DiseasesChemicals and DrugsAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPsychiatry and PsychologyPhenomena and ProcessesHealth Care
Breakthrough PainAdministration, BuccalFentanylAnalgesics, OpioidLabor PainPainAnalgesia, EpiduralPain MeasurementNasal SpraysDouble-Blind MethodNeoplasmsChronic DiseasePain, PostoperativePain ManagementChronic PainPain ThresholdPain, IntractableRadionuclide GeneratorsLow Back PainBack PainAnesthetics, IntravenousTreatment OutcomeAbdominal PainNeck PainTime FactorsMorphineAdministration, CutaneousAerosolsEpisode of CarePelvic PainFacial PainPain PerceptionGene DosageBupivacaineDosage FormsAnesthetics, Local
OverdoseOpioidInadequateHeroinAddictionWidelyAcutePatientsTherapiesMimicking pharmaceuticalPatient'sDrugsCloselyInterventionDrugManagementUsersADMINISTRATIONMedicalTreatment of PainRequiresProperAnalgesiaOpioidsSubsysTransdermalOveruseIntravenousCitrateMorphineIntrathecal2020Opioid analgesicsProcedureAdultsCYP3A4OccurDrugsPrimarilyNauseaReductionRespiratory depressionPainfulDurationAdverseMedicationsEffectsPersistentAdministrationIncreasesToleranceAnother episodeCancer patientsDiscussManagementProductsAdditionalPatientsDisordersTotalWorksChildrenRelief
Overdose10
  • Accidental ingestion of SUBSYS, especially by children, can result in a fatal overdose of fentanyl. (nih.gov)
  • Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose. (wikipedia.org)
  • Fentanyl continues to fuel an epidemic of synthetic opioid drug overdose deaths in the United States. (wikipedia.org)
  • Since 2018, fentanyl and its analogues have been responsible for most drug overdose deaths in the United States, causing over 71,238 deaths in 2021. (wikipedia.org)
  • Fentanyl constitutes the majority of all drug overdose deaths in the United States since it overtook heroin in 2018. (wikipedia.org)
  • There is a huge risk of overdose and death to those who abuse fentanyl or become addicted to it due to the drug's potency. (clearpathintervention.com)
  • Fentanyl and other synthetic opioids are now the most popular drug contributing to overdose deaths in the United States. (clearpathintervention.com)
  • The type of fentanyl responsible for overdose deaths is non-pharmaceutical grade fentanyl, which is made in other countries and smuggled into the US. (clearpathintervention.com)
  • What happens if they fentanyl overdose before the intervention ? (clearpathintervention.com)
  • A fentanyl overdose has the potential to be fatal. (clearpathintervention.com)
Opioid11
  • Due to the risk of fatal respiratory depression, SUBSYS is contraindicated in opioid non-tolerant patients ( 1 ) and in management of acute or postoperative pain, including headache/migraines. (nih.gov)
  • SUBSYS is an opioid agonist indicated for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to around-the-clock opioid therapy for their underlying persistent cancer pain. (nih.gov)
  • Fentanyl, also spelled fentanil, is a highly potent synthetic piperidine opioid drug primarily used as an analgesic. (wikipedia.org)
  • Fentanyl works by activating mu-opioid receptors. (wikipedia.org)
  • Fentanyl is the most commonly used intrathecal opioid because its lipophilic profile allows a quick onset of action (5-10 min) and intermediate duration of action (60-120 min). (wikipedia.org)
  • Nonopioid and opioid analgesics are the main drugs used to treat pain. (merckmanuals.com)
  • Patients with cancer or noncancer pain requiring chronic therapy are monitored closely to optimize treatment and to minimize the likelihood of complications of opioid use, including misuse or abuse. (tri-kobe.org)
  • Fentanyl is a powerful synthetic opioid that is around 100x more potent than morphine and much more deadly. (clearpathintervention.com)
  • Fentanyl comes from the opioid class of painkillers, meaning it is created synthetically. (clearpathintervention.com)
  • Non-pharmaceutical grade fentanyl has begun to be cut into other popular drugs like cocaine , meth , heroin, club drugs and even marijuana, resulting in an uptick in accidental opioid-driven deaths. (clearpathintervention.com)
  • This drug is often prescribed to those who have developed a tolerance to every other type of opiate or opioid, meaning that those being given access to fentanyl legally are often the same people who have misused and developed tolerances to other safer pain medication. (clearpathintervention.com)
