A patient with episodic headache, sweating and palpitations has hypertension and a confirmed adrenal phaeochromocytoma. Before surgery, which drug should be started first?
Answer and explanation
Correct answer: D. An alpha-blocker such as phenoxybenzamine
- Step 1: Catecholamine excess drives vasoconstriction and tachycardia. Step 2. Alpha blockade is started first to control hypertension and volume, and a beta-blocker is added later for tachycardia. Answer: An alpha-blocker such as phenoxybenzamine. Why not the others: A beta-blocker alone leaves unopposed alpha stimulation and can precipitate a hypertensive crisis. Thiazide and loop diuretics do not address the cause and risk volume depletion.
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