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Alpha Adrenergic Antagonist

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161. Hypofractionated Radiation Therapy for Localized Prostate Cancer

ratio. Classically, the probability of cell survival following a dose of ionizing radiation is governed by the linear-quadratic model. In this model, curves of cell survival as a function of dose have an initial linear component followed by a steeper quadratic component. The relative weighting of each component, and thus the sensitivity to fractionation of the irradiated tissue, is characterized by a parameter called the alpha-beta ratio. The alpha-beta ratio of adenocarcinoma of the prostate (...) is considered low compared to most other neoplasms, with several estimates derived from large populations in the range of 100 to 200 cGy. 5-7 Unlike other solid tumors with higher alpha-beta ratios, the alpha-beta ratio of the adjacent dose-limiting normal structure, namely the rectum, has been estimated to be greater than that of prostate cancer itself. 8,9 An implication of this relationship is that hypofractionation - daily delivery of EBRT with fraction sizes >200 cGy - may further improve

2018 American Urological Association

162. Chronic Pelvic Pain

urinary tract. J Urol, 1998. 159: 2185. 170. Parsons, C.L., et al. Cyto-injury factors in urine: a possible mechanism for the development of interstitial cystitis. J Urol, 2000. 164: 1381. 171. Chelimsky, G., et al. Autonomic Testing in Women with Chronic Pelvic Pain. J Urol, 2016. 196: 429. 172. Charrua, A., et al. Can the adrenergic system be implicated in the pathophysiology of bladder pain syndrome/interstitial cystitis? A clinical and experimental study. Neurourol Urodyn, 2015. 34: 489. 173

2018 European Association of Urology

163. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

, and combinations thereof Pharmacological interventions: Anticholinergics, onabotulinum toxin A (BTX), hormones; alpha agonists, beta agonists; antidepressants, periurethral bulking agents (see full report) Combinations of eligible nonpharmacological and pharmacological interventions. All doses or variations of interventions are included, including unapproved doses. Similarly, all eligible interventions are included regardless of regulatory body approval. Interventions not available in the United States (...) PFMT + vaginal estrogen; PFMT + pessaries + vaginal estrogen 2nd x x . . x Hormones Vaginal estrogen, oral estrogen, subcutaneous estrogen, transdermal estrogen, raloxifene 2nd x x . x x Intravesical pressure release . 3rd x x . x x Periurethral bulking Autologous fat, carbonated beads, collagen, dextranomer hyaluronate, polyacrylamide, polydimethylsiloxane, porcine collagen 3rd x x . x x Alpha agonists Duloxetine, midodrine 2nd x x . x x Interventions used for urgency UI § Anticholinergics

2018 Effective Health Care Program (AHRQ)

165. CRACKCast E161 – Antipsychotics

) Undesired clinical effects occurring in therapeutic use such as extrapyramidal syndromes Idiosyncratic effects such as NMS D2 receptor antagonism Reducing positive symptoms of schizophrenia EPS symptoms NMS Common “off- target” effects include: Alpha-1 adrenergic receptor antagonism Orthostatic hypotension Muscarinic acetylcholine receptor antagonism Anticholinergic toxicity Histamine H1 receptor antagonism Sedation Fast voltage-gated sodium channel blockade Wide complex dysrhythmias Delayed potassium (...) . Pupils may be of variable size Anticholinergic effects promote mydriasis, whereas miosis, resulting from alpha-antagonism, may mimic opioid toxicity. Mild orthostatic hypotension is also a common finding from alpha-adrenergic blockade Seizures EPS symptoms [3] Compare typical and atypical antipsychotic adverse effect profile Please refer to Box 155.1 in Rosen’s 9 th Edition for a comprehensive table outlining the various classifications of low/medium potency antipsychotics and atypical antipsychotics

2018 CandiEM

166. CRACKCast E151 – Antidepressants

: Phentolamine 2 – 3 mg increments every 10 – 15 minutes until BP close to 140 systolic Beta-adrenergic blockers are contraindicated due to the risk of unopposed alpha-agonist stimulation. Life threatening serotonin toxicity: Requires paralysis, intubation and ventilation to prevent multi organ failure Supportive Care Agitation and tachycardia: Increasing anxiety, sweating, tremor, tachycardia and mydriasis may herald the onset of seizures. Titrated doses of benzodiazepines are effective e.g. diazepam 2.5 (...) Hot as hell The bladder keeps its tone and the heart runs alone 5HT & NE reuptake inhibition (ie extra serotonin and norepinephrine) They look like sympathomimetic Tachycardia / hyperthermia, agitation, ALOC & Seizures GABA Blockade Seizures Alpha – 1 blockade Hypotension [2] What are the ECG findings associated with TCA toxicity and what are their implications As per Interventricular conduction delay — QRS > 100 ms in lead II Right axis deviation of the terminal QRS: Terminal R wave > 3 mm in aVR

