Episode Outline:
FENTANYL – USE VS. ABUSE
Bottomline – When used appropriately (surgery, cancer) it is very beneficial!
Approach: How to balance benefits vs. risks?
What it is?
• Synthetic narcotic painkiller and anesthetic – created 1960
• Pharmacology – binds to opiate receptors in brain – fast and in small doses 50-100x > morphine, 50x > heroin
• Dosage forms – injection, patch, sublingual, tablet, film, lozenges, lollipops
• Rx pain after surgery, severe cancer pain
o Rx requires enrollment in program to decrease risk of medication
o NMT 4x/day
• Drug Interactions –
o Heart: Amiodarone, Diltiazem
o Antibiotics: Clarithromycin, Erythromycin
o Antifungals: antifungals (fluconazole, itraconazole, ketoconazole)
o Heart burn: Cimetidine
o HIV drugs
o Depressants: Benzodiazepines, muscle relaxants, sedatives, tranquilizers
Risks?
• Narrow therapeutic index!
• Withdrawal – muscle pain, diarrhea, vomiting, nausea, sweating, abdominal pain, cramping, tachycardia, insomnia, tremors, anxiety
• NIH – 9580 deaths in 2015
• Illegal – cut heroin
• Addiction Treatment –
o Methadone, buprenorphine, naltrexone
o Recovery, professional therapy, group counseling
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