Читать книгу Fundamentals of Pharmacology for Paramedics - Группа авторов - Страница 36

You are treating 94‐year‐old Nelida, who has fallen in her residential aged care facility while going to the bathroom. She has a large bruise on the side of her head (temporal region) and a shortened and rotated left leg, as well as a deep laceration to her left upper thigh caused by the shard of a mirror that broke during the fall. Staff report that the patient has dementia but can still converse appropriately most days. The patient is in extreme pain but her heart rate is not elevated. You realise this is probably due to her being on a beta‐blocker for hypertension. You administer intranasal fentanyl repeatedly en route to hospital to treat her pain. On arrival, her level of consciousness has decreased. Reflecting on what might have caused this, you consider that the combination of blood loss and a blunted compensatory response due to the beta‐blockers, along with a reduced renal capacity due to her age, and the fact that the repeated fentanyl doses have not been cleared as rapidly as expected has resulted in an accumulation of medication, leading to adverse effects.

While this is not a contraindication of fentanyl, it is important to remember that older patients often clear medications much more slowly than younger patients, and dosing may need to be adjusted to account for this, to avoid adverse effects.