Fentanyl

Question 1

Presentation

Answer 1

100 mcg in 2 mL glass ampoule

250 mcg in 1 mL glass ampoule or cartridge (IN use only)

Question 2

Pharmacology

Answer 2

CNS effects:

• Depression – leading to analgesia
• Respiratory depression – leading to apnoea - Dependence (addiction)

Cardiovascular effects:
- Decreases conduction velocity through the A-V node

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 of labour

Question 6

Precautions

Answer 6

1. Elderly/frail patients
2. Impaired hepatic function
3. Respiratory depression, e.g. 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

ROA

Answer 7

IV
IN
IV infusion

Question 8

Side effects

Answer 8

Respiratory depression
Apnoea
Rigidity of the diaphragm and intercostal muscles Bradycardia

Question 9

Special notes

Answer 9

Fentanyl is a Schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility
Respiratory depression can be reversed with Naloxone
100 mcg Fentanyl is equivalent in analgesic activity to 10 mg Morphine
IV effects:
Onset: Immediate Peak: < 5 minutes Duration: 30 - 60 minutes
IN effects:
Peak: 2 minutes

Question 10

Dose

Answer 10

IV: 50mcg, repeat 50mcg every 5 minutes (max 200mcg)

IN: 200mcg loading dose, repeat 50mcg every 5 minutes (max 400mcg)

Old, frail, <60kg: 100mcg loading dose, repeat dose of 50mcg (maximum 200mcg)

Paed:
10-17kg 25mcg IN
18-39kg 25mcg or 50mcg IN
Repeat initial dose at 5-10 minute intervals (max 3 doses).