Fentanyl

Chemical name

N-Фенил-N-[1-(2-фенилэтил) -4-пиперидинил]пропана мид (in the form of citrate)

Gross

C22-H28-N2-O

Characteristics

The white crystalline powder. Virtually nerastvorim in water, easily soluble in alcohol.

Of drugs

The drugs-analgezirutee (drug). Waismann institute (mostly mu-) receptors CNS, spinal cord and peripheral tissues. Increases activity antinozizeptivna system increases the threshold of pain sensitivity. Violate any of the features and nespecificescomu sore ways to Walnut cheeks, hypothalamus, mindalevidnomu range. Changes emotive pain. Provides nursing impact (mainly for the withdrawal of controlling pain). It was euphoria. In reintroduce may develop tolerance and drug dependence. Oppressing breathing center, institute points wandering nerve emetic. Increases tone smooth muscle psoriasis ways sfinkterov, incl. urethra, bladder tumours Oddi, reduces intussusception irritative improves suction water from the blood. Reduces Kidney bloodstream. The increased blood content amilazy and Lipaza.dla the average concentration of anesthesia fentanyl must reach 15 to 20 ng / J The on / in the introduction effect occurs after 1-3 min, reaches its peak in 5-7 minutes and lasts for 20 to 60 minutes, with the m-by 7-15 min. A blood protein binds to 79%. Cl is 0.4-0.5 l / min, T_1/2-min 10-30, the distribution-80 litres. Quickly transferred from the blood and marrow in the muscles and jirovu fabric. Biotransformiroetsa in the liver (N-dealkilirovanie and gidrauxilirovnie), kidney, gut and napochechnikah. Return with urine (75%, in the form of metabolites and 10% in an unmodified form) and faeces (9% in the form of metabolites). Penetrates into breast Moloko.iz trancdermalna system (the software patch) release fentanyl occurs at a constant speed for 72 hours, with the therapeutic concentration in the serum is gradually increasing in the first 12-24 hours, persisting relatively constant for the remainder of the period (T_1/2 after the fourth application is about 17 hours). Removing the patch leads to a gradual decline in the standard.

Indications

Premedikation before surgery, anaesthesia induction, postoperative analgesia, neiroleptanalgesia expressed pain syndrome, chronic pain in oncology. Nekupeerootesa pain (thin strips).

Contraindications

Hypersensitivity, bronchial asthma, breathing oppression centre craniocerebral hypertension, obstetric operations, drug addiction, pregnancy, breast-feeding (breast-feeding deleted).

Side-Effects

Gipoventilatia, respiratory depression until stopping (in high doses), bronhospazm, paradoxical CNS stimulation, sputannosti consciousness, hallucinations, temporary rigidity of muscles (including infants), aetiology, nausea, vomiting, constipation, liver kolica, urine retention, ambliopia. Hanna : local skin reactions, skin, erythema, skin (disappear within 24 h after removal patch).

Specific guidance

Not a neiroleptanalgesia, in the absence of conditions for the IVL.

Patient interaction

The effect reduces buprenorphine. Opiates, sedatives, hypnotics, fenotiazina, tranquillisers, to narcosis, muscle relaxants, antihistamines preparations of sedatia, alcohol, etc. deprimirote means increases the likelihood of side effects of the (CNS oppression, gipoventilatia and hypotension, etc.). Benzodiazepines lengthened exit neiroleptanalgesia. Nitrous oxide increases muscle rigidity, antigipertenzivee means, hypotension, MAO inhibitors, the risk of severe complications.

Overdosing

Symptoms : oppression Dahania.lechenie : introduction naloxone, breathing oxygen IVL, in the case of a patch, its immediate removal.

Precautions

Lifting products are gradually. Using high doses of depleted and astenichnykh patients may develop secondary respiratory depression arising from the release of fentanyl in 1-2 hours after the opening stomach and rezorbziei follow. The patch is not recommended for treating acute or postoperative pain (due to the impossibility of identifying dose in a short period of treatment and the risk of gipoventilation), the women of childbearing age, and requires care for chronic, incl. obstructive lung diseases (possibly oppression respiratory centre), the violation of consciousness, coma, brain tumors, bradiaritmiah, liver and kidney failure, the elderly and children. Using strips advised to avoid direct external heat sources (heaters, saunas, sunbathing, etc.). During treatment should not engage in potentially hazardous activities that require greater attention and psychomotor reactions.

Dosing and Administration

In / in, in / m Local (trancdermalnaya system in the form of strips). For Then and aftercare period / m for 0.05-0.1 mg, children - 0,002 mg / kg; Induction narcosis in / in the 0.1-0.2 mg; Neiroleptanalgesia in / in the 0.2-0.6 mg (a repeat every 20 minutes); From the operations in the heart of the open-0.05-0.1 mg / kg Locally, at 1972 hrs placed on the flat surface of the skin (nerazdrajennouu, with a minimum cover of rejection, if necessary wamyten clean water, without the use of detergents and carefully clay), and keep close (seats chereduyut software). Dose picked individually. Patients who had not previously participated opiates, the initial dose of 25 µ g / h; With tolerance to opiates in the transition to treatment fentanyl initial dose calculated from the relevant tables from the previous day needs analgetikah; With a dose of 300 µ g / h possible additional or alternative means of introduction.

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