Fentanyl
 
Presentation
• 100mcg in 2ml amp
• 600mcg in 2ml (IN use only)
Pharmacology
• A synthetic narcotic analgesic
Actions
• Central Nervous System effects:
  - Depression, leading to analgesia
  - Respiratory depression, leading to apnoea
  - Dependence (addiction)
• Cardiovascular effects:
  - Decreases conduction velocity through the A.V. Node
Metabolism
• By the liver and excreted by the kidneys
Primary Emergency Indications
• Analgesia Adult Paed
• Intubation Facilitated by Sedation Adult Paed
• Rapid Sequence Intubation Adult
Contraindications
• Known hypersensitivity
• Late 2nd Stage Labour
• Severe undiagnosed headache (ALS only: unless consult)
• IV Amiodarone
Precautions
• Elderly Pts
• Impaired renal/hepatic function
• Respiratory depression, e.g. COPD
• Current asthma
• Pts on monoamine oxidase inhibitors
• Known addiction to narcotics
• Rhinorrhea or facial trauma (IN use)
• Oral Amiodarone
Route of Administration
• IV
• IN
Side Effects
• Respiratory depression
• Apnoea
• Rigidity of the diaphragm and intercostal muscles
• Bradycardia
Special Notes
• Fentanyl is a Schedule 8 drug under the Poisons Act and its use must be carefully controlled with accountability and responsibility.
• Respiratory depression can be reversed with Naloxone Hydrochloride.
• 100mcg Fentanyl is equivalent in analgesic activity to 10mg Morphine.
Therapeutic Effect
IV     
Onset:
Immediate
Peak:
<5min
Duration:
30-60min
 
IN     
Onset:
Immediate
Peak:
2min
Duration:
30-60min
Reference Dilutions
Fentanyl IN (Adult) and (Paed)
Further Reding Clinical Notes by Jeff Kenneally: Fentanyl