Question

A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator that the medication has been effective?

1) The patient reports no chest pain.
2) Blood pressure is 140/90 mm Hg.
3) Stools test negative for occult blood.
4) The apical pulse rate is 68 beats/minute.

Answer 1

The best indicator of effective propranolol treatment for a patient with cirrhosis and esophageal varices is stools testing negative for occult blood as it suggests no active gastrointestinal bleeding.

Step-by-step explanation:

The best indicator that the medication propranolol (Inderal) has been effective for a patient with cirrhosis and esophageal varices would be that the stools test negative for occult blood (option 3). Propranolol is a ß-blocker commonly used to lower blood pressure and reduce the risk of bleeding from esophageal varices by decreasing heart rate and portal blood pressure. While a controlled blood pressure (< 140/90 mm Hg) and a regular apical pulse rate could be positive signs, they are not direct indicators of reduced variceal bleeding risk. Chest pain relief is not specifically relevant to esophageal varices.

Propranolol achieves therapeutic effects by blocking ß1 receptors, which can help slow the heart rate (HR) and reduce blood pressure, two factors that are vital for patients with cirrhosis and esophageal varices to prevent variceal bleeding. Since the absence of occult blood in stools suggests that there is no active gastrointestinal bleeding, it would indicate the efficacy of propranolol in this specific clinical scenario.