IBCLC Exam: Research, Medications and Breast Milk Exam questions and answers 2024 already graded A+

maternal plasma concentration main driver of milk concentration of drug as level in blood falls, drug diffuses out of milk back into blood molecular weight of drug drug 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 most 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 higher lipid solubility means more drug in milk CNS drugs tend to have higher lipid solubility - antidepressants, anti-anxiety medication in colostrum paracellular 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 shorter 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) half lives until drug eliminated usually 5 features of safer meds for bf low maternal plasma concentration short half life low lipid solubility high protein binding (>90%) high molecular weight (>800 Da) Oral bioavailability if the drug enters the milk and infant swallows, how much survives the GI tract and enters infant blood? ex. insulin and Gentamicin have poor bioavailability so are given thru IV or parenterally. Relative infant dose (RID) Dose infant receives as % of maternal dose Most drugs are <10% which is considered relatively safe ex. ampicillin is 0.2-0.5% gentamicin is 2.1% magnesium sulfate is 0.2% milk/plasma ratio [milk]/[maternal plasma] <1 preferred 1-5 concerning, drug may sequester in milk at high levels pH and drugs lower pH or pKa is safer pKa >7.2 means more ion trapping when a drug has more ionic form is is less capable of moving back to the plasma and may be sequestered in milk L levels of drugs L1 - compatible with bf L2 - probably compatible L3 - probably compatible - less studied than L2; new drugs all L3 until studied L4 - potentially hazardous - some evidence of risk, may be necessary for maternal health L5 - contraindicated in bf mother drugs usually imcompatible with bf chemotherapy radioactive drugs like iodine (not including contrast for scans) chloramphenicol is L4 abx null hypothesis the hypothesis that there is no significant difference between specified populations, any observed difference being due to sampling or experimental error. p-value The probability level which forms basis for deciding if results are statistically significant (not due to chance). P >0.05 (or 5%) is considered statistically significant and null hypothesis would be rejected systematic review summarized findings from multiple studies of a specific clinical practice question or topic that recommend practice changes and future directions for research; one of the strongest sources of evidence for evidence-based practice meta-analysis a procedure for statistically combining the results of many different research studies as if they were one big study Randomized Controlled Trial (RCT) An experimental study in which researchers randomly assign individuals to either an experimental or a control group and expose the experimental group to the manipulated variable of interest. cohort study study that measures variables of a group of people over time - often years type of longitudinal study Case-control study A type of epidemiologic study where a group of individuals with the diseases, referred to as cases, are compared to individuals without the disease, referred to as controls cross-sectional study research that compares people across a population at the same point in time case report a detailed description of the management of a single patient/client that may serve as a basis for future research - often unusual cases Nominal Data data of categories only. Data cannot be arranged in an ordering scheme. (Gender, Race, Religion) ordinal data A statistical data type that exists on an arbitrary numerical scale where the exact numerical value has no significance other than to rank a set of data points. Deals with the order or position of items such as words,