How do I install the Ppgl Preoperative Alpha Blocker Selection skill?

Run npx skillmds@latest add dromlakhani/ppgl-preoperative-alpha-blocker-selection 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 Preoperative Alpha Blocker Selection safe to use?

This skill has not completed SkillMD's automated safety review yet. Independent scanners report: SkillSpector: PASS, Skill Scanner: PASS. Capability flags: docs only. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Ppgl Preoperative Alpha Blocker Selection?

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 Preoperative Alpha Blocker Selection free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Ppgl Preoperative Alpha Blocker Selection?

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

Ppgl Preoperative Alpha Blocker Selection by dromlakhani

Name: Ppgl Preoperative Alpha Blocker Selection
Rating: 4.2 (5 reviews)
Author: dromlakhani

Ppgl Preoperative Alpha Blocker Selection

Selects preoperative alpha-blocker therapy and establishes initial dosing regimen for PPGL blood pressure control. Triggered by biochemically confirmed PPGL requiring surgery, patient needs preoperative blood pressure control, or preparing for adrenalectomy in PPGL patient.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Preoperative Alpha-Blocker Selection and Initial Dosing for PPGL

STEP 1 — Gather Information

Collect biochemical confirmation of PPGL (elevated fractionated metanephrines or catecholamines), document clinical need for preoperative BP control, note planned surgery/adrenalectomy, record baseline BP and HR, assess orthostatic hypotension risk, review concomitant medications (especially drugs affecting catecholamine metabolism).

STEP 2 — Rule In / Rule Out

Is catecholamine overproduction biochemically confirmed? If yes, proceed to alpha-blocker initiation; if unclear, perform a comprehensive clinical assessment before considering alpha-blockers (per I-4-5).

STEP 3 — Classify or Stratify

For confirmed PPGL, select a selective alpha-blocker (e.g., doxazosin) as first-line; if BP reduction insufficient, add a calcium antagonist or metyrosine; if tachycardia/tachyarrhythmia present, add a beta-blocker only after adequate alpha-blockade.

STEP 4 — Decide

Initiate selective alpha-blocker (doxazosin 1–2 mg PO daily) at bedtime; titrate every 2–3 days to target BP <130/80 mmHg and HR 60–70 bpm sitting; add calcium antagonist or metyrosine if needed; start normal salt diet (9 g/day) or saline infusion (1–2 L) on the third day of alpha-blocker therapy; continue for at least 7–14 days preoperatively.

Clinical Guardrails / Mimics / Pitfalls

Do not administer a beta-blocker before an alpha-blocker (risk of hypertensive crisis); avoid nonselective alpha-blockers (phenoxybenzamine) as unavailable in Japan; do not use alpha-blockers if catecholamine overproduction is unclear without comprehensive assessment; monitor for orthostatic hypotension after the first dose; avoid abrupt withdrawal of alpha-blockers perioperatively.

Concrete Clinical Example

A 45-year-old with biochemically confirmed PPGL (urinary normetanephrine 5× ULN) scheduled for laparoscopic adrenalectomy in 10 days starts doxazosin 1 mg at bedtime, titrates to 4 mg daily over 6 days, achieves BP 122/78 mmHg, adds amlodipine 5 mg if needed, maintains normal salt diet, and proceeds to surgery with stable vitals.

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-preoperative-alpha-blocker-selectiondescription: Selects preoperative alpha-blocker therapy and establishes initial dosing regimen for PPGL blood pressure control. Triggered by biochemically confirmed PPGL requiring surgery, patient needs preoperative blood pressure control, or preparing for adrenalectomy in PPGL patient.---# Preoperative Alpha-Blocker Selection and Initial Dosing for PPGL## STEP 1 — Gather InformationCollect biochemical confirmation of PPGL (elevated fractionated metanephrines or catecholamines), document clinical need for preoperative BP control, note planned surgery/adrenalectomy, record baseline BP and HR, assess orthostatic hypotension risk, review concomitant medications (especially drugs affecting catecholamine metabolism).## STEP 2 — Rule In / Rule OutIs catecholamine overproduction biochemically confirmed? If yes, proceed to alpha-blocker initiation; if unclear, perform a comprehensive clinical assessment before considering alpha-blockers (per I-4-5).## STEP 3 — Classify or StratifyFor confirmed PPGL, select a selective alpha-blocker (e.g., doxazosin) as first-line; if BP reduction insufficient, add a calcium antagonist or metyrosine; if tachycardia/tachyarrhythmia present, add a beta-blocker only after adequate alpha-blockade.## STEP 4 — DecideInitiate selective alpha-blocker (doxazosin 1–2 mg PO daily) at bedtime; titrate every 2–3 days to target BP <130/80 mmHg and HR 60–70 bpm sitting; add calcium antagonist or metyrosine if needed; start normal salt diet (9 g/day) or saline infusion (1–2 L) on the third day of alpha-blocker therapy; continue for at least 7–14 days preoperatively.## Clinical Guardrails / Mimics / PitfallsDo not administer a beta-blocker before an alpha-blocker (risk of hypertensive crisis); avoid nonselective alpha-blockers (phenoxybenzamine) as unavailable in Japan; do not use alpha-blockers if catecholamine overproduction is unclear without comprehensive assessment; monitor for orthostatic hypotension after the first dose; avoid abrupt withdrawal of alpha-blockers perioperatively.## Concrete Clinical ExampleA 45-year-old with biochemically confirmed PPGL (urinary normetanephrine 5× ULN) scheduled for laparoscopic adrenalectomy in 10 days starts doxazosin 1 mg at bedtime, titrates to 4 mg daily over 6 days, achieves BP 122/78 mmHg, adds amlodipine 5 mg if needed, maintains normal salt diet, and proceeds to surgery with stable vitals.**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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