FENTANYL
_____________________
A Drug Study Presented to
the Faculty of Nursing Department
JOSEPHINE MAGNO R.N., M.N.
____________________
In Partial Fulfillment to
the Requirement in NCM 216 – RLE
OPERATING ROOM NURSING ROTATION
By:
Yvonnie Rosales, St. N.
BSN – 3J Group 1
February 4, 2021
Drug
Generic Name fentanyl transdermal
Brand Name Duragesic
Classification Opioid Analgesics
Mode of Action Narcotic agonist-analgesic of opiate receptors; inhibits
ascending pain pathways; alters pain perception, thus
altering response to pain; produces analgesia, respiratory
depression, and sedation
Dosage ADULTS, ELDERLY, CHILDREN 12 YRS AND OLDER:
Initially, 12–25 mcg/hr. May increase after 3 days.
Indication It is indicated for the management of pain in opioid-tolerant
patients, severe enough to require daily, around-the-clock,
long-term opioid treatment and for which alternative
treatment options are inadequate.
Patients considered opioid-tolerant are those who are
taking, for one week or longer, at least 60 mg
of morphine daily, or at least 30 mg of
oral oxycodone daily, or at least 8 mg of oral
hydromorphone daily, or an equianalgesic dose of another
opioid.
Contraindication DURAGESIC is contraindicated in the following patients
and situations:
o in patients who are not opioid-tolerant.
o in the management of acute or intermittent pain, or
in patients who require opioid analgesia for a short
period of time.
o in the management of post-operative pain, including
use after out-patient or day surgeries, (e.g.,
tonsillectomies).
o in the management of mild pain.
o in patients with significant respiratory compromise,
especially if adequate monitoring and resuscitative
equipment are not readily available.
o in patients who have acute or severe
bronchial asthma.
o in patients who have or are suspected of having
paralytic ileus.
o in patients with known hypersensitivity to fentanyl or
any components of the transdermal system. Severe
hypersensitivity reactions,
including anaphylaxis have been observed with
DURAGESIC.
Side Effects • headache
• mood changes
• feeling cold
• drowsiness
• depression
• difficulty falling asleep or staying asleep
• uncontrollable shaking of a part of the body
• pain, burning, tingling, or numbness in the hands or
feet
• dry mouth
• stomach pain
• indigestion
• back pain
• difficulty urinating
• itching
• skin irritation, redness, itching, or swelling in the
area where you wore the patch
Adverse Effects • changes in heartbeat
• agitation, hallucinations (seeing things or hearing
voices that do not exist), fever, sweating, confusion,
fast heartbeat, shivering, severe muscle stiffness or
twitching, loss of coordination, nausea, vomiting, or
diarrhea
• nausea, vomiting, loss of appetite, weakness, or
dizziness
• inability to get or keep an erection
• irregular menstruation
• decreased sexual desire
• chest pain
• seizure
• rash
• hives
• swelling of the eyes, face, mouth, tongue, throat,
arms, hands, feet, ankles, or lower legs
• hoarseness
• difficulty breathing or swallowing
Drug Interaction Drug to Drug : CYP3A4 inducers (e.g., rifAMPin,
modafinil) may decrease concentration, effects. Alcohol,
CNS depressant (e.g., LORazepam, gabapentin,
zolpidem) may increase CNS depression. CYP3A4
inhibitors (e.g., erythromycin, ketoconazole, protease
inhibitors [e.g., ritonavir]) may increase effects and
potential for respiratory depression.
Drug to Herbal: Gotu kola, kava kava, St. John’s wort,
valerian may increase CNS depression. St. John’s wort
may decrease concentration, effects.
Drug to Food: Grapefruit products may increase potential
for respiratory depression with oral, transmucosal forms.
Nursing • Instruct the patient to avoid alcohol.
Responsibilities • Do not take other medications without consulting
physician.
• Tell pt. to avoid tasks that require alertness, motor skills
until response to drug is established.
• Teach pt. proper transdermal administration.
• Transdermal: Instruct the pt to avoid saunas (increases
drug release time).
• Use as directed to avoid over dosage; potential for
physical dependence with prolonged use.
• Instruct pt. to never share opioid medicine with another
person, especially someone with a history of drug abuse or
addiction. MISUSE CAN CAUSE ADDICTION,
OVERDOSE, OR DEATH.
• Report constipation, absence of pain relief.
• Taper slowly after long-term use.
• Do not allow the skin patch to come into contact with
mouth, eyes, nose, or lips, or another person's skin.
References:
Kizior, R. and Hodgson, K. (2018). Saunders Nursing Drug Handbook 2019
(1st ed.). 3251 Riverport Lane St. Louis, Missouri. New York: Elsevier
Fentanyl transdermal (Rx). (n.d.). Retrieved on February 3, 2021 from
https://reference.medscape.com/drug/duragesic-fentanyl-transdermal
DURAGESIC. (2020, May 5). Retrieved on February 3, 2021 from
https://www.rxlist.com/duragesic-drug.htm#description
Fentanyl Transdermal Patch. (2021, January 22). Retrieved on
February 3, 2021 from https://medlineplus.gov/druginfo/meds/
