Question

Identify various medications utilized in treating the patient with cirrhosis of the liver. Be sure to include the action of each medication identified.

Answer 1

Answer :

Cirrhosis is generally termed as irreversible damage to liver characterised by extensive fibrosis and nodular regenerations.

Common complications or consequences of liver cirrhosis are

1) Ascites

2) Portal hypertension

3) Variceal bleeding

4) Hepatic encephalopathy.

Treatment :

Remove or treat the common causes such as alcohol or viruses such as hepatitis B and hepatitis C.

Medications for hepatitis B:

A) Tenofovir - Cytosine nucleoside analogue

B) Entecavir - Cyclopentyl guanosine analogue

C) Adefovir - Nucleotide reverse transcriptase inhibitor

Medications for hepatitis C:

A) Interferon alpha - Inhibits viral replication as well as acts as immunomodualator

B) Ribavirin - Nucleoside inhibitor

C) Telaprevir - Protease inhibitor.

Medications used in cirrhosis for complications :

1) For ascites

Diuretic - a) Loop diuretic - Furosemide b) Potassium sparing diuretic - Spironolactone

Albumin - To correct hypoalbuminemia

2) For variceal bleeding

Vasopressin - Constricts spanchnic arterioles and reduce portal pressure

Terlipressin , somatostatin and octreotide also act as vasoconstrictors

Vitamin K replacement for clotting factors produced by liver though the liver is cirrhosed

3) Hepatic encephalopathy

Lactulose- Its metabolism by colonic bacteria results in acidic pH which favours conversion of ammonia to ammonium which is poorly absorbed in circulation .

Mannitol to reduce cerebral edema.

For gut sterilisation rifaximin is used .

To prevent spontaneous bacterial peritonitis cefotaxime (cephalosporin antibiotic ) and norfloxacin (fluoroquonolne antibiotic) are used.

Propranolol (beta blocker ) is used to reduce portal pressure.

Hepatic transplantation is the ultimate treatment to replace almost non functioning liver In terminal stages.

Penicillamine to inhibit the formation of crosslinking in collagen. Colchicine inhibits assembly of collagen

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