Cirrhosis

Question 1

Spironolactone

Answer 1

MOA: blocks mineralocorticoid receptor
(receptor for aldosterone) –> decreases renal
sodium retention
Also blocks the androgen receptor (AR)

Use: Treats ascites

AEs: Hyperkalemia
Gynecomastia, sexual dysfunction (from
blocking AR)

Question 2

Propranolol

Answer 2

MOA: nonselective beta blocker
Blocks beta-2 –> decreases splanchnic vasodilation –> decreases portal pressure –> decreases risk of variceal bleeding

Use: Primary and secondary prophylaxis against variceal bleeding

AEs: same as you learned in previous blocks!

Question 3

Octreotide

Answer 3

MOA: somatostatin receptor (Gi-coupled) agonist
Stimulation of SST receptors –> decreases release of vasodilators? –> decreases splanchnic vasodilation –> decreases portal pressure

Use: Treats acute esophageal varciceal bleeding
* Also treats a variety of hormone secreting tumor syndromes

AEs: Abdominal pain, diarrhea, NV, gallstones

Question 4

Vasopressin

Answer 4

MOA: activates V1 receptors (Gq-coupled)
–> splanchnic vasoconstriction –> decreases portal pressure

Use: Treats acute esophageal varciceal bleeding

AEs: Hypertension, hyponatremia (stimulates V2 in kidney g water retention)

Question 5

Lactulose

Answer 5

MOA: metabolized by colonic bacteria to
formic and acetic acid –> acidifies lumen
–> protonates NH3 to NH4+ –> traps in
lumen

Use: Treats hepatic encephalopathy
*Also treats constipation

AEs: abdominal pain, flatulence, diarrhea

Question 6

Rifaximin

Answer 6

MOA: nonabsorbable antibiotic that kills
GI bacteria that metabolize urea to NH3

Use: Treats hepatic encephalopathy

AEs: GI (abdominal pain, nausea)