A woman who takes an angiotensin converting enzyme inhibitor for ...

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A woman who takes an angiotensin converting enzyme inhibitor for hypertension tells her primary care NP that she is trying to get pregnant. The NP should:
 
  a. consider replacing her angiotensin converting enzyme inhibitor with methyldopa.
  b. lower her angiotensin converting enzyme inhibitor dose during the first trimester.
  c. counsel her to increase her antihypertensive medications during pregnancy.
  d. add an angiotensin receptor blocker (ARB) during the first trimester of her pregnancy.

Question 2

A woman who is pregnant develops gestational diabetes. The NP's initial action is to:
 
  a. prescribe an oral antidiabetic agent.
  b. give her information about diet and exercise.
  c. begin treating her with daily insulin injections.
  d. reassure her that her glucose levels will return to normal after pregnancy.

[angrybirds13579]

Answer to Question 1

A
Angiotensin converting enzyme inhibitors, ARBs, and statins are contraindicated during the first trimester of pregnancy and should be discontinued before conception and replaced by safer alternatives, such as methyldopa. The use of antihypertensives during pregnancy remains controversial; increasing the dose is not indicated.

Answer to Question 2

B
Patients with gestational diabetes should be treated with diet and exercise, with insulin added as needed for poor control. There is insufficient evidence to support the use of oral antidiabetic agents during pregnancy, and some of these are pregnancy category D. Insulin injections may be used but are not the initial intervention. Although glucose levels will return to prepregnancy values in the postpartum period, the NP must initiate therapy.

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Gracias!

[pratush dev]

Excellent