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Pharmacology · single question

In a patient with liver cirrhosis, which analgesic is MOST appropriate to use cautiously (at low doses) compared to the one that must be AVOIDED?

  1. Use only opioids since other drugs are contraindicated
  2. Avoid both equally
  3. Avoid ibuprofen; use acetaminophen cautiously at low doses
  4. Avoid acetaminophen; use ibuprofen freely
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Correct answer: C. Avoid ibuprofen; use acetaminophen cautiously at low doses

  • A. Opioids are not the only remaining option — low-dose acetaminophen is generally preferred.
  • B. They are not equal — ibuprofen is more dangerous in cirrhosis due to renal and GI effects.
  • C. Correct. In liver cirrhosis: Ibuprofen (NSAID) should be AVOIDED — it causes renal vasoconstriction, increases risk of GI bleeding (especially with portal hypertension), and worsens fluid retention. Acetaminophen can be used cautiously at LOW doses (max 2g/day in cirrhotic patients) since it is hepatotoxic at high doses but safer than NSAIDs at low doses. Ibuprofen is actually the more dangerous choice in cirrhosis.
  • D. Ibuprofen is actually MORE contraindicated in cirrhosis than acetaminophen at low doses.

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