Fentanyl Flashcards
Fentanyl
Pharmacology
- Fentanyl and other opioid analgesics act on receptors (mainly mu-opioid) in the CNS and GIT producing analgesia,
respiratory depression, sedation and constipation.
Fentanyl Metabolism
- Fentanyl is mainly metabolised by the liver. Approximately 20% is excreted in urine within 8 hours.
Fentanyl
Route Onset Duration Half-Life
All Routes
Fentanyl
Route Onset Duration Half-Life
All Routes <3min 30-60min 2-3hrs
Fentanyl
Indications
- Agitation in the trauma & critically ill patient.
- Analgesia.
Fentanyl
Contraindications
3
⛔ Epistaxis or occluded nasal passages (IN route).
⛔ Previous or known allergy or adverse reaction.
⛔ Pregnant women ≥ 20 weeks gestation in labour.
Fentanyl
Adverse / Side Effects
Common
Rare
– Common (>1%) - rash, bradycardia; may have a lower incidence of nausea, vomiting and constipation than other opioids
– Rare (<0.1%) - chest wall rigidity with rapid/very high IV doses
Fentanyl
Precautions / Warnings
6
- Pregnant women ≥ 20 weeks.
- Bradyarrhythmias—may be exacerbated.
- Fentanyl should be administered with caution for patients who are receiving or have received treatment within 14 days,
with an MAOI due to the risk of serotonin toxicity (fentanyl can contribute to serotonin toxicity). Where an alternate
analgesic agent (e.g. morphine) is available it should be used. - Use opioids with extreme caution in patients with respiratory depression, severe obstructive airways disease, at risk of
upper airways obstruction (e.g. sleep apnoea), asthma or decreased respiratory reserve as they may depress respiration,
decrease the cough reflex and dry secretions. - Opioid analgesics may cause respiratory depression in the newborn; withdrawal effects may occur in neonates of
dependent mothers. - Effects on Ability to Drive and Use Machines - Fentanyl may cause drowsiness and general impairment of co-ordination
and may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as
driving a car or operating machinery. Ambulatory patients should be cautioned against driving or operating machinery.
Patients should only drive or operate a machine if sufficient time has elapsed (at least 24 hours) after the administration of
fentanyl.
Fentanyl
Interactions
- Fentanyl should be used with caution and with reduced dosage considered when used concurrently with patients
receiving other central nervous system depressants (including alcohol), due to the risk of profound sedation, respiratory
depression and hypotension.
Fentanyl
Notes
3
- Morphine is the preferred narcotic agent except under the following circumstances:
- Allergy and/or adverse drug reaction to morphine.
- Haemodynamic instability.
- Known or suspected kidney disease.
- When IN narcotic administration is the preferred treatment.
- Suspected ACS.
- A Morphine Milligram Equivalent (MME) dose of fentanyl can be calculated using the following formula: 100microg fentanyl
= 10mg MME. - Administration Advice
- Intranasal administration: Draw up required volume into a syringe, then attach an atomiser. Administer in aliquots up
to approximately 0.5mL (to maximise absorption and minimise sneezing) alternating between nostrils. Allow a short
interval (<1 minute) between aliquots if using only one nostril. - Elderly and frail patients:
- Opioid dose requirement decreases progressively with age.
- There is an increased risk of adverse effects in patients who are elderly or frail including cognitive impairment,
sedation, respiratory depression and falls. - Use a lower initial dose (e.g. 25–50% of usual adult dose) and titrate to effect.
Morphine is the preferred narcotic except under the following
5
Morphine is the preferred narcotic agent except under the following circumstances:
- Allergy and/or adverse drug reaction to morphine.
- Haemodynamic instability.
- Known or suspected kidney disease.
- When IN narcotic administration is the preferred treatment.
- Suspected ACS.
Fentanyl Analgesia Notes
- In the elderly and/or frail and/or critically ill (e.g. shocked) patient use 50% of the recommended lower end of the adult
dose range. - IN administration - Divide dose between nostrils to minimise swallowing and effects such as sneezing.
- The MAD nasal drug delivery devices have 0.1mL system dead space. Ensure preparation of the MAD includes priming
of the device. Priming is only to be done once per device.
Fentanyl
Analgesia
Adult Doses
Routes
IV/IO Diluted
Initial Dose: 25-50microg diluted
Repeat: Up to 50microg diluted every 5 minutes
Maximum Total Dose: 5microg/kg
Subcut Initial Dose: 50-100microg
Repeat: 15 minutes
Maximum Total Dose: 2microg/kg
Intranasal Initial Dose: 50-100microg (maximum initial dose 100microg)
Repeat: 5 minutes
Maximum Total Dose: No maximum total dose
Fentanyl
Analgesia
Paed doses
Routes
IV/IO Diluted
Initial Dose: 0.5-1microg/kg diluted bolus (maximum initial dose 25microg)
Repeat: 5 minutes
Maximum Total Dose: 5microg/kg
Intranasal Undiluted
Initial Dose: 1.5microg/kg bolus (maximum bolus 50microg)
Repeat: 10 minutes
Maximum Total Dose: 5 microg/kg
Fentanyl
Agitation in the Trauma & Critically Ill Pt
Adult Doses
IV/IO Diluted
Initial Dose: 25-50microg
Repeat: 5 minutes
Maximum Total Dose: 5microg/kg
Subcut Undiluted
Initial Dose: 50-100microg
Repeat: 5 minutes
Maximum Total Dose: No maximum total dose
Fentanyl
Agitation in the Trauma & Critically Ill Pt
Paed Doses
(6 years or older)
IV/IO Diluted
Initial Dose: 0.25-0.5microg/kg
Repeat: every 5 minutes
Maximum Total Dose: 5microg/kg
Subcut Undiluted
Initial Dose: 0.5-1microg/kg
Repeat: 5 minutes
Maximum Total Dose: No maximum total dose
