Lactation Pharmacology Flashcards

1
Q

Why is drug transfer to milk enhanced in the first 4 days postpartum?

A

large gaps between alveolar cells permit drug passage (after this point, alveolar cells enlarge and shut off the gaps)

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2
Q

Drugs that act on which system generally pass more easily into milk?

A

CNS drugs (lipid soluble)

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3
Q

Main method by which drugs enter the milk?

A

Diffusion (plasma-milk)

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4
Q

Drugs with high protein binding enter milk freely. True or false

A

False. They are largely sequestered in the protein and have a hard time entering the milk.

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5
Q

Drugs above which molecular weight do not readily enter the milk?

A

800 Daltons

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6
Q

What is ion-trapping?

A

Drugs with a pKa higher than 7.2 may get trapped in the milk compartment and unable to exit. It is rarely clinically important

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7
Q

The lower the bioavailability of a drug, the _____ transfers into the breastmilk. We prefer drugs with a _____ bioavailability.

A

less, lower.

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8
Q

The highest risk for drug accumulation in the infant is when?

A

first two months after birth

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9
Q

Drugs with high milk-to-plasma ratio enter the milk easily. True or False

A

True

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10
Q

Medication with high milk to plasma ratio is never safe for breastfeeding. True or false

A

false. A high milk to plasma ratio but a low parental serum lever still ends up being a relatively low infant dose.

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11
Q

Most important clinical parameter for determining safety of a drug entering the milk

A

Relative infant dose

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12
Q

Calculation for RID

A

infant dose mg/kg/day divided by parent dose mg/kg/day

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13
Q

More caution is required at which age? why?

A

2 weeks-6 months, because milk volume is high and infant ability to metabolize drugs is low

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14
Q

At which age are infants more capable of metabolizing small loads of drugs through milk?

A

9-12 months

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15
Q

One strategy for lowering infant dose with timing of feeds/medication spacing?

A

breastfeed, then take medication and avoid feeding at peak plasma level. (works for drugs with half life less than 4 hours)

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16
Q

Are hair dyes and topical creams safe for breastfeeding infants?

A

Yes

17
Q

What is the parental plasma level of inhaled (asthma) medications?

A

Virtually nil

18
Q

Can milk be save/stored or fed to an infant if breastfeeding parent is using anticancer, antimetabolite or other noxious drugs?

A

No. they must follow guidelines for pumping and discarding milk for 5-7 half lives

19
Q

Is it safe to breastfeed if undergoing CT/MRT with contrast?

A

Generally speaking, yes

20
Q

List some common drugs used during lactation which are considered safe

A

Acetaminophen, Aspirin, Ibuprofen, Diphenhydramine, Cetirizine, vaccines

21
Q

What is one vaccine not recommended during lactation?

A

Yellow fever (when infant is less than 9 months old)

22
Q

Review antibiotic usage

A
  • Tetracyclines: (safe short term)
  • acyclovir: (HSV treatment, safe)
  • penicillins: safe
  • cephalosporins: no concerns
  • fluroquinolones: (prefer ofloxacin but probably fine)
  • metronidazole: moderate RID but nontoxic so used clinically
  • antifungals: avoid clotrimazole
23
Q

General consensus on antidepressant therapy?

A

Strongly recommended for parental depression. Most often studied class of drugs in lactation. Minimal transfer to milk. Most often used SSRIs

24
Q

Which anticoagulants are preferred over Direct Oral Anticoagulants?

A

Enoxaparin, warfarin

25
Q

antihypertensive meds are generally not an issue. true or false

A

true

26
Q

What serum level should be checked when considering Domperidone as a galactogogue?

A

Prolactin. It will only work if prolactin is low.

27
Q

What is a major downside of domperidone related to cessation of use?

A

Can cause major psychiatric symptoms