The document provides information on counseling principles for medication use during breastfeeding. It discusses the benefits of breastfeeding and outlines general guidelines for exclusive breastfeeding for the first 6 months with continued breastfeeding up to 1 year with appropriate solid foods. It also discusses how drugs can transfer into breast milk and potential harm to infants. Key factors that determine the effect of drugs on nursing infants include the amount transferred into milk, amount of milk consumed, and the infant's ability to metabolize and excrete the drug. The document provides guidance on evaluating risk to infants and minimizing exposure through careful medication selection and dosing.
The document discusses several key points about medication and breastfeeding:
1. Nearly all drugs transfer into breast milk to some extent through passive diffusion, with rare exceptions like heparin and insulin.
2. The amount transferred depends on factors like the mother's serum drug level, protein binding, lipophilicity, and molecular weight of the drug.
3. The infant's exposure also depends on the volume of milk consumed and the infant's ability to absorb and eliminate the drug.
4. Drugs are generally classified based on their safety profile during breastfeeding, with categories for compatible, compatible with monitoring, avoid if possible, and contraindicated drugs.
Use and abuse of drugs in breast feedingKawita Bapat
This document discusses the use and abuse of drugs during breastfeeding. It provides classifications of drugs according to their safety for breastfeeding mothers by the American Academy of Pediatrics. While most drugs pass into breastmilk in small amounts, very few are contraindicated. Factors like plasma concentration, protein binding, lipid solubility and infant characteristics influence drug transfer and risk of adverse effects. Proper positioning, frequent feeding and ensuring milk supply can help minimize drug exposure for infants.
1) Nearly all drugs taken by a breastfeeding mother pass into her breastmilk in small amounts, usually less than 1% of the maternal dose.
2) Many factors influence how much of a drug passes into breastmilk, including the drug's properties, dosage and duration, and the infant's ability to metabolize the drug.
3) When counseling breastfeeding mothers about drug use, healthcare providers should consider whether the drug is absolutely necessary, timing of feeds around medication, and choosing short-acting or locally-acting drugs when possible to minimize infant exposure.
This document discusses guidelines for drug use during lactation. It begins by outlining principles from the Quran and Hadith regarding breastfeeding. It then discusses anatomy related to lactation and hormonal regulation. Guidelines for chemotherapy during lactation emphasize using drugs with minimal infant exposure and avoiding unnecessary drugs. Several classes of drugs are discussed, identifying those that are generally safe to use during lactation like beta-blockers, thiazides, ACE inhibitors, warfarin, inhaled asthma medications, and corticosteroids. Drugs that should be avoided include phenobarbital, primodone, and clonazepam. The document also covers stimulants and inhibitors of lactation.
Milk has a lower pH and protein binding capacity than plasma, so drugs distribute into milk depending on their lipophilicity and plasma protein binding. Highly plasma protein-bound drugs remain in the bloodstream and have lower concentrations in milk. All antithyroid drugs are secreted in milk, so breastfeeding is not recommended for women taking these medications. The extent a drug transfers to milk is affected by its pKa, protein binding, and lipophilicity. Drugs that are basic, have low plasma protein binding, and are lipophilic will have higher milk concentrations. The timing of breastfeeding should be considered when taking certain drugs.
Use Of Galactogogues In Initiating Or Augmenting Maternal Milk SupplyBiblioteca Virtual
The document discusses the use of galactogogues, or substances used to induce, maintain, or augment maternal milk production. It provides guidelines for using galactogogues, including evaluating other factors first and increasing breast emptying. The most well-studied galactogogues are metoclopramide and domperidone, which work through dopamine antagonism. Herbal galactogogues like fenugreek are also discussed. Close monitoring of both mother and infant is recommended when using any galactogogue.
Volatile oils used in genitourinary tract infectionsReem Frrag
The document discusses genitourinary tract infections and the use of volatile essential oils to treat them. It provides an overview of common infections like urinary tract infections (UTIs) and genital tract infections (GTIs) in both males and females. Specific essential oils are examined for their antimicrobial properties against common pathogens. Oregano, frankincense and tea tree oils show effectiveness against E. coli. Pulsatilla is used traditionally to treat epididymitis. Melissa has antiviral activity against herpes simplex virus. Couchgrass is used for prostate enlargement. Hormonal imbalances are also discussed and clary sage is examined as an oil that can help balance hormones.
This document discusses prescribing medications to lactating mothers. It begins by explaining the mechanisms by which drugs pass into breast milk, including lipid solubility, plasma concentration, protein binding, molecular weight, and pH. Basic drugs are more likely to be secreted in breast milk due to ion trapping. Drugs that should be avoided include basic drugs like morphine and oral contraceptives, acidic drugs available as salts like sulfonamides and ampicillin, non-electrolytes like ethanol, lithium, and drugs that can cause hemolysis in G6PD deficient individuals. In conclusion, drugs administered to nursing mothers can be secreted in quantities significant for the breastfed infant, and it is important for pediatricians to consider
The document discusses several key points about medication and breastfeeding:
1. Nearly all drugs transfer into breast milk to some extent through passive diffusion, with rare exceptions like heparin and insulin.
2. The amount transferred depends on factors like the mother's serum drug level, protein binding, lipophilicity, and molecular weight of the drug.
3. The infant's exposure also depends on the volume of milk consumed and the infant's ability to absorb and eliminate the drug.
4. Drugs are generally classified based on their safety profile during breastfeeding, with categories for compatible, compatible with monitoring, avoid if possible, and contraindicated drugs.
Use and abuse of drugs in breast feedingKawita Bapat
This document discusses the use and abuse of drugs during breastfeeding. It provides classifications of drugs according to their safety for breastfeeding mothers by the American Academy of Pediatrics. While most drugs pass into breastmilk in small amounts, very few are contraindicated. Factors like plasma concentration, protein binding, lipid solubility and infant characteristics influence drug transfer and risk of adverse effects. Proper positioning, frequent feeding and ensuring milk supply can help minimize drug exposure for infants.
1) Nearly all drugs taken by a breastfeeding mother pass into her breastmilk in small amounts, usually less than 1% of the maternal dose.
2) Many factors influence how much of a drug passes into breastmilk, including the drug's properties, dosage and duration, and the infant's ability to metabolize the drug.
3) When counseling breastfeeding mothers about drug use, healthcare providers should consider whether the drug is absolutely necessary, timing of feeds around medication, and choosing short-acting or locally-acting drugs when possible to minimize infant exposure.
