Which antihypertensive is not given in pregnancy -
Ans. is 'a' i.e., ACE inhibitorso Ace inhibitors are associated with fetal malformations and thus should he avoided in oresnancv. They are suitable for chronic hypertension in nonprevnant state or post partum. Andhvpertensive DrugsDrugsMechanism of ActionDoseSide effectsContraindications and PrecautionsMethyldopaDrugs of first choice. Central and peripheral antiadrenergic action. Effective and safe for both the mother and the fetus.o Orally-250 mg bid-may be increased to 1 g qid depending upon the response.o IV infusion - 250-500 rrigo Maternal-Postural hypotension, hemolytic anemia, sodium retention, excessive sedation. Coomb's test may be positiveo Fetal - Intestinal ileusHepatic disorders psychic patients congestive cardiac failure.Postpartum (risk of depression)HydralazineActs by peripheral vasodilatation as it relaxes the arterial smooth muscle. Orally it is weak and should be combined with methyldopa or b blockers. It increases the cardiac output and renal blood flow.o Orally - 100 mg/day in four divided doseso IV 5-10 mg every 20 min maximum 20 mg.o Maternal hypotension, tachycardia, arrhythmia, palpitation, lupus like syndrome, fluid retentiono Fetal - reasonably safeo Neonatal - thrombocytopenaiBecause ofvariable sodium retention, diuretics should be used. To control arrhythmias, propranolol may be administered intravenously.LabetalolCombind a and b adrenergic blocking agento Orally - 100 mg tid may be increased up to 2,400 mg dailyo IV infusion (Hypertensive crisis 20-40 mg IV every 10-15 min until desired effect, maximum up to 220 mg.o Tremors, headache, asthma, congestive cardiac failure,o Efficacy and safety with short-term use appear to methyldopa.o Hepatic disorderso Asthma, congestive cardiac failure.NifedipineDirect arteriolar vasodilatation by inhibition of slow inward calcium channels in vascular smooth muscle.Orally 5-10 mg tid maximum dose 60-120 mg/dayRushing, hypotension, headache, tachycardia, inhibition of laborSimultaneous use of magnesium sulfate could behazardous due to synergistic effect.SoudimNitroprussideDirect vasodilator (arterial and venous )IV infusion0.25-8ug/kg/mino Maternal: Nausea, vomiting, severe hypotensiono Fetal toxicity due to metabolites - cyanide and thiocynateDrug of last resortfor acute hypertension. Should be used in critical care unit for very short time (10 minutes).NitroglycerineRelaxes mainly the venous but also arterial smooth muscleGiven as IV infusion 5ug/min to be increased at every 3-5 min up to 100 ug/min.Tachycardia, headache. MethemoglobinemiaUsed in hypertensive crisis for short time only.Contraindicated in hypertensive encephalopathy as it increases blood florand intracranial pressure.ACE inhibitors Angiotensin- II receptor blockers (AARB)ACE inhibitors, inhibit formation of angiotensin II from angiotensin I. ARB-Blocks Angiotensin-II receptorso Captopril orally 6.25 mg bido Telmisartan orally 20-40 mg a dayo Maternal; Hypotension, headache, asthenia arrhythmias.o Fetal: Oligohydramnios IUGR, fetal renal tubular dysgenesis, neonatal renal failure, pulmonary hypoplasiaShould be aboided in pregnancy.Suitable for chronic hypertension in nonpregnant state or postpartum.
Ace inhibitors
Methyldopa
Hydralazine
Labetolol
Management and Long-Term Consequences