new_n_lost
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A 38-year-old pregnant woman with a past medical history significant for chronic hypertension presents with a blood pressure of 158/105 mm Hg.
Which of the following antihypertensive agents would be most suitable for initial therapy in this patient?
A. Bumetanide
B. Fosinopril
C. Hydrochlorothiazide
D. Methyldopa
E. Valsartan
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| po
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C. Hydrochlorothiazide
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| keepgoing
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methyldopa
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| edie
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I agree w/KeepGoing, methyldopa
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| po
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 dint notice pregnant part
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| new_n_lost
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keepgoing wrote:
methyldopa
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| new_n_lost
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The correct answer is D.
Pregnant women with chronic hypertension "require" antihypertensive therapy when the diastolic pressure is greater than 100 mm Hg; however, some clinicians may decide to treat patients with diastolic blood pressures less than 100 mm Hg. For the initiation of therapy, methyldopa is still considered to be the agent of choice. Methyldopa is converted intraneuronally to a-methylnorepinephrine, an alpha-2 adrenergic agonist, which is subsequently released. Release of a-methylnorepinephrine in the medulla leads to a decrease in sympathetic outflow, thus lowering blood pressure. Methyldopa has been safely used in the treatment of hypertension during pregnancy; this agent is not associated with the development of teratogenic or other fetal abnormalities.
Diuretics, such as bumetanide (choice A) and hydrochlorothiazide (choice C), are often avoided since these agents can produce hypovolemia, leading to reduced uterine blood flow. Although these agents can be used during pregnancy, methyldopa and hydralazine are the drugs of choice for hypertension during pregnancy.
Fosinopril (choice B) is an angiotensin-converting enzyme (ACE) inhibitor that should not be administered to pregnant women, especially in the second or third trimesters. These agents have been associated with severe fetal and neonatal injury, such as hypotension, neonatal skull hypoplasia, anuria, renal failure, and death.
Along the same lines, the use of the angiotensin II receptor antagonists, such as valsartan (choice E), is not recommended since these agents cause fetal complications similar to the ACE inhibitors.
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| Ig F
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itz methyldopa.......can be safely use in preganant ptz..withoyt fear of teratogenicity...
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| sidiyaa
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the safest antihypertensive agents are two : methyldopa,hydralazine
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| macintosh
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sidiyaa wrote:
the safest antihypertensive agents are two : methyldopa,hydralazine
I am sorry but I fail to understand your point. In what respects is hydralazine safe. And if you are referring to its use in pregnancy; it is classifed as "C" in the pregnancy category. Don't know how safe that is? More generally it is involved in a drug induced lupus like syndrome in the slow acetylators. Don't know how dangerous that could be?
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| Tiff
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macintosh wrote:
I am sorry but I fail to understand your point. In what respects is hydralazine safe. And if you are referring to its use in pregnancy; it is classifed as "C" in the pregnancy category. Don't know how safe that is? More generally it is involved in a drug induced lupus like syndrome in the slow acetylators. Don't know how dangerous that could be?
I guess no drug is really safe. Being a Category C drug, Hydralazine is commonly used in pregnancy for hypertension especially in preeclampsia and considered a better option. If the benefits outweigh the risks, its certainly worth using. That's just my point of view. 
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