Module 9 Drugs: Complex care 1 Flashcards
How do drugs affect us?
Mood
Behaviour
Finance
Social: family dysfunction
Health: Physical and mental
Society: Health costs
Death
Care requirements of drug affected women
Multidisciplinary approach
Mental health issues
Confidentiality
Pregnancy care
Child protection
Staff opinions
Contraception
Comorbidities ie transmission of viruses
Common drugs abused in pregnancy
Tobacco
Cannabis
Alcohol
Caffeine
Amphetamines ‘ICE’
Opioids: methadone, heroin, morphine, oxycodone
Naltrexone
Cocaine
Benzodiazepines
Inhalants
Effects of smoking in pregnancy
Low birth weight
Preterm birth
SGA
Perinatal deaths
If women stop before 15 weeks rates of preterm birth and SGA did not differ from non-smokers.
Incidence of smoking in pregnancy
17.3%
Most common in NT 29.3% and least common in NSW 13.5%
Reduced further in 2019 to 8.8%
Smoking interventions
Quit for new life program
Training for staff
Nicotine replacement therapy
Effects of alcohol
Alcohol crosses the placenta and can cause bleeding, miscarriage, stillbirth and premature birth.
Alcohol withdrawal of the infant can occur, poor coordination and movement, fetal alcohol spectrum disorder
There are no known safe levels of alcohol
Alcohol is excreted in breast milk and can reduce supply.
Fetal alcohol spectrum disorder (FASD)
Prevalence up to 2%. Causes mental and physical delays
Effects of caffeine
Moderate consumption (up to 4 cups = 350mg a day) can cause dependence and withdrawal.
Maternal = osteoporosis, high bp, heart disease, heartburn, ulcers, severe insomnia, anxiety, depression and infertility
Pregnancy = Increased risk of miscarriage, difficult birth, low weight babies
Effects of marijuana
Most commonly used illicit drug.
Maternal = Causes relaxed, happy and talkative state. Can increase appetite, lower sex drive, lowers sperm count, difficulty concentrating, impaired motor skills, slow reflexes, reduced co-ordination, risks to mental health, can lead to deterioration in the condition of people with pre-existing mental illness and symptoms of schizophrenia.
Pregnancy = crosses the placenta, low birth weight babies, secreted in breastmilk
Effects of heroin
Slow down the CNS.
Pregnancy = affects fetal development, increased risk of miscarriage and premature birth, SGA, prone to illness, withdrawal (Neonatal abstinence syndrome)
60-90% of exposed infants show symptoms of NAS
Sudden ceasing of heroin in pregnancy can increase the risk of miscarriage, premature birth and stillbirth
Risk of HIV and hepatitis infection for mother and baby
Treatment for heroin dependence
Buprenorphine (Subutex)
Methadone
Naltrexone
Use of methadone in pregnancy
Pregnant women who are dependent on opiates are encouraged to enter a methadone program to result in fewer complications. Given as an oral syrup often to treat heroin. Clean and cheap.
Early engagement should be encouraged to improve outcomes.
Small amounts are passed into breastmilk and mothers are encouraged to breastfeed as this assists with withdrawal. Breastfeeding is optimal just before a dose to reduce the amount available.
Management of neonatal abstinence syndrome (NAS)
NAS occurs in newborns going through withdrawal.
Finnegan scoring system is used to evaluate the degree of NAS
NAS is characterised by hyperirritability, gastrointestinal dysfunction and respiratory distress, yawning, sneezing, mottling and fever.
Usually begins within 72 hours, may appear up to 2 weeks post birth
Pharmacological management includes morphine and phenobarbitone.
Cocaine in pregnancy
Stimulant and potent vasoconstrictor can cause fetal tachycardia and affect variability. Decreases uterine blood flow by 50% and increases uterine vascular resistance. Increases risk of preterm birth, SGA, slow growth after birth, language and executive function issues.
May cause miscarriage, placental abruption, premature labour or stillbirth.