Inadequate1
  • If initial recommended doses provide inadequate analgesia, a higher dose is given, up to the conventional safe maximum dose. (merckmanuals.com)
Heroin2
  • Fentanyl is often mixed, cut, or ingested alongside other drugs, including cocaine and heroin. (wikipedia.org)
  • If you intentionally abuse fentanyl-laced heroin, cocaine , opioids, or even fentanyl, you need a good addiction treatment program. (clearpathintervention.com)
Addiction5
Widely3
  • Fentanyl's ease of manufacture and high potency makes it easier to produce and smuggle, resulting in fentanyl replacing other abused narcotics and becoming more widely used. (wikipedia.org)
  • It is widely used in obstetrical anesthesia because of its short time to action peak (about 5 minutes), the rapid termination of its effect after a single dose, and the occurrence of relative cardiovascular stability. (wikipedia.org)
  • Pharmaceutical-grade fentanyl has been widely used in hospitals for years to block pain during surgical procedures and to treat chronic pain. (clearpathintervention.com)
Acute4
  • Not for use in the management of acute or postoperative pain, including headache/migraine, dental pain, or in the emergency room. (nih.gov)
  • Pain has sensory and emotional components and is often classified as acute or chronic. (merckmanuals.com)
  • Acute pain is frequently associated with anxiety. (merckmanuals.com)
  • Is the pain acute or chronic? (tri-kobe.org)
Patients7
  • limit dosages and durations to the minimum required and follow patients for signs and symptoms of respiratory depression and sedation. (nih.gov)
  • Because fentanyl is 50 to 100 times more potent than morphine, its primary clinical utility is in pain management for cancer patients and those recovering from painful surgical operations. (wikipedia.org)
  • Cognitive-behavioral interventions may reduce pain and pain-related disability and help patients cope. (merckmanuals.com)
  • These interventions include counseling to refocus a patient's thoughts from the effects and limitations of pain to the development of personal coping strategies and may include counseling to help patients and their family work together to manage pain. (merckmanuals.com)
  • Overview of Pain Pain is the most common reason patients seek medical care. (merckmanuals.com)
  • Pain is one of the most common symptoms in cancer patients and often has a negative impact on patients' functional status and quality of life. (tri-kobe.org)
  • [ 3 ] Pain is commonly experienced by cancer patients. (tri-kobe.org)
Therapies1
  • Identifying the optimal pharmacologic and nonpharmacologic treatment options (refer to the Pharmacologic Therapies for Pain Control section of this summary for more information), including referrals to specialists, if needed. (tri-kobe.org)
Mimicking pharmaceutical1
  • Fentanyl has been reported in pill form, including pills mimicking pharmaceutical drugs such as oxycodone. (wikipedia.org)
Patient's1
  • Regular screening to ensure that the patient's pain is recognized early. (tri-kobe.org)
Drugs2
  • Antidepressants, antiseizure drugs, and other central nervous system (CNS)-active drugs may also be used for chronic or neuropathic pain and are first-line therapy for some conditions. (merckmanuals.com)
  • The other issue with the fentanyl invasion is that the drug is being inadvertently consumed by those addicted to or abusing more mainstream drugs. (clearpathintervention.com)
Closely2
  • Monitor closely, especially upon initiation or following a dose increase. (nih.gov)
  • In obstetrics, the dose must be closely regulated in order to prevent large amounts of transfer from mother to fetus. (wikipedia.org)
Intervention1
  • Complex pain often requires multidimensional interdisciplinary evaluation and intervention. (tri-kobe.org)
Drug3
  • Balancing this medication and titrating the drug based on expected stimuli and the person's responses can result in stable blood pressure and heart rate throughout a procedure and a faster emergence from anesthesia with minimal pain. (wikipedia.org)
  • At high doses, the drug may act on the fetus to cause postnatal respiratory distress. (wikipedia.org)
