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Pharmacology · single question

A patient taking hydrochlorothiazide and lisinopril has a periapical radiograph showing symptomatic irreversible pulpitis with a normal periodontal status, and reports significant pain. Which pain medication choice is most appropriate, given this patient's specific medication regimen?

  1. Acetaminophen
  2. Any NSAID, since drug interactions don't matter for short-term dental pain management
  3. A high-dose combination of multiple different NSAIDs simultaneously
  4. No analgesic of any kind should ever be prescribed
Show answer and explanation

Correct answer: A. Acetaminophen

The combination of an ACE inhibitor (lisinopril) plus a diuretic (hydrochlorothiazide) plus an NSAID is sometimes called the 'triple whammy' — each component reduces renal blood flow/function through a different mechanism, and together they meaningfully increase acute kidney injury risk, especially with repeated NSAID dosing. Acetaminophen avoids this specific interaction, making it the more appropriate analgesic choice for this patient's pain management.

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