Neomycin is administered to a patient with hepatic cirrhosis to prevent the formation of?

UPRVUNL - 2021

Pharmacology

Hard

Appeared in: UPRVUNL - 2021

Explanation

In hepatic cirrhosis, the liver's ability to convert ammonia to urea is impaired, leading to toxic ammonia accumulation.
Ammonia is primarily produced by bacteria in the intestines that break down proteins and urea.
Neomycin is a non-absorbable antibiotic that acts locally in the gut to kill these ammonia-producing bacteria.
By reducing the bacterial load, Neomycin decreases the production of ammonia, thereby lowering blood ammonia levels and preventing or treating hepatic encephalopathy.

Option B: Neomycin does not prevent the formation of urea. Urea is synthesized in the liver from ammonia as part of the urea cycle to detoxify ammonia. In fact, intestinal bacteria break down urea to produce more ammonia, a process that Neomycin helps to reduce.
Option C: Hemoglobin is the protein in red blood cells responsible for oxygen transport. Its formation and function are unrelated to the action of Neomycin in the gut for hepatic cirrhosis.
Option D: Bile is produced by the liver to aid in the digestion and absorption of fats. Neomycin's mechanism of action does not involve the prevention of bile formation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological management of hepatic encephalopathy in cirrhosis to guide bedside assessment, documentation, and the next nursing action.
Nurses must vigilantly monitor the neurological status of patients with cirrhosis for subtle changes indicating the onset or worsening of hepatic encephalopathy, such as increased confusion or the appearance of asterixis.
Due to the risk of nephrotoxicity and ototoxicity with long-term use, nurses should monitor renal function (I&O, creatinine) and assess for hearing changes in patients receiving Neomycin.
Patient education regarding dietary protein is crucial. While protein restriction was common, current practice often involves moderate protein intake unless encephalopathy is severe, balancing nutrition with ammonia control.

How to Approach the Question

First, identify the key elements of the question: the drug (Neomycin), the condition (hepatic cirrhosis), and the purpose (prevent the formation of...).
Recall the major complications of hepatic cirrhosis. One of the most critical is the liver's inability to detoxify substances, leading to hepatic encephalopathy.
Consider the cause of hepatic encephalopathy. It's primarily caused by the accumulation of neurotoxic substances, with ammonia being the most well-known.
Analyze the drug's class. Neomycin is an antibiotic. How would an antibiotic help in this context? It would act on bacteria.
Connect the pathophysiology to the drug's action. Gut bacteria produce ammonia. An antibiotic like Neomycin would kill these bacteria, thus reducing ammonia production.
Evaluate the options based on this reasoning. Ammonia is the direct target. Urea is part of the cycle but not what's being prevented. Hemoglobin and bile are unrelated to this specific mechanism.

Concept Tested & Keywords

Concept Tested: Pharmacological management of hepatic encephalopathy in cirrhosis.
Stem keywords: Neomycin, hepatic cirrhosis, prevent formation
Lead-in keywords: to prevent the formation of
Clinical cues: Patient with hepatic cirrhosis
Negative lead-in flag: false

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