An epinephrine use is contraindicated in which condition?

• A. Thyrotoxicosis
• B. Coronary artery disease
• C. Peripheral vascular disease
• D. Vasospastic patients

Answer: (D)

Epinephrine stimulates alpha-adrenergic receptors that cause vasoconstriction. In vessels that are prone to spasm, such as in vasospastic conditions (eg, Prinzmetal’s angina or other vasospastic disorders), this vasoconstriction can trigger or worsen a sudden, severe narrowing of the artery. That sharp reduction in blood flow can precipitate chest pain, ischemia, or even an infarct, making epinephrine particularly risky in these patients.

In contrast, thyrotoxicosis can heighten sensitivity to catecholamines, and coronary or peripheral arterial disease may require caution or dose adjustment, but the strongest, most direct contraindication among these options is the vasospastic state because the vasoconstrictive effect directly exacerbates the underlying problem.