This document discusses guidelines for drug use during lactation. It begins by outlining principles from the Quran and Hadith regarding breastfeeding. It then discusses anatomy related to lactation and hormonal regulation. Guidelines for chemotherapy during lactation emphasize using drugs with minimal infant exposure and avoiding unnecessary drugs. Several classes of drugs are discussed, identifying those that are generally safe to use during lactation like beta-blockers, thiazides, ACE inhibitors, warfarin, inhaled asthma medications, and corticosteroids. Drugs that should be avoided include phenobarbital, primodone, and clonazepam. The document also covers stimulants and inhibitors of lactation.
Milk has a lower pH and protein binding capacity than plasma, so drugs distribute into milk depending on their lipophilicity and plasma protein binding. Highly plasma protein-bound drugs remain in the bloodstream and have lower concentrations in milk. All antithyroid drugs are secreted in milk, so breastfeeding is not recommended for women taking these medications. The extent a drug transfers to milk is affected by its pKa, protein binding, and lipophilicity. Drugs that are basic, have low plasma protein binding, and are lipophilic will have higher milk concentrations. The timing of breastfeeding should be considered when taking certain drugs.
Use Of Galactogogues In Initiating Or Augmenting Maternal Milk SupplyBiblioteca Virtual
The document discusses the use of galactogogues, or substances used to induce, maintain, or augment maternal milk production. It provides guidelines for using galactogogues, including evaluating other factors first and increasing breast emptying. The most well-studied galactogogues are metoclopramide and domperidone, which work through dopamine antagonism. Herbal galactogogues like fenugreek are also discussed. Close monitoring of both mother and infant is recommended when using any galactogogue.
Volatile oils used in genitourinary tract infectionsReem Frrag
The document discusses genitourinary tract infections and the use of volatile essential oils to treat them. It provides an overview of common infections like urinary tract infections (UTIs) and genital tract infections (GTIs) in both males and females. Specific essential oils are examined for their antimicrobial properties against common pathogens. Oregano, frankincense and tea tree oils show effectiveness against E. coli. Pulsatilla is used traditionally to treat epididymitis. Melissa has antiviral activity against herpes simplex virus. Couchgrass is used for prostate enlargement. Hormonal imbalances are also discussed and clary sage is examined as an oil that can help balance hormones.
This document discusses prescribing medications to lactating mothers. It begins by explaining the mechanisms by which drugs pass into breast milk, including lipid solubility, plasma concentration, protein binding, molecular weight, and pH. Basic drugs are more likely to be secreted in breast milk due to ion trapping. Drugs that should be avoided include basic drugs like morphine and oral contraceptives, acidic drugs available as salts like sulfonamides and ampicillin, non-electrolytes like ethanol, lithium, and drugs that can cause hemolysis in G6PD deficient individuals. In conclusion, drugs administered to nursing mothers can be secreted in quantities significant for the breastfed infant, and it is important for pediatricians to consider
This document discusses induced lactation from Islamic perspectives, protocols for induced lactation, and the effects of galactogogues. It notes that Islam permits adoptive mothers to induce their own lactation with medical assistance. It describes the Newman Goldfarb Protocol, which uses medications and pumping to induce lactation. It discusses the effects of hormones like prolactin and oxytocin on breast milk production. It provides details on regular, accelerated, and menopause protocols for induced lactation using medications. It also discusses the use of galactogogues like herbs and medications to increase milk supply and notes potential risks and lack of research on many galactagogues.
The document discusses drugs and breastfeeding. It provides information on factors that determine whether and how much of a drug passes into breastmilk, including molecular weight, protein binding, lipid solubility, and oral bioavailability. It notes that most drugs pass into breastmilk in small amounts, usually less than 1% of the maternal dose. The document outlines general principles for counseling nursing mothers on drug use, such as choosing short-acting drugs, administering drugs after feeding, and monitoring infants for side effects. It also categorizes drugs based on their safety profile for breastfeeding according to the AAP.
This document discusses drug use during pregnancy and lactation. It notes that drug use requires special consideration as both the mother and child are affected. During the first trimester, drugs can cause birth defects, and later in pregnancy they can impact fetal growth or development. The principles of therapy are to only use medications when clearly needed, starting with non-drug options, and using the lowest effective dose for shortest time. The document categorizes drugs from A to X based on safety in pregnancy, with Category X posing the greatest risk to the fetus. It also covers common pregnancy issues and medications that may be used to treat them.
Oral contraceptives, also known as birth control pills, are designed to prevent pregnancy by stopping ovulation. They can be taken continuously for 84 days on and 7 days off to have 4 periods per year, and can also be used to regulate menstrual cycles and decrease painful periods or treat acne. Benefits include allowing women to space out pregnancies and prevent unwanted pregnancies that carry medical, social, and financial risks. Potential side effects include depression, anxiety, increased blood pressure, blood clots, and bleeding, so women should see a doctor if any side effects occur. It is important to take the pill at the same time each day to prevent pregnancy from missed doses.
The document discusses different types of oral contraceptives including combination pills containing estrogen and progestin, progestin-only pills, and emergency contraceptive pills. Combination pills are available in monophasic, multiphasic, and extended-cycle formulations. Progestin-only pills contain only progestin and have no inactive pills. Emergency contraceptive pills can prevent pregnancy if taken within 72 hours of unprotected sex. Oral contraceptives work by preventing ovulation, thickening cervical mucus, or altering the uterine lining. They are highly effective but can have side effects like headaches or mood changes. Long term use carries small risks of blood clots, heart attack, or stroke.
This document discusses drug use during breastfeeding. It notes that nearly all drugs pass into human milk in small amounts, usually less than 1% of the maternal dose, and very few drugs are contraindicated for nursing mothers. When selecting drugs for breastfeeding women, factors like the drug's diffusion rate, plasma level, lipid solubility, and protein binding should be considered, as well as the infant's age, weight, and health status. The document provides guidelines for selecting safer drugs and monitoring infants exposed to drugs via breastmilk. Common reasons women contact a breastfeeding counseling hotline include issues like hemorrhoids, cardiovascular or gastrointestinal diseases, contraception, and mental health conditions.
Drug safety in pregnancy and lactation is an important consideration. The FDA categorizes drugs into A, B, C, D or X based on risk during pregnancy, with Category X being contraindicated. Many drugs can cause teratogenic effects like antibiotics causing fetal ototoxicity or anticonvulsants causing neural tube defects. Drugs secreted into breastmilk can potentially cause side effects in infants like diarrhea, irritability or drowsiness. Selection of drugs during pregnancy and lactation requires weighing risks and benefits for both mother and child.
This document provides information on Methergine and Clomiphene Citrate.
