Term
| What are Drugs of choice intrauterine? |
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Definition
Marijuana represented 3/4 of illicit drug use1
Cocaine accounted for 1/10 of illicit drug use1
Highest Rates of Drug Use:
Cocaine (4.5%) in AA
Alcohol (23%) + Cigarettes (24%) in Caucasian
>50% of pregnant women use alcohol or cigarettes.1
25% of all pregnant women in U.S. smoke2
Women who used both Alcohol and Cigarettes:3
20% used Marijuana, 10% used cocaine
0.2% and 0.1% in non-drinking /non-smoking |
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Term
| after recognitino of preg, able to stop? |
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Definition
28% of those who used drugs stopped in the first trimester
93% stopped by the third trimester
Net postpartum reduction was only 24% due to relapse |
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Term
| who has high rate of use among pregnants women? |
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Definition
Younger age (18 to 30 years old)1
Unmarried status1
Less than high school education1
Substance Abuse by Significant Other2
Family Violence2 |
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Term
| What acute disruptions of pregnancy are caused? |
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Definition
By nicotine: Spontaneous Abortion Premature Delivery
Cocaine: Spontaneous Abortion, Premature Delivery , Abruptio Placentae, Fetal Demise |
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Term
| Is cocaine better in a binge or in daily use? |
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Definition
Daily use.
Erratic Use: highest rate of Vaginal Bleeding (22%), Abruptio Placentae (14%), Premature Delivery (36%), Still Birth (21%)
Daily Use: highest rate of SGA births (33%), other endpoints (except premature delivery) significantly lower1
Abruptio Placenta: due to chorionic villus edema and chorionic villus hemorrhage2 |
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Term
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Definition
60% to 90% of infants prenatally exposed to drugs will experience withdrawal, (esp. with opiate exposure)
signs and symptoms for opiates, alcohol, barbiturates (appearing within 72 hrs):
irritability, tremulousness, increased muscle tone, feeding difficulties (excessive, poorly coordinated sucking), tachypnea, diarrhea, disturbed sleep, fever, vomiting, high-pitched cry, seizures. |
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Term
| neonate withdrawl of MJ, N? |
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Definition
Marijuana and Nicotine:
Increased startle, tremors, hypertonic, irritability, less responsiveness and poor habituation to light |
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Term
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Definition
| Cocaine: increased tone, drowsiness |
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Term
| neonate withdrawl to polysubstance use? |
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Definition
Polysubstance Use:
Increased tone, tachypnea, disturbed sleep, fever, excessive sucking, loose/watery stools. |
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Term
| what are the effects of the drugs on neonates? |
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Definition
Synaptogenesis (brain growth spurt) occurs from 6 mo gestation to several years post birth.
Drugs that block NMDA glutamate receptors and those that activate GABAA receptors trigger widespread apoptosis of neurons1
Causing pathologic rather than physiologic cell death.
