Study Questions
Which vitamin, when ingested in large quantities, causes a well-described constellation of birth defects?
The correct answer is A.
Which of the following medications should be discontinued in a woman with essential hypertension who is trying to get pregnant?
The correct answer is D. You answered A.
Answer: D
ACE inhibitors and ARBs are a pregnancy class D (known to cause fetal abnormalities). Losartan, an ARB, should be discontinued in a woman who is trying to get pregnant. Methyldopa (antiadrenergic), labetalol (beta blocker), and nifedipine (calcium channel blocker) are preferred medications for chronic hypertension in pregnancy. These medications are characterized as pregnancy class C (risk cannot be ruled out) although they have no known association with congenital abnormalities but may cause neonatal hypotension.
References: Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248.1. Pubmed ID: 29146535.
Management of pregnancy with chronic hypertension. In: National Collaborating Centre for Women's and Children's Health (UK). Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. London: RCOG Press; 2010. (NICE Clinical Guidelines, No. 107). https://www.ncbi.nlm.nih.gov/books/NBK62651/.
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