Methergine is an ergot alkaloid administered postpartum to help deliver the placenta and control bleeding by improving uterine muscle tone and contractions. It has potential side effects like nausea and leg cramps. Nurses must monitor vital signs and uterine response after administration and educate patients on signs of problems.
Clomiphene Citrate is used to induce ovulation in women with infertility. It works by inhibiting estrogen receptors in the brain to stimulate ovulation. It has potential visual and ovarian side effects and drug interactions. Nurses must monitor patients for abnormal bleeding or vision changes and educate them on proper administration and signs of problems.
This document provides information about oral contraceptives, including how they work to prevent pregnancy, types of oral contraceptives, emergency contraception, side effects and drug interactions. It discusses both combined oral contraceptives containing estrogen and progesterone, as well as progestin-only pills. Emergency contraceptive pills containing levonorgestrel are described as well as long acting injectable and implantable progestin-only methods. Warnings and instructions regarding proper use and storage are also summarized.
This document provides information on medication use during pregnancy. It discusses:
- The FDA pregnancy categories (A, B, C, D, X) which assess risk of fetal injury from drugs. Category A drugs are safest, while X should never be used.
- Common drugs used in pregnancy and their categories, including analgesics, antibiotics, vitamins, and hormones.
- Drugs that are contraindicated like thalidomide, Accutane, and warfarin due to known risks of birth defects.
- Specific risks to the fetus from various drugs like NSAIDs causing PDA, lithium causing heart defects, and alcohol causing fetal alcohol syndrome.
This document discusses hormonal contraceptives, including their mechanisms of action, types, effectiveness, side effects, and considerations for use. It covers oral contraceptives like combined and progestin-only pills, injectables, implants, and emerging options. The main points are: hormonal contraceptives work by suppressing ovulation and thickening cervical mucus; combined oral contraceptives are highly effective but can have side effects; progestin-only options have lower effectiveness and fewer side effects than combined pills; long-acting reversible contraceptives like implants provide years of pregnancy prevention. Risks, drug interactions, and proper use are also outlined.
This document provides information about oral contraceptives. It discusses the types of oral contraceptives including combination pills (monophasic, biphasic, triphasic), progestin pills, and morning after pills. Combination pills contain both estrogen and progesterone while progestin pills only contain progesterone. The document explains the mode of action of oral contraceptives by suppressing LH and FSH to inhibit ovulation. Potential side effects are also outlined such as nausea, headaches, and weight gain. In summary, this document reviews the different types of oral contraceptive pills, their mode of action in preventing pregnancy, and possible adverse effects.
Hormonal contraceptive- medical information ( all about hormonal contracepti...martinshaji
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive.Hormonal methods of birth control prevent eggs from being released from the ovaries, thicken cervical mucus to prevent sperm from entering the uterus, and thin the lining of the uterus to prevent implantation. Hormone pills come in packs. Most packs contain 3 weeks of hormone pills.
this describes all the aspects of hormonal contraceptives in brief .
please comment
thank uuuuu
Breastfeeding And Drugs Prescribed, Over The Counter, Herbs, IllegalBiblioteca Virtual
The document provides guidance for breastfeeding mothers on taking prescribed drugs, over-the-counter medications, herbs, and illegal substances while breastfeeding, noting they can pass into breastmilk and potentially harm babies. It advises mothers to ask their doctors several key questions about any drugs to determine safety and offers alternatives to avoid when possible, such as short-acting drugs with minimal risk of side effects or building up in the baby's system. Mothers are warned never to take illegal street drugs while breastfeeding as they are very dangerous to babies.
Prescribing safely in pregnancy and lactationMini Sood
Slides for medical students dealing with pregnant and postpartum women. Safe drugs for common conditions. Presentation with interactive quiz. 48 slides
Depo-Provera CI (Medroxyprogesterone Acetate Injectable Suspension) The Swiss Pharmacy
Depo-Provera Contraceptive Injection (Medroxyprogesterone Acetate injectable Suspension) is a progestin indicated for use by females of reproductive potential to prevent pregnancy. It is also used to treat endometriosis, abnormal uterine bleeding, abnormal sexuality in males, and certain types of cancer.
This document discusses different types of contraceptive methods including permanent, spacing, and emergency contraceptives. It focuses on oral contraceptives, describing combined oral contraceptives that contain estrogen and progestin in monophasic, biphasic, or triphasic formulations. Progesterone-only pills are also discussed. The document explains how these contraceptives work to prevent ovulation and implantation. Potential side effects and benefits are summarized for each method. Emergency hormonal contraception and intrauterine devices are also briefly described.
This document discusses oral contraceptives and provides information on:
- Their low failure rate and side effect incidence. Serious complications are rare.
- Numerous non-contraceptive benefits including menstrual cycle management and cancer prevention.
- Modifying regimens, such as extending the number of active pills, can help manage side effects and improve compliance. Extending the active pill period helped reduce symptoms for 74% of patients in one study.
- Other options include shortening the hormone-free interval or adding estrogen during that time.
The document provides information on counseling principles for medication use during breastfeeding. It discusses several key points:
- Nearly all drugs pass into human milk, usually in small amounts less than 1% of the maternal dose. Very few drugs are contraindicated.
- Factors like a drug's protein binding, lipid solubility, molecular weight, and oral bioavailability determine how much passes into breastmilk. Short-acting drugs with high protein binding and low lipid solubility pass in smaller amounts.
- When counseling patients, healthcare providers should evaluate if medication is truly needed, recommend taking it after nursing, and choose drugs with known low risk to infants based on existing data. Short-term use or local administration can
1) Nearly all drugs taken by a breastfeeding mother pass into her breastmilk in small amounts. Very few drugs are contraindicated.
2) The amount of drug that passes into breastmilk depends on factors like the drug's lipid solubility, protein binding, and the mother's dosage and half-life.
3) To minimize infant drug exposure, a mother can avoid feeding during peak drug levels, temporarily pause breastfeeding for short-term drugs, and choose drugs with low milk concentrations and established safety profiles.
This document discusses induced lactation from Islamic perspectives, protocols for induced lactation, and the effects of galactogogues. It notes that Islam permits adoptive mothers to induce their own lactation with medical assistance. It describes the Newman Goldfarb Protocol, which uses medications and pumping to induce lactation. It discusses the effects of hormones like prolactin and oxytocin on breast milk production. It provides details on regular, accelerated, and menopause protocols for induced lactation using medications. It also discusses the use of galactogogues like herbs and medications to increase milk supply and notes potential risks and lack of research on many galactagogues.
