Cardiovascular: ACE inhibitors in pregnancy: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Cardiovascular: ACE inhibitors in pregnancy

Sample item

A woman with hypertension on enalapril finds she is 14 weeks pregnant. What is the best action?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Stop enalapril and switch to labetalol or nifedipine

ACE inhibitors and ARBs cause fetal renal dysgenesis, oligohydramnios, skull hypoplasia and neonatal anuria, especially in the second and third trimesters. They are stopped and replaced by labetalol, nifedipine or methyldopa.

Option by option

  • A. Continue enalapril as it is safe in early pregnancy

    Continuing exposes the fetus to renal toxicity.

  • B. Switch to losartan

    ARBs carry the same fetal toxicity.

  • C. Double the dose of enalapril

    Raising the dose increases fetal risk.

  • D. Stop enalapril and switch to labetalol or nifedipine (correct)

    Correct. Replace with a pregnancy-safe agent.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Stop enalapril and switch to labetalol or nifedipine. ACE inhibitors and ARBs cause fetal renal dysgenesis, oligohydramnios, skull hypoplasia and neonatal anuria, especially in the second and third trimesters.

Why is "Continue enalapril as it is safe in early pregnancy" not the answer?

Continuing exposes the fetus to renal toxicity.

Why is "Switch to losartan" not the answer?

ARBs carry the same fetal toxicity.

Why is "Double the dose of enalapril" not the answer?

Raising the dose increases fetal risk.

What concept does this question test?

It tests Cardiovascular: ACE inhibitors in pregnancy in Pharmacology. They are stopped and replaced by labetalol, nifedipine or methyldopa.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular: ACE inhibitors in pregnancy?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.