ANTIHYPERTENSIVES THERAPY AND MONITORING IN PRE-ECLAMPSIA: ROLE OF THE PHARMACIST

Main Article Content

Francis Fordjour
Edward Tieru Dassah
Kofi Boama Mensah
Adu Appiah-Kubi
Patrick Amoateng
Boabeng Kwame Ohene
Darko Kwadwo Addae

Keywords

antihypertensives in pre-eclampsia, obstetrics, hypertension in pregnancy, monitoring, pharmacists’ role

Abstract

Pre-eclampsia is an obstetric disorder that affects the prognosis of pregnancy, resulting in complications or mortalities. It is typically associated with hypertension which should be managed pharmacologically to protect the health of the mother and the fetus. Yet, not much is known about pharmacists’ roles and commitment to pre-eclampsia management. In this review, we update pharmacists on antihypertensives indicated in pre-eclampsia as well as parameters they have to monitor during pharmacotherapy in line with their duty of care to women with pre-eclampsia. Using recent evidence from 16 national/international guidelines (2014-2022), we compared antihypertensives approved for use in pregnancy and highlighted major drug information that pharmacists require to optimize the use of these medications in pre-eclampsia. Intravenous labetalol, hydralazine or oral nifedipine agents are mostly indicated in pre-eclampsia with severe hypertension. In mild-moderate hypertension, oral agents such as methyldopa, labetalol, sustained released nifedipine and hydralazine are the commonest recommendations. While monitoring for maternal bronchoconstriction, neonatal bradycardia or hypoglycemia is required with the administration of intravenous labetalol; intravenous hydralazine is observed for maternal shock; nifedipine for tachycardia, headache, ankle edema and methyldopa for depression if use is extended to the postpartum period. Controlled hypertension in pre-eclampsia mitigates maternal vascular complications. Apart from early referral and counselling of pregnant women at risk, pharmacists with sound knowledge of the pharmacotherapy of pre-eclampsia could advise on appropriate antihypertensive therapy and follow on to ensure that these medicines are responsibly used for optimal outcomes. These roles by pharmacists, may reduce adverse maternal outcomes associated with pre-eclampsia.


 

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