Rosh Internal Medicine Boost Practice Exam

In a patient with severe hypertension and kidney dysfunction, which medication is contraindicated for blood pressure control?

1. Esmolol

2. Labetalol

3. Nicardipine

4. Nitroprusside

The correct answer is: Nitroprusside

In the context of severe hypertension and kidney dysfunction, nitroprusside is contraindicated due to its potential adverse effects, specifically the risk of cyanide toxicity. Nitroprusside is a potent vasodilator that acts quickly to lower blood pressure, but in patients with impaired renal function, the metabolism of nitroprusside can lead to accumulation of toxic levels of cyanide and thiocyanate, especially if used for extended periods or at high doses. This toxicity can exacerbate kidney damage and significantly harm the patient. Esmolol, labetalol, and nicardipine are generally safer alternatives. Esmolol is a short-acting beta-blocker that can be used effectively in acute settings. Labetalol is a non-selective beta-blocker with alpha-1 blocking activity that is also safe for use in patients with kidney dysfunction. Nicardipine is a calcium channel blocker that can be used to manage blood pressure in various clinical scenarios, including those with renal impairment.