A 29-year-old male presents with substernal chest pressure after using cocaine. What is the best medication for his cardiovascular status?

In this scenario, the patient is presenting with substernal chest pressure after cocaine use. Cocaine is known to cause vasoconstriction and can lead to increased blood pressure and heart rate, potentially resulting in myocardial ischemia. In managing such a case, the treatment goal is to alleviate symptoms while also addressing the underlying physiological effects of cocaine on the cardiovascular system.

Lorazepam is a benzodiazepine that can be particularly useful in this situation. It may help to reduce anxiety and provide sedation, which can help to stabilize the patient's emotional state and decrease myocardial oxygen demand. Additionally, by calming the sympathetic response caused by cocaine use, lorazepam can indirectly assist in managing hypertension and tachycardia linked to increased catecholamine activity.

Other medications listed, like lidocaine, are typically used for arrhythmias but would not be the best first-line choice in this situation. Metoprolol, a beta-blocker, is sometimes used in cases of stress-induced cardiomyopathy or hypertensive episodes, but it can also lead to unopposed alpha-adrenergic receptor stimulation when used in conjunction with cocaine, potentially worsening chest pain or myocardial ischemia. Phenoxybenzamine is an alpha-blocker that might be used in other