Lactation is a complex physiological process that provides critical nutrition and immunological protection to the infant. For pharmacists, a thorough understanding of lactation is vital for providing accurate counseling on medication safety during breastfeeding, managing common lactation-related challenges, and supporting parents in their infant feeding goals. This quiz covers key aspects of lactation physiology, pharmacology, and clinical management relevant to the practice of pharmacy.
1. Which two hormones are the primary drivers of milk production and milk ejection (let-down), respectively?
- Estrogen and Progesterone
- Prolactin and Oxytocin
- Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH)
- Testosterone and Cortisol
Answer: Prolactin and Oxytocin
2. The principle of “supply and demand” in lactation means that milk production is primarily driven by:
- The mother’s fluid intake
- The time of day
- Frequent and effective removal of milk from the breast
- The mother’s pre-pregnancy weight
Answer: Frequent and effective removal of milk from the breast
3. A drug’s passage into breast milk is generally increased if the drug has which of the following characteristics?
- High molecular weight
- High protein binding
- Low lipid solubility
- Low molecular weight and low protein binding
Answer: Low molecular weight and low protein binding
4. A common cause of sore nipples in the early days of breastfeeding is:
- An oversupply of milk
- A poor or shallow latch
- The baby being too old
- Using a breast pump
Answer: A poor or shallow latch
5. Mastitis is an inflammation of the breast tissue. What is the most common causative organism in infectious mastitis?
- Escherichia coli
- Staphylococcus aureus
- Streptococcus pneumoniae
- Candida albicans
Answer: Staphylococcus aureus
6. Which of the following pain relievers is generally considered the safest first-line option for a breastfeeding mother?
- Aspirin
- Codeine
- Ibuprofen or Acetaminophen
- Hydrocodone
Answer: Ibuprofen or Acetaminophen
7. A medication’s “Relative Infant Dose” (RID) is a calculation used to estimate:
- The therapeutic dose of the drug for an infant
- The percentage of the maternal dose that the infant receives through breast milk
- The milk-to-plasma concentration ratio
- The time it takes for the drug to be eliminated from breast milk
Answer: The percentage of the maternal dose that the infant receives through breast milk
8. Which of the following contraceptive methods is most preferred for a breastfeeding mother in the immediate postpartum period?
- Combined oral contraceptives (COCs)
- Progestin-only methods (e.g., mini-pill, depot injection)
- Transdermal patch
- Vaginal ring
Answer: Progestin-only methods (e.g., mini-pill, depot injection)
9. A breastfeeding mother is diagnosed with postpartum depression. Which antidepressant class is often considered a first-line choice due to favorable safety data in lactation?
- Tricyclic Antidepressants (TCAs)
- Monoamine Oxidase Inhibitors (MAOIs)
- Selective Serotonin Reuptake Inhibitors (SSRIs) like sertraline
- Benzodiazepines
Answer: Selective Serotonin Reuptake Inhibitors (SSRIs) like sertraline
10. What is a key counseling point for a mother experiencing breast engorgement?
- To limit breastfeeding sessions to save milk
- To apply warm compresses before feeding and cold compresses after feeding
- To bind the breasts tightly to stop milk production
- To drink less water
Answer: To apply warm compresses before feeding and cold compresses after feeding
11. The first milk produced after birth, which is rich in antibodies and nutrients, is called:
- Hindmilk
- Foremilk
- Colostrum
- Transitional milk
Answer: Colostrum
12. Drugs with a high volume of distribution (Vd) tend to have what level of concentration in breast milk?
- Higher concentrations
- Lower concentrations
- The Vd does not affect milk concentration
- The concentration is unpredictable
Answer: Lower concentrations
13. A medication that is known to decrease milk supply is:
- Fenugreek
- Metoclopramide
- Pseudoephedrine
- Domperidone
Answer: Pseudoephedrine
14. A pharmacist receives a prescription for codeine for a breastfeeding mother. The pharmacist should be concerned due to the risk of:
- Decreased milk supply
- Excessive infant sedation if the mother is an ultra-rapid metabolizer of CYP2D6
- Causing hypertension in the mother
- Having no effect on the infant
Answer: Excessive infant sedation if the mother is an ultra-rapid metabolizer of CYP2D6
15. What is the “pump and dump” method?
- A technique to increase milk supply
- The practice of expressing milk and discarding it to maintain supply while avoiding infant exposure to a medication
- A method for storing breast milk
- A type of breastfeeding position
Answer: The practice of expressing milk and discarding it to maintain supply while avoiding infant exposure to a medication
