Assessment

• Monitor type, location, and intensity of pain before and 1 hr after administration of buccal fentanyl

• Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is <10 min, assess level of sedation. Physical stimulation may be sufficient to prevent hypoventilation. Subsequent doses may need to be decreased. Patients tolerant to opioid analgesics are usually tolerant to the respiratory depressant effects also

• Monitor for application site reactions (paresthesia, ulceration, bleeding, pain, ulcer, irritation). Reactions are usually self-limited and rarely require discontinuation

• May cause anemia, neutropenia, thrombocytopenia, and leukopenia

» May cause hypokalemia, hypoalbuminemia, hypercalcemia, hypomagnesemia, and hyponatremia

• If an opioid antagonist is required to reverse respiratory depression or coma, naloxone (Narcan) is the antidote. Dilute the 0.4-mg ampule of naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL (0.02 mg) by direct IV push every 2 min. For patients weighing <40 kg, dilute 0.1 mg of naloxone in 10 mL of 0.9% NaCl for a concentration of 10 mcg/mL and administer 0.5 mcg every 2 min. Use extreme caution when titrating dose in patients physically dependent on opioid analgesics to avoid withdrawal, seizures, and severe pain. Duration of respiratory depression may be longer than duration of opioid antagonist, requiring repeated doses

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