Geriatric patients may be more susceptible to the hypoglycemic effects of glyburide. Hypoglycemia can also be more difficult to detect in the older adult, and these patients are also more likely to have renal dysfunction that may impair drug elimination. Therefore, geriatric patients should receive conservative initial and maintenance doses of glyburide to avoid hypoglycemic reactions. Due to the long duration of glyburide and associated increased risk of hypoglycemic episodes reported in geriatric adults, other sulfonylurea agents such as tolbutamide, glipizide, or glimepiride may be preferred. According to the Beers Criteria, glyburide is considered a potentially inappropriate medication (PIM) for use in geriatric patients and should be avoided due to a greater risk of severe and prolonged hypoglycemia in older adults than in younger adult patients. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). According to OBRA, the use of antidiabetic medications should include monitoring (., periodic blood glucose) for effectiveness based on desired goals for that individual and to identify complications of treatment such as hypoglycemia or impaired renal function. Glyburide is not considered a hypoglycemic agent of choice in older adults because of the long half-life and/or duration of action and the increased risk of prolonged and serious hypoglycemia, with symptoms including tachycardia, palpitations, irritability, headache, hypothermia, visual disturbances, lethargy, confusion, seizures, and/or coma. Sulfonylureas such as glyburide can cause SIADH and result in hyponatremia.
The ACCP guidelines recommend dalteparin 100 IU/kg SC twice daily with anti-factor Xa concentrations monitored and maintained at 1— IU/ml 4 hours after dose administration. Dalteparin can be administered either throughout pregnancy, or from weeks 6—12, followed by warfarin (INR —) until the middle of the third trimester with dalteparin then given for the remainder of the pregnancy. Prospective, randomized, controlled trials have not been completed in this population, and treatment failures with the use of LMWH have been reported. Patients should be treated and monitored aggressively with dose adjustments throughout pregnancy reflective of changes in the patient's weight or as indicated by anti-factor Xa concentrations. In women who are at especially high risk, the addition of aspirin 75—162 mg/day PO is recommended. The 2006 ACC/AHA guidelines recommend similar courses of action; however, the goal anti-factor Xa concentration is — IU/ml 4 hours after dose administration.
Oxandrolone is a synthetic androstane steroid and a 17α-alkylated derivative of DHT.    It is also known as 2-oxa-17α-methyl-5α-dihydrotestosterone (2-oxa-17α-methyl-DHT) or as 2-oxa-17α-methyl-5α-androstan-17β-ol-3-one, and is DHT with a methyl group at the C17α position and the C2 carbon replaced with an oxygen atom.    Closely related AAS include the marketed AAS mestanolone (17α-methyl-DHT), oxymetholone (2-hydroxymethylene-17α-methyl-DHT), and stanozolol (a 2,3- pyrazole A ring -fused derivative of 17α-methyl-DHT) and the never-marketed/ designer AAS desoxymethyltestosterone (3-deketo-17α-methyl-δ 2 -DHT), methasterone (2α,17α-dimethyl-DHT), methyl-1-testosterone (17α-methyl-δ 1 -DHT), and methylstenbolone (2,17α-dimethyl-δ 1 -DHT).