16. Which of the following is a reliable resource for checking the safety of medications during lactation?
- A general internet search engine
- A social media parent group
- LactMed® (Drugs and Lactation Database)
- The drug manufacturer’s website exclusively
Answer: LactMed® (Drugs and Lactation Database)
17. The hormone responsible for the milk ejection reflex, or “let-down,” is:
- Prolactin
- Estrogen
- Oxytocin
- Progesterone
Answer: Oxytocin
18. A baby with a tongue-tie (ankyloglossia) may cause what problem for the breastfeeding dyad?
- Ineffective milk transfer and maternal nipple pain
- An oversupply of milk
- A reduced risk of mastitis
- Rapid weight gain in the infant
Answer: Ineffective milk transfer and maternal nipple pain
19. A breastfeeding mother needs to take a short-acting medication that is known to pass into breast milk. To minimize infant exposure, when is the best time for her to take the dose?
- Immediately before a long breastfeeding session
- In the middle of the night
- Immediately after breastfeeding
- At any time, as timing does not matter
Answer: Immediately after breastfeeding
20. A pharmacist’s role in lactation support includes:
- Recommending immediate cessation of breastfeeding if any medication is needed
- Providing evidence-based information on medication safety
- Diagnosing the cause of low milk supply
- Selling the most expensive breast pump available
Answer: Providing evidence-based information on medication safety
21. A common non-pharmacologic treatment for a plugged duct is:
- Stopping breastfeeding on the affected side
- Applying cold packs only
- Gentle massage, warmth, and frequent, effective milk removal
- Wearing a tight, restrictive bra
Answer: Gentle massage, warmth, and frequent, effective milk removal
22. Which of the following best describes the properties of foremilk?
- It is higher in fat and calories
- It is the milk expressed at the end of a feeding
- It is watery, lower in fat, and quenches the baby’s thirst
- It is identical in composition to hindmilk
Answer: It is watery, lower in fat, and quenches the baby’s thirst
23. Why are estrogen-containing contraceptives generally avoided in the first few weeks postpartum?
- They can increase the risk of thromboembolism and may decrease milk supply
- They are not effective as contraceptives
- They are known to increase milk supply significantly
- They must be administered intravenously
Answer: They can increase the risk of thromboembolism and may decrease milk supply
24. A key benefit of breast milk for the infant is the transfer of what?
- Maternal antibodies that provide passive immunity
- A standardized amount of Vitamin D
- High levels of iron
- A fixed number of calories per ounce
Answer: Maternal antibodies that provide passive immunity
25. A mother has a fungal infection (thrush) on her nipples. What is the appropriate management?
- Treatment of both the mother and the baby with an antifungal medication
- Discontinuing breastfeeding permanently
- Applying a topical corticosteroid only
- Waiting for the infection to resolve on its own
Answer: Treatment of both the mother and the baby with an antifungal medication
26. The “let-down” reflex can be inhibited by:
- A baby suckling at the breast
- Stress, pain, and anxiety
- Looking at a picture of the baby
- Hearing a baby cry
Answer: Stress, pain, and anxiety
27. For a drug to pass into breast milk, it must cross from the maternal plasma into the:
- Myoepithelial cells
- Lactocytes (alveolar cells)
- Fat globules
- Stroma
Answer: Lactocytes (alveolar cells)
28. A medication with a very short half-life is generally considered ________ for a breastfeeding mother compared to one with a long half-life.
- more risky
- safer
- equally risky
- contraindicated
Answer: safer
29. Which of the following is NOT a reliable sign of adequate milk intake in a breastfed infant?
- 6-8 wet diapers per day
- Regular bowel movements
- The mother feeling that her breasts are empty
- Appropriate weight gain
Answer: The mother feeling that her breasts are empty
30. Domperidone and metoclopramide are sometimes used off-label as galactagogues. They work by:
- Directly stimulating oxytocin release
- Increasing prolactin levels
- Blocking estrogen receptors
- Decreasing dopamine levels
Answer: Increasing prolactin levels
31. A pharmacist is asked if it is safe to drink alcohol while breastfeeding. The best advice is to:
- Advise that heavy, regular alcohol use should be avoided and that waiting 2-3 hours per drink before nursing can minimize infant exposure
- State that any amount of alcohol is completely safe
- Recommend drinking alcohol immediately before breastfeeding
- Tell the mother to pump and dump for 24 hours after a single drink
Answer: Advise that heavy, regular alcohol use should be avoided and that waiting 2-3 hours per drink before nursing can minimize infant exposure
