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Old 11-30-2011
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Drug First line anti-hypertensive therapy for this pregnant woman

A 38-year-old woman is 10 weeks pregnant with her second pregnancy and is found to have blood pressures exceeding the 150 to 160 mm Hg systolic range and 100 to 110 mm Hg diastolic range at her first prenatal visit. She has no other medical problems. She had a cholecystectomy at the age of 20. She takes no medications and is allergic to sulfa drugs. Her family history is significant for hypertension on both her maternal and paternal sides. Physical examination is normal, including an obstetrical ultrasound demonstrating a 10-week intrauterine pregnancy. The patient is diagnosed with chronic hypertension. Which of the following should be used as first-line antihypertensive therapy for this patient?

A. Atenolol
B. Captopril
C. Lisinopril
D. Magnesium sulfate
E. Methyldopa
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Old 11-30-2011
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E. Methyldopa
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Old 11-30-2011
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A.

Atenolol
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Old 12-01-2011
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E.methyl dopa
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Old 12-01-2011
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the is methyldopa.....
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Old 12-01-2011
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Methyldopa
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Old 12-01-2011
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The correct answer is E. Chronic hypertension affects up to 5% of all pregnant women. Numerous antihypertensives are available to treat pregnant women. Methyldopa has historically been the most common antihypertensive used to treat pregnant women and is still considered an appropriate first-line antihypertensive treatment for pregnant women. The American College of Obstetricians and Gynecologists considers methyldopa and labetalol to be the appropriate first-line treatments for the hypertensive patient. Methyldopa has been demonstrated to be safe in numerous studies and appears to have limited effects on uteroplacental blood flow. Methyldopa acts by stimulating central inhibitory alpha-adrenergic receptors. It may also cause false neurotransmission and a reduction of plasma renin activity. Transient sedation may occur during initiation of treatment and with any increases in therapy; however, methyldopa is generally a well-tolerated drug with few side effects.
Atenolol (choice A) is a beta-blocker that has been associated with growth restriction during pregnancy. It is not recommended for use in pregnancy.
Captopril (choice B) and lisinopril (choice C) are drugs that belong to the ACE-inhibitor class of medications. ACE-inhibitors are contraindicated during pregnancy. Captopril, enalapril, and lisinopril are the three ACE-inhibitors about which there is the most data regarding their effects during pregnancy. These ACE-inhibitors are associated with fetal renal failure, oligohydramnios, anuria, renal dysgenesis, pulmonary hypoplasia, intrauterine growth restriction, fetal death, neonatal renal failure, and neonatal death. Interestingly, ACE-inhibitor use during the first 14 weeks of pregnancy does not appear to cause an increase in birth defects.
Magnesium sulfate (choice D) is used in obstetrics for tocolysis and to prevent seizures in patients with preeclampsia (or further seizures in patient who have already had an eclamptic episode.) Although it has been shown in some studies to cause a lowering of blood pressure when used for seizure prophylaxis, it is not used as an antihypertensive agent to control high blood pressure.
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