In addition to supportive care, seizure cessation, and pain management, the patient with a black widow bite is likely to require

• A. Antihypertensive therapy
• B. Vasopressor therapy
• C. Fomepizole
• D. Arachno-Fab

Answer: (A)

Black widow venom can cause a pronounced autonomic storm, with a sudden surge of catecholamines that drives hypertension, tachycardia, sweating, and severe muscle cramps. Beyond providing supportive care, controlling this blood pressure surge is often essential to prevent cardiovascular complications and to help the patient tolerate analgesia and any sedative therapy used to manage muscle spasms. That makes antihypertensive therapy the most on-target additional treatment in this scenario.

Vasopressor therapy would worsen high blood pressure and isn’t appropriate unless there were concurrent hypotension. Fomepizole targets methanol or ethylene glycol poisoning, not spider venom effects. An antivenom, such as Arachno-Fab, can be considered in some severe cases, but not all patients require it, and antihypertensive management directly addresses the common and clinically significant autonomic effects of the venom.