IBCLC Exam: Research, Medications and Breast Milk Questions & Answers 2024/25

IBCLC Exam: Research, Medications and Breast Milk Questions & Answers 2024/25 maternal plasma concentration - ANSWERSmain driver of milk concentration of drug as level in blood falls, drug diffuses out of milk back into blood molecular weight of drug - ANSWERSdrug over 800 Daltons doesn't pass into milk easily ex. insulin is 6000 Da heparin is 40,000 Da alcohol 200 Da caffeine 194 Da protein binding of drugs - ANSWERSmost drugs pass into milk while bound to albumin some drugs are highly (90%) protein bound to other proteins and don't easily pass into milk ex. ibuprofen, warfarin, diazepam, propanolol but lithium is 0% and passes into milk lipid solubility of drugs - ANSWERShigher lipid solubility means more drug in milk CNS drugs tend to have higher lipid solubility - antidepressants, anti-anxiety medication in colostrum - ANSWERSparacellular pathway is open - gaps between cells so more drug enters milk but total dose is small as volume of colostrum is small half life of drug - ANSWERSshorter half lives are preferred as they leave the milk sooner - can be taken right after a feed to maximize the short half-life and reduce exposure to infant ex. ibuprofen - 120 mins, alcohol - 24 mins, fluoxetine (2-3 days)