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Preschool Language Intervention > Prenatal Exposure to Drugs > Flashcards

Prenatal Exposure to Drugs Flashcards

1
Q

Addiction Definition

A

a primary chronic disease of brain reward, motivation, memory, & related circuitry

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2
Q

Components of Addiction

A

Inability to abstain, impaired behavioral control, craving, diminished recognition of problems resulting from it, Dysfunctional Emotional Response

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3
Q

Family & Addiction

A

History in grandparents & other family
Lack of access to resources & support
Low SES
Domestic violence
Abusive behavior (physical, emotional, sexual)
Mental health issues in mother and other family members

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4
Q

Extensiveness of Problem

A

3 million 12 year olds and up used illicit drugs for the first time in 2010
8100 people a day used illicit drugs for the first time in 2010
Average age of initiation was 19.1 years
Whatever age they start using is their mental age until they get clean

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5
Q

Pregnancy & Illicit Drug Use

A

6% of pregnant women ages 15-44 reported non-medical use of prescription type psychotherapeutic drugs in the past year
4.5% of pregnant women used illicit drugs the month before delivery
Types of drugs: 4.4% pain relievers, 2% tranquilizers, 1.3% stimulants, .8% methamphetamines, .3% sedatives
Crack/cocaine most common followed by meth then marijuana
Most common age is 15-17 yo, least common is 26-44 yo

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6
Q

NAS

A

Generalized disorder characterized by central nervous system hyper-irritability, gastro-intestinal dysfunction, respiratory distress and vague autonomic symptoms

Occurs due to exposure in-utero to licit or illicit drugs of abuse or from postnatal iatrogenic effects
Opioids (ex. Methadone, codeine, oxycodone, heroin) most common drugs from which infants withdraw
Exposure to opiates can lead to it in 60-90% of infants (up to 60% require pharmacologic tx)
Opioid withdrawal is 1 of few disorders that can be treated
Actual disorder in which they are addicted
Can be prenatally exposed w/o having it
Neonatal withdrawal usually occurs 48-72 hours after birth, sometimes it’s after 2 to 4 wks (& then it’s too late to test mom)
Sx’s most severe may last up to 6-12 months (sweating, tremors, etc.)

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7
Q

General Risks Associated with Prenatal Exposure to Drugs

A

SIDS, IUGR (intrauterine growth retardation), pre-term labor & delivery, learning disabilities

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8
Q

Infant Red-Flags of When to Screen for NAS

A

Prematurity, unexplained IUGR, neurobehavioral abnormalities, atypical CVAs, myocardial infarctions, NEC (necrotizing entercolitis-part of bowel dies)

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9
Q

Mother Red-Flags of When to Screen for NAS

A

Lack of prenatal care, unexplained fetal demise, placental abruption, severe mood swings, CVAs, myocardial infarctions, repeated spontaneous abortions

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10
Q

Preterm infants less than 30 wks. gestation have a _____ risk of drug withdrawal than infants born later

A

Lower: less exposure & because CNS is under-developed

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11
Q

How do we test Prenatal Drug Exposure?

A

Urine drug screening (only recent exposure: high false negative), meconium drug testing (4-5 months; more accurate), Umbilical cord toxicology screening (not as accurate as meconium but still used), hair testing (for several months)

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12
Q

Presentation of NAS differs based on 3 primary factors:

A

Type (not amount) of drug abused
Time between last use by mother & delivery
Maternal / infant metabolism & excretion
Other factors may impact how infant presents

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13
Q

Signs & Sx’s of NAS

A

Neurological excitability
Gastrointestinal dysfunction
Autonomic signs

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14
Q

Neurological excitability

A

tremor, high-pitched crying, exaggerated reflexes, sneezing, yawning, difficulty getting to sleep
2-11% with opioid withdrawal also have seizures

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15
Q

Gastrointestinal dysfunction

A

poor feeding, vomit & diarrhea, uncoordinated suck, dehydration

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16
Q

Autonomic Signs

A

(sweating, etc.), nasal stuffiness, temp instability, fever, modeling

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17
Q

Feeding the Infant with NAS

A

Poor feeding, uncoordinated suck, vomiting, diarrhea, dehydration, poor weight gain

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18
Q

Managing poor feeding in infant with NAS

A

Low lactose, soy, or elemental formula (helps with feeding intolerance & cramping)
Mylicon (avoid use of sucrose)
Managing environment: decrease extraneous noise, consistency, dim lighting

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19
Q

Managing GERD in infants with NAS

A

Elevating head of bed
Thickening feedings (though research doesn’t support use of thickened liquid as reliable for managing reflux; no longer indicated in literature, but can work for some)
Increase frequency/reduce volume of feeding

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20
Q

Managing Poor Sucking in Infants with NAS

A

Uncoordinated sucking prevents infant from efficient intake
Frustration increases due to inability to take in liquid efficiently
Hyperactive gag: may be exacerbated due to incoordination
Swaddling may support organization; external pacing may be required; temp control may influence organization

21
Q

Vomiting & Diarrhea in Infants with NAS

A

Lead to dehydration/poor weight gain
Increased caloric expenditure secondary to increased activity/agitation (even keeping body temp up burns calories)
Increasing caloric density may promote weight gain (24-27 cal/oz)
May use Immodium if diarrhea causes too much weight loss
Clonidine

22
Q

Breast Feeding the Infant with NAS

A

Only minimal amts of methadone cross into breast milk so advantages outweigh issues
MBM is more easily tolerated
Indirectly decreases sx’s of NAS: decreases GI irritation scores; improved GI tolerance results in better growth; lowered NAS scores result in less dosage of meds needed to tx infant for withdrawal

23
Q

When not to breast feed

A

If mother is taking: amphetamines (more irritable & sleep probs), marijuana (fat soluble), cocaine (irritability, vomiting, diarrhea, tremors, seizures), heroin (?)

