Age is a key factor underlying the determination of dosing for many drugs. It is obvious that there exist developmental factors that affect the dosage. These factors range from body size, adaptation, tolerance and tissue complexity. Also, other factors such as drug administration time and route, treatment required, gender affect dosage. These factors, therefore, lead to variations in the dosage prescription. Although all these factors affect the effectiveness of drugs actions, I will describe the effects derived from the aspect of age and disease state. In a bid to perform this task, I will make an intimate enumeration and evaluation concerning the impacts of age and disease state on fentanyl dosing.
Fentanyl sensitivity is higher in older patients than younger patients. However, dosage preference differs on a wide range due to these factors. For instance, a forty-year-old patient suffering from severe hepatic impairment may possess a double sensitivity to fentanyl compared with sixteen years old patient suffering a similar problem. However, this is not always the scenario. In some cases, certain diseases and operations call for variations in prescriptions. Patients undergoing surgical procedures such as transplantation cannot receive similar dosing with patients undergoing mild treatment (Lehmann 1991). Research performed in1982 implied that the degradation of fentanyl was low in an older patient. This depicted the clinical effectiveness of fentanyl in old patients than in young patients. Other demonstrations have shown a decreasing dosage with an increase in age (50% decrement from twenty to eighty-nine years).
When undergoing the minor procedure, children between the age of 1 and 12 years require doses of one to two micrograms per kilogram at intervals of a half minute and one minute. Also, opioid-tolerant children above two years old can receive initial doses of twenty-five micrograms hourly (Cote, Jerrold & Tedros 2009). Children above twelve years old and adults use lower doses of 0.5 to 1 microgram/kilogram/hour to sedate minor operations. Major procedures, however, require a higher dosage of 25-50 micrograms repeat after every five minutes (McPherson 2010). The nasal application of fentanyl is only used by cancer suffering patients above the age of eighteen years. Patients who are above sixty-five years should use fentanyl under strict caution because they show many side effects. These arguments support and purport that fentanyl administration and performance are dependent on age.
Different diseases have varying requirements for drug administration. Some diseases depict a higher need for the concentration of the drug while others show requires low concentrations to reach clinical effect. For instance, patients with cancer, renal and hepatic diseases show differences in sensitivity to fentanyl. The liver metabolizes fentanyl into norfentanyl at the initial stages. If this metabolism fails, fentanyl remains in the body and performs untargeted roles that affect the system adversely. These characteristics of drug non-clearance are evident in patients with uremia. The patients depict reduced fentanyl clearance rates. The reduction results in the depression of respiration. Adjustments are only necessary for cancerous hepatic dysfunction patients to fit the clinical effect. Hepatic diseases that are severe require strict monitoring.
Patients with hepatic diseases are at risk of opioid adverse effects. An example of a disease that could evidence the statement above is liver cancer (Forbes 2007). It is, therefore, vital to take caution when using fentanyl because research predicts fentanyl accumulation in the body system. Therefore, patients with severe liver failure should avoid fentanyl. This will ensure that drug failing metabolism does not accumulate in the system. Administration of high doses of fentanyl, also, leads to its accumulation in muscles and fats where the circulation is prolonged. These effects call for counsel and further research to reveal and ascertain the viability of the drug in accordance with its strengths and weakness (Semla, Beize & Higbee 2008).
It is crucial to point out that fentanyl is subject to abuse. It provides a relaxation feeling of lightheadedness, sleepiness and distresses. People should understand that fentanyl has adverse effects that include tolerance and accumulation in the body system. These effects would lead to future problems of using fentanyl for pain relief because the patient would require higher doses. It also causes blurred vision which is critical for drivers.
Drug administration to the body requires the strict following of instructions. Failure to follow instructions could lead to unexpected results and diseases. It is, therefore, the role of patients, researchers and doctors to ensure proper use of all drugs. The check about the advisable procedures of administration, appropriate dosage and reconsider all factors inclusive in affecting the effective performances of drugs. In this way, there will be an assurance of results and reduction of effects that affect the use of drugs presently (Fentanyl situation report 2006).
In conclusion, age and status of diseases are key determinants of dosage. The two requires considerations to warrant effective drug use. These statements do not mean that they are the sole operating factor in dosage determination. They only complement other factors. In fact, more factors such as administration route are exceptional and complement the dosage determination. However, they possess significant consideration for this discussion.
References
Cote, C, Jerrold, L & Todres, D 2009, A practice of anesthesia for infants and children, Saunders, Philadelphia, PA.
Fentanyl situation report 2006, National Drug Intelligence Center, Johnstown, Pa.
Forbes, K 2007, Opioids in cancer pain, Oxford University Press, Oxford.
Lehmann, K 1991, Transdermal Fentanyl, Springer, Berlin.
McPherson, M 2010, Demystifying opioid conversion calculations: a guide for effective dosing, American Society of Health-System Pharmacists, Bethsaida, MD.
Semla, T, Beizer, J & Higbee, M 2008, Geriatric dosage handbook: including clinical recommendations and monitoring guidelines, Lexi-Comp, Hudson, Ohio.