Antihypertensive not contraindicated in pregnancy
Ans. is 'b' i.e. Labetalol Drugs used for the t/t of Hypertensive pregnancy B etter M other C are D uring H ypertensive P regnancy Beta blockers (labetalol, atenolol) Methyl dopa (.D.O.C. in pregnancy) Clonidine Dihydropyridine CCB's (discontinue before labour as they weaken uterine contractions) Hydralazine (D.O.C in hypertensive emergency) Prazosin Antihypertensives to be avoided during pregnancy Diuretics Tends to reduce blood volume - accentuate uteroplacental perfusion deficit (of toxemia) - increased risk of foetal wastage, placental infarcts, miscarriage, still birth. ACE inhibitors, AT1 antagonists Risk of foetal damage, growth retardation. Reserpine Suicidal depression in mother, nasal obstruction, deranged respiratory and temperature control in the new bom. Nonselective b blockers Propranolol has been implicated to cause low birth weight decreased placental size, neonatal bradycardia and hypoglycemia. Sodium Nitroprusside Contraindicated in eclampsia Pregnancy hypertension There is a lack of good clinical trial evidence, on which to base recommendations of one agent over another. Instead, drug usage reflects longevity of use without obvious harm to the fetus. Hence methyldopa is still the drug of choice for many obstetricians. Calcium channel blockers (especially nifedipine) are common second line drugs. Parenteral hydralazine is reserved for emergency reduction of blood pressure in late pregnancy, preferably in combination a b blocker to avoid unpleasant tachycardia (labetalol and atenolol) are often effective and probably the drug of choice in the third trimester. There is anecdotal evidence to suggest growth retardation with b blockade used in first and second trimester. Diuretics reduce the chance of developing preeclampsia but are avoided in pre-eclampsia itself because these patients, already have a contracted circulatory volume. Spironolactone is a diuretic which is avoided in pregnancy because of its antiandrogenic effect on fetus. ACE inhibitors (and by implication angiotensin AT1receptor antagonist) are absolutely contraindicated during pregnancy where they cause fetal death, typically midtrimester (they can be prescribed during first trimester) Note : There is no evidence that ACE inhibitors - or any of the commonly used antihypertensive drugs are teratogenic and women who become pregnant while receiving these should be reassured but should, of course, then discontinue the ACE inhibitor or AT1receptor antagonist.
Spironolactone
Labetalol
Sodium Nitroprusside
ACE inhibitor
C.V.S