IBCLC EXAM- PHARMACOLOGY AND
TOXICOLOGY QUESTIONS AND
ANSWERS WITH COMPLETE
SOLUTIONS !!!
What are galactagogues (or lactagogues)?
✔✔ Answer: Medications or substances believed to help start, maintain, or
increase milk production in lactating parents
Why are galactagogues used?
✔✔ Answer:
To increase low or perceived low milk supply
To support milk production in mothers of preterm infants
To help maintain milk production for mothers expressing milk by hand or
pump
To assist with induced lactation, relactation after weaning, or lactation in
transgender women
What are the most commonly used pharmaceutical galactagogues today?
✔✔ Answer: Domperidone and Metoclopramide
✔✔ Both work as dopamine antagonists that increase prolactin secretion.
What are some other commonly used galactagogues?
✔✔ Answer: Fenugreek and Silymarin
Herbals, Foods, and Beverages as Galactogogues -ANSWER ✔✔fenugreek, goat's
rue, milk thistle (Silybum marianum), oats, dandelion, millet, seaweed, anise, basil,
blessed thistle, fennel seeds, marshmallow, moringa leaf, shatavari, and torbangun
among others
,Galactogogues- evidence and risks -ANSWER ✔✔While the fact that these herbs
have been used for centuries without apparent harm is reassuring, there is also little
or no scientific evidence for their effectiveness or safety.
It is important to note that caution is required for the use of herbal preparations
because of the lack of standardized dosing preparations (other than in research
settings), possible contaminants, allergic potential, and drug interactions
Practice Recommendations for low milk supply -ANSWER ✔✔1. Evaluate the
mother for medical causes of low milk supply
2. Assess and increase the frequency and effectiveness of milk removal.
3. ABM cannot recommend any specific galactogogue at this time.
4. If the healthcare provider chooses to prescribe a galactogogue after weighing
potential risks versus potential benefits of these agents, they should follow the
guidelines below.
a. Inform women about available data concerning efficacy, timing of use, and
duration of therapy, potential adverse effects of galactogogues.
-Screen the mother for contraindications to, allergies to, or drug interactions with
the chosen medication or other substance.
medical causes of low milk supply: -ANSWER ✔✔pregnancy, medications,
primary mammary glandular insufficiency, breast surgery, polycystic ovarian
syndrome, hypothyroidism, retained placenta, ingestion of placenta capsules, theca
lutein cyst, loss of prolactin secretion following postpartum hemorrhage, heavy
smoking or alcohol use, or other pertinent conditions.
Modifiable factors to address: -ANSWER ✔✔maternal anxiety and mental health
issues, comfort and relaxation for the mother, frequency and effectiveness of milk
removal, and any underlying medical conditions.
, Medication should never replace evaluation and counseling on modifiable factors.
Illicit drug use and legal substance use/abuse -ANSWER ✔✔signify risk for the
breastfed infant, in addition to the drug exposure
Drug users are at high risk for infections such as human immunodeficiency virus
and/or hepatitis B and C.
Psychiatric disorders that require pharmacotherapeutic intervention are more
prevalent with substance use, as breastfeeding may not be recommended for
women taking some psychotropic medications.
drug-exposed infants, who are at a high risk for an array of medical, psychological,
and developmental issues, as well as their mothers, stand to benefit significantly
from breastfeeding.
Should mothers exposed to drugs and alcohol breastfeed? -ANSWER
✔✔Although many of the factors listed above may pose a risk to the infant, the
documented benefits of human milk and breastfeeding must be carefully and
thoughtfully weighed against the risks associated with the substance that the infant
may be exposed to during lactation
research on individual drugs of abuse remains lacking and difficult to perform
Do elicit drugs transfer to breastmilk? -ANSWER ✔✔Most illicit drugs are found
in human milk, with varying degrees of oral bioavailability
Effects of marijuana -ANSWER ✔✔plays a crucial role in the ontogeny of the
central nervous system and its activation, during brain development.
