Neurotoxic Reaction

[hypnosis3000]

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I got this question today. What's the answer and why?

A 55 y/o M is brought to the ED with complaints of chest pain, severe headache, and breathing difficulties. Examination reveals a BP of 260/100, a respiratory rate of 60/min, and papilledema. IV drug therapy is continued for several days to normalize his BP and other associated symptoms. After 3 days he develops a neurotoxic syndrome including psychosis, hyperreflexia, confusion, tinnitus, and convulsions. The drug most likely to have caused this neurotoxic reaction is

A. methyldopa
B. diazoxide
C. guanethidine
D. nitroprusside
E. propranolol

I don't recall seeing neurotoxic reactions in First Aid, so I'm kinda confused on this one.
Thanks

 

[loveoforganic2]

I got this question today. What's the answer and why?

A 55 y/o M is brought to the ED with complaints of chest pain, severe headache, and breathing difficulties. Examination reveals a BP of 260/100, a respiratory rate of 60/min, and papilledema. IV drug therapy is continued for several days to normalize his BP and other associated symptoms. After 3 days he develops a neurotoxic syndrome including psychosis, hyperreflexia, confusion, tinnitus, and convulsions. The drug most likely to have caused this neurotoxic reaction is

A. methyldopa
B. diazoxide
C. guanethidine
D. nitroprusside
E. propranolol

I don't recall seeing neurotoxic reactions in First Aid, so I'm kinda confused on this one.
Thanks

My initial guess was between methyldopa (d/t central action) and nitroprusside (only drug I know on that last that's strongly indicated in malignant hypertension). Had no idea for the actual side effect presentation. Some searching seems to indicate that those symptoms are consistent with thiocyanate toxicity (usually secondary to cyanide toxicity, e.g. with use of nitroprusside, while in the setting of renal dysfunction, which could be present due to the malignant hypertension). Not a question a lot of people would know the real answer to imo

 

[wingshorns]

my guess it they want to you realize that nitroprusside contains a cyanide molecule, and may result in cyanide toxicity if it dissociates. similar to how pepto contains bismuth, which can also be extremely toxic when dissociated (ie. by uv light).

 

[hypnosis3000]

Nitroprusside makes sense. I didn't catch how cyanide toxicity would present. I kept on thinking what drug could possibly cause tinnitus and all I came up with was propranolol.

 

[loveoforganic2]

To be clear, I don't think that's direct toxicity of cyanide, but the hepatic "detoxification" product (thiocyanate)