Pharmacology · single question
A Hepatitis B carrier with a history of drug and alcohol use (now 2 years sober) presents with dental pain. What is the most appropriate analgesic?
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Correct answer: B. Ibuprofen 600mg + Acetaminophen 500mg
In a patient with hepatitis B (hepatic involvement) and history of substance abuse (addiction risk), opioids (hydrocodone, oxycodone, tramadol) are contraindicated due to abuse potential. High-dose NSAIDs must be used cautiously with liver disease (avoid in hepatic impairment), but standard dose ibuprofen + acetaminophen (at safe doses) is appropriate for a recovered patient 2 years sober with non-severe liver disease. NSAIDs + acetaminophen (at recommended doses) are the first-line non-opioid approach.
- A. Incorrect. Hydrocodone is an opioid — contraindicated in patients with history of substance abuse due to high relapse/addiction risk.
- B. Incorrect. Oxycodone is a Schedule II opioid with high addiction potential — absolutely contraindicated in recovering addicts.
- C. CORRECT. Ibuprofen + acetaminophen (at appropriate doses) provides effective multimodal analgesia without opioid addiction risk. This is the safest choice for a recovering addict.
- D. Incorrect. Tramadol has abuse potential and serotonergic properties — it is not a safe choice for patients with substance use history.