  • This effect appears to vary by specific drug, as well as by dose and duration. (merckmanuals.com)
Management1
  • The goal of the following summary is to provide evidence-based, up-to-date, and practical information on the management of cancer pain. (tri-kobe.org)
Users1
ADMINISTRATION1
Medical1
  • Fentanyl was first synthesized by Paul Janssen in 1959 and was approved for medical use in the United States in 1968. (wikipedia.org)
Treatment of Pain1
  • This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the pathophysiology and treatment of pain. (tri-kobe.org)
Requires1
  • Determining whether the pain requires pharmacologic and/or other modalities of treatment. (tri-kobe.org)
Proper1
  • Proper characterization of the pain to identify underlying pathophysiology, which could significantly influence treatment options. (tri-kobe.org)
Analgesia9
  • CLINICAL PHARMACOLOGY Mechanism Of Action Fentanyl is an opioid agonist whose principal therapeutic action is analgesia. (clustermed.info)
  • monitor and titrate to a tolerable dosage level until adequate analgesia achieved using a single Subsys dose per episode. (empr.com)
  • If adequate analgesia obtained within 30 mins, treat subsequent episodes with this dose. (empr.com)
  • Fentanyl is sometimes given intrathecally as part of spinal anesthesia or epidurally for epidural anaesthesia and analgesia. (wikipedia.org)
  • INTERVENTIONS: Combined spinal-epidural labor analgesia was initiated with intrathecal fentanyl and epidural analgesia was maintained using continuous epidural infusion with patient-controlled epidural boluses. (bvsalud.org)
  • BACKGROUND: Epidural analgesia is often used for pain relief during labour and childbirth, and involves administration of local anaesthetics (LA) into the epidural space resulting in sensory blockade of the abdomen, pelvis, and perineum. (bvsalud.org)
  • Also, differences in the initiation of epidural analgesia such as combined spinal-epidural (CSE) (medications given into the intrathecal space in addition to the epidural space) compared to epidural only, and medications used (types and doses of LA or opioids) may not have been accounted for in previous reviews. (bvsalud.org)
  • Our prior systematic review suggested that AMB reduces the incidence of breakthrough pain compared to BI with no significant difference in the incidence of caesarean delivery or instrumental delivery, duration of labour analgesia, and LA consumption. (bvsalud.org)
  • SELECTION CRITERIA: We included all randomised controlled studies that compared bolus dosing AMB with continuous BI during epidural analgesia. (bvsalud.org)
Opioids4
  • Updates to the IR opioids state that these drugs should not be used for an extended period unless the pain remains severe enough to require an opioid pain medicine and alternative treatment options are insufficient, and that many acute pain conditions treated in the outpatient setting require no more than a few days of an opioid pain medicine. (medlineplus.gov)
  • Updates to the ER/LA opioids recommend that these drugs be reserved for severe and persistent pain requiring an extended period of treatment with a daily opioid pain medicine and for which alternative treatment options are inadequate. (medlineplus.gov)
  • Alvimopan is contraindicated in opioid tolerant patients (ie, those who have taken therapeutic doses of opioids for >7 consecutive days immediately prior to taking alvimopan). (medscape.com)
  • It will also discuss the core aspects of prescribing opioids for pain, including best-practice opioid prescribing guidelines, proper monitoring of patients on long-term opioid therapy, and the clinical features of opioid misuse/OUD. (nursingce.com)
Subsys1
Transdermal1
  • Opioid-tolerant patients are those taking oral morphine ≥60mg/day, transdermal fentanyl ≥25mcg/hr, oral oxycodone ≥30mg/day, oral hydromorphone ≥8mg/day, oral oxymorphone ≥25mg/day, oral hydrocodone ≥60mg/day, or equianalgesic dose of another opioid for ≥1 week. (empr.com)
Overuse2
  • There is a greater risk that you will overuse fentanyl sublingual spray if you have or have ever had any of these conditions. (medlineplus.gov)
  • Mechanical pain is induced by trauma, injury, or overuse. (nursingce.com)
Intravenous2
