Transdermal fentanyl patch in the use of chronic and non chronic pain

What is Fentanyl?

Transdermal Fentanyl is a man-made narcotic anodyne that is widely used in clinical anesthesia which was originally synthesised by Dr Paul Janssen in the early 1960ss. It is about one hundred times more powerful that morphia ; which is thought of a the aureate criterion for opiods ; this is where other opiods are compared and tested against morphia. Due to its authority, Fentanyl is chiefly used for chronic long term unwellnesss such as malignant neoplastic disease ; nevertheless it is besides used in short term ague hurting for illustration kid birth ( a Fentanyl epidural would be used in this state of affairs ) . Fentanyl can be administrated in many ways, which include: spot, ionysys, ice lolly, injection and extradural.

Biochemistry

Janssen ‘s synthesis of Fentanyl was to reactN-phenethylpiperidone with aminobenzine to make 4-anilino-N-phenethylpiperidine. This compound is so reacted with propionyl chloride to give pure Fentanyl, which is toxic and must be diluted in order to administer to patients. American Chemical society 2005.

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Transdermal Fentanyl plants by adhering itself to the µ-opioid receptors found in the Central Nervous System and the Gastro-Intestinal piece of land. It has high lipid solubility therefore it binds strongly to plasma proteins and can rapidly traverse the blood-brain barrier. This in bend causes the patient to hold a sense of euphory by increasing the patients pain threshold ( the sum of uncomfortableness a individual feels adequate to see hurting ) and cut downing the sensitiveness of hurting.

Side effects and Benefits

Transdermal Fentanyl is a more popular pick among patients as it provides a better quality of life and produces fewer side effects compared to that of other opiods. The side effects of Fentanyl are generic for all opiods, these include ; respiratory depression ( where the patients take a breathing becomes down and slow ) musculus cramp ‘s, unnatural blood force per unit area ( could be both high or low ) , sickness, purging, blurred vision, rubing ( caused by the substance doing direct contact with the tegument ) , euphoria, giddiness, weight loss and irregularity.

On the other manus there are many benefits that come from utilizing the drug, illustration ; A longer period of release i.e. Fentanyl spot can be released throughout the organic structure for a 70 two hr period utilizing the spot ; and harmonizing to clinical surveies provides an improved hurting alleviation compared to that of morphia. A smaller volume is needed due to its authority and less irregularity and less sedation occurs ( the patient recovers motor map quicker ) .

Converting a patient onto Transdermal Fentanyl Patch from Morphine

The direct version from Morphine to Fentanyl was foremost determined and tried by malignant neoplastic disease patients. These patients are seen to hold a steady and changeless degree of hurting, and are having a changeless dose of Morphine to alleviate it. On unstable hurting Fentanyl does non work at its best.

Below is an illustration of a patient having 100mg IV Morphine Sulphate and is traveling place on Fentanyl spot.

1 ) Convert to 24h unwritten MS dosage

100mg/ IV MS

=

ten

10mg/d IV MS

30mg/d unwritten MS

2 ) Adjust for cross-Tolerance

300mg/d unwritten MS x 0.65† = 200mg/d unwritten MS

† Deducing a 35 % decrease is tantamount to multiplying by 0.65

3 ) Convert seting to dose to Fentanyl Transdermal Patch dosage

200mg/d unwritten MS =

55µ/hr Fentanyl Patch

3.6

4 ) Round to closest Fentanyl Patch dose from ( 25, 50, 75, 100 )

55µ/hr > 50µ/hr Fentanyl patch††

††Replace spot every 3 yearss

5 ) Provide unwritten morphia q2-4h for a break-through -pain at 10 % of 24hr period sum

200mg/d unwritten MS x 0.10 = 20mg unwritten MS q2-4h prn discovery hurting

Ali Olyaei PharmD, 2005

Fentanyl spot

The Fentanyl spot is by and large deliberated if there is no entree viva voce for the patient and is unable to take Fentanyl orally in a tablet/lozenge signifier or If the patient is loath to go on on morphia to due unpleasant side effects such as irregularity, tolerance ; or if the patient is know to o.d. or non taking the medicine this is where the patient will go supervised.

The Transdermal Fentanyl spot is frequently seen as the most common and easy manner to handle chronic and non-chronic hurting. It allows the patient to self administer the drug at place and has the longest consequence on the organic structure. ( Margaret Gibbs 2009 ) The Spot can besides be assisted by the ice lolly, by utilizing it as a top up mechanism to trouble alleviation. Many wellness attention professionals suggest that the spot should merely be used for patients who are opioid-tolerant and can non successfully pull off at that place hurting with other dugs such as morphia. The Spot can come in two signifiers which include ; a Reservoir spot, where the spot is suspended in a matrix and placed onto the tegument ; and a Matrix spot where the drug is distributed equally throughout a matrix.

Reservoir Patch

The rule of this spot is to understand and measure the stableness and skin incursion profiles of Fentanyl.

For this spot the Fentanyl is limited within a reservoir within the spot in a gel signifier.

Dangerous drugs, Justinian Lane 2010

Matrix Patch

Unlike the Reservoir spot there is no Fentanyl gel contained within the spot. This manner of spot topographic points the Fentanyl within the adhesive so it makes direct contact with the tegument. ( Causing the side consequence of rubing ) . This design of spot is seen every bit safer as is it unable to leak gel. Dangerous drugs, Justinian Lane 2010

How to use the Spot

There are many guidelines harmonizing to Drug and Therapeutics Committee August 2009 ; that a patient is required to follow in order to utilize the spot successfully.

