Nursing

Name of Drug Classification Mechanism of Action Indication Contraindication Side Effects

Responsibilities
Generic Name: Pharmacologic Binds to opioid receptor sites in the CNS, General ● Hypersensitivity to CNS: headache, Before
Fentanyl Class: altering perception of and emotional Indications: drug or transdermal dizziness, vertigo, ● Assess for muscle
Opioid agonist response to pain by inhibiting ascending ➣ Breakthrough adhesive (with floating feeling, rigidity in
pain pathways. Fentanyl may alter pain in fentanyl transdermal) lethargy, confusion, patients receiving
Trade/Brand Name: neurotransmitter release from afferent opioidtolerant ● Opioid-nontolerant light-headedness, high doses; discuss
Actiq, Lazanda, Onsolis, Sublimaze, nerves responsive to painful stimuli, and it patients with patient nervousness, need for
Subsys causes respiratory depression by acting cancer ● Intermittent pain hallucinations, neuromuscular
directly on respiratory centers in the brain ➣ Management (on as-needed basis) delirium, insomnia, blockers with
Patients’ Dose: Therapeutic stem. of chronic pain ● Management of anxiety, prescriber. Patient
Class: in acute or mild pain fear, mood changes, receiving blocker
: Opioid Route Onset Peak Duration patients ● Management of tremor, sedation, will need ventilator.
Route: analgesic, IV 1-2 min 3-5 0.5-1 hr requiring opioid postoperative pain coma, seizures ● Monitor respiratory
IV, IM, Buccal film, Nasal spray, Sublingual anesthesia min analgesics (except for injection CV: palpitations, and cardiovascular
spray, Transdermal, Transmucosal adjunct IM 7-8 min 20- 1-2 hr ➣ Short-term form) hypotension, function and urine
30 analgesia during ● Acute or severe hypertension, output.
Form: min anesthesia and bronchial asthma tachycardia, ● With transdermal
IM or IV injection, Iontophoretic transdermal, Buccal film unknown 1 hr Unknown immediate (Duragesic), bradycardia, system, monitor
transmucosal lozenge (Actiq), Transmucosal Nasal spray unknown 15- unknown preoperative and significant respiratory arrhythmias, patient’s pain level
soluble film (Onsolis), Nasal spray (Lazanda), Controlled 21 postoperative depression, especially circulatory depression, often to determine if
Subingual Spray (Subsys), Transdermal System substance min periods in unmonitored cardiac arrest, shock patch is effective for
(Duragesic) schedule II Sublingual unknown 1.5 Unknown ➣ General settings without EENT: blurred vision, 72 hours or needs
spray hr anesthesia (with resuscitation diplopia, to be replaced after
Maximum dose: Transdermal 6 hr 12- 72 hr oxygen equipment pharyngolaryngeal 48 hours. Know
>Iontophoretic transdermal- Six 40-mcg 24 only) ● Known or suspected pain, laryngospasm that drug level rises
doses/hour and hr ➣ Adjunct to paralytic ileus GI: nausea, vomiting, gradually for first
eighty 40-mcg doses/24 hours for maxi Transmucosa rapid 15- Several regional Precautions constipation, biliary 24 hours after patch
mum of 72 hours Pregnancy l 30 hr anesthesia Use cautiously in: tract spasm, dry is applied;
>Transmucosal soluble film- Maximum: Four Category: min ● diabetes mellitus, mouth, anorexia supplemental
200-mcg film sheets or one C severe or chronic GU: urinary retention analgesics may be
1, 200-mcg film sheet four times daily Patient’s pulmonary or hepatic or hesitancy, needed
>Nasal spray- 800 mcg four times daily. Pharmacokinetics Indication: disease, ureteral or vesical then.
>Subingual Spray- 1600 Absorption: Transmucosal: Rapidly absorbed cardiovascular sphincter spasm,
mcg given twice 30 minutes apart four from buccal and nasal mucosa, the remainder is disease, CNS tumors, decreased libido,
times daily swallowed and slowly absorbed from the GI adrenal insufficiency, erectile dysfunction During
tract. Transdermal: Slow absorption after hypothyroidism, Musculoskeletal: ● If patient develops
Minimum dose: application. Bioavailability: Buccal film: 71%; renal impairment, skeletal and thoracic fever, assess for
>IM or IV injection- 0.05 to 0.1 mg I.M. or slow head injury or muscle rigidity signs and symptoms
I.V. over buccal tab: 65%; lozenge: Approx 50%; increased intracranial Respiratory: epistaxis, of opioid toxicity,
1 to 2 min. sublingual spray: 76%; sublingual tab: 54%. pressure (use cough, nasal as more drug is
>Iontophoretic transdermal- 40 mg on-demand, Time to peak plasma concentration: Buccal film: with extreme caution) discomfort, absorbed at higher
released over 10 0.75-4 hr; sublingual spray: 10-120 min; ● concurrent use of rhinorrhea, nasal body temperatures.
min sublingual tab: 15-240 min; transdermal patch: CNS depressants congestion, postnasal ● If adverse reactions
