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An 88-year-old man is brought to the emergency department within 45 minutes of the witnessed onset of dysarthria and right face, arm, and leg weakness. Recombinant tissue plasminogen activator is administered intravenously 105 minutes after symptom onset. The patient is then admitted to the intensive care unit, and 4 hours after thrombolysis, his neurologic symptoms and signs are rapidly improving.
On physical examination, vital signs are normal, except for a blood pressure of 190/105 mm Hg. There is right pronator drift, right facial droop, and mild residual dysarthria.
Which of the following is the most appropriate treatment of this patient™s elevated blood pressure
A Intravenous labetalol
B Intravenous nitroprusside
C Oral nifedipine
D Withholding of antihypertensive
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could u plz send me mksap 15 synopsis ...my id is aafsheen20.
God blees u
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please give the ans .
is it from mksap .which subjests mksap more high yield
thanks in advance
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well give u answer after couple of more responses
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answer is A
In patients who have received recombinant tissue plasminogen activator as treatment of stroke, systolic blood pressure should be maintained below 180 mm Hg and diastolic blood pressure below 105 mm Hg for at least the first 24 hours after thrombolysis treatment. According to current clinical guidelines, intravenous administration of labetalol or nicardipine can best achieve this goal (class II recommendation). Therefore, of the options listed, intravenous administration of labetalol is most appropriate for this patient whose systolic blood pressure is 190 mm Hg and whose diastolic blood pressure is 105 mm Hg.
Intravenous administration of nitroprusside should be instituted only if either labetalol or nicardipine proves unsuccessful in controlling this patient™s blood pressure. Intravenous nitroprusside is considered second-line therapy because it may be associated with increased intracranial pressure.
Oral administration of nifedipine is inappropriate because of its rapid absorption, which can result in a secondary precipitous decline in blood pressure.
Withholding antihypertensive medications is inappropriate in this patient. Excessively high blood pressure is associated with an increased risk of symptomatic hemorrhagic transformation after thrombolytic therapy and may be prevented with careful adjustment of the blood pressure to target levels recommended by treatment guidelines
