ADC - Australian Dental Council Pharmacology and Pain Management 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?

Accepted Answer

Paracetamol 1000mg

Answer

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?

Accepted Answer

Amoxicillin with clavulanate

Answer

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?

Accepted Answer

7 cartridges

Answer

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?

Accepted Answer

Ibuprofen

Answer

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?

Accepted Answer

Arrange for an escort to drive them home from the appointment.

Answer

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.

ADC - Australian Dental Council Practice Test

ADC - Australian Dental Council Practice Test

ADC - Australian Dental Council Pharmacology and Pain Management Questions and Answers