>Transmucosal lozenge- Initial: 200 mcg placed 20-72 hr. ● alcoholism or drug drip (Lazanda), to transdermal
between Distribution: Highly lipophilic, distributes abuse dyspnea, slow and system occur,
cheek and gum for 15 min followed by rapidly from blood into the lungs and skeletal ● MAO inhibitor use shallow respirations, monitor patient for at
second dose 15 min after first dose ends, if muscles then into deeper fat compartments. It within 14 days suppressed cough least 12 hours after
needed. Dosage increased according to crosses the placenta, enters the breast milk and (not recommended) reflex, apnea, patch removal.
patient’s needs. appears in the CSF. Volume of distribution: 4-6 ● elderly patients bronchospasm ● Carefully monitor
>Transmucosal soluble film- . Initial: 200-mcg L/kg. Plasma protein binding: Approx 80%. ● pregnant patients Skin: local skin hematologic studies
film sheet placed Metabolism: Hepatic via N-dealkylation and ● labor and delivery irritation (with and hepatic enzyme
against inside of cheek per episode. Increased, hydroxylation by CYP3A4 isoenzyme.. ● breastfeeding transdermal system), levels.
as needed, by 200 mcg in each subsequent Excretion: Via urine (75%, primarily as patients (not rash, urticaria,
episode, with doses at least 2 hours apart. metabolites; <7-10% as unchanged drug); faeces recommended) pruritus, diaphoresis,
>Nasal spray- Initial: 100 mcg. Increased, as (approx 9%). Elimination half-life: IV: 2-4 hr; ● children younger flushing, erythema, After
needed, to 200 mcg, then 400 mcg, then transdermal patch: 20-27 hr; transmucosal: 3-14 than age 2 (Duragesic, cold sensitivity ● Instruct patient to
800 mcg with doses spaced at least 2 hours hr (dose-dependent); nasal spray: 15-25 hr Sublimaze), younger Other: oral mucosal place lozenge
apart. than age 16 reactions (at between cheek and
>Subingual Spray- Initial: 100 mcg followed by (Actiq), or younger application site with gum and suck on it
100 than age 18 buccal tablets), for 15 minutes
mcg 30 minutes later, if needed. Increased, (Abstral, Fentora, physical or without chewing or
as needed, to 200 mcg, then 400 mcg, then Lazanda, Onsolis, psychological drug swallowing.
600 mcg, then 800 mcg, then 1200 mcg, Subsys) (safety not dependence, drug ● Teach patient
then 1600 mcg with doses spaced at least 4 established). tolerance, pain or proper technique for
hours apart. A second dose of same phlebitis applying and
strength may be taken 30 minutes after the at injection site, disposing of
first dose, as needed and counted as 1 hypersensitivity, transdermal
breakthrough episode. anaphylaxis (with oral patch.
>Transdermal System- Initial: transmucosal ● Tell patient that
One 25-mcg/hr patch, replaced every 72 hr forms) transdermal form is
(or 48 hr, if needed). Dosage increased by absorbed more
12.5 mcg/hr, as needed, after first 72 hr and rapidly if skin is
then every 6 days. For more than 100 mcg/ warm
hr, more than one patch is used. from fever or hot
environment.
Instruct patient to
Availability: avoid electric
Buccal soluble film: 200 mcg, 400 mcg, blankets, heating
600 mcg, 800 mcg, 1,200 mcg pads, heat lamps, hot
Buccal tablets: 100 mcg, 200 mcg, tubs, and heated
400 mcg, 600 mcg, 800 mcg water beds and to
Injection: 0.05 mg/ml promptly report fever
Nasal spray: 100 mcg, 400 mcg in 5-ml or a move to a
bottle hot climate.
Sublingual spray: 100 mcg, 200 mcg, ● Instruct patient not
400 mcg, 600 mcg, 800 mcg to open buccal
Tablets (buccal): 100 mcg, 200 mcg, tablet blister pack
300 mcg, 400 mcg, 600 mcg, 800 mcg until ready to use.
Tablets (sublingual): 100 mcg, 200 mcg, Teach patient to peel
300 mcg, 400 mcg, 600 mcg, 800 mcg back blister backing
Transdermal system: 12 mcg/hour, 25 to expose buccal
mcg/hour, 50 mcg/hour, 75 mcg/hour, tablet and not to
100 mcg/hour push tablet through
Transmucosal lozenges: 200 mcg, 400 blister.
mcg, 600 mcg, 800 mcg, 1,200 mcg, ● Caution patient not
1,600 mcg to break, suck,
chew, or swallow
Content: buccal tablet.
● Instruct patient to
Fentanyl is a synthetic opioid, which means it is place buccal tablet
manmade in laboratories. It does not rely on the between upper check
opium poppy for production like opiates such as and gum near
morphine. It is produced through a number of rear molar until it
chemical reactions that require specialized skills dissolves, and to
and access to restricted chemicals. swallow remnants
with a glass of water
after 30 minutes.
● Instruct patient to
use alternate sides
of mouth when taking
subsequent
doses of buccal
tablets.
● Instruct patient to
open buccal soluble
film or spray
packages
immediately
 before use.

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