Breastfeeding & Medication

Question 1

Routes of drugs

Answer 1

Orally 
IM
Through the skin
Rectally
Vaginally

Question 2

Source of information

Answer 2

BNF- tells whether the drug is licensed and if it’s okay for breastfeeding
It does not tell information about the age of the baby , how often the baby is feeding and the potential side effects.
The HCP will take responsibility if something was to go wrong

Therapeutic Range- Below the level doesn’t have any effect on baby
Within this levels has an effect

Plasma protein binding- how the medication is binding to the molecules to be transported in the plasma. Drugs which are highly bound to proteins in the maternal plasma are unable to transfer into breast milk in high levels.

Question 3

Source of information 2

Answer 3

Half life - how long is it lasting in the system for example; antibiotics - short half life removed from the system quite quickly
If half life is 24 hours, at 24 hours the drug will be at 50%. So if the next dosage is given then the body will have 150% of the drug.

Bio availability- if a drug can’t be absorbed from the stomach the baby will not be able to absorbed for example is injection and vaccination is unlikely to be absorbed by the baby
Specialised texts and websites

Question 4

Reasons for drug offered when breastfeeding

Answer 4

Inflammatory mastitis - build up of milk production over stimulating , will over build and sit in the breast

Postnatal- difficult deliveries haematoma

Breasts shiny and stretched
Raised temp

Question 5

Risks of not breastfeeding

Answer 5

Allergies

Lack of nutrition

Risk of sudden infant syndrome

Check drug charts to see if mother is on drug and that is the reason why she is not breastfeeding

Question 6

KEY POINTS

Answer 6

Infant dose 
Milk:plasma ration
Plasma protein binding 
The molecular weight of the drug
Oral bio-availabilty 
Short half life
If the drug is licensed
Be cautious to herbal drugs.
If the medication is useful at all.

Question 7

Fat soluble drugs pass easily in to breast milk

Answer 7

TRUE

Question 8

Intercelluar gaps

Answer 8

Wide open at delivery but they gradually tighten over the days following the birth
more drugs pass into the milk in day 1 then day 3
advise mum to stop breastfeeding to take the medicine is always the final resort
Medicine should be taken after a feed to minimse drug level