Peripartum Emergencies/Perinatal Substance Abuse

Question 1

Peripartum Depression usually manifests between __ to __ months after delivery

Answer 1

2-6 months

Question 2

These 2 hormones steadily rise and peak in the 3rd trimester of pregnancy then suddenly crash in the days after delivery

Answer 2

Estrogen and progesterone

Question 3

This hormone can affect serotonin by way of MAO-A levels and can also affect dopamine and norepinephrine

Answer 3

Estrogen

Question 4

This hormone can impact GABA receptors

Answer 4

Progesterone

Question 5

Symptoms of either hyper OR hypothyroidism can occur in up to 6-9% of women after pregnancy when this medical condition occurs

Answer 5

Postpartum Thyroiditis

Question 6

Having twins increases risk for what disorder?

Answer 6

Post Partum Depression

Question 7

With the Baby Blues, there is no SI/HI and symptoms usually resolve by __ weeks

Answer 7

2 weeks

Question 8

**A major component of treatment for PPD is addressing the mother’s

Answer 8

SLEEP

Question 9

The 1st-line (drug) tx option for PPD is

Answer 9

SSRI. But should also trial non-pharm interventions (CBT, IPT, Bright Light Therapy). **Weigh risks vs benefits of starting meds.

Question 10

2nd-line tx option for PPD is

Answer 10

SSRI/SNRI

Question 11

FDA-approved synthetic steroid-based IV infusion for the tx of PPD by way of affecting GABA. Must be given over 60hrs, $30K, AEs extreme sedation/ALOC, *REMS evaluation

Answer 11

Zulresso (allopregnanolone)

Question 12

Postpartum psychosis typically occurs within 2-__ days of delivery

Answer 12

10 days

Question 13

This postpartum condition increases the risk for both suicide and INFANTICIDE

Answer 13

Postpartum Psychosis

Question 14

The 1st step in the 4-step TX protocol for postpartum psychosis is the use of this class of drug for the first 3 days

Answer 14

benzodiazepine (to see if restoration of sleep will resolve psychosis)

Question 15

The 2nd step in the 4-step tx protocol for postpartum psychosis is the addition of this class of drug

Answer 15

antipsychotic on day 4 (after 3 days of benzo). This combo is continued for 2 weeks.

Question 16

If after 2 weeks of the 4-step tx protocol for postpartum psychosis, the mother is still symptomatic, this drug is started

Answer 16

Lithium. And resumed for 9months

Question 17

The 1st-line tx for postpartum OCD is

Answer 17

CBT

Question 18

The 2nd-line tx for postpartum OCD is

Answer 18

CBT + SSRI (sertraline best choice if breastfeeding and no hx of failed trial)

Question 19

The only self-report tool that has been validated for postpartum OCD is the ____ ____ ____ _____. The Yale Brown Obsessive Compulsive Scale (YBOCS) can also be used.

Answer 19

Perinatal Obsessive Compulsive Scale

Question 20

This TCA is often very effective for treating postpartum OCD, but this factor must also be taken into consideration

Answer 20

clomipramine (Anafranil)

Anticholinergic effects may decrease milk production

Question 21

2 specific screening tools to assess for substance use during pregnancy include the:

Answer 21

Antenatal Psychosocial Health Assessment (ALPHA)

Prenatal Risk Overview (PRO)

Question 22

According to US Surgeon General (2005), how much/when can alcohol be used during pregnancy?

Answer 22

NO safe use of alcohol during pregnancy

Question 23

This substance-related condition is characterized by CNS and craniofacial abnormalities, limb malformations, cardiac and renal defects

Answer 23

Fetal Alcohol Spectrum Disorder (FAS)

Question 24

On the less severe end of the Fetal Alcohol Spectrum, the cognitive, motor, memory, language, emotional processing and behavioral problems characterize this disorder

Answer 24

Alcohol Related Neurodevelopmental Disorder (ARND)

Question 25

These 2 assessment tools have been validated for the assessment of alcohol use in pregnant women

Answer 25

t-ACE (TOLERANCE, ANNOYANCE when asked about drinking, tried to CUT down, and do you need an EYE opener) TWEAK (TOLERANCE, WORRIED about drinking, EYE opener, AMNESIA when drinking, and tried to KUT down [with a K instead of C])

Question 26

Low birth weight, preterm birth, SGA, and admission to NICU are associated with this substance use during pregnancy

Answer 26

Cannabis

Question 27

Tremors, inconsolable crying, hyperreflexia and feeding issues are characteristic of this syndrome associated with stimulant AND opiate use during pregnancy

Answer 27

Neonatal Abstinence Syndrome (NAS)

Question 28

Risks for baby with use of these types of substances during pregnancy include VASOCONSTRICTION, hypertension, placental hemorrhage/abruption, premature labor, low birth weight, maternal/infant death

Answer 28

Stimulants

Question 29

Fetal risks of this type of substance during pregnancy include: low birth weight, premature delivery, MECONIUM ASPIRATION, RESPIRATORY DEPRESSION, NAS

Answer 29

Opiates

Question 30

These 2 drugs can be used in Medication-Assisted Treatment (MAT) for opiate addiction in pregnancy. Although still associated with Neonatal Abstinence Syndrome (NAS), the goal is harm reduction (prevent maternal OD)

Answer 30

``` Methadone Buprenorphine (shorter hospital stays for NAS compared to methadone) ```

Question 31

Aside from MAT, other TXs for opiate addiction during pregnancy include: MI, CBT and _____ ______

Answer 31

Contingency Management