Fentanyl

Question 1

Fentanyl - more of action

Answer 1

Synthetic opioid - binds to opioid receptors

Question 2

Fentanyl - indications

Answer 2

1. Sedation to facilitate and maintain intubation
2. Sedation for transthoracic pacing
3. Sedation for synchronised cardioversion
4. CPR interfering Pt
5. Analgesia

Question 3

Fentanyl - reasons to prioritise fentanyl over morphine

Answer 3

1. Hypersensitivity or allergy to morphine
2. Known renal impairment/failure
3. Short duration of action desirable
4. Hypotension
5. Nausea & vomiting
6. Severe headache

Question 4

Fentanyl - contraindications

Answer 4

1. Late second stage labour
2. Known hypersensitivity
3. Serotonin syndrome
4. Monoamine oxidase inhibitors within the past 14 days

Question 5

Fentanyl - precautions

Answer 5

1. Elderly/frail
2. Impaired hepatic function
3. Respiratory depression
4. Current asthma
5. Patients on monoamine oxidase inhibitors
6. Known addiction to opioids
7. Rhinitis, rhinorrhea or facial trauma (IN)

Question 6

Fentanyl - side effects

Answer 6

1. Respiratory depression
2. Apnoea
3. Rigidity of diaphragm and intercostal muscles
4. Bradycardia

Question 7

Fentanyl - why are monoamine oxidase inhibitors a contraindication?

Answer 7

MAOI’s are usually used to treat depression and increase the amount of serotonin within the body - large amounts of serotonin can cause serotonin toxicity (both fentanyl & morphine also increase levels of serotonin resulting in increased risk of serotonin syndrome)