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Fentanyl is a potent synthetic opioid, which, similar to morphine, produces analgesia but to a greater extent. This robust pharmacologic agent is typically 50 to 100 times more potent. A dose of only 100 micrograms can produce equivalent analgesia to approximately 10 mg of morphine. However, fentanyl exhibits vastly different properties and pharmacokinetics. Clinically, its most common use is as a sedative in intubated patients and in severe cases of pain in patients with renal failure due to its primarily hepatic elimination. At times, fentanyl may also be indicated to treat chronic pain patients who have developed tolerance to opiates. When used as a sedative, drug administration is most commonly via a drip. Lastly, fentanyl use can extend to the treatment of epilepsy. That is, in combination with certain neuroleptic medications as part of therapeutic neuroleptanalgesia. This activity outlines the indications, mechanism of action, administration methods, significant adverse effects, contraindications, monitoring, and toxicity of fentanyl so that providers can direct patient therapy to optimal outcomes. Objectives: Identify the mechanism of action of fentanyl. Summarize the approved indications for pain control therapy with fentanyl. Review the contraindications and adverse event profile of fentanyl. Explain interprofessional team strategies for improving care coordination and communication to advance fentanyl therapy, improve outcomes, and minimize adverse events and misuse, especially in light of the ongoing opioid crisis. Access free multiple choice questions on this topic.

Typically, a fentanyl overdose manifests as an extrapolation of its pharmacological side effects. Although the clinical scenarios may vary among patients, one of the main concerns is the level of expression of OIRD. In such cases, oxygen administration and respiratory assistance are a priority. An opioid drug antagonist such as naloxone can help to correct OIRD symptoms. Commonly, repeated doses are necessary since, over time, respiratory depression may overcome the effects of the antagonist drug, particularly with opiates such as fentanyl, in which increased receptor affinity may be present as compared to other opiates. Thus, the therapeutic approach should continue until a normal respiratory rate coincides with appropriate oxygen saturation levels. Naloxone/naltrexone are robust opioid antagonists that function by blocking µ-receptors. The FDA has approved these antidote medications for emergency treatment of patients with known or suspected opioid overdose experiencing respiratory and/or central nervous system (CNS) depression. Common routes of naloxone administration include IV, IM, IN, or subcutaneous (SC). Researchers have recently posed a caveat regarding the intranasal route for naloxone administration. Since the incidence of obstructive nasal pathology is relatively high in patients who experience serious OIRD, there is documentation of relevant instances of treatment failures when using the IN formulations. Also, an IV neuromuscular blocker may be employed in cases of severe muscular rigidity to assist the controlled respiration treatments.

Fentanyl is a widely used narcotic in the hospital environment. However, with recent concerns about opiate overdose and toxicity, all interprofessional healthcare team members who prescribe, administer, or dispense this medication should be familiar with the drug's adverse effects and how to reverse them. This includes all clinicians (including mid-level practitioners), nurses, and pharmacists. When prescribing fentanyl, the dose and duration should be the lowest and shortest effective, and the patient is continually assessed for compliance and/or diversion in outpatient settings. Healthcare workers should be aware of new prescribing laws governing opioids, and unlike in the past, empirical prescribing of narcotics can lead to legal troubles, including loss of prescription privilege.[11][12] With interprofessional coordination of activities and open communication, fentanyl therapy can be successful and adverse events avoided or managed if they arise. [Level 5]