- Continuous Hemodiafiltration for Pheochromocytoma Crisis with a Positive Outcome: A Case Report. [Journal Article]
- IMIntern Med 2019 Jul 10
- A 38-year-old woman who consulted a local doctor with chief complaints of sudden palpitations, headaches, and chest pain is herein presented. After admission, pheochromocytoma crisis was suspected. S…
A 38-year-old woman who consulted a local doctor with chief complaints of sudden palpitations, headaches, and chest pain is herein presented. After admission, pheochromocytoma crisis was suspected. Since the patient had a history of acute heart failure and had once survived an episode of cardiac arrest, a rapid decrease in the catecholamine levels was needed. After resuscitation, pharmacological therapy with agents such as phentolamine and landiolol was administered, and continuous hemodiafiltration (CHDF) was performed to reduce the catecholamine levels. Elective surgery was then performed, and a positive outcome was achieved. This case suggests that the preoperative use of CHDF to control pheochromocytoma crisis may therefore be effective.
- Phentolamine mesylate: pharmacology, efficacy, and safety. [Journal Article]
- GDGen Dent 2019 May-Jun; 67(3):12-17
- StatPearls: Alprostadil [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Over 150 million people worldwide are affected by erectile dysfunction. Alprostadil is an approved second-line treatment for erectile dysfunction (oral phosphodiesterase-5 inhibitors, for example…
Over 150 million people worldwide are affected by erectile dysfunction. Alprostadil is an approved second-line treatment for erectile dysfunction (oral phosphodiesterase-5 inhibitors, for example, sildenafil, is the first line therapy). Alprostadil can be used in combination with other medications, the combination of papaverine, phentolamine, and alprostadil, known as "trimix," is particularly effective when used for intracavernous injection as a treatment for erectile dysfunction. However, it is only available from pharmacies authorized to produce such mixtures as it is otherwise not produced commercially.
- A Distinct Role of the Autonomic Nervous System in Modulating the Function of Lymphatic Vessels under Physiological and Tumor-Draining Conditions. [Journal Article]
- CRCell Rep 2019 Jun 11; 27(11):3305-3314.e13
- Lymphatic vessels (LVs) are important in the regulation of tissue fluid homeostasis and the pathogenesis of tumor progression. We investigated the innervation of LVs and the response to agonists and …
Lymphatic vessels (LVs) are important in the regulation of tissue fluid homeostasis and the pathogenesis of tumor progression. We investigated the innervation of LVs and the response to agonists and antagonists of the autonomic nervous system in vivo. While skin-draining collecting LVs express muscarinic, α1- and β2-adrenergic receptors on lymphatic endothelial cells and smooth muscle cells, intestinal lacteals express only β-adrenergic receptors and muscarinic receptors on their smooth muscle cells. Quantitative in vivo near-infrared imaging of the exposed flank-collecting LV revealed that muscarinic and α1-adrenergic agonists increased LV contractility, whereas activation of β2-adrenergic receptors inhibited contractility and initiated nitric oxide (NO)-dependent vasodilation. Tumor-draining LVs were expanded and showed a higher innervation density and contractility that was reduced by treatment with atropine, phentolamine, and, most potently, isoproterenol. These findings likely have clinical implications given the impact of lymphatic fluid drainage on intratumoral fluid pressure and thus drug delivery.
- Safety profile of phentolamine mesylate as reversal agent of pulpal and soft tissue dental anesthesia: a systematic review and meta-analysis. [Journal Article]
- QIQuintessence Int 2019; 50(7):568-575
- CONCLUSIONS: There were no severe complications reported in any of the included studies, but the occurrence of adverse events (mild and moderate) was greater in the phentolamine mesylate group compared to the control group. Age has a significant effect on the possibility of adverse events with phentolamine mesylate.
- Phentolamine Reverses Epinephrine-Enhanced Skin Antinociception of Dibucaine in Rats. [Journal Article]
- A&AAnesth Analg 2019; 128(6):1336-1343
- CONCLUSIONS: The preclinical data indicated that there is no statistically significant difference between the potency and duration of dibucaine and bupivacaine in this model. Epinephrine synergistically enhances the effects of dibucaine, while phentolamine partially blocked those effects. α-Adrenergic receptors play an important role in controlling synergistic analgesic effect of dibucaine combined with epinephrine.
- Mechanism of Electroacupuncture on Postoperative Ileus Induced by Surgical Stress in Rats. [Journal Article]
- MAMed Acupunct 2019 Apr 01; 31(2):109-115
- CONCLUSIONS: The current study demonstrated that surgery induced a delay in CT through the sympathetic pathway via α-adrenoreceptors; CT was restored by EA. These results suggest that EA can be used to treat POI through mediation of the autonomic nervous system.
