1. Fentanyl

2. Fentanyl 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 morphine  Chemically unrelated to morphine, but 50 to 100 times more potent  Duration 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 morphine  Chemically unrelated to morphine, but 50 to 100 times more potent  Duration of action is considerably shorter than morphine – from 30 to 60 minutes

3. Fentanyl 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

4. Fentanyl Pharmacokinetics  Absorption  Immediate onset by IV.  +/- 8 minutes by IM  Peak effects in 3-5 minutes  Duration of effects 30 to 60 minutes  Distribution  Widespread  Metabolism  Hepatic  Elimination  Urine  Absorption  Immediate onset by IV.  +/- 8 minutes by IM  Peak effects in 3-5 minutes  Duration of effects 30 to 60 minutes  Distribution  Widespread  Metabolism  Hepatic  Elimination  Urine

5. 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

6. Fentanyl 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

7. 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.

8. 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

9. Fentanyl 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

10. Fentanyl 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

11. Fentanyl concentration

12. Fentanyl Benefits  Used in the EMS environment for…  Pain management Fewer negative effects than morphine on…  Blood pressure  Respiratory effort  Less incidents of nausea and vomiting!!!  Used in the EMS environment for…  Pain management Fewer negative effects than morphine on…  Blood pressure  Respiratory effort  Less incidents of nausea and vomiting!!!

13. Considerations  Parenteral dose may be given diluted or undiluted  Administer IV over 1 to 2 minutes  Protect from light  Closely monitor vital signs  Respiratory depression may out last the analgesic effect  Effects may be reversed by naloxon (Narcan®)  Parenteral dose may be given diluted or undiluted  Administer IV over 1 to 2 minutes  Protect from light  Closely monitor vital signs  Respiratory depression may out last the analgesic effect  Effects may be reversed by naloxon (Narcan®)

14. Fentanyl – In Summary  Fentanyl is a potent analgesic  Dose is 1 mcg/kg up to 100 mcg- MC option for repeat dose  Reversal agent is Narcan®  1 mg of MS can equal 50 mcg of Fentanyl  Fentanyl is a potent analgesic  Dose is 1 mcg/kg up to 100 mcg- MC option for repeat dose  Reversal agent is Narcan®  1 mg of MS can equal 50 mcg of Fentanyl