Drugs in Lacatation Flashcards
(28 cards)
List common issues when BF
inadeq production, poor milk extraction, insuff caloric intake to meet demands, latching issues, nipple pain, mastitis, clogged ducts
what factors influence amount of drug that baby absorbs from mother
volume of milk consumed, concentration of drug in milk, baby kinetics
compare plasma and milk
plasma: water-like, electrolytes, molecules and proteins
milk: lipophilic, fat, protein and carbs
what is the normal pH of milk? compare this to plasma
6.6-6.8, more acidic than plasma
describe difference in cell junctions in first 3-4 days post birth compared to after this
large gaps in first few days to let immunoglobulins through but this can also let more drugs through, keep in mind but not too worried since baby stomach and intake small
what effect does milk pH have on drug absorption?
milk being more acidic than plasma creates ion trap for weak based drugs, trapping them in breast milk (avoid), acidic drugs get trapped in plasma so they are ideal
what factors can influence milk pH
fortification, vege/fibre intake, PP day
how can gestational age affect amount of drugs absorbed in the infant?
if infant is prem may have reduced liver/renal function causing drug accumulation
what infant factors affect amount of drug absorbed?
gestational age, amount consumed, timing
discuss bioavailability factors for drugs PP
ideally wany low bioavailability as this means less in bloodstream = not in breast milk
discuss plasma protein binding factors for drugs PP
high binding ideal to avoid passive diffusion into breast milk
discuss molecular weight factors for drugs PP
high molecular weight to avoid passing through junctions
discuss lipid solubility factors for drugs PP
want low lipid solubility, fatty/oily drugs more likely to transfer
discuss pKa factors for drugs PP
acidic drugs get trapped in plasma, avoid weak bases
discuss half-life factors for drugs PP
shorter half life better as cleared quicker
describe relative infant dose
dose in infant/dose in BF person, if <10% should be okay
when might 10% relative infant dose be too much?
drugs with high toxicity (chemo), unusually high doses, allergic reactions to infant
what is usual recommendation in BF when antidepressant used in pregnancy?
recommend to BF to help wean baby off drug and reduce withdrawal
what is best antidepressant to use when BF and what should be avoided
SSRI: sertraline, avoid fluoxetine
why should aspirin be avoided in BF
linked to Reye’s syndrome
describe infections effect on BF
likely to decrease milk prod, may req ABs which can cause diarrhoea in infant
describe usual laxative tx in BF
non-pharm first: fluid intake, dietary fibre, exercise -> pharm: start with bulk-forming then add or switch to osmotic
describe nicotine and BF
nicotine is lipophilic and will pass into breast milk, risks insomnia and irritability in infant, may inhibit let down
describe cannabis/THC and BF
THC rapidly distributes into brain and adipose tissue and passes into milk
