Summary of Drug Adjustments in Cirrhosis

Question 1

1. Which “Analgesics” drugs should be avoided in patients with Cirrhosis?

A. Esomeprazole, Famotidine

B. Furosemide, Spironolactone, Hydrochlorothiazide

C. Acetaminophen, COX-2 inhibitors, NSAIDs

D. Amoxicillin, Amoxicillin/ clavulanic acid, Ciprofloxacin, Rifaximin

Answer 1

C. Acetaminophen, COX-2 inhibitors, NSAIDs

Rationale:
Analgesics:

Avoid: Acetaminophen, COX-2 inhibitors, NSAIDs

Question 2

2. Which “Antibiotics” drugs are safe to use in Cirrhosis?

A. Azithromycin, Erythromycin

B. Amoxicillin, Amoxicillin/ clavulanic acid, Ciprofloxacin, Rifaximin

C. Insulin, Glucagon-like peptide-1 agonists, Sulfonylureas

D. ACE inhibitors, ARBs, Verapamil

Answer 2

B. Amoxicillin, Amoxicillin/ clavulanic acid, Ciprofloxacin, Rifaximin

Rationale:
Antibiotics:

Safe: Amoxicillin, Amoxicillin/ clavulanic acid, Ciprofloxacin, Rifaximin

Question 3

3. Which “Antidiabetic drugs” should be avoided in Cirrhosis?

A. Insulin, Glucagon-like peptide-1 agonists, Sulfonylureas

B. Furosemide, Spironolactone, Hydrochlorothiazide

C. Metformin, Pioglitazone

D. Cholestyramine

Answer 3

C. Metformin, Pioglitazone

Rationale:
Antidiabetic drugs:

Avoid: Metformin, Pioglitazone

Question 4

Which “Antihypertensives” drugs are not recommended for patients with Cirrhosis?

A. Calcium channel blockers

B. Amoxicillin, Amoxicillin/ clavulanic acid, Ciprofloxacin, Rifaximin

C. Insulin, Glucagon-like peptide-1 agonists, Sulfonylureas

D. ACE inhibitors, ARBs, Verapamil

Answer 4

D. ACE inhibitors, ARBs, Verapamil

Rationale:
Antihypertensives:

Avoid: ACE inhibitors, ARBs, Verapamil

Question 5

5. Which “Lipid-lowering agents” should be avoided in Cirrhosis?

A. Statins

B. Cholestyramine

C. Esomeprazole, Famotidine

D. Furosemide, Spironolactone, Hydrochlorothiazide

Answer 5

A. Statins

Rationale:
Lipid-lowering agents:

Avoid: Statins

Question 6

6. Which “Diuretics” are considered safe in Cirrhosis?

A. ACE inhibitors, ARBs, Verapamil

B. Statins

C. Furosemide, Spironolactone, Hydrochlorothiazide

D. Metformin, Pioglitazone

Answer 6

C. Furosemide, Spironolactone, Hydrochlorothiazide

Rationale:
Diuretics:

Safe: Furosemide, Spironolactone, Hydrochlorothiazide

Question 7

7. Which “Lipid-lowering agents” is considered safe in Cirrhosis?

A. Statins

B. Cholestyramine

C. Acetaminophen, COX-2 inhibitors, NSAIDs

D. Azithromycin, Erythromycin

Answer 7

B. Cholestyramine

Rationale:
Lipid-lowering agents:

Safe: Cholestyramine

Question 8

8. Which “Acid-suppressing agents” are considered safe for patients with Cirrhosis?

A. Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole, Cimetidine

B. Esomeprazole, Famotidine

C. Metformin, Pioglitazone

D. Statins

Answer 8

B. Esomeprazole, Famotidine

Rationale:
Acid-suppressing agents:

Safe: Esomeprazole, Famotidine

Question 9

11. Among the following “Antibiotics”, which one should be avoided in Cirrhosis patients?

A. Amoxicillin

B. Azithromycin

C. Ciprofloxacin

D. Rifaximin

Answer 9

Answer: B. Azithromycin

Rationale:
Antibiotics:

Avoid: Azithromycin, Erythromycin`

Question 10

Which of the following antidiabetic drugs are considered safe for patients with Cirrhosis?

A. Metformin, Pioglitazone

B. Insulin, Glucagon-like peptide-1 agonists

C. Pioglitazone, SGLT-2 inhibitors

D. Sulfonylureas, Dipeptidyl peptidase-4 inhibitors, Metformin

Answer 10

B. Insulin, Glucagon-like peptide-1 agonists

Rationale:
Antidiabetic drugs safe for Cirrhosis:

Insulin, Glucagon-like peptide-1 agonists, Sulfonylureas, Dipeptidyl peptidase-4 inhibitors, SGLT-2 inhibitors

Question 11

What to “Acid-suppressing agents” drugs to avoid in Cirrhosis?

A. Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole, Cimetidine
B. Esomeprazole, Famotidine
C. Acetaminophen, COX-2 inhibitors, NSAIDs
D. Cholestyramine

Answer 11

A. Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole, Cimetidine

Rationale:
Acid-suppressing agents:
* Safe: Esomeprazole, Famotidine
* Avoid: Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole, Cimetidine

Question 12

Which of the following antihypertensives is considered safe for patients with Cirrhosis?

A. ACE inhibitors

B. ARBs

C. Calcium channel blockers

D. Verapamil

Answer 12

C. Calcium channel blockers

Rationale:
Antihypertensives:

Safe: Calcium channel blockers (but note that among the calcium channel blockers, Verapamil is not recommended for cirrhotic patients).