New medications and new guidelines are constantly being released. Pharmacists need a mechanism to keep up with these new medications and guidelines.

Hepatorenal syndrome is a serious complication of advanced liver cirrhosis. The hallmark of hepatorenal syndrome (HRS) is peripheral arterial/splanchnic vasodilation, coupled with intense renal vasoconstriction leading to decreased renal perfusion. This decreased renal perfusion leads to a potentially reversible acute kidney injury (AKI). However, when left untreated, this disease is associated with a mortality rate of nearly 50% within 2 weeks up to 80% by 30 days. The only curative treatment for hepatorenal syndrome is liver transplant; however, treatment with norepinephrine in combination with albumin has been our historically preferred treatment for HRS in patients unable to receive transplants or as a bridging therapy to transplant. Terlipressin, a vasopressin analogue prodrug, recently received approval from the FDA for the indication of HRS reversal. While current guidelines recommend the use of terlipressin for HRS reversal, questions still exist about the safety and efficacy of the medication. More data is needed to better identify an optimal place in therapy and monitoring parameters for this newly-approved therapy.