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In the case of a 56-year-old male presenting with severely elevated blood pressure and a history of cocaine use, the most appropriate initial management strategy is to administer oral labetalol. Labetalol is a combined alpha and beta-adrenergic antagonist that can effectively lower blood pressure in situations of acute hypertension, particularly in individuals with a history of stimulant use, such as cocaine.

Cocaine use can lead to significant cardiovascular complications, including hypertension, myocardial infarction, and even arrhythmias. The dual mechanism of action of labetalol allows for effective management of the hypertensive crisis, providing both peripheral vasodilation and heart rate reduction without the risk of exacerbating coronary vasospasm, which can occur with pure beta-blockers.

While obtaining a urine drug screen may provide valuable information on the patient's drug use, it does not address the immediate clinical need to manage the severe hypertension. Starting intravenous nitroglycerin is typically reserved for specific scenarios, such as acute heart failure or myocardial ischemia, rather than as a first-line treatment in the context of cocaine-associated hypertension. Prescribing a pure beta blocker is not advisable in this situation because pure beta-blockers can lead to unopposed alpha-adrenergic activity, which may