Which medication requires monitoring for signs of cyanide toxicity?

Nitroprusside requires monitoring for signs of cyanide toxicity because it is a potent vasodilator that can release cyanide ions when metabolized in the body. This occurs primarily when the drug is administered at high doses or for prolonged periods. Patients receiving nitroprusside must be observed for symptoms of cyanide toxicity, which can include acute confusion, headache, dizziness, palpitations, and in severe cases, seizures, and respiratory failure.

This monitoring is crucial because cyanide is a toxic substance that can interfere with cellular respiration, leading to severe metabolic disturbances. Regular checks on serum cyanide levels may be necessary during nitroprusside administration, especially in patients with liver impairment or those receiving higher doses.

Other medications listed do not have the same risk of cyanide toxicity. Norepinephrine, epinephrine, and phentolamine do not metabolize to cyanide nor significantly pose the same risk associated with nitroprusside administration.