Fentanyl

Question 1

Pharmacology and presentation of Fentanyl?

Answer 1

100mcg in 2ml

Synthetic opiate analgesic, that binds and stimulates opiate receptors in the brain and spinal cord causing CNS depression, resp depression, decreased AV Node conduction velocity & can lead to dependence.

Question 2

Indicators of Fentanyl?

Answer 2

• Moderate to severe pain.
• Cardiogenic pulmonary oedema with severe anxiety.
• RSI
• Sedation post intubation.
• Symptom control during end of life care.

Question 3

Contraindications of Fentanyl?

Answer 3

• Known severe allergy.
• Unable to obey commands (exceptions: administration for RSI, end of life care and post intubation).
• Respiratory depression.

Question 4

Cautions of Fentanyl?
3x age, 3 x down

Answer 4

• Aged less than one year.
• Elderly and/or frail.
• Labour.
• At high risk of respiratory depression. For example, severe COPD, morbid obesity or on home BiPAP.
• Concurrent administration of other opiates, ketamine or midazolam.
• Signs of shock.

Question 5

Side Effects of Fentanyl?
3x head tap, 3x chest tap, 1x arm scratch
HEN RIBS

Answer 5

• Euphoria.
• Sedation.
• Nausea and vomiting.
• Respiratory depression.
• Bradycardia.
• Hypotension.
• Itch.

Question 6

Dosing Regimes of Fentanyl?

Answer 6

Fentanyl IV Adult
- 10-50mcg IV, every 5mins prn for pain relief
- 10-20mcg IV doses every 5mins prn for severe anxiety in CPO

Fentanyl IM Adult
- 50-100mcg IM or SC, if IV can’t be obtained and IN inappropriate, repeat once after 20mins

Fentanyl IN Adult >80kgs
- 200mcg initially, repeats of up to 100mcg may be given 10minutely prn, halve the doses if PT is frail or physiologically unstable

Fentanyl IN Adult < or equal to 80kgs
- 100mcg initially, repeats of up to 50mcg may be given 10minutely prn, halve the doses if PT is frail or physiologically unstable

Fentanyl IV Paediatrics
- 5kg = 1-5mcg
- 10kg = 2-10mcg
- 20kg = 5-20mcg
- 30kg = 10-30mcg
- 40kg = 10-40mcg

Fentanyl IM Paediatrics
- 1mcg per kg, repeat once after 20mins

Fentanyl IN Paediatrics
- 2mcg per kg initially, 1mcg per kg repeats 10 minutely prn

Administration in Peadiatrics 20kg or less
- Draw up 100mcg:2ml, with 5% Glucose to make 100mcg:100ml

Question 7

Onset and duration of Fentanyl?

Answer 7

Onset:
- IV: 2-5 minutes. The maximal analgesic and respiratory depressant effects may not occur until 10-15 minutes and this may be longer in the elderly.
- IN: 5-10 minutes.
- IM: 5-10 minutes.

Duration
- 30-60minutes