TB 171 Fentanyl Citrate

Question 1

Fentanyl Citrate (Fentanyl), a ____, has replaced Morphine Sulfate (MS) for the management of ______ pain.

Answer 1

synthetic opiate / moderate to severe

Question 2

Fentanyl is ____ more powerful than MS yet produces fewer side effects (emetic, histamine, and vascular effects) and has no adverse effect on cardiac preload or afterload.

Answer 2

50-100 times

Question 3

Additionally, Fentanyl has a ____ than MS as well as a shorter half-life, which improves a physician’s ability to properly assess the patient.

Answer 3

faster onset

Question 4

Indications for use

Answer 4

Burns

Isolated extremity injury and trauma

Medical complaints, i.e., non-traumatic abdominal pain

Chest Pain (cardiac)

Question 5

Fentanyl is contraindicated in patients with any of the following:

Answer 5

Known hypersensitivity or allergy
Respiratory depression (<12 /min)
Active labor

Question 6

Use caution with the following patients:

Answer 6

Elderly / Systolic Blood Pressure (SBP) < 100mmHg / ALOC / Sudden onset acute headache / Respiratory failure / Suspected drug/alcohol intoxication

Question 7

Application

Answer 7

IV (Intravenous)

IM (Intramuscular)

IN (Intranasal)

IO (Intraosseous) for critical patients w/o IV access (post EMS 2018 update)

Question 8

Fentanyl is administered in micrograms (mcg) not ____ with emphasis on titrating slowly to pain relief.

Answer 8

milligrams (mg)

Question 9

Adult dosing

Answer 9

50mcg (1mL) slow IV/IO push or IM/IN May repeat every 5 minutes prn

Question 10

Adult dosing

Answer 10

Maximum dose 150mcg prior to Base contact

Question 11

Adult dosing

Answer 11

May repeat every 5 minutes prn up to total maximum dose of 250mcg

Question 12

Adult dosing

Answer 12

Start with a 25mcg dose in the elderly

Question 13

Pediatric

Multi-system traum & isolated head injury

Answer 13

1mcg/kg slow IV/IO push or IM one time only, or 1.5mcg/kg IN one time only

Question 14

Pediatric

Multi-system traum & isolated head injury

Answer 14

Contact Base for additional pain management or for initial orders if patient is not alert and oriented with GCS of 15. Maximum 4 total

Question 15

Pediatric

Multi-system traum & isolated head injury

Answer 15

doses for multi-system trauma, 2 total doses for isolated head injury

Question 16

Pediatric

Isolated Extremity Injury

Answer 16

1mcg/kg slow IV push or IM,

or 1.5mcg/kg IN

Question 17

Pediatric

Isolated Extremity Injury

Answer 17

May repeat in 5 minutes prn x 1, maximum 2 doses prior to Base contact Maximum of 4 total doses

Question 18

___ may be used to reverse Fentanyl

Answer 18

Naloxone

Question 19

Common side effects can include:

Answer 19

Nausea / Vomiting / Drowsiness / Dry Mouth

/ Dizziness / Difficulty urinating / Constricted pupils