How do I install the Ppgl Beta Blocker Timing skill?

Run npx skillmds@latest add dromlakhani/ppgl-beta-blocker-timing 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.

Is Ppgl Beta Blocker Timing safe to use?

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Which AI agents work with Ppgl Beta Blocker Timing?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Ppgl Beta Blocker Timing free to use?

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Who published Ppgl Beta Blocker Timing?

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

Ppgl Beta Blocker Timing by dromlakhani

Name: Ppgl Beta Blocker Timing
Rating: 4.2 (5 reviews)
Author: dromlakhani

Ppgl Beta Blocker Timing

Determines the appropriate timing for initiating beta-blocker therapy in patients with pheochromocytoma/paraganglioma (PPGL) to prevent hypertensive crisis. Indicated for tachycardia/tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease only after adequate alpha-blockade; contraindicated before alpha-blocker initiation, and triggered by clinician statements such as “Patient develops tachycardia on alpha-blocker therapy,” “Need to control heart rate in PPGL with cardiac comorbidities,” or “Assessing safety of adding beta-blocker to current regimen.”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Beta-Blocker Timing in PPGL Management

STEP 1 — Gather Information

Assess for tachycardia, tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease; evaluate current alpha-blocker type, dose, duration, and blood pressure/heart rate control; verify volume status and absence of contraindications (e.g., severe asthma, bradycardia).

STEP 2 — Rule In / Rule Out

Is there a clinical indication for beta-blocker (tachycardia/tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease)? If no, do not initiate beta-blocker; if yes, proceed to assess alpha-blockade adequacy.

STEP 3 — Classify or Stratify

Has adequate alpha-blockade been achieved (e.g., doxazosin ≥8 mg/day or equivalent, seated BP <130/80 mmHg, orthostatic SBP ≥90 mmHg, HR 60–80 bpm) for at least 7–14 days? If yes, proceed to beta-blocker initiation; if no, continue alpha-blocker titration and reassess in 2–3 days.

STEP 4 — Decide

If indication present and adequate alpha-blockade confirmed, start a cardioselective beta-blocker (e.g., atenolol 25 mg daily or metoprolol succinate 25–50 mg daily) with close BP/HR monitoring; if inadequate alpha-blockade, maintain current alpha-blocker regimen and re-evaluate indication after further titration.

Clinical Guardrails / Mimics / Pitfalls

Avoid nonselective beta-blockers (e.g., propranolol) and alpha-beta blockers (labetalol, carvedilol) due to risk of hypertensive crisis; never administer beta-blocker before adequate alpha-blockade; monitor for excessive hypotension or reflex tachycardia after initiation; ensure euvolemia with normal saline diet; discontinue beta-blocker if severe bradycardia (<50 bpm) or symptomatic hypotension occurs.

Concrete Clinical Example

A 58‑year‑old patient with PPGL on doxazosin 8 mg daily develops sinus tachycardia (110 bpm) and mild dyspnea after 10 days of alpha‑blockade; seated BP is 122/78 mmHg, orthostatic SBP 92 mmHg. Indication present, alpha‑blockade adequate; start atenolol 25 mg daily, with BP/HR checked q4h for first 24h, then daily.

Source: Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, DOI: 10.1507/endocrj.EJ25-0165

---name: ppgl-beta-blocker-timingdescription: Determines the appropriate timing for initiating beta-blocker therapy in patients with pheochromocytoma/paraganglioma (PPGL) to prevent hypertensive crisis. Indicated for tachycardia/tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease only after adequate alpha-blockade; contraindicated before alpha-blocker initiation, and triggered by clinician statements such as “Patient develops tachycardia on alpha-blocker therapy,” “Need to control heart rate in PPGL with cardiac comorbidities,” or “Assessing safety of adding beta-blocker to current regimen.”---# Beta-Blocker Timing in PPGL Management## STEP 1 — Gather InformationAssess for tachycardia, tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease; evaluate current alpha-blocker type, dose, duration, and blood pressure/heart rate control; verify volume status and absence of contraindications (e.g., severe asthma, bradycardia).## STEP 2 — Rule In / Rule OutIs there a clinical indication for beta-blocker (tachycardia/tachyarrhythmia, myocardial damage, heart failure, or ischemic heart disease)? If no, do not initiate beta-blocker; if yes, proceed to assess alpha-blockade adequacy.## STEP 3 — Classify or StratifyHas adequate alpha-blockade been achieved (e.g., doxazosin ≥8 mg/day or equivalent, seated BP <130/80 mmHg, orthostatic SBP ≥90 mmHg, HR 60–80 bpm) for at least 7–14 days? If yes, proceed to beta-blocker initiation; if no, continue alpha-blocker titration and reassess in 2–3 days.## STEP 4 — DecideIf indication present and adequate alpha-blockade confirmed, start a cardioselective beta-blocker (e.g., atenolol 25 mg daily or metoprolol succinate 25–50 mg daily) with close BP/HR monitoring; if inadequate alpha-blockade, maintain current alpha-blocker regimen and re-evaluate indication after further titration.## Clinical Guardrails / Mimics / PitfallsAvoid nonselective beta-blockers (e.g., propranolol) and alpha-beta blockers (labetalol, carvedilol) due to risk of hypertensive crisis; never administer beta-blocker before adequate alpha-blockade; monitor for excessive hypotension or reflex tachycardia after initiation; ensure euvolemia with normal saline diet; discontinue beta-blocker if severe bradycardia (<50 bpm) or symptomatic hypotension occurs.## Concrete Clinical ExampleA 58‑year‑old patient with PPGL on doxazosin 8 mg daily develops sinus tachycardia (110 bpm) and mild dyspnea after 10 days of alpha‑blockade; seated BP is 122/78 mmHg, orthostatic SBP 92 mmHg. Indication present, alpha‑blockade adequate; start atenolol 25 mg daily, with BP/HR checked q4h for first 24h, then daily.**Source:** Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, DOI: 10.1507/endocrj.EJ25-0165

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