Nurses Compass
Drug Guide
Alfentanil Hydrochloride
Classification
Therapeutic: Analgesic, Opioid
Pharmacological: Mu-Opioid Receptor Agonist
FDA Approved Indications
- Anesthesia induction and maintenance during surgical procedures
Mechanism of Action
Alfentanil stimulates mu-opioid receptors in the central nervous system, resulting in analgesia and sedation.
Dosage and Administration
Adult: Dose varies; typically 10-20 mcg/kg administered intravenously before surgery, repeated PRN based on response.
Pediatric: Use with caution; dosing individualized based on weight and procedure.
Geriatric: Start at lower end of dosing range due to increased sensitivity.
Renal Impairment: Adjust dose carefully; renal impairment may prolong half-life.
Hepatic Impairment: Use with caution; monitor for prolonged effects.
Pharmacokinetics
Absorption: Immediate onset when administered IV.
Distribution: Widely distributed; crosses the blood-brain barrier.
Metabolism: Primarily by hepatic esterases and cytochrome P450 enzymes.
Excretion: Renal excretion of metabolites.
Half Life: Approximately 90-111 minutes.
Contraindications
- Hypersensitivity to alfentanil or other opioids.
- Respiratory depression.
Precautions
- Use with caution in patients with compromised cardiopulmonary status, head injury, or increased intracranial pressure.
- Monitor closely in elderly and renal/hepatic impairment.
Adverse Reactions - Common
- Respiratory depression (Common)
- hypotension (Common)
- Nausea and vomiting (Common)
Adverse Reactions - Serious
- Serious respiratory depression (Rare)
- Anaphylaxis (Rare)
- Bradycardia (Rare)
Drug-Drug Interactions
- Other CNS depressants, sedatives, or anesthetics increase respiratory depression risk.
- MAO inhibitors may enhance opioid effects.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor vital signs closely, especially respiration and blood pressure.
Diagnoses:
- Impaired gas exchange
- Risk for hypotension
Implementation: Administer IV as prescribed, titrate to effect, have resuscitation equipment ready.
Evaluation: Ensure adequate oxygenation, stable vital signs, and appropriate level of sedation.
Patient/Family Teaching
- Report any difficulty breathing or excessive sedation.
- Avoid operating machinery or driving after sedation.
Special Considerations
Black Box Warnings:
- Potential for respiratory depression and death if improperly used.
Genetic Factors: N/A
Lab Test Interference: N/A
Overdose Management
Signs/Symptoms: Respiratory depression, unconsciousness, pinpoint pupils.
Treatment: Supportive care, airway management, administration of opioid antagonists such as naloxone.
Storage and Handling
Storage: Store in a secure area at room temperature, protected from light.
Stability: Stable under recommended storage conditions.