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CCRN-NIC > Perinatal Substance Abuse > Flashcards

Perinatal Substance Abuse Flashcards

1
Q

Infants with NAS are more likely to have what problems compared to infants not experiencing NAS

A

respiratory diagnoses, low birth weight , feeding difficulties, and seizures

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2
Q

Smoking during pregnancy has a high correlation to which infant problem?

A

SIDS sudden infant death syndrome

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3
Q

Which two opioid medications are used purposely to to improve neonatal outcomes associated with untreated heroin abuse

A

Methadone and Buprenorphine (Subutex)

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4
Q

How does tobacco affect a growing fetus?

A

hypoxia, undernourishment of the fetus, direct vasoconstrictor effects on the placenta and umbilical vessels, and it increased the amount of carbon monoxide x5 those altering fetal oxygenation

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5
Q

How does marijuana affect a growing fetus?

A

altered uterine blood flow, altered maternal health behaviors, and it increases the amount of carbon monoxide x5 thus altering fetal oxygenation

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6
Q

How long can marijuana stay in the body

A

30 days, thus prolonging fetal exposure, but the placenta appears to limit fetal exposure

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7
Q

Opioids cross the placenta how fast?

A

rapidly with drug equilibrium between mom and baby

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8
Q

Opioids have been show to do what in animal cells/bodies?

A

decrease brain growth and cell development

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9
Q

Cocaine ____ crosses the placenta and ____?

A

Cocaine easily crosses the placenta and blood brain barrier

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10
Q

Areas affected by cocaine in the fetus’ developing brain

A

areas that regulate attention and execute functioning such as arousal, attention, and memory

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11
Q

Methamphetamine ____ crosses the placenta and ____?

A

Methamphetamine easily crosses the placenta and blood brain barrier

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12
Q

Maternal characteristics that suggest a need for drug screening may include:

A

no prenatal care, previous unexplained fetal demise, precipitous labor, abruptio placentae, hypertensive episodes, severe mood swings, frequent request for maternal dosing of pain meds, myocardial infarction, and repeated spontaneous abortions

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13
Q

Four of the most commons methods of testing for prenatal exposure to drugs

A

Meconium, urine, hair, and cord blood

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14
Q

Urine testing identifies ___ drug use

A

recent

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15
Q

Meconium is a more accurate indicator of _____ exposure to drugs

A

long term

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16
Q

Meconium reflects exposure to drugs in which time of the pregnancy

A

second and third trimesters

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17
Q

Urine identifies exposure to which drugs

A

nicotine, opiate, cocaine, and amphetamines

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18
Q

Meconium identifies exposure to which drugs

A

nicotine, alcohol, marijuana, opiate, cocaine, and amphetamines

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19
Q

For maximum sensitivity, how much meconium is recommended for testing

A

2-3g ( 1 tsp) from multiple stools is best

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20
Q

Hair testing is easy to collect and reflect drug use over a long period of time, but parents usually _____ this sampling method

A

decline

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21
Q

Hair detects exposure to

A

nicotine, opiates, cocaine, and amphetamines

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22
Q

What is the benefit to umbilical cord tissue testing

A

rapid turn around time vs waiting for meconium to be passed

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23
Q

Umbilical cord tissue testing is as reliable as ____ testing

A

meconium

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24
Q

How many inches of the cord is required for umbilical cord testing

A

6 inches

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25
Q

Each ____ has different laws regarding the legal implications of testing

A

state

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26
Q

Tobacco, alcohol, opiates, cocaine, and methamphetamine exposure all lead to

A

low birth weight and intrauterine growth restriction

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27
Q

Alcohol exposure leads to which neurobehavioral abnormalities

A

low levels of arousal and motor abnormalities

28
Q

Cocaine exposure leads to which neurobehavioral abnormalities

A

irritability and lability of state, decreased behavioral and autonomic regulation, and poor alertness and orientation

29
Q

Nicotine exposure leads to which neurobehavioral abnormalities

A

impaired orientation, autonomic regulation and abnormalities of muscle tone

30
Q

Marijuana exposure leads to which neurobehavioral abnormalities

A

increased startles and tremors

31
Q

Methamphetamine exposure leads to which neurobehavioral abnormalities

A

abnormal neurobehavioral patterns in exposed newborn infants like poor movement quality, decreased arousal, and increased stress

32
Q

Only the ____ drug class requires pharmacological treatment of NAS symptoms

A

Opioid

33
Q

Signs and symptoms of opioid, benzo, and alcohol withdrawal worsen and drug levels ____ in the body?

A

decrease

34
Q

Drugs other than opioids/benzos cause signs and symptoms due to _____

A

acute toxicity; once the drug is gone, the symptoms resolve

35
Q

Opioid withdrawal symptoms (NAS) include:

A

sweating, irritability, increased myscle tone and activity, feeding problems, diarrhea, and seizures

36
Q

When do infants exhibit symptoms of prenatal cocaine exposure ?

