Adult Cocaine Overdose (Chest Pain): Initial medication?

• A. Fentanyl
• B. Aspirin
• C. Versed
• D. Normal Saline

Answer: (C)

The key idea is that cocaine overdose with chest pain is driven by excessive sympathetic stimulation. The fastest, most effective way to calm that surge is to use a benzodiazepine. Midazolam (Versed) provides rapid anxiolysis and sedation, lowers central nervous system excitation, and reduces sympathetic outflow. As a result heart rate, blood pressure, and myocardial oxygen demand decrease, helping relieve chest pain and prevent further strain on the heart. This makes it the best initial medication in this scenario.

Fentanyl can relieve pain but doesn’t address the underlying sympathetic surge and can complicate breathing, so it’s not the first choice for cocaine-related chest pain. Aspirin is useful if there’s concern for acute coronary syndrome, but it doesn’t treat the cocaine-induced sympathetic effects and isn’t the initial targeted treatment. Normal saline is supportive but not a targeted intervention for the cocaine-driven chest pain; it may be used later if fluid status requires it, but it doesn’t counteract the primary problem.

So, starting with a benzodiazepine like Versed best tackles the root issue—reducing the cocaine-induced sympathetic activation and its consequences.