Lactation: Drugs Flashcards
Prolactin stimulates…?
- Glandular proliferation = antenatal
- Breasr milk production = postnatal
Lactation stage 1: 16-32 weeks
Prolactin, produces milk
Progesterone, inhibits milk secretion
Lactation stage 2: 30hr after birth
- Progesterone levels DROP, due to placenta removal = milk releases
- Prolacin triggers milk production
** large gaps between lactocytes = allows for transmission of macrophages, neutrophils, lymphocytes
Lactation stage 3
Regulated by?
Regulated milk removal (local) and hormonal control (feedback)
What dose the FEEDBAXK INHBITOR OF LACTATION (FIL) do?
Negative feedback
High conc of FIL = slows milk production
Positive feedback hormones to increase milk?
- Prolactin = stimulates lactocytes to secrete milk
- Oxytocin = stimulate myoepithelial cells to eject milk into ducts
How can drugs enter breastmilk
- SIMPLE DIFFUSION
- MEMBRANE TRANSPORTWRS
- VASICULAR TRANSCYTOSIS
- Vesicles released after EXOCYTOSIS
- LIPIDs
Factors that influence drug passage into breastmilk
- Molecular Weight
= over 1000 Da - Lipid solubility
=lipid soluble drugs more permeable - Protein binding
=highly protein bound don’t diffuse (eg. Ibuprofen and Warfarin) less transfer - Degree of innovation
= milk slightly acidic, so attracts weak bases (oxycodone, codeine) they get trapped in the milk! - Vd = higher Vd, lower conc in milk
- Half life
- PKa of drug
Which routes of admin have low degrees of oral absorptionn
Toical, intranasal, inhaled, vaginal, derm
Choose drugs with the following properties…. 5
- High molecular weight
- High protein binding
- Short half life
- High Vd
- Low Oral bioavailability
Which 2 drug properties have great most influence on drug transfer to milk?
- Molecular Weight
- Protein binding
Which kind of drugs produce the most side effects (sedation, lethargy, apnea, seizures)
Drugs that affect the CNS
Drugs that can inhbit prolactin secretion!!! 😔 decrease milk
Dopamine agonists (levodopa, bromocriptine, nicotine)
Drugs thst enhance prolactin secretion 😊 galactagogues
Dopamine Antagonists (chmoropromazine, haloperidol, metoclopramide, domperidone
Drugs that can IMPACT BF
- Sympahtomimetic drugs ( vasoconstriction of blood vessel in breast) = avoid pseudophedrine!!!)
Drugs used to INTENTIONALLY STOP MILK PRODUCTIOJ
Cabergoline (drug of choice)
Drugs used to INTENTIONALLY increase milk (galactogogues)
Dopamine Antagonists
Domperidone
Metoclopramide
How long should you wait to breastfeed after drinking alcohol?
Wait 2 hours before Bf
BF just before a mother takes a drug, doesn’t apply to which drugs?
Long half life drugs (ie. Diazepam)
