Fentanyl CPG

Question 1

Fentanyl - Presentation

Answer 1

100 mcg in 2 mL glass ampoule

250 mcg in 1 mL glass ampoule or cartridge (IN use only)

Question 2

Fentanyl - Pharmacology

Answer 2

A synthetic opioid analgesic

Actions:

CNS effects:

• Depression - leading to analgesia
• Respiratory depression - leading to apnoea
• Dependence (addiction)

Cardiovascular effects:

• Decreases conduction velocity through the AV node

Question 3

Fentanyl - Metabolism

Answer 3

By the liver; excreted by the kidneys

Question 4

Fentanyl - Primary emergency indications

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 - IV/IN
   - Hx of hypersensitivity or allergy to morphine
   - Known renal impairment/failure
   - Short duration of action desirable
   - Hypotension
   - Nausea and/or vomiting
   - Severe headache

Question 5

Fentanyl - Contraindications

Answer 5

1. Hx of hypersensitivity
2. Late second stage of labour

Question 6

Fentanyl - Precautions

Answer 6

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

Question 7

Fentanyl - Route of administration

Answer 7

IV

IN

IV infusion

Question 8

Fentanyl - Side effects

Answer 8

Respiratory depression

Apnoea

Rigidity of the diaphragm and intercostal muscles

Bradycardia

Question 9

Fentanyl - Special notes

Answer 9

Fentanyl is a schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility

Respiratory depression can be reversed with Naloxone

100mcg Fentanyl is equivalent in analgesic activity to 10mg Morphine

IV effects:

Onset: Immediate

Peak: < 5min

Duration: 30-60min

IN effects:

Peak: 2min