2018 CandiEM

167. ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay

with heart rates 0.30 s) with a narrow QRS complex. AV indicates atrioventricular; ACHD, adult congenital heart disease; CHD, congenital heart disease; and CM, cardiomyopathy. Table 4. Medications That Can Induce/Exacerbate Bradycardia or Conduction Disorders Antihypertensive Antiarrhythmic Psychoactive Other • Beta-adrenergic receptor blockers (including beta- adrenergic blocking eye drops used for glaucoma) • Clonidine • Methyldopa • Non-dihydropyridine calcium channel blockers • Reserpine • Adenosine

2018 American College of Cardiology

168. CRACKCast E195 – Procedural Sedation and Analgesia

Semisynthetic Mu Opioid Receptor Agonist Analgesic IV 0.1-0.15 mcg/kg/min infusion; supplement boluses of 1-2 mcg/kg increments Dexmedetomidine Alpha-2 Adrenergic Agonist Analgesic, sedative IV 1 mcg/kg over 10 min, then 0.2-0.7 mcg/kg/hr [9] What are our reversal agents for opioids and benzodiazepines, and how are they dosed? Opioid Reversal Agent: Naloxone Competitive antagonist of opioids Reverses opioid-related respiratory depression Rapid onset, half life of 45 minutes Clinical effects only for 15-30 (...) minutes – MAY NEED TO RE-DOSE Can be dosed IV/IM Should only dose enough to reverse opioid respiratory depression Consider initial IV doses of 0.04-0.1 mg q 1-2 minutes Complete reversal usually occurs with 1-2 mg IV Risks Few, largely rare complications Pulmonary edema, seizure, and dysrhythmias have been described Benzodiazepine Reversal Agent: Flumazenil Competitive antagonist of benzodiazepines Reverses sedation, but is NOT EFFECTIVE for reversing respiratory depression Rapid onset, peak effect

2018 CandiEM

169. Gastroesophageal Reflux Disease (GERD)

Subglottic stenosis Weight loss Globus sensation Early satiety Avoid large meals Chest pain Vomiting Weight loss Onset of symptoms at age > 50 Avoid medications that can potentiate symptoms: calcium channel blockers, beta-agonists, alpha- adrenergic agonists, theophylline, nitrates, and some sedatives (benzodiazepines). 3 UMHS GERD Guideline, September, 2013 Table 4. Medications for Acute Treatment and Maintenance Regimens Drug Dose Equivalents a Dosage b OTC Generic c Brand c H2 receptor antagonists (...) with an increase in GERD symptoms (over 1-2 days); yet smoking cessation was not shown to decrease GERD symptoms in 3 low-quality studies. Alcohol use may or may not be associated with reflux symptoms. Avoid medications that decrease lower esophageal pressure or irritate the esophagus. Medications that decrease lower esophageal sphincter pressure should be avoided in patients with symptoms of GERD. These medications include calcium channel blockers, beta-agonists, alpha- adrenergic agonists, theophylline

2018 University of Michigan Health System

170. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia

). Traditionally, the primary goal of treatment has been to alleviate bothersome LUTS that result from BPO. More recently, treatment has also been focused on the alteration of disease progression and prevention of complications that can be associated with BPH/LUTS, such as acute urinary retention. 16 A variety of pharmacologic classes of medications are employed to treat LUTS attributed to BPH, including alpha- adrenergic antagonists (alpha-blockers), beta adrenergic agonists, 5-alpha- reductase inhibitors (5

