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!