FENTANYL (SUBLIMAZE)

Class

Narcotic analgesic

Pharmacology and Actions

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

Indications

1. Adult and pediatric pain management
2. Chest pain
3. STEMI

Precautions

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

Administration

1. Adult Pain Management
   1. 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.
   2. 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.
2. Reassess pain scale and vital signs including pulse oximetry every 5 minutes
3. 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
4. Pediatric Pain Management
   1. 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

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