Exam 1 - Maternal Medications Flashcards
When is the greatest risk of exposure babies breast feeding?
In the first 4-6 months of life
When do babies take in the most amount of breast milk?
In the first 4-6 months of life
What are the most common adverse drug reactions during breast feeding?
1) Diarrhea
2) Drowsiness
3) Irritability
What drugs commonly cause diarrhea while breast feeding?
Antibiotics
Which drugs commonly cause drowsiness while breast feeding?
1) Analgesics
2) Sedatives
Which drugs commonly cause irritability while breast feeding?
Antihistamines
What should we consider when evaluating the use of medications in a breastfeeding mother?
- Length of time breast feeding
- How old the baby is
- Exclusively breast feeding
T/F: To pass into breast milk, the substance must first be absorbed into the mother’s body.
TRUE
T/F: To be active in the infant, it must be absorbed through the kidneys.
FALSE
-To be active in the infant, it must be absorbed through the GI TRACT
Drugs given to _____ moms reach infants in ____ amounts than drugs given to pregnant women.
Drugs given to NURSING moms reach infants in SMALLER amounts than drugs given to pregnant women.
What are the mother/infant factors to consider?
- Disease states
- Absorption
- Distribution
- Metabolism
- Excretion
- Variances with age
How does drug transfer into breast milk?
1) Intracellular diffusion
2) Transcellular diffusion
3) Active transport (minimal)
Name the 2 cells that participate in intracellular diffusion.
1) Macrophages
2) Lymphocytes
Name the 2 requirements for transcellular diffusion.
1) Lipid solubility
2) Low molecular weight
Name the 4 ways that amount and rate of diffusion is determined by.
1) Molecular size
2) Ion trapping
3) Lipid partitioning
4) Protein binding
T/F: Small molecules are less likely to pass into breast milk.
FALSE
-Large (>200 daltons) are less likely to pass into breast milk
T/F: Breast milk is 100% fat.
FALSE
-Breast milk is not 100% fat
____ soluble drugs will concentrate in the milk fat.
LIPID soluble drugs will concentrate in the milk fat.
What percentage is fat of breast milk?
3-5% of total volume of milk
When does colostrum produce?
0-5 days
T/F: Colostrum is high in protein and fat.
TRUE
pH of milk is slightly _____ compared to plasma.
pH of milk is slightly ACIDIC compared to plasma.
____ bases will concentrate in the milk.
WEAK bases will concentrate in the milk.
What is the major binding protein?
ALBUMIN
Drugs which are ____ ____ ____ will remain in the plasma.
Drugs which are HIGHLY PROTEIN BOUND will remain in the plasma.
Name the factors that cause a drug to stay in the bloodstream.
- Large size
- Weak acid
- Protein bound
- Water soluble
Name the factors that cause a drug to go through breast milk.
- Small size
- Weak base
- Low binding
- Lipid soluble
How many t 1/2 (half-lives) until drug is out of the body?
5
FIVE!!!!!!
What is the pH of milk?
7.2 (acidic)
T/F: Drugs with shorter half-lives clear the body faster.
TRUE
T/F: Longer half-lives lead to accumulation.
TRUE
T/F: Passage into breast milk is only a fraction of the excretion.
TRUE
- Less than 2%
- Kidneys and liver excrete a larger amount than what is actually absorbed into the breast milk
When should you take drug with intermittent dosing?
At a trough; with short half-life drugs can take them right before nursing or right after
_____ _____ dosing is close to steady state conditions.
ONCE DAILY dosing is close to steady state conditions.
What is milk/plasma ratio?
The ratio of concentration in milk to the ratio concentration in plasma.
How do you calculate the infant dose?
Infant dose (mg) = mom’s dose (mg) * % dose absorbed by infant
Infant dose (mg) = Conc. in milk (mg/mL) * volume of milk (mL)
What are the considerations in drug choice?
- Dosage and duration
- Infant maturity
- Quantity of milk consumed
- Experience with drug in infants
- Oral absorption
- Potential long-term effects
- Possible interference with lactation
- Non-dose related toxicity
Which types of drugs have potential long-term side effects?
CNS agents (Valium/Diazepam, Clonazepam, Xanax/Alprazolam)
SSRIs (Citalopram, Escitalopram, Fluoxetine, Sertraline)
Which drug has a possible interference with lactation?
