A Textbook of Clinical Pharmacology and Therapeutics

SPECIALGROUPS 123

Case history

A 45-year-old man with agoraphobia, anxiety and depres-
sion associated with hypochondriacal features is treated
with phenelzine. He has no history of hypertension. He is
seen in the Accident and Emergency Department because
of a throbbing headache and palpitations. On examination
he is hypertensive 260/120 mmHg with a heart rate of 40
beats/minute. He is noted to have nasal congestion.
Question 1
What is the likely diagnosis?
Question 2
What is the most appropriate treatment?
Answer 1
Hypertensive crisis, possibly secondary to taking a cold cure
containing an indirectly acting sympathomimetic.
Answer 2
Phentolamine, a short-acting alpha-blocker, may be given
by intravenous injection, with repeat doses titrated against
response.

FURTHER READING

Aronson SC, Ayres VD. Depression: a treatment algorithm for the

family physician. Hospital Physician2000; 44 : 21–38.

Ebmeier KP, Donaghey C, Steele JD. Recent developments and current

controversies in depression. The Lancet2005; 367 : 153–67.