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Old 09-24-2012
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Arrow Gyrus Daily Questions; Internal Medicine #29

A 20-year-old female is seen in the emergency department with symptoms of severe periodic headaches, sweating, and nausea with vomiting. She also complains of feeling light-headed with standing. Her blood pressure on presentation is 240/136, with a heart rate of 92. On standing, the patient has a blood pressure of 204/98, with a heart rate of 136. On ophthalmologic examination the patient has mild blurring of the optic discs without hemorrhage. The examination is otherwise normal. What is the best medication for the management of this patient’s hypertension?

A. Phentolamine
B. Fenoldopam
C. Esmolol
D. Nicardipine
E. Diazoxide
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Old 09-24-2012
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episodic "periodic" HTN -> pheochromocytoma -> best medication is an alpha blocker, preferably phenoxybenzamine, as it is a non-competitive antagonist
but since thats not in the options, & neither is hydralazine, i'm only left with phentolamine
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Old 09-24-2012
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A. Phentolamine

She has Pheo and you need to block alpha receptors first
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Old 09-24-2012
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Answer A.............
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