9.docx

**Pregnant and Breastfeeding Clients** - 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 lac...

**Pregnant and Breastfeeding Clients** - 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 often referenced in practice and across settings and, therefore, provided in this course. - Metformin and glyburide have been used during pregnancy. However, insulin is preferred as it does not cross the placenta or enter breast milk in significant amounts.   - Most oral diabetes medications are generally avoided during pregnancy and breastfeeding due to insufficient safety data.  - Consider altered pharmacokinetics related to pregnancy.  **Pediatric Clients** - Insulin dosages may need careful adjustment due to varying insulin sensitivity and the unpredictability of children\'s eating habits and physical activity.   - Metformin can be used in children ten years and older for type 2 diabetes and is often considered when lifestyle changes are insufficient.   - Consider whether medications for diabetes 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** - Insulin therapy may require adjustments to avoid hypoglycemia, as older adults often have decreased renal function, altered nutrition, and comorbid conditions.  - Metformin requires monitoring of renal function since older adults are at increased risk for renal impairment.  - Sulfonylureas should be used with caution due to the increased risk of hypoglycemia in older adults.  - 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.