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Simmons NURP 501 Exam 4 > Narcotics use/ NAS > Flashcards

Narcotics use/ NAS Flashcards

1
Q

naturally occurring narcotics

A

codeine morphine opium

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2
Q

synthetic and semisynthetic narcotics

A
  • fentanyl
  • heroin
  • hydromorphone (dilaudid)
  • methadone
  • meperidine
  • oxycodone
  • propoxyphene
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3
Q

narcotic dependence

A

simultaneous tolerance to narcotics of any type with symptoms of withdrawal upon discontinuation

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4
Q

symptoms of heroin withdrawal occur in up to _____ of infants and in up to ______ exposed to methadone

A
  • 75%
  • 90%

****withdrawal syndrome is more severe and more prolonged with methadone than heroin****

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5
Q

Narcotics effects of fetus

A

increased rate of spontaneous abortion and stillbirth, sometimes as a result of withdrawal syndrome IUGR~ may be due to direct effect on growth and /or related to poor nutrition and stressed lifestyle common among addicted women

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6
Q

S/S of neonatal abstinence syndrome

A
  • high pitched cry
  • tremulousness
  • sleeplessness
  • difficulty feeding
  • sweating
  • nasal stuffiness
  • sneezing
  • vomiting
  • cramping
  • diarrhea
  • seizures
  • EEG abnormalities
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7
Q

symptoms tend to be ______ in premature infants likely due to _____

A

symptoms tend to be LESS COMMON in premature infants likely due to IMMATURE NEUROLOGICAL SYSTEM.

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8
Q

Differential diagnosis of NAS

A
  • sepsis
  • hypoglycemia
  • cns hemorrhage
  • infection
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9
Q

Onset of NAS

A
  • usually develop within 48 hrs of life
  • 96% by 4 days

*****can depend on half life of drug of abuse and mothers last dose

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10
Q

If mothers last dose was greater than ________prior to delivery, _______likelihood of withdrawal symptoms

A
  • one week
  • very low
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11
Q

T/F Methadone withdrawal begins later than heroin withdrawal but both typically before 72 hrs of life

A

False, usually before 48 hrs of life

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12
Q

symptoms usually present within _____ to ______ but can be delayed______

A
  • 48 - 72 hrs
  • 4 weeks
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13
Q

severity of symptoms vary with _____

A

mothers dose

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14
Q

What babies are usually discharged with plan for close follow up?

A

babies that are asymptomatic at 72 hrs ( short acting) or 5-7 days ( long acting) of life

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15
Q

How long can symptoms persist?

A

4-6 months after birth

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16
Q

Maternal screening for what co morbidities needs to performed?

A
  • HIV
  • Hepatitis B
  • Hepatitis C
  • polydrug abuse
17
Q

When to assess Finnegan score and how often?

A
  • assess the infant initially 2 hrs after birth and q4 hrs
  • total points for s/s seen during that interval =if score is > 8 change to every 2 hrs and continue q2 hrs until 24 hrs after the last total score >8 then resume every 4 hrs
  • use new sheet every day
  • most prodominant tool used
  • include mother/family in assessment of symptoms
18
Q

Treatment for NAS~ supportive care

A
  • frequent small feedings of hypercaloric ( 24 cal/oz) formula or EBM
  • suck, swaddle, sush, swing
  • IV fluids/ electrolyte replacement
  • 150-250 cal/kg/day necessary for proper growth in neonates suffering withdrawal
  • usually indicated with a Finnegan score of <8
19
Q

Treatment of NAS ~ only clearly defined benefit of using pharmacological intervention ?

A

short term improvement of clinical signs

***pharmacological intervention should be used if seizures or symptoms affecting growth/hydration status….. ie vomiting, diarrhea***

20
Q

Risks associated with using pharmacological intervention?

A
  • prolonged drug exposure and hospitalization time and serve as a detriment to maternal/infant bonding
  • long term morbidity r/t neonatal drug withdrawal is decreased by pharmacologic management of symptomatic infants remains unproven
  • the risk of compounding intrauterine induced deficits with neonatal exposure to other drugs is unknown
  • some believe that pharmacologic therapy of an infant may reinforce the maternal idea that discomfort or annoying behaviors should be treated with drugs
21
Q

Indications for pharmacological therapy for NAS

A
  • seizures
  • poor feeding
  • diarrhea and vomiting resulting in excessive weight loss
  • inability to sleep
  • fever unrelated to infection
22
Q

NAS pharmacological Intervention

A
23
Q

selective Serotonin Reuptake Inhibitors (SSRI)

A
24
Q

NAS Outcome

A

Simmons NURP 501 Exam 4 (21 decks)

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