Pharmacology · patient case question
A patient with hepatitis and gastro-oesophageal reflux disease has had teeth #30 and #31 extracted. Which analgesic should NOT be prescribed?
Patient case: Analgesia, paediatric trauma and restorative decisions
Scenario: Four items, three of them treatment decisions.
Show answer and explanation
Correct answer: A. Aspirin
- A. Correct. Aspirin is the one to avoid outright: it irreversibly inhibits platelet function — a real concern in liver disease with impaired clotting factor synthesis — and it is directly ulcerogenic in a patient with reflux.
- B. Ibuprofen carries gastrointestinal risk too and should be used cautiously and briefly, but it is not absolutely contraindicated.
- C. Hydrocodone spares the stomach and platelets. It needs care in hepatic impairment because of the paracetamol usually combined with it, but it is not the contraindicated choice.
- D. Naproxen shares that caution; its longer half-life makes the gastrointestinal exposure greater.
Note: Acetaminophen at a reduced ceiling dose is usually the safest starting point in hepatic impairment — confirm current liver function with the physician.