The document discusses drugs and breastfeeding. It provides information on factors that determine whether and how much of a drug passes into breastmilk, including molecular weight, protein binding, lipid solubility, and oral bioavailability. It notes that most drugs pass into breastmilk in small amounts, usually less than 1% of the maternal dose. The document outlines general principles for counseling nursing mothers on drug use, such as choosing short-acting drugs, administering drugs after feeding, and monitoring infants for side effects. It also categorizes drugs based on their safety profile for breastfeeding according to the AAP.
This document discusses drug use during pregnancy and lactation. It notes that drug use requires special consideration as both the mother and child are affected. During the first trimester, drugs can cause birth defects, and later in pregnancy they can impact fetal growth or development. The principles of therapy are to only use medications when clearly needed, starting with non-drug options, and using the lowest effective dose for shortest time. The document categorizes drugs from A to X based on safety in pregnancy, with Category X posing the greatest risk to the fetus. It also covers common pregnancy issues and medications that may be used to treat them.
Oral contraceptives, also known as birth control pills, are designed to prevent pregnancy by stopping ovulation. They can be taken continuously for 84 days on and 7 days off to have 4 periods per year, and can also be used to regulate menstrual cycles and decrease painful periods or treat acne. Benefits include allowing women to space out pregnancies and prevent unwanted pregnancies that carry medical, social, and financial risks. Potential side effects include depression, anxiety, increased blood pressure, blood clots, and bleeding, so women should see a doctor if any side effects occur. It is important to take the pill at the same time each day to prevent pregnancy from missed doses.
The document discusses different types of oral contraceptives including combination pills containing estrogen and progestin, progestin-only pills, and emergency contraceptive pills. Combination pills are available in monophasic, multiphasic, and extended-cycle formulations. Progestin-only pills contain only progestin and have no inactive pills. Emergency contraceptive pills can prevent pregnancy if taken within 72 hours of unprotected sex. Oral contraceptives work by preventing ovulation, thickening cervical mucus, or altering the uterine lining. They are highly effective but can have side effects like headaches or mood changes. Long term use carries small risks of blood clots, heart attack, or stroke.
This document discusses drug use during breastfeeding. It notes that nearly all drugs pass into human milk in small amounts, usually less than 1% of the maternal dose, and very few drugs are contraindicated for nursing mothers. When selecting drugs for breastfeeding women, factors like the drug's diffusion rate, plasma level, lipid solubility, and protein binding should be considered, as well as the infant's age, weight, and health status. The document provides guidelines for selecting safer drugs and monitoring infants exposed to drugs via breastmilk. Common reasons women contact a breastfeeding counseling hotline include issues like hemorrhoids, cardiovascular or gastrointestinal diseases, contraception, and mental health conditions.
Drug safety in pregnancy and lactation is an important consideration. The FDA categorizes drugs into A, B, C, D or X based on risk during pregnancy, with Category X being contraindicated. Many drugs can cause teratogenic effects like antibiotics causing fetal ototoxicity or anticonvulsants causing neural tube defects. Drugs secreted into breastmilk can potentially cause side effects in infants like diarrhea, irritability or drowsiness. Selection of drugs during pregnancy and lactation requires weighing risks and benefits for both mother and child.
This document provides information on Methergine and Clomiphene Citrate.
Methergine is an ergot alkaloid administered postpartum to help deliver the placenta and control bleeding by improving uterine muscle tone and contractions. It has potential side effects like nausea and leg cramps. Nurses must monitor vital signs and uterine response after administration and educate patients on signs of problems.
Clomiphene Citrate is used to induce ovulation in women with infertility. It works by inhibiting estrogen receptors in the brain to stimulate ovulation. It has potential visual and ovarian side effects and drug interactions. Nurses must monitor patients for abnormal bleeding or vision changes and educate them on proper administration and signs of problems.
This document provides information about oral contraceptives, including how they work to prevent pregnancy, types of oral contraceptives, emergency contraception, side effects and drug interactions. It discusses both combined oral contraceptives containing estrogen and progesterone, as well as progestin-only pills. Emergency contraceptive pills containing levonorgestrel are described as well as long acting injectable and implantable progestin-only methods. Warnings and instructions regarding proper use and storage are also summarized.
This document provides information on medication use during pregnancy. It discusses:
- The FDA pregnancy categories (A, B, C, D, X) which assess risk of fetal injury from drugs. Category A drugs are safest, while X should never be used.
- Common drugs used in pregnancy and their categories, including analgesics, antibiotics, vitamins, and hormones.
- Drugs that are contraindicated like thalidomide, Accutane, and warfarin due to known risks of birth defects.
- Specific risks to the fetus from various drugs like NSAIDs causing PDA, lithium causing heart defects, and alcohol causing fetal alcohol syndrome.
This document discusses hormonal contraceptives, including their mechanisms of action, types, effectiveness, side effects, and considerations for use. It covers oral contraceptives like combined and progestin-only pills, injectables, implants, and emerging options. The main points are: hormonal contraceptives work by suppressing ovulation and thickening cervical mucus; combined oral contraceptives are highly effective but can have side effects; progestin-only options have lower effectiveness and fewer side effects than combined pills; long-acting reversible contraceptives like implants provide years of pregnancy prevention. Risks, drug interactions, and proper use are also outlined.
This document provides information about oral contraceptives. It discusses the types of oral contraceptives including combination pills (monophasic, biphasic, triphasic), progestin pills, and morning after pills. Combination pills contain both estrogen and progesterone while progestin pills only contain progesterone. The document explains the mode of action of oral contraceptives by suppressing LH and FSH to inhibit ovulation. Potential side effects are also outlined such as nausea, headaches, and weight gain. In summary, this document reviews the different types of oral contraceptive pills, their mode of action in preventing pregnancy, and possible adverse effects.
Hormonal contraceptive- medical information ( all about hormonal contracepti...martinshaji
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive.Hormonal methods of birth control prevent eggs from being released from the ovaries, thicken cervical mucus to prevent sperm from entering the uterus, and thin the lining of the uterus to prevent implantation. Hormone pills come in packs. Most packs contain 3 weeks of hormone pills.
this describes all the aspects of hormonal contraceptives in brief .
please comment
thank uuuuu
Breastfeeding And Drugs Prescribed, Over The Counter, Herbs, IllegalBiblioteca Virtual
The document provides guidance for breastfeeding mothers on taking prescribed drugs, over-the-counter medications, herbs, and illegal substances while breastfeeding, noting they can pass into breastmilk and potentially harm babies. It advises mothers to ask their doctors several key questions about any drugs to determine safety and offers alternatives to avoid when possible, such as short-acting drugs with minimal risk of side effects or building up in the baby's system. Mothers are warned never to take illegal street drugs while breastfeeding as they are very dangerous to babies.
