Fentanyl

Question 1

MoA

Answer 1

It is an opiate analgesic. it is an opiate agonist (or stimulator) that binds to opiate receptors in the brain and spinal cord causing analgesia.

Question 2

Indications

Answer 2

• Moderate to severe pain
• ACPO with severe anxiety
• RSI
• Sedation post intubation
• Control of pain, agitation, or SOB during end of life care.

Question 3

Contraindications

Answer 3

Known severe allergy

Question 4

Cautions

Answer 4

• ALOC
• age <1yr. increased risk of respiratory depression.
• Respiratory depression or high risk of. e.g. COPD, morbid obesity, home BiPAP.
• Labour. Opiates cross to the placenta and can cause respiratory depression in the baby. Contact LMC.
• Concurrent administration of other opiates, ketamine, or midazolam. This will increase or prolong the effects.
• age >75yrs
• signs of shock

Question 5

Dosage: IV analgesia

Answer 5

10-50mcg every 5 minutes for an adult.

Question 6

Dosage: IM or SC

Answer 6

50 - 100mcg

subsequent 3 doses every 20min

Question 7

Adverse Effects

Answer 7

• Respiratory depression
• Brady
• Hypotension
• Sedation
• Nausea and vomiting
• Itch
• Euphoria

Question 8

Pharmacokinetics

Answer 8

• It is more lipoliphic (fat soluble) than morphine and this is why it is well absorbed through the nasal mucosa
• Fentanyl may cause a small amount of histamine release. can cause the hypotension.
• Fentanyl is metabolised in the liver.