Your answer
(C) is not the one that we were looking for! (A) is correct!
- Nitroprusside is the drug of choice in patients
with hypertensive encepholapathy.
- IV nitroglycerin (NTG) may also be useful since
it offers a more gentle decrease in blood pressure and may be tried
first before switching over to nitroprusside.
- Blood pressure should be reduced by 25% of the
mean arterial pressure and should not be reduced below a diastolic BP
of 100-120 mm Hg. If BP is lowered beyond this point, autoregulation
of the brain and kidney will be impaired secondary to the decrease in
renal and cerebral perfusion.
- Agents used to treat hypertensive encepholapathy
should have few or no CNS side effects
For this reason, clonidine and rarely used agents like methyldopa (Aldomet®)
and reserpine should be avoided.
- Diazoxide should also be avoided because it
can reduce cerebral flow. Also, the decrease in blood pressure may be
less predictable and more difficult to regulate than intravenous infusion
of nitroprusside and NTG
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