lucky_doc
Forum Junior
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a 48 yo M presents to the ED complaining of stabbing abdominal pain that increases when he tries tgo eat. He admits to current cocaine and alcohol use. On examination, he is hypertensive to 162/100 mmHg, and diaphoretic. His amylase and lipase confirm that he has acute pancreatitis. He is placed on empiric antibiotics, agressive intravenous fluids, and is made NPO status. His BP remains elevated. What agent should the physician use to lower is blodd pressure?
A Alprenolol
B Atenolol
C Lorazepam
D Metoprolol
E Verapamil
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| Korotkoff
Forum Senior
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E?
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| neuroblastoma
Forum Guru
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A.Alprenolol has little to no intrinsic sympathomimetic activity and, unlike some other beta-adrenergic blocking agents, alprenolol has little direct myocardial depressant activity and does not have an anesthetic-like membrane-stabilizing action.
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| farnsworth
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the patient is diaphoretic, hypertensive, and admits to currently abuse cocaine and EtOH? sounds like withdrawal coming his way...
lorazepam, though it's not an antihypertensive drug per se... (my choice would be clonidine)
Beta receptor antagonists are notorious for causing acute pancreatitis (as well as: diuretics, ACEI, methyldopa, estrogens! -> OCPs!, glucocorticosteroids, erythromycin, rifampicin, tetracycline, didanosin, zalcitabin, valproate, carbamazepin, NSAIDs, mesalazin, sulfasalazin, gold salts, cyclosporin, azathioprine, mercaptopurine).
does anyone have information on verapamil and hypocalcemia?
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| Ivonne
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If concomitant use of alcohol wouldn't be there, the answer would be easy------>C but benzodiazepines can be very dangerous with alcohol so i guess will go with --------->E but i am not sure...
All b-blockers are contraindicated here.
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| neuroblastoma
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yes agree with C
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| farnsworth
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lorazepam is not that dangerous, as long as it is titrated for effect (usually it takes more than one doctor to kill a patient ;-). the patient should be transferred to the ICU anyway.
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| farnsworth
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd...
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| Korotkoff
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how does lorazepam lower the blood pressure?
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| farnsworth
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withdrawal -> stress -> activation of the sympathetic nervous system -> plasma levels of epinephrine (and to a certain degree norepinephrine) increase -> tachycardia and hypertension.
you can use lorazepam to treat withdrawal (of course you can use a drug that directly lowers the blood pressure, but you should treat the disease if possible, not just cover the symptoms).
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| sandra
Forum Guru
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C
looks like cocaine induced hypertension. treatment is BZs. moreover, lorazepam is also helpful in alcohol withdrawal. correct me if im wrong.
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| lucky_doc
Forum Junior
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Good guess guys C is the answer 
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