Fentanyl citrate

Question 1

Trade name for fentanyl citrate?

Answer 1

Sublimaze

Question 2

Drug classification of fentanyl?

Answer 2

Opioid agonist, analgesic (synthetic Opioid)

Question 3

How is fentanyl generally supplied?

Answer 3

In a 50 mcg/mL (ampule)

Question 4

Describe the MOA (pharmacodynamics) of fentanyl

Answer 4

Binds to opiate receptors in the CNS, altering the response to, and perception of, pain. It has CNS respiratory depressant effects similar to morphine.

Question 5

What are the indications for fentanyl?

Answer 5

• Medicated Facilitated Intubation (MFI)
• Maintenance of sedation post MFI
• Analgesia (i.e. pacing, cardioversion, ACS, musculoskeletal injuries, headache etc.)

Question 6

What is the adult dose of fentanyl for analgesia?

Answer 6

25 - 50 mcg/dose prn SIVP/IO/IM. Provide lower dose if BP <90 systolic; (titrate to desired effect).

2mcg/kg IN to max single dose of 100mcg (50mcg per nostril), prn 5 minutes to total max of 200mcg

Question 7

What is the adult dose of fentanyl for MFI?

Answer 7

1 - 2 mcg/kg IVP (if systolic BP <90mmHg use ketamine)

Question 8

What is the adult dose of fentanyl for maintenance of sedation/procedural?

Answer 8

1 to 2 mcg/kg SIVP prn; titrate to desired effect

Question 9

What is the adult dose for fentanyl infusion?

Answer 9

1 to 2 mcg/kg/hr (usual dose is 50 to 250mcg/hr)

Analgesic doses are low while maintenance of sedation doses are higher. Used for long transports over 30 minutes.

Question 10

What is the pediatric dose for fentanyl?

Answer 10

1 to 2 mcg/kg slow IV push or IM

Question 11

What are the contraindications for fentanyl?

Answer 11

• Hypersensitivity
• Cross hypersensitivity may occur with meperidine
• MAO inhibitors within 14 days (may produce unpredictable, potentially fatal reactions).

Question 12

What are some precautions for fentanyl administration?

Answer 12

• Use with caution in myasthenia gravis
• High doses can produce muscle rigidity (wooden lung). Can be reversed with naloxone or rocuronium.
• Use cautiously in elderly or debilitated patients or those patients with impaired renal or hepatic function.

Question 13

How do you set up a fentanyl infusion?

Answer 13

Mix 500mcg in a 100ml NS or D5W bag. This gives you a concentration of 5mcg/ml.

Question 14

What happens if you give fentanyl along side midazolam or ketamine?

Answer 14

There is a synergistic effect

Question 15

When can the IM route for fentanyl be considered?

Answer 15

When it’s indicated only for analgesia

Question 16

Your patient is having a STEMI or NSTEMI. What is something to consider about fentanyl?

Answer 16

Avoid using large amount in STEMI/NSTEMI as it can decrease the effectiveness of Plavix and Ticagrelor.

Question 17

Does fentanyl induce hypnotic activity or histamine release?

Answer 17

Has little hypnotic activity and rarely causes histamine release.

Question 18

Can fentanyl induce hypotension?

Answer 18

Yes. Even when used appropriately, it can induce hypotension.