Paracetamol is contraindicated in - - RUHS, Jaipur, PB B.Sc Nursing Entrance-2024

RUHS, Jaipur, PB B.Sc Nursing Entrance-2024

Pharmacology

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2024

Explanation

Paracetamol is primarily metabolized in the liver, making it the organ most susceptible to its toxic effects.
In individuals with liver disease, the ability to safely metabolize the drug is significantly compromised.
A toxic metabolite, N-acetyl-p-benzoquinoneimine (NAPQI), can accumulate when liver function is poor or when glutathione stores are depleted.
This accumulation of NAPQI leads to severe liver cell damage, a condition known as hepatotoxicity.
Therefore, a pre-existing liver disorder is the most critical contraindication for paracetamol use among the given options.

Option A: Paracetamol is generally considered safer for the kidneys than Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in therapeutic doses.
Option B: Paracetamol does not affect respiratory function or trigger bronchospasm, making it a preferred analgesic for patients with asthma.
Option C: Paracetamol has minimal effects on the gastrointestinal lining and does not increase the risk of ulcers or bleeding at therapeutic doses.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Paracetamol (Acetaminophen) Administration as background academic context rather than a clinical decision trigger.
Always assess for underlying liver conditions (e.g., cirrhosis, hepatitis) and a history of chronic alcohol abuse before administering or recommending paracetamol.
Educate patients to not exceed the maximum daily dose (4 grams for healthy adults, 2 grams for those with liver issues or chronic alcohol use) and to be aware of 'hidden' paracetamol in many over-the-counter cold and flu remedies to prevent accidental overdose.
The antidote for paracetamol overdose, N-acetylcysteine (NAC), is most effective when given within 8-10 hours of ingestion and works by replenishing the liver's glutathione stores.

How to Approach the Question

First, identify the drug in the question: Paracetamol (also known as acetaminophen).
Next, recall the primary organ responsible for this drug's metabolism. For paracetamol, this is the liver.
Consider the meaning of 'contraindicated'—a situation where a drug should not be used because it may be harmful.
Connect the site of metabolism with the potential for harm. Since the liver metabolizes paracetamol, a disorder of the liver would most directly and severely impact the body's ability to process the drug safely.
Evaluate the other options. While high doses can affect kidneys, and other drugs affect the GIT/lungs, the most direct and well-known contraindication for paracetamol is a liver disorder.

Concept Tested & Keywords

Concept Tested: Contraindications for Paracetamol (Acetaminophen) Administration
Stem keywords: Paracetamol, contraindicated
Lead-in keywords: BEST, MOST RELEVANT CLUE
Negative lead-in flag: false

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