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)
