Fentanyl vs Morphine

[Dustdevil]

Mixing narcotics has far less predictable results than simply hyperdosing with a single narcotic. Therefore, I would be more inclined to stick with Fentanyl.

And no, I would not remove the patch for the "baseline" reason that WelshMedic mentions.

[akflightmedic]

Throw some penthrane in the mix as well...been having great results with it here!!! LOL

[AnthonyM83]

If you know the specific amount of morphine a patient has taken, isn't there a formula for how you would adjust your dosage? I remember a doctor with a mostly full beer mug telling me...but I've forgotten...

(I know it doesn't apply to this scenario since the patch dose is uncertain).

[akroeze]

If you know the specific amount of morphine a patient has taken, isn't there a formula for how you would adjust your dosage? I remember a doctor with a mostly full beer mug telling me...but I've forgotten...

(I know it doesn't apply to this scenario since the patch dose is uncertain).

Yup! Just google "Narcotic Equivalency" and you will find lots of charts. There is even a web site that is fill in the blanks:

http://www.medcalc.com/narcotics.html

[DartmouthDave]

Hello,

Fentanyl patches are in mcg/hr.

The ratio for MSO4:Fentanyl is 1:10 in general.

Cheers

D

[celticcare]

We use Fentynal here in the CCU if the serum creatinine is unstable for Morphine as the Morphine will damage the kidneys, so I would take that into account before I gave pain relief. I know there isnt a mobile lab out there in the field yet, but check into your patients history whether there is renal impairment before pushing morphine if you have fentynal as a substitute.

Just my two cents and just thought I would add it.

Scotty

[zippyRN]

I agree that anyone that is on a fentanyl patch daily, will have a high tolerance for any pain medication that you choose to administer, but you still have to worry about OD. I would remove the fentanyl patch, and continue with Fentanyl IV. Since it is shorter acting, you have less risk of OD, than you would with piling MS on top of the fentanyl and whatever other pain medications are already in their body. If you had a long transport time and the fentanyl wasnt working, you could then move on to the next med in your arsenal.

DO NOT REMOVE THE PATCH !

any predominatly agonist opiate / opioid couldbe used for breakthrough / additional pain relief

[krumel]

Hi,

learned not to remove the patch until needed (i.e. cause she got unconscious, etc.), like welsh said for the base line reasons.

The problem with mixing opiate/opioids is the receptor block. The fentanyl is blocking the my*1 rezeptor already (and much stronger due to the fact that it is much more my1 dependent)so the morphine will mainly go to the kappa1* rezeptor which is mainly responsible for the respiratory depression.

So more morphine mainly means a bigger risk for an respiratory problem, not necessary a good pain relief....

I woul consider using the analgetic effects for an very strong pain in this situation. For an normal pain relief going up with the fentanyl's dose seems sufficient for me.

* Couldn't find and do not know the right name in english..sorry.

Greetings,

Phil