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Fentanyl Citrate

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.

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Fentanyl Citrate

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  1. Fentanyl Citrate Narcotic agonist/narcotic analgesic

  2. 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.

  3. 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

  4. Contraindications • Known allergy or intolerance to drug • (assess for medic alert bracelet) • Respiratory depression if airway and breathing can’t be supported • Known elevated intracranial pressure e.g. mass lesion • Head injury with ALOC (relative) • Asthma (relative)

  5. 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

  6. Special notes: Although chest wall rigidity is uncommon and usually doesn’t 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

  7. Have resuscitative & intubation equipment & oxygen readily available.

  8. 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/IO • Max 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.

  9. Pediatric Dosage IV/IO Dose: 1-2 mcg/kg (over 2 minutes) • Max initial dose of 25 mcg • May repeat in 5 minutes • Max dose of 200 mcg IM/IN Dose: 2 mcg/kg • Max initial dose of 50mcg • May repeat in 10 minutes

  10. Fentanyl Citrate Onset: 1-2 minutes IV/IO 8 minutes IM Peak: 3-5 minutes IV route Less predictable IM route Duration: 30-60 minutes IV 1-2 hours IM Duration of respiratory depressant effect of fentanyl may be longer than the analgesic effect

  11. Fentanyl Ampules

  12. Last key points related to Fentanyl ampules • Currently only available in ampules due to drug shortages. • Must use a filter needle to draw up medication • Be careful not to break ampule……lots 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

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