Preg: Smoking + Alcohol Flashcards
What is the single most preventable cause of morbidity and mortality
Smoking
What % of woman spoke during part or all through pregnancy?
10% !!!!!!!!!
Nicotine dependance includes…
Behavioural
Cognitive and
Physiological phenomena
What is the most addictive part of cigarettes?
Nicotine… but its not the most toxic part
Is nicotine dependence considered a “disease?
Yes…
DSM5 = TOBACCO USE DISORDER
What is the major non-addictiive metabolite of nicotine?
Cotinine
What is nicotine metabolised by? Which enzyme?
CYP2A6
What does nicotine bind to in the brain?
Nicotinic acetylcholine receptors (a4b2 subunit)
What happens to the nicotine receptors during dependance?
Desensitisation and upregulation of receptors with chronic exposure
Effects of smoking to a pregnant mother?
Placental abruption
Place ta praevia
Premature rupture of membranes
Ectopic pregnancy
Miscarriage
Effects of passive smoke to a pregnant woman
Reduced fertility
Miscarriage
Premature delivery
Low birth weight
Stillbirth
Birth defects
Assessment of dependance
4
- Fagerstrom test
- Heaviness of smoking index
- Expired CO levels using a CO monitor
- Urine/salivary/blood cotinine levels
1st line therapy for smoking cessation
Non pharmacological
Which pharmacological intervnetiond can be using in pregnancy for cessation of smoking
NRT
NOT…. VARENCILINE (RECALLED)
NOT,,,, BUPROPION
When should NRT be considered in pregnant woman
- Failure of non pharmacological measures
- Benefits of quitting outweigh the risks of NRT and continued smoking
