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PHA 397 - Make-Up Therapeutics > Exam 1 - Maternal Medications > Flashcards

Exam 1 - Maternal Medications Flashcards

1
Q

When is the greatest risk of exposure babies breast feeding?

A

In the first 4-6 months of life

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2
Q

When do babies take in the most amount of breast milk?

A

In the first 4-6 months of life

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3
Q

What are the most common adverse drug reactions during breast feeding?

A

1) Diarrhea
2) Drowsiness
3) Irritability

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4
Q

What drugs commonly cause diarrhea while breast feeding?

A

Antibiotics

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5
Q

Which drugs commonly cause drowsiness while breast feeding?

A

1) Analgesics

2) Sedatives

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6
Q

Which drugs commonly cause irritability while breast feeding?

A

Antihistamines

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7
Q

What should we consider when evaluating the use of medications in a breastfeeding mother?

A
  • Length of time breast feeding
  • How old the baby is
  • Exclusively breast feeding
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8
Q

T/F: To pass into breast milk, the substance must first be absorbed into the mother’s body.

A

TRUE

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9
Q

T/F: To be active in the infant, it must be absorbed through the kidneys.

A

FALSE

-To be active in the infant, it must be absorbed through the GI TRACT

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10
Q

Drugs given to _____ moms reach infants in ____ amounts than drugs given to pregnant women.

A

Drugs given to NURSING moms reach infants in SMALLER amounts than drugs given to pregnant women.

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11
Q

What are the mother/infant factors to consider?

A
  • Disease states
  • Absorption
  • Distribution
  • Metabolism
  • Excretion
  • Variances with age
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12
Q

How does drug transfer into breast milk?

A

1) Intracellular diffusion
2) Transcellular diffusion
3) Active transport (minimal)

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13
Q

Name the 2 cells that participate in intracellular diffusion.

A

1) Macrophages

2) Lymphocytes

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14
Q

Name the 2 requirements for transcellular diffusion.

A

1) Lipid solubility

2) Low molecular weight

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15
Q

Name the 4 ways that amount and rate of diffusion is determined by.

A

1) Molecular size
2) Ion trapping
3) Lipid partitioning
4) Protein binding

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16
Q

T/F: Small molecules are less likely to pass into breast milk.

A

FALSE

-Large (>200 daltons) are less likely to pass into breast milk

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17
Q

T/F: Breast milk is 100% fat.

A

FALSE

-Breast milk is not 100% fat

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18
Q

____ soluble drugs will concentrate in the milk fat.

A

LIPID soluble drugs will concentrate in the milk fat.

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19
Q

What percentage is fat of breast milk?

A

3-5% of total volume of milk

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20
Q

When does colostrum produce?

A

0-5 days

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21
Q

T/F: Colostrum is high in protein and fat.

A

TRUE

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22
Q

pH of milk is slightly _____ compared to plasma.

A

pH of milk is slightly ACIDIC compared to plasma.

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23
Q

____ bases will concentrate in the milk.

A

WEAK bases will concentrate in the milk.

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24
Q

What is the major binding protein?

A

ALBUMIN

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25
Q

Drugs which are ____ ____ ____ will remain in the plasma.

A

Drugs which are HIGHLY PROTEIN BOUND will remain in the plasma.

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26
Q

Name the factors that cause a drug to stay in the bloodstream.

A
  • Large size
  • Weak acid
  • Protein bound
  • Water soluble
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27
Q

Name the factors that cause a drug to go through breast milk.

A
  • Small size
  • Weak base
  • Low binding
  • Lipid soluble
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28
Q

How many t 1/2 (half-lives) until drug is out of the body?

A

5

FIVE!!!!!!

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29
Q

What is the pH of milk?

A

7.2 (acidic)

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30
Q

T/F: Drugs with shorter half-lives clear the body faster.

A

TRUE

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31
Q

T/F: Longer half-lives lead to accumulation.

A

TRUE

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32
Q

T/F: Passage into breast milk is only a fraction of the excretion.

A

TRUE

  • Less than 2%
  • Kidneys and liver excrete a larger amount than what is actually absorbed into the breast milk
33
Q

When should you take drug with intermittent dosing?

A

At a trough; with short half-life drugs can take them right before nursing or right after

34
Q

_____ _____ dosing is close to steady state conditions.

A

ONCE DAILY dosing is close to steady state conditions.

35
Q

What is milk/plasma ratio?

A

The ratio of concentration in milk to the ratio concentration in plasma.

36
Q

How do you calculate the infant dose?

A

Infant dose (mg) = mom’s dose (mg) * % dose absorbed by infant

Infant dose (mg) = Conc. in milk (mg/mL) * volume of milk (mL)

37
Q

What are the considerations in drug choice?

A
  • 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
38
Q

Which types of drugs have potential long-term side effects?

A

CNS agents (Valium/Diazepam, Clonazepam, Xanax/Alprazolam)

SSRIs (Citalopram, Escitalopram, Fluoxetine, Sertraline)

39
Q

Which drug has a possible interference with lactation?

