Lifespan Considerations for Pregnant and Breastfeeding Clients PDF

Pregnant and Breastfeeding Clients **Antiretroviral Medications** - In 2015, the FDA revised pregnancy labeling guidelines to move away from the A, B, C, D, and X labels to the Pregnancy and Lactation Labeling Rule (PLLR), which requires labels to a summary of the risk of using the d...

Pregnant and Breastfeeding Clients **Antiretroviral Medications** - In 2015, the FDA revised pregnancy labeling guidelines to move away from the A, B, C, D, and X labels to the Pregnancy and Lactation Labeling Rule (PLLR), which requires labels to a summary of the risk of using the drug during pregnancy and lactation, data supporting the summary, and counseling information. These labels must be updated when new information is available. Although the PLLR is recommended, original labeling categories are still often referenced in practice and across settings and therefore provided below. - Certain antiretroviral drugs, previously classified as Pregnancy Risk Category B agents, are considered safer during pregnancy. Others may pose higher risks and require more careful risk-benefit analysis. - Zidovudine is the medication of choice for preventing transmission of HIV during labor and delivery, even though it was previously classified as Pregnancy Risk Category C agent. - Breastfeeding is generally contraindicated for clients with HIV due to the risk of viral transmission through breast milk. **Herpes Simplex Virus and Varicella-Zoster** - Acyclovir, famciclovir, and valacyclovir were previously classified as Pregnancy Risk Category B agents, indicating no evidence of risk in humans. However, consideration is needed due to potential risks and limited studies on breastfeeding clients. **Influenza** - Oseltamivir is generally considered safe, but zanamivir\'s safety profile is less clear due to its inhalation route and potential effects on lung function. **COVID-19** - Data on the use of Paxlovid during pregnancy is insufficient. **General** - Consider altered pharmacokinetics related to pregnancy. Adolescents **Antiretroviral Medications** - As they approach adult body size, dosing regimens may transition to adult dosing. - Consider lifestyle and preferences to help with adherence to medication schedules. - Address the risk of transmission through sexual activity, along with safe sex practices. **Herpes Simplex Virus and Varicella-Zoster** - Ganciclovir and valganciclovir can be used with considerations for dosing adjustments based on renal function and potential side effects. **Influenza** - Initiate early treatment with oseltamivir to maximize benefits and reduce complications. **COVID-19** - Paxlovid is authorized for use in adolescents 12 years of age and older weighing at least 40 kg with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19, including hospitalization or death. **General** - Consider whether medications are indicated for certain age groups. - Consider the ability of the family to manage a medication regimen. - Consider altered pharmacokinetics based on age. Older Adults **Antiretroviral Medications** - Potential for age-related changes in drug metabolism and elimination necessitates careful monitoring for adverse effects. **Herpes Simplex Virus and Varicella-Zoster** - No specific contraindications, but lower doses are recommended for those with renal impairment. **Influenza** - Emphasis on early treatment initiation for oseltamivir and cautious use of zanamivir in those with underlying airway diseases, with dosing adjustments for renal impairment. **COVID-19** - Dose adjustments and monitoring are advised for those with renal or hepatic impairment. **General** - Consider the ability of the client and support system to safely self-administer medications without skipping or doubling doses. - Consider altered pharmacokinetics based on age-related changes. - Consider polypharmacy and drug interactions.