IBCLC Exam Pathology, Medications, and Vaccines

Includes galactogogues as "medications"

Fenugreek

Galactogogue L3. Side affects include bleeding, hypoglycemia, maple syrup odor to sweat and urine. Those who are allergic to soybeans, chickpeas, and peanuts may be allergic to this

Statins

Drugs that lower high cholesterol and can be contraindicated with breastfeeding

Vancomycin

Antibiotic with poor bioavailability. Considered safe

Tuberculosis

A bacterial infection. Safe to give mother’s pumped milk if mother and baby have started treatments. If mother was already being treated prior to and after birth it is safe to breastfeed.

MRSA

Candidiasis

Diabetes

PKU

Galactosemia

Yellow fever vaccine

Pyloric stenosis

GERD

Famotidine

Gastric acid secretion inhibitor. L1

Metronidazole/Flagyl

Antibiotic L2

Dioxin

A persistent chemical contaminant in the environment

Fentanyl

Opiate analgesic L2. Used during labor and delivery

Affects of alcohol on lactation

Can inhibit milk ejection. Lactation delayed 2 hours for every drink consumed

Aspirin

Salicylate analgesic L3. Use associated with causing Reye’s syndrome in infants

Milk:plasma ratio

Quantity of a drug in human milk in relation to maternal plasma. If M/P ratio is >1 the drug is found in greater quantities in milk than plasma

Progestin only birth control pills

Hormonal birth control that doesn’t contain estrogen. Not likely to decrease milk production after 6 weeks

Bactrim/Septra

Sulfonamide antibiotic L3. Use with caution in preterm or jaundiced infants

Echinacea

Herbal immunostimulant L3

Ciprofloxacin

Antibiotic L3

Fluconazole

Antifungal L2. Safe

Gentian violet

Purple dye with antifungal properties. L3

Insulin

Hormone L1. Too large a molecule to enter BM

Goat’s Rue

An herbal galactogogue. Chemically similar to metformin

Warfarin and Heparin

Antiplatelet and anticoagulant therapies compatible with lactation

pKa

Ph of a drug when equally ionic and nonionic. Drugs with pKa higher than 7.2 may be sequestered in breastmilk

Acyclovir

Antiviral used to treat herpes L2

Fluoxetine

Antidepressant. L2

Sertraline

Antidepressant L2. Short half life

Nicotine

Chemical in cigarette smoke L2

Benzodiazepine

Sedative generally discouraged in lactation

Lorazepam and Oxazepam

Benzos that are preferred in lactation

Pseudoephedrine

Decongestant L3. Can reduce milk supply

Comfrey

Herbal poultice L5

Isoniazid

Anti TB drug L3. Compatible with lactation

St John’s Wort

Herbal antidepressant L3

Cephalexin/ Keflex

Antibiotic L1

Chamomile

Herb L3. Anti-inflammatory and antiseptic properties

Aldomet/Methyldopa

Antihypertensive L2

Protein binding

Percentage of a drug bound to maternal plasma. High ___ means less in breastmilk

Loratadine

Antihistamine L1

Metformin/glucophage

Antidiabetic agent L1. Can also be used to treat PCOS

Heroin

Narcotic L5

Bioavailability

The amount of a drug that reaches systemic circulation after administration

Half life

Length of time for a drug to be eliminated

Amoxicillin

Antibiotic L1

Molecular weight

The chemical size of a molecule of a drug. Medications with __ under 200 daltons pass easily into milk. Medications under 800 daltons are less likely to pass into BM

Selective serotonin reuptake inhibitor

Class of antidepressants that inhibit the inactivation of serotonin by blocking its reuptake

Prednisone

Steroid L2

Ampicillin

Antibiotic L1

Blessed thistle

Herbal galactogogue L3

IUD

Birth control device. Non hormone types have been shown to have no effect on lactation.

Domperidone

Drug used off label to induce lactation. Inhibits the release of dopamine

Metoclopramide

Drug used off label to induce lactation. Inhibits the release of dopamine. May cause depression

Ebola

Viral infection that contraindicates breastfeeding and feeding of mother’s milk

HIV

Human immunodeficiency virus. Safe to breastfeed if mother is on ART and achieved viral suppression

HTLV

Sexually transmitted infection. Not safe to breastfeed.