Prescribing safely in pregnancy and lactationMini Sood
Slides for medical students dealing with pregnant and postpartum women. Safe drugs for common conditions. Presentation with interactive quiz. 48 slides
Depo-Provera CI (Medroxyprogesterone Acetate Injectable Suspension) The Swiss Pharmacy
Depo-Provera Contraceptive Injection (Medroxyprogesterone Acetate injectable Suspension) is a progestin indicated for use by females of reproductive potential to prevent pregnancy. It is also used to treat endometriosis, abnormal uterine bleeding, abnormal sexuality in males, and certain types of cancer.
This document discusses different types of contraceptive methods including permanent, spacing, and emergency contraceptives. It focuses on oral contraceptives, describing combined oral contraceptives that contain estrogen and progestin in monophasic, biphasic, or triphasic formulations. Progesterone-only pills are also discussed. The document explains how these contraceptives work to prevent ovulation and implantation. Potential side effects and benefits are summarized for each method. Emergency hormonal contraception and intrauterine devices are also briefly described.
This document discusses oral contraceptives and provides information on:
- Their low failure rate and side effect incidence. Serious complications are rare.
- Numerous non-contraceptive benefits including menstrual cycle management and cancer prevention.
- Modifying regimens, such as extending the number of active pills, can help manage side effects and improve compliance. Extending the active pill period helped reduce symptoms for 74% of patients in one study.
- Other options include shortening the hormone-free interval or adding estrogen during that time.
The document provides information on counseling principles for medication use during breastfeeding. It discusses several key points:
- Nearly all drugs pass into human milk, usually in small amounts less than 1% of the maternal dose. Very few drugs are contraindicated.
- Factors like a drug's protein binding, lipid solubility, molecular weight, and oral bioavailability determine how much passes into breastmilk. Short-acting drugs with high protein binding and low lipid solubility pass in smaller amounts.
- When counseling patients, healthcare providers should evaluate if medication is truly needed, recommend taking it after nursing, and choose drugs with known low risk to infants based on existing data. Short-term use or local administration can
1) Nearly all drugs taken by a breastfeeding mother pass into her breastmilk in small amounts. Very few drugs are contraindicated.
2) The amount of drug that passes into breastmilk depends on factors like the drug's lipid solubility, protein binding, and the mother's dosage and half-life.
3) To minimize infant drug exposure, a mother can avoid feeding during peak drug levels, temporarily pause breastfeeding for short-term drugs, and choose drugs with low milk concentrations and established safety profiles.
6 breastfeeding and drugs and acceptable medical reasons for artificial feedi...Varsha Shah
This document discusses breastfeeding and drug use in mothers. It provides guidance on determining if a drug is safe for breastfeeding by considering factors like if the drug transfers to breastmilk, the effect on the infant, and if the infant can metabolize the drug. Common drugs are evaluated such as antidepressants, painkillers, and recreational drugs. Guidelines recommend against breastfeeding if using recreational drugs or drinking excess alcohol. Nicotine and methadone use may be allowed with certain precautions. Overall, the document provides a framework for evaluating drug safety and outlines recommendations to support breastfeeding whenever possible.
This document discusses maternal medication use and breastfeeding. It notes that over 75% of infants in the US are breastfed initially, but that rate drops to around 50% by 6 months due to various social factors and medication use. The average number of medications taken by breastfeeding mothers is 4. Key concepts around how medications enter breast milk are discussed, such as molecular weight, plasma levels, and protein binding. Calculating the relative infant dose is presented as a useful tool to determine safety. Common psychiatric medications like SSRIs, benzodiazepines, and atypical antipsychotics are highlighted as generally compatible with breastfeeding when used at standard doses due to low relative infant doses. Antiepileptics and mood stabil
Pediatric Pharmacology:Pharmacokinetics and pharmacodynamics .pptxAzad Haleem
This document discusses several key topics related to pediatric pharmacology:
- It outlines age classifications in childhood and describes differences in absorption, distribution, metabolism and excretion of drugs between neonates, infants, children and adolescents compared to adults.
- Specific examples are provided of how drug properties like protein binding and hepatic/renal function impact drug levels at different ages.
- Indications for drug monitoring are outlined for medications with a narrow therapeutic window.
- The importance of considering drug interactions is emphasized, especially for drugs metabolized by the liver.
- Factors determining excretion of drugs into breast milk and safety for breastfeeding are summarized.
- A short list of drugs contraindicated in breastfeeding
Drug use in paediatric & geriatric patientsViraj Shinde
This document discusses drug use in paediatric and geriatric patients. It covers changes in pharmacokinetics and pharmacodynamics that occur during development and aging. In paediatrics, absorption, distribution, metabolism and excretion of drugs are often altered compared to adults due to developmental changes. In geriatrics, changes like reduced organ function and body composition affect pharmacokinetics and increase sensitivity to drugs. The document provides examples of these changes and their implications for dosing and drug selection in both populations.
Treatment Track, National Rx Drug Abuse Summit, April 2-4, 2013. Neonatal Abstinence Syndrome: Treating Pregnant Women presentation by Dr. Rick McClead, Mona Prasad, Jacqueline Magers and Gail A. Bagwell
This document discusses issues related to drug exposed infants. It provides information on an upcoming conference on drug exposed infants including accepted learning objectives, disclosure statements, and trends in drug use during pregnancy. Specific drugs discussed include nicotine, alcohol, benzodiazepines, marijuana, stimulants, cocaine, and opiates. Information is presented on trends in neonatal abstinence syndrome, mechanisms of action and effects of various opioids including methadone and buprenorphine. The document also discusses complications of chronic opiate use for both mother and fetus, and recommendations for screening, treatment and recognizing neonatal withdrawal.
GENERAL PRESCRIBING GUIDELINES FOR PAEDIATRIC PATIENTS.pptxkavitharaninachiya
This document provides guidelines for prescribing medications to pediatric patients. It discusses that children differ from adults in their response to drugs due to immature organ systems. Proper dosing and administration methods are important, especially for neonates. The document outlines classifications of pediatric patients and factors that affect drug absorption, distribution, metabolism, and excretion in children. It recommends the oral route when possible and provides guidance on writing prescriptions, calculating doses, and monitoring pediatric patients.
Pediatric pharmacology by dr.azad al.kurdiAzad Haleem
This document discusses several key topics in pediatric pharmacology:
1) Dosing methods for children include weight-based and surface area-based calculations since clinical drug data for children is often limited. Surface area dosing is generally more accurate.
2) Drug monitoring is important for medications with narrow therapeutic windows to ensure safe and effective levels. Common drugs monitored include antiepileptics and antibiotics.
