A person has headache & profuse sweating. On examination his B.P is 200/120 mm Hg. Which of the following shoud not be used
**Core Concept**
The patient's presentation of hypertension (200/120 mm Hg) along with headache and profuse sweating suggests a hypertensive crisis, which requires immediate attention. In this scenario, the choice of antihypertensive medication is crucial to prevent further complications.
**Why the Correct Answer is Right**
The correct answer is **Labetalol** (Option not provided). Labetalol is a non-selective beta-blocker with alpha-1 adrenergic blocking activity. However, in the setting of a hypertensive crisis, beta-blockers can worsen cardiac output and increase peripheral resistance, potentially leading to a paradoxical increase in blood pressure. This is particularly concerning in the presence of a high heart rate, as seen in this patient.
**Why Each Wrong Option is Incorrect**
* **Option A:** Nitroglycerin is often used to manage hypertensive crises, especially when there is evidence of cardiac ischemia or heart failure. It works by dilating blood vessels and reducing cardiac preload and afterload.
* **Option B:** Sodium nitroprusside is a potent vasodilator that can be used to manage severe hypertension. It works by releasing nitric oxide, which relaxes vascular smooth muscle and reduces blood pressure.
* **Option C:** Enalapril is an ACE inhibitor that can be used to manage hypertension. It works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.
**Clinical Pearl / High-Yield Fact**
In the setting of a hypertensive crisis, it is essential to choose an antihypertensive medication that can be titrated quickly to achieve the desired effect. Sodium nitroprusside is often the preferred choice due to its rapid onset of action and ability to be titrated easily.
**Correct Answer:** A.