Fentanyl

dr.joan

Fentanyl:
Trade names: Actiq, Duragesic, Fentanyl Oralet, Fentanyl
Transdermal, Fentanyl Transmucosal, Sublimaze

Drug class

· Narcotic agonist analgesic
Pregnancy: (Category C/ D if used for prolonged periods or in high doses at term)

Therapeutic actions

§ Acts at specific opioid receptors, causing analgesia, respiratory depression, physical depression, euphoria.

Indications

• Analgesic action of short duration during anesthesia and immediate postop period
• Analgesic supplement in general or regional anesthesia
• Administration with a neuroleptic as an anesthetic premeditation, for induction of anesthesia, and as an adjunct in maintenance of general and regional anesthesia
• For use as an anesthetic agent with oxygen in selected high-risk patients
• Transdermal system: management of chronic pain in patients requiring opioid analgesia
• Treatment of breakthrough pain in cancer patients being treated with narcotics

Contraindications/cautions

• Contraindications: hypersensitivity to narcotics, diarrhea caused by poisoning, acute bronchial asthma, upper airway obstruction, pregnancy.
• Use cautiously with bradycardia, history of seizures, lactation.

Dose
by intravenous injection, with spontaneous respiration, 50–200 micrograms, then 50 micrograms as required; CHILD 3–5 micrograms/kg, then 1 microgram/kg as required
With assisted ventilation, 0.3–3.5 mg, then 100–200 micrograms as required;
Child: 15 micrograms/kg, then 1–3 micrograms/kg as required
By intravenous infusion In ICU: 0.5 – 1 micrograms/kg/ hour

Adverse effects

• CNS: Sedation, clamminess, sweating, headache, vertigo, floating feeling, dizziness, lethargy, confusion, light-headedness, nervousness, unusual dreams, agitation, euphoria, hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, convulsions
• GI: Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm
• CV: Palpitation, increase or decrease in BP, circulatory depression, cardiac arrest, shock, tachycardia, bradycardia, arrhythmia, palpitations
• Respiratory: Slow, shallow respiration, apnea, suppression of cough reflex, laryngospasm, bronchospasm
• GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency
• EENT: Diplopia, blurred vision
• Dermatologic: Rash, hives, pruritus, flushing, warmth, sensitivity to cold
• Local: Phlebitis following IV injection, pain at injection site; tissue irritation and induration (SC injection)
• Other: Physical tolerance and dependence, psychological dependence; local skin irritation with transdermal system

Clinically important interactions

• Drug-drug
  • Potentiation of effects when given with barbiturate anesthetics; decrease dose of fentanyl when coadministering
• Drug-lab test
  • Elevated biliary tract pressure may cause increases in plasma amylase, lipase; determinations of these levels may be unreliable for 24 h after administration of narcotics

Nursing Considerations

v Administer to women who are nursing a baby 4---6 h before the next scheduled feeding to minimize the amount in milk.
v Provide narcotic antagonist, facilities for assisted or controlled respiration on standby during parenteral administration.
v Prepare site by clipping (not shaving) hair at site; do not use soap, oils, lotions, alcohol; allow skin to dry completely before application. Apply immediately after removal from the sealed package; firmly press the transdermal system in place with the palm of the hand for 10---20 sec, making sure the contact is complete. Must be worn continually for 72 h.

Use caution with Actiq form to keep this drug out of the reach of children (looks like a lollipop) and follow the distribution restrictions in place with this drug very carefully.