lactation Flashcards by Janvi Patel

what is the value of breastfeeding for mother

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

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what is the value of breastfeeding for baby

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

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it is recommended to exclusively breastfeeding for the first

6 months
-encouraged for 12 months and longer if willing

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what are breastfeeding CI

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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the higher the bioavailability, the ____ gets into maternal plasma

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more drug in the blood means what

more drug can get in milk

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

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

lower

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

high

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what does large vd mean

reduced maternal free concen

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if less drug is bound to maternal proteins then

more drug is free to pass into milk

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breast milk is _____ acidic

weakly

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

poorly

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avoid what kind of formulations or drugs with active metabolites

long acting

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nursing should be avoided when

peak drug concentration

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drugs should be taken when if breastfeeding

shortly after feeding or before a long sleep period

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should you take extra strength products

no!! regular strength

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what is mastitis

inflammation of breast

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sx of mastitis

breast tender
redness
warmth
fever
flu like sx

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what is the most common cause of mastitis

milk stasis

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what is most common bacterial cause of mastitis

staph aureus

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how long is the antibiotic course for mastitis

10-14 days

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what antibiotics are used for mastitis

dicloxacillin
cephalexin
–clindamycin if allergic to those

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

warm wet washcloth

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when having mastitis you should continue what

breastfeeding on both sides

for pain control what non opioids should you use

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

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

morphine (poor bioavailability in infant)

what opioids should be avoided for pain control

codeine hydrocodone

T/F: a depressed mother should be treated

true

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

true

what class is the class of choice for depression

SSRIs

what SSRI is preferred for depression

sertraline -paroxetine can be considered

what SSRI should be avoided for depression

fluoxetine (fussiness and crying reported in breastfed infants)

what TCA is preferred for depression

amitriptyline (highly protein bound)

what TCA is not recommended for depression

doxepin (accumulates in infant)

what drug can decrease milk supply

buprorion

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

yes

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

low

what atypical antipsychotics are used

risperidone quetiapine olanzapine

for epilepsy you should

continue on current medication if possible

what effects are unknown for valproic acid (epilepsy)

long term cog

when using lamotrigine for epilepsy you should

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

what are the preferred antihypertensives

hydralazine methyldopa

what ACE inhibitors are safe alternative in lactating women w hypertension

enalapril captopril

there is not much data with class for hypertension

diuretics

calcium channel blocks are usually

safe

what are some examples of Ca channel blockers

nifedipine verapamil

beta blockers should be used

cautiously--infant hypotension reported

what are the beta blockers of choice

propranolol metoprolol labetolol

what beta blockers should be avoided

atenolol acebutolol

for antihistamines, what are the drugs of choice

loratadine cetirizine -little sedative effect

diphenhydramine is acceptable but isnt the drug of choice bc

risk of irritability/sedation infant

phenylephrine (decongestant) is reported to have

no AE infant -doesnt appear to affect milk production

pseduephedrine (decongestant) is reported to

cause infant irritability may decrease milk production

what should be avoided for allergies and colds

herbals use lowest dose vitamin C/zinc

is insulin safe to use

yes

insulin is safe to use since it has a

high MW

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

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

is metformin safe to use

yes

for diabetes, what sulfonylurea is the DOC

glyburide

what is the recommendation on starting oral contraceptives

wait till 6 weeks post partum

what contraceptive is preferred

progestin only (less impact on lactation)

what can progesterone or combo oral contraceptives do to lactation

suppress it

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

loose stools

what drug classes are preferred for antibiotics

penicillins cephalosporins

what other antibiotics are safe to use

erythromycin azithromycin

what can long term use of tetracyclines do

tooth staining and reduced bone growth

nitrofurantoin and sulfonamides can be used if infant is

> 1-2 months

what forms of metronidazole should be used since its controversial

topical/vaginal

what form of antifungals are preferred

topical

if systemic antifungal therapy is needed what is the DOC

fluconazole

what antivirals are considered safe

acyclovir valacyclovir

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

herpes

what drug is preferred for GERD

H2RA--famotidine

for nausea what agents are preferred

dimenydrinate ondansetron metoclopramide

is warfarin compatible w feeding

yes

heparin is compatible bc why

large molecules

OTC meds that are usually safe are

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

maternal smoking is a major risk factor for what

SIDS

more than how many drinks can negatively impact an infant

what meds are CI in lactation

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

prolactin levels do what in postpartum

decrease

what med increases prolactin levels

metoclopramide (dopamine antagonist)

what are SE of metoclopramide

depression gastric cramping

what decreases lactation

alcohol bromocriptine/cabergoline (dopamine agonist) oral contraceptives sudafed