- Effect of the drug combination of magnesium sulfate and phentolamine on homocysteine and C-reactive protein in the serum of patients with pregnancy-induced hypertension syndrome. [Journal Article]
- ETExp Ther Med 2019; 17(5):3682-3688
- Effect and clinical efficacy of magnesium sulfate combined with phentolamine on homocysteine and C-reactive protein in the serum of patients with pregnancy-induced hypertension syndrome were investig…
Effect and clinical efficacy of magnesium sulfate combined with phentolamine on homocysteine and C-reactive protein in the serum of patients with pregnancy-induced hypertension syndrome were investigated. A total of 96 patients with pregnancy-induced hypertension syndrome who were diagnosed and treated in Jining No. 1 People's Hospital from February 2016 to January 2018 were retrospectively analyzed. The patients were grouped according to the dosage regimen. The patients who received the combination treatment of magnesium sulfate and phentolamine on the basis of magnesium sulfate were included in the observation group, and the patients who were treated with the intravenous infusion of magnesium sulfate alone were included in the control group. Mean arterial pressure (MAP), the content of 24 h urine protein, systolic blood pressure (SBP), diastolic blood pressure (DBP), Hcy, and CRP of the pregnant women were observed. MAP and the content of 24 h urine protein, SBP and DBP of the patients in the observation group after the treatment were significantly lower than those of the patients in the control group (P<0.001). Hcy and CRP of the patients in the observation group after the treatment were significantly lower than those of the patients in the control group (P<0.001). The total effective rate of the patients in the observation group was significantly higher than that of the patients in the control group (P<0.05). In conclusion, the meliorative effect of magnesium sulphate combined with phentolamine on the level of MAP, the content of 24 h urine protein, SBP, DBP, Hcy and CRP in pregnant woman had a greater impact than that of the single use of the intravenous infusion of magnesium sulfate in the treatment of pregnancy-induced hypertension syndrome, and the clinical efficacy of magnesium sulphate combined with phentolamine was better, thus worthwhile to promote widely in clinic.
- Amphetamine and Clonidine Toxicity Resulting in Posterior Reversible Encephalopathy Syndrome. [Journal Article]
- PEPediatr Emerg Care 2019 Apr 09
- Amphetamine toxicity typically presents with hypertension and tachycardia. Conversely, clonidine acts as an agonist at central α2 and imidazoline receptors, which may cause brief initial hypertension…
Amphetamine toxicity typically presents with hypertension and tachycardia. Conversely, clonidine acts as an agonist at central α2 and imidazoline receptors, which may cause brief initial hypertension followed by hypotension and bradycardia in overdose. We report a case of mixed ingestion resulting in posterior reversible encephalopathy syndrome (PRES) successfully treated with phentolamine.A 17-year-old male adolescent presented to the emergency department 2 hours after ingesting up to 25 each of clonidine 0.1-mg tablets and dextroamphetamine 10 mg extended-release capsules. He reported nausea and fatigue with initial blood pressure (BP) 145/95 mm Hg and heart rate (HR) 52 beats per minute (bpm). Nine hours postingestion (HPI), the patient developed headache, photophobia, and confusion with BP 182/111 mm Hg and HR 48 bpm. A computed tomography scan of the head revealed generalized fullness of the cerebellum, upward bulging of the tentorial leaflets, effacement of the fourth ventricle, and crowding of the foramen magnum, suspicious for an atypical presentation of PRES. The patient's systolic BP rose over 200 mm Hg and treated with 2 mg of intravenous phentolamine at 14 HPI. Blood pressure decreased to 133/82 mm Hg, and HR increased to 56 bpm with improvements in headache. Following repeat doses of phentolamine, nicardipine was initiated and increased to 2.5 mg/h for 12 hours. The patient was stable with normal vital signs at 36 HPI.The delayed presentation of hypertensive emergency with PRES may have been due to the actions of extended-release dextroamphetamine and the α2-agonistic effects of clonidine. Phentolamine was chosen for its α1-antagonism and was effective in managing symptoms.
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- StatPearls: Alpha Adrenergic Receptors [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- The indication for the use of an alpha receptor modifying medication depends on which receptor is the target; the alpha 1 receptor or the alpha 2 receptor. Alpha 1 receptors bind catecholamines inc…
The indication for the use of an alpha receptor modifying medication depends on which receptor is the target; the alpha 1 receptor or the alpha 2 receptor. Alpha 1 receptors bind catecholamines including, both epinephrine and norepinephrine. In instances in which there is hypoperfusion secondary to decreased cardiac output or decreased systemic vasculature resistance, alpha 1 receptors are stimulated. It is worth noting that these compounds are not purely selective for the alpha receptor, and often engage beta-adrenergic receptors as well. The use of alpha 1 agonists is common in all types of shock, cardiopulmonary resuscitation, and heart failure decompensation. Alpha 1 agonists, such as phenylephrine, are also used to treat upper airway congestion as stimulating the receptor leads to a decreased mucus secretion. Alpha-antagonists, colloquially known as alpha blockers, work in the peripheral vasculature and inhibit the uptake of catecholamines in smooth muscles cells resulting in vasodilation and blood pressure lowering. Alpha-antagonists including doxazosin prazosin, and phentolamine - are primarily used in the treatment of hypertension and urinary retention.