Fentanyl

Question 1

Pharmacology and presentation of Fentanyl?

Answer 1

100mcg in 2ml

Synthetic opiate analgesic, that binds and stimulates opiate receptors in the brain and spinal cord causing CNS depression, resp depression, decreased AV Node conduction velocity & can lead to dependence.

Question 2

Indicators of Fentanyl?

Answer 2

• Analgesia - IV/IN
• Sedation to maintain intubation

Question 3

Contraindications of Fentanyl?

Answer 3

• Hypersensitivity
• Active labour
• Pt’s <1years
• Epistaxis or occluded nasal passage

Question 4

Cautions of Fentanyl?

(MARKLE)

Answer 4

• Monoamine Oxidase Inhibitors
• Current Asthma
• Respiratory depression. For example, severe COPD, morbid obesity or on home BiPAP
• Known narcotic addiction
• Labour
• Elderly and/or frail.

Question 5

Side Effects of Fentanyl?

Answer 5

• Bradycardia
• Resp Depression
• Apnoea
• Diaphragm/intercostal muscle rigidity

Question 6

Dosing regimes of Fentanyl?

Answer 6

IM/SC
- Adults = 1mcg/kg IM/SC to a max of 100mcg, repeated once after 20 mins

IV/IO
- Adults = 0.5mcg/kg IV/IO to a max of 50mcg per dose (10mcg = 20kg), repeating 5 minutely to a max of 200mcg

IN (Paeds Only)
- Small Child (10-24kg) = 25mcg IN, repeated 5 minutely to a max of 3 doses
- Large Child (≥25kg) = 50mcg IN, repeated 5 minutely to a max of 3 doses
- Children <10kg = consult
- an initial extra 0.1ml should be drawn up in unprimed MADs to account for dead space

Question 7

Onset and Duration of Fentanyl?

Answer 7

• Onset = <3 minutes (immediate)
• Duration = 30–60 minutes