Issues:
(1) body weight for dosing in the presence of ascites
(2) concomitant renal dysfunction (hepatorenal syndrome)
(3) drugs contraindicated in a patient with cirrhosis
(4) drugs needed to avoid complications
(5) compliance
(6) continued substance abuse
Examples of medications that may be inappropriate:
(1) nonsteroidal anti-inflammatory agent (NSAID)
(2) high doses of acetaminophen
(3) opiate
(4) benzodiazepine
Examples of medications that may be appropriate:
(1) antibiotics following spontaneous bacterial peritonitis
(2) beta blocker following variceal bleeding
(3) diuretic
(4) lactulose for hepatic encephalopathy
Problems:
(1) noncompliance
(2) inability to afford medications
(3) hepatic encephalopathy and ability to follow instructions