* Apply to clean, hairless tegument such as the upper arm ( which has non exposed to radiotherapy ) and prehend in topographic point for 1 minute.

* The spot works by making a sedimentation of drug under the tegument through the pores of the tegument.

* The spot should be replaced every 72 hours. Rotate place so non to annoy the tegument.

* Avoid direct heat – and if the patient has a febrility observe for opioid toxicity.

* Fentanyl is causes less irregularity than morphia. Therefore use half the dosage of laxative if needed and repetition.

* Prescribe strong opioid for discovery with either immediate release morphia sulphate /oxycodone or hypodermic strong opioid

The Patch plants by let go ofing Fentanyl ( either from the matrix gel or the Fentanyl Adhesive ) into the organic structure fats through the pores of the tegument, which in bend releases the drug easy and invariably around the blood stream finally go throughing the blood encephalon barrier leting it to adhere to µ-opiod receptors, giving a changeless hurting alleviation of between 48 and 72 hours which is normally changeless. However, it takes about four- 12 hours for the spot to get down let go ofing Fentanyl into the organic structure. At this point the Fentanyl ice lolly would be used to maintain the patients pain relief up.

Dose is based on the size of the spot and soaking up rate is normally regular, depending on many factors which include organic structure temperature, size of the patient, skin type, measure of organic structure fat, and arrangement of the spot ; can all hold major effects on hurting alleviation and dose.

Fentanyl spots are manufactured in five sizes: 12.5 µg/h,25µg/h, 50µg/h, 75µg/h and 100µg/h.

Fentanyl Lollipop

The Transdermal Fentanyl Lollipop is a fast terminal effectual method of administering the drug, as the drug enters the organic structure via mucose membranes in the oral cavity. It is chiefly used as a “ top up ” method of hurting alleviation in concurrence to the Fentanyl Patch, when the patient requires it. It is an good signifier of disposal as the ice lolly does n’t necessitate trained medical staff sing disposal Richard Payneb et Al. It is preferred among patient as it is portable and fast-acting. The doses for the ice lolly are the undermentioned:

– 200 µg in grey

– 400 µg in bluish

– 600 µg in orange

– 800 µg in purple

– 1200 µg in green

– 1600 µg in Bourgogne

Fentanyl is prescribed after an appraisal of the patient ‘s status, medical history and known tolerance to trouble medicine, such as Morphine. In add-on, the dose is decided based on the badness of the hurting over a 24 hr period.

Decision

To summarize Transdermal Fentanyl is a powerful man-made anodyne which was manufactured for the intervention of both chronic and non chronic hurting direction which include state of affairss such as malignant neoplastic disease or childbearing. It is widely used for the intervention of malignant neoplastic disease as is it about one hundred times more powerful than morphia which is described as the “ aureate criterion ” for opiods. The Fentanyl spot is manufactured in two different manners ; Matrix and Reservoir ; they work by spreading the drug through the pores of the tegument and leting it to be transported around the organic structure ‘s blood system furthermore traversing the blood barrier adhering to the µ-opiod receptors. The ice lolly as a top up mechanism in concurrence harmonizing to the patient ‘s hurting degree. The spot is effectual and preferred by patients as it has fewer side effects than the bulk of opiods i.e. morphia, and provides the patient with a better quality of life as it can be administrated at place and last for about 72 hours.

Mentions

~ Margaret Gibbs, The function of transdermic Fentanyl spots in the effectual direction of malignant neoplastic disease painhttp, ( June 2009 ) : //www.internurse.com – Last accessed 1ts December 2009

~ Last accessed 1st March 2010 ( Online ) hypertext transfer protocol: //www.medicinenet.com/fentanyl_transdermal_system/article.htm

~ Figure 1 ( online ) hypertext transfer protocol: //pubs.acs.org/cen/img/83/i25/8325fentanyl.gif

~ American Chemical society 2005 ( online ) Last accessed 10th March 2010 hypertext transfer protocol: //pubs.acs.org/cen/coverstory/83/8325/8325fentanyl.html

~ Drug and Therapeutics Committee August 2009 ( online ) Last accessed 12th March 2010 hypertext transfer protocol: //www.typepad.com/services/trackback/6a00d8341c716c53ef011571115245970c

~ Figure 2 ( online ) hypertext transfer protocol: //corpreform.typepad.com/.a/6a00d8341c716c53ef01157205fb1a970b-pi

~ Figure 3 ( online ) hypertext transfer protocol: //corpreform.typepad.com/.a/6a00d8341c716c53ef01157205fb2a970b-pi

~ Figure 4 ( online ) hypertext transfer protocol: //pi.watson.com/product_shot_images/00591_3213_72.jpg

~ Last accessed 12th March 2010 ( online ) hypertext transfer protocol: //www.fifeadtc.scot.nhs.uk/support/Fentanyl % 20palliative % 20care.pdf

~ Last accessed 12th March 2010 ( online ) hypertext transfer protocol: //www.typepad.com/services/trackback/6a00d8341c716c53ef011571115245970c

~ Richard Payneb et Al ( online ) Oral transmucosal Fentanyl citrate ( OTFC ) for the intervention of discovery hurting in malignant neoplastic disease patients: a controlled dosage titration survey, ( 1999 ) Trouble 79 303-312, Last accessed www.sciencedirect.com 21/01/2010

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