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gu/repro > lactation > Flashcards

lactation Flashcards

1
Q

what is the value of breastfeeding for mother

A

less postpartum bleeding
faster return to pre-preg wt
reduced risk of certain cancers
lowered risk of OP

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2
Q

what is the value of breastfeeding for baby

A

lower incidence of; diarrhea, constipation, infections, uti, eczema
-maybe protection against: SIDs, diabetes, obesity, crohns, appendicitis

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3
Q

it is recommended to exclusively breastfeeding for the first

A

6 months
-encouraged for 12 months and longer if willing

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4
Q

what are breastfeeding CI

A

infant with galactosemia
-if mom has: HIV, t cell lymphoma, active or untreated TB, H1N1, or varicella, active herpes or using ilicit drugs

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5
Q

the higher the bioavailability, the ____ gets into maternal plasma

A

more

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6
Q

more drug in the blood means what

A

more drug can get in milk

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7
Q

drugs with longer half lives are more or less likely to get into milk and stay there

A

more

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8
Q

is it easier for lower or higher MW drugs to pass through ducts in the breast

A

lower

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9
Q

breast tissue is fatty so drugs with high or low lipid solubility transfer easier

A

high

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10
Q

what does large vd mean

A

reduced maternal free concen

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11
Q

if less drug is bound to maternal proteins then

A

more drug is free to pass into milk

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12
Q

breast milk is _____ acidic

A

weakly

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13
Q

for selecting a drug, choose one that _____ passes into breast milk

A

poorly

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14
Q

avoid what kind of formulations or drugs with active metabolites

A

long acting

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15
Q

nursing should be avoided when

A

peak drug concentration

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16
Q

drugs should be taken when if breastfeeding

A

shortly after feeding or before a long sleep period

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17
Q

should you take extra strength products

A

no!! regular strength

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18
Q

what is mastitis

A

inflammation of breast

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19
Q

sx of mastitis

A

breast tender
redness
warmth
fever
flu like sx

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20
Q

what is the most common cause of mastitis

A

milk stasis

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21
Q

what is most common bacterial cause of mastitis

A

staph aureus

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22
Q

how long is the antibiotic course for mastitis

A

10-14 days

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23
Q

what antibiotics are used for mastitis

A

dicloxacillin
cephalexin
–clindamycin if allergic to those

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24
Q

what helps when putting it on breast for 15 mins before feeding to increase milk flow in breast

A

warm wet washcloth

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25
Q

when having mastitis you should continue what

A

breastfeeding on both sides

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26
Q

for pain control what non opioids should you use

A

apap (<3 g/day)
ibuprofen–NSAID of choice

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27
Q

for what opioids what is the drug of choice for pain control

A

morphine (poor bioavailability in infant)

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28
Q

what opioids should be avoided for pain control

A

codeine
hydrocodone

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29
Q

T/F: a depressed mother should be treated

A

true

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30
Q

T/F : there is more benefit to baby for a mom to breastfeed while on antidepressant then for her to d/c breastfeeding

A

true

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31
Q

what class is the class of choice for depression

A

SSRIs

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32
Q

what SSRI is preferred for depression

A

sertraline
-paroxetine can be considered

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33
Q

what SSRI should be avoided for depression

A

fluoxetine (fussiness and crying reported in breastfed infants)

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34
Q

what TCA is preferred for depression

A

amitriptyline (highly protein bound)

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35
Q

what TCA is not recommended for depression

A

doxepin (accumulates in infant)

36
Q

what drug can decrease milk supply

A

buprorion

37
Q

are benzos okay to use (lorazepam, clonazepam, midazolam)

A

yes

38
Q

when on benzos are there high or low rates of sedation during breastfeeding

A

low

39
Q

what atypical antipsychotics are used

A

risperidone
quetiapine
olanzapine

40
Q

for epilepsy you should

A

continue on current medication if possible

41
Q

what effects are unknown for valproic acid (epilepsy)

