Prescribing Medications for Patient Treatment

SCENARIO : Sarah Johnson – Hypertension in Pregnancy

Problem: Sarah Johnson, a 32-year-old pregnant female at 24 weeks gestation, presents with a history of hypertension, previously treated with Lisinopril, which was discontinued due to pregnancy. Her current blood pressure of 150/95 mmHg indicates uncontrolled hypertension.

Background: Hypertension in pregnancy is a significant risk factor for maternal and fetal complications, including preeclampsia, preterm birth, and fetal growth restriction (Agrawal & Wenger, 2020). ACE inhibitors like Lisinopril are contraindicated in pregnancy due to their teratogenic effects, requiring alternative treatment.

Treatment Goals: The goal is to reduce Sarah’s BP to below 140/90 mmHg, minimizing the risk of complications while maintaining safety for both the mother and fetus (Garovic et al., 2022). Medications that are safe in pregnancy must be selected.

Medication Options: First-line antihypertensive drugs during pregnancy include methyldopa, labetalol, and nifedipine (Conti-Ramsden et al., 2024).

Methyldopa: It acts centrally by inhibiting sympathetic outflow, reducing BP. It is safe in pregnancy but may cause sedation, which can affect patient adherence.

Labetalol: A combined alpha and beta-blocker that reduces BP without significantly affecting uteroplacental blood flow.

Nifedipine (extended-release): A calcium channel blocker that can also be used, especially in cases of severe hypertension.

Given Sarah’s elevated BP, labetalol is preferred for its efficacy and safety profile.

Medication Order:

· Drug: Labetalol 100 mg

· Dose: 100 mg

· Route: Oral

· Frequency: Twice daily (BID)

· Special instructions: Titrate dose upward every 1-2 weeks, as needed, to achieve target BP

· # Dispensed: 30-day supply

· Refills: 1

Monitoring:

· Weekly BP checks to ensure the treatment is effective.