TOXICOLOGY QUESTIONS AND
ANSWERS WITH COMPLETE
SOLUTIONS !!!
What are galactagogues (or lactagogues)?
✔✔ Answer: Medications or substances believed to help start, maintain, or
increase milk production in lactating parents
Why are galactagogues used?
✔✔ Answer:
To increase low or perceived low milk supply
To support milk production in mothers of preterm infants
To help maintain milk production for mothers expressing milk by hand or
pump
To assist with induced lactation, relactation after weaning, or lactation in
transgender women
What are the most commonly used pharmaceutical galactagogues today?
✔✔ Answer: Domperidone and Metoclopramide
✔✔ Both work as dopamine antagonists that increase prolactin secretion.
What are some other commonly used galactagogues?
✔✔ Answer: Fenugreek and Silymarin
Herbals, Foods, and Beverages as Galactogogues -ANSWER ✔✔fenugreek, goat's
rue, milk thistle (Silybum marianum), oats, dandelion, millet, seaweed, anise, basil,
blessed thistle, fennel seeds, marshmallow, moringa leaf, shatavari, and torbangun
among others
,Galactogogues- evidence and risks -ANSWER ✔✔While the fact that these herbs
have been used for centuries without apparent harm is reassuring, there is also little
or no scientific evidence for their effectiveness or safety.
It is important to note that caution is required for the use of herbal preparations
because of the lack of standardized dosing preparations (other than in research
settings), possible contaminants, allergic potential, and drug interactions
Practice Recommendations for low milk supply -ANSWER ✔✔1. Evaluate the
mother for medical causes of low milk supply
2. Assess and increase the frequency and effectiveness of milk removal.
3. ABM cannot recommend any specific galactogogue at this time.
4. If the healthcare provider chooses to prescribe a galactogogue after weighing
potential risks versus potential benefits of these agents, they should follow the
guidelines below.
a. Inform women about available data concerning efficacy, timing of use, and
duration of therapy, potential adverse effects of galactogogues.
-Screen the mother for contraindications to, allergies to, or drug interactions with
the chosen medication or other substance.
medical causes of low milk supply: -ANSWER ✔✔pregnancy, medications,
primary mammary glandular insufficiency, breast surgery, polycystic ovarian
syndrome, hypothyroidism, retained placenta, ingestion of placenta capsules, theca
lutein cyst, loss of prolactin secretion following postpartum hemorrhage, heavy
smoking or alcohol use, or other pertinent conditions.
Modifiable factors to address: -ANSWER ✔✔maternal anxiety and mental health
issues, comfort and relaxation for the mother, frequency and effectiveness of milk
removal, and any underlying medical conditions.
, Medication should never replace evaluation and counseling on modifiable factors.
Illicit drug use and legal substance use/abuse -ANSWER ✔✔signify risk for the
breastfed infant, in addition to the drug exposure
Drug users are at high risk for infections such as human immunodeficiency virus
and/or hepatitis B and C.
Psychiatric disorders that require pharmacotherapeutic intervention are more
prevalent with substance use, as breastfeeding may not be recommended for
women taking some psychotropic medications.
drug-exposed infants, who are at a high risk for an array of medical, psychological,
and developmental issues, as well as their mothers, stand to benefit significantly
from breastfeeding.
Should mothers exposed to drugs and alcohol breastfeed? -ANSWER
✔✔Although many of the factors listed above may pose a risk to the infant, the
documented benefits of human milk and breastfeeding must be carefully and
thoughtfully weighed against the risks associated with the substance that the infant
may be exposed to during lactation
research on individual drugs of abuse remains lacking and difficult to perform
Do elicit drugs transfer to breastmilk? -ANSWER ✔✔Most illicit drugs are found
in human milk, with varying degrees of oral bioavailability
Effects of marijuana -ANSWER ✔✔plays a crucial role in the ontogeny of the
central nervous system and its activation, during brain development.
