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Flashcards in Fentanyl Deck (32):
1

What is the drug class of Fentanyl?

synthetic phenylpiperidine opioid agonist, analgesic

2

What are the uses of Fentanyl?

-Analgesia intraop and postop
-administered as premed to blunt hemodynamic responses to airway manipulation and reduce inhalation agent dosage requirements
-provides GA either administered as sole anesthetic or in combo with IV sedatives/hypnotics
-administered in the epidural and subarachnoid spaces to augment the effectiveness of RA

3

What is the MOA of Fentanyl?

-Binds to mu opioid receptors in the brain, brainstem, spinal cord, and primary afferent peripheral terminals producing analgesia
-mimics the actions of enkephalins, endorphins, dynorphins causing the action of antinocioceptive systems resulting in cellular hyperpolarization and inhibition of NT release

4

How is Fentanyl metabolized?

primarily in the liver by N-dealkylation and Hydroxylation
-dependent on liver blood flow/ high hepatic extraction ratio

5

Does metabolism of Fentanyl produce metabolites?

-minimally pharmacologically active metabolites: Norfentanil, hydroxyproprionyl-fentanyl, and hydroxyproprionyl-norfentanyl

6

How is Fentanyl redistributed?

-Fentanyl is highly lipid soluble allowing rapid crossing of biological membranes and uptake by highly perfused tissue groups including the brain, heart, lungs
-Rapidly redistributed to inactive tissue sites such as fat and muscle

7

What is important about the lungs and Fentanyl?

The lungs serve as a large inactive storage site, with an estimated 75% of the initial dose undergoing 1st pass pulmonary uptake

8

What is the Volume of Distribution?

Vd is 4L/kg

9

What is the distribution time? redistribution time?

Distrib time: 1.7 minutes
Redistribution time: 13 minutes

10

What is the termination elimination 1/2 time of Fentanyl?

3.1 - 6.6 hours

11

How is Fentanyl eliminated?

Norfentanyl (principle metabolite) excreted by the kidneys and can be detected in the urine 48 - 72 hours after administration

12

Is Fentanyl protein bound?

approx 80% protein bound to plasma proteins

13

What are the CNS side effects of Fentanyl?

-increase in ICP in head injury patients if respiration is not controlled
-seizure like activity and muscle rigidity
-Dizziness, blurred vision
-Miosis
-Pruritis
-Drowsiness, Sedation, Confusion
-CNS depression

14

What are the CV effects of Fentanyl?

-Bradycardia
-Elevated CVP, PAP, and PVR associated with opioid induced muscle rigidity, hypotension, peripheral vasodilation, arrythmia

15

What are the respiratory effects of Fentanyl?

-Respiratory depression
-depression of airway reflexes
-decreased lung compliance, FRC, hypercapnia, and hypoxemia associated with opioid induced muscle rigidity
-Bronchospasm
-Laryngospasm

16

What are the GI effects of Fentanyl?

-increased common bile duct pressure
-N/V
-Delayed gastric emptying and intestinal transit

17

What are the endocrine/metabolic effects of Fentanyl?

ADH release

18

What are the contraindications to use of Fentanyl?

-use with caution in patients with impaired hepatic and/or renal function, head trauma, elevated ICP, and bradyarrhythmias

19

What synergistic effect occurs with Fentanyl and ____________ and __________?

Benzodiazepines and other CNS depressants cause marked opioid synergism with respect to hypnosis and respiratory depression

20

What drug interaction can occur between Fentanyl and Nitrous Oxide?

cardiovascular depression

21

Adminstration with _________ and Fentanyl may cause?

Droperidol
may cause hypotension or HTN

22

What is the anesthetic premedication dose of Fentanyl?

25 - 100 mcg

23

What is the analgesia (including post-op bolus) dose of Fentanyl?

1 - 2 mcg/kg (usually 0.5-1 mcg/kg)

24

What is the infusion dose of Fentanyl?

0.01 - 0.05 mcg/kg/min

25

What is the GA IV dose for a sole agent, for Fentanyl?

50 - 150 mcg/kg

26

What is the regional anesthesia dose for Fentanyl?

Epidural: 50 - 100 mcg (loading)
Spinal: 10 - 25 mcg

27

What is the reversal/ antagonist of Fentanyl and the dose of it?

Naloxone (Narcan) at 0.1 - 2 mg IV incremental doses; 10 mg max

28

Is Fentanyl more or less lipid soluble than morphine with a longer or shorter DOA?

MORE lipid soluble than Morphine with SHORTER DOA- 75% of initial dose undergoing first pass pulmonary uptake

29

_______ redistribution to _________ tissue sites as ______, _________ _________, and ________

rapid redistribution to inactive tissue sites as fat, skeletal muscle, and lungs

30

What can multiple IV doses or continuous infusion produce?

progressive saturation of inactive tissue->leads to 2nd peak b/c comes back to plasma

31

Does plasma concentration decrease rapidly?

Plasma concentration does NOT decrease rapidly and DOA is prolonged-> 2dary peak in plasma levels

32

What is the clinical significance of Fentanyl?

-Used as analgesic adjunct for surgery
-as adjuvant to blunt stimulation of incision, laryngoscopy
-as sole anesthetic in large doses due to hemodynamic stability
-100 x more potent than morphine
-wide range of doses given: 1-20 mcg/kg
-Lozenges (fent lollipop) 5-20 mcg/kg 45 min prior to induction