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You have a 44 y/o female patient with an arterial line monitoring her blood pressure which is reading 302/156 mm Hg. Her heart rate is 140 bpm. Her history reveals she is taking a monoamine oxidase inhibitor (MAOI) and has inadvertantly ingested tyramine at her friend's cheese/wine party. What do you do?
- Conditions producing hypertensive crisis from catecholamine surges (phenylephrine overdose, cocaine, tyramine interactions, pheochromocytoma) can be treated with phentolamine
- Phentolamine is a nonspecifc alpha blocking agent which produces peripheral vasodilation with a resultant fall in blood pressure in most patients.
- Other uses include extravasation of some vasopressors (e.g. norepineprhine)
- May see an increase in HR after administration (once alpha blockade is established, beta-blocker can be administered)
- Dose: 5-15 mg IV/IM
- Duration: 30-45 minutes