Which of the following drug is contraindicated in pregnancy?

Appeared in: ISRO- 2016

Explanation

Enalapril is an Angiotensin-Converting Enzyme (ACE) inhibitor.
ACE inhibitors are teratogenic and absolutely contraindicated in all trimesters of pregnancy.
They interfere with the fetal renin-angiotensin system, which is critical for fetal renal development and amniotic fluid regulation.
Exposure can cause severe fetal harm, including renal failure, incomplete skull formation (hypocalvaria), lung underdevelopment (pulmonary hypoplasia), and fetal death.

Option A: Methyldopa is a centrally-acting antihypertensive that is widely considered a first-line, safe option for managing hypertension during pregnancy.
Option B: Clonidine is a second-line antihypertensive agent. While not a preferred first choice, it is not contraindicated and can be used during pregnancy if necessary.
Option C: Amlodipine is a calcium channel blocker. This class of drugs, especially nifedipine and labetalol, is considered a safe and effective first-line option for treating hypertension in pregnancy.

Clinical Relevance

Nursing practice connection: Knowing Pharmacotherapy in Pregnancy helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses play a critical role in medication reconciliation for all women of childbearing age. It is essential to identify and flag any teratogenic medications, like ACE inhibitors, especially upon confirmation of pregnancy.
Immediate communication with the prescribing provider is necessary to switch the patient from a contraindicated drug to a pregnancy-safe alternative to prevent fetal harm.
Patient education is paramount. The nurse should be prepared to explain, in simple terms, why certain medications are unsafe during pregnancy and the importance of adhering to the new, safer regimen.

How to Approach the Question

First, read the question carefully to identify the key concept: a drug that is 'contraindicated' in pregnancy.
Next, analyze the options by identifying the drug class for each medication.
A. Methyl dopa: Centrally acting alpha-agonist.
B. Clonidine: Centrally acting alpha-agonist.
C. Amlodipine: Calcium channel blocker.
D. Enalapril: Angiotensin-Converting Enzyme (ACE) inhibitor.

Concept Tested & Keywords

Q34sWttfk9bcjSjefZypGt

E6 Obstetrics Williams p. 67-89

E6 Medicine Harrison 22e Part 2 p. 1803-1805

Practise the full ISRO- 2016

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