Which medication class should be avoided in cocaine-associated agitation due to risk of unopposed alpha-adrenergic effects?

Which medication class should be avoided in cocaine-associated agitation due to risk of unopposed alpha-adrenergic effects?

• A. Beta blockers
• B. Benzodiazepines
• C. Antipsychotics
• D. Opioids

Answer: (A)

Key concept: cocaine causes a surge of sympathetic activity with strong alpha-adrenergic vasoconstriction. Blocking beta receptors removes the heart’s and vessels’ beta-mediated counterbalance, leaving alpha effects unopposed. That can drive dangerous hypertension and coronary vasospasm, increasing the risk of myocardial ischemia. So beta-blockers are avoided in cocaine-associated agitation. Treat with benzodiazepines to reduce agitation and sympathetic tone; if needed, employ alpha-adrenergic blockade (like phentolamine) for hypertension or vasospasm, and manage chest pain with nitrates.

Key concept: cocaine causes a surge of sympathetic activity with strong alpha-adrenergic vasoconstriction. Blocking beta receptors removes the heart’s and vessels’ beta-mediated counterbalance, leaving alpha effects unopposed. That can drive dangerous hypertension and coronary vasospasm, increasing the risk of myocardial ischemia. So beta-blockers are avoided in cocaine-associated agitation. Treat with benzodiazepines to reduce agitation and sympathetic tone; if needed, employ alpha-adrenergic blockade (like phentolamine) for hypertension or vasospasm, and manage chest pain with nitrates.