3) Drug interactions can impact medication levels and effects through induction or inhibition of liver enzymes. Incompatibilities between injectable drugs must also be considered.
4) Most drugs are considered safe during breastfeeding as exposure risk to infants is low, but some medications like cancer drugs are contraindicated. The benefits of breast
This document discusses drug use during pregnancy and lactation. It covers principles of therapy during pregnancy and lactation, emphasizing using the lowest effective dose for shortest time. Physiologic and pharmacokinetic changes in pregnancy that affect drug distribution and metabolism are described. The fetal circulation is explained, along with how drugs can affect the fetus. Drugs are categorized based on safety in pregnancy. Common issues in pregnancy like anemia and constipation are also covered.
This document discusses drug use during pregnancy and lactation. It covers principles of therapy during pregnancy and lactation, emphasizing using the lowest effective dose for shortest time. Physiologic and pharmacokinetic changes in pregnancy that affect drug distribution and metabolism are described. The fetal circulation is explained, as well as how drugs can affect the fetus. Drug categories in pregnancy from A to X are defined based on safety evidence. Common issues in pregnancy like anemia, constipation, and gestational diabetes are also covered.
This document summarizes the effects of pregnancy on pharmacokinetics and the use of various medications in obstetrics. It discusses how pregnancy affects absorption, distribution, metabolism and elimination of drugs. It then covers the effects of medications during pregnancy, labour, and the puerperium. Various drug classes used in obstetrics like oxytocics, tocolytics, anticonvulsants and diuretics are described along with their indications, dosages, side effects and contraindications. The placental transfer of drugs and their potential teratogenic effects on the fetus are also summarized.
1. Pharmacokinetics such as absorption, distribution, metabolism, and excretion differ in children compared to adults due to developmental differences. Renal blood flow, glomerular filtration, and tubular function are decreased in neonates and infants compared to older children and adults.
2. Drug administration and dosages in pediatric patients consider factors like age, weight, and surface area. Dosages are often calculated using Clark's and Young's rules. Common dosage forms for children include elixirs and suspensions.
3. Adherence to drug regimens can be challenging in pediatric patients and may involve careful measurement, administration supervision, and addressing issues like spilling or spitting out medication. Overall dos
1. The document discusses the transfer of drugs from a breastfeeding mother into breast milk and the potential effects on the nursing infant.
2. Key factors that determine the effect of drugs on the infant include the amount transferred into breast milk, how much milk the infant consumes, and the infant's ability to metabolize and excrete the drugs.
3. International health organizations provide classifications of drugs from most compatible with breastfeeding to contraindicated during breastfeeding due to risk of adverse effects in the infant. Physicians should consider risks and benefits when prescribing drugs to lactating mothers.
The document provides information on breastfeeding and lactation. It discusses:
- The benefits of breastfeeding for infant health and development as well as maternal health.
- The anatomy and physiology of lactation, including hormone changes during pregnancy and breastfeeding that stimulate milk production.
- The process of milk production, including the let-down reflex and suckling stimulating milk secretion.
- The composition and properties of colostrum, transitional milk, and mature breastmilk.
- The short-term and long-term health benefits of breastfeeding for infants and children.
Safety of Mebendazole Use During Lactationmothersafe
This case series study evaluated the safety of mebendazole use in 45 lactating women and their infants. Mebendazole was administered using single or repeated doses and was well tolerated by both the mothers and infants, with no adverse effects observed in infants. Mild GI irritability occurred in two treated mothers. This study provides the first evidence that mebendazole is safe for use in breastfeeding.
This document summarizes a study that examined the relationship between the drug domperidone, which is commonly used off-label to stimulate lactation, and the risk of ventricular arrhythmia and mortality during the postpartum period. The study used a retrospective cohort of over 225,000 women in British Columbia between 2002-2011. It found a possible doubling of the risk of hospitalization for ventricular arrhythmia among those exposed to domperidone, though the results were not statistically significant. Larger studies are needed to confirm any association.
This document summarizes key findings from several studies on exposures during pregnancy and lactation. The studies found:
- Teratogen information services receive thousands of calls annually regarding exposures to medications, infections, herbs and other substances during pregnancy and breastfeeding. The majority of calls concern analgesics, cold medications, herbs and dietary supplements.
- Most calls are made by exposed individuals themselves, highlighting a need for more education during prenatal care about risks of nonprescription drugs and vaccines.
- While some drugs used to treat autoimmune diseases like methotrexate and leflunomide can cause harm if taken during early pregnancy, others like sulfasalazine, azathioprine and antimalarials are
(마더리스크라운드) Thyroid disease in pregnancy 임신 중 갑상선mothersafe
This study examined pregnancy outcomes for women exposed to antithyroid medications or levothyroxine for thyroid disorders. The study found that infants of mothers treated for hyperthyroidism with antithyroid medications were more likely to be born preterm or with low birth weight. However, treatment of hypothyroidism with levothyroxine did not negatively impact birth outcomes and showed no increased risk of infant mortality. Additionally, the study found no evidence that levothyroxine exposure increased the risk of major congenital anomalies.
Diclectin in NVP, 44th 유럽기형학회보고 / 한정열 교수mothersafe
This document summarizes a presentation on making a difference as concerned scientists in an environmentally contaminated world. It discusses how scientists have identified problems like chemical pollution and investigated effects on human health. It provides examples like Rachel Carson's Silent Spring which brought attention to pesticide impacts and led to regulations. Endocrine disrupting chemicals can alter fetal development with impacts like reduced intelligence only appearing later. The document then summarizes several talks on topics like the impacts of maternal health conditions like diabetes and epilepsy during pregnancy, using the human placenta to test chemical safety, prenatal metal exposure and DNA methylation in the placenta, free fetal hemoglobin as a potential cause and target for preeclampsia, and revising guidelines
Maternal smoking during pregnancy was associated with an increased risk of major malformations in newborns. A study of over 2000 pregnancies found the risk of major malformations was 3.3 times higher for babies exposed to maternal smoking compared to non-exposed babies. Paternal smoking was also high among the smoking mothers, occurring in over 60% of smoking mothers compared to 38% of non-smoking mothers. Exposure to alcohol and lower education levels were also associated with increased risk of maternal smoking during pregnancy.
This document summarizes guidelines and studies on screening and management of subclinical hypothyroidism during pregnancy. Key points include:
- Guidelines from thyroid societies recommend trimester-specific reference ranges for TSH and treatment of SCH with levothyroxine.
- Studies show mixed results on associations between SCH and adverse pregnancy/child outcomes, and limited benefits of levothyroxine treatment.
