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List and explain why the patient is taking each of his current medications.
Specifically, what is the benefit of prescribing spironolactone and propranolol
together?
Lactulose: This is a nonabsorbable disaccharide used to reduce the risk of hepatic
encephalopathy in a patient with liver disease. It is broken down by intestinal bacteria into lactic
acids and other organic compounds. Lactulose inhibits the production of intestinal ammonia. It is
converted to acetic acid and lactic acid leading to acidification of the lumen. This enables the
conversion of ammonia to ammonium ions, which is impermeable hence remaining trapped in
the lumen of the colon (Ravindra .K.V. et al. 2007).
Spironolactone: The drug antagonizes aldosterone in the renal tubules. It mainly acts on the
distal tubule to increase natriuresis and, at the same time, conserve potassium. It is used in the
initial treatment of the patients with ascites caused by cirrhosis.
Furosemide: The drug works by increasing the excretion of water in the tubules. It interferes with
the chloride-binding co-transporter system. Therefore, it inhibits the reabsorption of sodium and
chloride in the distal renal tubule and ascending loop of Henle. It can be used alone or combined
with spironolactone in treating the patient with ascites.
Propranolol: This is a nonselective beta-blocker. It works by dilating blood vessels and slowing
heart rate. This appears to reduce blood pressure in the varices bypassing the liver. In patients
with esophageal varices, propranolol minimizes the risk of bleeding. It is used both as primary or
secondary prophylaxis.
Famotidine: This is an H2-receptor blocker. The patient has a history of gastritis, and the
medication is used to reduce stomach acidity. Also, it is beneficial to use a combination of
propranolol and spironolactone in patients with esophageal varices. There are excellent
hemodynamic effects and better response with more reduction in the hepatic venous pressure
gradient in secondary prevention of variceal bleeding (Ravindra .K.V. et al. 2007).
References
Ravindra, .K.V, Eng. M & Marvin M. (2007). Current management of sinusoidal portal
hypertension. Am Surg. 74(1):4-10