exam 1 Flashcards
Factors to consider for Drug Use During Pregnancy
Look at all factors together!
- maternal blood concentration
- molecular weight
- plasma elimination half-life
- lipid solubility
- ionization at physiologic pH
- plasma protein binding
- placental metabolizing enzymes
_______ - stimulates production of milk
prolactin
_______ - stimulates ejection of milk
oxytocin
Physiology of lactation:
o Abrupt decrease in progesterone after delivery allows __________ to stimulate production of breast milk
o ________ stimulates milk ejection by causing contraction of myoepithelial cells in alveoli and small milk ducts
o ________ produced during the 1st few days, small quantity; full of immunoglobulins & anti-oxidants
o ________ milk produced in the first 5 minutes of nursing, 2-3% lipid
o ________ produced after 5 minutes of nursing, 10% lipid; more nutrition/calories
- prolactin
- oxytocin
- colostrum
- foremilk
- hindmilk
Duration of breastfeeding:
exclusively 4-6 months
Factors to consider for Drug Use During Lactation
Look at all factors together!
- molecular weight
- lipid solubility
- maternal plasma level of drug
- plasma protein binding
- ionization at physiologic pH
- bioavailability
Milk/plasma ratio
- Ratio of concentrations of a drug in milk and plasma may be used as a measure of a drug’s passage into breastmilk
o Milk/plasma ratio > 1 means:
(more/less) drug in the milk ?
more drug in the milk
o Milk/plasma ratio = 1 means:
baby is taking in drug (ex. Alcohol)
Relative infant dose
- Standardized means of referencing infant exposure to maternal exposure on a dose/weight basis
Relative infant dose: RID (%)
= absolute infant dose (mg/kg/day) via milk / maternal dose (mg/kg/day)
Drugs that decrease milk ejection
o Ethanol – inhibits oxytocin
Drugs that decrease milk production
– decrease prolactin o Anticholinergics o Diuretics o Dopaminergic agents o Estrogens o Cigarette smoking o Sympathomimetic vasoconstrictors
Drugs that increase milk supply (galactagogues)
o Dopamine antagonists (metoclopramide)
o Fenugreek
Contraception effectiveness are measured by ________ ____ in the first year of use.
failure rates
Contraception typical use:
= unintended or accidental pregnancy during the year but not all use the method perfectly for a year; condom broke, not consistently, missing dose
Contraception perfect use:
= % of couples who used the method correctly and consistently everytime they had intercourse for a year but had an accidental pregnancy (even if used correctly and consistently)
Non-Hormonal Forms of Contraception:
- lactational amenorrhea
- fertility awareness-based (cycle beads, symptothermal)
- barrier techniques (diaphragm, cervical cap, male condom, female condom)
- spermicides
- sponge
Latex condom can be used with _____-based lubricants
water
What types of method are more effective?
IUD, implanon, sterilization