In the NEALSIVMAN acronym, which drug corresponds to the letter E?

• A. Ephedrine
• B. Epinephrine
• C. Enalapril
• D. Erlotinib

Answer: (A)

In this mnemonic, the letter E stands for Ephedrine. Ephedrine is a mixed-acting sympathomimetic: it increases blood pressure by both releasing endogenous norepinephrine (indirect action) and directly stimulating alpha and beta receptors (direct action). This combination makes it a classic drug for correcting intraoperative hypotension, especially in neuraxial anesthesia, where a moderate, titratable pressor response is desirable.

Ephedrine fits this position because the other options don’t align with the same role in the mnemonic framework. Epinephrine is a potent direct-acting catecholamine with strong alpha and beta effects and is typically reserved for more emergent scenarios; Enalapril is an ACE inhibitor used for chronic hypertension rather than acute intraoperative support; Erlotinib is a cancer drug with no role as an intraoperative vasopressor.