lactation Flashcards
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
what is the value of breastfeeding for baby
lower incidence of; diarrhea, constipation, infections, uti, eczema
-maybe protection against: SIDs, diabetes, obesity, crohns, appendicitis
it is recommended to exclusively breastfeeding for the first
6 months
-encouraged for 12 months and longer if willing
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
the higher the bioavailability, the ____ gets into maternal plasma
more
more drug in the blood means what
more drug can get in milk
drugs with longer half lives are more or less likely to get into milk and stay there
more
is it easier for lower or higher MW drugs to pass through ducts in the breast
lower
breast tissue is fatty so drugs with high or low lipid solubility transfer easier
high
what does large vd mean
reduced maternal free concen
if less drug is bound to maternal proteins then
more drug is free to pass into milk
breast milk is _____ acidic
weakly
for selecting a drug, choose one that _____ passes into breast milk
poorly
avoid what kind of formulations or drugs with active metabolites
long acting
nursing should be avoided when
peak drug concentration
drugs should be taken when if breastfeeding
shortly after feeding or before a long sleep period
should you take extra strength products
no!! regular strength
what is mastitis
inflammation of breast
sx of mastitis
breast tender
redness
warmth
fever
flu like sx
what is the most common cause of mastitis
milk stasis
what is most common bacterial cause of mastitis
staph aureus
how long is the antibiotic course for mastitis
10-14 days
what antibiotics are used for mastitis
dicloxacillin
cephalexin
–clindamycin if allergic to those
what helps when putting it on breast for 15 mins before feeding to increase milk flow in breast
warm wet washcloth
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
2
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
