Narcotics use/ NAS Flashcards
naturally occurring narcotics
codeine morphine opium
synthetic and semisynthetic narcotics
- fentanyl
- heroin
- hydromorphone (dilaudid)
- methadone
- meperidine
- oxycodone
- propoxyphene
narcotic dependence
simultaneous tolerance to narcotics of any type with symptoms of withdrawal upon discontinuation
symptoms of heroin withdrawal occur in up to _____ of infants and in up to ______ exposed to methadone
- 75%
- 90%
****withdrawal syndrome is more severe and more prolonged with methadone than heroin****
Narcotics effects of fetus
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
S/S of neonatal abstinence syndrome
- high pitched cry
- tremulousness
- sleeplessness
- difficulty feeding
- sweating
- nasal stuffiness
- sneezing
- vomiting
- cramping
- diarrhea
- seizures
- EEG abnormalities
symptoms tend to be ______ in premature infants likely due to _____
symptoms tend to be LESS COMMON in premature infants likely due to IMMATURE NEUROLOGICAL SYSTEM.
Differential diagnosis of NAS
- sepsis
- hypoglycemia
- cns hemorrhage
- infection
Onset of NAS
- usually develop within 48 hrs of life
- 96% by 4 days
*****can depend on half life of drug of abuse and mothers last dose
If mothers last dose was greater than ________prior to delivery, _______likelihood of withdrawal symptoms
- one week
- very low
T/F Methadone withdrawal begins later than heroin withdrawal but both typically before 72 hrs of life
False, usually before 48 hrs of life
symptoms usually present within _____ to ______ but can be delayed______
- 48 - 72 hrs
- 4 weeks
severity of symptoms vary with _____
mothers dose
What babies are usually discharged with plan for close follow up?
babies that are asymptomatic at 72 hrs ( short acting) or 5-7 days ( long acting) of life
How long can symptoms persist?
4-6 months after birth
Maternal screening for what co morbidities needs to performed?
- HIV
- Hepatitis B
- Hepatitis C
- polydrug abuse
When to assess Finnegan score and how often?
- 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
Treatment for NAS~ supportive care
- 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
Treatment of NAS ~ only clearly defined benefit of using pharmacological intervention ?
short term improvement of clinical signs
***pharmacological intervention should be used if seizures or symptoms affecting growth/hydration status….. ie vomiting, diarrhea***
Risks associated with using pharmacological intervention?
- 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
Indications for pharmacological therapy for NAS
- seizures
- poor feeding
- diarrhea and vomiting resulting in excessive weight loss
- inability to sleep
- fever unrelated to infection
NAS pharmacological Intervention
selective Serotonin Reuptake Inhibitors (SSRI)
NAS Outcome
