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1. All of the following are typical characteristics of patients with hepatorenal syndrome (HRS), EXCEPT:

A. Cirrhosis with ascites B. Serum creatinine (SCr) > 1.5 mg/dL C. Absence of shock D. Presence of parenchymal kidney disease

2. Immediate discontinuation of intravenous vasoconstrictor therapy should be considered in the presence of all of the following adverse effects, EXCEPT:

A. Myocardial ischemia B. Tachycardia C. Digital cyanosis D. Mesenteric ischemia

3. Which of following is MOST likely to trigger HRS type I in a patient with severe cirrhosis and ascites:

A. Spontaneous bacterial peritonitis B. Diarrhea C. Discontinuation of furosemide and spironolactone D. Propranolol prophylaxis for esophageal varices

4. All of the following are appropriate goals for vasoconstrictor therapy in patients with HRS, EXCEPT:

A. Increase urine output B. Increase mean arterial pressure by > 10 mm Hg C. Decrease serum creatinine to < 1.5 mg/dL D. Reduce Model for End-Stage Liver Disease (MELD) score to lower patients status on transplant list

5. All of the following are potential roles for the clinical pharmacist in the management of HRS, EXCEPT:

A. Identification of potentially nephrotoxic medications B. Discuss the potential benefits and risks of therapeutic options C. Determine when to initiate renal replacement therapy D. Outline a plan for vasoconstrictor titration and monitoring

6. Which of the following is the MOST appropriate intravenous dosing strategy for vasopressin for the treatment of HRS:

A. Use a fixed dose of 0.04 units/min B. Initiate at 0.04 units/min and titrate every 30 to 60 minutes to achieve > 10 mm Hg increase in MAP from baseline C. Start vasopressin at 0.8 units/min and titrate down if ischemic complications occur D. Vasopressin 40 unit bolus, repeat every 20 minutes as needed to maintain a MAP increase > 10 mm Hg from baseline

7. All of the following vasoconstrictor options have demonstrated the ability to improve HRS physiology, EXCEPT:

A. Dopamine B. Terlipressin C. Norepinephrine D. Vasopressin

8. Which of the following artificial organ support systems is most effective for reversing HRS:

A. Renal replacement therapy B. Molecular adsorbent recirculating system (MARS) C. Prometheus D. None of the above has demonstrated improved clinical outcomes when treating those with HRS; therefore, their routine use is not recommended

9. A recommendation to discontinue vasoconstrictor therapy when encountering futility regarding the management of those with HRS should be initiated at what time point during therapy?

A. After 4 days of appropriately titrated therapy with no response in SCr B. After 10 days of appropriately titrated therapy with no response in SCr C. After 14 days of appropriately titrated therapy with no response in SCr D. Therapy should be continued until liver transplant, regardless of SCr

10. All of the following are considered an appropriate use of albumin for patients who are at risk for HRS or those who already have HRS, EXCEPT?

A. Adjunctive administration during vasoconstrictor therapy B. To determine the diagnosis of HRS C. To prevent HRS in patients with spontaneous bacterial peritonitis D. To supplement serum albumin to achieve a concentration > 4 g/dL