The correct answer is "NSAIDs." This is the correct answer because NSAIDs are known to be irritants of the gastrointestinal tract, and prolonged and/or extensive use of NSAIDs can increase the risk of developing gastrointestinal ulcers, as well as consequent gastrointestinal bleeds in the setting of ulcers. Given this patient's medical history, which already contains multiple gastrointestinal bleeds and peptic ulcer disease, NSAIDs should be used very, very carefully, if at all, in this patient.

The other choices are incorrect. Acetaminophen is not known to increase the risk of gastrointestinal bleeding or peptic ulcer formation. Morphine, oxycodone, and hydromorphone are all opioid analgesics and are not known to increase the risk of gastrointestinal bleeding or peptic ulcer formation.

Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). These drugs work by inhibiting cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), which reduces the synthesis of pro-inflammatory prostaglandins and thromboxane.

Naloxone antidotes opioid overdose by competitively binding to μ-opioid receptors. Flumazenil is an antidote to benzodiazepines. Glucagon is an antidote for beta blocker overdose. N-acetylcysteine is an antidote for acetaminophen.

The correct answer is "meperidine." Meperidine, a potent opioid analgesic, also known as Demerol, is one of the only opioids that produces dilated pupils, rather than constricted, "pinpoint" pupils. A way to remember this is to remember the phrase, "Demerol Dilates." The other choices are incorrect. Acetaminophen has no known effect on pupil size. Morphine, oxycodone, and hydromorphone, all opioid analgesics, are known to constrict the pupils.

Acetaminophen in doses over 3000mg per day can result in significant liver damage or liver failure. From 1998 to 2003, acetaminophen was the leading cause of acute liver failure in the United States. According to a population-based report in 2007 there are an estimated 1600 cases of acute liver failure in the United States every year, with acetaminophen being the most common etiology.

Fentanyl citrate comes in solid form on a stick (often referred to as a "fentanyl lollipop"). This form is 80-100 times more potent than morphine and intended for use by cancer patients and patients that have become tolerant to opioids.

Misoprostol is used for the prevention of non steroidal anti inflammatory drug (NSAID) induced gastric ulcers. Taking this drug will prevent gastric ulcers and relieve epigastric pain.

The correct answer is "insomnia," as steroids are known to increase patients' vigilance and energy levels, thereby frequently making it difficult for patients to fall asleep and/or stay asleep while taking their steroid medication. The other choices are incorrect. Decreased appetite is not a side effect of taking steroid medications. Patients on steroids often have increased appetite. Hyponatremia and hyperkalemia both are not side effects of taking steroid medications. Hypernatremia and hypokalemia are more common side effects of steroids. Hypertension, rather than hypotension is a known side effect of steroid use.

A direct bilirubin level of 2mg/dL or greater indicates acetaminophen toxicity.

The correct answer is "acetaminophen." This is the correct answer because acetaminophen, also known as Tylenol, is initially metabolized into a hepatotoxic intermediate (it transiently becomes a reactive oxygen species, which can cause liver hepatotoxicity). As such, in patients who already have pre-existing liver disease who are already more prone to liver injury from substances and diseases that affect the liver, it is prudent to avoid medications like acetaminophen that have a known potential to cause liver damage.

Meloxicam, ibuprofen, naproxen, and ketorolac are all examples of non-steroidal anti-inflammatory drugs (NSAIDs). These medications have the potential to cause renal damage or gastrointestinal damage if used in excess, but do not have the known hepatotoxic properties that acetaminophen does.