Pharmacology · patient case question
Which analgesic is preferred for this patient?
Patient case: Pregnant patient with lingering pain
Patient: Female, 29 years old
Chief Complaint: Severe pain in a lower molar, worse with hot, relieved briefly by cold.
Background: 24 weeks pregnant, uncomplicated pregnancy. No other medical history.
Current Findings: Deep caries in tooth #19. Pain lingers for several minutes after a cold stimulus is removed and wakes her at night. The tooth is tender to percussion. No swelling and no sinus tract.
Show answer and explanation
Correct answer: C. Acetaminophen
- A. NSAIDs are avoided, especially in the third trimester, because prostaglandin inhibition can cause premature closure of the ductus arteriosus, oligohydramnios and prolonged labour.
- B. Benzodiazepines are avoided in pregnancy and are not analgesics in any case.
- C. CORRECT. Acetaminophen is the analgesic of choice throughout pregnancy. It has the longest safety record and no established teratogenic or fetal circulatory effect at therapeutic dose.
- D. High-dose aspirin carries the same prostaglandin-mediated risks plus bleeding risk for both mother and neonate. (Low-dose aspirin prescribed by an obstetrician for pre-eclampsia prophylaxis is an entirely different matter.)
Note: Safe in pregnancy: acetaminophen, penicillins, cephalosporins, clindamycin, lidocaine with epinephrine, isoniazid, folic acid, levothyroxine. AVOID: NSAIDs and high-dose aspirin, tetracyclines, benzodiazepines, nitrous oxide in the first trimester.