ADC - Australian Dental Council Pharmacology and Pain Management Questions and Answers — Questions and Answers
Question 1: A 68-year-old patient with a history of poorly controlled asthma and a previous gastric ulcer requires post-operative analgesia following a surgical extraction. Which of the following is the most appropriate medication to prescribe for moderate pain?
- Ibuprofen 400mg
- Aspirin 300mg
- Paracetamol 1000mg (Correct answer)
- Mefenamic Acid 500mg
Correct answer: Paracetamol 1000mg
Paracetamol is the most appropriate analgesic choice. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, and mefenamic acid are contraindicated in this patient. NSAIDs can precipitate bronchospasm in individuals with asthma and are known to cause gastric irritation, which could exacerbate or reactivate a gastric ulcer.
Question 2: According to the Australian Therapeutic Guidelines, which of the following is the recommended first-line antibiotic therapy for a severe, spreading odontogenic infection (e.g., cellulitis) when definitive dental treatment is likely to be delayed beyond 24 hours?
- Phenoxymethylpenicillin alone
- Clindamycin
- Metronidazole alone
- Amoxicillin with clavulanate (Correct answer)
Correct answer: Amoxicillin with clavulanate
For a severe odontogenic infection where the source cannot be immediately managed, the Australian Therapeutic Guidelines recommend broader-spectrum therapy. Amoxicillin with clavulanate provides coverage against common oral aerobes and anaerobes, including beta-lactamase-producing bacteria which are more likely in severe or persistent infections. Penicillin alone may not be sufficient if treatment is delayed, and clindamycin is typically reserved for patients with a severe penicillin hypersensitivity.
Question 3: A healthy 50kg adult patient requires extensive local anaesthesia for a procedure using 2% Lidocaine with 1:100,000 adrenaline. What is the absolute maximum number of standard 2.2mL Australian dental cartridges that can be safely administered?
- 5 cartridges
- 7 cartridges (Correct answer)
- 10 cartridges
- 13 cartridges
Correct answer: 7 cartridges
The maximum recommended dose of Lidocaine with a vasoconstrictor is 7 mg/kg. For a 50kg patient, the total maximum dose is 50 kg * 7 mg/kg = 350 mg. A standard Australian 2.2mL cartridge of 2% Lidocaine contains 44 mg of the drug (20 mg/mL * 2.2 mL). Therefore, the maximum number of cartridges is 350 mg / 44 mg/cartridge = 7.95. The maximum number of full cartridges that can be safely administered is 7.
Question 4: A patient taking Warfarin for atrial fibrillation requires an extraction. Which analgesic, if prescribed for post-operative pain, would most significantly increase the risk of bleeding by potentiating the effect of Warfarin?
- Paracetamol
- Codeine
- Ibuprofen (Correct answer)
- Tramadol
Correct answer: Ibuprofen
Non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen significantly increase the anticoagulant effect of Warfarin and the risk of bleeding. This occurs through multiple mechanisms, including inhibition of platelet function and displacement of warfarin from plasma protein binding sites, which increases the concentration of free, active drug. Paracetamol and opioids are considered safer alternatives in patients taking Warfarin.
Question 5: A 45-year-old patient with severe dental anxiety and no other medical conditions is scheduled for a lengthy procedure under oral sedation using Diazepam. Which piece of pre-operative advice is most critical for ensuring patient safety?
- Take the medication with a large meal to avoid nausea.
- Arrange for an escort to drive them home from the appointment. (Correct answer)
- Avoid caffeine for at least 24 hours prior to the appointment.
- Double the dose if they still feel anxious one hour before.
Correct answer: Arrange for an escort to drive them home from the appointment.
Diazepam is a benzodiazepine that causes central nervous system depression, leading to drowsiness, impaired coordination, and altered judgement. These effects make it unsafe to drive or operate machinery. For safety, it is mandatory for a patient who has taken an oral sedative to be accompanied by a responsible adult escort to and from the appointment.
Question 6: According to current Australian guidelines for infective endocarditis prophylaxis, which of the following patient conditions requires antibiotic cover prior to an invasive dental procedure such as an extraction?
- Mitral valve prolapse with regurgitation
- Previous coronary artery bypass surgery
- Prosthetic heart valve (Correct answer)
- Bicuspid aortic valve
Correct answer: Prosthetic heart valve
Current Australian guidelines restrict antibiotic prophylaxis to patients with the highest risk of adverse outcomes from infective endocarditis. This group includes patients with a prosthetic heart valve or material used for valve repair, a history of previous infective endocarditis, and certain congenital heart conditions. Conditions such as mitral valve prolapse, previous bypass surgery, and bicuspid aortic valve are no longer considered indications for routine antibiotic prophylaxis.
ADC - Australian Dental Council Pharmacology and Pain Management Questions and Answers
A 68-year-old patient with a history of poorly controlled asthma and a previous gastric ulcer requires post-operative analgesia following a surgical extraction.
Which of the following is the most appropriate medication to prescribe for moderate pain?