View source for FENTANYL (SUBLIMAZE)

'''Class'''

Narcotic analgesic

'''Pharmacology and Actions'''

# Potent synthetic narcotic analgesic with actions similar to those of morphine, but action is more prompt and less prolonged
# The emetic effect is less than morphine.

'''Indications'''

# Adult and pediatric pain management
# Chest pain
# STEMI

'''Precautions'''

# Contraindicated in patients taking MOA inhibitors
# Myasthenia gravis
# Use with caution with head injuries, ICP, elderly, COPD, liver and kidney dysfunction, and bradydysrhythmias.

'''Administration'''

# Adult Pain Management
## For patients 6-75 years old: Administer '''fentanyl (Sublimaze)''' 0.5-1 mcg/kg INTRANASAL/INTRAMUSCULAR or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV/IO. Reassess patient vital signs and pain scale after 5 minutes.
## For patients > 75 years old: Administer '''fentanyl (Sublimaze)''' 0.5 mcg/kg INTRANASAL/INTRAMUSCULAR or mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV/IO. Reassess patient vital signs and pain scale after 5 minutes.
# Reassess pain scale and vital signs including pulse oximetry every 5 minutes
# If sufficient pain relief is not obtained with the initial dose, then an additional dose of '''fentanyl (Sublimaze)''' 0.5 mcg/kg may be administered IV/IO, IN, IM, provided systolic BP remains above 100 mm Hg for a total max dose of 150 mcg
# Pediatric Pain Management
## 1 mcg/kg mixed in 5 mL normal saline and given IV/IO push over 2-4 minutes to a maximum single dose of 100 mcg IV/IO. Reassess patient vital signs and pain scale after 5 minutes.

'''Side Effects and Special Notes'''

# Sedation, euphoria, dizziness, and diaphoresis.
# Seizures with high doses.
# Nausea and vomiting.
# Bronchoconstriction, respiratory depression or arrest if given as a rapid IV infusion.
# Can be reversed with Narcan.