How do I install the Endo Avoid Sympathomimetic Htn skill?

Run npx skillmds@latest add dromlakhani/endo-avoid-sympathomimetic-htn in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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Is Endo Avoid Sympathomimetic Htn free to use?

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Who published Endo Avoid Sympathomimetic Htn?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Endo Avoid Sympathomimetic Htn by dromlakhani

Name: Endo Avoid Sympathomimetic Htn
Rating: 4.5 (4 reviews)
Author: dromlakhani

Endo Avoid Sympathomimetic Htn

Recommends against using sympathomimetic agents (phentermine, diethylpropion) in patients with uncontrolled hypertension or a history of heart disease. Triggers include clinician questions such as “Is it safe to prescribe phentermine for this patient with uncontrolled hypertension?” or “Should I avoid sympathomimetics in a patient with prior MI seeking weight‑loss medication?”.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Avoid sympathomimetics in uncontrolled hypertension/heart disease

STEP 1 — Gather Information

Measure current blood pressure (SBP/DBP) and assess hypertension control status.
Obtain history of heart disease: prior MI, angina, heart failure, significant arrhythmia, or revascularization.
Review current medications for contraindications (MAOIs, other sympathomimetics) and assess pregnancy, glaucoma, hyperthyroidism, substance use.

STEP 2 — Rule In / Rule Out

Rule in contraindication if: (a) SBP ≥140 mm Hg or DBP ≥90 mm Hg despite treatment OR (b) documented history of heart disease (MI, CHF, significant arrhythmia).
Rule out if blood pressure is at goal (<140/90) and no cardiac history; then sympathomimetics may be considered per other guidelines.

STEP 3 — Classify or Stratify

Uncontrolled hypertension (BP ≥140/90) → high risk for sympathomimetic‑induced BP rise.
Controlled hypertension (BP <140/90) → lower risk, but still exercise caution.
History of heart disease → independent contraindication regardless of BP.

STEP 4 — Decide

If contraindication ruled in, avoid phentermine and diethylpropion.
Select alternative weight‑loss agents with lower cardiovascular risk (e.g., orlistat, lorcaserin, or phentermine/topiramate only after cardiology clearance).
Document decision and discuss lifestyle modification as first‑line.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on self‑reported “normal” BP; use office‑measured values.
Beware of masked hypertension; consider ambulatory monitoring if borderline.
Avoid in patients with tachycardia, arrhythmia, or uncontrolled hyperthyroidism.
Do not combine with MAOIs or other stimulants due to hypertensive crisis risk.
Monitor BP and heart rate after initiation if any weight‑loss drug is used.

Concrete Clinical Example

A 58‑year‑old man with BMI 32 kg/m² presents for weight‑loss counseling. His office BP is 152/94 mm Hg on lisinopril and hydrochlorothiazide, and he reports a prior MI 2 years ago. He asks whether phentermine is safe. Following the algorithm, uncontrolled hypertension and history of heart disease trigger the contraindication; phentermine is avoided and orlistat is prescribed instead, with monthly BP checks.

Source: Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, Apovian et al., 2015, DOI:10.1210/jc.2014-3415

---name: endo-avoid-sympathomimetic-htndescription: Recommends against using sympathomimetic agents (phentermine, diethylpropion) in patients with uncontrolled hypertension or a history of heart disease. Triggers include clinician questions such as “Is it safe to prescribe phentermine for this patient with uncontrolled hypertension?” or “Should I avoid sympathomimetics in a patient with prior MI seeking weight‑loss medication?”.---# Avoid sympathomimetics in uncontrolled hypertension/heart disease## STEP 1 — Gather Information- Measure current blood pressure (SBP/DBP) and assess hypertension control status.- Obtain history of heart disease: prior MI, angina, heart failure, significant arrhythmia, or revascularization.- Review current medications for contraindications (MAOIs, other sympathomimetics) and assess pregnancy, glaucoma, hyperthyroidism, substance use.## STEP 2 — Rule In / Rule Out- **Rule in contraindication** if: (a) SBP ≥140 mm Hg or DBP ≥90 mm Hg despite treatment **OR** (b) documented history of heart disease (MI, CHF, significant arrhythmia). - **Rule out** if blood pressure is at goal (<140/90) and no cardiac history; then sympathomimetics may be considered per other guidelines.## STEP 3 — Classify or Stratify- **Uncontrolled hypertension** (BP ≥140/90) → high risk for sympathomimetic‑induced BP rise. - **Controlled hypertension** (BP <140/90) → lower risk, but still exercise caution. - **History of heart disease** → independent contraindication regardless of BP.## STEP 4 — Decide- If contraindication ruled in, **avoid phentermine and diethylpropion**. - Select alternative weight‑loss agents with lower cardiovascular risk (e.g., orlistat, lorcaserin, or phentermine/topiramate only after cardiology clearance). - Document decision and discuss lifestyle modification as first‑line.## Clinical Guardrails / Mimics / Pitfalls- Do not rely on self‑reported “normal” BP; use office‑measured values. - Beware of masked hypertension; consider ambulatory monitoring if borderline. - Avoid in patients with tachycardia, arrhythmia, or uncontrolled hyperthyroidism. - Do not combine with MAOIs or other stimulants due to hypertensive crisis risk. - Monitor BP and heart rate after initiation if any weight‑loss drug is used.## Concrete Clinical ExampleA 58‑year‑old man with BMI 32 kg/m² presents for weight‑loss counseling. His office BP is 152/94 mm Hg on lisinopril and hydrochlorothiazide, and he reports a prior MI 2 years ago. He asks whether phentermine is safe. Following the algorithm, uncontrolled hypertension and history of heart disease trigger the contraindication; phentermine is avoided and orlistat is prescribed instead, with monthly BP checks.**Source:** Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, Apovian et al., 2015, DOI:10.1210/jc.2014-3415

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