- •Cardiotocography
- •Ultrasound examination
- •Self control questions.
- •3.5.2. Self control tests.
- •Gestosis
- •Oligoamnios
- •Anemia
- •Hydramnion
- •1. Recognize factors which determine drug passage across the placenta and into breast milk.
- •2. Identify aspects of medications that determine safety during lactation.
- •• A substance, organism, physical agents or deficiency state capable of inducing abnormal structure or function such as:
- •• Timing of exposure
- •• Developmental stage during exposure
- •• Maternal dose and duration
- •• Maternal pharmacokinetics
- •IV. FDA Pregnancy Categories
- •V. FDA Pregnancy Categories
- •VI. FDA Labeling Changes
- •VII. Drug Transfer to the Fetus
- •VIII. Drug Passage into Breast Milk
- •IX. Drug Transfer
- •XI. Fetal Drug Disposition
- •• 60 – 80% passes through liver, the rest travels through ductus venosus to heart and brain
- •XII. Drug Concentration in Breast Milk
- •XIII. Calculating Drug Exposure
- •Infant dose/maternal dose using mg/kg/d
- •XIV. Neonatal Factors
- •XV. Infant Adverse Effects
- •XVI. Anti-infectives
- •XVII. Penicillins
- •XVIII. Cephalosporins
- •• Category B/C/B in pregnancy
- •XXIII. Sulfonamides
- •XXV. Miscellaneous Antibiotics
- •XXVI. Miscellaneous Antibiotics
- •XXVII. Miscellaneous Antibiotics
- •XXVIII. Miscellaneous Antibiotics
- •Antiretrovirals/NNRTI (delavirdine, efavirenz, nevirapine)
- •Antiretrovirals/PI
- •Antiretrovirals/Fusion Inhibitor (enfuvirtide)
- •Antiretroviral Combinations
- •Antifungals/Echinocandins (anidulofungin, caspofungin, micafungin)
- •Antifungals/Polyenes
- •XXXII. Migraine Headache Therapy
- •Triptans (5-HT1 agonists)
- •Triptans (5-HT1 agonists)
- •Butalbital and Caffeine
- •Dichloralphenazone and Isometheptene (Midrin)
- •Questions to Ask:
- •Questions to Ask:
- •Considerations in Breastfeeding:
- •• Withhold or delay therapy if possible
•Hepatic drug metabolism
•Adrenal gland metabolism
•Recirculation through amniotic fluid
XII. Drug Concentration in Breast Milk
•Lower pH than serum
•Varying degrees of fat concentrations
–Foremilk
–Hindmilk
•Milk/Plasma ratio
XIII. Calculating Drug Exposure
•
•
•
•
Milk consumption – 150 ml/kg/d
Milk concentration – either Cpmax or random sample Maximum exposure will be at Cpmax
Relative infant dose - < 10% better
Infant dose/maternal dose using mg/kg/d
XIV. Neonatal Factors
•Volume of milk consumed
•Higher gastric pH
•Differences in GI flora
•GI transit time
•Higher concentrations of free drug
•Higher percentage of body water
•Lower rates of metabolism and excretion
XV. Infant Adverse Effects
•GI – diarrhea, constipation, vomiting, feeding intolerance, hypoglycemia
•CNS – lethargy, sedation, poor suckling, muscle hypotonia, tremors, restlessness, withdrawal upon discontinuation
•Other – possible sensitization or allergic reaction, culture results if needed may be difficult to interpret