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Thread: management of pheoctyochroma?

  1. #1
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    Thumbs up management of pheoctyochroma?

    a patient knonwn 2 b suffering from pheochromctoma presents 2 the emergency with a BP of 230/120. the house officer on duty prescribed high dose beta -blocker(propanolol) for lowering the blood pressure. do u agree with the treatment offered by this house officer or not? in any case support your argument..
    Most people are only alive because it is illegal to shoot them.

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    high dose of propanolol will increase potency but not efficacy..it can't be used as less efficacious in emegencies.
    and main reason after using it, unopposed alpha action by endogenous catecholamines and further increse in BP.
    alpha plus beta blocker should be used.[phenoxybenzemine or phentolamine + beta blocker]


    e.g.
    Phentolamine (REGITINE) can be used in short-term control of hypertension in patients with pheochromocytoma. Rapid infusions of phentolamine may cause severe hypotension, so the drug should be administered cautiously. Phentolamine also may be useful to relieve pseudo-obstruction of the bowel in patients with pheochromocytoma; this condition may result from the inhibitory effects of catecholamines on intestinal smooth muscle.

    and for surgical t/t reffer steps in book..rightnow not in mood to write.


    This question is hot favourite in 1 marks in pharmacology in our university. They ask by different way all the times but the basic answer remain same.

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    Why Not U Will Try Labetalol Mixed Action In Single Drug Phenoxybenazamien Is Irrevrsible Blocker And Have Long Life Phenotalmaine Is Reversible Blocker Can Be Used But Pure Alpha Blocker
    Clonidine Can Also Help

    Surgical Management Should Be Done ............

    What Ever This Case With Such A High Bp Come In Definition Hypertensive Crisis And As Here Detaila Regarding End Organ Damage Is Not Given So It Is Hypertensive Urgency

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    Rx -

    - Before surgery - Suppress epinephrine and nor epinephrine by Alpha - Blockade - Phenoxybenzene, Phentolamine

    - Palpitations and other symptoms even after alpha blockers - Only then, Add beta blocker (Not to be added simultaneously with alpha at the begining)

    - Volume repletion before surgery.

    - Surgery only after BP is normal.

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    as 2 pharmacotherapy ,beta blockers should never b used alone. it will further rise BP due to unoppsed alpha receptors. however, beta blockers may b used only after preceding alpha blokade( but not in the reverse order). ali is right, labetalol can b another option.
    Most people are only alive because it is illegal to shoot them.

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