Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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?
|
False
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?
|
True
|
|
|
pH of the milk is (MORE/LESS) acidic than plasma?
|
more
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?
|
decrease
|
|
|
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?
|
Cephalosporins
Aminoglycosides Macrolides Penicillins "CAMP" |
|
|
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 |
|
|
Acetaminophen
- does it enter the milk? - is it safe? Ibuprofen and ketorolac - infant dose is <__& - compatible? |
APAP
- yes, yes Ibu/Ketor - <1%; yes |
|
|
True or false: long acting NSAIDs (naproxen) can be given indefinitely
|
False
- 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?
|
False
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) |
