Pharmacology in breast feeding

Question 1

Describe some advantages of breast feeding on the baby

Answer 1

• Reduced risk of infections (GI, UTIs, otitis media, respiratory diseases, NEC; encrotizing enterocolitis in preterm babies)
  -** Neurological** development benifits
• Protection against later development of atopic diseases e.g. eczema
• Lower incidence of insulin dependant diabetes
• Lower incidence of sudden infant death syndrome (SIDS)

Question 2

List some benefits of breast feeding to the mother

Answer 2

• Reduced risk or pre-menopausal breast & ovarian cancers and hip fractures
• Quicker return of uterus to its normal size & faster weight loss postnatally
• Prevents post-natal depression
• **Contraception: LAM **(lactational amenorrhoea method)

Question 3

What are some maternal factors that influence wheather/how much of a drug will cross into the breast milk

Answer 3

• dosage regieme
• route of administration (IV ^ concentration than oral or tropical)
• Drug clearance by kidneys & liver

Question 4

What are some drug characteristics that will influence wheather/how much of a drug will cross into the breast milk

Answer 4

• Degree of inonisation at physiological pH (lipid soluble)
• Protein binding
• Molecular weight (MW less than 200 appear rapidly in breastmilk, eg alcohol)

Question 5

What type of drugs are favourable/what drugs should we avoid?

Answer 5

Avoid drugs with long half-lives
Drugs that are highly protein bound are preferred

Question 6

List some drugs to be avoided during breast feeding

Answer 6

• Cytotoxic drugs i.e. cancer tretment
• Immunosuppressants
• Anti-convulsants (not all)
• Drugs of abuse (consider recreational)
• Amiodarone
• Lithium
• Radio-iodine

Question 7

Describe the effects of tetracycline on the infant

Answer 7

Risk of permanent tooth staining

Question 8

Describe the effects of Isoniazid on the infant

Answer 8

Risk of pyridoxine deficiency

Question 9

Describe the effects of Barbiturates on the infant

Answer 9

Lethargy, sedation & poor such reflexes

Question 10

Describe the effects of Chloral hydrate on the infant

Answer 10

Drowsiness if infant fed at peak

Question 11

Describe the effects of diazepam on the infant

Answer 11

Drug accumulation & sedation

Question 12

Describe the effects of methadone on the infant

Answer 12

Risk of withdrawal if breast feeding

Question 13

Describe the effects of iodine on the infant

Answer 13

Thyroid suppression and risk of cancer

Question 14

Describe the effects of propylthiouracil on the infant

Answer 14

Can suppress thyroid function in the infant

Question 15

What medication is used for inhibition of lactation

Answer 15

Cabergoline

Prevention: 1mg orally, single dose on first day postpartum

Supression: 250 micrograms every 12 hours for 2 days

Question 16

What medication is used for enhancment of lactation

Answer 16

Metoclopramide
10mg 2-3 times daily