions:
CNS effects:
- depression- leading to analgesia
- respiratory depression- leading to apnoea
- dependence (addiction) 
Cardiovascular effects:
- decrease conduction velocity through the AV node

Question 2

Presentation

Answer 2

100mcg in 2ml glass ampoule

250mcg in 1ml cartridge (IN use only)

Question 3

Metabolism

Answer 3

By the liver; excreted by the kidneys

Question 4

Primary emergency indications

Answer 4

1. sedation to facilitate intubation
2. sedation to maintain intubation
3. sedation to facilitate transthoracic pacing
4. sedation to facilitate synchronised cardioversion
5. CPR interfering patient- ALS
6. Analgesia- IV/IN: history of hypersensitivity or allergy to morphine, known renal impairment/failure, short duration of action desirable, hypotension, nausea and/or vomiting, severe headache

Question 5

Contraindications

Answer 5

1. history of hypersensitivity

2. late second stage labour

Question 6

Precautions

Answer 6

1. elderly/frail patients
2. impaired hepatic function
3. respiratory depression eg. COPD
4. current asthma
5. patients on monoamine oxidase inhibitors
6. known addiction to opioids
7. rhinitis, rhinorrhea or facial trauma (IN route)

Question 7

Route of administration

Answer 7

IV
IN
SC

Question 8

Side effects

Answer 8

• respiratory depression
• apnoea
• rigidity of the diaphragm and intercostal muscles
• bradycardia

Question 9

Special notes

Answer 9

Respiratory depression can be reversed with naloxone.
100mcg of fentanyl is equivalent in analgesic to 10mg of morphine.
IV effects
Onset: immediate
Peak: < 5mins
Duration: 30-60mins
IN effects
Peak: 2mins