lactation

Question 1

general recommendation for breastfeeding

Answer 1

take the meds immediately after feeding the baby, or when the baby will be sleeping for long periods

Question 2

ethanol

Answer 2

avoid feeding within 2 hours

Question 3

caffeine

Answer 3

high milk transfer within 1 hour

Question 4

pain

Answer 4

use APAP and NSAIDs first

FDA warns against oxycodone, codeine, and tramadol

buprenorphine and methadone are not contraindicated for addiction

Question 5

cough/cold

Answer 5

avoid decongestants, antihistamines 1st generation, anticholinergics, DM, codeine

Question 6

hearburn

Answer 6

PPI or H2RA are ok except cimetidine

Question 7

cardio

Answer 7

avoid atenolol and acebutelol
ACE, ARB, diuretics OK

Question 8

estrogen

Answer 8

avoid

Question 9

thrombosis

Answer 9

warfarin low passage
UFH/LMWH useful

Question 10

anxiety

Answer 10

SSRIs not contraindicated
benzos may pass but not contraindicated

Question 11

mastitis

Answer 11

keflex, clindamycin, azithromycin

Question 12

nipple candida

Answer 12

topical/oral, need to treat baby

Question 13

HIV

Answer 13

infant antiretrovirals

Question 14

Flu

Answer 14

oseltamivir

Question 15

if 2 gm flagyl is used for trichomonas

Answer 15

avoid feeding x 12 hours

Question 16

positive benefits of breast feeding to infant

Answer 16

improved development, decreased mortality
protection against disease
decreased risk of DM, leukemia, obesity, asthma, ADHD
provides intestinal microbiome

Question 17

breastfeeding is especially important in ___

Answer 17

premature infants, newborns

Question 18

positive benefits of breastfeeding to mother

Answer 18

decreases postpartum bleeding, decreased risk of breast and ovarian cancer, hip fracture post menopause, DM

increased bonding

Question 19

drugs that can reduce milk supply

Answer 19

alcohol
anticholinergic antihistamines
diuretics
estrogens
nicotine
pseudoephedrine

Question 20

drugs that can enhance milk supply

Answer 20

metoclopramide
fenugreek

Question 21

PK factors that affect drug passage into milk

Answer 21

drug half life, bioavailability, negligible amounts of drug removed in milk

Question 22

drugs contraindicated in lactation

Answer 22

amiodarone
antineoplastics, immunosuppressants
bromocriptine
recreational drugs
ergotamine
lithium
misoprostol
single dose flagyl: temporary dc
isotretinoin