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Fentanyl.

VOL: 101, ISSUE: 24, PAGE NO: 29

Generic and proprietary names

Generic and proprietary names
- Fentanyl.

- Actiq.

- Durogesic.

- Sublimaze.

Action
- Fentanyl acts in the central nervous system (CNS) to relieve pain.

Classification

- Functional class: opioid analgesic.

- Chemical class: synthetic phenylpiperdine or phenylpiperdine derivative.

Indications
- The treatment of breakthrough cancer pain in patients receiving opioid therapy.

- Analgesia during operations, enhancement of anaesthesia.

Contraindications
- Acute respiratory depression.

- Acute alcoholism.

- Raised intracranial pressure such as in head injury.

Cautions
- Hypotension.

- Hypothyroidism.

- Asthma or decreased respiratory reserve.

- Breastfeeding.

- Hepatic impairment.

- Older people or those who are debilitated may need a reduced dose.

Common side-effects
- Nausea and vomiting.

- Dizziness.

- Constipation.

Other side-effects
- Difficulty with micturition.

- Dry mouth.

- Sweating.

- Headache.

- Bradycardia.

- Tachycardia.

- Postural hypotension.

- Hallucinations.

Interactions
- Alcohol will enhance the drug's hypotensive and sedative effects.

Administration
- For breakthrough cancer pain:

- Lozenges;

- Patches.

- During anaesthesia:

- Intravenous injection;

- Intravenous infusion.

Nursing considerations
- Repeated intraoperative doses can cause respiratory depression to persist into the postoperative period.

- Fentanyl interferes with respiratory function and pupil reaction, both of which are essential parts of neurological assessment.

- Assess the therapeutic response and in breakthrough cancer pain consider adjustment of background analgesia where this is appropriate.

- Excessive heat may increase absorption from patches so local heat should not be applied and patients with fever should be carefully monitored.

Patient teaching
- Medication should be kept out of reach of children and in its original packaging.

- Avoid activities that require alertness if patient is affected by drowsiness.

- Lozenges should be removed from foil just before administration and sucked over a 15-minute period, not chewed.

- Patches should be applied to dry, intact skin, non-irradiated non-hairy skin on the torso or upper arm. Replacement patches should be sited on a different area.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines

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