Exam 1 - Maternal Medications

Question 1

When is the greatest risk of exposure babies breast feeding?

Answer 1

In the first 4-6 months of life

Question 2

When do babies take in the most amount of breast milk?

Answer 2

In the first 4-6 months of life

Question 3

What are the most common adverse drug reactions during breast feeding?

Answer 3

1) Diarrhea
2) Drowsiness
3) Irritability

Question 4

What drugs commonly cause diarrhea while breast feeding?

Answer 4

Antibiotics

Question 5

Which drugs commonly cause drowsiness while breast feeding?

Answer 5

1) Analgesics

2) Sedatives

Question 6

Which drugs commonly cause irritability while breast feeding?

Answer 6

Antihistamines

Question 7

What should we consider when evaluating the use of medications in a breastfeeding mother?

Answer 7

• Length of time breast feeding
• How old the baby is
• Exclusively breast feeding

Question 8

T/F: To pass into breast milk, the substance must first be absorbed into the mother’s body.

Answer 8

TRUE

Question 9

T/F: To be active in the infant, it must be absorbed through the kidneys.

Answer 9

FALSE

-To be active in the infant, it must be absorbed through the GI TRACT

Question 10

Drugs given to _____ moms reach infants in ____ amounts than drugs given to pregnant women.

Answer 10

Drugs given to NURSING moms reach infants in SMALLER amounts than drugs given to pregnant women.

Question 11

What are the mother/infant factors to consider?

Answer 11

• Disease states
• Absorption
• Distribution
• Metabolism
• Excretion
• Variances with age

Question 12

How does drug transfer into breast milk?

Answer 12

1) Intracellular diffusion
2) Transcellular diffusion
3) Active transport (minimal)

Question 13

Name the 2 cells that participate in intracellular diffusion.

Answer 13

1) Macrophages

2) Lymphocytes

Question 14

Name the 2 requirements for transcellular diffusion.

Answer 14

1) Lipid solubility

2) Low molecular weight

Question 15

Name the 4 ways that amount and rate of diffusion is determined by.

Answer 15

1) Molecular size
2) Ion trapping
3) Lipid partitioning
4) Protein binding

Question 16

T/F: Small molecules are less likely to pass into breast milk.

Answer 16

FALSE

-Large (>200 daltons) are less likely to pass into breast milk

Question 17

T/F: Breast milk is 100% fat.

Answer 17

FALSE

-Breast milk is not 100% fat

Question 18

____ soluble drugs will concentrate in the milk fat.

Answer 18

LIPID soluble drugs will concentrate in the milk fat.

Question 19

What percentage is fat of breast milk?

Answer 19

3-5% of total volume of milk

Question 20

When does colostrum produce?

Answer 20

0-5 days

Question 21

T/F: Colostrum is high in protein and fat.

Answer 21

TRUE

Question 22

pH of milk is slightly _____ compared to plasma.

Answer 22

pH of milk is slightly ACIDIC compared to plasma.

Question 23

____ bases will concentrate in the milk.

Answer 23

WEAK bases will concentrate in the milk.

Question 24

What is the major binding protein?

Answer 24

ALBUMIN

Question 25

Drugs which are ____ ____ ____ will remain in the plasma.

Answer 25

Drugs which are HIGHLY PROTEIN BOUND will remain in the plasma.

Question 26

Name the factors that cause a drug to stay in the bloodstream.

Answer 26

- Large size - Weak acid - Protein bound - Water soluble

Question 27

Name the factors that cause a drug to go through breast milk.

Answer 27

- Small size - Weak base - Low binding - Lipid soluble

Question 28

How many t 1/2 (half-lives) until drug is out of the body?

Answer 28

5 FIVE!!!!!!

Question 29

What is the pH of milk?

Answer 29

7.2 (acidic)

Question 30

T/F: Drugs with shorter half-lives clear the body faster.

Answer 30

TRUE

Question 31

T/F: Longer half-lives lead to accumulation.

Answer 31

TRUE

Question 32

T/F: Passage into breast milk is only a fraction of the excretion.

Answer 32

TRUE - Less than 2% - Kidneys and liver excrete a larger amount than what is actually absorbed into the breast milk

Question 33

When should you take drug with intermittent dosing?

Answer 33

At a trough; with short half-life drugs can take them right before nursing or right after

Question 34

_____ _____ dosing is close to steady state conditions.

Answer 34

ONCE DAILY dosing is close to steady state conditions.

Question 35

What is milk/plasma ratio?

Answer 35

The ratio of concentration in milk to the ratio concentration in plasma.

Question 36

How do you calculate the infant dose?

Answer 36

Infant dose (mg) = mom's dose (mg) * % dose absorbed by infant Infant dose (mg) = Conc. in milk (mg/mL) * volume of milk (mL)

Question 37

What are the considerations in drug choice?

Answer 37

- Dosage and duration - Infant maturity - Quantity of milk consumed - Experience with drug in infants - Oral absorption - Potential long-term effects - Possible interference with lactation - Non-dose related toxicity

Question 38

Which types of drugs have potential long-term side effects?

Answer 38

CNS agents (Valium/Diazepam, Clonazepam, Xanax/Alprazolam) SSRIs (Citalopram, Escitalopram, Fluoxetine, Sertraline)

Question 39

Which drug has a possible interference with lactation?

