Lactation Flashcards
How long should babies be breastfed?
exclusively for the first 6 months and then used as a supplement for up to 1 year
What should pump and dump be based on?
half-life/ active metabolites
What are the benefits of breastfeeding?
- accelerated recovery from childbirth
- decreased risk of post partum depression
- decreased risk of breast, ovarian cancer, and osteoporosis
What are the characteristics of medications found in breast milk?
- MW < 500 Da
- non ionized
- lipophilic (usually cross BBB)
- nonprotein bound
- high oral bioavailability
- weak bases
- long half life
When is the best time to take medications?
dose just after nursing and or just before the child’s longest sleep period
What is the relative infant dose?
values <10% considered safe in lactation
What is the RID equation?
dose infant (mg/kg/day)/ mother’s dose (mg/kg/day)
What medications are considered contraindicated in lactation?
- Acitretin
- Amiodarone
- chemo
- Dicyclomine
- Didanosine
- Dopamine agonist
- Doxepin
- Dronedarone
- Ergotamine
- Fenofibrate
- gold salts
- isotretinoin/retinoids
- methamphetamines
- methimazole
- statins
- tetracyclines (chronic)
- marijuana
What medications decrease milk supply?
- dopamine agonist
- estrogen
- intense diuresis
- pseudoephedrine (with chronic use)
- moderate to heavy alcohol consumption
- cigarette
Are anticonvulsants compatible with lactation?
YES
What herbal supplements are preferred in pregnancy?
- echinacea
- fennel
- fenugreek
- garlic
- ginko
- goldenrod
- milk thistle
- st. john wart
- valerian
What are treatments to increase milk supply?
- warm compress on breasts
- dopamine agonists (metoclopramide, domperidone)
- fenugreek
What is mastitis?
tender, hot, swollen, wedge-shaped area of breast associated with temp >/=101 chills, flu-like aching, systemic illness; staph. aureus common cause
What is tx for mastitis?
- nursing
- supportive measures
- antibiotics
What are treatment options for non-severe mastitis infection w/o MRSA risk factors?
- Dicloxacillin
- Cephalexin
- Clindamycin
What are treatment options for non-severe mastitis infection with MRSA risk factors?
- Bactrim
- Clindamycin
What are treatment options for severe mastitis infection?
Vancomycin IV
What are the recommendations for the baby when the mother is taking antibiotics?
diarrhea due to modification of bowel flora; pre-treat with butt cream
What antibiotics should be avoided to the nursing mother of jaundiced infant <1 mo old?
sulfa antibiotics
What are preferred SSRIs in lactation?
- paroxetine
- sertraline
What SSRI should be avoided in pregnancy?
fluoxetine
What analgesics are preferred in lactation?
acetaminophen
ibuprofen (preferred over other NSAIDs)
What cough/cold products are safe in lactation?
- DM
- guaifenesin
- pseudoephedrine (short-term)
- topical decongestants
What oral contraceptives are safe in lactation?
low dose estrogen-progesterone combination products
How long postpartum is it safe to initiate estrogen-progesterone contraceptive?
4-6 weeks due to VTE risk and decreased milk supply
How long after having a drink does the mother have to wait to breast feed?
2 hours
How many drinks can decrease milk production?
4
What is the recommended daily caffeine intake when breastfeeding?
200-300 mg/day