  • Although not observed with oral transmucosal fentanyl products in clinical trials, fentanyl given rapidly by intravenous injection in large doses may interfere with respiration by causing rigidity in the muscles of respiration [see WARNINGS AND PRECAUTIONS]. (clustermed.info)
  • Intravenous fentanyl is often used for anesthesia and as an analgesic. (wikipedia.org)
Citrate2
  • Peak respiratory depressive effects may be seen as early as 15 to 30 minutes from the start of oral transmucosal fentanyl citrate product administration and may persist for several hours. (clustermed.info)
  • Fentanyl is also commonly known as fentanyl citrate and is sold under the brand name Sublimaze, among others. (wikipedia.org)
Morphine1
Intrathecal1
  • Fentanyl is the most commonly used intrathecal opioid because its lipophilic profile allows a quick onset of action (5-10 min) and intermediate duration of action (60-120 min). (wikipedia.org)
20202
  • The United States National Forensic Laboratory estimates fentanyl reports by federal, state, and local forensic laboratories increased from 4,697 reports in 2014 to 117,045 reports in 2020. (wikipedia.org)
  • In 2020, the International Association for the Study of Pain (IASP) revised its definition of pain for the first time since 1979 to the following: "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage" (IASP, 2020). (nursingce.com)
Opioid analgesics1
Procedure3
  • This medication should not be used to treat pain other than chronic cancer pain, especially short-term pain such as migraines or other headaches, pain from an injury, or pain after a medical or dental procedure. (medlineplus.gov)
  • Balancing this medication and titrating the drug based on expected stimuli and the person's responses can result in stable blood pressure and heart rate throughout a procedure and a faster emergence from anesthesia with minimal pain. (wikipedia.org)
  • The almost immediate onset of fentanyl reduces visceral discomfort and even nausea during the procedure. (wikipedia.org)
Adults1
  • Even used fentanyl sublingual spray containers may contain enough medication to cause serious harm or death to children or other adults. (medlineplus.gov)
CYP3A41
  • Concomitant use or discontinuation of CYP3A4 inhibitors or inducers: monitor closely and consider dose adjustments (see full labeling). (empr.com)
Occur3
  • Serious or fatal respiratory depression can occur even at recommended doses. (clustermed.info)
  • It should be used only to treat breakthrough cancer pain (sudden episodes of pain that occur despite around-the-clock treatment with pain medication) in cancer patients at least 18 years of age who are taking regularly scheduled doses of another narcotic (opiate) pain medication, and who are tolerant (used to the effects of the medication) to narcotic pain medications. (medlineplus.gov)
  • 4 episodes per day occur. (empr.com)
Drugs3
  • Fentanyl is often mixed, cut, or ingested alongside other drugs, including cocaine and heroin. (wikipedia.org)
  • Fentanyl has been reported in pill form, including pills mimicking pharmaceutical drugs such as oxycodone. (wikipedia.org)
  • Antidepressants, antiseizure drugs, and other central nervous system (CNS)-active drugs may also be used for chronic or neuropathic pain and are first-line therapy for some conditions. (msdmanuals.com)
Primarily1
  • Fentanyl, also spelled fentanil, is a highly potent synthetic piperidine opioid drug primarily used as an analgesic. (wikipedia.org)
Nausea1
  • Concentration-Adverse Reaction Relationships There is a relationship between increasing fentanyl plasma concentration and increasing frequency of dose-related opioid adverse reactions such as nausea, vomiting, CNS effects, and respiratory depression. (clustermed.info)
Reduction2
  • Effects On The Gastrointestinal Tract And Other Smooth Muscle Fentanyl causes a reduction in motility associated with an increase in smooth muscle tone in the antrum of the stomach and duodenum. (clustermed.info)
  • consider dose reduction if CSA develops. (empr.com)
Respiratory depression3
  • Pharmacodynamics Effects On The Central Nervous System Fentanyl produces respiratory depression by direct action on brain stem respiratory centers. (clustermed.info)
  • Respiratory System All opioid mu-receptor agonists, including fentanyl, produce dose-dependent respiratory depression. (clustermed.info)
