A male patient presents with headache, profuse sweating and palpitations with a blood pressure of 180/120 mm Hg. The drug of choice would be
## **Core Concept**
The patient's presentation of headache, profuse sweating, palpitations, and significantly elevated blood pressure (180/120 mm Hg) is suggestive of a **hypertensive crisis**, specifically **pheochromocytoma crisis**. This condition is caused by excessive release of catecholamines (adrenaline and noradrenaline) from a pheochromocytoma, a type of tumor that arises from the adrenal glands.
## **Why the Correct Answer is Right**
The drug of choice in managing a pheochromocytoma crisis is a medication that can effectively block the alpha-adrenergic receptors to counteract the effects of excessive catecholamines. **Phentolamine** is a non-selective alpha-adrenergic blocker that can rapidly control blood pressure in such cases. It works by blocking the alpha-1 and alpha-2 adrenergic receptors, thereby reducing vascular tone and blood pressure. Its ability to quickly manage hypertensive emergencies associated with pheochromocytoma makes it the correct choice.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because, although beta-blockers like propranolol can control some symptoms like palpitations and tachycardia, they should not be used as the initial treatment in a pheochromocytoma crisis. Beta-blockers can cause unopposed alpha-adrenergic receptor stimulation, potentially worsening hypertension.
- **Option B:** This option is incorrect as it does not specify a medication.
- **Option D:** This option is incorrect because nifedipine, a calcium channel blocker, can be used to manage hypertension but is not the first-line treatment for a pheochromocytoma crisis. It does not address the underlying cause as effectively as phentolamine.
## **Clinical Pearl / High-Yield Fact**
A crucial point to remember is that in the management of pheochromocytoma, **alpha-blockade should be initiated before beta-blockade** to prevent a sudden increase in blood pressure. Phentolamine is specifically useful in emergencies due to its rapid onset of action.
## **Correct Answer:** C. Phentolamine.