Fentanyl Transdermal Patch and Fatal Adverse Reactions Essays

Fentanyl Transdermal Patch and Fatal Adverse Reactions Essays Fentanyl Transdermal Patch and Fatal Adverse Reactions Paper Fentanyl Transdermal Patch and Fatal Adverse Reactions Paper The fentanyl transdermal system is used to manage pain. Unlike other pain killers this system manages moderate to severe chronic pain, which other means like opiod combination cannot manage. Safety concerns This system’s safety is only guaranteed if used according to the conditions recommended in the Canadian product monograph. Duragesic is the brand name under which the fentanyl transdermal system has been marked since the year 1992. Two generic products were introduced in July 2006. They are Ran Fentanyl and Ratio-Fentanyl transdermal systems. There have been numerous reports of serious adverse reactions which Health Canada suspects that they are linked to fentanyl transdermal patches. Health Canada is closely monitoring this situation. Fatal outcomes involved opioid-naive adolescents who are suspected to have abused the medication. AR with a fatal outcome linked to fentanyl trandermal patches There were fifty-two AR reports with a fatal outcome being linked to fentanyl transdermal patches. These were submitted to Health Canada from January 1, 1992 to December 31, 2007. : A total of six cases of AR were due to dose initiation and titration. Prescriptions to oploid-naive patients were three, quick titration doses two and one high initiation dose. There was also one case of use concomitant with other central nervous system depressants. The death occurred within twenty-four hours after initiation. CNS depression due to combination of the medication with other CNS depressants was reported as the cause of death. A death was also reported due to interaction between CY3A4 inhibitor and fentanyl transdermal. It occurred less than four days after being initiated during fentanyl transdermal therapy. Six patients died due to patch application by the patients. Four of the patients applied more than the prescribed medication while one patient applied a new patch with the old patches on. Another patient changed the patch daily instead of every three days. There were three fatalities due to caregiver application of the patch. One case was due to the caregiver attempting to reduce dosage by folding the patch in half. Another case was due to the caregiver administering new patch while the old one was on. Still one more case was due to the caregiver pressing on it because it did not stick, thereby leaking fentanyl transdermal and overdosing the patient. One fatality occurred due to a patient using a patch prescribed for another patient. The sixty-four year old man applied the patch prescribed for his wife. The patient became unresponsive, vomited and aspirated. He died five days later due to pneumonia and renal failure. Five fatalities occurred due to accidental overdose. One patient was elderly and underweight. Another died of cardiac arrhythmia as a result of overdose fentanyl and antidepressants. Another had toxic levels of fentanyl after the second dose. The other two cases had limited information and could not be immediately established. Intentional overdose with suicide missions was evident in four of the cases while those of intentional drug abuse of the fentanyl patches were a massive twenty-five (MacMorran, 2008). Health promotion initiatives Health care professionals should therefore follow the directions available in the fentanyl transdermia patches product monographs. It is essential for patients, caregivers and their respective families to be guided on using the product safely. This includes safe storage of the drugs, preventing their accessibility for abuse and to prevent any accidental overdose. Rectification steps Following death reports linked to inappropriate use of the medication, the Canadian product monograph had to be revised in 2005. This was in order to emphasize this safety information. Subsequent advisories followed again in September 2005. A number of publications have followed suit in highlighting safety issues related to the medication use. Health Canada received 105 reports from Jan 1, 1992 to December 31, 2007. According to these reports, the ARs are suspected of being closely associated with fentanyl transdermal patches and one fatal case was reported. Twenty-seven of these reports were received after the last risk communication by Health Canada. The data were analyzed as part of monitoring AR reports. This was to identify any potentially preventable incidents and increase awareness on the product’s safety. In some cases there was no evidence to link the deaths to fentanyl transdermal. This was the case in thirty-three out of the 105 of these reports. In twenty such cases, there was insufficient information in the report for any meaningful evaluation (Raymond et al, 2004). Personal interest held by the advisory The drug advisory has challenged me personally to come up with alternative drugs that can serve the same purpose but are less risky. Proper administration and usage of drugs has also been emphasized. I have been encouraged to handle any drugs carefully. It has brought a very clear realization that people’s lives are at stake and we have to be very careful. Impact of the advisory on a practicing nurse in 2008 The advisory has had a significant impact on the practicing nurse. They have to be very careful not to administer the Fentanyl patch to any more patients unless under prescription and strict following of instructions. This has led to seeking alternative drugs. The altenative drugs have their own short-comings which the patients may not be used to or even aware of. In cases where usage of Fentanyl cannot be abandoned, very strict measures have had to be taken to avoid misuse, overdose and abuse. This has added some extra responsibilities to the nurses. References Canadian Safety Bull. (2006). Fentanyl transdermia: a misunderstood dosage form. 6 (5). Canada Safety Bull (2007). Fentanyl patch linked to another death in Canada. Duragenic (2007). Fentanyl transdermal System: product monograph. Janssen-Ortho Inc: Toronto. MacMorran, M. (2008). Fentanyl transdermia patch and fatal adverse reactions. Canadian Adverse Reaction Newsletter. Raymond, B. et al (2004). Respiratory arrest in adolescents. Duragenic. Canadian Adverse Reaction News. 14 (4): 1-2