  • Information in the boxed warning for all IR and ER/LA opioid pain medicines will be updated and reordered to elevate the importance of warnings concerning life-threatening respiratory depression, and risks associated with using opioid pain medicines in conjunction with benzodiazepines or other medicines that depress the central nervous system (CNS). (medlineplus.gov)
Painful1
  • Fundamentally, pain is felt when sensory nerve endings called nociceptors (or pain receptors) come in contact with a noxious (painful) stimulus. (nursingce.com)
Duration2
  • Use lowest effective dose for shortest duration. (empr.com)
  • This effect appears to vary by specific drug, as well as by dose and duration. (msdmanuals.com)
Adverse1
  • In opioid-tolerant patients, the situation may be altered by the development of tolerance to opioid-related adverse reactions [see DOSAGE AND ADMINISTRATION]. (clustermed.info)
Medications2
  • Fentanyl sublingual spray may cause serious breathing problems or death, especially if it is used by people who have not been treated with other narcotic medications or who are not tolerant (used to the effects of the medication) to narcotic medications. (medlineplus.gov)
  • The superior method of delivering epidural medications would result in lower incidence of pain requiring anaesthesiologist intervention (breakthrough pain). (bvsalud.org)
Effects3
  • Effects On The Cardiovascular System Fentanyl produces peripheral vasodilation which may result in orthostatic hypotension or syncope. (clustermed.info)
  • Concentration-Efficacy Relationships The analgesic effects of fentanyl are related to the blood level of the drug, if proper allowance is made for the delay into and out of the CNS (a process with a 3- to 5-minute half-life). (clustermed.info)
  • These interventions include counseling to refocus a patient's thoughts from the effects and limitations of pain to the development of personal coping strategies and may include counseling to help patients and their family work together to manage pain. (msdmanuals.com)
Persistent1
  • Management of breakthrough pain in opioid-tolerant cancer patients who are already receiving and are tolerant to around-the-clock opioid therapy for their underlying persistent cancer pain. (empr.com)
Administration1
Increases1
  • monitor within first 24-72hrs of initiating therapy and following dose increases. (empr.com)
Tolerance1
  • The minimum effective analgesic concentration of fentanyl for any individual patient may increase over time due to an increase in pain, the development of a new pain syndrome, and/or the development of analgesic tolerance. (clustermed.info)
Another episode1
  • Wait at least 4hrs before treating another episode. (empr.com)
Cancer patients1
  • Fentanyl sublingual spray should be prescribed by doctors who are experienced in treating pain in cancer patients. (medlineplus.gov)
Discuss2
  • While using fentanyl sublingual spray, discuss with your health care provider your pain treatment goals, length of treatment, and other ways to manage your pain. (medlineplus.gov)
  • This course will provide an overview of the pathophysiology of pain, the components of a comprehensive pain assessment, and discuss nonpharmacological and non-opioid pharmacological management of pain. (nursingce.com)
Management1
  • In 1968, Margo McCaffery, a pioneer and world-renowned expert in pain management, defined pain as "…whatever the experiencing person says it is, existing whenever he says it does" (McCaffrey, 1968). (nursingce.com)
Products1
Additional1
Patients2
  • Cognitive-behavioral interventions may reduce pain and pain-related disability and help patients cope. (msdmanuals.com)
  • patient-controlled epidural boluses use and timing require numeric understanding, as patients need to understand when they can administer supplemental boluses, lockout intervals, and total doses. (bvsalud.org)
Disorders1
  • Chemical pain is associated with inflammatory disorders, and thermal pain is due to excessive heat or cold exposure. (nursingce.com)
Total1
Works1
  • Fentanyl works by activating mu-opioid receptors. (wikipedia.org)
Children1
Relief1
  • For pain relief after surgery, use can decrease the amount of inhalational anesthetic needed for emergence from anesthesia. (wikipedia.org)