American Board of Internal Medicine (ABIM) Certification Practice Exam

To prevent vasospasm following aneurysmal subarachnoid hemorrhage, what medication is recommended?

1. Oral nimodipine

2. Intravenous nitroglycerin

3. Oral aspirin

4. Injectable heparin

The correct answer is: Oral nimodipine

Oral nimodipine is the recommended medication to prevent vasospasm following aneurysmal subarachnoid hemorrhage. This medication is a calcium channel blocker that works by relaxing blood vessels, thus improving blood flow and reducing the risk of vasospasm, which is a common complication after subarachnoid hemorrhage. Nimodipine specifically targets cerebral arteries and has been shown through clinical studies to significantly decrease the incidence of delayed cerebral ischemia, a serious complication that can lead to poor outcomes in patients post-hemorrhage. The utilization of nimodipine is also important due to its specific formulation and ability to cross the blood-brain barrier, which is crucial in addressing vascular changes in the brain. By administering nimodipine orally, it can effectively achieve therapeutic levels in the central nervous system over an extended period, providing ongoing protection against vasospasm. In contrast, the other options do not have the same targeted effect on preventing vasospasm following subarachnoid hemorrhage. Intravenous nitroglycerin, while it does cause vasodilation, is not specific to cerebral vasospasm and is generally more used for managing acute coronary syndromes. Oral aspirin has been studied for various cardiovascular benefits but does