Fentanyl

Question 1

Generic Name:

Answer 1

Fentanyl Citrate

Question 2

Trade Name:

Answer 2

Sublimaze

Question 3

Supplied:

Answer 3

100 mcg/2mL vial

Question 4

Class:

Answer 4

Narcotic Agonist/Narcotic Analgesic

Question 5

Mechanism of Action:

Answer 5

•  Alleviates pain by acting on the pain receptors in the brain; elevates pain threshold.
•  Depresses central nervous system; depresses brainstem respiratory centers; decreases responsiveness to changes in PaC02.
•  Increases venous capacitance (venous pooling) and vasodilates arterioles thereby reducing preload and afterload.

Question 6

Indications and Field Use:

Answer 6

- Analgesia, especially in patients with burns or other trauma, myocardial infarction, renal colic.
- Adjunct to sedation in post-intubation state.
- Adjunct to induction in Rapid Sequence Intubation (RSI) or medication assisted intubation.

Question 7

Contraindications:

Answer 7

- Known allergy or intolerance to drug (assess for medic alert bracelet)
- Respiratory depression if airway and breathing can’t be supported
- Known elevated intracranial pressure e.g. mass lesion
-  Head injury with ALOC (relative)
- Asthma (relative)
- Abdominal pain (relative)

Question 8

Adverse Reactions:

Answer 8

MS: Muscle rigidity, particularly involving muscles of respiration.

CV: Bradydysrhythmias (common) or tachydrysrhythmias, hypotension, orthostatic hypotension

Resp: Respiratory depression (common) or arrest.

CNS: Excess sedation, seizures leading to coma and arrest, pupillary constriction, dizziness, blurred vision.

GI: Nausea and vomiting

Derm: Histamine release may cause local or generalized urticaria. Diaphoresis.

Question 9

Notes on Administration:

Answer 9

Resuscitative and intubation equipment and oxygen should be readily available.

CNS, Respiratory and to a certain extent CV: side effects can be reversed by naloxone. This does not preclude the aggressive support of airway, ventilation and circulation prior to the administration of naloxone if the clinical situation dictates.

Question 10

Adult Dosage: IV/IO:

Answer 10

Administer 25-50 mcg (0.5 – 1.0 mL of 50mcg/mL concentration) increments slow IV push (over 1-5 minutes) until desired effect. Consider the lower dose in the elderly, debilitated, or those with chronic lung disease. Onset of analgesic action almost immediate, duration of analgesic action 30-60 minutes.

Question 11

Adult Dosage: IM:

Answer 11

Same as IV/IO dose. Onset of analgesic action seven to eight minutes, duration of analgesic action one to two hours.

Question 12

Adult Dosage: IN:

Answer 12

25-50 mcg

Question 13

Adult Dosage: Total Dose:

Answer 13

Not to exceed 200 mcg

Question 14

Note:

Answer 14

Duration of respiratory depressant effect of fentanyl may be longer than analgesic effect.

Question 15

Pediatric Dosage (12 mo - <17 years): IV/IO:

Answer 15

1-2 mcg/kg (0.02-0.04 mL/kg of 50 mcg/mL concentration) slow IV/IO push

Question 16

Pediatric Dosage (12 mo - <17 years): IM:

Answer 16

Same as IV/IO dose

Question 17

Pediatric Dosage (12 mo - <17 years): IN:

Answer 17

1-2 mcg/kg

Question 18

Pediatric Dosage (12 mo - <17 years): Total Dose:

Answer 18

Not to exceed 50 mcg, Q1hr prn

Question 19

Pediatric Note:

Answer 19

Patch for on-line medical direction if Fentanyl citrate use is considered in children <2 or if additional doses are needed.

Question 20

Routes of Administration:

Answer 20

Usually given IV/IO in the field, can be given IM or IN

Question 21

Peak Effects:

Answer 21

Within 5 to 15 minutes when given IV/IO/IN. Less predictable when given IM. Peak respiratory depressant effect within 5 to 15 minutes after onset of analgesic effect.

Question 22

Arizona Drug Box Minimum Supply:

Answer 22

200 mcg

Question 23

Special Notes:

Answer 23

- Schedule II narcotic. EMS providers should take appropriate anti-diversion precautions.
- Literature supports 100 mcg (2 mL) fentanyl citrate is equivalent in analgesic activity to 7-10 mg of morphine sulfate.
- Watch for histamine release effects (wheals, urticaria). Thought to be much less common than with morphine sulfate. Contact medical control if generalized urticaria or other s/sx of anaphylactoid reaction.
- Attempt to correct hypotension before administration with IV fluids and/or vasopressors.
- Although chest wall rigidity is uncommon and usually doesn’t result with small doses and slow IV bolus (over > 1 minute) the provider must have a heightened awareness this complication could result and be prepared to treat appropriately with benzodiazepines and other airway and mechanical ventilation techniques up to and including RSI.Pregnancy Category C. No adequate and well controlled studies exist in pregnant women. Should be used during pregnancy only if the potential benefit to mother justifies the potential risk to fetus.
- Safe for nursing mothers.
- Recommended storage: Protect from light. 20-25 degrees C (68-77 degrees F) suggested, 15-30 degrees C (59-86 degrees F) permitted. (Source: Drugs.com)