A client at 9 weeks gestation arrives at the clinic for an initial obstetric appointment. The nurse reviews the client's medical history and obtains a list of current medications. The nurse recognizes that which of the following medications should be clarified with the health care provider immediately? Select all that apply.

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11ecbb05_ccb3_d1b0_b433_255e9456d0a6_MD0009_00 Clients with preexisting conditions (eg, asthma, hypertension, diabetes) may require changes to medication therapy if they become pregnant. In particular, teratogenic or unnecessary medications should be discontinued (before conception, when possible). The nurse should refer a client taking contraindicated medications to a health care provider immediately. For example: Doxycycline, a tetracycline antibiotic, is avoided in pregnancy because it can impair bone mineralization and discolor permanent teeth in the fetus (Option B). Isotretinoin (Accutane) has a black box warning for severe birth defects. Retinoids may not be prescribed to women of childbearing age without a formal agreement to participate in iPLEDGE (a prescription tracking program) and a commitment to use two forms of contraception (Option D). ACE inhibitors such as lisinopril (Prinivil) have a black box warning for use in pregnancy because they can affect fetal renal function and lung development or cause fetal death (Option F). (Option A) Albuterol, an inhaled beta agonist, has not been conclusively proved to be safe during pregnancy but should be continued when medically indicated (eg, severe asthma) to prevent the risks of asthma during pregnancy (eg, preterm birth, growth restriction). (Option C) Insulin is safe for use during pregnancy and is commonly used to treat pregestational or gestational diabetes. (Option E) Levothyroxine (Synthroid) for treatment of hypothyroidism is safe but should be monitored carefully to ensure an appropriate dose due to physiological changes in pregnancy. Educational objective: Commonly used medications that are absolutely contraindicated in pregnancy include doxycycline, isotretinoin, and ACE inhibitors.

A Client at 9 Weeks Gestation Arrives at the Clinic