Fentanyl+Patch

=Fentanyl Patch=

How it works
Durogesic patches contain a medicine called fentanyl. This strong pain reliever belongs to a group of medicines known as opioid analgesics. Fentanyl relieves pain by blocking the nerves that recognise pain messages from the body. This is used in patients intolerant of morphine. //Opioid analgesics mimic endogenous opioids by activating opioid receptors in the central and peripheral nervous systems to produce analgesia, respiratory depression, sedation and constipation. They prevent transmission of the pain impulse by acting pre- and post-synaptically in the spinal cord, and by modulating the descending inhibitory pathways from the brain. Cough suppression occurs in the medullary centre of the brain. The affinity of individual opioid analgesics for receptors varies and opioids may act as pure agonists or partial agonists. Partial agonists demonstrate a ceiling response above which an increase in dose does not produce an additional increase in effect.//

Questions to Ask
What medications? //fluconazole, ritonavir and voriconazole (decrease fentanyl metabolism), CNS depressants (increase risk of respiratory depression), drugs that lower BP or cause bradycardia (as all opioids can cause hypotension), MAOIs (should not be used within 14 days of cessation)// - medical conditions? fentanyl can be used in severe renal impairment (no active/toxic metabolites) - allergies?

Be aware that drug interactions may persist longer if fentanyl patches are used (plasma fentanyl concentration slowly falls after patch removal, eg is halved after about 22–25 hours).

How to take
Do not use fentanyl patch in opioid-naive patients. Base dose on previous 24-hour opioid requirement; calculate equivalent 24-hour fentanyl dose if necessary. It may be appropriate to stabilise the patient on fentanyl SC infusion, and then convert to the patch which releases fentanyl at the same hourly rate as the infusion. Use 1 patch every 3 days. Adjust dose according to response, no more frequently than every 3 days if analgesia is insufficient
 * Chronic pain**

1. Find an intact and hairless spot of skin on the upper part of your body or on your upper arm. The skin should be healthy and undamaged. Do not place the patch onto skin that is red, burnt or damaged. 2 . Trim any excess hair with scissors. Do not shave the hair off since this may affect the skin. If you need to wash the skin before applying the patch, use clean water only. Do not use soap, oils or lotions. The skin should be completely dry before applying the patch. 3. To open the pouch, locate the pre-cut notch indicated by the scissors. Make a small cut and fold at the notch. Carefully tear the pouch along the edge and then fully open the pouch by folding it open like a book. 4. Remove the Durogesic patch from the sealed pouch. **Do not apply the patch if it looks damaged in any way. Never cut or divide the patch. Do not use a patch that has been divided, cut, or damaged in any way.** 5. Each Durogesic patch has a clear plastic protective (release) liner that can be peeled off in two pieces. After folding the patch in the middle, peel off each part of the protective liner separately. **Avoid touching the adhesive side of the patch.** <span style="FONT-FAMILY: Arial, Helvetica, sans-serif">6. Apply the patch to the skin and press with the palm of the hand for about 30 seconds. Make sure all of the patch is in contact with skin and the corners are stuck tightly. 7. Wash hands after applying or removing the patch. You can now leave the patch on the skin for three days (72 hours). You may have a bath, shower or swim. Always write the date and time you applied the patch on the pack. It will help you to use Durogesic correctly and remember when the next patch is due. <span style="FONT-FAMILY: Arial, Helvetica, sans-serif">1. After three days (72 hours), remove the patch. 2. Fold the used patch in half so that the adhesive side sticks to itself. Wrap the folded patch and carefully dispose of it in the garbage. <span style="FONT-FAMILY: Arial, Helvetica, sans-serif">3. Apply a new patch straight away to a different area of the skin.
 * How to use**
 * How to remove**

//The manufacturer states that 25 micrograms/hour patch is approximately equivalent to 90 mg/24 hours oral morphine.//

Side effects
rash, erythema, itch (patch); bradycardia; may have a lower incidence of nausea, vomiting and constipation than other opioids chest wall rigidity with rapid/very high IV doses
 * Common**
 * Rare**

Other advice?

 * do not use patch for postoperative and other acute pain because of the risk of life-threatening respiratory depression; it has a prolonged onset and duration of action; rapid and safe dose titration is not possible
 * patch takes about 24–72 hours to reach maximum effect; steady state concentration may not be reached until the second patch is applied; wean other analgesics slowly after first patch is applied
 * patch is effective for 72 hours; plasma concentration slowly falls after patch removal (eg concentration is halved after about 22–25 hours)
 * monitor for adverse effects for up to 24 hours after removal of patch
 * heat increases the release of fentanyl from patch; monitor for increased adverse effects if patient is exposed to high ambient temperatures, external heat source (including heated blanket), or develops a fever
 * 40–50% of the dose remains in the patch after 3 days; it is important that the patient/carer understands how to dispose of patches safely

CMI
[|Durogesic] [|AMH]