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Transdermal fentanyl is a medication used in the management and treatment of chronic pain and cancer pain. It is part of the opioid class of drugs. This activity outlines and reviews the indications, action, and contraindications for Transdermal fentanyl as a valuable agent in treating chronic pain. This activity will highlight the mechanism of action, adverse event profile, dosing, monitoring, and toxicity pertinent for the healthcare team members in the pain management of patients with chronic pain and related conditions. Objectives: Identify the mechanism of action of transdermal fentanyl. Describe the contraindications of transdermal fentanyl. Review the appropriate monitoring for transdermal fentanyl. Discuss interprofessional team strategies for improving care coordination and communication to advance transdermal fentanyl and improve outcomes. Access free multiple choice questions on this topic.

The most concerning adverse reaction with fentanyl is respiratory depression. The treatment approach is by management via mechanical ventilation, using a laryngeal mask airway (LMA), or bag-mask ventilation. Securing the airway is of utmost importance to counteract hypoventilation.[5] Naloxone administration will block mu-opioid receptors in severe cases. However, immediate antagonism of such receptors has the possible outcome of precipitating withdrawal symptoms that merit attention. Symptoms of opioid withdrawal may include nausea, vomiting, piloerection, myalgia, rhinorrhea, photophobia, and autonomic hyperreactivity.[14] Repeat administrations of naloxone may often be required. Also, the transdermal fentanyl patch requires removal, and the area of the skin should be wiped clean. Additional medication from the upper layer of the skin will continue to absorb; however, the remaining amount of the removed patch will be unable to precipitate toxicity.[5] As mentioned earlier, fentanyl is a synthetic opioid that is 100 times stronger than morphine. Due to its powerful opioid properties, fentanyl diversion for misuse is a problem. Fentanyl is added to heroin to increase its potency or is disguised as highly potent heroin. Many users believe that they are purchasing heroin, but it has been adulterated with fentanyl – which often results in overdose deaths.

Transdermal fentanyl is extremely effective for pain control, but it requires careful monitoring. Physicians, nurses, pharmacists, and allied health professionals (NPs and PAs) must have training in patient safety, possess the proper knowledge and readily available information to screen for opiate abuse, misuse, and toxicity.[15] Healthcare team members recognize signs of addiction, dependence, and adverse side effects. Healthcare professionals who order and administer transdermal fentanyl must be conscious of the specific indications for the drug to avoid non-indicated usage. Proper protocols must be in place and discussed to prevent accidents in administration. To add, every member in contact with chronic pain patients must be knowledgeable on opioid reversal agents. Proper communication and delivery of opioid medications such as transdermal fentanyl must be discussed, and clear communication among all healthcare members involved in patient care should take place to avoid adverse effects. Interprofessional team communication among all healthcare team members will result in more effective outcomes from fentanyl therapy with fewer adverse events. [Level 5]