A 28-year-old man presents with chest pain, agitation, and blood pressure 210/120 mmHg shortly after crack cocaine use. ECG shows sinus tachycardia without ST changes. Which management is most appropriate?
- A Intravenous labetalol monotherapy
- B Oral clonidine loading
- C Intravenous benzodiazepine with phentolamine if BP remains elevated ✓
- D Intravenous furosemide infusion
Correct answer: C. Intravenous benzodiazepine with phentolamine if BP remains elevated
Explanation
Cocaine induced hypertension and ischemia are managed first with benzodiazepines, which reduce central sympathetic outflow. Phentolamine is the preferred antihypertensive if BP remains high. Pure beta blockers such as propranolol are avoided because unopposed alpha mediated vasoconstriction can raise BP and worsen coronary vasospasm. Labetalol has significant beta activity and is not recommended as monotherapy in cocaine toxicity.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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