You are using an outdated browser. Please upgrade your browser to improve your experience.
Become a Fellow
ACP offers a number of resources to help members make sense of the MOC requirements and earn points.
Understanding MOC Requirements
Earn MOC points
The most comprehensive meeting in Internal Medicine.
April 11-13, 2019
Internal Medicine Meeting 2019
Prepare for the Certification and Maintenance of Certification (MOC)
Exam with an ACP review course.
Board Certification Review Courses
MOC Exam Prep Courses
Treating a patient? Researching a topic? Get answers now.
Visit AnnalsLearn More
Visit MKSAP 17 Learn More
Visit DynaMed Plus
Ensure payment and avoid policy violations. Plus, new resources to help you navigate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Access helpful forms developed by a variety of sources for patient charts, logs, information sheets, office signs, and use by practice administration.
ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas:
© Copyright 2018 American College of Physicians. All Rights Reserved. 190 North Independence Mall West, Philadelphia, PA 19106-1572
Toll Free: (800) 523.1546 · Local: (215) 351.2400
Adjust medications in a woman who may become pregnant.
Discontinuation of atorvastatin is indicated in this patient who is planning pregnancy. Statin medications should be avoided in pregnancy due to the potential risk for congenital abnormalities. In patients actively planning pregnancy, dyslipidemia is best managed with diet and lifestyle modification for the duration of the pregnancy. Because the effects of statin use during breastfeeding are not known, their use during nursing should be discouraged.
ACE inhibitors and angiotensin receptor blockers are also contraindicated due to potential risk of teratogenicity and should be discontinued in women who are planning pregnancy, as was done in this patient. Her hypertension should be followed and treated, if needed, with another agent known to be safe in pregnancy, such as β-blockers, calcium channel blockers, or methyldopa.
Oral antidiabetic agents should be continued in women contemplating pregnancy to maintain control of diabetes mellitus. Metformin is an FDA pregnancy category B medication (no definitive studies in pregnant women but no animal studies showing risk to the fetus) and is a reasonable option for controlling this patient's hyperglycemia before pregnancy. Evidence suggests that metformin and sulfonylureas are acceptable during pregnancy; however, further management decisions are best made through co-management of medical and obstetric issues with a high-risk obstetrician.
In the treatment of depression, medication discontinuation may not be appropriate in women with a history of major or recurrent depression. Some selective serotonin reuptake inhibitors (SSRIs), including sertraline and fluoxetine, are FDA pregnancy category C (no definitive studies in pregnant women but evidence of potential harm in animal reproduction studies, although potential benefits may warrant use despite potential risks), and their use must be determined on an individual basis. Such agents may be continued if needed, but the risks and benefits of treatment, taking into account severity of depressive symptoms, stage of gestation, and associated circumstances, should be evaluated by a psychiatrist or high-risk obstetrician. SSRIs should not be stopped precipitously.
Because this patient is on a known medication classified as FDA pregnancy category X (atorvastatin), continued treatment with this agent would be inappropriate.
Statins, ACE inhibitors, and angiotensin receptor blockers are teratogenic and should be discontinued in women planning pregnancy.
Callegari LS, Ma EW, Schwarz EB. Preconception care and reproductive planning in primary care. Med Clin North Am. 2015 May;99(3):663-82. [PMID: 25841606]
Back to the January 2018 issue of ACP International