Exam (elaborations)
Week 9 Case Study.
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Exam of 7 pages for the course CHEM 219 Organic Chemistry Module 5 at CHEM 219 Organic Chemistry Module 5 (Week 9 Case Study.)
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Scenario 1Problem
Sarah: 32 years old, pregnant, currently 24 weeks pregnant, has hypertension for 3 years.
Her levels of blood pressure today were high at 150/95 mm Hg. Before commencing the present
pregnancy, she was on Lisinopril, an ACE inhibitor, for managing hypertension; however, this
drug was stopped because ACE inhibitors are categorically forbidden in pregnant women. She
has isotretinoin and spironolactone for her acne, and these drugs are not allowed in pregnancy.
Treatment Plan
Managing hypertension in pregnancy is therefore aimed at lowering maternal risk factors
and at the same time not endangering the fetus. Labetalol, methyldopa and nifedipine are
categories B antihypertensive drugs that are safe to utilize during pregnancy. The use of ACE
inhibitors, ARBs, and direct renin inhibitors is contraindicated because these are teratogens.
1. Medication Choice
Labetalol is commonly recommended as the first-line agent for hypertension in
pregnancy because of its safety profile and ability to lower blood pressure effectively
without significantly affecting uteroplacental blood flow (Shah, 2020).
Methyldopa is another option but is typically reserved for cases where labetalol or
nifedipine is not tolerated.
2. Complete Medication Order
Drug: Labetalol 100 mg oral twice daily (BID)
, Route: Oral
Frequency: Twice a day (BID)
Special Instructions: May increase by 100 mg twice daily every 2-3 days if needed to
achieve goal blood pressure.
Dispensed (Days Supply): 60 tablets for 30 days
Refills: 2 refills
Indication: Hypertension in pregnancy
Monitoring: Monitor BP at home and in clinic every 1-2 weeks. Watch for symptoms of
hypotension or bradycardia.
3. Discontinue Current Medications
Isotretinoin (Accutane) should be discontinued immediately as it is a known teratogen
associated with severe birth defects.
Spironolactone should also be discontinued due to its anti-androgenic effects, which can
interfere with fetal development, particularly masculinization of a male fetus (Wilkerson
& Ogunbodede, 2019).
4. Lifestyle Modifications
Reduce caffeine intake to less than 200 mg/day (equivalent to ≤1 cup of coffee per day).
Encourage a low-sodium diet (less than 2,300 mg/day) and regular physical activity such
as walking 30 minutes daily, unless contraindicated.
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