Why ACE inhibitors are contraindicated in pregnancy?

It is well accepted that angiotensin-converting enzyme (ACE) inhibitors are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage. First-trimester use, however, has not been linked to adverse fetal outcomes.

Why are ACE inhibitors teratogenic?

Angiotensin converting enzyme (ACE) inhibitors are thought to produce a fetopathy by inhibiting fetal urine production and therefore only do so when taken in the second and third trimesters: the drugs have been considered safe in the first trimester.

Why are aces and ARBs contraindicated in pregnancy?

Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are known to cause fetal renal damage in pregnancy.

Why are ACE inhibitors contraindicated?

Contraindications to ACEI use include hyperkalemia (>5.5 mmol/L), renal artery stenosis, pregnancy (ACEI or Australian Drug Evaluation Committee [ADEC] pregnancy category D), or prior adverse reaction to an ACEI including angioedema.

Why is enalapril contraindicated in pregnancy?

Enalapril-felodipine is considered contraindicated during pregnancy. Drugs that act directly on the renin-angiotensin system can cause fetal and neonatal morbidity and death when administered during pregnancy. A committee of the National Institutes of Health has recommended that these drugs be avoided during pregnancy.

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Why is hydralazine given during pregnancy?

For many years, hydralazine has been the recommended antihypertensive of first choice for severe hypertension in pregnancy. Its side effects (such as headache, nausea, and vomiting) are common and mimic symptoms of deteriorating pre-eclampsia.

Why Tetracycline is contraindicated in pregnancy and pediatric patient?

Tetracyclines are contraindicated in pregnancy because of the risk of hepatotoxicity in the mother, the potential for permanent discoloration of teeth in the fetus (yellow or brown in appearance), as well as impairment of fetal long bone growth.

Why is captopril contraindicated in pregnancy?

Captopril should not be used during the second and third trimesters of pregnancy because it may be harmful to a developing baby. It’s not recommended in the first trimester unless considered essential by your doctor.

Why are diuretics contraindicated in pregnancy?

Diuretics do not cause fetal malformations but are generally avoided in pregnancy, as they prevent the physiologic volume expansion seen in normal pregnancy. They may be used in states of volume-dependent hypertension, such as renal or cardiac disease.

Why is losartan contraindicated in pregnancy?

Do not take losartan if you are pregnant. If you become pregnant while you are taking losartan, stop taking losartan and call your doctor immediately. Losartan may cause death or serious injury to the fetus when taken in the last 6 months of pregnancy.

Why can ACE inhibitors cause renal failure?

During ACEI initiation, renal dysfunction can occur due to a drop in renal perfusion pressure and subsequent decrease in glomerular filtration. This is attributed to the drug’s preferential vasodilation of the renal efferent arteriole, which impairs the kidney’s ability to compensate for low perfusion states.

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Why do ACE inhibitors cause hyperkalemia?

Main mechanisms contributing to hyperkalemia with ACEi/ARB include decreased aldosterone concentrations, decreased delivery of sodium to the distal nephron, abnormal collecting tubule function, and excessive potassium intake (Table 1).

Why are ACE inhibitors used in CKD?

ACE inhibitors effectively reduce systemic vascular resistance in patients with hypertension, heart failure or chronic renal disease. This antihypertensive efficacy probably accounts for an important part of their long term renoprotective effects in patients with diabetic and non-diabetic renal disease.

Why diuretics are contraindicated in preeclampsia?

This practice became controversial when concerns were raised that diuretics may further reduce plasma volume in women with pre-eclampsia, thereby increasing the risk of adverse effects on the mother and baby, particularly fetal growth.

Why ACE inhibitors are contraindicated in bilateral renal artery stenosis?

Angiotensin-converting enzyme inhibitors (ACEIs) are contraindicated in patients with bilateral renal artery stenosis due to risk of azotemia resulting from preferential efferent arteriolar vasodilation in the renal glomerulus due to inhibition of angiotensin II.