Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 25-year-old woman comes for a preconception evaluation

mksap
Conditions
January 24, 2015
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 25-year-old woman comes for a preconception evaluation. She has a history of hypertension that is well controlled with lisinopril. Medical history is otherwise unremarkable.

On physical examination, blood pressure is 134/86 mm Hg in both upper extremities; other vital signs are normal. Results of the cardiovascular examination are unremarkable. There is no edema, cyanosis, digital clubbing, or radial artery-femoral artery pulse delay.

Laboratory studies reveal normal electrolytes, complete blood count, thyroid-stimulating hormone level, kidney function, and urinalysis.

An electrocardiogram is normal.

In addition to starting a prenatal vitamin, which of the following medication adjustments should be made before this patient proceeds with pregnancy?

A: Discontinue lisinopril
B: Substitute labetalol for lisinopril
C: Substitute losartan for lisinopril
D: Substitute spironolactone for lisinopril

MKSAP Answer and Critique

The correct answer is B: Substitute labetalol for lisinopril.

This patient has essential hypertension and should be switched from lisinopril to labetalol before pregnancy. Exposure to ACE inhibitors such as lisinopril during the first trimester has been associated with fetal cardiac abnormalities, and exposure during the second and third trimesters has been associated with neonatal kidney failure and death. Angiotensin receptor antagonists such as losartan have been associated with similar fetal toxicity as ACE inhibitors, most likely because of the dependence of the fetal kidney on the renin-angiotensin system. Therefore, both of these agents are pregnancy category X drugs and are contraindicated throughout pregnancy and in women planning to conceive.

Labetalol is a pregnancy risk category C drug and is commonly used during pregnancy owing to its combined α- and β-blocking properties and because it does not compromise uteroplacental blood flow. Methyldopa also is used extensively in pregnancy and is one of the only agents in which long-term follow-up of infants exposed in utero has proved to be safe. Furthermore, methyldopa is the only agent classified as a pregnancy category B drug. However, controlling blood pressure with single-agent methyldopa is often difficult, and many women are bothered by its sedating properties.

Cessation of antihypertensive therapy in a patient with hypertension is not recommended before pregnancy.

Aldosterone antagonists such as spironolactone have an antiandrogenic effect on the fetus when exposure occurs during the first trimester and should be avoided in women planning to conceive.

Key Point

ADVERTISEMENT

  • ACE inhibitors, angiotensin receptor blockers, and aldosterone antagonists should be avoided during pregnancy and in women planning to conceive.

This content is excerpted from MKSAP 16 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

Top stories in health and medicine, January 24, 2015

January 24, 2015 Kevin 0
…
Next

The gifts of burnout: An evolutionary wake-up call for doctors

January 24, 2015 Kevin 11
…

Tagged as: Cardiology

Post navigation

< Previous Post
Top stories in health and medicine, January 24, 2015
Next Post >
The gifts of burnout: An evolutionary wake-up call for doctors

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

More in Conditions

  • The hidden dangers of over-the-counter weight-loss supplements

    STRIPED, Harvard T.H. Chan School of Public Health
  • How denial of hypertension endangers lives and what doctors can do

    Dr. Aminat O. Akintola
  • How physicians can reclaim resilience through better sleep, nutrition, and exercise

    Kim Downey, PT & Shirish Sachdeva, PT, DPT & Ziya Altug, PT, DPT
  • Who are you outside of the white coat?

    Annia Raja, PhD
  • How hospitals can prepare for CMS’s new patient safety rule

    Kim Adelman, PhD
  • The humanity we bring: a call to hold space in medicine

    Kathleen Muldoon, PhD
  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Reframing self-care as required maintenance for physicians [PODCAST]

      The Podcast by KevinMD | Podcast
    • Focusing on well-being versus wellness: What it means for physicians (and their patients)

      Kim Downey, PT & Nikolai Blinow & Tonya Caylor, MD | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Reframing self-care as required maintenance for physicians [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden dangers of over-the-counter weight-loss supplements

      STRIPED, Harvard T.H. Chan School of Public Health | Conditions
    • Implementing value-based telehealth pain management and substance misuse therapy service

      Olumuyiwa Bamgbade, MD | Physician
    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • A powerful story of addiction, strength, and redemption

      Ryan McCarthy, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Reframing self-care as required maintenance for physicians [PODCAST]

      The Podcast by KevinMD | Podcast
    • Focusing on well-being versus wellness: What it means for physicians (and their patients)

      Kim Downey, PT & Nikolai Blinow & Tonya Caylor, MD | Physician
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • Reframing self-care as required maintenance for physicians [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden dangers of over-the-counter weight-loss supplements

      STRIPED, Harvard T.H. Chan School of Public Health | Conditions
    • Implementing value-based telehealth pain management and substance misuse therapy service

      Olumuyiwa Bamgbade, MD | Physician
    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • A powerful story of addiction, strength, and redemption

      Ryan McCarthy, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...