CDC Pharmacology & Medication Management 3 — Questions and Answers
Question 1: A patient taking metformin requires IV contrast for imaging. Which dental sedation drug class requires the most caution due to lactic acidosis risk when combined with contrast?
- Benzodiazepines (Correct answer)
- Opioids
- Nitrous oxide
- Anticholinergics
Correct answer: Benzodiazepines
While metformin-contrast interaction is the primary concern, benzodiazepines used in sedation can mask early lactic acidosis symptoms, complicating monitoring.
Question 2: What is the reversal agent for benzodiazepine-induced respiratory depression in dental sedation emergencies?
- Naloxone
- Flumazenil (Correct answer)
- Epinephrine
- Atropine
Correct answer: Flumazenil
Flumazenil is a competitive benzodiazepine receptor antagonist that rapidly reverses sedation and respiratory depression caused by benzodiazepines.
Question 3: Which drug is used to manage methemoglobinemia caused by excessive prilocaine administration?
- Epinephrine
- Naloxone
- Methylene blue (Correct answer)
- Flumazenil
Correct answer: Methylene blue
Methylene blue reduces methemoglobin back to functional hemoglobin by acting as an electron donor in the NADPH pathway.
Question 4: A patient on chronic corticosteroid therapy requires oral surgery. Which perioperative management concern is MOST relevant?
- Increased bleeding risk
- Adrenal insufficiency (Correct answer)
- Nephrotoxicity
- Antibiotic resistance
Correct answer: Adrenal insufficiency
Chronic corticosteroid use suppresses the HPA axis, placing patients at risk for adrenal crisis under surgical stress; steroid supplementation may be needed.
Question 5: Which antifungal drug used to treat oral candidiasis is known to significantly inhibit CYP3A4 and increase levels of many co-administered drugs?
- Nystatin
- Fluconazole (Correct answer)
- Clotrimazole
- Amphotericin B
Correct answer: Fluconazole
Fluconazole is a potent CYP3A4 inhibitor that can markedly elevate plasma concentrations of drugs like warfarin, benzodiazepines, and statins.
Question 6: What is the maximum safe daily dose of acetaminophen for a healthy adult patient to avoid hepatotoxicity?
- 2,000 mg
- 3,000 mg
- 4,000 mg (Correct answer)
- 6,000 mg
Correct answer: 4,000 mg
The FDA recommends a maximum daily dose of 4,000 mg acetaminophen for healthy adults, though 3,000 mg is preferred for elderly or at-risk patients.
Question 7: Which local anesthetic is CONTRAINDICATED in patients with a hereditary condition causing abnormal plasma cholinesterase (pseudocholinesterase deficiency)?
- Lidocaine
- Bupivacaine
- Articaine
- Benzocaine (Correct answer)
Correct answer: Benzocaine
Benzocaine is an ester-type local anesthetic metabolized by plasma cholinesterase; patients with pseudocholinesterase deficiency cannot break it down effectively, leading to toxicity.
CDC Pharmacology & Medication Management 3
A patient taking metformin requires IV contrast for imaging.
Which dental sedation drug class requires the most caution due to lactic acidosis risk when combined with contrast?