NUR 302 Concepts In Nursing


By susannah:
Prinzide is a combination drug that comprises of Lisinopril an angiotensin-converting enzyme inhibitor (ACEI) and Hydrochlorothiazide (HCTZ) is a diuretic. ACEIs can cause fetal and neonatal morbidity and mortality, and is a Pregnancy Category C in the first trimester of pregnancy and Pregnancy Category D in the second and third trimesters and during lactation. Hydrochlorothiazide is a Pregnancy Category B (Woo & Wynne, 2011). In this case, it is contraindicated for BD to continue the current therapy of Prinzide.

By shyRhonda:
Given that BD is pregnant, would there be any contraindications pharmcalogically with treating her HTN?

Yes, according to James & Nelson-Piercy (2004), ACE inhibitors and Angiotension II Receptor blockers (ARB) are fetotoxic and should be discontinued within the first trimester of pregnancy. The greatest risk to the fetus is during the third trimester however the earlier they are discontinued the better. Such malformations to the fetus include: oligohydramnios, joint contractures, pulmonary hypoplasia, hypocalvaria, fetal renal tubular dysplasia or neonatal renal failure.

Depending on the severity of BD’s hypertension, it maybe she can be removed from her hypertensive medications and monitored closely during the first trimester half of her pregnancy due to the physiological fall in blood pressure during this time (James & Nelson-Piercy, 2004). If need be, therapy can be started when blood pressure reaches mild-hypertension at 140/90 (Podymow, T. & August, P., 2008).

The first line drug for chronic hypertension during pregnancy is Aldomet/methyldopa which is a centrally acting alpha agonist. This drug works at the site of the brain stem to decrease mental alertness leading to impaired sleep which may lead to fatigue and/or depression. For this reason, it should be used in caution in women who have a history of depression. Aldomet has not demonstrated to have had adverse effects on uteroplactal fetal hemodynamics or development (Podymow, T. & August, P., 2008).

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