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What is Which of the following is not used in pre-eclampsia? and explain in detail?
(B) Atenolol[?]Objectives of treatment of Pre-Eclampsia:To stabilise hypertension & to prevent its progression to severe pre-eclampsia.To prevent the complicationsTo prevent eclampsiaDelivery of a healthy baby in optional time.Restoration of the health of the mother in puerperium.ANTIHYPERTENSIVE DRUGS USED IN PREGNANCYThese agents* may be used with chronic hypertension (DBP>100mmHg) or acute hypertension (DBP>105mmHg)Central Alpha agonistsMethyldopa is the drug of choiceBeta blockers & Alpha, beta blockersAtenolol, metoprolol & labetalo) appear safe & effective in late pregnancyCalcium antagonistsPotential synergism with magnesium sulfate may lead to precipitous hypotension.[?]Treatment of Chronic Hypertension:Methyldopa, labetalol & nifedipine most common oral agents.AVOID: ACEI & ARBs, atenolol, thiazide diureticsWomen in active labor with uncontrolled severe chronic hypertension require treatment with intravenous labetalol or hydralazine.No other additional maternal/fetal complications = wait until >38w.Oral Antihypertensive for Control of Mild to Moderate Hypertension in Pregnancy*. Methyldopa*. A drug of first choice; Central & peripheral anti adrenergic action*. Labetalol*. A reasonable alternative; Adrenoceptor antagonist (Alpha & Beta blocker)*. Atenolol*. To be avoided*. Nifedipine*. Calcium channel blocker in late pregnancy; Calcium channel blocker*. Propranolol*. Can be used in late pregnancy*. Hydralazine*. Add on therapy to Methyldopa; Vascular smooth muscle relaxant*. ACE inhibitors*. To be avoided*. Diuretics*. Not to be used as antihypertensiveManagement of HTN disorder:Antihypertensive Therapy:Non-severe hypertension (BP:140-159/90-10gmmHg)-BP goal: w/o cormorbid - 130-155/80-105-BP goal: w/o cormorbid - 130/139/80-8gDrug of Choice: Methyldopa, labetalol, other beta blockers, CCB (nifedipine). (I-A)ACEi & ARBs should not be used. (II-2E)Atenolol & prazosin are not recommended.Level A;ACE inhibitors & angiotension receptor blockers; Contraindicated in all trimesters of pregnancy.Level B:Woman with severe HTN - require antihypertensive medication for acute | BP.Methyldopa & Labetalol; a good option for 1st line tx of chronic HTN in pregnancy - based on the overall low rate of adverse effects & good efficacy.Atenolol; not currently recommended due to IUGR.Thiazide used in women before pregnancy.No need to be discontinued during pregnancy.Antihypertensives use in Pre-Eclampsia:Have limited value in controlling blood pressure in pre-eclampsia.Indications for anti-hypertensive drugs are:-In persistent rise of blood pressure (If diastolic BP>110mmHg, & if urgent & associated with proteinuria).-In severe pre-eclampsia (to reduce BP during continued pregnancy & during period of induction of labor).