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Women's Health 2 > Pharm - Lactation > Flashcards

Pharm - Lactation Flashcards

1
Q

State the AAP and ACOG recommendations for duration of exclusive breastfeeding

A

Exclusive breastfeeding for about 6 months with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.

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2
Q

What are the AAP recommendations for feeding pre-term infants?

A

The potent benefits of human milk are such that all preterm infants should receive human milk (fresh, frozen, or from donor).
*milk should be fortified appropriately for infant born weighing less than 1.5kg

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3
Q

Benefits of breastfeeding to the mother

A

•Decreased postpartum blood loss and more rapid involution of the uterus
•Women with cumulative lactation history of 12-23 months had significant reduction in HTN, hyperlipidemia, CV disease and DM
•Cumulative duration of breastfeeding of >12 months associated with 28% decrease in breast cancer (esp. premenopausal) and ovarian cancer.
**Each year of breastfeeding = 4.3% reduction in breast cancer

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4
Q

GI breastfeeding benefits in term infant

A

o Stimulates GI growth/motility - enhance maturity of GI tract
o Protective/decreases risk of necrotizing enterocolitis (NEC) and other infections
o Episodes of gastroenteritis/hospitalization for diarrhea decreased reduction in incidence of nonspecific gut infection (after 2 months)

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5
Q

Respiratory breastfeeding benefits in term infant

A

o Respiratory illnesses reduced in frequency and/or duration
o Incidence of OM and recurrent OM reduced (esp. in <2y/o)
o Significant reduction in severity of RSV bronchitis

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6
Q

Long-term breastfeeding benefits in term infant

A

o Reduce acute illnesses even after breastfeeding discontinued
o Reduction in incidence of OM, serious colds, throat infections
o Reduction in SIDS, asthma, atopic dermatitis, eczema
o Reduction in celiac disease, risk of childhood IBD
o Lower rates of obesity (4% for every month of breastfeeding)
o Reduction in DM 1&2

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7
Q

Breastfeeding benefits in pre-term infant

A
  • Lower rates of sepsis
  • Reduction in incidence of NEC, fewer hospital readmissions in 1 year
  • Lower mortality, lower long-term growth failure and neurodevelopmental disabilities
  • Improved clinical feeding tolerance, lower retinopathy or prematurity
  • Lower rates of metabolic syndrome, lower BP and LDL cholesterol
  • Improved neurodevelopment: higher IQ, greater white matter and total brain volume, higher mental, motor, behavior ratings at 18 and 30 months
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8
Q

Contraindications to breastfeeding

-infant

A

Infants with metabolic disorders - classic galactosemia, phenylketonuria (alternate breastfeeding with modified formula)

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9
Q

Contraindications to breastfeeding

-maternal, infectious

A

Infectious: active (infectious) untreated TB, HIV positive

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10
Q

Contraindications to breastfeeding

-maternal, substances

A

Substances = alcohol, nicotine, illicit drug use

• Use of street drugs like PCP, cocaine, cannabis, etc. - effect neurobehavioral development

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11
Q

Contraindications to breastfeeding

-maternal, alcohol

A

• Avoid/limit alcohol: can blunt prolactin response to suckling and affect infant motor development.
o Limit 2oz liquor, 8oz wine, 2 beers  wait ≥ 2 hours from intake before breastfeeding

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12
Q

Contraindications to breastfeeding

-maternal, smoking

A

• Discourage smoking: increased incidence in infant respiratory allergy and SIDS.
o Also decreases milk supply and increases risk of poor weight gain

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13
Q

Identify the daily caloric requirements and DHA requirements for breastfeeding women

A
  • Increased need of ~500 kcal/day with modest increase in normal balanced diet
  • Include 200-300mg omega-3 long-chain polyunsaturated fatty acids (DHA)
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14
Q

Identify the signs of effective breastfeeding (5)

A
  1. Frequent feedings 8-12 times daily
  2. Infant should have ~6-8 wet diapers/24-hr period once breast feeding established
  3. Bowel movements every 24 hours
  4. Average daily weight gain of 15-30 grams
  5. Infant regained birth weight by day 10 of life
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15
Q

What is the most appropriate treatment for blocked milk duct?

A
  • bleb should be removed with needle or rubbing with cloth

- frequent breastfeeding, warm compresses/showers, massaging affected area toward nipple

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16
Q

What is the most appropriate treatment for mastitis?

A 
•Improve breastfeeding technique, referral to lactation specialist may be needed drain breast milk through breastfeeding or milk pumped and discarded
o NSAIDS for pain/swelling
o Cold compresses
o Breastfeeding does not have to stop
o Antibiotics
17
Q

What are the antibiotics used to treat mastitis?

A

MC = dicloxacillin, cephalexin, clindamycin dicloxacillin if no MRSA risk

  • TMP/SMX or clindamycin if MRSA suspected
  • Vancomycin in severe infections
18
Q

What are the complications of mastitis?

A

breast abscess and cessation of breastfeeding

19
Q

What is the most appropriate treatment for sore/cracked nipples?

A

• Keep nipples dry, change nursing pads often, NL saline rinse
o Continue to express milk to avoid blocked ducts and mastitis
o Use of medical grade lanolin ointment (Lansinoh, Purelan) or hydrogel dressing (ComfortGel, Soothies)
-If needed, topical abx like Bactroban or Polysporin: apply sparingly after feeding
- Can use acetaminophen/ibuprofen

20
Q

Factors to consider when evaluating drug use during lactation (part 1)

A
  • Need for the drug by the mother (risk vs benefit) weight against risk to infant
  • Potential effects of drug on milk production
  • Amount of drug excreted into human milk
  • Extent/oral absorption by infant
  • Potential adverse effects on infant
21
Q

Factors to consider when evaluating drug use during lactation (part 2)

A

• Age of infant: most adverse effects associated with drug exposure via breast milk happen more in neonates < 2months and more rarely in > 6 months
• Pharmacokinetic factors: drugs with longer half-lives are more likely to accumulate
o Lipid soluble ones pass into breast milk really easily
• Was infant introduced to it in utero or is this a novel treatment?
• Single dose vs. short term use vs. chronic use
• Preterm vs. mature, healthy infant

22
Q

State the major effect of psychotropic agents on a nursing infant

A

Prolonged half-life –> immature liver and renal function of infant –> potential effect on neural tissue

23
Q

List the pain medications that a breastfeeding mother CAN use.

A
  • Narcotic - consider butorphanol or hydromorphone (Dilaudid)
  • Ibuprofen/Acetaminophen can be used
  • Short term use of Celecoxib and Naproxen is okay (AVOID all other NSAIDs)
  • Low dose aspirin acceptable (higher dose avoided)
24
Q

What medications should be avoided by breastfeeding mothers d/t negative effect on the infant?
-psychotropic

A
  • bupropion
  • diazepam
  • fluoxetine
  • citalopram
  • lithium
  • lamotrigine
  • venlafaxine
25
Q

What medications should be avoided by breastfeeding mothers d/t negative effect on the infant?
-pain

A
  • codeine
  • hydrocodone
  • oxycodone
  • pentazocine
  • meperidine
26
Q

What medications should be avoided by breastfeeding mothers d/t negative effect on the infant?
-smoking cessation

A
  • buproprion

- Chantix

27
Q

What medications should be avoided by breastfeeding mothers d/t negative effect on the infant?
-others

A
  • Amphetamines
  • Chemotherapy
  • Ergotamine
  • Statins
  • Marijuana

Women's Health 2 (9 decks)

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