Cirrhosis: drug management and complications MCQs With Answer

Cirrhosis: drug management and complications MCQs With Answer

Introduction: This quiz set focuses on pharmacologic management and common complications of cirrhosis tailored for M.Pharm students studying Pharmacotherapeutics I (MPP 102T). Questions emphasize evidence-based drug choices, mechanisms of action, dose adjustments, monitoring parameters, and complication-specific therapies such as hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, variceal bleeding and hepatorenal syndrome. Each MCQ is designed to test both conceptual understanding and practical application in clinical pharmacotherapy, including adverse effects and contraindications. Use these items for focused revision, to deepen your pharmacologic reasoning, and to prepare for exams and clinical decision-making in hepatology.

Q1. Which pharmacologic agent is considered first-line therapy for sodium retention leading to ascites in cirrhosis?

• Furosemide alone
• Spironolactone alone
• Spironolactone combined with furosemide
• Amiloride

Correct Answer: Spironolactone combined with furosemide

Q2. What is the initial pharmacologic treatment of choice for acute hepatic encephalopathy?

• Rifaximin
• Neomycin
• Lactulose
• Metronidazole

Correct Answer: Lactulose

Q3. Which statement best describes rifaximin’s pharmacologic action in hepatic encephalopathy?

• Systemic bactericidal fluoroquinolone that reduces ammonia absorption
• Nonabsorbable rifamycin that reduces ammonia-producing gut bacteria by inhibiting bacterial RNA polymerase
• Probiotic that restores gut flora balance and increases ammonia metabolism
• Oral carbonic anhydrase inhibitor that increases renal ammonia excretion

Correct Answer: Nonabsorbable rifamycin that reduces ammonia-producing gut bacteria by inhibiting bacterial RNA polymerase

Q4. Which drug class is used prophylactically to reduce portal pressure and prevent first variceal hemorrhage in cirrhotic patients with esophageal varices?

• Selective beta-1 blockers (e.g., metoprolol)
• Nonselective beta-blockers (e.g., propranolol, nadolol)
• ACE inhibitors (e.g., enalapril)
• Calcium channel blockers (e.g., amlodipine)

Correct Answer: Nonselective beta-blockers (e.g., propranolol, nadolol)

Q5. Which vasoactive drug is commonly used intravenously to control acute variceal bleeding?

• Terazosin
• Intravenous octreotide
• Intravenous heparin
• Intravenous furosemide

Correct Answer: Intravenous octreotide

Q6. What is the recommended empiric antibiotic for suspected spontaneous bacterial peritonitis (SBP) in hospitalized cirrhotic patients?

• Oral norfloxacin
• Intravenous cefotaxime (third-generation cephalosporin)
• Intravenous vancomycin
• Intravenous gentamicin

Correct Answer: Intravenous cefotaxime (third-generation cephalosporin)

Q7. What is the primary rationale for intravenous albumin administration in patients with SBP?

• To directly eradicate bacteria in ascitic fluid
• To reduce portal pressure by oncotic mobilization
• To decrease renal vasoconstriction, reducing risk of hepatorenal syndrome and improving survival
• To neutralize endotoxins in the circulation

Correct Answer: To decrease renal vasoconstriction, reducing risk of hepatorenal syndrome and improving survival

Q8. Which analgesic is preferred in cirrhotic patients for chronic pain at a reduced dose to minimize hepatotoxicity?

• Ibuprofen (NSAID)
• Acetaminophen (paracetamol) at reduced dose
• Aspirin
• Naproxen (NSAID)

Correct Answer: Acetaminophen (paracetamol) at reduced dose

Q9. What is the recommended pharmacologic therapy for type 1 hepatorenal syndrome?

• High-dose loop diuretics alone
• Terlipressin combined with intravenous albumin
• Oral midodrine alone
• Immediate long-term spironolactone therapy

Correct Answer: Terlipressin combined with intravenous albumin

Q10. Which electrolyte abnormality is most commonly associated with spironolactone therapy in cirrhotic patients?

• Hypokalemia
• Hyperkalemia
• Hypernatremia
• Hypocalcemia

Correct Answer: Hyperkalemia

Q11. Which of the following nonselective beta-blockers is classically used for portal hypertension and secondary prophylaxis of variceal bleeding?

• Metoprolol
• Propranolol
• Atenolol
• Bisoprolol

Correct Answer: Propranolol

Q12. How does lactulose reduce systemic ammonia levels in hepatic encephalopathy?

• Enhances renal ammonia excretion by diuresis
• Acidifies colonic contents, converting ammonia (NH3) to ammonium (NH4+) for fecal excretion
• Directly inhibits hepatic urease activity
• Systemically binds ammonia in plasma for renal elimination

Correct Answer: Acidifies colonic contents, converting ammonia (NH3) to ammonium (NH4+) for fecal excretion

Q13. In recurrent hepatic encephalopathy despite lactulose, what is the recommended adjunct antibiotic to reduce recurrence?

• Vancomycin orally
• Rifaximin orally
• Oral ampicillin
• Oral tetracycline

Correct Answer: Rifaximin orally

Q14. Which class of commonly used analgesics should be avoided in cirrhotic patients because it increases risk of gastrointestinal bleeding and renal impairment?

• Acetaminophen
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Topical opioids
• Selective COX-2 inhibitors at low dose

Correct Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs)

Q15. For long-term prophylaxis against SBP in high-risk cirrhotic patients, which oral antibiotic is commonly prescribed?

• Oral amoxicillin
• Oral norfloxacin
• Oral doxycycline
• Oral cephalexin

Correct Answer: Oral norfloxacin

Q16. Which drug class is not routinely recommended for hyponatremia in cirrhosis due to potential hepatotoxicity and limited data on safety?

• Loop diuretics
• Vasopressin receptor antagonists (vaptans) such as tolvaptan
• Oral sodium supplementation
• Fluid restriction

Correct Answer: Vasopressin receptor antagonists (vaptans) such as tolvaptan

Q17. Which statin is generally considered safer or preferable in patients with chronic liver disease due to minimal CYP-dependent hepatic metabolism?

• Atorvastatin
• Simvastatin
• Pravastatin
• Lovastatin

Correct Answer: Pravastatin

Q18. Which laboratory parameters are essential to monitor in cirrhotic patients receiving combined spironolactone and loop diuretic therapy?

• Lipid profile only
• Serum electrolytes (Na+, K+) and renal function (creatinine, BUN)
• Liver enzymes (ALT/AST) exclusively
• Hemoglobin A1c

Correct Answer: Serum electrolytes (Na+, K+) and renal function (creatinine, BUN)

Q19. After control of an acute variceal bleed, which long-term strategy most reduces recurrence of variceal hemorrhage?

• Endoscopic variceal ligation (EVL) alone
• Nonselective beta-blocker therapy alone
• Combination of nonselective beta-blocker therapy and endoscopic variceal ligation
• Long-term systemic corticosteroids

Correct Answer: Combination of nonselective beta-blocker therapy and endoscopic variceal ligation

Q20. Which class of central nervous system–active medications is most likely to precipitate or worsen hepatic encephalopathy in cirrhotic patients?

• Selective serotonin reuptake inhibitors (SSRIs)
• Benzodiazepines (e.g., diazepam)
• Topical local anesthetics
• Inhaled bronchodilators

Correct Answer: Benzodiazepines (e.g., diazepam)

Download