Is there any additional subjective or objective information you need for this client? Explain
It is essential to know about the patient’s social history, such as smoking. Smoking has many implications during pregnancy, including low birth weight, cardiovascular disease, and preterm labor (Magee et al., 2015). The doctor has to ask about ethnicity as clinical studies on Prinizide show that black patients have a higher risk for angioedema in comparison to non-blacks.
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Objectively, it is important to ask if the patient has insurance and her insurance status as it will affect the choice of medication. Inability to pay for drugs leads to noncompliance and further complications during pregnancy.
Is Prinizide safe in pregnancy? What are the possible complications to the pregnant woman and her fetus?
Prinizide is not safe during pregnancy. Prinizide is a combination of angiotensin-converting enzyme inhibitor and diuretic, and when used in pregnancy, it can cause injury or even death of the fetus. The patient should discontinue Prinizide use immediately once pregnancy is detected. Epidemiological studies on infants whose mothers took ACE inhibitor during the first trimester reported that they had increased risk for major congenital malformations. Risks associated with Prinizide during the second and third trimesters include fetal and neonatal injury, including hypotension, renal failure, and even death.
Why is it important to assess the above laboratory values? How might this information impact your treatment plan?
It is important to assess the patient’s laboratory values, particularly patients with history of hypertension. According to Magee et al. (2015) hypertension in pregnancy requires close monitoring through regular physical exams. The patient’s hypertension is under control as her values are within the normal range. When the values are not within the normal range, for example, in case of elevated blood pressure, the patient might require medication.
Would you make any changes to Ms. BD’s blood pressure medications? Explain. If yes, what would you prescribe?
I will not make any changes to Ms. BD’s as changes can only be made after a consultation with a specialist. However, I will advise Ms. BD about the teratogenic effects of Prinizide and encourage her to stop using. There are other blood pressure medications such as methyldopa, labetalol, and nifedipine, which are the acceptable HTN medications for pregnant women.
Discuss the medications safety in pregnancy, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.
Medications raise issues of safety among pregnant women. There are many medications, such as Prinizide that have teratogenic effects. Certain medications can reach the fetus and cause harm. For oral medication, they are absorbed through passive dilution in the small intestine (Feghali et al., 2015). Some medications can reach the fetus through the same route as oxygen and nutrients by crossing the placenta. The liver is responsible for the metabolism and elimination of drugs. The half-life of the drug depends on the specific drug, dosage, the volume of distribution, and bioavailability. For example, water-soluble drugs are distributed in a diluted state, unlike fat-soluble drugs which are distributed widely. The drugs are eliminated through renal excretion depending on the filtration rate, tubular secretion, and reabsorption. Pregnant women should pay attention to contraindications and black box warnings as they highlight the drug-related risks. Most warnings indicate whether the drug is safe for pregnant women or not.
What health maintenance or preventive education is important for this client based on your choice medication/treatment? Would you treat this patient or refer her? Where would you refer this patient?
The patient needs education on the side effects of the drugs she is taking. The patient is taking Prinizide, which is not safe for pregnant women. The patient needs to be advised about the right medication and adherence to the medication (Lupattelli et al., 2015). As a nurse, I will treat the patient before referring her to an obstetrics specialist for further consultation about her blood pressure.
References
Feghali, M., Venkataramanan, R., & Caritis, S. (2015, November). Pharmacokinetics of drugs in pregnancy. In Seminars in perinatology (Vol. 39, No. 7, pp. 512-519). WB Saunders.
Lupattelli, A., Spigset, O., Björnsdóttir, I., Hämeen ‐ Anttila, K., Mårdby, A. C., Panchaud, A., & Twigg, M. J. (2015). Patterns and factors associated with low adherence to psychotropic medications during pregnancy—a cross ‐ sectional, multinational web ‐ based study. Depression and anxiety , 32 (6), 426-436.
Magee, L. A., von Dadelszen, P., Rey, E., Ross, S., Asztalos, E., Murphy, K. E., & Gruslin, A. (2015). Less-tight versus tight control of hypertension in pregnancy. New England Journal of Medicine , 372 (5), 407-417.
