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

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)

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

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

Adult Dosage: IV/IO Dose: 50 mcg slow push (over 2 minutes) May repeat every 5 minutes at a range of 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.

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

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

Fentanyl Ampules

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