24
Q

Pharmacologic Tx of NAS

A

Primary: morphine & methadone
Secondary: clonidine, phenobarbital

25
Q

Fetal & Neonatal Effects of Marijuana

A

THC easily crosses the placenta & is present in amniotic fluid
High lipid solubility, slow elimination, prolonged fetal exposure
Cannabinoid receptors present in early gestation, modifies neurotransmitters (serotonin, dopamine, GABA), altered neuronal growth, maturation & differentiation, & structural or functional abnormalities
Impact generally subtle, outcomes usually associated with heavy or frequent use

26
Q

Intrapartum Complications of Fetal Exposure to Marijuana

A

Dysfunctional labor

Meconium stained AF (not itself a big deal; usually indicative of distress)

27
Q

Neonatal Complications of Fetal Exposure to Marijuana

A

Prematurity

28
Q

Long Term Complications of Fetal Exposure to Marijuana

A

Fine tremors, poor sleep, visual reasoning poor (reading affected down the road), poor memory & verbal skills, abnormal attention, slightly increased risk for SIDS

29
Q

Neurotransmitters Affected by Cocaine

A

Norepinephrine, serotonin, dopamine

Inhibits reuptake of NE and D, accumulates at synapse, resulting in prolonged stimulation of receptors
Low molecular weight, high lipid solubility, crosses placenta by simple diffusion
Cocaine & metabolites slow to be eliminated which increases toxicity to fetus
Placental perfusion decreases (blood flow from mom to fetus decreases)
Congenital malformation not increased

30
Q

NE Stimulation

A

Tachycardia, HTN, diaphoresis, tremors

31
Q

Dopamine Stimulation

A

Increased alertness, euphoria, enhanced feeling of well-being, heightened energy

32
Q

Antenatal Complications of Exposure to Cocaine

A

Stillbirth, abortion, infection/STD, placental infarcts, IUGR, abnormal fetal breathing

33
Q

Intrapartum Complications of Exposure to Cocaine

A

Premature labor, PROM (premature rupture of membranes), shortened labor, meconium stained AF

34
Q

Neonatal Complications of Exposure to Cocaine

A

PT, LBW, SGA; postnatal growth restriction; cerebral infarction, seizures, cortical atrophy, IVH, abnormal EEG & BAER; NEC; intestinal perforation

35
Q

Long-term Complications of Exposure to Cocaine

A

Expressive/receptive language delay/d/o
Poor recognition/memory/info processing
Decreased visual attention
Behavioral issues (ADHD)

36
Q

Methyphenyethlamine

A

stimulant of norepinephrine, dopamine, & serotonin release

37
Q

Metamphetamine (meth, speed, ice, crystal)

A

Higher CNS stimulation; less PNS & cardiovascular stimulation

38
Q

Effects of Amphetamines

A

Euphoria, aggressive behavior, arrhythmias, anxiety, seizures, shock, stroke, abdominal cramps, insomnia, death

39
Q

Antenatal Complications of Amphetamines

A

Fetal death, retroplacental hemmorhage

40
Q

Neonatal Complications of Amphetamines

A

Premature, neonatal death, drug intoxication, tremors, abnormal sleep cycles, poor feeding, hypertonia, sneezing, high-pitched cry, loose stools, fever, yawning, hyperreflexia

41
Q

Long-term Complications of Amphetamines/Methamphetamines

A

Decreased IQ, aggressive behavior, peer-related problems, poor academic performance

42
Q

Tobacco Use during Pregnancy

A

Approximately 20% of women smoke during pregnancy

Nicotine is a primary psychoactive chemical

43
Q

Fetal Complications of Exposure to Tobacco

A

SAB, stillbirth, placental decidual necrosis

44
Q

Intrapartum Fetal Complications of Exposure to Tobacco

A

Abruption, premature labor

45
Q

Neonatal Fetal Complications of Exposure to Tobacco

A

IUGR (small), CHD (congenital heart disease), deformities of extremities, polycystic kidneys, gastroschisis (intestine outside body), skull deformities, PPHN (persistent pulmonary HTN)

46
Q

Long-term Fetal Complications of Exposure to Tobacco

A

Low test scores (cognitive, language, general academic achievement), behavior disorder, adolescent onset of drug dependence, SIDS

47
Q

Teratogenic Effects of Alcohol

A

Direct toxic effect on cells
Hypoxia (secondary to impaired placental/fetal blood flow)
Cell migration in brain affected
Apoptosis is affected

48
Q

Characteristics of FAS

A

Sx’s range from mild to severe, abnormal facial features, smooth philtrum, small head size, shorter than avg height, low body weight, poor coordination, hyperactive behavior, problems with heart, kidney, bones; difficulty paying attention; poor memory; difficulty in school (esp. math); LD’s; S-L delays; ID or low IQ; poor reasoning/judgment; sleep probs as baby; sucking probs as baby; vision & hearing issues

Preschool Language Intervention (3 decks)

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