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Fentanyl
trade name
Sublimaze
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Fentanyl
class
narcotic analgesic
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Fentanyl
mechanism of action
Provides analgesia and sedation by acting on the opiate receptors in the brain, blocking sensation of pain.
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Fentanyl
indications
- 1. sedation during rapid sequence intubation
- 2. control severe pain
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Fentanyl
contraindications
- 1. patients who have received MAO inhibitors in the last 14 days
- 2. myasthenia gravis
- 3. safe use in pregnancy and in children < 2 years old not established
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Fentanyl
side effects
- CNS: sedation, euphoria, dizziness, diaphoresis, seizures with high doses, delirium
- Cardiovascular: hypotension, bradycardia, circulatory depression, cardiac arrest
- Respiratory: respiratory depression or arrest, bronchoconstriction, laryngospasm
- GI: nausea/vomiting, constipation
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Fentanyl
precautions
Use with caution in head injuries, suspected or known increased intracranial pressure; the elderly, debilitated or immuno-compromised patients; COPD or other respiratory problems and those with kidney or liver dysfunction.
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Fentanyl
interactions
Alcohol and other CNS depressants potentiate effects of fentanyl; MAO inhibitors may precipitate hypertensive crisis.
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Fentanyl
routes
IV, IO, IM (also found in home medication form in the transdermal patch)
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Fentanyl
onset and duration
Onset is immediate; peak effect in 3-5 min IV, 5-15 IM; duration is 30-60 minutes (or hours with transdermal patch).
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Fentanyl
dosages
- Adult: 25-100 mcg SLOW IV push (over 2-3 minutes)
- Pediatric (child > 2 years): 2.0 mcg/kg SLOW IV push or IM
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Fentanyl
notes
Fentanyl provides much faster acting, more prolonged pain relief. Duration of respiratory depressant effects may be significantly longer than analgesic effects – always have oxygen immediately available and be prepared with intubation equipment and a narcotic antagonist (i.e. naloxone).
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