ORE Part 1 Pharmacology 2

Question 1

Which drug should be available in every UK dental practice for the management of anaphylaxis?

Accepted Answer

Adrenaline (epinephrine)

Answer

Adrenaline (epinephrine) 1:1000 for intramuscular injection is the most critical drug in anaphylaxis management and must be available in every dental practice as per Resuscitation Council (UK) guidelines. While hydrocortisone and chlorphenamine are adjunctive treatments, adrenaline is the life-saving first-line drug.

Question 2

What is the primary mechanism by which amoxicillin exerts its antibacterial effect?

Accepted Answer

Inhibition of bacterial cell wall synthesis by binding to penicillin-binding proteins

Answer

Amoxicillin, like all beta-lactam antibiotics, works by binding to penicillin-binding proteins (PBPs) and inhibiting transpeptidation, the final step in bacterial cell wall (peptidoglycan) synthesis. This leads to cell lysis, particularly of actively dividing bacteria, making it bactericidal.

Question 3

A patient taking the direct oral anticoagulant (DOAC) apixaban attends for extraction. What is the current SDCEP advice?

Accepted Answer

Continue the DOAC and use local haemostatic measures

Answer

SDCEP guidance recommends that patients on DOACs (apixaban, rivarelbant, dabigatran, edoxaban) should continue their medication for dental extractions. Local haemostatic measures (sutures, oxidised cellulose, tranexamic acid) should be used. For procedures with higher bleeding risk, timing the appointment to coincide with trough drug levels is advised.

Question 4

Which drug is used as a reversal agent for benzodiazepine sedation in dentistry?

Accepted Answer

Flumazenil

Answer

Flumazenil is a competitive antagonist at the benzodiazepine binding site on the GABA-A receptor. It is used to reverse benzodiazepine sedation (midazolam) in emergency situations. However, its duration of action is shorter than midazolam, so re-sedation can occur and the patient must be monitored.

Question 5

What is the recommended first-line analgesic regimen following dental extraction in an adult with no contraindications?

Accepted Answer

Ibuprofen 400mg and paracetamol 1g taken together

Answer

The combination of ibuprofen 400mg and paracetamol 1g provides superior analgesia to either drug alone through synergistic action on different pain pathways. This combination is now recommended as first-line post-extraction analgesia in UK dental practice guidelines, avoiding the side effects of opioid-based alternatives.

ORE Part 1 Practice Test

ORE Part 1 Practice Test

ORE Part 1 Pharmacology 2