Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics > Drug Use During Lactation > Flashcards

Drug Use During Lactation Flashcards

1
Q

What is the best form of nutrition for young infants?

A

Breast milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mothers should breast feed exclusively for ____, and continue until at least ___ while other foods are introduced.

A

6 months; 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Breast feeding provides:

A

1) Protection of the infant against gastric, respiratory, and urinary tract infections.

2) Reduction in the rate of obesity, and juvenile onset diabetes mellitus.

3) Reduction in the rate of atopic diseases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Maternal benefits of beast feeding include:

A

1) Reduced risk of developing pre-menopausal breast cancer
2) Strengthens the mother-infant bond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The drug dose ingested by the infant via breast milk ___(usually/rarely) causes adverse effects.

A

Rarely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Almost all drugs enter breast milk by:

A

Passive diffusion through the lipid membrane of the alveolar cells of the breast.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Drugs that enter the breast milk should be:

A

1) Un-ionized
2) Not protein bound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Factors affecting rate and extent of passive diffusion of drug to breast milk include:

A

1) Maternal plasma drug level
2) Physiological differences between plasma and milk
3) Physicochemical properties of the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the pH of breast milk?

A

6.8 – 7.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In which ways does breast milk differ from blood?

A

1) Lower pH
2) Lowering buffering capacity
3) Higher fat content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the drug parameters affecting the extent of transfer
into milk?

A

1) pKa
2) Protein binding
3) Lipophilicity
4) Molecular weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does the pKa determine?

A

Drug ionization at a given pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Do highly ionized drugs tend to concentrate in milk?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Is Erythromycin acidic or basic?

A

Basic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

For basic drugs, a greater fraction will be ionized at a(n) ___(basic/acidic) pH. What does this mean?

A

Acidic; That the milk compartment tends to trap weak bases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Is Penicillin acidic or basic?

A

Acidic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acidic drugs are more ionized at ___(lower/higher) pH values and will be trapped in the __ compartment.

A

Higher; Plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Drugs with higher pKa values generally have higher ____.

A

Milk/plasma ratios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Is Warfarin highly bound to plasma proteins?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Drugs that are highly bound to plasma proteins (warfarin) are likely to be retained in the __.

A

Plasma; because there is lower protein content in milk (~1%).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

__-active drugs usually cross to breast milk.

A

CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Do water-soluble drugs effectively cross the alveolar epithelium of the breast?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Drugs with what molecular weight readily pass into the milk?

A

Low molecular weight (<200)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do low molecular weight drugs pass into the breast milk?

A

Through small pores in the cell wall of alveolar cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do high molecular weight drugs pass into the breast milk?

A

By dissolving in the lipid layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which are virtually excluded from passing into breast milk?

A

Protein molecules (very large molecular weights >6000 daltons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Drugs that pass minimally to breast milk would be:

A

1) Acidic drugs
2) Drugs with high plasma protein binding
3) Drugs with low-to-moderate lipophilicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is an example of a drug that would pass minimally into breastmilk?

A

Most NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Drugs that pass significantly to breast milk would be:

A

1) Basic drugs
2) Drugs with low plasma protein binding
3) drugs with relatively high lipophilicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is an example of a drug that would pass significantly into breastmilk?

A

Sotalol

31
Q

Why is there enhanced passage of drugs into breastmilk in the first few days of life?

A

Because in the first week, large gaps exist between alveolar cells

32
Q

The large gaps between the alveolar cells close under the influence of:

A

Prolactin

32
Q

What is colustrum?

A

The first breast milk released in the first 2 days after giving birth

32
Q

Colustrum has high amounts of:

A

1) Immunoglobulins
2) Maternal lymphocytes
3) Maternal macrophages

33
Q

Greater amounts of drugs are present in colustrum, but the amounts received by infants are low. Why?

A

Because of the low volume of colustrum produced

34
Q

Which drug is actively pumped into breast milk?

A

Iodides

35
Q

Which drug is found in breast milk in high concentrations?

A

Iodides

36
Q

Which factors should be considered when assessing the risk to the infant?

A

1) Inherent toxicity of the drug
2) Multiple maternal therapy with drugs having similar adverse effects
3) Active metabolites
4) Drugs with long half-lives
5) Gestational age
6) Maternal drug regimen

37
Q

Which drugs are contraindicated during lactation for being hazardous to infants?