2018 American Urological Association

171. Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update

of Pharmacological Treatments 75 Detailed Synthesis: Placebo-Controlled Trials of Alpha-Blockers 76 Detailed Synthesis: Placebo-Controlled Trials of Anticonvulsants/Mood Stabilizers 77 Detailed Synthesis: Placebo-Controlled Trials of Atypical Antipsychotics 78 Detailed Synthesis: Placebo-Controlled Trials of Benzodiazepines 82 Detailed Synthesis: Selective Serotonin Reuptake Inhibitors 82 Detailed Synthesis: Serotonin and Norepinephrine Reuptake Inhibitors 87 Detailed Synthesis: Placebo-Controlled Trials (...) interventions 59 Table 16. Characteristics of included studies that compared efficacy or comparative effectiveness between patients having different characteristics or specific trauma types 71 Table 17. Summary of efficacy and strength of evidence of PTSD pharmacological treatments 73 Table 18. Characteristics of included placebo-controlled trials of alpha-blockers 76 Table 19. Characteristics of included placebo-controlled trials of anticonvulsants, by drug 77 Table 20. Characteristics of included placebo

2018 Effective Health Care Program (AHRQ)

173. Dutasteride, tamsulosin, alfuzosin and dutasteride/tamsulosin combination for benign prostatic hyperplasia

Alfuzosin and tamsulosin are alpha-1-adrenergic antagonists (alpha blockers) used for the relief of lower urinary tract symptoms (LUTS) associated with BPH. The use of alpha-blockers for bothersome moderate to severe LUTS is supported by local and international clinical guidelines and constitutes routine clinical practice. The Committee acknowledged that an alpha-blocker (terazosin) is already listed on SDL for the treatment LUTS. 2.2 Dutasteride is a 5-alpha-reductase inhibitor which is used in line (...) the 5-alpha-reductase inhibitors, dutasteride is typically preferred for its longer half-life (5 weeks versus 8 hours for finasteride) which the clinicians suggested could improve treatment compliance. For the alpha-blockers, terazosin requires dose titration and close clinical monitoring, and therefore is often the least preferred agent within the class. Clinical effectiveness and safety Point Item 3.1 On the basis of the available clinical evidence, the Committee agreed that all alpha-blockers

2018 Appropriate Care Guides, Agency for Care Effectiveness (Singapore)

174. Management of specific situations in polycythaemia vera and secondary erythrocytosis Full Text available with Trip Pro

(Landolfi et al , ). Low‐dose aspirin, which describes various doses (e.g. 75, 81 or 100 mg) used in different countries, is the only dose to have been assessed in recent clinical trials. The risk of major bleeding, particularly gastro‐intestinal, increases with age, and proton pump inhibitors should be given to patients over 75 years of age as well as to those a with high bleeding risk. The role of the ADP‐receptor antagonist, clopidogrel, in the long‐term prevention of MPN‐related thrombosis has (...) should be undertaken if it is not controlled at the time of acute thrombosis. For arterial thrombosis, low dose aspirin should be offered to all patients, and specialist advice should be sought. For venous thromboembolism (VTE), anticoagulation should be commenced. Low molecular weight heparin (LMWH) remains the first choice in the acute setting, followed by vitamin K antagonists (VKA) as per guidelines (NICE, ). Direct oral anticoagulants (DOACs) are increasingly used in the non‐MPN population

2018 British Committee for Standards in Haematology

175. Management of Hypertension (5th Edition)

Failure Chronic, uncontrolled hypertension can cause heart failure, even in the presence of normal systolic function. Anti-hypertensive agents including ß-blockers, 170-172 ACEIs, 172 and aldosterone antagonist, 173 have shown mortality benefits and reduction in the number of hospitalizations, in patients with systolic heart failure. The evidence for ARB is less convincing 174 except for ACEI intolerant patients. 175 However for patients having heart failure with preserved systolic function, results (...) and Aldosterone antagonists should be given to patients with systolic heart failure to reduce morbidity and mortality. (Grade A) • Angiotensin receptor blockers or ACEIs should be used on heart failure patients with preserved ejection fraction. (Grade B) • Blood pressure in post myocardial infarction and heart failure patients should be lowered to 75 years old) who are on anticoagaulation for atrial fibrillation, both ACEI and ARB reduce mortality. 187 (Level II-2) For rate-control of permanent atrial

2018 Ministry of Health, Malaysia

176. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update

arousal systems. The same is true for any drug which blocks one of the other arousal systems; they produce a degree of sedation but are not generally e?ective hypnotics. However, someagentshavespeci?cactionsoncertainsleepparameters; for instance, drugs which block 5HT2 receptors (such as ritanserin or eplivanserin) can increase slow-wave sleep (Idzikowski et al., 1988; Landolt et al., 1999) whereas the alpha-1 adrenergic blocker prazosin is useful in post-trau- matic stress disorder-related nightmares (...) of proteins with bind- ing sites for a number of sleep-promoting drugs, in particu- lar benzodiazepines, so-called Z-drugs and barbiturates, all of which enhance the e?ects of GABA’s actions at the GABA A receptor. There are a number of subtypes of this receptor which are relevant for sleep, not only because of their di?erent location in the brain but also because of the fact that some hypnotic drugs are selective for a particular subtype. The alpha-1 subtype is highly expressed in the cortex and probably

