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26 Cards in this Set
- Front
- Back
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What are the most common type of drugs used by breastfeeding mothers that have effects on the infant?
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Analgesics
antibiotics antihistamines sedatives |
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Most common infant ADR after mother drug use during breastfeeding:
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Diarrhea (antibiotics)
Drowsiness (analgesics and sedative) Irritability (antihistamines) |
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What are the first few questions to ask about a drug to be used during breastfeeding?
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Is the medication absorbed in to the blood?
Is it absorbed by the infant? |
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What pharmacodynamic properties make a drug more likely to cross into the breast milk?
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Small molecule
low protein binding lipophilic weak bases |
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Drugs that decrease milk supply:
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Dopaminergic Agents – ergots, levodopa, B6
Estrogens Androgens Vasoconstrictors (pseudaphen, antihistamines) Diuretics (high dose) Alcohol (high dose) Marijuana |
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Drugs that increase milk supply:
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Metoclopramide
Neuroleptics Methyldopa H-2 Antagonists (high dose IV), , Tryptophan Fenugreek |
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Diabetic agents considered safe to use while breastfeeding:
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Insulin
Tolbutamide or Chlorpropamide Glipizide and glyburide |
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Contraceptives considerations during breastfeeding:
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Prefer progestin-only pills (Micronor®)
IUD Estrogen containing may suppress lactation and quality of milk (if must used: low dose combo after 6 weeks) Depo-Provera (lowers milk production) |
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What antibiotics are considered safe to use during breastfeeding?
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Penicillins
Cephalosporins Macrolides including azithromycin Quinolones |
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What antibiotics should not be used during breastfeeding?
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Chloramphenicol
Sulfa agents (1st month) Tetracycline (repeated use) |
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How to treat mastitis?
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Cephalosporin (10-14 days)
- alternatives: dicloxacillin and oxacillin Ibuprofen for pain Warm/clod packs Continue breastfeeding |
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Antihypertensive agents preferred during breastfeeding:
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BB: propranolol and metoprolol
CCB: nifedipine and nimodipine Hydralazine (in hospital setting) |
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What analgesics may and may not be used during breastfeeding?
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SAFE:
- APAP and IBP - Codeine, hydrocodone, oxycodone, and morphine AVOID: - Naproxen and ketoprofen (long half life) - Ketorolac (high risk for maternal bleeding) - Aspirin (Reyes Syndrome) - Meperidine (metabolite with long half life) |
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How to treat cough and cold during breastfeeding?
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- Avoid antihistamines and decongestants if possible (suppress lactation)
- Alternatives: chlorpheniramine and pseudoephedrine - Dextromethorphan is OK but avoid multi-symptom preparations - Guaifenesin and saline nasal sprays considered safe |
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Antidepressant options during breastfeeding:
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Order of options:
1st: Sertraline 2nd: Paroxetine 3rd: Escitalopram 4th: Desvenlafaxine AVOID: fluoxetine |
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Which Benzos can be used during breastfeeding and how?
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Short acting benzos:
Lorazepam (Ativan®) Alprazolam (Xanax®) Midazolam (Versed®) - Brief use |
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Preferred GI and antisecretory agents:
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H2 blockers: famotidine and nizatidine
PPIs: omeprazole and lansoprazole AVOID: Metoclopramide (tardive dyskinesias) May use after the first 6 weeks post partum |
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Preferred asthma agents during breastfeeding:
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Mast-cell stabilizers (safest):
- Cromolyn (Intal®) - Nedocromil (Tilade®) Inhaled corticosteroids: - Fluticasone (Flovent®) Terbutaline (inhaled and oral) Theophylline Montelukast and Zafirlukast |
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Consideration of smoking during breastfeeding:
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- Urge cessation
- Significant SE - Breast feeding and smoking is better than bottle feeding and smoking - Suggest nicotine replacement therapy |
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SE of heavy maternal caffeine use during breastfeeding:
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irritability and poor sleeping patterns
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Is seizure medication OK during breastfeeding?
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YES
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Dosage of metoclopramide when it is used to enhance lactation:
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10 mg PO TID X 7 – 14 days
- Taper dose down |
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Glucocorticoids of choice for lactation:
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Prednisolone and prednisone
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Antiepilieptics of choice for lactation:
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Phenytoin, CBZ, VPA
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Drugs to Avoid in Lactation:
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Immunosuppressives
Antineoplastics Drugs of Abuse Iodine Lithium Radiopharmaceuticals Social Drugs-alcohol and nicotine |
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What references are best at identifying the risk vs. benefit of medications during lactation?
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Medications and Mothers’ Milk
Clinical Therapy in Breastfeeding Patients Drugs in Pregnancy and Lactation Textbook of Human Lactation Lexi-Comp |