A

long term cog

42
Q

when using lamotrigine for epilepsy you should

A

monitor symptomatic infants plasma levels
watch for apnea, rash in preemie

43
Q

what are the preferred antihypertensives

A

hydralazine
methyldopa

44
Q

what ACE inhibitors are safe alternative in lactating women w hypertension

A

enalapril
captopril

45
Q

there is not much data with class for hypertension

A

diuretics

46
Q

calcium channel blocks are usually

A

safe

47
Q

what are some examples of Ca channel blockers

A

nifedipine
verapamil

48
Q

beta blockers should be used

A

cautiously–infant hypotension reported

49
Q

what are the beta blockers of choice

A

propranolol
metoprolol
labetolol

50
Q

what beta blockers should be avoided

A

atenolol
acebutolol

51
Q

for antihistamines, what are the drugs of choice

A

loratadine
cetirizine
-little sedative effect

52
Q

diphenhydramine is acceptable but isnt the drug of choice bc

A

risk of irritability/sedation infant

53
Q

phenylephrine (decongestant) is reported to have

A

no AE infant
-doesnt appear to affect milk production

54
Q

pseduephedrine (decongestant) is reported to

A

cause infant irritability
may decrease milk production

55
Q

what should be avoided for allergies and colds

A

herbals
use lowest dose vitamin C/zinc

56
Q

is insulin safe to use

A

yes

57
Q

insulin is safe to use since it has a

A

high MW

58
Q

for insulin you made need to decrease the pre-preg dose by…

A

25% to avoid hypoglycemia in the mom (feeding lowers glucose levels)

59
Q

is metformin safe to use

A

yes

60
Q

for diabetes, what sulfonylurea is the DOC

A

glyburide

61
Q

what is the recommendation on starting oral contraceptives

A

wait till 6 weeks post partum

62
Q

what contraceptive is preferred

A

progestin only (less impact on lactation)

63
Q

what can progesterone or combo oral contraceptives do to lactation

A

suppress it

64
Q

what is the most common side effect in infants if mom takes antibiotics while breastfeeding

A

loose stools

65
Q

what drug classes are preferred for antibiotics

A

penicillins
cephalosporins

66
Q

what other antibiotics are safe to use

A

erythromycin
azithromycin

67
Q

what can long term use of tetracyclines do

A

tooth staining and reduced bone growth

68
Q

nitrofurantoin and sulfonamides can be used if infant is

A

> 1-2 months

69
Q

what forms of metronidazole should be used since its controversial

A

topical/vaginal

70
Q

what form of antifungals are preferred

A

topical

71
Q

if systemic antifungal therapy is needed what is the DOC

A

fluconazole

72
Q

what antivirals are considered safe

A

acyclovir
valacyclovir

73
Q

women with what virus on the breast or nipple should avoid breastfeeding

A

herpes

74
Q

what drug is preferred for GERD

A

H2RA–famotidine

75
Q

for nausea what agents are preferred

A

dimenydrinate
ondansetron
metoclopramide

76
Q

is warfarin compatible w feeding

A

yes

77
Q

heparin is compatible bc why

A

large molecules

78
Q

OTC meds that are usually safe are

A

caffeine
laxatives
loperamide
iron
stool softners
herbals/dietary supplements–CAUTION

79
Q

maternal smoking is a major risk factor for what

A

SIDS

80
Q

more than how many drinks can negatively impact an infant

A

2

81
Q

what meds are CI in lactation

A

amphetamines (poor sleep)
antineoplastics (cancer tx)
illicit substances
radioactive substances (iodine)
immunosuppressants
lithium (tremors)
misoprostol (diarrhea)

82
Q

prolactin levels do what in postpartum

A

decrease

83
Q

what med increases prolactin levels

A

metoclopramide (dopamine antagonist)

84
Q

what are SE of metoclopramide

A

depression
gastric cramping

85
Q

what decreases lactation

A

alcohol
bromocriptine/cabergoline (dopamine agonist)
oral contraceptives
sudafed

gu/repro (5 decks)

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