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31 Cards in this Set

  • Front
  • Back
AAP recommends exclusive breastfeeding for first ___ months of life
6 months
True or False: prior to a drug coming to market, it must first be studied in lactaction?

Most data is from after-market studies
What are some contraindications to breast feeding?
1. infants with galactosemia
2. mothers with active or untreated TB or Tcell lymphotropic virus type I or II +
3. Mothers receiving radioactive isotopes
4. Mothers receiving chemo or antimetabolites
5. Mothers using drugs of abuse
6. mothers with herpes lesions on breast
7. Mothers with HIV
How do drugs pass into milk?

What is the concentration gradient formed by?
- passive diffusion across semi-permeable lipid membrane

- The amount of free, non-ionized drug on each side of the membrane
Drugs with (LOW/HIGH) molecular weight pass readily into breast milk

Highly protein bound drugs (WILL/WILL NOT) pass well into human milk?

Lipid soluble drugs diffuse and enter milk (MORE/LESS) readily
- Low

- will NOT

- More
Medications with (HIGH/LOW) pH will become trapped in breast milk

(IONIZED/UN-IONIZED) meds pass freely into milk
- high pH

- Non-ionized
if the milk:plasma ratio of a drug is >___ the infant is at risk

(MILK/PLASMA) level may lag behing (MILK/PLASMA) level
- >1 milk:plasma ratio

- Milk may lag behind plasma
Infant Dose medication

Infant dose = ____ concentration in milk x ____ of milk ingested

Usual volume of milk ingested daily is ____ml/kg/day
[drug] in milk X volume ingested

150 ml/kg/day
Infant dose example:

A mother took ibuprofen and the concentration measured in the milk was 4mcg/ml and the baby drank 1000ml milk. What dose of ibuprofen did the infant get?
Answer: 4mg/day
Drug admin during lactation:

1. Peak concentrations occur __-__ hours after the dose of regular formulations

2. When should a mother take a drug?
1. 1-3 hours

2. take drug after nursing or before the longest period of sleep
True or false: "pumping and dumping" is not an effective method for increasing drug elimination from milk?
pH of the milk is (MORE/LESS) acidic than plasma?

milk ~ pH 7.1
plasma ~ pH ~7.4
Decreased ____ allows for more prolactin release and increases milk supply

What are some examples of drugs that block the blank above?
- dopamine

- haloperidol, thorazine, metocloopramide
True or False: metoclopromide is a definitive agent used to augment milk supply?
False, still questionable
Anticholinergics (atropine) and sympathomimetics (ephedrine) may (INCREASE/DECREASE) milk supply?
Peripherally acting agents like ____ directly decrease lactation
- estrogens
Low dose _____ are preferred agent for contraception during lactation
Low dose progestins

Note: however, low dose combos are generally complication free
What type of antimicrobials are compatible in breast feeding?

Why are quinolones controversial in lactation?

What about metronidazole
Tendon arthropathy

Carcinogen in rodents
Why is nitrofurantoin controversial in lactation?
Actively txp'd into milk and achieves concentration in milk greatly exceeding those in serum
Which beta blockers have the lowest transfer in to milk?

Which have the highest and what do they cause?
Lowest: propranolol, metoprolol, labetolol

Highest: Acebutolol, atenolol

cause bradycardia and hypotension

"Stay away from the A's"
Which calcium channel blockers have the lowest transfer into milk?
Diltiazem, nifedipine, verapamil
Which ACE-I's have been reviewed by the AAP as compatible after the first few weeks?
Captopril and Enalapril
_____ is the preferrred antihistamine

Which nasal decongestant is considered compatible?
- loratadine

- pseudoephedrine
- does it enter the milk?
- is it safe?

Ibuprofen and ketorolac
- infant dose is <__&
- compatible?
- yes, yes

- <1%; yes
True or false: long acting NSAIDs (naproxen) can be given indefinitely

- only for short term therapy
- increased potential for accumulating in the infants plasma
True or false: opiates should never be given during lactation
False- generally safe

AVOID MEPERIDINE due to toxic metabolite
IV contrast dyes are considered (SAFE/UNSAFE) therefore breastfeeding should be (CONTINUED/INTERRUPTED) during administration
- Safe, continued

however, you can discard milk for 24 hours if you're concerned
True or false: Warfarin should be avoided in breast feeding due to increase INR and bleeding risks in the infant?

considered safe, does not cross readily ( highly protein bound)
One way to minimize infant exposure is to temporarily withhold feeding for __-__ half lives for typical drugs or __-__ for toxic compounds
1-2 for typical

4-5 for toxic
If a drug has a half life of 8 hours, how long could you hold off breast feeding if you're concerend about exposure?
8-16 hours

(1-2 half lives)