Lactation: Drugs

Question 1

Prolactin stimulates…?

Answer 1

1. Glandular proliferation = antenatal
2. Breasr milk production = postnatal

Question 2

Lactation stage 1: 16-32 weeks

Answer 2

Prolactin, produces milk

Progesterone, inhibits milk secretion

Question 3

Lactation stage 2: 30hr after birth

Answer 3

1. Progesterone levels DROP, due to placenta removal = milk releases
2. Prolacin triggers milk production

** large gaps between lactocytes = allows for transmission of macrophages, neutrophils, lymphocytes

Question 4

Lactation stage 3

Regulated by?

Answer 4

Regulated milk removal (local) and hormonal control (feedback)

Question 5

What dose the FEEDBAXK INHBITOR OF LACTATION (FIL) do?

Negative feedback

Answer 5

High conc of FIL = slows milk production

Question 6

Positive feedback hormones to increase milk?

Answer 6

1. Prolactin = stimulates lactocytes to secrete milk
2. Oxytocin = stimulate myoepithelial cells to eject milk into ducts

Question 7

How can drugs enter breastmilk

1. SIMPLE DIFFUSION
2. MEMBRANE TRANSPORTWRS
3. VASICULAR TRANSCYTOSIS
4. Vesicles released after EXOCYTOSIS
5. LIPIDs

Question 8

Factors that influence drug passage into breastmilk

Answer 8

1. Molecular Weight
   = over 1000 Da
2. Lipid solubility
   =lipid soluble drugs more permeable
3. Protein binding
   =highly protein bound don’t diffuse (eg. Ibuprofen and Warfarin) less transfer
4. Degree of innovation
   = milk slightly acidic, so attracts weak bases (oxycodone, codeine) they get trapped in the milk!
5. Vd = higher Vd, lower conc in milk
6. Half life
7. PKa of drug

Question 9

Which routes of admin have low degrees of oral absorptionn

Answer 9

Toical, intranasal, inhaled, vaginal, derm

Question 10

Choose drugs with the following properties…. 5

Answer 10

1. High molecular weight
2. High protein binding
3. Short half life
4. High Vd
5. Low Oral bioavailability

Question 11

Which 2 drug properties have great most influence on drug transfer to milk?

Answer 11

1. Molecular Weight
2. Protein binding

Question 12

Which kind of drugs produce the most side effects (sedation, lethargy, apnea, seizures)

Answer 12

Drugs that affect the CNS

Question 13

Drugs that can inhbit prolactin secretion!!! 😔 decrease milk

Answer 13

Dopamine agonists (levodopa, bromocriptine, nicotine)

Question 14

Drugs thst enhance prolactin secretion 😊 galactagogues

Answer 14

Dopamine Antagonists (chmoropromazine, haloperidol, metoclopramide, domperidone

Question 15

Drugs that can IMPACT BF

Answer 15

1. Sympahtomimetic drugs ( vasoconstriction of blood vessel in breast) = avoid pseudophedrine!!!)

Question 16

Drugs used to INTENTIONALLY STOP MILK PRODUCTIOJ

Answer 16

Cabergoline (drug of choice)

Question 17

Drugs used to INTENTIONALLY increase milk (galactogogues)

Answer 17

Dopamine Antagonists

Domperidone
Metoclopramide

Question 18

How long should you wait to breastfeed after drinking alcohol?

Answer 18

Wait 2 hours before Bf

Question 19

BF just before a mother takes a drug, doesn’t apply to which drugs?

Answer 19

Long half life drugs (ie. Diazepam)