Which of the following antihypertensive drug is contraindicated in pregnancy:

Appeared in: BHU NO-2019

Explanation

Enalapril belongs to the class of drugs known as Angiotensin-Converting Enzyme (ACE) inhibitors.
ACE inhibitors are strictly contraindicated during pregnancy because they are teratogenic, meaning they can cause developmental malformations in the fetus.
Exposure, particularly during the second and third trimesters, is associated with severe fetal complications, including renal failure, oligohydramnios (insufficient amniotic fluid), and hypocalvaria (incomplete development of the skull bones).
Due to these significant risks, ACE inhibitors should be discontinued in women who are pregnant or planning to become pregnant.

Option B: Hydralazine is a vasodilator that is considered safe for use in pregnancy.
Option C: Metoprolol is a beta-blocker that is generally considered safe and compatible with pregnancy.
Option D: Alpha methyldopa is a centrally acting alpha-agonist with a long-standing safety record in pregnancy.

Clinical Relevance

Nursing practice connection: Knowing Pharmacology: Safety of antihypertensive medications in pregnancy helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must perform a thorough medication reconciliation for all pregnant patients to identify and flag any contraindicated drugs, such as ACE inhibitors and ARBs.
Patient education is a critical nursing role. It is essential to inform women of childbearing age who are taking ACE inhibitors or ARBs about the potential risks in pregnancy and the importance of discussing family planning with their provider.
If a pregnant patient is found to be taking a contraindicated antihypertensive, the nurse must ensure the prescribing physician is notified immediately so the medication can be switched to a safer alternative.

How to Approach the Question

First, identify the key terms in the question: 'antihypertensive drug' and 'contraindicated in pregnancy'. This is a direct recall question about pharmacology.
Next, categorize each of the drug options by its class: Enalapril (ACE inhibitor), Hydralazine (vasodilator), Metoprolol (beta-blocker), and Alpha methyldopa (central alpha-agonist).
Recall the safety profiles of these drug classes during pregnancy.
The most critical rule to remember is that ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) are absolutely contraindicated due to their known teratogenic effects on the fetus.
Identify Enalapril as the ACE inhibitor among the choices.
Confirm that the other options (Hydralazine, Metoprolol, Alpha methyldopa) are recognized as safe or first-line treatments for hypertension in pregnancy. This confirms Enalapril is the correct answer.

Concept Tested & Keywords

Concept Tested: Pharmacology: Safety of antihypertensive medications in pregnancy
Stem keywords: antihypertensive drug, contraindicated, pregnancy
Lead-in keywords: Which
Negative lead-in flag: false

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E6 Obstetrics Williams p. 67-89

E6 Medicine Harrison 22e Part 2 p. 44-46

Practise the full BHU NO-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.