Perinatal Substance Abuse

Question 1

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

Answer 1

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

Question 2

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

Answer 2

SIDS sudden infant death syndrome

Question 3

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

Answer 3

Methadone and Buprenorphine (Subutex)

Question 4

How does tobacco affect a growing fetus?

Answer 4

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

Question 5

How does marijuana affect a growing fetus?

Answer 5

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

Question 6

How long can marijuana stay in the body

Answer 6

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

Question 7

Opioids cross the placenta how fast?

Answer 7

rapidly with drug equilibrium between mom and baby

Question 8

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

Answer 8

decrease brain growth and cell development

Question 9

Cocaine ____ crosses the placenta and ____?

Answer 9

Cocaine easily crosses the placenta and blood brain barrier

Question 10

Areas affected by cocaine in the fetus’ developing brain

Answer 10

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

Question 11

Methamphetamine ____ crosses the placenta and ____?

Answer 11

Methamphetamine easily crosses the placenta and blood brain barrier

Question 12

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

Answer 12

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

Question 13

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

Answer 13

Meconium, urine, hair, and cord blood

Question 14

Urine testing identifies ___ drug use

Answer 14

recent

Question 15

Meconium is a more accurate indicator of _____ exposure to drugs

Answer 15

long term

Question 16

Meconium reflects exposure to drugs in which time of the pregnancy

Answer 16

second and third trimesters

Question 17

Urine identifies exposure to which drugs

Answer 17

nicotine, opiate, cocaine, and amphetamines

Question 18

Meconium identifies exposure to which drugs

Answer 18

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

Question 19

For maximum sensitivity, how much meconium is recommended for testing

Answer 19

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

Question 20

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

Answer 20

decline

Question 21

Hair detects exposure to

Answer 21

nicotine, opiates, cocaine, and amphetamines

Question 22

What is the benefit to umbilical cord tissue testing

Answer 22

rapid turn around time vs waiting for meconium to be passed

Question 23

Umbilical cord tissue testing is as reliable as ____ testing

Answer 23

meconium

Question 24

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

Answer 24

6 inches

Question 25

Each ____ has different laws regarding the legal implications of testing

Answer 25

state

Question 26

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

Answer 26

low birth weight and intrauterine growth restriction

Question 27

Alcohol exposure leads to which neurobehavioral abnormalities

Answer 27

low levels of arousal and motor abnormalities

Question 28

Cocaine exposure leads to which neurobehavioral abnormalities

Answer 28

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

Question 29

Nicotine exposure leads to which neurobehavioral abnormalities

Answer 29

impaired orientation, autonomic regulation and abnormalities of muscle tone

Question 30

Marijuana exposure leads to which neurobehavioral abnormalities

Answer 30

increased startles and tremors

Question 31

Methamphetamine exposure leads to which neurobehavioral abnormalities

Answer 31

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

Question 32

Only the ____ drug class requires pharmacological treatment of NAS symptoms

Answer 32

Opioid

Question 33

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

Answer 33

decrease

Question 34

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

Answer 34

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

Question 35

Opioid withdrawal symptoms (NAS) include:

Answer 35

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

Question 36

When do infants exhibit symptoms of prenatal cocaine exposure ?

Answer 36

Postnatal day 2 or 3

Question 37

Cocaine exposure symptoms

Answer 37

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

Question 38

Where are opioid receptors concentrated in the body?

Answer 38

CNS and gastrointestinal tract

Question 39

Heroin's onset of withdrawal begins _____?

Answer 39

within 24 hrs of birth

Question 40

Methadone onset of withdrawal begins _____?

Answer 40

around 24-72 hours

Question 41

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

Answer 41

peaks at 40 hrs and is worst at 70 hrs

Question 42

Withdrawal from ethanol begins as early as

Answer 42

first 3-12 hours of life

Question 43

Clinical features of NAS fall into which two categories

Answer 43

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

Question 44

Nonpharmalogical treatments for NAS

Answer 44

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

Question 45

Drug therapy is used for NAS patients to prevent

Answer 45

fever, weight loss, and seizures

Question 46

Unnecessary drug therapy will prolong ___?

Answer 46

drug exposure and duration of hospitalization | which could affect maternal infant bonding

Question 47

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

Answer 47

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

Question 48

Is methadone contraindicated for breastfeeding?

Answer 48

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

Question 49

Which drugs' half life is longer?

Answer 49

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

Question 50

S/S of amphetamine exposure on the baby

Answer 50

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

Question 51

S/S of nicotine exposure on the baby

Answer 51

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

Question 52

S/S of marijuana exposure on the baby

Answer 52

premature, low birth weight, anencephaly, and anemia

Question 53

S/S of cocaine exposure

Answer 53

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

Question 54

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

Answer 54

Heroin, methadone, and buprenorphine

Question 55

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

Answer 55

Cocaine

Question 56

In utero exposure to amphetamines can lead to

Answer 56

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

Question 57

Effects of lithium toxicity on neonate

Answer 57

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

Question 58

What is iatrogenic NAS

Answer 58

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

Question 59

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

Answer 59

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

Question 60

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

Answer 60

buprenorphine

Question 61

Mean day at seizure onset in NAS babies

Answer 61

10 days

Question 62

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

Answer 62

increased respiratory rates, hypocapnia, and increased blood pH

Question 63

At what Finnegan scale score do we initiate medication

Answer 63

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

Question 64

S/S of alcohol withdrawal in neonate

Answer 64

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

Question 65

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

Answer 65

morphine

Question 66

Defects associated with alcohol/tobacco exposure

Answer 66

oral clefts and skeletal defects

Question 67

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

Answer 67

2 hours