December 4, 2022

Hypertension in Pregnancy

Anti-hypertensives in pregnancy 🤰🏻⁠

✏️ Hypertension is defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Chronic hypertension occurs before pregnancy or before 20 weeks gestation and gestational hypertension occurs after 20 weeks⁠

⚠️ Complications of high blood pressure include increased risks for preeclampsia/eclampsia/stroke for the mother and preterm delivery for the baby⁠

📖 As with most medications in pregnancy, antihypertensives have not been evaluated in robust randomized controlled trials. Check out the post for the preferred anti-hypertensive drugs used in pregnancy. ⁠

⭐ Methyldopa is recommended first-line due to its proven safe and effective use in pregnancy due to its long history of safety in pregnancy but its use in clinical practice may be less due to adverse reactions (e.g., fatigue, dizziness).⁠

Aminoglycosides

Aminoglycosides – ‘The 3 Amigos’⁠

⭐ AMINOglycosides are antibiotics comprised of AMINO acid sugars that are linked together. ⁠

3️⃣ The three most commonly used are (mnemonic: TAG): ⁠
-Tobramycin⁠
-Amikacin⁠
-Gentamicin⁠

Other agents include plazomicin, streptomycin, and neomycin. ⁠

⭐ They are used for serious infections caused by gram-negative bacteria such as complicated UTIs, sepsis, or intraabdominal infections. They can also be used in combination with other agents for infectious caused by gram-positive bacteria in endocarditis. ⁠

⭐ MOA: they kill bacteria by binding onto 30S ribosomal subunits inhibiting the bacteria’s ability to synthesize proteins, leading to cell death⁠

⭐ Other key facts to know:⁠
-Adverse effects include nephrotoxicity and ototoxicity⁠
-They are approximately 70-95% excreted renally⁠
-They are concentration-dependent bacterial killers, which means bacterial killing increases with rising drug concentrations⁠
-Monitor serum drug levels (troughs and peaks), serum creatinine, BUN, urine output, and hearing⁠.