lecture 5 Flashcards
supervised consumption sites benefits:
reduces overdose and physical harm, reduces community harm discarded needles, decreased healthcare costs, safety
supervised consumption sites drawbacks
fear of bringing criminal element into neighborhoods, message that use is acceptable
fentanyl test strips test:
unregulated drugs for the contamination of fentanyl and various analogs in powder and pill form
fentanyl test strips do not provide a:
quantity of fentanyl present in the substance
a negative result on a fentanyl test strop does not guarantee
substance is free from fentanyl or other synthetic opioids
neonatal abstinence syndrome:
passive exposure to a newborn from a neuroactive drug, when the infant is deprived of these substances a withdrawal syndrome may develop
which drug is most associated with NAS?
opiates/opioids
cost and average stay for hospital stay for newborn with NAS:
7,800 in 2020, 9 days compared to 2 days for other newborns
opioid use during pregnancy has a greater risk of these on baby:
low birthweight, respiratory problems, third trimester bleeding, toxemia and mortality
toxicology screening of newborns:
Urine, poop, hair
poop detects from which trimester?
2nd
hair detects from which trimester?
3rd, need 20-50 mgs
neurobehavioral dysregulation sensory processing:
hyper/hypo. visual auditory tactile
neurobehavioral dysregulation state control/attention
lability, staring, irritability, gaze aversion
neurobehavioral dysregulation autonomic control:
respiration, gastrointestinal, skin temp/color
neurobehavioral dysregulation motor and tone control:
tremors, seizures, coordination problems
the hallmark of neonatal withdrawal is a:
sticking disorder of movement or “jitteriness”, GI problems such as vomiting and food intolerance, rapid breathing nasal flaring due to breathing difficulties
autonomic over-reactivity:
yawning, sneezing, fever, excessive or continuous cry, tremor
excoriation:
rubs their chins, knees, elbows, nose and toes against blankets, sheets or clothing
cerebral irritation:
term used to describe perceived pain that a newborn experiences which is of unknown. hypertonic and irritability, difficulty nursing from a bottle or mother
which gender has been reported to have more severe NAS expression?
male infants
which infant has less severe expression?
preterm infants
NICU care may _____ NAS severity while maternal rooming-in can ____ it
increase; reduce
onset of withdrawal for methadone:
24-72 hours
onset of withdrawal for heroine
within 24 hours
onset of withdrawal for Suboxone
within 48 hours
infants are monitored for how many days for signs of withdrawal because of what?
7 days bc of rare cases of late onset
finnegan scoring system:
assessment for NAS which helps quantify the severity of the withdrawal and are used as a guide to start, wean, and discontinue treatment
a normal newborn can have scores as high as:
8, anything greater requires treatment
Non-pharmacologic Management
decrease environmental stimuli, dim lighting, peaceful and quiet environment, swaddle, pacifier, tactile stimulation
observational assessment that guides Tx:
can the infant eat more than 1 oz per feed or breast feed well? can the infant sleep more than 1 hour? can the infant be consoled within 10 minutes? if so, discontinue treatment
true of false, Newborn babies exposed to opioids or the medication for opioid use disorder should not
breastfeed.
false, encouraged to breastfeed unless they have illicit drugs in system
pharmacologic management:
morphine or methadone administered every 4 hours, monitored for respiratory distress, for an increase in consitpation and weight loss. phenobarbital for severe NAS, benzos used in cases of polysubstance abuse
children exposed to opioids found reduced regional volumes in these brain areas:
cortex, amygdala, basil ganglia and reductions in head circumference
how many states consider substance use during pregnancy child abuse?
25 and the District of Columbia