A

Postnatal day 2 or 3

37
Q

Cocaine exposure symptoms

A

irritability, hyperactivity, tremors, high-pitched cry, and excessive sucking

38
Q

Where are opioid receptors concentrated in the body?

A

CNS and gastrointestinal tract

39
Q

Heroin’s onset of withdrawal begins _____?

A

within 24 hrs of birth

40
Q

Methadone onset of withdrawal begins _____?

A

around 24-72 hours

41
Q

Buprenorphine onset of withdrawal peaks at ___ and is worst at ____?

A

peaks at 40 hrs and is worst at 70 hrs

42
Q

Withdrawal from ethanol begins as early as

A

first 3-12 hours of life

43
Q

Clinical features of NAS fall into which two categories

A

neurological excitability (high pitched cry, tremors, increased wakefulness) and gastrointestinal dysfunction (vomiting, fever, sweating)

44
Q

Nonpharmalogical treatments for NAS

A

minimizing stimuli
avoiding self-stimulation by swaddling
comforting techniques (swaying/rocking)
small frequent feeds to avoid hunger/support growth
Increased caloric needs d/t increased energy expenditure and loss from GI issues

45
Q

Drug therapy is used for NAS patients to prevent

A

fever, weight loss, and seizures

46
Q

Unnecessary drug therapy will prolong ___?

A

drug exposure and duration of hospitalization

which could affect maternal infant bonding

47
Q

Selective serotonin reuptake inhibitors (SSRI’s) and tricyclic antidepressants produce what effect in the neonate?

A

significant increase in the risk of neonatal respiratory distress, hypoglycemia, neonatal convulsions, and the occurrence of NAS

48
Q

Is methadone contraindicated for breastfeeding?

A

No according to the AAP approved category for breastfeeding women; current guidelines recommend breastfeeding for mothers stabilized on either methadone or buprenorphine; studies have shown this actually helps infants with NAS

49
Q

Which drugs’ half life is longer?

A

Methadone

Thats why withdrawal symptoms appear after 48hrs and heroin within 24 hrs

50
Q

S/S of amphetamine exposure on the baby

A

decreased arousal, tremors, hyperactive reflexes, abnormal cry, increased stress, drowsiness, poor feeding, and seizures

51
Q

S/S of nicotine exposure on the baby

A

preterm, low birth weight, cleft lip, cleft palate, and SIDS

52
Q

S/S of marijuana exposure on the baby

A

premature, low birth weight, anencephaly, and anemia

53
Q

S/S of cocaine exposure

A

low birth weight and subtle decrements in neurobehavioral, cognitive, and language function

54
Q

Which drugs DO NOT have an association with congenital malformations or any specific dysmorphic syndrome in offspring

A

Heroin, methadone, and buprenorphine

55
Q

Which drug has a significant vasoconstricting affect and decreases blood flow to the placenta and fetus, contributing to fetal growth restriction and hypoxia?

A

Cocaine

56
Q

In utero exposure to amphetamines can lead to

A

congenital brain lesions including hemorrhage, infarction, cavitary lesions, or generalized atrophy which could all lead to sudden infant death syndrome

57
Q

Effects of lithium toxicity on neonate

A

hypotonia, cyanosis, lethargy, jaundice, hypothermia, poor sucking, poor respiratory effort, poor Moro reflex, reversible inhibition of thyroid function, and diabetes insipidus

58
Q

What is iatrogenic NAS

A

the active administration of opiates/opioids, to the neonate for analgesia and sedation

59
Q

Subacute symptoms of NAS that may last for 4-6 months

A

irritability, sleep pattern disturbance, hyperactivity, feeding problems, and hypertonia

60
Q

Nasal stuffiness, sneezing, and loose stools are more commonly seen through which drug exposure

A

buprenorphine

61
Q

Mean day at seizure onset in NAS babies

A

10 days

62
Q

Infants with acute heroin withdrawal have shown increased rates of having ___ in the first week of life?

A

increased respiratory rates, hypocapnia, and increased blood pH

63
Q

At what Finnegan scale score do we initiate medication

A

score of 8 or higher x 3 consecutively or if the infants score is 12 or higher x 2

64
Q

S/S of alcohol withdrawal in neonate

A

hyperactivity, crying, irritability, poor suck, tremors, seizures, poor sleeping pattern, hyperphagia, and diaphoresis

65
Q

Recommended drug choice for treatment of NAS by the American Academy of Pediatrics

A

morphine

66
Q

Defects associated with alcohol/tobacco exposure

A

oral clefts and skeletal defects

67
Q

The initial assessment for NAS should be done within the first ____ hours of admission to the nursery. This score reflects all infant behaviors from admission until the point of time the infant no longer requires scoring

A

2 hours

CCRN-NIC (3 decks)

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