Fentanyl - IV Flashcards
What is the brand/trade name for fentanyl?
What is the pharmacologic category/class of fentanyl?
- Opioid Analgesic — Synthetic
- Phenylpiperidine
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 4. Classification, Relative Potency & Opioid Abuse
What is the mechanism of action of fentanyl?
Opioid rececptor agonism, especially mu
- Presynaptic: decreases cAMP-dependent influx of calcium ions → inhibition of neurotransmitter release
- Post synaptic: increased outward K+ conductance → hyperpolarization of nerve cell
resultant increase in pain threshold, altered pain perception, and inhibition of ascending pain pathways
Note that these are similar to those of other opioids
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 2. Opioid Receptors
DrugBank Online - Fentanyl
Nagelhout (7th ed.), pp. 141 - Fig. 11.2, 142, 1295-1296, 1298
Stoelting’s Pharmacology (5th ed.), pp. 218-219
The experience of pain can be divided into four steps: transduction, transmission, modulation, and perception. Which of these does fentanyl have an effect on?
Along with other opioids, fentanyl effects
- transduction (peripheral nerves)
- modulation (spinal cord)
- perception (brain/brainstem)
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 1 & 2
When used as an adjunct during induction and intubation what dose of fentanyl is used?
- 1-3 mcg/kg IV
This helps to blunt the SNS response to laryngoscopy
Dosing is similar for pediatrics
Stoelting’s Pharmacology (5th ed.), p. 232
UpToDate - Fentanyl: Drug Information
What is the typical dose of fentanyl for procedural sedation and analgesia?
Emphasis because ranges may vary depending on patient/procedure
- 0.5-1 mcg/kg IV (or just like 25-100 mcg at a time)
repeated as often as every 2-15 minutes to achieve desired level of sedation/analgesia — continuous infusion is also an option
Dosing is similar for pediatrics
Stoelting’s Pharmacology (5th ed.), p. 232
UpToDate - Fentanyl: Drug Information
What is the onset of action for fentanyl?
- “Rapid/immediate” with maximal effects in 2-5 minutes
Nagelhout (7th ed.), p. 1298
Stoelting’s Pharmacology (5th ed.), p. 231
What is the duration of action for fentanyl?
- 30-60 minutes
Duration related to rapid redistribution to inactive tissue sites
What organ(s) are responsible for fentanyl’s clearance (metabolism/elimination)?
- Metabolism: Liver (P450)
- Elimination: Kidneys
Half-life: ~3-6 hrs — due to sequestration in tissues
As an analgesic, fentanyl is __________ times more potent than morphine
- ~100
This number varies slightly between texts
Anesthesia Guidebook - Episode 17: Anesthesia Top Drawer Run Down - Part 1
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 4. Classification, Relative Potency & Opioid Abuse
Cardiovascular effects of fentanyl include:
- Bradycardia
- Stable SVR/MAP
no histamine release
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3
Stoelting’s Pharmacology (5th ed.), p. 233
What are the respiratory effects of fentanyl?
- Dose dependent depression of ventilation — RR affected before Vt
(shifting of the CO2 response curve) - Inhibits hypoxic ventilatory drive
- Apnea at large doses
Note that these are similar to those of other opioids
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3
Nagelhout (7th ed.), p. 142
Stoelting’s Pharmacology (5th ed.), p. 222
What are the effects of fentanyl on the CNS?
- Sedation
- Miosis/pinpoint pupils
- Mild hypothermia
resets hypothalamic temperature setpoint - N/V
Partial dopamine agonists at CTZ
Note that these are similar to those of other opioids
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3
Nagelhout (7th ed.), p. 142
Stoelting’s Pharmacology (5th ed.), p. 222
What are the GI/GU effects of fentanyl?
- Slowed peristalsis → CONSTIPATION
- N/V
- Contraction of sphincter of Oddi → biliary colic (meh)
evidence is kind meh on this - Delayed gastric emptying
- Urinary retention (IDGAF)
detrusor relaxation, urinary sphincter constriction
Note that these are similar to those of other opioids
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lessons 2 & 3
Nagelhout (7th ed.), pp. 143-144
Stoelting’s Pharmacology (5th ed.), pp. 223-224
Rapid IV administration of large doses of opioids, particularly fentanyl and its derivatives, can lead to generalized ______________; the greatest impact is on the ability to ______________
- Skeletal muscle rigidity
- Ventilate
some decrease in chest wall compliance, but this is mostly related to constriction of laryngeal musculature
Apex Unit 5: Pharmacology 2; Opioid & Non-Opioid Analgesics; Lesson 10. Skeletal Muscle Rigidity
Nagelhout (7th ed.), pp. 143-144
Stoelting’s Pharmacology (5th ed.), p. 223
