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Nurs 5229 Clinical Pharmacotherapeutics > Drugs used in Lactation > Flashcards

Drugs used in Lactation Flashcards

1
Q

FACTORS THAT AFFECT THE TRANSFER OF MEDICATIONS INTO
HUMAN MILK
- Milk

A

 plasma ratio (amount excreted in the milk)
 Dependent on timing of dose relative to breastfeeding
 Varies with changes in milk volume, pH, and content of fat and protein

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2
Q

FACTORS THAT AFFECT THE TRANSFER OF MEDICATIONS INTO
HUMAN MILK
- relative infant dose

A

Relative infant dose
 percentage of maternal dose (mg/kg) received by infant in 24 hour period
relative infant dose < 10% considered safe; more clinically useful
Bioavailability (mother and infant)

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3
Q

FACTORS THAT AFFECT THE TRANSFER OF MEDICATIONS INTO
HUMAN MILK
- maternal factors

A 
 Drug dosage and duration of therapy
 Route and frequency of administration
 Metabolism and renal clearance
 Blood flow to the breasts
 Milk pH and composition
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4
Q

FACTORS THAT AFFECT THE TRANSFER OF MEDICATIONS INTO

HUMAN MILK - infant phamacokinetic factors

A

Infant pharmacokinetic factors
 Age of infant
 hepatic capacity in neonate is 10-25% of adult
Lower protein concentration means less bound drug
Lower renal excretion in the first few weeks of life
Lower percent of body fat
 Feeding pattern and amount consumed

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5
Q

infant pharmacokinetic factors

A

 Age of infant
 hepatic capacity in neonate is 10-25% of adult
Lower protein concentration means less bound drug
Lower renal excretion in the first few weeks of life
Lower percent of body fat
 Feeding pattern and amount consumed

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6
Q 
Drug characteristics (Those most likely to be transferred from
maternal plasma to milk)
A 
Nonionized
Nonprotein bound
Low molecular weight
 High lipid solubility
 High pH
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7
Q

Dopamine agonit -examples

A

metoclopramide

doperidone

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8
Q

domperidone

A

 off-label use to improve milk supply
 development of fatal cardiac arrhythmias
 FDA advises against use

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9
Q

Metoclopramide

A

 used off-label to augment milk supply or induce lactation

 potential CNS effects

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10
Q

Dopamine antagonist

A

 Cabergoline

 off-label use to inhibit lactation

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11
Q

Nasal decongestant Pseudoephedrine

A

 Inhibits milk production

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12
Q

Estrogen

A

Inhibits milk production

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13
Q

GUIDELINES FOR PRESCRIPTION DURING LACTATION - avoid

A

Avoid medications when possible

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14
Q

GUIDELINES FOR PRESCRIPTION DURING LACTATION use medicaitons with a realiatve

A

Use medications with a relative infant dose < 10 percent (found in published
guides on medication use during lactation)

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15
Q

GUIDELINES FOR PRESCRIPTION DURING LACTATION - use medicaitons with a short

A

Use medications with a short half-life, high protein binding, low oral
biovailability, and high molecular weight

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16
Q

GUIDELINES FOR PRESCRIPTION DURING LACTATION avoid drus with a

A

Avoid drugs with a long half-life

17
Q

GUIDELINES FOR PRESCRIPTION DURING LACTATION if a drug has a

A

If a drug has a short half-life, give it after nursing or before a prolonged
period of infant sleep.

18
Q

GUIDELINES FOR PRESCRIPTION DURING LACTATION use caution with

A

Use caution with low birth-weight or preterm infants because of potentially
immature organ systems

19
Q

GUIDELINES FOR PRESCRIPTION DURING LACTATION monitor

A

Monitor the infant

20
Q

GUIDELINES FOR PRESCRIPTION DURING LACTATION discuss

A

Discuss risks and benefits with the patient as informed consent issue

21
Q

GENERALLY CONTRAINDICATED MEDICATIONS

A

Immunosuppressive and cytotoxic agents
Drugs with high relative infant dose and/or long half-life
Gold salts
Lithium
Ergotamine
Amiodarone
Retinoids
Long term Tetracyclines
Others: ASA, acebutolol, bromocriptine, phenindione, primidone, sulfasalazine.
Lamitrogine (anticonvulsant), nefazodone (Serzone, antidepressant)

22
Q

DRUGS DEEMED SAFE DURING LACTATION - antibiotics

A

Penicillins, cephalosporins, macrolides, aminoglycosides

23
Q

DRUGS DEEMED SAFE DURING LACTATION - psychotroipic

A

 SSRIs (citalopram,escitalopram, sertraline, fluvoxamine, fluoxetine, paroxetine)
 Bupropion (Wellbutrin) (no quantifiable levels in infants after breast feeding; not as well studies).
 Venlafaxine (Effexor) (passes more readily into infant serum, no noted adverse effects)
 Tricyclic antidepressants (excreted into breast milk in low concentrations, no adverse infant effects except

24
Q

DRUGS DEEMED SAFE DURING LACTATION - anticoagulants

A 
 Unfractionated heparin and warfarin
 Fondaparinux
 Danaparoid
 Low molecular weight heparins
 Aspirin
25
Q

DRUGS DEEMED SAFE DURING LACTATION anticonvulants

A

carbamazepine, ehtosuximide, phenytoin, and valproic acid (some side effects, but
generally considered safe
 Ethosuximide (infant side effects, monitor infant serum levels)
 Gabapentin (limited studies, but promising)

26
Q

DRUGS DEEMED SAFE DURING LACTATION - antihypertensives

A

Beta-blockers (propranolol, metoprolol, labetalol OK, not acebutlol or atenolol)
 calcium channel blockers (diltiazem, nifedipine, verapamil)
 ACE inhibitors (use caution in the first few weeks of life, enalapril and captopril OK later)

27
Q

DRUGS DEEMED SAFE DURING LACTATION - antihistamines

A

 loratadine (Claritin) OK
 first generation diphenhydramine and chlorpheniramine have been used without significant
reactions.

28
Q

DRUGS DEEMED SAFE FOR USE DURING LACTATION - nasal

A

Nasal decongestants: pseudoephedrine may decrease milk supply, chronic use
not recommended

29
Q

DRUGS DEEMED SAFE FOR USE DURING LACTATION contracepton

A

 Progestin-only recommended (commencement at 6 wks post partum if exclusively
breast feeding versus 3 weeks of supplementing with formula).
 Combined estrogen-progestin (recommendations vary, data mixed, has been shown
to decrease milk supply).
 Levonorgestrel releasing IUD at 6 weeks postpartum OK

30
Q

OTHER DRUG RECOMMENDATIONS

- analgesics

A

 Acetaminophen, ibuprofen OK
 Longer acting NSAIDs (naproxen) caution advised. ASA not generally recommended.
 Narcotics OK (caution with meperidine); infants should be monitored carefully
 Anesthesia:
 mother should breastfeed immediately before surgery
 may resume when mother is awake and alert
 anesthesia should be informed of lactation and effort madeto use: short-acting benzodiazepines, propofol, muscle relaxants,
inhalation agents and local anesthetics; long-acting medications should be avoided

31
Q

OTHER DRUG RECOMMENDATIONS - social substances

A

 Caffeine (moderate intake 200-300mg/d OK), alcohol (decreases milk production
 Alcohol
 Generally not recommended
 Single drink cleared within 2-3 hours
 Tobacco not recommended for other reasons
 Substance abuse:
 Generally not recommended
 Methadone is compatible with breastfeeding

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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