Fentanyl

Question 1

Fentanyl

Presentation

Answer 1

• Fentanyl: 450mcg in 1.5ml (300mcg/ml); intra-nasal administration only
• Fentanyl Citrate (Sublimaze): 100mcg in 2ml ampoule (50mcg/ml); IV/IO only
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Question 2

Fentanyl

Use

Answer 2

• Moderate to severe pain.
• Acute Coronary Syndromes where GTN has been ineffective
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Question 3

Fentanyl

Type

Answer 3

A short acting synthetic narcotic analgesic

Question 4

Fentanyl

Dose

Answer 4

IV / IO Fentanyl Citrate
Adult < 70 years old:
• Loading dose: Titrate 1mcg/kg slow IV push (maximum single dose: 100mcg)
• Subsequent dose: 25mcg to effect every 5 minutes
Adult > 70 years old or frail:
• Loading dose: Titrate 0.5mcg/kg slow IV push (maximum single dose: 50mcg)
• Subsequent dose: 25mcg to effect every 5 minutes
Paediatric:
• Loading dose: Titrate 1mcg/kg slow IV push (maximum single dose: 25mcg)
• Subsequent dose: 1mcg/kg (up to 25mcg) to effect every 5 minutes.
Intranasal Fentanyl
Age Initial Dose Subsequent at 5 minutes Subsequent IV Dose if required
< 20 kg 1 x 0.05ml
(15mcg) 1 x 0.05ml
(15mcg) Up to 1mcg/kg titrated to effect every 5 minutes
(Maximum bolus dose 25mcg each time)
21 - 30 kg 1 x 0.10ml
(30mcg) 1 x 0.10ml
(30mcg) Up to 1mcg/kg titrated to effect every 5 minutes
(Maximum bolus dose 25mcg each time).
31 - 40 kg 1 x 0.15ml
(45mcg) 1 x 0.15ml
(45mcg) Subsequent dose 25mcg titrated to effect every 5 minutes
Small / elderly / frail 2 x 0.2ml
(120mcg) 1 x 0.2ml
(60mcg) Subsequent dose 25mcg titrated to effect every 5 minutes
Adult 3 x 0.2ml
(180mcg) 1 x 0.2ml
(60mcg) Subsequent dose 25mcg titrated to effect every 5 minutes
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Question 5

Fentanyl

Actions

Answer 5

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Question 6

Fentanyl

Contraindications

Answer 6

• Hypersensitivity to Fentanyl
• Less than 1 year of age (IV / IO only)
• Occluded nasal passages or epistaxis (intranasal only)
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Question 7

Fentanyl

Adverse effects

Answer 7

•	Nausea/vomiting
•	Respiratory depression; monitor pulse oximetry for all patients having IV / IN Fentanyl
•	Cardiovascular effects:
o	Bradycardia
o	Hypotension (rare)
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Question 8

Fentanyl

Precautions

Answer 8

• Elderly patients
• Respiratory depression: especially those at risk e.g. patients with severe COPD
• Patients on MAO inhibitors
• Caution in larger doses of women in active labour
• Use of IV Ketamine as analgesic prior to minimum (age dependant) dose of IV Fentanyl requires ASMA authorisation:
o Paediatric: 100mcg
o Adult < 70 years old: 200mcg
o Adult > 70 (or frail): 100mcg
• Administer slowly
• Cease administration prior to calculated dose if desired effect is obtained.
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