32. What happens to the gaps between alveolar cells in the breast after the first few days postpartum?
- They become larger, allowing more drug transfer
- They close, making it more difficult for drugs to pass into the milk
- They do not change
- They are replaced by fat cells
Answer: They close, making it more difficult for drugs to pass into the milk
33. What is the primary treatment for infectious mastitis?
- Discontinuing breastfeeding and applying ice packs
- Antibiotics effective against S. aureus and continued milk removal
- A single dose of a long-acting steroid
- A topical antifungal cream
Answer: Antibiotics effective against S. aureus and continued milk removal
34. The American Academy of Pediatrics recommends exclusive breastfeeding for how long?
- The first month
- The first 3 months
- The first 6 months
- The first year
Answer: The first 6 months
35. A drug that is highly protein-bound is generally ________ to pass into breast milk.
- more likely
- less likely
- guaranteed
- unable
Answer: less likely
36. A pharmacist can be a valuable member of the lactation support team by:
- Providing evidence-based medication recommendations
- Helping to troubleshoot common breastfeeding problems
- Referring to other healthcare professionals like lactation consultants when necessary
- All of the above
Answer: All of the above
37. Which of these is a known galactagogue (a substance that may increase milk supply)?
- Peppermint
- Parsley
- Fenugreek
- Sage
Answer: Fenugreek
38. The process of milk synthesis and secretion is called:
- Lactogenesis
- Involution
- Galactorrhea
- Menstruation
Answer: Lactogenesis
39. A key factor to consider when assessing risk of a medication to a breastfed infant is the:
- Infant’s age and health status
- Cost of the medication
- Color of the medication
- Shape of the tablet
Answer: Infant’s age and health status
40. Why is it important to completely empty the breast during feeding or pumping?
- To signal the body to produce more milk
- To ensure the baby receives the fatty hindmilk
- To help prevent plugged ducts and mastitis
- All of the above
Answer: All of the above
41. Which of the following statements about milk storage is correct?
- Freshly expressed milk can be stored at room temperature for up to 12 hours
- Freshly expressed milk can be stored in the refrigerator for up to 4 days
- Frozen milk can be kept in a standard freezer for up to 1 year
- Thawed milk can be refrozen if unused
Answer: Freshly expressed milk can be stored in the refrigerator for up to 4 days
42. A breastfeeding mother requires treatment with a radioactive isotope for a diagnostic test. What is the most likely recommendation?
- Continue breastfeeding without interruption
- Temporarily interrupt breastfeeding and pump and dump until the isotope has cleared
- Switch to formula permanently
- Double her fluid intake to clear the isotope faster
Answer: Temporarily interrupt breastfeeding and pump and dump until the isotope has cleared
43. A pharmacist’s role in promoting breastfeeding includes:
- Creating a supportive and welcoming environment in the pharmacy
- Providing accurate information to counteract myths and misinformation
- Counseling on the proper use of breast pumps and other supplies
- All of the above
Answer: All of the above
44. A drug with a high milk-to-plasma (M/P) ratio indicates that:
- The drug is concentrated in the breast milk
- The drug is sequestered in the maternal plasma
- The drug does not pass into breast milk
- The drug is eliminated quickly from the milk
Answer: The drug is concentrated in the breast milk
45. Which of the following is an absolute contraindication to breastfeeding in the United States?
- The mother has a common cold
- The infant has galactosemia
- The mother is taking ibuprofen
- The mother has well-controlled hypertension
Answer: The infant has galactosemia
46. The hormone that maintains milk production after lactation is established is:
- Oxytocin
- Estrogen
- Prolactin
- Progesterone
Answer: Prolactin
47. A key to successfully managing most common breastfeeding challenges is:
- Discontinuing breastfeeding
- Switching to a different brand of pump
- Ensuring effective and frequent milk removal
- Supplementing with formula after every feeding
Answer: Ensuring effective and frequent milk removal
48. A mother with inverted nipples may find it helpful to use what device to help her baby latch?
- A bottle
- A pacifier
- A nipple shield
- A supplemental nursing system
Answer: A nipple shield
49. When evaluating a medication for use during lactation, a pharmacist should always consider:
- The risk of infant exposure versus the benefit of the medication for the mother
- The cost of the medication as the primary factor
- The availability of an injectable alternative
- The mother’s personal opinion only
Answer: The risk of infant exposure versus the benefit of the medication for the mother
50. The ultimate goal of providing lactation support and information is to:
- Ensure every mother breastfeeds for at least two years
- Empower the parent to meet their own infant feeding goals safely and effectively
- Promote the sales of breast pumps and accessories
- Eliminate the use of all medications during the lactation period
Answer: Empower the parent to meet their own infant feeding goals safely and effectively
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com