- Targeted high-risk screening misses a significant percentage of women with thyroid dysfunction compared to universal screening.
- While evidence is still limited, most experts recommend universal screening to detect and treat overt hypothyroidism given potential benefits.
This document provides information about external cephalic version (ECV):
1. ECV is a procedure performed near term to manually turn a breech baby into a head-down position. The success rate of ECV is reported between 35-86%.
2. ECV has been performed since ancient times but was improved in the 1970s by performing it under tocolysis after screening with ultrasound and fetal monitoring. Recent studies show ECV effectively reduces non-cephalic births and C-sections for malpresentation.
3. Guidelines from obstetric organizations recommend offering ECV to women with a breech fetus near term due to evidence it can reduce C-sections. Factors like adequate amni
1. Proper management of diabetes before and during pregnancy is important to reduce risks of complications. Tight glucose control through medical nutrition therapy, exercise, and insulin treatment can decrease risks of fetal anomalies and growth issues.
2. Gestational diabetes is diagnosed through an oral glucose tolerance test and treated with lifestyle changes and possibly insulin to control blood glucose. Women with a history of GDM require follow up after pregnancy to screen for diabetes.
3. Preconception counseling and care is crucial for women with pre-existing diabetes to optimize health before pregnancy in order to lower risks during pregnancy through strict glucose monitoring and management.
This document discusses alcohol intake during pregnancy and fetal alcohol spectrum disorders (FASD). It provides statistics on alcohol use during pregnancy from various studies. It notes that a safe level of alcohol during pregnancy has not been determined, as the effects of alcohol on the fetus are variable depending on factors like the mother's metabolism and drinking patterns. Low to moderate prenatal alcohol exposure has not shown effects in some studies, but other research has found children with FAS even with reported low alcohol intake. The document describes clinical features of FASD including facial abnormalities, growth issues, central nervous system anomalies, and functional impairments. It discusses diagnostic criteria from various organizations and guidelines for diagnosing FASD.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Advice on infant feeding
• Breast milk is the best form of nutrition for infants.
• Exclusive breastfeeding for the first 6 months.
• Breastfeeding (and/or formula milk) with appropriate solid food after 6 months, ideally for
up to 1 year.
3.
4. Medication and breastfeeding
• Breast-feeding has many benefits.
• Potential harm to the nursing infant from maternal drugs is a reason to discontinue breast-
feeding.
• Physicians receive little education about breast-feeding and even less training on the effects
of maternal drugs on the nursing infant.
6. A ducts
B lobules
C dilated section of duct to hold mi
lk
D nipple
E fat
F pectoralis major muscle
G chest wall/rib cage
Enlargement:
A normal duct cells
B basement membrane
C lumen (center of duct)
7. Methods of drug transfer into milk
• Passive diffusion
• Active transport against a concentration gradient
• Transcellular diffusion
8. • Diffusion
– Plasma levels in the mother
– Lipid solubility of the drug and fat content of milk
– Milk ph
– Molecular size of the drug
– Protein binding of the drug in mother’s plasma
– Maternal half-life of the drug
– Molecular weight of drug
– Bioavailability of the medication to the infant
9. Transfer of dugs into Breast Milk
• Nearly all drugs transfer into breast milk to some extent.
• Notable exceptions are heparin and insulin {too large to cross biological membranes}.
• Drug transfer from maternal plasma to milk is, with rare exceptions, by passive diffusion
across biological membranes.
• Almost all medication appears in small amounts, usually less than 1% of the maternal dose
• Very few drugs are contraindicated for nursing mothers
10. The effect of drugs on the nursing infant depends on
• Transfer of drug into Breast Milk
• The amount of breast milk consumed by the infant.
• The pharmacologic activity of the drug: absorption, distribution, metabolism and elimination
by the infant.
• Condition of the infant:
• Greater precaution for infants
– premature or
– compromised or
– in the first week of life than for older, healthy infants.
11. Route of drugs from mother to baby via breastmilk
Drug Oral bioavailability varies
High (>90%) Low (<50%)
Acetaminopen Acyclovir
Lorazepam Azithromycin
Maternal gut and liver Metronidazole Budesonide
Minoxidil Sulfasalazine
Maternal plasma Dilution of all drugs leads to low
concentrations in mother’s plasma
Only drugs are not protein-bound
can pass into milk
Drug protein binding
High Low
Bepridil >99% Bisoprolol 30%
Diazepam 99% Cyclophosphamide 13%
Diclofenac >99% Ranitidine 15%
Propranolol 90% Primidone <20%
Oral bioavailiability varies Infant gut
Usually very low levels
(often undetectable) Infant plasma
12.
13. Drug therapy during lactation
• Drugs that passes minimally into milk:
– Acid drug
– Highly protein bound drug
– E.g NSAID
Blood Milk – Weekly basic drug with low plasma
protein binding and highly lipophilic
Protein 19% 2.5% will achieve higher concentration in
Lipid 1% 4.5% milk
– E.g. sotalol.
pH 7.4 7.2(6.8-7.6)
14. Factors affecting drug transfer
• The maternal serum drug concentration.
• Drugs:
– pKa of drug (fraction of drug that is ionized at a given pH)
• Basic drugs -> ionized at acidic pH(low pH) -> trapped in milk
• Acidic drug ionized at higher pH -> trapped in maternal plasma
– Protein binding (highly protein bound drug -> less transfer to milk)
– Lipipophilicity: (high lipophilic drugs-> more drug in milk).
– Molecular weight of drug: high MW -> less drug in milk (insulin, heparin do not enter
breast milk)
15. Factors determining drug concentration in milk
• Milk composition
– Milk at the end of a feed (hindmilk) contains considerably more fat than foremilk and
may concentrate fat-soluble drugs.
• Age of infant:
• In the early postpartum period, large gaps between the mammary alveolar cells allow
many dugs to pass. These gaps close by the 2nd week of lactation.
• Premature babies & infants less than 1 month have a different capacity to absorb and
excrete drugs than older infants.
• Nursing time of baby.
• Milk to plasma concentration(M/P) ratio: for most drug M/P ratio is <1 (drugs with higher
M/P ratio (e.g. 5) are unsafe)
16. Estimating risk to infant
• Milk to plasma concentration (M/P) ratio:
• If M/P ratio of a drug is known
• Amount (dose) of drug ingested by infant can be calculated by
• Dinfant = Cpmat x M/P x Vmax
• Cpmat: average maternal plasma concentration
• Vmax: volume of milk which is assumed to be 150ml
• For most drug, an exposure <10% of weight adjusted maternal dose is acceptable.
