NBDE Pharmacology and Pain Control 2 — Questions and Answers
Question 1: Which opioid analgesic is considered safest for patients with hepatic impairment due to its primarily renal excretion?
- Codeine
- Hydrocodone
- Tramadol
- Morphine (Correct answer)
Correct answer: Morphine
Morphine is preferred in hepatic impairment because its primary metabolite, morphine-6-glucuronide, is renally excreted rather than hepatically processed.
Question 2: A patient on warfarin requires dental extraction. Which analgesic is MOST appropriate for postoperative pain management?
- Aspirin
- Ibuprofen
- Naproxen
- Acetaminophen (Correct answer)
Correct answer: Acetaminophen
Acetaminophen does not inhibit platelet function or significantly potentiate warfarin anticoagulation at recommended doses, making it the safest choice.
Question 3: The maximum recommended daily dose of acetaminophen in a healthy adult is:
- 2,000 mg
- 3,000 mg
- 4,000 mg (Correct answer)
- 5,000 mg
Correct answer: 4,000 mg
The FDA recommends a maximum of 4,000 mg per day for healthy adults to avoid hepatotoxicity; lower limits apply to those with liver disease or heavy alcohol use.
Question 4: Which benzodiazepine is preferred for IV conscious sedation in dentistry because of its short half-life and amnestic properties?
- Diazepam
- Lorazepam
- Midazolam (Correct answer)
- Clonazepam
Correct answer: Midazolam
Midazolam has a rapid onset, short duration, and pronounced anterograde amnesia, making it ideal for brief dental sedation procedures.
Question 5: Epinephrine in local anesthetic solutions acts primarily to:
- Lower seizure threshold
- Decrease systemic toxicity of the anesthetic (Correct answer)
- Accelerate hepatic metabolism
- Reduce the need for vasodilators
Correct answer: Decrease systemic toxicity of the anesthetic
Epinephrine causes vasoconstriction at the injection site, slowing systemic absorption and decreasing peak plasma concentration of the local anesthetic, reducing toxicity risk.
Question 6: A dentist administers prilocaine and the patient develops cyanosis unresponsive to oxygen. The most likely diagnosis is:
- Anaphylaxis
- Methemoglobinemia (Correct answer)
- Local anesthetic systemic toxicity
- Vasovagal syncope
Correct answer: Methemoglobinemia
Prilocaine's metabolite o-toluidine oxidizes hemoglobin to methemoglobin, which cannot carry oxygen, causing characteristic cyanosis unresponsive to supplemental O2.
Question 7: Which drug class is CONTRAINDICATED with the use of epinephrine-containing local anesthetics due to risk of severe hypertension?
- Beta-blockers
- Non-selective beta-blockers (Correct answer)
- Tricyclic antidepressants
- ACE inhibitors
Correct answer: Non-selective beta-blockers
Non-selective beta-blockers leave alpha-adrenergic receptors unopposed when epinephrine is given, causing potentially severe hypertension and reflex bradycardia.
NBDE Pharmacology and Pain Control 2
Which opioid analgesic is considered safest for patients with hepatic impairment due to its primarily renal excretion?