**Question:** All of the following drugs are used in hypertensive crisis except:

A. Lisinopril
B. Amlodipine
C. Nitroglycerin
D. Epinephrine

**Core Concept:**
Hypertensive crisis is a severe and life-threatening stage of hypertension where the blood pressure remains persistently high, causing significant organ damage. Treatment in hypertensive crisis focuses on lowering blood pressure rapidly while minimizing potential harm to organs.

**Why the Correct Answer is Right:**
Option D, Epinephrine, is incorrect because it is a sympathomimetic amine that causes vasoconstriction and tachycardia, worsening hypertension. In contrast, all other options are vasodilators that help lower blood pressure.

**Why Each Wrong Option is Wrong:**
A. Lisinopril (Angiotensin-Converting Enzyme Inhibitor) - This drug works by blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Using lisinopril in hypertensive crisis would not help lower blood pressure but may actually worsen it.

B. Amlodipine (Calcium Channel Blocker) - Similar to lisinopril, amlodipine works by blocking the influx of calcium ions into vascular smooth muscle cells, causing vasodilation. Applying amlodipine in hypertensive crisis would be counterproductive.

C. Nitroglycerin (Nitrate) - Nitroglycerin is a vasodilator that works by increasing intracellular cyclic GMP levels, causing vascular smooth muscle relaxation. Applying nitroglycerin in hypertensive crisis would help lower blood pressure.

**Clinical Pearl:**
Nitroglycerin is a valuable drug for the management of acute coronary syndromes, particularly ST-elevation myocardial infarction (MI) due to its ability to dilate coronary arteries and reduce myocardial oxygen demand. However, in hypertensive crisis, using nitroglycerin would be appropriate to lower blood pressure, while avoiding ACE inhibitors, calcium channel blockers, and epinephrine.

**Correct Answer:** C. Nitroglycerin