Diphendydramine (Benadryl)
-Dries up secretion and inhibits lactation
Name the drugs that decrease milk supply (“DAM DAVE”).
D - Dopamine Agents (ergots, levodopa, B6)
A - Androgens
M - Marijuana
D - Diuretics (high dose)
A - Alcohol (high dose)
V - Vasoconstrictors (Sudafed)
E - Estrogens
What do dopamine agents (like ergots, levodopa, B6) do to milk supply to decrease it?
Inhibit prolactin release
What produces milk?
Rising levels of prolactin
What do estrogens do to decrease milk production?
Block the effect of prolactin
What do androgens do to decrease milk production?
Suppress plasma prolactin
What do rising levels of prolactin do?
Produce milk
What do vasoconstrictors do to decrease milk supply?
Decreased blood flow to the breast
Name the drugs that increase milk supply.
- Metoclopramide, Neuroleptics
- Methyldopa
- H2 Antagonists
- Tryptophan
- Fenugreek
How do Metoclopramide and Neuroleptics increase milk supply?
Inhibit dopamine secretion
How does Methyldopa increase milk supply?
False dopamine precursor
How do H2 Antagonists and Tryptophan increase milk supply?
Increase serotonergic transmission
What are some strategies to minimize infant exposure?
- Use short half-life drugs
- Take before longest sleep period (baby’s)
- Switch to safer drug
- Use different route (i.e. steroid creme)
- Stop the drug
T/F: Estrogen containing products may suppress lactation and quality of milk produced.
TRUE
What type of contraception is preferred in lactation?
PROGESTIN-ONLY PILLS (Micronor, Slynd)
When can you use estrogen contraception if you have to?
After 6+ weeks postpartum
T/F: IUD is a safe contraceptive during lactation.
TRUE
T/F: Depo-Provera lowers milk production.
TRUE
Name the non-dose related toxicity associated with Antibiotics.
- Diarrhea
- C. Difficle
- Candida overgrowth
Name the antibiotics safe in lactation (“PCM Q”).
P - Penicillins
C - Cephalosporins
M - Macrolides (Azithromycin)
Q - Quinolones (Ciprofloxacin, Ofloxacin)
Name the antibiotics that should be cautioned in lactation (“CST”).
C - Chloramphenicol
S - Sulfa agents - first month of life!
T - Tetracycline - repeated use!
What bacteria causes mastitis?
S. aureus
E. coli
Srep.
What do you treat mastitis with?
Dicloxacillin
Oxacillin
Cephalosporin
How long is mastitis treated for?
10-14 days
T/F: IBU can be used for pain in mastitis.
TRUE
T/F: You can continue to breast feed with mastitis.
TRUE
Breast milk and HIV are _______.
Breast milk and HIV are CONTRAINDICATED.
T/F: The influenza treatments, Oseltamivir and Zanamivir are considered safe.
TRUE
T/F: In HSV, Acyclovir and Valacyclovir are considered unsafe.
FALSE
-In HSV, Acyclovir and Valacyclovir are considered safe
Name the 2 contraindicated immunizations.
1) Smallpox (LIVE)
2) Yellow Fever (LIVE)
Why are Smallpox and Yellow Fever vaccinations/immunizations contraindicated in lactation?
B/C they contain live virus
What HTN adverse drug reactions should you monitor for in lactation?
- Apnea
- Weakness
- Hypoglycemia
T/F: HTN has the potential to reduce milk production.
TRUE
Name the preferred beta blockers for HTN treatment.
1) Propranolol
2) Metoprolol
Name the preferred calcium channel blockers in HTN treatment.
1) Nifedipine
2) Nimodipine
Which anticoagulation treatments are considered safe (“WALH”)?
W - Warfarin - UNLIKE DURING PG
A - ASA - low dose
L - Low molecular weight heparin - Lovenox, Enoxaparin
H - Heparin
Which anticoagulation treatments are cautioned during lactation?
Clopidogrel
DOAC - can use Rivaroxaban
T/F: Antihistamines and decongestants both suppress lactation.
TRUE
T/F: Guaifenesin and saline nasal sprays are considered unsafe in lactation.
FALSE
-Guaifenesin and saline nasal sprays are considered safe in lactation
T/F: IBU and acetaminophen are considered safe in lactation.
TRUE
