This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: NSAIDs, Gout and Rheumatoid Ahritis, Subject name: Pharmacology
Which of the following NSAIDs can cause hepatic necrosis if used in overdose? 
Select and explain. 
A. Diclofenac sodium, B. Acetaminophen, C. Indomethacin, D. Piroxicam
B: Acetaminophen
Answer: B: Acetaminophen 
Explanation: Paracetamol (Acetaminophen) It is metabolized to N-acetyl paraaminobenzo quinoneimine (NAPQ) by microsomal enzymes. This metabolite has high affinity for sulfhydryl groups and can combine with the enzymes and other biomolecules resulting in hepatotoxicity characterized by hepatic necrosis. Normally acetaminophen is a safe drug because glutathione (contain sulfhydryl group due to presence of sulfur containing amino acid, cysteine) produced by the liver combines with NAPQ to detoxify it. However chronic alcoholics are predisposed to toxicity Acetaminophen toxicity can be decreased by providing sulfhydryl donors like N-acetylcysteine (antidote of choice).