Fentanyl

Question 1

Pharmacology and presentation of Fentanyl?

Answer 1

100microg/2ml Ampoule or 250microg /1ml cartridge

Opiate analgesic,that binds and stimulates opiate receptors in the brain and spinal cord causing analgesia. It can lead to CNS and respiratory depression, it is addictive and has a number of secondary actions including decreasing conduction velocity through the atrioventricular node.

Question 2

Indicators of Fentanyl

• AID

Answer 2

• Pain relief particularly if contraindicated to morphine
• Component of therapy in Medication Assisted Intubation and post intubation ventilation
• Autonomic Dysreflexia with SBP >160mmHg.

Question 3

Contraindications of Fentanyl?

Answer 3

• Known allergy
• Late second stage labour.

Question 4

Cautions of Fentanyl?

-CHIMERRA

Answer 4

• Elderly
• Impaired liver function
• Conscious state depression
• Respiratory depression
• Hypotensive patients
• Patient on Monoamine Oxidase Inhibitors (MAOI)
• Known addiction to narcotics
• Rhinitis, rhinorrhoea or facial trauma (IN route only).

Question 5

Side Effects of Fentanyl?

• RAD BP

Answer 5

• Respiratory Depression
• Apnoea
• Rigidity of the diaphragm or respiratory muscles
• Bradycardia
• Pinpoint pupils.

Question 6

Onset and Duration of Fentanyl?

Answer 6

• Onset = <3 minutes
• Duration = 30–60 minutes

Question 7

Dosing regimes of Fentanyl?

Answer 7

IN (divide IN dose across both nostrils)
- Adults <65years = 50-100mcg IN, repeat 50mcg 10 minutely as required to a max does of 300mcg before consulting
- Adults >65years or frail = 50mcg IN, repeat 25mcg 10 minutely as required to a max does of 200mcg before consulting
- Paed >1yr = 1.5mcg/kg IN to a max of 50mcg in a single dose, repeat dose once at 10mins to a max of 100mcg before consulting, round up to the nearest 25mcg

IM
- Adults <65years = 25-100mcg IM, repeat 25-50mcg 10 minutely as required to a max does of 200mcg before consulting
- Adults >65years or frail = consider half doses and repeat at 25mcg 10 minutely to a max of 200mcg before consulting
- Paed >1yr = 1-2mcg/kg IM to a max of 50mcg in a single dose, repeat dose 10minutley to a max of 100mcg before consulting

IV/IO
- Adults <65years = 25-50mcg IV/IO, repeat 25-50mcg 5-10 minutely as required to a max does of 300mcg before consulting
- Adults >65years or frail = consider half doses and repeat at 25mcg 10 minutely as required to a max does of 300mcg before consulting