A

1) Antiarrhythmic drugs
2) Anticholinergic drugs
3) Anti-infective drugs
4) CNS stimulants
5) Cytotoxic agents
6) Illicit substances
7) Immunosuppressants
8) Thalidomide
9) Lithium
10) MAOIs
11) Radioactive substances
12) Skeletal muscle relaxants
13) Tetracyclines
14) Tricyclic antidepressants
15) Retinoic acid derivatives

38
Q

Anticonvulsants should not be given with:

A

Psychotropic drugs

39
Q

What is a drug with active metabolites?

A

Benzodiazepines

40
Q

Fluoxetine has a ___(short/long) half-life

A

Long

41
Q

Why are drugs with active metabolites contraindicated during lactation?

A

They may prolong infant drug exposure and lead to drug
accumulation.

42
Q

Premature infants are more
susceptible to drugs because of:

A

Low clearance

43
Q

What are some strategies to reduce the risk of drugs in breast fed infants?

A

1) Choose medications considered safe for use in infants

2) Give the maternal dose immediately after the infant has been fed

3) If the mother is receiving a single dose of a hazardous material (radiopharmaceuticals),
avoid breast feeding and resume after a reasonable washout period

4) Administer once-daily meds before the infant’s longest sleep
period to increase the interval to next feeding.

5) Breastfeeding mothers should avoid self-medication

6) When drug use is indicated, the lowest effective dose should be used for the shortest possible period of time.

7) Simplify maternal regimen as much as possible

8) New drugs are best avoided if a therapeutic equivalent is available for which data on safe use during lactation is available

9) Monitor exposed infants for adverse effects.

10) During short-term drug therapy, and if the medication is NOT compatible with breastfeeding, the mother can pump milk out and discard it to preserve here milk-producing capability

44
Q

What is the usual washout period for drugs?

A

5 half-lives

45
Q

Which drugs should be selected during lactation?

A

1) Short half-lives
2) High protein binding

46
Q

______ are at greater risk of developing adverse effects to drugs after exposure via breast milk.

A

Neonates and premature infants

47
Q

Gastric emptying time in neonates and premature infants is ___(shortened/prolonged) and may alter drug absorption.

A

Prolonged

48
Q

Protein binding in neonates and premature infants is ___(increased/decreased).

A

Decreased

49
Q

Do neonates and premature infants have higher or lower total body water?

A

Higher

50
Q

Oxazepam is eliminated by:

A

Direct conjugation with glucuronide

51
Q

Neonates and premature infants should not be exposed to oxazepam. Why?

A

Because their conjugation capacity is deficient

52
Q

What does a Glucose-6 phosphate dehydrogenase (G6PD) deficiency do to erthyrocytes?

A

Makes them more susceptible to oxidative stress = hemolysis

53
Q

Should you breastfeed with a G6PD deficiency if you’re taking hemolysis-inducing drugs?

A

No, even small amounts of the drug can cause hemolysis

54
Q

What does a high intake of alcohol in breastfeeding mothers do?

A

1) Decreases milk let down reflex
2) Disrupts nursing
3) Causes sedation, fluid retention, and hormone imbalances in infants.

55
Q

What does nicotine do during lactation?

A

Decreases basal prolactin production

56
Q

Caffeine appears in breast milk __(slowly/rapidly) after maternal intake.

A

Rapidly

57
Q

10 or more cups of coffee per day by the mother causes what in breast fed infants?

A

1) Fussiness
2) Jitteriness
3) Poor sleep patterns

58
Q

Preterm and newborn infants metabolize caffeine ___(rapidly/slowly) and are at increased risk.

A

Slowly

59
Q

Which drugs are the main cause of effects on milk production?

A

Drugs that affect dopamine activity

60
Q

Cabergoline is a dopamine __(agonist/antagonist).

A

Agonist

61
Q

Dopamine agonists __(increase/decrease) milk production.

A

Decrease

62
Q

Domperidone is a dopamine __(agonist/antagonist).

A

Antagonist

63
Q

Dopamine antagonists
__(increase/decrease) milk production

A

Increase

64
Q

Early postpartum use of ___ may reduce the volume of milk.

A

Estrogens

65
Q

Milk production can be abolished by the use of:

A

1) Estrogens
2) Oral contraceptives

66
Q

Breast milk production can be increased by:

A

Metoclopramide

67
Q

Metoclopramide stimulates ___ secretion

A

Prolactin

68
Q

Can we give Amantadine during lactation?

A

No, it decreases milk production

69
Q

What is Fenugreek?

A

A botanical galactagogue

70
Q

Does Fenugreek increase or decrease milk production?

A

Increase

71
Q

Do botanical galactagogues increase or decrease milk production?

A

Increase

72
Q

Which botanical galactagogues are common?

A

1) Fenugreek
2) Fennel
3) Anise
4) Milk thistle
5) Barley

Therapeutics (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions