Medications may be prescribed at any point in a person's life. Different medications will have different effects at different stages of one's life. Each student allocated into this group should discuss a particular therapeutic agent (or a class of agents) and determine its (their) appropriateness for breastfeeding women. Consider your area of practice and select a class of medication that you commonly encounter. You will need to discuss the reasons for your determination that the medication is or is not appropriate. You may find that within a class, there are medications which are appropriate and ones which are not; or alternatively it could be a class effect where all agents within that class are appropriate or are not. If your medication is not appropriate, is there a suitable alternative therapeutic class of medication? If it is appropriate, why is it a more appropriate choice than other therapeutically similar medications?Following is only an example from my friend, you have to do it differently,
Example: (Don’t copy this)
Consider your area of practice and select a class of medication that you commonly encounter.
One of the very common classes of medication I come across in my practice is Anti hypertensives. Treatment of hypertension is most important to prevent the risk of coronary heart disease, stroke, congestive heart failure, end-stage renal disease, and peripheral vascular disease. Heart Foundation Australia (2008) recommend the following drugs; ACE inhibitors OR angiotensin II receptor antagonists • dihydropyridine calcium channel blockers • low-dose thiazide diuretics (for patients aged 65 years and older) for first line treatment in uncomplicated hypertension, both in initial and maintenance therapy.
Discuss the reasons for your determination that the medication is or is not appropriate for breast-feeding mothers.
Not many studies conducted in relation to the compatibility of antihypertensive drugs and breastfeeding. There is insufficient evidence to ascertain the safety of angiotensin ii receptor antagonists, thiazide diuretics and calcium channel blockers during lactation. Determining the risk –benefit ratio of a mothers antihypertensive medication for an infant require careful consideration of all advantages and the risk of medication to the given child (Schaefer et al 2007).
Antihypertensive drugs cross into breast milk through passive diffusion and the drug concentrations in breast milk depend on maternal serum concentration of the given drug. (Spencer, J.P.,Gonzalez.L.S.,& Barnhart.D.J.(2001).Medication that are highly protein bound, that have large molecular weights or that are poorly lipid-soluble tend not to enter the breast milk in clinically important quantities. ACE Inhibitors have a small molecular size and so their transfer to breast milk is possible. Data on the use of ACE inhibitors in breastfeeding are sparse and relate mostly to captopril, enalapril, and quinapril; findings indicate that drug is transferred to breast milk. The infant’s drug exposure depends on factors such as the drug’s concentration in the breast milk, the amount of breast milk consumed by the infant, age and maturity of the infants liver and kidneys to metabolize and excrete the medicine from its system. In case of premature and neonates, inability or delays in metabolism, elimination of the drugs can result in accumulation and toxicity. (Schaefer et al 2007).
If your medication is not appropriate, is there a suitable alternative therapeutic class of medication? If it is appropriate, why is it a more appropriate choice than other therapeutically similar medications?
Beta Blockers Preferred Beta Blockers during breast-feeding include propranolol, labetalol and metoprolol. Other B Blockers, example atenolol, sotalol have low protein binding and excreted in high amount in milk, which can lead to hypotension, bradycardia and tachypnea in infants therefore not recommended for breast feeding mothers. (Donovan.P.2012)
Calcium channel Blockers- Nifedipine is the only safe calcium channel blocker during breast-feeding. With Verapamil and Diltiazem due to limited data related to safety, safer alternatives are preferred (Donovan.P.2012)
Angiotensin Converting enzyme inhibitors (ACEI)- With most amount of data available on breast-feeding, Captopril and Enalapril are the safest ACEIs in breast-feeding women. However they are not recommended during the first few weeks of delivery due to its profound effect on neonatal hypotension particularly premature babies be at risk of renal toxicity. Exposed neonates should be carefully monitored for hypotension (Spencer, J.P.,Gonzalez.L.S.,& Barnhart.D.J.(2001).
Methyldopa - Methyldopa is one of the preferred antihypertensive in breastfeeding women; low levels of methyldopa are found in breastfed infants and are not expected to cause adverse effects (Donovan .P. 2012