What medication should be administered prior to initiating nitroprusside therapy?

Prior to initiating nitroprusside therapy, it is important to administer a beta blocker. Nitroprusside is a potent vasodilator used to quickly reduce blood pressure, particularly in hypertensive emergencies. However, its rapid action can lead to reflex tachycardia, which can potentially exacerbate certain underlying cardiac conditions, particularly in patients with coronary artery disease or those with heart failure.

Using a beta blocker prior to or concurrently with nitroprusside helps to mitigate this reflex tachycardic response. By blocking the beta-adrenergic receptors, beta blockers reduce heart rate and myocardial oxygen demand, providing a more controlled hemodynamic response and offering additional protection to the myocardium during acute blood pressure management.

While other medications in the options, such as calcium channel blockers, ACE inhibitors, or diuretics, have their own roles in treating hypertension or heart failure, they do not specifically address the reflex tachycardia caused by nitroprusside like beta blockers do. Hence, the best practice involves starting beta blockers as a preventive measure in conjunction with nitroprusside therapy.