NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

What is the first line treatment for hepatic encephalopathy?

1. Rifaximin

2. Lactulose

3. Ceftriaxone

4. Spironolactone

The correct answer is: Lactulose

Lactulose is the first-line treatment for hepatic encephalopathy. It works by reducing the blood ammonia levels through its laxative effect in the colon, resulting in the excretion of ammonia in the form of ammonium (NH4+). This leads to a decrease in the production of ammonia by colonic bacteria. Therefore, lactulose helps in managing the neurological symptoms associated with hepatic encephalopathy. Rifaximin (Choice A) may be used as an adjunctive therapy in patients with hepatic encephalopathy, particularly for recurrent episodes. Ceftriaxone (Choice C) is not commonly used for hepatic encephalopathy. Spironolactone (Choice D) is a potassium-sparing diuretic primarily used for conditions like heart failure and hypertension, not hepatic encephalopathy.