NAPLEX Question of the Week: Pregnancy and Hypertension

Special populations are an important part of the NAPLEX as well as daily practice.

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AB is a 31 year old female reporting to your clinic for a pre-natal checkup. Her past medical history includes HTN. She is planning to become pregnant in the next few months and wants to be placed on a medication regimen that is appropriate during pregnancy. Which of the following would be contraindicated for AB’s hypertension during pregnancy? Select all that apply.

A. Labetalol

B. Methyldopa

C. Losartan

D. Nifedipine

E. Lisinopril

Answers C and E are correct.

Special populations, such as pregnancy and pediatrics, often have very specific recommendations for drug therapy. For example with anticoagulation, warfarin is contraindicated in pregnancy while heparin or low molecular weight heparin would be preferred.

The American College of Obstetrics and Gynecology (ACOG) recommends labetalol, nifedipine IR, and methyldopa as first line oral antihypertensive options in pregnancy. Hydrochlorothiazide is recommended as a second or third line option.   Answers C and E are incorrect because both ACE inhibitors and ARBs are contraindicated in pregnancy. There is a class wide black box warning for drugs acting on the renin-angiotensin system. They specifically should not be used in the second or third trimester as they can cause injury or even death to the developing fetus.

For many of you, rotations have been completed. Congratulations as you work toward taking the NAPLEX!

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.