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Fentanyl Fentanyl
Fentanyl BasicsFentanyl Basics
First synthesized in Belgium in the 1950’s for anesthesia
Trade Name “Sublimaze”It is a potent synthetic narcotic with
properties similar to those of morphineChemically unrelated to morphine, but 50
to 100 times more potentDuration of action is considerably shorter
than morphine – from 30 to 60 minutes
First synthesized in Belgium in the 1950’s for anesthesia
Trade Name “Sublimaze”It is a potent synthetic narcotic with
properties similar to those of morphineChemically unrelated to morphine, but 50
to 100 times more potentDuration of action is considerably shorter
than morphine – from 30 to 60 minutes
Fentanyl OverviewFentanyl Overview
Class:Narcotic analgesic
Indications:Adjunctive agent for MFI and for moderate
to severe pain
Dose:1 mcg/kg slow IVP, IM, or intranasal
Class:Narcotic analgesic
Indications:Adjunctive agent for MFI and for moderate
to severe pain
Dose:1 mcg/kg slow IVP, IM, or intranasal
Fentanyl PharmacokineticsFentanyl Pharmacokinetics
AbsorptionImmediate onset by IV.+/- 8 minutes by IMPeak effects in 3-5 minutesDuration of effects 30 to 60 minutes
DistributionWidespread
MetabolismHepatic
EliminationUrine
AbsorptionImmediate onset by IV.+/- 8 minutes by IMPeak effects in 3-5 minutesDuration of effects 30 to 60 minutes
DistributionWidespread
MetabolismHepatic
EliminationUrine
Choose one Choose one
ANALGESIC MEDICATION OPTIONS
(Choose one)
Fentanyl ( indicated for patients with multi-trauma, or the presence of, or potential for hypotension, abdominal pain.
OR
Morphine sulfate
ANALGESIC MEDICATION OPTIONS
(Choose one)
Fentanyl ( indicated for patients with multi-trauma, or the presence of, or potential for hypotension, abdominal pain.
OR
Morphine sulfate
Fentanyl ConcernsFentanyl Concerns
Fentanyl is the most diverted medication in the medical community!
It has an increasing street value!It has a very high potential for
habituation
Fentanyl is the most diverted medication in the medical community!
It has an increasing street value!It has a very high potential for
habituation
Fentanyl Precautions/Warnings Fentanyl Precautions/Warnings
Alcohol and Drugs of Abuse - May be expected to have additive CNS depressant effects when used in conjunction with alcohol
Cardiac Disease – may produce bradycardia should be used with caution in patients with known bradyarrythmias.
Hepatic or Renal Disease – Caution because of the hepatic metabolism and renal excretion of Fentanyl.
Alcohol and Drugs of Abuse - May be expected to have additive CNS depressant effects when used in conjunction with alcohol
Cardiac Disease – may produce bradycardia should be used with caution in patients with known bradyarrythmias.
Hepatic or Renal Disease – Caution because of the hepatic metabolism and renal excretion of Fentanyl.
Fentanyl Precautions/Warnings Fentanyl Precautions/Warnings
Hypoventilation-respiratory depression from opioids is manifested by a reduced drive to breath and reduced rate, often associated with “sighing” pattern.
COPD-in such patients normal analgesic doses of opioids may further decrease respiratory drive to the point of failure
Hypoventilation-respiratory depression from opioids is manifested by a reduced drive to breath and reduced rate, often associated with “sighing” pattern.
COPD-in such patients normal analgesic doses of opioids may further decrease respiratory drive to the point of failure
Fentanyl ContraindicationsFentanyl Contraindications
Not opioid tolerant
Intermittent pain
In situations of significant respiratory depression especially in unmonitored settings
In patients who have acute or severe asthma
Patients who have or are suspected of having a paralytic ileus - paralysis of the intestine
Known hypersensitivity
Not opioid tolerant
Intermittent pain
In situations of significant respiratory depression especially in unmonitored settings
In patients who have acute or severe asthma
Patients who have or are suspected of having a paralytic ileus - paralysis of the intestine
Known hypersensitivity
Fentanyl Side Effects Common & UncommonFentanyl Side Effects Common & Uncommon
Common
Rash, Nausea, Vomiting (Zofran!!) Drowsiness, Dry Mouth, Dizziness, Difficulty Urinating, Constipation (prolonged use), Constricted pupils
Uncommon
Rigid chest wall (may be reversed with naloxone-controversial), Decreased Breathing, Confusion, Hives, Itching, Slowing or Elevated HR, ABD pain, Flushing
Common
Rash, Nausea, Vomiting (Zofran!!) Drowsiness, Dry Mouth, Dizziness, Difficulty Urinating, Constipation (prolonged use), Constricted pupils
Uncommon
Rigid chest wall (may be reversed with naloxone-controversial), Decreased Breathing, Confusion, Hives, Itching, Slowing or Elevated HR, ABD pain, Flushing
Fentanyl concentrationFentanyl concentration
Fentanyl BenefitsFentanyl Benefits
Used in the EMS environment for…Pain management
Fewer negative effects than morphine on…Blood pressureRespiratory effort
Less incidents of nausea and vomiting!!!
Used in the EMS environment for…Pain management
Fewer negative effects than morphine on…Blood pressureRespiratory effort
Less incidents of nausea and vomiting!!!
ConsiderationsConsiderations
Parenteral dose may be given diluted or undiluted
Administer IV over 1 to 2 minutesProtect from lightClosely monitor vital signsRespiratory depression may out last the
analgesic effectEffects may be reversed by naloxon
(Narcan®)
Parenteral dose may be given diluted or undiluted
Administer IV over 1 to 2 minutesProtect from lightClosely monitor vital signsRespiratory depression may out last the
analgesic effectEffects may be reversed by naloxon
(Narcan®)
Fentanyl – In SummaryFentanyl – In Summary
Fentanyl is a potent analgesicDose is 1 mcg/kg up to 100 mcg- MC
option for repeat doseReversal agent is Narcan®1 mg of MS can equal 50 mcg of Fentanyl
Fentanyl is a potent analgesicDose is 1 mcg/kg up to 100 mcg- MC
option for repeat doseReversal agent is Narcan®1 mg of MS can equal 50 mcg of Fentanyl