A 24-year-old man is brought with agitation, chest pain, and severe hypertension (200/110 mm Hg) after insufflating a white crystalline substance at a party. ECG shows ST elevation in leads V1-V3. Which medication is contraindicated in the acute management of this patient?

• A Lorazepam
• B Nitroglycerin
• C Phentolamine
• D Propranolol ✓

Explanation

The presentation is consistent with cocaine-induced acute coronary syndrome with severe hypertension and tachycardia. Cocaine blocks norepinephrine reuptake, causing alpha- and beta-adrenergic stimulation. Beta-blockers unopposed alpha-adrenergic stimulation worsens vasoconstriction and hypertension, making them contraindicated. Benzodiazepines are first-line, and phentolamine or nitroglycerin are preferred for vasodilation.

Reference: Harrison's Principles of Internal Medicine, 20th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.