Answer 39

Diphendydramine (Benadryl) | -Dries up secretion and inhibits lactation

Question 40

Name the drugs that decrease milk supply ("DAM DAVE").

Answer 40

D - Dopamine Agents (ergots, levodopa, B6) A - Androgens M - Marijuana D - Diuretics (high dose) A - Alcohol (high dose) V - Vasoconstrictors (Sudafed) E - Estrogens

Question 41

What do dopamine agents (like ergots, levodopa, B6) do to milk supply to decrease it?

Answer 41

Inhibit prolactin release

Question 42

What produces milk?

Answer 42

Rising levels of prolactin

Question 43

What do estrogens do to decrease milk production?

Answer 43

Block the effect of prolactin

Question 44

What do androgens do to decrease milk production?

Answer 44

Suppress plasma prolactin

Question 45

What do rising levels of prolactin do?

Answer 45

Produce milk

Question 46

What do vasoconstrictors do to decrease milk supply?

Answer 46

Decreased blood flow to the breast

Question 47

Name the drugs that increase milk supply.

Answer 47

- Metoclopramide, Neuroleptics - Methyldopa - H2 Antagonists - Tryptophan - Fenugreek

Question 48

How do Metoclopramide and Neuroleptics increase milk supply?

Answer 48

Inhibit dopamine secretion

Question 49

How does Methyldopa increase milk supply?

Answer 49

False dopamine precursor

Question 50

How do H2 Antagonists and Tryptophan increase milk supply?

Answer 50

Increase serotonergic transmission

Question 51

What are some strategies to minimize infant exposure?

Answer 51

- Use short half-life drugs - Take before longest sleep period (baby's) - Switch to safer drug - Use different route (i.e. steroid creme) - Stop the drug

Question 52

T/F: Estrogen containing products may suppress lactation and quality of milk produced.

Answer 52

TRUE

Question 53

What type of contraception is preferred in lactation?

Answer 53

PROGESTIN-ONLY PILLS (Micronor, Slynd)

Question 54

When can you use estrogen contraception if you have to?

Answer 54

After 6+ weeks postpartum

Question 55

T/F: IUD is a safe contraceptive during lactation.

Answer 55

TRUE

Question 56

T/F: Depo-Provera lowers milk production.

Answer 56

TRUE

Question 57

Name the non-dose related toxicity associated with Antibiotics.

Answer 57

- Diarrhea - C. Difficle - Candida overgrowth

Question 58

Name the antibiotics safe in lactation ("PCM Q").

Answer 58

P - Penicillins C - Cephalosporins M - Macrolides (Azithromycin) Q - Quinolones (Ciprofloxacin, Ofloxacin)

Question 59

Name the antibiotics that should be cautioned in lactation ("CST").

Answer 59

C - Chloramphenicol S - Sulfa agents - first month of life! T - Tetracycline - repeated use!

Question 60

What bacteria causes mastitis?

Answer 60

S. aureus E. coli Srep.

Question 61

What do you treat mastitis with?

Answer 61

Dicloxacillin Oxacillin Cephalosporin

Question 62

How long is mastitis treated for?

Answer 62

10-14 days

Question 63

T/F: IBU can be used for pain in mastitis.

Answer 63

TRUE

Question 64

T/F: You can continue to breast feed with mastitis.

Answer 64

TRUE

Question 65

Breast milk and HIV are _______.

Answer 65

Breast milk and HIV are CONTRAINDICATED.

Question 66

T/F: The influenza treatments, Oseltamivir and Zanamivir are considered safe.

Answer 66

TRUE

Question 67

T/F: In HSV, Acyclovir and Valacyclovir are considered unsafe.

Answer 67

FALSE | -In HSV, Acyclovir and Valacyclovir are considered safe

Question 68

Name the 2 contraindicated immunizations.

Answer 68

1) Smallpox (LIVE) | 2) Yellow Fever (LIVE)

Question 69

Why are Smallpox and Yellow Fever vaccinations/immunizations contraindicated in lactation?

Answer 69

B/C they contain live virus

Question 70

What HTN adverse drug reactions should you monitor for in lactation?

Answer 70

- Apnea - Weakness - Hypoglycemia

Question 71

T/F: HTN has the potential to reduce milk production.

Answer 71

TRUE

Question 72

Name the preferred beta blockers for HTN treatment.

Answer 72

1) Propranolol | 2) Metoprolol

Question 73

Name the preferred calcium channel blockers in HTN treatment.

Answer 73

1) Nifedipine | 2) Nimodipine

Question 74

Which anticoagulation treatments are considered safe ("WALH")?

Answer 74

W - Warfarin - UNLIKE DURING PG A - ASA - low dose L - Low molecular weight heparin - Lovenox, Enoxaparin H - Heparin

Question 75

Which anticoagulation treatments are cautioned during lactation?

Answer 75

Clopidogrel | DOAC - can use Rivaroxaban

Question 76

T/F: Antihistamines and decongestants both suppress lactation.

Answer 76

TRUE

Question 77

T/F: Guaifenesin and saline nasal sprays are considered unsafe in lactation.

Answer 77

FALSE | -Guaifenesin and saline nasal sprays are considered safe in lactation

Question 78

T/F: IBU and acetaminophen are considered safe in lactation.

Answer 78

TRUE