Which medication should be avoided in a client with hepatic encephalopathy?

In the context of hepatic encephalopathy, the medication that should be avoided is alprazolam. This is because alprazolam, a benzodiazepine, has central nervous system depressant properties that can exacerbate the symptoms of hepatic encephalopathy, such as confusion, altered mental status, and decreased responsiveness. Patients with liver dysfunction already have impaired processing of medications due to a decreased ability to metabolize drugs, and adding a CNS depressant can increase the risk of sedation and further cognitive impairment.

In contrast, lactulose is often used to treat hepatic encephalopathy as it helps reduce ammonia levels in the bloodstream, which is crucial in managing this condition. Rifaximin is an antibiotic that can help decrease gut bacteria that contribute to ammonia production, making it beneficial in this context as well. Spironolactone is a diuretic often used to manage fluid retention in liver disease, particularly in patients with ascites, and does not carry the same risks associated with cognitive impairment. Thus, alprazolam's risks in patients with hepatic encephalopathy make it the medication to avoid in this scenario.