2019 British Association for Psychopharmacology

177. Tadalafil Medical Expulsive Therapy in Ureteral Calculi: A New Kid on the Block?

a high ureteral stone expulsion rate as well as significant pain control. You wonder how it might compare to α-receptor blockers, such as tamsulosin or silodosin. Search Strategy Medline 1966-11/15 using OVID interface, Cochrane Library (2015), and Embase (exp ureteral obstruction/ or exp ureteral calculi/ or exp renal colic) AND [(exp adrenergic alpha-antagonists/ or or AND (exp phosphodiesterase-5 inhibitors/ or]. Limit to human, English language Search (...) Episodes Group B had a lower mean number of colic episodes than Group A (0.45 vs. 1.60, p Mean Number of Hospital Visits Group B had a lower mean number of hospital visits than Group A (2.2 vs. 2.85, p=0.001). Adverse Effects There was no statistically significant difference in rates of adverse effects, but there was a trend towards increased rates of adverse effects in Group B compared to Group A. Comment(s) α-adrenergic antagonists such as tamsulosin have been used to treat patients with renal colic

2017 BestBETS

178. Management of Cancer Pain in Adult Patients: ESMO Clinical Practice Guidelines

and tolerability of morphine administered orally or by epidural [159, 160]. An improvement in pain control as well as in adverse effects was shown by switching from oral to epidural infusion of mor- phine [159]. However, Kalso et al. showed no signi?cant bene?ts, either in ef?cacy or in adverse effects, by administering morphine via the epidural route compared with the s.c. route. The authors concluded that the co-administration of local anaesthetic agents, alpha-2-adrenergic agonists or NMDA antagonists may (...) strontium, samarium or rhenium has been investigated in a sys- tematic review [138]. The results showed only a small bene?cial ef- fect on pain control in the short and medium term (1–6 months), with no modi?cation of the analgesics used but relatively frequent adverse effects including leukopaenia and thrombocytopaenia. A randomised trial has evaluated the effect of radium-223 (an alpha emitter releasing short-range radiation, with little bone mar- row toxicity) in patients with castrate-resistant

2018 European Society for Medical Oncology

179. Pharmacological Management of Hypertension

controlled with triple therapy (i.e., thiazide-type diuretics, ACEI or ARB, and CCBs). Drug classes to consider include aldosterone receptor antagonists (e.g., spironolactone); peripherally acting antiadrenergic agents (e.g., reserpine); direct vasodilators (e.g., hydralazine); dual alpha-beta adrenergic blockers (e.g., carvedilol); and centrally acting antiadrenergic drugs (e.g., clonidine). The ACP/AAFP guideline does not address pharmacologic treatment of refractory hypertension. Areas of Difference (...) diuretics, ACEI or ARB, and CCBs] described in Recommendation 43) or as supplementary therapy in some clinical indications. Drug classes for consideration can include (not in priority order): Aldosterone/mineralocorticoid receptor antagonists (e.g., spironolactone, eplerenone) Other potassium-sparing diuretic (i.e., amiloride) Alpha-adrenergic blockers Beta-adrenergic blockers Non-dihydropyridine CCBs Combined alpha-beta adrenergic blockers Peripherally acting antiadrenergic agents (reserpine, pending

2017 National Guideline Clearinghouse (partial archive)

180. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

and Independent Transitioning by Students with Autism Spectrum Disorder. Journal of Autism & Developmental Disorders. 2011;41(6):687- 704 18p. doi: 10.1007/s10803-010-1088-6. PMID: 104896825. Language: English. Entry Date: 20110719. Revision Date: 20150711. Publication Type: Journal Article.X-3, X-4 754. Mehta MV, Gandal MJ, Siegel SJ. mGluR5-antagonist mediated reversal of elevated stereotyped, repetitive behaviors in D-65 the VPA model of autism. PLoS One. 2011;6(10):e26077. doi: 10.1371/journal.pone

2017 Effective Health Care Program (AHRQ)

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