Fentanyl

1 Elisabeth Fandrich NURS 2516 Clinical Medications Worksheets (You will need to make additional copies of these forms) Generic Name Fentanyl citrate Peak 12-22hr

Trade Name Duragesic Onset 6 hrs

Classification opioid analgesics

Dose 25 mcg/hr

Duration 72hr

Mechanism of action and indications (Why med ordered) Binds to opiate receptors in the CNS, altering the response to and perception of pain Pain

Route patch

Time/frequency Change q 72 hrs

For IV meds, compatibility with IV drips and /or solutions N/A Nursing Implications (what to focus on) Contraindications/warnings/interactions Contraindicated in: Hypersensitivity to fentanyl or adhesives Known intolerance Acute pain (onset not rapid enough) Alcohol intolerance (small amounts of alcohol released into skin) Use Cautiously in: Geri: Patients >60 yr, cachectic or debilitated patients (dose reduction suggested because of altered drug disposition) Diabetes Patients with severe pulmonary or hepatic disease CNS tumors Increased intracranial pressure Head trauma Adrenal insufficiency Undiagnosed abdominal pain Hypothyroidism Alcoholism Cardiac disease (particularly bradyarrhythmias) Fever or situations that increase body temperature (increases release of fentanyl from delivery system) Titration period (additional analgesics may be required) Common side effects confusion, sedation, weakness, anorexia, constipation, dry mouth, nausea, vomiting, sweating

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) None for this patient

Lab value alterations caused by medicine May ↑ plasma amylase and lipase levels

2 Elisabeth Fandrich Be sure to teach the patient the following about this medication Instruct patient in how and when to ask for pain medication Instruct patient in correct method for application and disposal of transdermal system. Fatalities have occurred from children having access to improperly discarded patches May be worn while bathing, showering, or swimming May cause drowsiness or dizziness. Caution patient to call for assistance when ambulating or smoking and to avoid driving or other activities requiring alertness until response to medication is known Advise patient to change positions slowly to minimize dizziness Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication Advise patient that fever, electric blankets, heating pads, saunas, hot tubs, and heated water beds increase the release of fentanyl from the patch Advise patient that good oral hygiene, frequent mouth rinses, and sugarless gum or candy may decrease dry mouth Nursing Process- Assessment (Pre-administration assessment) Assess type, location, and intensity of pain before and 24 hr after application and periodically during therapy. Monitor pain frequently during initiation of therapy and dose changes to assess need for supplementary analgesics for breakthrough pain. Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 25-50%. Initial drowsiness will diminish with continued use. Assess bowel function routinely. Prevent constipation with increased intake of fluids and bulk, and laxatives to minimize constipating effects. Administer stimulant laxatives routinely if opioid use exceeds 2-3 days, unless contraindicated

Assessment Why would you hold or not give this med? Patient not in pain. Respiratory rate < 10/min.

Evaluation Check after giving Decrease in severity of pain without a significant alteration in level of consciousness, respiratory status, or blood pressure