pregnant

[IMG SURVIVOR]

A 22-year-old female is pregnant and now she is suffering from pain in her left eye, the intern notice that her BP is 150/90 so he gives her Captopril and sends her to her house with a prescription of Captopril

Is that ok?
What are the side effects of Ace inhibitors?

[IMG SURVIVOR]

No is not ok, remember that Ace inhibitors are teratogenics.
Captopril is the neumonic to remember the side effects
Cough
Angioedema
Proteinuria
Taste change
Hypotension
Rash
Increase renin
Low angiotensin 2* Its that the correc one?

[dr.kirk]

Ace inhibitors will cause renal damage to fetus- teratogenic. Give methyldopa to hypertensive pregnant females instead.

[Dr. X]

nice one img.. and ya.. L is for low A-II. you left the second "P" which is for "pregnancy related problem" which is the fetal renal damage like dr.kirk said.

i remember from somewhere that captopril causes cough because it increases bradykinin. If on captopril and cough develops --> to suppress the cough you can give losartan instead to normal HTN pxts but not to pregnants because that one's also teratogenic.. (fetal reneal damage).. :(

[student-2]

What's the major concern with giving methyldopa in any patient???

[Dr. X]

with alpha-methyldopa.. they may feel drowsy and sedated which could interfere with daily activities such as not safe to drive etc..

and as for pregnants.. with methyldopa, combination of hydralazine is given.

While b-blockers are great for those with HTN and with heart failure, male patients compliance is decreased just because... ?

[student-2]

Methyldopa can cause coombs positive test!!!!!

[ZAPATA]

ACE degrades bradykinin, so ACE-Is will increase the availability of bradykinin=> cough. ARBs (losartan) do not interact with ACE so bradykinin metabolism is not disturbed, therefore no cough as SE.

[AUCMD2006]

Ace inhibitors will cause renal damage to fetus- teratogenic. Give methyldopa to hypertensive pregnant females instead.

if this is an acute event you treat with hydralazine, labetalol, or nifedipine


methyldopa rarely is able to reach your therapaudic goals and it is usually at the max end of the dosage spectrum with all sedative side effects that most patients are bothered by so from the 1960's until the 1990's yes it was widely used, the trend now is to use labetalol as first choice. what you guys have to watch out for on step 2 are next level questions this one is too "easy" imho.

the better step 2 question would have all the above medications in the answer and throw in some pertinent medical history that will make using one vs the other the correct answer. for example
-you use propanalol is the pregnant pt has hyperthyroid
-nifedipine in diabetic patients
-thiazide in CHF or as second agent
-labetalol avoid in asthmatics

the other thing to watch out for are situational things that will make one treatment better.