JIPMER Nursing Office…: Which antihypertensive medicine is contraindicative in gestational hypertension?

JIPMER Nursing Officer - 2020

Pharmacology

Easy

Appeared in: JIPMER Nursing Officer - 2020

Explanation

Losartan is an Angiotensin II Receptor Blocker (ARB), a class of drugs that is absolutely contraindicated during all trimesters of pregnancy.
ARBs block the renin-angiotensin-aldosterone system (RAAS), which is crucial for fetal renal development, blood pressure regulation, and amniotic fluid homeostasis.
Exposure to Losartan during pregnancy can cause severe fetal complications, including renal failure, oligohydramnios (dangerously low amniotic fluid), pulmonary hypoplasia (underdeveloped lungs), and hypocalvaria (incomplete skull formation).
Due to these severe risks, any woman of childbearing potential on an ARB like Losartan should be counseled on effective contraception and switched to a safer alternative if pregnancy is planned or occurs.

Option A: Nicardipine is a calcium channel blocker (CCB). CCBs, particularly nifedipine and nicardipine, are considered safe and are frequently used as first or second-line agents to treat severe hypertension and preeclampsia during pregnancy.
Option C: This option represents a class of drugs, Calcium Channel Blockers (CCBs). As a class, CCBs are not contraindicated and are among the recommended therapies for managing hypertension in pregnancy.
Option D: Atenolol is a beta-blocker. While it is generally avoided during pregnancy due to an association with fetal growth restriction, it is not considered absolutely contraindicated in the same way as ARBs or ACE inhibitors. Other beta-blockers, such as Labetalol, are preferred and considered first-line therapy.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacology and contraindications of antihypertensive medications during pregnancy as background academic context rather than a clinical decision trigger.
A nurse's primary role includes obtaining a thorough medication history for any woman of childbearing age. It is critical to identify the use of teratogenic drugs like Losartan before or during early pregnancy.
Patient education is paramount. The nurse must explain why certain medications are unsafe during pregnancy and the importance of switching to a safer alternative under medical supervision.
If a pregnant patient presents with hypertension, the nurse must be vigilant in monitoring blood pressure, assessing for signs of preeclampsia (headache, visual changes, epigastric pain), and monitoring fetal well-being.

How to Approach the Question

First, identify the core of the question: it asks for a medication that is 'contraindicative' (harmful and should not be used) in pregnancy.
Next, analyze the options by classifying each drug: Nicardipine (CCB), Losartan (ARB), Calcium channel blocks (drug class), and Atenolol (Beta-blocker).
Recall the pregnancy safety categories for major antihypertensive drug classes. The most critical contraindication is for drugs that interfere with the renin-angiotensin system.
ACE Inhibitors and ARBs (like Losartan) fall into this category and are known teratogens, making them absolutely contraindicated.
CCBs (like Nicardipine) and certain beta-blockers (like Labetalol) are known to be relatively safe and are often used.
Atenolol is a beta-blocker that is less preferred due to risks like fetal growth restriction, but the contraindication for ARBs is more absolute and severe. Therefore, Losartan is the most definitive answer.

Concept Tested & Keywords

Concept Tested: Pharmacology and contraindications of antihypertensive medications during pregnancy.
Stem keywords: antihypertensive medicine, contraindicative, gestational hypertension
Lead-in keywords: Which

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