A

Diphendydramine (Benadryl)

-Dries up secretion and inhibits lactation

40
Q

Name the drugs that decrease milk supply (“DAM DAVE”).

A

D - Dopamine Agents (ergots, levodopa, B6)
A - Androgens
M - Marijuana

D - Diuretics (high dose)
A - Alcohol (high dose)
V - Vasoconstrictors (Sudafed)
E - Estrogens

41
Q

What do dopamine agents (like ergots, levodopa, B6) do to milk supply to decrease it?

A

Inhibit prolactin release

42
Q

What produces milk?

A

Rising levels of prolactin

43
Q

What do estrogens do to decrease milk production?

A

Block the effect of prolactin

44
Q

What do androgens do to decrease milk production?

A

Suppress plasma prolactin

45
Q

What do rising levels of prolactin do?

A

Produce milk

46
Q

What do vasoconstrictors do to decrease milk supply?

A

Decreased blood flow to the breast

47
Q

Name the drugs that increase milk supply.

A
  • Metoclopramide, Neuroleptics
  • Methyldopa
  • H2 Antagonists
  • Tryptophan
  • Fenugreek
48
Q

How do Metoclopramide and Neuroleptics increase milk supply?

A

Inhibit dopamine secretion

49
Q

How does Methyldopa increase milk supply?

A

False dopamine precursor

50
Q

How do H2 Antagonists and Tryptophan increase milk supply?

A

Increase serotonergic transmission

51
Q

What are some strategies to minimize infant exposure?

A
  • 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
52
Q

T/F: Estrogen containing products may suppress lactation and quality of milk produced.

A

TRUE

53
Q

What type of contraception is preferred in lactation?

A

PROGESTIN-ONLY PILLS (Micronor, Slynd)

54
Q

When can you use estrogen contraception if you have to?

A

After 6+ weeks postpartum

55
Q

T/F: IUD is a safe contraceptive during lactation.

A

TRUE

56
Q

T/F: Depo-Provera lowers milk production.

A

TRUE

57
Q

Name the non-dose related toxicity associated with Antibiotics.

A
  • Diarrhea
  • C. Difficle
  • Candida overgrowth
58
Q

Name the antibiotics safe in lactation (“PCM Q”).

A

P - Penicillins
C - Cephalosporins
M - Macrolides (Azithromycin)

Q - Quinolones (Ciprofloxacin, Ofloxacin)

59
Q

Name the antibiotics that should be cautioned in lactation (“CST”).

A

C - Chloramphenicol
S - Sulfa agents - first month of life!
T - Tetracycline - repeated use!

60
Q

What bacteria causes mastitis?

A

S. aureus
E. coli
Srep.

61
Q

What do you treat mastitis with?

A

Dicloxacillin
Oxacillin
Cephalosporin

62
Q

How long is mastitis treated for?

A

10-14 days

63
Q

T/F: IBU can be used for pain in mastitis.

A

TRUE

64
Q

T/F: You can continue to breast feed with mastitis.

A

TRUE

65
Q

Breast milk and HIV are _______.

A

Breast milk and HIV are CONTRAINDICATED.

66
Q

T/F: The influenza treatments, Oseltamivir and Zanamivir are considered safe.

A

TRUE

67
Q

T/F: In HSV, Acyclovir and Valacyclovir are considered unsafe.

A

FALSE

-In HSV, Acyclovir and Valacyclovir are considered safe

68
Q

Name the 2 contraindicated immunizations.

A

1) Smallpox (LIVE)

2) Yellow Fever (LIVE)

69
Q

Why are Smallpox and Yellow Fever vaccinations/immunizations contraindicated in lactation?

A

B/C they contain live virus

70
Q

What HTN adverse drug reactions should you monitor for in lactation?

A
  • Apnea
  • Weakness
  • Hypoglycemia
71
Q

T/F: HTN has the potential to reduce milk production.

A

TRUE

72
Q

Name the preferred beta blockers for HTN treatment.

A

1) Propranolol

2) Metoprolol

73
Q

Name the preferred calcium channel blockers in HTN treatment.

A

1) Nifedipine

2) Nimodipine

74
Q

Which anticoagulation treatments are considered safe (“WALH”)?

A

W - Warfarin - UNLIKE DURING PG
A - ASA - low dose
L - Low molecular weight heparin - Lovenox, Enoxaparin
H - Heparin

75
Q

Which anticoagulation treatments are cautioned during lactation?

A

Clopidogrel

DOAC - can use Rivaroxaban

76
Q

T/F: Antihistamines and decongestants both suppress lactation.

A

TRUE

77
Q

T/F: Guaifenesin and saline nasal sprays are considered unsafe in lactation.

A

FALSE

-Guaifenesin and saline nasal sprays are considered safe in lactation

78
Q

T/F: IBU and acetaminophen are considered safe in lactation.

A

TRUE

PHA 397 - Make-Up Therapeutics (15 decks)

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