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D&T2 Exam 2 > Drugs and Pregnancy - Chaffin > Flashcards

Drugs and Pregnancy - Chaffin Flashcards

1
Q

which gender gets addicted is less time and develop larger harbits

A

women

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2
Q

if mother uses amphetamines, is it found in cord CHS neonates vs. cord study

A

no

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3
Q

if mother uses cocaine, is it found in cord for CHS neonates vs. cord study

A

no

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4
Q

what is the most common drug found in cord in CHS neonates vs. cord study

A

THC

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5
Q

if you decrease the pain clinics then what other drug rises

A

opioid use

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6
Q

Source where pain relievers were obtained for most recent nonmedical use among past year users aged 12 or older are fom

A

free from friend/relative

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7
Q

will you take care of a pregnant opiate addict in your 3 rd year

A

yes

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8
Q

naturally occuring: papavor somniferium poppy

codiene morphine

A

opiates

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9
Q

what opioid has the greatest addiction potential of all narcotics and easily crosses the BBB

A

heroin

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10
Q

MOA of opioids

A

stimulate the mu receptor in CNS

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11
Q

what are 4 clinical effects of opiates

A

drowsy
slurred speech
impaired attention
impaired memory

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12
Q

opioids are unable to develop tolerance to what

A

miotic effects
constipation
respiratory depression

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13
Q

when does tolerance occur for opioids

A

after 3 weeks of dialy usage

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14
Q

Withdrawal symptoms from opioids

A 
yawning           myalgia 
piloerection     muscle spasms
lacrimation       anorexia
rhinorrhea        nausea/vomiting
perspiration      Abdominal cramps 
tremor               Diarrhea
restlessness      fever/chills/fush
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15
Q

how long can opioid withdrawal symptoms last

A

10 days

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16
Q

what is the PE for opioid withdrawal

A

hypertension
hyperventilation
tachycardia

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17
Q

timeline of withdrawal ( short acting opioid): 3-4 hours after last dose

A

drug craving, anxiety, fear of withdrawal

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18
Q

timeline of withdrawal ( short acting opioid): 8-14 hours after last dose

A

anxiety, restlessness, insomnia, yawning, rhinorrhea, lacrimation, diaphoresis, stomach cramps, mydriasis

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19
Q

timeline of withdrawal ( short acting opioid): 1-3 days after last dose

A

tremor, muscle spasm, vomiting, diarrhea, hypertension, tachycardia, fever, chills, piloerection

20
Q

are opioids teratogenic

A

no

21
Q

what temporary substitution of long-acting opioid reduces withdrawal severity

A

methadone

Buprenorphine

22
Q

what can you give for treatment of withdrawal from opioid in pregnant women

A

Pentzocin
Nalbuphine
butorphanol

23
Q

can you give antagonist for treatment of withdrawal? why or why not

A

NO

can precipitate immediate withdrawal

24
Q

chronic relapsing condition which untreated may lead to what

A

severe complications and death

25
Q

is addiction as a chronic disease treatable? curable?

A

treatable yes

but not curable

26
Q

what is the key to treatment of addiction as a chronic disease? what needs to change in the patient

A

retention

behavioural changes

27
Q

what do you want to avoid in managing a pregnant women? why?

A

withdrawal

- fetus: hypoxia, bradycardia, intrauterine demise,

28
Q

what is an indicator of fetal withdrawal

A

increased fetal movement

29
Q

what is the main issue with medication assisted treatment ( MAT) for addiction during pregnancy

A

replase

30
Q

what is the current treatment of choice for opiate addicted pregnant women

A

methadone

31
Q

what happens in the first day of methdone maintenance

A

Starting dose: 10-20m mg
evaluate at 6 hours interval
5-10mg additional dosing for persistent signs and symptoms of withdrawal

32
Q

what happens in the second day of methdone maintenance

A

total methadone dose in first 24 hours, may be given as single of split dose

33
Q

how do you treat someone on illicit narcotics

A
  • start methadone at 20 mg BID
  • increase dose by 10-20 mg/day until on stable once daily dose
  • dosage needs to change as pregnancy progresses
34
Q

during the pregnancy when do you consider detoxification

A

of on dosage less than 40 mg daily and gestational age less than 20 weeks

35
Q

can you prescribe opioid as an outpatient

A

no, due to addiction maintenance

36
Q

how do you detoxify from methadone maintenance? for inpatient and outpatient?

A

gradually secondary to risk of fetal compromise

inpatient: 2mg/day decreases in daily dose
outpatient: 5-10 mg/week decrease in dose

37
Q

what is the alternative approach to detoxify from methadone maintenance

A

Ativan .5- 1 mg every 8 hours
decrease methadone 5mg/day every 1-2 days
once methadone discontinued taper Ativan

38
Q

MOA of Buprenorophine? how is it given to patient

A

partial opioid agonist

sublingual with naloxone

39
Q

what can happen to Naloxone if given parenterally

A

may precipitate withdrawal

40
Q

compare buprenorphine and methadone

A

Buprenorphrine: lowers rates of illicit opioid consumption, fewer withdrawal symtpoms, lower potential for respiratory depression
methadone: more effective for polypharmacy

41
Q

Maternal addiction and recovery center MARC

A

by Chaffin

42
Q

for the MARC, long standing addiction to what drug is contraindication? what must be done if this is the case.

A

benzodiazopine,

- monitor withdrawal prior to initializing buprenorphine

43
Q

what is the correlation of Bupronorphrine dose and median hospital days for MARC

A

directly related

44
Q

does maternal dose or cord tissue level of Buprenophrine correlate with neonatal abstinence substance severity or length of hospital day

A

NO

45
Q

neonatal abstinence syndrome is most common in what drug

A

methadone exposed babies

46
Q

treatment for neonatal abstinence sydnrome

A

Diazepam
Chlorpromazine
Phenobarbital
Methadone

47
Q

Finnegan scale

A

The neonatal abstinence syndrome scoring system

D&T2 Exam 2 (14 decks)

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