Many test-takers worry about the pharm/tox questions, but with these tips you'll be fine!

Multiple test-takers have told me they had “trouble” answering the IBLCE Exam’s pharmacology/toxicology questions. I’ve heard this from both first-time candidates and from those who are re-certifying. To give some guidance for everyone, here are my top tips for handling pharm/tox questions.

1. Understand the rudiments of pharmacokinetics

True, you need to know what common drugs do to the body (pharmacodynamics). But few people who attend my live review course understand the rudiments of pharmacokinetics. Pharmacokinetics is what the body does to the drug. 

More often than not, risk/benefit depends on a fundamental understanding of half-life, protein-binding, molecular size, milk-to-plasma ratio, and more. So at least know the definition of many termsrelated to pharmacokinetics, and their effect on the breastfed infant.  

2. Know your role — and its limitations

The IBLCE has never said that you can or should make the risk/benefit decision about safety of a drug for mother — or her breastfed baby. To the contrary; it’s fairly clear that determining risk/benefit is not within the IBCLC’s Scope of Practice can argue that even the primary care provider — who is legally authorized to prescribe — should not have the “last word” on risk/benefit. The client should have the final say on risk/benefit!

For the client to be empowered in that way, the IBCLC must understand factors that affect risk/benefit (hello, pharmacokinetics!) and, if necessary, be ready to discuss those factors with providers (using professional terms) or patients (using lay terms). The IBCLC’s role is to give information, not advice. Knowledge is necessary but not sufficient. Whether you teach, counsel, or advocate, you’ll need superior communication skills.  

Giving reassurance about a drug that has already been prescribed for the mother is okay, if you know it will not affect the safety or volume of her milk. 

3. Know indications and basic side effects

You need to know why a drug would be prescribed or used, how it might affect the milk (e.g., discolors the milk), how it might affect the baby’s behavior (lethargy?), or the mother’s ability to feed or care for her infant.  

4. Know your social and recreational drugs

Alcohol, caffeine, and other substances are “fair game” for the IBLCE exam. Know the basics of drugs that have adverse effects, especially substances that are abused.

5. Brush up on environmental toxins

Okay, I agree, this is a tough one. But environmental toxins, such as mercury, lead, pesticides, or perchloroethylene or other environmental toxins are fair game.

6. Learn all you can about galactagogues

Galactagogues are substances that are thought to increase milk supply. These differ from one culture to another. Teas made from certain herbs, foods, drinks (including beer), and pharmaceutical preparations all qualify as galactagogues.

7. Learn all you can about milk suppressants

While one dose of over-the-counter drugs like pseudoephedrine or diphenhydramine aren’t likely to dry up milk, repeated doses could. Most mothers don’t think of mint as a milk suppressant, but in large quantities, it could be, because mint is part of the sage family. Sage is well-known for its milk-suppressant effects. 

However, a peppermint patty is not a problem. An Altoid or two is fine, but eating the whole box in one day could substantially suppress supply. 

8. Identify drugs that have a potentially lethal effect on the infant

Years ago, I probably would have said, “identify drugs that are contraindicated when nursing.” Nowadays, the emphasis is on weighing risk/benefit in individual cases, rather than lumping “contraindicated” drugs into one category. 

That said, two categories are particularly concerning. If a mother needs cytotoxic drugs (cancer drugs) or radiopharmaceutical substances, it is likely she will be required to wean or temporarily interrupt breastfeeding. 

9. Know trade names and generic names of medications

The IBLCE Exam uses trade names, not generic names. I suggest you think of 50 of the most commonly-used medications, and then try to match them with their generic names. 

10. Remember, it’s the smallest percentage of the IBLCE Exam

This year, I made a pie chart showing the percentages of all questions on the Detailed Content Outline. Pharm/tox questions comprise the smallest section of the exam — only 7 percent of the total test items. 

So I’m not suggesting that you blow it off. But don’t spend a disproportionate amount of time on it, and don’t lose too much sleep over it.

If you use these 10 tips while you study, I think you’ll be just fine! 

How are you preparing for the pharm/tox questions? If you’ve taken the exam, what did you find helpful in preparing for the pharm/tox questions? Tell me in the comments below.

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