Fentanyl

Question 1

Fentanyl - Drug Class

Answer 1

Narcotic Analgesic

Question 2

Fentanyl - Pharmacology

Answer 2

Fentanyl is a synthetic narcotic analgesic that acts on the central nervous system by binding with the opioid receptors.

Question 3

Fentanyl - Metabolism

Answer 3

Hepatic metabolism and renal excretion

Question 4

Fentanyl - Indications

Answer 4

• Significant pain
• Autonomic Dysreflexia (sys BP >160mmHg)
• Sedation (for the maintenance of an established ETT)

Question 5

Fentanyl - Contraindications

Answer 5

KSAR or hypersensitivity to fentanyl

Question 6

Fentanyl - Precautions

Answer 6

• Elderly patients
• Hypotension
• Respiratory Tract burns
• Respiratory depression and/or failure
• Known addiction to narcotics
• Current MAOI therapy

Question 7

Fentanyl - Side Effects

Answer 7

• Bradycardia
• Hypotension
• Drowsiness
• Nausea and/or vomiting
• Pin point pupils
• Respiratory Depression
• Muscular rigidity (particularly muscles of respiration)

Question 8

Fentanyl - Presentation

Answer 8

ampoule 100 microg / 2mL

Question 9

Fentanyl - Onset, duration, half-life

Answer 9

• Onset (NAS/IV) < 3 mins
• Duration (NAS / IV) 30-60 minutes
• Half-life 2-3 hours

Question 10

Fentanyl - Schedule

Answer 10

S8 controlled drug

Question 11

Fentanyl - Routes of Administration

Answer 11

Intranasal, Subcut, IM, IV

Question 12

Fentanyl - Adult dosages - Significant pain

Answer 12

SUBCUT - QAS clinical consultation and advice line approval required in all situations.

IM - > (or equal to) 70 years - 25-50 microg
Repeated at up to 50 microg every 10 mins
Total max dose - 100 microg
IM - < 70 years - 25-100 microg
Repeated at up to 50 microg every 10 mins
Total max dose - 200 microg

IV - > (or equal to) 70 years - 25 microg
Repeated at up to 25 microg every 5 mins
Total max dose - 100 microg
IV - < 70 years - 25-50 microg
Repeated at up to 50 microg every 5 mins
Total max dose - 200 microg

Question 13

Fentanyl - Adult dosages - Autonomic Dysreflexia (with a significant BP > 160 mmHG)

Answer 13

IM - > (or equal to) 70 years - 25-50 microg
Repeated at up to 50 microg every 10 mins
Total max dose - 100 microg
IM - < 70 years - 25-100 microg
Repeated at up to 50 microg every 10 mins
Total max dose - 200 microg

IV - > (or equal to) 70 years - 25 microg
Repeated at up to 25 microg every 5 mins
Total max dose - 100 microg
IV - < 70 years - 25-50 microg
Repeated at up to 50 microg every 5 mins
Total max dose - 200 microg

Question 14

Fentanyl - Paediatric dosages - Significant Pain

Answer 14

NAS - > (or equal to) 1 year - 1.5 microg / kg
Repeated once at 1 microg / kg at 10 mins
Total max dose - 100 microg
NAS - < 1 year - QAS clinical consultation & advice line approval required in all situations

SUBCUT - QAS clinical consultation & advice line approval required in all situations

IM - > (or equal to) 1 year - 1-2 microg / kg
Single max dose 50 microg
Total max dose 2 microg / kg
IM - < 1 year - QAS clinical consultation & advice line approval required in all situations

IV - > (or equal to) 1 year - 1 microg / kg
Single max dose 25 microg
Repeated at 0.5 microg / kg (maximum 25 microg) at 5 min intervals
Total max dose 2 microg / kg
IV - < 1 year - QAS clinical consultation & advice line approval required in all situations

Question 15

Fentanyl - Special Notes

Answer 15

• Fentanyl is the preferred narcotic for patients presenting with ACS
• Fentanyl is a rapid onset synthetic narcotic that may potentiate respiratory depression and haemodynamic instability, particularly when administered IV in the setting of CNS depression or hypovolaemia
• When fentanyl is administered to a hypotensive patient, ACP’s must call for CCP backup where available
• In the setting of hypotensive adult patients (SBP <90 mmHG) all incremental fentanyl doses are to be <25 microg for IV and < 50 microg for IM.