e.g.: alcohol, PCP, Special K, Barbiturates, Benzodiazepines |
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Term
| effects of coke on neonate? |
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Definition
Dopamine System:
Produces dysfunctions in the signaling of the D1 receptor and abnormalities in the development of the frontocingulate cortex leading to difficulties with attentional focus and stimulus processing by the cingulate cortex.1
Suppression of frontal 5-HT system with resultant poor response inhibition.2 |
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Term
| effects of nicotine on neonate? |
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Definition
Nicotine triggers abnormal neuronal cell proliferation and differentiation,
Disrupts the development of cholinergic and catecholaminergic systems |
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Term
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Definition
Severe developmental disorder associated with maternal drinking
Growth Retardation (height/weight below 5 %)
CNS dysfunction (impaired motor, LD, behav d/o)
Characteristic craniofacial abnormalities (need 2)
Short palpebral fissures
Flat midface
Short nose
Indistinct Philtrum
Thin upper lip |
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Term
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Definition
| Direct toxic effects of alcohol and acetaldehyde on the embryo and placenta |
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Term
| what are related effects btw drugs and later outcomes of kids? |
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Definition
Nicotine: association with ADHD and Conduct Disorder1
unclear if genetic or environmental
Marijuana: high hyperactivity, impulsivity, delinquency, poor sustained attention and visual memory4
Cocaine: “crack babies” by age 6 show no gross differences c/w controls.2
May have more subtle problems with arousal regulation affecting orientation, selective attention, information processing, learning and memory3 |
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Term
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Definition
Abstinence-based AA-model (all substances except opiates)
Success hinges on retention
Retention is facilitated by provision of support services
child care, parenting classes, vocational training
addressing violence, abuse, safety issues and mood disorders
Opiates: abstinence vs. methadone maintenance (based on likely hood of successful abstinence) |
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Term
| Tx for neonatal withdrawl? |
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Definition
Supportive Measure in the Infant Nursery
Provide containment by swaddling with blankets (tremors, increased tone)
Gentle moving and awakening of infant to reduce startle
Quiet environment with reduced lights
Dress in light clothing to reduce overheating
Loose/watery stools may require treatment with opiods (tincture of opium, oral morphine or methadone)
Provide access to addiction treatment for the mother and father
Provide parenting education and support
Provide early intervention/ enriched environment for the child |
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Term
| effect of nicotine on adolescent? |
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Definition
Female rats exposed to nicotine in adolescence self-administered 2X the amount of drug/kg weight than those exposed as adults and this escalation persisted into adulthood
Persistent learning impairments were seen in adulthood after adolescent nicotine exposure |
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Term
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Definition
affect hippocampus!!Adolescents are more vulnerable than adults to the effects of alcohol on learning and memory at lower doses of alcohol
Replicated in human subjects in early 20’s vs. late 20’s (worse memory at same dose of etoh)
Teens w/ Etoh abuse have smaller hippocampus on MRI*
Glutamatergic (NMDA) receptor-mediated neurotransmission in hippocampus inhibited more powerfully by acute etoh during adolescents than adulthood AS WELL AS
Adolescents have less sensitivity to the sedative and motor-impairing effects of etoh
Adolescent GABA receptor less sensitive to etoh (theory)
Normal “STOP DRINKING” brakes are absent
Allowing adolescents to consume more etoh over longer periods w/higher blood etoh levels |
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Term
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Definition
Initiation before age 17:
was associated with lower verbal IQ scores1
impaired working memory2
smaller whole brain and cortical gray3 matter volumes
Both males and females were smaller in height and weight (males>females) |
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Term
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Definition
Adolescent hamsters repeatedly exposed to cocaine in adolescence have higher offensive aggression (attacks, bites, latency to bite) than control littermates.
Effect mediated through cocaine activating prefrontal neurons critical for aggression and decrease in serotonin inhibition signal to this brain region to help regulate aggression |
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Term
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Definition
Children of Parents with Substance Abuse Disorder have a 4 to 7 fold higher risk of developing Substance Use Disorder.1
Genetic Component of liability to SUD estimated at 0.31 in males and 0.22 in females and can reach as high as 0.79 in some studies. (higher for stimulants 0.44)
The Environmental Component carries the remainder of liability to SUD
Environment easier to change than genetics |
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Term
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Definition
Access to drugs1
27% of those who experiment with drugs >6 times will become daily users
50% of daily users will develop drug abuse or dependence
Early age of first use2
Drug experimentation before age 13 significantly increased probability of developing SUD by age 17
Negative parent-child interactions3
Problems at school and with peers
Peers who use drugs |
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Term
| How do you ID high risk kids? |
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Definition
Externalizing Disorders
Neurobehavioral Disinhibition1
Difficult temperament, aggression, violation of rules, noncompliance with authority figures, hyperactive/impulsive behavior, sensation seeking, high response to reward, poor response to punishment, poor cognitive control over behavior and emotion.
Conduct Disorder2
Especially when persists beyond age 15, increased the relative likelihood of substance use disorders five-to six fold
Other Psychiatric Disorders
Depression, Anxiety |
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