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