Download Fentanyl Citrate - Verde Valley Emergency Medical Services

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:
 CV:
 Resp:
 CNS:
 GI:
 Derm:
Muscle rigidity, particularly involving
muscles of respiration.
Bradydysrhythmias (common) or
tachydysrhythmias, hypotension,
orthostatic hypotension
Respiratory depression (common) or arrest.
Pupillary constriction. Sedation
Nausea and Vomiting
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
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.
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:
Peak:
Duration:
1-2 minutes IV/IO
8 minutes IM
3-5 minutes IV route
Less predictable IM route
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



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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