Which of the following can he used in pregnancy?
Ans. d. Propylthiouracil Propylthiouracil is the drug of choice for hyperthyroidism during pregnancy."ACE inhibitors inhibit the conversion of angiotensin-I to the potent vasoconstrictor angiotensin-II. They can cause severe fetal malformations that include hypocalvaria when given in the second and third trimesters. Because of this, they are not recommended during pregnancy. Angiotensin-receptor blockers act in a similar manner, but instead of blocking the production of angiotensin-II, they inhibit binding to its receptor. They are presumed to have the same fetal effects as ACE inhibitors and are also contraindicated. "- Goodman and Gilman 12/e p736Antihypertensives to be avoided in Pregnancy (Mnemonic: SAAND)* Sodium nitroprusside* ACE inhibitors0* ARBs* Non-selective beta blockers* Diuretics Drugs in PregnancyAntithyroid drugsAntihypertensive Drugs* Propylthiouracil and methimezole are both antithyroid drug that cross the placenta and can lead to fetal goiter.* Methimazole has been associated with "cutis aplasia'-, scalp defects, cloanat atresia esophageal atresia and increased maternal side effects.* Because both medications are equally effective the drug of choice for hyperthyroidism in pregnancy is propylthiouracil.* ACE inhibitor e.g. Enalaprif captopril can cause fetal renal tubular dysplasia in the second and third trimesters leading to oligohydramnios, fetal limb contractures, craniofacial deformities and hypoplastic lung development.* Angiotensin II receptor antagonist have been shown to have second and third trimester finding consistent with ACE inhibitors and are not recommended in pregnancy.
ACE inhibitors
Aldosterone
AT receptor antagonist
Propylthiouracil
Management and Long-Term Consequences