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Flashcards in Fentanyl Deck (32)
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1
Q

What is the drug class of Fentanyl?

A

synthetic phenylpiperidine opioid agonist, analgesic

2
Q

What are the uses of Fentanyl?

A
  • Analgesia intraop and postop
  • administered as premed to blunt hemodynamic responses to airway manipulation and reduce inhalation agent dosage requirements
  • provides GA either administered as sole anesthetic or in combo with IV sedatives/hypnotics
  • administered in the epidural and subarachnoid spaces to augment the effectiveness of RA
3
Q

What is the MOA of Fentanyl?

A
  • Binds to mu opioid receptors in the brain, brainstem, spinal cord, and primary afferent peripheral terminals producing analgesia
  • mimics the actions of enkephalins, endorphins, dynorphins causing the action of antinocioceptive systems resulting in cellular hyperpolarization and inhibition of NT release
4
Q

How is Fentanyl metabolized?

A

primarily in the liver by N-dealkylation and Hydroxylation

-dependent on liver blood flow/ high hepatic extraction ratio

5
Q

Does metabolism of Fentanyl produce metabolites?

A

-minimally pharmacologically active metabolites: Norfentanil, hydroxyproprionyl-fentanyl, and hydroxyproprionyl-norfentanyl

6
Q

How is Fentanyl redistributed?

A
  • Fentanyl is highly lipid soluble allowing rapid crossing of biological membranes and uptake by highly perfused tissue groups including the brain, heart, lungs
  • Rapidly redistributed to inactive tissue sites such as fat and muscle
7
Q

What is important about the lungs and Fentanyl?

A

The lungs serve as a large inactive storage site, with an estimated 75% of the initial dose undergoing 1st pass pulmonary uptake

8
Q

What is the Volume of Distribution?

A

Vd is 4L/kg

9
Q

What is the distribution time? redistribution time?

A

Distrib time: 1.7 minutes

Redistribution time: 13 minutes

10
Q

What is the termination elimination 1/2 time of Fentanyl?

A

3.1 - 6.6 hours

11
Q

How is Fentanyl eliminated?

A

Norfentanyl (principle metabolite) excreted by the kidneys and can be detected in the urine 48 - 72 hours after administration

12
Q

Is Fentanyl protein bound?

A

approx 80% protein bound to plasma proteins

13
Q

What are the CNS side effects of Fentanyl?

A
  • increase in ICP in head injury patients if respiration is not controlled
  • seizure like activity and muscle rigidity
  • Dizziness, blurred vision
  • Miosis
  • Pruritis
  • Drowsiness, Sedation, Confusion
  • CNS depression
14
Q

What are the CV effects of Fentanyl?

A
  • Bradycardia
  • Elevated CVP, PAP, and PVR associated with opioid induced muscle rigidity, hypotension, peripheral vasodilation, arrythmia
15
Q

What are the respiratory effects of Fentanyl?

A
  • Respiratory depression
  • depression of airway reflexes
  • decreased lung compliance, FRC, hypercapnia, and hypoxemia associated with opioid induced muscle rigidity
  • Bronchospasm
  • Laryngospasm
16
Q

What are the GI effects of Fentanyl?

A
  • increased common bile duct pressure
  • N/V
  • Delayed gastric emptying and intestinal transit
17
Q

What are the endocrine/metabolic effects of Fentanyl?

A

ADH release

18
Q

What are the contraindications to use of Fentanyl?

A

-use with caution in patients with impaired hepatic and/or renal function, head trauma, elevated ICP, and bradyarrhythmias

19
Q

What synergistic effect occurs with Fentanyl and ____________ and __________?

A

Benzodiazepines and other CNS depressants cause marked opioid synergism with respect to hypnosis and respiratory depression

20
Q

What drug interaction can occur between Fentanyl and Nitrous Oxide?

A

cardiovascular depression

21
Q

Adminstration with _________ and Fentanyl may cause?

A

Droperidol

may cause hypotension or HTN

22
Q

What is the anesthetic premedication dose of Fentanyl?

A

25 - 100 mcg

23
Q

What is the analgesia (including post-op bolus) dose of Fentanyl?

A

1 - 2 mcg/kg (usually 0.5-1 mcg/kg)

24
Q

What is the infusion dose of Fentanyl?

A

0.01 - 0.05 mcg/kg/min

25
Q

What is the GA IV dose for a sole agent, for Fentanyl?

A

50 - 150 mcg/kg

26
Q

What is the regional anesthesia dose for Fentanyl?

A

Epidural: 50 - 100 mcg (loading)
Spinal: 10 - 25 mcg

27
Q

What is the reversal/ antagonist of Fentanyl and the dose of it?

A

Naloxone (Narcan) at 0.1 - 2 mg IV incremental doses; 10 mg max

28
Q

Is Fentanyl more or less lipid soluble than morphine with a longer or shorter DOA?

A

MORE lipid soluble than Morphine with SHORTER DOA- 75% of initial dose undergoing first pass pulmonary uptake

29
Q

_______ redistribution to _________ tissue sites as ______, _________ _________, and ________

A

rapid redistribution to inactive tissue sites as fat, skeletal muscle, and lungs

30
Q

What can multiple IV doses or continuous infusion produce?

A

progressive saturation of inactive tissue->leads to 2nd peak b/c comes back to plasma

31
Q

Does plasma concentration decrease rapidly?

A

Plasma concentration does NOT decrease rapidly and DOA is prolonged-> 2dary peak in plasma levels

32
Q

What is the clinical significance of Fentanyl?

A
  • Used as analgesic adjunct for surgery
  • as adjuvant to blunt stimulation of incision, laryngoscopy
  • as sole anesthetic in large doses due to hemodynamic stability
  • 100 x more potent than morphine
  • wide range of doses given: 1-20 mcg/kg
  • Lozenges (fent lollipop) 5-20 mcg/kg 45 min prior to induction