Lactation

Question 1

How long should babies be breastfed?

Answer 1

exclusively for the first 6 months and then used as a supplement for up to 1 year

Question 2

What should pump and dump be based on?

Answer 2

half-life/ active metabolites

Question 3

What are the benefits of breastfeeding?

Answer 3

1. accelerated recovery from childbirth
2. decreased risk of post partum depression
3. decreased risk of breast, ovarian cancer, and osteoporosis

Question 4

What are the characteristics of medications found in breast milk?

Answer 4

1. MW < 500 Da
2. non ionized
3. lipophilic (usually cross BBB)
4. nonprotein bound
5. high oral bioavailability
6. weak bases
7. long half life

Question 5

When is the best time to take medications?

Answer 5

dose just after nursing and or just before the child’s longest sleep period

Question 6

What is the relative infant dose?

Answer 6

values <10% considered safe in lactation

Question 7

What is the RID equation?

Answer 7

dose infant (mg/kg/day)/ mother’s dose (mg/kg/day)

Question 8

What medications are considered contraindicated in lactation?

Answer 8

1. Acitretin
2. Amiodarone
3. chemo
4. Dicyclomine
5. Didanosine
6. Dopamine agonist
7. Doxepin
8. Dronedarone
9. Ergotamine
10. Fenofibrate
11. gold salts
12. isotretinoin/retinoids
13. methamphetamines
14. methimazole
15. statins
16. tetracyclines (chronic)
17. marijuana

Question 9

What medications decrease milk supply?

Answer 9

1. dopamine agonist
2. estrogen
3. intense diuresis
4. pseudoephedrine (with chronic use)
5. moderate to heavy alcohol consumption
6. cigarette

Question 10

Are anticonvulsants compatible with lactation?

Answer 10

YES

Question 11

What herbal supplements are preferred in pregnancy?

Answer 11

1. echinacea
2. fennel
3. fenugreek
4. garlic
5. ginko
6. goldenrod
7. milk thistle
8. st. john wart
9. valerian

Question 12

What are treatments to increase milk supply?

Answer 12

1. warm compress on breasts
2. dopamine agonists (metoclopramide, domperidone)
3. fenugreek

Question 13

What is mastitis?

Answer 13

tender, hot, swollen, wedge-shaped area of breast associated with temp >/=101 chills, flu-like aching, systemic illness; staph. aureus common cause

Question 14

What is tx for mastitis?

Answer 14

1. nursing
2. supportive measures
3. antibiotics

Question 15

What are treatment options for non-severe mastitis infection w/o MRSA risk factors?

Answer 15

1. Dicloxacillin
2. Cephalexin
3. Clindamycin

Question 16

What are treatment options for non-severe mastitis infection with MRSA risk factors?

Answer 16

1. Bactrim
2. Clindamycin

Question 17

What are treatment options for severe mastitis infection?

Answer 17

Vancomycin IV

Question 18

What are the recommendations for the baby when the mother is taking antibiotics?

Answer 18

diarrhea due to modification of bowel flora; pre-treat with butt cream

Question 19

What antibiotics should be avoided to the nursing mother of jaundiced infant <1 mo old?

Answer 19

sulfa antibiotics

Question 20

What are preferred SSRIs in lactation?

Answer 20

1. paroxetine
2. sertraline

Question 21

What SSRI should be avoided in pregnancy?

Answer 21

fluoxetine

Question 22

What analgesics are preferred in lactation?

Answer 22

acetaminophen
ibuprofen (preferred over other NSAIDs)

Question 23

What cough/cold products are safe in lactation?

Answer 23

1. DM
2. guaifenesin
3. pseudoephedrine (short-term)
4. topical decongestants

Question 24

What oral contraceptives are safe in lactation?

Answer 24

low dose estrogen-progesterone combination products

Question 25

How long postpartum is it safe to initiate estrogen-progesterone contraceptive?

Answer 25

4-6 weeks due to VTE risk and decreased milk supply

Question 26

How long after having a drink does the mother have to wait to breast feed?

Answer 26

2 hours

Question 27

How many drinks can decrease milk production?

Answer 27

4

Question 28

What is the recommended daily caffeine intake when breastfeeding?

Answer 28

200-300 mg/day