Fentanyl

Question 1

Fentanyl Overview

Answer 1

A short acting synthetic narcotic analgesic

Question 2

2 Fentanyl Indications

Answer 2

• Moderate to severe pain.
• Acute Coronary Syndromes where GTN has been ineffective

Question 3

3 Fentanyl Contras

Answer 3

• Hypersensitivity to Fentanyl
• Child <1 year of age (IV / IO only)
• Occluded nasal passages or epistaxis (intranasal only)

Question 4

Fentanyl Precautions / Notes

Answer 4

• Elderly patients
• Respiratory depression: especially those at risk e.g. patients with severe COPD
• Patients on MAO inhibitors (Antidepressants) or MAO inhibitor use within previous 14 days
• Caution in larger doses of women in active labour
• Use of IV Ketamine as analgesic prior to minimum (age dependant) dose of IV Fentanyl requires ASMA authorisation:
  
  • -Paediatric: 100mcg
  • -Adult < 70 years old: 200mcg
  • -Adult > 70 (or frail): 100mcg
• Administer slowly
• Cease administration prior to calculated dose if desired effect is obtained.
• Patients under extended care (e.g. ‘ramped’ patients) who have already been administered pain relief should have careful consideration with regards to the dosages of fentanyl administered, titrating only to effect.

Question 5

Fentanyl Special Considerations (Side Effects)

Answer 5

• Adopt a low threshold to engage with the ED team if pain remains difficult to control
• Drowsiness
• Nausea/vomiting
• Respiratory depression; monitor pulse oximetry for all patients having IV / IN Fentanyl
• Cardiovascular effects:
  - -Bradycardia
  - -Hypotension (rare)