Soru

A 45-year-old woman is brought to the emergency department by her husband due to a severe, throbbing headache, blurred vision, and chest palpitations that began 45 minutes ago. She has a 10-year history of major depressive disorder that was poorly responsive to multiple trials of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Six weeks ago, her psychiatrist started her on tranylcypromine. Vital signs are temperature 37.2°C (99.0°F), blood pressure 228/132 mm Hg, pulse 118/min, and respirations 20/min. Physical examination reveals profuse diaphoresis, facial flushing, and pupillary dilation. Neurological examination shows normal muscle tone, 2+ deep tendon reflexes symmetrically, and absent clonus. Mental status examination reveals an anxious woman who is fully oriented to person, place, and time. Her husband mentions they were celebrating their anniversary at a restaurant earlier this evening, where they shared a large platter of aged cheeses and cured meats. Which of the following is the most appropriate initial pharmacological intervention for this patient's current condition?