Which of these drugs is contraindicated in a laboring client with a history of hypertension?

Daman & Diu Staff Nurse - 2018

Obstetrics & Gynaecology

Hard

Appeared in: Daman & Diu Staff Nurse - 2018

Explanation

Methergine (methylergonovine) is an ergot alkaloid used to control postpartum hemorrhage.
Its primary mechanism involves causing intense vasoconstriction (narrowing of blood vessels) and strong uterine contractions.
In a client with pre-existing hypertension, this vasoconstrictive effect can lead to a dangerously sharp increase in blood pressure.
This hypertensive spike increases the risk of severe complications such as stroke, myocardial infarction, or eclamptic seizures.
Therefore, it is strictly contraindicated in patients with hypertension, pre-eclampsia, or eclampsia.

Option A: Oxytocin is the first-line drug for both labor induction and control of postpartum hemorrhage. It does not have the significant vasoconstrictive effects of Methergine, making it the preferred and safest choice for hypertensive clients.
Option B: Prostaglandins (e.g., Misoprostol, Carboprost) are used for cervical ripening and treating postpartum hemorrhage. While generally considered safe in hypertension, Carboprost is contraindicated in patients with asthma due to its bronchoconstrictive effects. They are not the primary contraindication for hypertension.
Option C: Magnesium sulphate is not contraindicated; it is an indicated treatment for hypertensive disorders of pregnancy like pre-eclampsia and eclampsia. It acts as a CNS depressant to prevent seizures and also has a mild antihypertensive effect.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological contraindications for uterotonic drugs in hypertensive clients as background academic context rather than a clinical decision trigger.
A nurse's primary safety check before administering Methergine is to assess the patient's blood pressure. Administering it to a hypertensive patient is a serious medication error.
This concept is critical for managing postpartum hemorrhage (PPH), a leading cause of maternal mortality. Knowing which drug is safe for which patient is essential.
What if? If a hypertensive patient has PPH and is not responding to Oxytocin, the next line of treatment would likely be a prostaglandin like Misoprostol or Carboprost (if no asthma), while Methergine remains strictly avoided.

How to Approach the Question

First, identify the key patient condition in the question stem: 'history of hypertension'.
Next, identify the core question: which drug is 'contraindicated' (should not be used).
Review each drug option and recall its primary mechanism of action and major side effects.
Oxytocin: Stimulates uterine contractions, generally safe.
Prostaglandins: Stimulate uterine contractions, caution with asthma for some types.
Magnesium sulphate: CNS depressant, used to treat pre-eclampsia.

Concept Tested & Keywords

Concept Tested: Pharmacological contraindications for uterotonic drugs in hypertensive clients
Stem keywords: contraindicated, laboring client, history of hypertension
Lead-in keywords: Which
Clinical cues: History of hypertension is the key clinical detail that determines the contraindication.

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 242-244

E6 Pharmacology Nurses Shanbhag 3e pp. 242-244, 243-245