Breastfeeding

Question 1

when are solids introduced?

Answer 1

6 months alongside breastfeeding

Question 2

what is colostrum?

Answer 2

thick yellow milk rich in protein and immunoglobulins produce first few days after birth

Question 3

what is transitional milk?

Answer 3

milk produced days 4-10 after birth which has reduced protein but increasing fat content (effects lipophilic drugs)

Question 4

what is mature milk?

Answer 4

produced from day 10 until stop feeding. continuously increasing fat content

Question 5

why are day old babies at higher risk of drug toxicity?

Answer 5

to allow passage of immunoglobulins through milk ducts there are large spaces between the alveolar cells. large gaps allowed larger drug mols to pass/more to pass

Question 6

what are the changes during a feed?

Answer 6

increasing pH from 7.2-7.4
increasing fat over first 20 mins

Question 7

when is ideal for mum to take her meds when breastfeeding and why?

Answer 7

straight after a feed to avoid peak plasma concentrations

Question 8

what characteristics make a drug most likely to transfer through milk?

Answer 8

unionsed
small mw
low vd, stay in mums plasma
low maternal protein binding, stays in mums plasma
more lipid sol drugs
weak basic drugs

Question 9

what are the risks of breastfeeding whilst mum is on meds?

Answer 9

can cause toxicity in baby
can disrupt feeds
mother might hesitate/stop taking her meds- decline in mothers health

Question 10

what is milk:plasma ratio?

Answer 10

the drug concentration in milk vs mothers plasma. higher= more in milk=bad

Question 11

what are limitations of using milk:plasma ratio?

Answer 11

doesnt consider how much babyy consumes
doesnt consider babies clearance
assumes milk and plasma conc rise and fall in parallel
can vary during feeds
low ratio doesnt mean safe- chemo might be low but is very toxic to child

Question 12

What are the advantages of exposure index compared to milk:plasma ratio?

Answer 12

considers amount of milk consumed and babies clearance

Question 13

what is relevant infant dose? (RID)

Answer 13

% of drug that baby receives. higher = worse. less than 10% generally safe, over 25% not safe

Question 14

what are the effects of drugs on breastfeeding/milk prodction?

Answer 14

decreased prolactin- dopamine agonists- bromocriptine
increased prolactin- dopamine antagonists- metoclopramide
decreased milk prodcution- hormonal contr, pseudoephedrine
decreases mums blood volume- diuretics
inhibits babys sucking reflex- phenobarbital

Question 15

what are good prescribing considerations in breastfeeding?

Answer 15

avoid long half life drugs/mr
avoid toxics
simplify mums med regime
avoid new meds/unfamiliar