A young adult presents with chest pain, marked hypertension, agitation and ventricular ectopy shortly after intranasal drug use. The ECG shows ST depression. Which drug should be AVOIDED in managing his arrhythmia?
- A Benzodiazepines
- B Nitroglycerin
- C Propranolol ✓
- D Aspirin
Correct answer: C. Propranolol
Explanation
Cocaine blocks presynaptic reuptake of dopamine, noradrenaline and serotonin, producing sympathomimetic excess with coronary vasospasm and thrombosis. Non-selective beta blockers such as propranolol leave alpha-mediated vasoconstriction unopposed and can worsen coronary spasm and hypertension, so they are avoided. Benzodiazepines are first line, nitrates relieve spasm, and aspirin addresses platelet aggregation in cocaine-associated myocardial infarction.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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