In tyramine crisis, which agent can be used to control hypertensive emergency?

In tyramine crisis, which agent can be used to control hypertensive emergency?

• A. Hydralazine
• B. Sertraline
• C. Diazepam
• D. Metformin

Answer: (A)

The key idea is that tyramine crisis from MAO inhibitor use causes a surge of norepinephrine, leading to a hypertensive emergency. The way to counter this is to reduce the vascular resistance rapidly. While the most specific treatment is an alpha-adrenergic blocker (phentolamine) to block the excessive alpha-adrenergic effects of norepinephrine, the option listed here that directly lowers blood pressure quickly in an acute emergency is a direct-acting vasodilator of the arterioles. Hydralazine works by relaxing smooth muscle in small arteries, producing a rapid drop in systemic vascular resistance and blood pressure. This makes it useful for urgent BP control when a quick antihypertensive effect is needed and other agents that specifically block the catecholamine surge aren’t available in the moment. The other choices don’t provide the needed immediate antihypertensive effect: sertraline won’t acutely lower BP, diazepam doesn’t address the hypertensive crisis, and metformin has no role in acute blood pressure management. In ideal practice, phentolamine would be preferred for tyramine-induced hypertensive emergencies, but among these options, hydralazine is the appropriate choice to control the crisis promptly.

The key idea is that tyramine crisis from MAO inhibitor use causes a surge of norepinephrine, leading to a hypertensive emergency. The way to counter this is to reduce the vascular resistance rapidly. While the most specific treatment is an alpha-adrenergic blocker (phentolamine) to block the excessive alpha-adrenergic effects of norepinephrine, the option listed here that directly lowers blood pressure quickly in an acute emergency is a direct-acting vasodilator of the arterioles. Hydralazine works by relaxing smooth muscle in small arteries, producing a rapid drop in systemic vascular resistance and blood pressure. This makes it useful for urgent BP control when a quick antihypertensive effect is needed and other agents that specifically block the catecholamine surge aren’t available in the moment. The other choices don’t provide the needed immediate antihypertensive effect: sertraline won’t acutely lower BP, diazepam doesn’t address the hypertensive crisis, and metformin has no role in acute blood pressure management. In ideal practice, phentolamine would be preferred for tyramine-induced hypertensive emergencies, but among these options, hydralazine is the appropriate choice to control the crisis promptly.