Fentanyl

Question 1

What is the presentation of Fentanyl?

Answer 1

100mcg in 2mL

250mcg in 1mL (cartridge)

Question 2

Outline the pharmacology of Fentanyl, and list the 4 actions.

Answer 2

A synthetic opioid analgesic.
Actions:
CNS EFFECTS
1. Depression - leading to analgesia
2. Respiratory depression - leading to apnoea
3. Dependence
CARDIOVASCULAR EFFECTS
4. Decreases conduction velocity via the AV node

Question 3

How is Fentanyl metabolised and excreted?

Answer 3

Metabolised by the liver.

Excreted by the kidneys.

Question 4

List the PEI’s for Fentanyl, and outline the specific indications as an analgesic option.

Answer 4

1. Sedation to facilitate intubation.
2. Sedation to maintain intubation.
3. Sedation to facilitate transthoracic pacing.
4. Sedation to facilitate synchronised cardioversion.
5. CPR interfering pt (ALS)
6. Analgesia
   - Hx hypersensitivity/allergy to morphine
   - Known renal impairment/failure
   - Short duration of action desirable
   - Hypotension
   - Nausea/vomiting
   - Severe headache

Question 5

List the contraindications to Fentanyl.

Answer 5

1. Hx hypersensitivity

2. Late second stage of labour.

Question 6

List the precautions to Fentanyl.

Answer 6

REPRICK

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

Question 7

List the side effects of Fentanyl.

Answer 7

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

Question 8

What are the special notes for Fentanyl?

Answer 8

1. Fentanyl is a S8 and must be accountably controlled
2. Respiratory depression can be reversed with Naloxone
3. 100mcg Fentanyl is equivalent in analgesic activity to 10mg of Morphine

Question 9

What is the onset, peak and duration of IV Fentanyl?

Answer 9

O: Immediate
P: <5mins
D: 30-60mins

Question 10

What is the peak of IN Fentanyl?

*Onset and duration not listed.

Answer 10

P: 2mins