17. Calculation of infant exposure to drugs
• The infant dose (mg/kg)
– D infant (mg/kg/day)= C maternal (mg/L) x M/PAUC x V infant (L/kg/day)
Cmaternal= maternal plasma concentration
M/PAUC ratio = milk to plasma concentration ratio area under curve.
Vinfant= volume of milk ingested
• As a percentage of the maternal dose (mg/kg). The volume of milk ingested by infants is
commonly estimated as 0.15 L/kg/day.
An arbitrary cut-off of 10% has been selected as a guide to the safe use of drugs during
lactation.
18. How much of the medicine reaches the baby?
Depends on:
• Blood level of medicine in the mother.
• Characteristics of the medicine.
• Amount of medicine passed into breast milk.
• Amount of milk taken by baby per feed (approx 150mL/kg).
19. Methods of decreasing toxicity in nursing infant
• Select safe drug
• Nurse immediately before taking drug.
• Take drug 3-4 hours before next feeding
• Avoid feeding when drug reaches peak concentration in milk and plasma
• Use drug with short half life
• Instruct patient to monitor ADRs
20. General advice
• Avoid unnecessary use of medicines.
• Assess risk / benefit for mother and baby.
• Higher risk for premature babies.
• Check if medicine licensed for babies.
• Avoid long-acting medicines
• Avoid new medicines.
• Try to time feed to avoid when drug levels in milk are highest.
• Monitor baby for adverse effects.
21. Essential questions to ask
• Has mum already taken the medicine(s) or is she wanting to take?
• Medicine(s), indication, dose, frequency, route & duration of exposure?
• Has this been prescribed or self-treating?
• Have any other medicines been considered or tried?
• What age is the baby? Full term & healthy?
• How often is baby feeding? – Totally breast fed or bottle too?
22. WHO classification of drugs during breastfeeding (2002)
• 1. Compatible with breastfeeding
• 2. Compatible with breastfeeding {occasional mild side effects} Monitor infant for side
effects
• 3. Avoid if possible. {significant side effects} Monitor infant for side-effects
• 4. Avoid if possible. {May inhibit lactation}. Monitor for amount of milk
• 5. Contraindicated {dangerous side effects}
23. Compatible with breastfeeding
• There are no known or theoretical contraindications for their use, and it is considered safe for
the mother to take the drug and continue to breastfeed.
24. Compatible with breastfeeding {Occasional mild side-effects}
Monitor infant for side-effects
• If side-effects:
– stop the drug, and
– find an alternative.
• If the mother cannot stop the drug, she may need to stop breastfeeding and feed her baby
artificially until her treatment is completed.
25. Avoid if possible {significant side effects}
Monitor infant for side-effect
26. Avoid if possible {May inhibit lactation}
• However, if a mother has to take one of these drugs for a short period, she does
not need to give artificial milk to her baby. She can off set the possible decrease
in milk production by encouraging her baby to suckle more frequently.
– Estrogen
– COC
– Ergometrin
– Thiazides
27. Contraindicated {Dangerous side-effects}.
• If they are essential:
• stop breast feeding until treatment is completed.
• If treatment is prolonged, she may need to stop breastfeeding altogether.
• There are very few drugs in this category apart from anticancer drugs and radioactive
substances.
28.
29.
30. LACTATION RISK CATEGORY
BY THOMAS W HALE
• L1 safest
• L2 safer
• L3 moderately safe
• L4 possibly hazardous
• L5 contraindicated
31. DRUG CLASSIFICATION BY AAP
• Cytotoxic drugs
• Drugs of abuse for which adverse effects on the infant
• Radioactive compounds that require temporary cessation of breastfeeding
• Drugs for which the effect on nursing infants in unknown but may be concern
• Drugs that have been associated with significant effects on some nursing infants and should
be given to nursing mothers with caution
• Maternal medication usually compatible with breastfeeding
33. Before prescribing drugs to lactating women
• Is drug really necessary? If drugs are required, consultation between the pediatrician and the
mother’s physician can be most useful in determining what options to choose.
• The safest drug should be chosen e.g. acetaminophen rather than aspirin for analgesia.
• If there is a possibility that a drug may present a risk to the infant, consideration should be
given to measurement of blood concentrations in the nursing infant.
• Drug exposure to the nursing infant may be minimized
34. Medication selection
• Choose medications with the shortest half-life and highest protein-binding ability.
• Choose medications that are well-studied in infants.
• Choose medications with the poorest oral absorption.
• Choose medications with the lowest lipid solubility.
• Use topical therapy when possible.
• Drugs that are safe for the nursing infant’s age are generally safe for the breast-
feeding mother.
• Drugs that are safe in pregnancy are not always safe in breast-feeding mothers
{nursing infant must independently metabolize and excrete the medication}.
35. Medication dosing
• Administer single daily-dose drugs just before the longest sleep interval for the infant, usually
after the bed-time feeding.
• Breast-feed infant immediately before medication dose when multiple daily doses are needed
36. Common drugs excreted in breast milk
• Most antibiotics taken by nursing mothers can be detected in breast milk
• Tetracycline concentrations in breast milk is 70% of maternal serum concentrations and
present a risk of permanent tooth staining in infant
• Isonized rapidly reaches equilibrium between breast milk and maternal blood. So that signs of
pyridoxine deficiency may occur in the infant if the mother is not given pyridoxine
supplements.
• Most sedatives and hypnotics enters breast milk sufficient to produce a pharmacologic effect
in infants.
• Barbiturates taken in hypnotic doses by mother can produce lethargy, sedation, and poor suck
reflexes in infant.
37. • Chloral hydrate can produce sedation if infant is fed at peak milk concentrations.
• Diazepam can have a sedative effect on the nursing infant
• Lithium enters breast milk in concentrations equal to those in maternal serum
• Radioiodine can cause thyroid suppression
• Breast-feeding is contraindicated after large doses of radioiodine and should be withheld for
days to weeks after small doses.
38. • Breast-feeding should be avoided in mothers receiving cancer chemotherapy
• Opioids such as heroin, methadone, and morphine enter breast milk (neonatal narcotic
dependence).
• Very small amounts of caffeine are excreted in the breast milk of coffee-drinking mothers.
39. 상담 시 주지 사항 및 상담내용
• 약을 꼭 복용해야 하는지 평가한다.
• 젖을 빨리고 난 다음 약을 복용한다.
• 약물을 단기간 사용 할 경우에는 수유를 잠시 멈춘다.
• 정확한 정보가 있는 약으로 아이에게 영향이 적은 약을 선택하게 한다.
• 전신적으로 작용하는 약보다는 국소적으로 작용하는 약을 선택하게 한다.