Meds in Human Milk

Question 1

What percent of newborns are dc’d from the hospital breastfeeding?

Answer 1

77%; increased from the 1970s (20%)

Question 2

What percent of newborns are breastfeeding at 6 mos?

Answer 2

35%; increased from the 1970s (15%)

Question 3

Why has the incidence of BF increased?

Answer 3

owing largely to the efforts of La Leche & AAP, public health campaigns and federal gov’t support

Question 4

What are the advantages of BF?

Answer 4

Protection from infx (passive immunity), dec URTI, dec otitis media, dec GI illness, inc bonding/attachment, inc IQ, inexpensive, right temp, right quantitiy, convenient and maternal benefits

Question 5

What meds are most commonly taken by lactating mothers?

Answer 5

multivits, NSAIDs, Acetaminophen, Progestins, Antibiotics and Decongestants

Question 6

Who is more likely to medications?

Answer 6

lactating mothers > pregnant women

Question 7

What is the pH of human milk?

Answer 7

~7.0

Question 8

What is the pH of bovine milk?

Answer 8

6.8 or <

Question 9

How much milk can a lactating mother produce per day?

Answer 9

600 mL

Question 10

What is the composition of human milk?

Answer 10

it is a suspension of fat and protein in a lactose and mineral solution

Question 11

What are the components of human milk?

Answer 11

immunoglobulins, macrophages, lymphocytes, transferrin, lactoferrin, interferon, complement, fibronectin, erythropoietin and other biological components

Question 12

How does the composition of human milk vary?

Answer 12

varies with the duration of lactation and even within the time of a single feed

Question 13

When is the rate of milk synthesis at its maximum?

Answer 13

when the breast is empty

Question 14

When is the rate of milk synthesis at its minimum?

Answer 14

When the breast is full

Question 15

When does the infant’s caloric needs require the supplementation of food?

Answer 15

by 6 mos

Question 16

What are all the components of human milk designed to do?

Answer 16

protect the infant and accelerate the maturation of many physiological processes

Question 17

Why is the pH of milk important?

Answer 17

high pH can have a significant effect on medications depending on their pH

Question 18

what is the mechanism of drug excretion via breast milk?

Answer 18

diffusion

Question 19

what facilitates or impedes drug diffusion?

Answer 19

the degree of ionization of the drug (charge) and the degree of difference of pH across the membrane.

Question 20

who is at most risk for adverse events r/t drug excretion via BM?

Answer 20

the very young are the most at risk for the potential negative effects of drugs

Question 21

what drugs/chemicals can easily cross from plasma to BM via simple diffusion?

Answer 21

drugs with a molecular weight <200 daltons

Question 22

what is the rate of transport from plasma to BM?

Answer 22

rapid

Question 23

what do concentrations of medications in BM parallel?

Answer 23

plasma concentrations of medications in time

Question 24

what is the total amount of maternal drug available for infant absorption?

Answer 24

<1%

Question 25

how can the amount of maternal medication absorbed by the infant be minimized?

Answer 25

by BF at times when maternal serum levels are lowest; take meds right after pumping with theoretically give you 2-3h to metabolize med; if babe is sleeping through the night, take after last feed of day

Question 26

what is the risk of med absorption to the infant?

Answer 26

very small; the risk is greatest for baby <2mos

Question 27

how many drugs are contraindicated with BF?

Answer 27

very few; consult references if uncertain

Question 28

What action is advisable with mothers receiving radioactive isotopes?

Answer 28

may need to delay the test, use a different test or discontinue all together. in rare circumstances is it recommended to dc BF.

Question 29

what is recommended for BF moms wanting to use herbal products?

Answer 29

until more data is available, should be avoided

Question 30

why is the use of herbal products not recommended?

Answer 30

products are not regulated by the FDA and contents are not entirely defined and purity is widely variable; concerns have been raised regarding purity, safety and efficacy.

Question 31

what herbal product has been recommended to amplify BM production?

Answer 31

fenugreek

Question 32

what is the current recommendation regarding silicone breast implants?

Answer 32

evidence does not justify classifying silicone breast implants as a contraindication

Question 33

what are the reported effects of oral contraceptive use on BM production?

Answer 33

reports of decreasing milk production

Question 34

when should mothers begin taking oral contraceptives again?

Answer 34

wait until milk production is established

Question 35

the class of psychotropic drugs includes what medications?

Answer 35

antidepressants, anitanxiety agents and antipsychotic drugs

Question 36

what is the milk:plasma ratio of psychotropic drugs?

Answer 36

<1; virtually all drugs in this class have been detected in human milk after maternal ingestion.

Question 37

what are the short term effects of maternal psychotropic drug use?

Answer 37

no difficulties

Question 38

what are the long term effects of maternal psychotropic drug use?

Answer 38

not known

Question 39

what references can be consulted for maternal medications in BM?

Answer 39

AAP- committee on drugs, LactMed, tetbooks (hail and briggs)