Fentanyl

Question 1

Drug class

Answer 1

Narcotic analgesic

Question 2

Pharmacology

Answer 2

Synthetic narcotic analgesic that acts on the CNS by binding with opiod receptors

Question 3

Metabolism

Answer 3

Heaptic metabolism & renal excretion

Question 4

Indications

Answer 4

• Significant pain
• Sedation
• Autonomic dyslexia (SBP >160mmHg)
• Induction for RSI

*Morphine preferred narcotic EXCEPT under following:
• allergy and/or adverse drug reaction to Morphine
• haemodynamic instability
• known/suspected kidney disease
• when NAS narc admin is preferred
• suspected ACS

Question 5

Contraindications

Answer 5

Allergy and/or adverse drug reaction

Question 6

Precautions

Answer 6

• Low body weight, older or frail
• Hypotension
• Respiratory tract burns
• Respiratory depression and/or failure
• Known addiction to narcotics
• Current MAOI therapy

Question 7

Side effects

Answer 7

• Bradycardia
• Drowsiness
• Hypotension
• Nausea / vomiting
• Pin point pupils
• Respiratory depression
• Muscular rigidity (particularly those of respiration)

Question 8

Presentation

Answer 8

100mcg/2ml ampoule

Question 9

Onset

Duration

Answer 9

<3min

30-60min

Question 10

Routes of administration

Answer 10

NAS
SUBCUT
IM
IV

Question 11

Adult dosages

Answer 11

• Significant Pain
• Autonomic dysreflexia (SBP >160)
▪︎≥ 70yrs 
   • NAS / IM -  25-50mcg
    Repeated at up to 50mcg every 10mins
    Total max dose 100mcg (or MME)
   • IV - 25mcg
    Repeated at up to 25mcg every 5mins
    Total max dose 100mcg (or MME)

▪︎< 70yrs
   • NAS - 50-100mcg
    Repeated at up to 100mcg every 10mins 
    Total max dose 200mcg (or MME)
   • IM - 25-100mcg
    Repeated at up to 50mcg every 10mins 
    Total max dose 200mcg (or MME)
   • IV - 25-50mcg
    Repeated at up to 50mcg every 5mins
    Total max dose 200mcg (or MME)

** must consult for SUBCUT for significant pain

Question 12

Paediatric dosages

Answer 12

Significant Pain 
≥ 1yr:
• NAS 1.5mcg/kg
Single max dose 50mcg
Repeated once after 10mins at 1mcg/kg
Total max dose 100mcg (or MME)

• IM 1-2mcg/kg
Single max dose 50mcg
Total max dose 2mcg/kg (or MME)

• IV 1mcg/kg
Single max dose 25mcg
Repeated at 0.5mcg/kg (max 25mcg) at 5mins
Total max dose 2mcg/kg (or MME)

• • consult < 1yr
• • consult SUBCUT

Question 13

Special notes

Answer 13

MME (Morhpine Milligram Equivalent)
A MME dose of fentanyl formula: 100mcg fent = 10mg MME

CCP BU for all hypotensive pts admin fentanyl

Hypotensive (SBP < 90mmHg) = doses no more than 25mcg IV & 50mcg IM