A patient with alcoholism, Hepatitis C, and confirmed liver cirrhosis requires pain management after a dental procedure. Which analgesic(s) should be AVOIDED in this patient?

Managing pain in liver cirrhosis requires careful analgesic selection: NSAIDs (e.g., ibuprofen) are CONTRAINDICATED in cirrhosis — they cause nephrotoxicity, gastrointestinal hemorrhage, and platelet dysfunction, all dangerous in patients with existing coagulopathy and portal hypertension. Opioids (e.g., hydrocodone) should also be AVOIDED or used with extreme caution — impaired hepatic metabolism causes drug accumulation, leading to hepatic encephalopathy and sedation. Acetaminophen — despite its hepatotoxic reputation — is actually the SAFEST analgesic in cirrhosis when dosed at ≤2 g/day in non-drinking patients. This is per gastroenterology consensus guidelines. Key principle: In cirrhosis — AVOID NSAIDs (renal failure, GI bleed), AVOID opioids (encephalopathy), USE low-dose acetaminophen as the preferred option. Note: acetaminophen must be AVOIDED in active drinkers.