Pharm Liver/Kidney

Ascites Tx

Diuretics: Spironolactone + Furosemide
Sodium/Fluid Restriction

Ascites Tx Mechanism

Reduce fluid accumulation
Spironolactone antagonizes aldosterone

Ascites Tx Monitoring

BP, Potassium Level, Gynecomastia

Varices Tx

Non-selective Beta Blockers (Propranolol, Nadolol, Carvedilol)

Varices Tx Mechanism

Reduce portal pressure to prevent a first variceal bleed

Varices Tx Monitoring

HR
BP

Acute Variceal Bleeding Tx

Octreotide
Endoscopic banding
Antibiotics

Acute Variceal Bleeding Tx Mechanism

Octreotide decreases splanchnic blood flow to stop bleeding
Antibiotics prevent SBP

Acute Variceal Bleeding Tx Monitoring

Hemodynamic stability
Sx of infection

Hepatic Encephalopathy Tx

Lactulose
Rifaximin

Hepatic Encephalopathy Tx Mech

Decreases ammonia levels
Lactulose increases ammonia elimination via stool
Rifaximin is an antibiotic that reduces ammonia production by gut bacteria

Hepatic Encephalopathy Tx Monitoring

Mental Status
Goal of 2-3 soft stools per day

Spontaneous Bacterial Peritonitis Tx

Antibiotics
Albumin

Hepatic Encephalopathy Tx Mech

Treat Infection
Albumin infusion helps reduce the rate of renal failure

Hepatic Encephalopathy Tx Monitoring

Fever
Abdominal Pain
WBC Count

Drugs to delay progression of Kidney Disease

ARB
ACEI
SGLT2I
Non-Dihydropyridine CCB

Anemia Tx

Erythropoiesis Stimulating Agents (ESAs)
Iron Supplementation

Anemia Tx Mechanism

Stimulate RBC production
Provide necessary substrate

Anemia Tx Monitoring

Hemoglobin target <11
Iron studies
BP

Hyperphosphatemia Tx

Phosphate Binders
Dietary Restriction

Hyperphosphatemia Tx Mech

Binders prevent dietary phosphorus from being absorbed
Must be taken with meals and snacks

Hyperphosphatemia Tx Monitoring

Phosphorus levels
Calcium levels

Hyperkalemia Acute/Emergent Tx

Stabilize Cardiac Membrane: IV calcium
Shift K+ intracellularly: Regular Insulin + Glucose, Albuterol

Hyperkalemia Acute/Emergent Tx Mech

Prevent fatal arrhythmias and remove excess K from the body

Hyperkalemia Acute/Emergent Tx Monitoring

ECG changes
Increased serum K

Hyperkalemia Chronic Tx

Potassium Binders
Sodium Zirconium
Dietary Restriction

Hyperkalemia Chronic Tx Mech

Exchange resins that bind K to the GI tract for elimination

Hyperkalemia Chronic Tx Monitoring

Serum Potassium
Edema
Constipation
Requires separation from other medications