The patient with cocaine toxicity is best treated initially with which medication?

• A. Benzodiazepine
• B. Ketamine
• C. Nitroglycerin
• D. Nifedipine

Answer: (A)

The primary issue in cocaine toxicity is excessive sympathetic activation that drives agitation, rapid heart rate, and high blood pressure. The most effective initial move is a benzodiazepine given intravenously. It rapidly calms the patient and lowers central and peripheral sympathetic outflow, which reduces heart rate, blood pressure, and myocardial oxygen demand. This directly addresses the dangerous overactivity caused by cocaine and helps prevent progression to seizures or ischemia.

Other options don’t tackle the root problem as quickly. Ketamine tends to increase sympathetic tone, so it’s not favored in this context. Nitroglycerin and nifedipine can help with chest pain or hypertension as adjuncts, but they don’t promptly counteract CNS stimulation and agitation. They’re useful as adjuncts after benzodiazepines if symptoms persist.