[WVUturtle514]

Swtooth is right on....although morphine and fentanyl work by the same mechanism (through agonism of the mu opioid receptors), it does not cause a histamine release like morphine does, which is the reason for the decrease in afterload. I have never heard of fentanyl being given for MI, mainly for the reason above, but also because fentanyl is such a short acting drug, I can't see that it would have much benefit in the MI patient.

[ceecel.dee]

A patch can never be used acutely...it takes hours (like 12-24) to reach therapeutic levels.

[Sweetooth EMT-P, RN]

cee

I think we are all talking about use of IV fentanyl in the cardiac patient, not the patch.

Swtooth

[ceecel.dee]

Originally Posted by swtooth

cee

I think we are all talking about use of IV fentanyl in the cardiac patient, not the patch.

Swtooth

Well, someone else brought up the patch. Certainly just my $0.02 worth.

[royr]

Fentanyl is the pain drug of choice for Pt's with Gall Bladder pain because Morphene makes GB issues worse not better. We also use it for end of life cancer pain for GI cancers along with roxenal and Morphene (anything that helps is given for those in this condition - have put 8 Fentanyl patches + IV push Morphene every hour + sublingual Roxenal with some of these pts that nothing else helps with.

[subee]

Originally Posted by royr

Fentanyl is the pain drug of choice for Pt's with Gall Bladder pain because Morphene makes GB issues worse not better. We also use it for end of life cancer pain for GI cancers along with roxenal and Morphene (anything that helps is given for those in this condition - have put 8 Fentanyl patches + IV push Morphene every hour + sublingual Roxenal with some of these pts that nothing else helps with.

I administer fentanyl many times a day and never have thought about its use in an acute MI but this question is forcing to to think! Its the narcotic of choice for cardiac anesthesia because in large doses it prevents increases in heart rate. Pain during an MI should be treated aggressively to decrease sympathetic stimulation and fentanyl would be more ideal for this than morphine. No problem with it being short acting - just give it more often or follow it with a morphine chaser. Pain is always the enemy during MI.