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14 Cards in this Set
- Front
- Back
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Fentanyl MOA |
Opiate analgesic.
Opiate agonist that binds to opiate receptors in the brain and spinal cord, causing analgesia. |
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Fentanyl INDICATIONS |
1. Moderate to severe pain. 2. CPO with severe anxiety. 3. Symptom control during end of life care. 4. RSI. 5. Sedation post intubation. |
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Fentanyl CONTRAINDICATIONS |
1. Known severe Ax. 2. Respiratory depression. 3. Unable to obey commands (exceptions for RSI, EOLC, post intubation). |
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Fentanyl CAUTIONS |
1. Aged less than one year (at increased risk of respiratory depression).
2. At high risk of resp depression e.g. Severe COPD, morbid obesity or on BiPAP.
3. Labour. Opiates can cross the placenta. Can cause drowsiness and/or resp depression, particularly when administered within a few hrs of birth.
4. Concurrent administration of sedatives (increase and prolong effects).
5. Elderly and/or frail. Increase and prolong effects
6. Signs of shock. May worsen shock. |
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Fentanyl IN PREGNANCY/BREASTFEEDING |
Safety not demonstrated in pregnancy. May be administered if breastfeeding. Stop and seek advice from LMC/GP. |
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Fentanyl DOSAGE |
IV analgesia - 10-50mcg every 5 Mins for an adult. - see paed dose tables for child.
IN analgesia - 100mcg IN for an adult weighing 80kg or less. Further doses of 50mcg every 10 mins (halve these doses if elderly/frail/unstable). - 200 mcg IN if over 80kg with further doses of 100 mcg. - see paed drug dose table.
IM for analgesia if access unobtained and IN inappropriate. - 50-100mcg IM. Repeated once after 20 mins. - see paed drug dose. |
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Fentanyl ADMINISTRATION |
Preferred route is IV.
IV - dilute 100mcg up to 10ml (anyone rounded up to and over 30kg) = 10mcg/ml.
20 kg or less - 100mcg in 100ml = 1mcg/ml.
IN in Children.
Draw up fentanyl undiluted, placing half of the total dose into 2 separate 1ml syringes. When drawing up the first syringe, draw up atn additional 0.1ml of fentanyl over and above the planned volume and expel slowly through the NAD to fill dead space. Administer rapidly by injecting one syringe (half of the dose) in to each nostril. **rapid to achieve fine mist, maximising absorption** IN administration in Adults. Draw up fentanyl undiluted using 1ml syringes. Administer a max of 1ml at a time per nostril **dead space is small and does not need to be taken in to account with adults** Administer IN rapidly by injecting 1 syringe (half the dose) in each nostril. If the dose is 200mcg (=4mls total), administer 1ml into each nostril, wait 5 Mins and then administer a further 1ml. Maximises absorption. IM administration - undiluted.
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Fentanyl COMMON ADVERSE EFFECTS |
1. Respiratory depression 2. Bradycardia 3. Hypotension 4. Sedation 5. Nausea and vomiting 6. Itch 7. Euphoria |
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Fentanyl ONSET |
IV - 2-5 mins. Max analgesic effects and respiratory depressant effects may no occur until 10-15mins (may be longer in elderly). IN - 5-10 mins IM - 5-10 mins |
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Fentanyl DURATION |
30-60 mins Effect on respiration may last several hours |
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Fentanyl PREPARATION |
Ampoule 100mcg in 2ml |
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Fentanyl PHARMACOKINETICS |
Fentanyl is more lipophilic (fat soluble) than morphine and therefore is well absorbed through the nasal mucosa. May cause small amount of histamine release. In combination with a relief in pain this usually results in a small fall in BP. Fentanyl is metabolised in the liver. No significant liver impairment on acute administration. |
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Fentanyl COMMON INTERACTIONS |
Effects increased in the presence of other opiates and sedatives, for example benzodiazipines or alcohol. |
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Fentanyl ADDITIONAL INFO |
Must be given a clear recommendation to be transported to medical facility by ambulance, unless being treated for: - EOLC - patella dislocation - shoulder dislocation Usually taken to ED unless pt has chronic condition and is known well at the medical facility. |
