What should NEVER be used to treat cocaine-associated chest pain?

The use of beta blockers in treating cocaine-associated chest pain is particularly contraindicated due to the unique pathophysiological effects of cocaine on the cardiovascular system. Cocaine acts as a stimulant that leads to increased sympathetic nervous system activity, resulting in elevated heart rate, increased myocardial oxygen demand, and vasoconstriction. Using beta blockers in this scenario can lead to unopposed alpha-adrenergic receptor stimulation. As a result, this can cause further vasoconstriction and worsening of ischemia, making the situation more dangerous for the patient.

In contrast, other treatments like calcium channel blockers can help by promoting vasodilation and reducing myocardial oxygen demand. Nitroglycerin is beneficial in alleviating chest pain through vasodilation as well. Opiates can be used for pain management in a controlled setting but do not address the underlying issues caused by cocaine. The key reason beta blockers should be avoided is that they can worsen symptoms and put the patient at greater risk for complications stemming from cocaine use.