Pharmacology · single question
An alcoholic patient with hepatitis C and liver cirrhosis needs pain management. What analgesic is MOST contraindicated?
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Correct answer: D. Acetaminophen
- A. Incorrect. Codeine should be used cautiously in liver disease, but acetaminophen is THE primary contraindication for this specific patient.
- B. Incorrect. NSAIDs (ibuprofen) are problematic in cirrhosis (GI bleeding, renal impairment) but the ABSOLUTE most critical contraindication in an ALCOHOLIC with cirrhosis is acetaminophen.
- C. Incorrect. Aspirin carries GI bleeding risk but is not the MOST critical contraindication compared to acetaminophen in alcoholic cirrhosis.
- D. Correct. ACETAMINOPHEN is ABSOLUTELY CONTRAINDICATED in alcoholics with liver cirrhosis. Chronic alcohol use induces CYP2E1, converting more acetaminophen to toxic NAPQI, overwhelming glutathione stores and causing hepatotoxicity — even at therapeutic doses. Most important drug to avoid.