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Transcript of Fentanyl Citrate
Narcotic agonist/narcotic analgesic
Mechanism of Action:Alleviates pain by acting on the pain receptors in the brain; elevates pain threshold.Depresses central nervous system; depresses brainstem respiratory centers; decreases responsiveness to changes in PaC02. Increases venous capacitance (venous pooling) and vasodilates arterioles thereby reducing preload and afterload.
Indications and field use:
Analgesia, especially in patients with burns or other trauma, myocardial infarction, renal colic.
Adjunct to sedation in post-intubation state.
Adjunct to induction in Rapid Sequence Intubation (RSI) or medication assisted intubation
ContraindicationsKnown allergy or intolerance to drug (assess for medic alert bracelet) Respiratory depression if airway and breathing cant be supported Known elevated intracranial pressure e.g. mass lesion Head injury with ALOC (relative) Asthma (relative)
Adverse Reactions:MS: Muscle rigidity, particularly involving muscles of respiration. CV: Bradydysrhythmias (common) or tachydysrhythmias, hypotension, orthostatic hypotension Resp: Respiratory depression (common) or arrest. CNS: Pupillary constriction. Sedation GI: Nausea and Vomiting Derm: Histamine release may cause local or general urticaria
Although chest wall rigidity is uncommon and usually doesnt result with small doses and slow IV bolus (over > 2 minutes) the provider must have a heightened awareness this complication could result and be prepared to treat appropriately with benzodiazepines and other airway and mechanical ventilation techniques
Adult Dosage:IV/IO Dose: 50 mcg slow push (over 2 minutes)May repeat every 5 minutes at a range of 25-50 mcg IV/IOMax dose of 200 mcg
IM Dose: 50 mcg May repeat once in 5 minutes
Remember Fentanyl comes in 100mcg/2ml
Consider the lower dose in the elderly, debilitated, or those with chronic lung disease.
Pediatric DosageIV/IO Dose: 1-2 mcg/kg (over 2 minutes)Max initial dose of 25 mcgMay repeat in 5 minutesMax dose of 200 mcg
IM/IN Dose: 2 mcg/kg Max initial dose of 50mcgMay repeat in 10 minutes
Fentanyl CitrateOnset: 1-2 minutes IV/IO8 minutes IM Peak:3-5 minutes IV routeLess predictable IM routeDuration:30-60 minutes IV1-2 hours IM
Duration of respiratory depressant effect of fentanyl may be longer than the analgesic effect
Last key points related to Fentanyl ampulesCurrently only available in ampules due to drug shortages.Must use a filter needle to draw up medicationBe careful not to break ampulelots of paperwork required with DHS and DEA!This is a class II drug. If ampule is broken. It must be reported to Tish Arwine and VVMC Pharmacy that day- along with written documentation and witness if available. Broken ampule should also be taken to VVMC Pharmacy
Fentanyl has several advantages for out of hospital analgesia, including rapid onset, short duration and less histamine release.
*Currently not in protocol for RSI use *Use caution in trauma patients with suspected ICP*Muscular rigidity is possible in the chest if the medication is pushed too fast. Push slow!For the most part it does not affect the cardiovascular system. Respiratory drive is more decreased than with Morphine use. Watch for Decreased rate and depthRarely is there a histamine release.