A patient is a known hepatitis B carrier with a past history of opioid addiction. Which analgesic is MOST appropriate for dental pain management?

Correct answer: A. Acetaminophen alone (standard dose)

• A. CORRECT. In a patient with hepatitis B (potential liver compromise) AND a history of opioid addiction: (1) opioids must be avoided due to addiction history; (2) NSAIDs should be avoided with liver disease (risk of GI bleeding and worsening hepatic function); (3) acetaminophen at standard doses (≤3g/day) is safer than NSAIDs in liver disease when not using alcohol. Acetaminophen alone is the safest choice here.
• B. Ibuprofen (an NSAID) is relatively contraindicated with liver disease due to increased risk of GI bleeding and impaired renal function.
• C. Hydrocodone is an opioid — contraindicated in a patient with opioid addiction history.
• D. Tramadol has opioid activity (mu-receptor agonism) and CNS effects — prescribing it to a patient with opioid addiction history is inappropriate.