INBDE Pharmacology & Pain Control practice questions

Question 1

A 45-year-old patient with a history of hypertension controlled by propranolol requires an extraction. Which of the following describes the most significant risk when administering local anesthetic with epinephrine to this patient?

Accepted Answer

Hypertension and reflex bradycardia due to unopposed alpha-1 stimulation.

Answer

Hypotension and bradycardia due to beta-2 blockade.

Answer

Tachycardia and hypertension due to synergistic beta-1 stimulation.

Answer

Increased risk of local anesthetic toxicity due to reduced hepatic blood flow.

Question 2

A patient requires local anesthesia for a mandibular molar restoration. The tissue in the area is acutely infected and has a lower pH than healthy tissue. Why is it often more difficult to achieve profound anesthesia in this scenario?

Accepted Answer

The acidic environment increases the proportion of the ionized (charged) form of the anesthetic, which cannot cross the nerve membrane.

Answer

The acidic environment degrades the amide bond of the anesthetic molecule immediately upon injection.

Answer

Infection increases vascularity, which speeds up the systemic absorption and reduces the local concentration of the drug.

Answer

The lower pH increases the threshold potential of the nerve, requiring more sodium channels to be blocked.

Question 3

Which of the following local anesthetics is unique because it contains an ester group but is classified as an amide, and is primarily metabolized by plasma pseudocholinesterase?

Accepted Answer

Articaine

Answer

Lidocaine

Answer

Prilocaine

Answer

Mepivacaine

Question 4

A 25-kg child requires multiple extractions. If the dentist uses 2% lidocaine with 1:100,000 epinephrine, what is the maximum recommended dose (MRD) of lidocaine (using 7 mg/kg as the limit), and approximately how many cartridges can be safely administered?

Accepted Answer

175 mg; ~4.8 cartridges

Answer

175 mg; ~9.7 cartridges

Answer

125 mg; ~3.4 cartridges

Answer

500 mg; ~13.8 cartridges

Question 5

A patient with a history of prosthetic heart valve replacement is allergic to penicillin (history of anaphylaxis). Which of the following is the recommended antibiotic and dose for IE prophylaxis 30-60 minutes prior to a dental extraction?

Accepted Answer

Azithromycin 500 mg

Answer

Clindamycin 600 mg

Answer

Cephalexin 2 g

Answer

Amoxicillin 2 g

Question 6

Which of the following conditions is NO LONGER an indication for antibiotic prophylaxis prior to dental procedures according to the most recent AHA/ADA guidelines?

Accepted Answer

Mitral valve prolapse with regurgitation

Answer

Prosthetic cardiac valves

Answer

A history of infective endocarditis

Answer

Unrepaired cyanotic congenital heart disease

Question 7

A patient taking Warfarin (Coumadin) for atrial fibrillation requires a single tooth extraction. The patient's most recent INR was 2.5. What is the most appropriate management strategy?

Accepted Answer

Perform the extraction without altering the Warfarin dose and use local hemostatic measures.

Answer

Discontinue Warfarin 3 days prior to the procedure.

Answer

Bridge the patient with Heparin before the extraction.

Answer

Refer the patient to the physician to reduce the INR to below 1.5.

Question 8

A patient with chronic bone pain is taking IV Zoledronic acid (Reclast) once a year. What is the primary concern regarding dental surgical procedures for this patient?

Accepted Answer

Increased risk of Medication-Related Osteonecrosis of the Jaw (MRONJ).

Answer

Increased risk of post-operative infection due to immunosuppression.

Answer

Prolonged bleeding due to platelet inhibition.

Answer

Decreased metabolism of local anesthetics.

Question 9

A patient with a history of moderate-to-severe asthma and nasal polyps requires an analgesic for post-operative pain. Which of the following should be avoided?

Accepted Answer

Ibuprofen

Answer

Acetaminophen

Answer

Codeine

Answer

Oxycodone

Question 10

While administering an Inferior Alveolar Nerve Block, the patient suddenly reports a metallic taste, becomes talkative and anxious, and then experiences a brief seizure. What is the most likely cause?

Accepted Answer

Local anesthetic systemic toxicity (LAST) from intravascular injection.

Answer

Epinephrine reaction from intravascular injection.

Answer

Allergic reaction to the amide local anesthetic.

Answer

Syncope-induced hypoxia.

INBDE Pharmacology & Pain Control practice questions

A 45-year-old patient with a history of hypertension controlled by propranolol requires an extraction. Which of the following describes the most significant risk when administering local anesthetic with epinephrine to this patient?

A patient requires local anesthesia for a mandibular molar restoration. The tissue in the area is acutely infected and has a lower pH than healthy tissue. Why is it often more difficult to achieve profound anesthesia in this scenario?

Which of the following local anesthetics is unique because it contains an ester group but is classified as an amide, and is primarily metabolized by plasma pseudocholinesterase?

A 25-kg child requires multiple extractions. If the dentist uses 2% lidocaine with 1:100,000 epinephrine, what is the maximum recommended dose (MRD) of lidocaine (using 7 mg/kg as the limit), and approximately how many cartridges can be safely administered?

A patient with a history of prosthetic heart valve replacement is allergic to penicillin (history of anaphylaxis). Which of the following is the recommended antibiotic and dose for IE prophylaxis 30-60 minutes prior to a dental extraction?

Which of the following conditions is NO LONGER an indication for antibiotic prophylaxis prior to dental procedures according to the most recent AHA/ADA guidelines?

A patient taking Warfarin (Coumadin) for atrial fibrillation requires a single tooth extraction. The patient's most recent INR was 2.5. What is the most appropriate management strategy?

A patient with chronic bone pain is taking IV Zoledronic acid (Reclast) once a year. What is the primary concern regarding dental surgical procedures for this patient?

A patient with a history of moderate-to-severe asthma and nasal polyps requires an analgesic for post-operative pain. Which of the following should be avoided?

While administering an Inferior Alveolar Nerve Block, the patient suddenly reports a metallic taste, becomes talkative and anxious, and then experiences a brief seizure. What is the most likely cause?

The first 10 are free. 10 more below.

Which of the following drugs acts as a competitive antagonist at the opioid receptor and is used to reverse respiratory depression caused by an opioid overdose?

A patient is taking a Tricyclic Antidepressant (TCA) such as Amitriptyline. What precaution should the dentist take when using epinephrine?

A patient with chronic xerostomia due to Sjögren’s syndrome is prescribed Pilocarpine. What is the mechanism of action of this drug?

Which of the following is the mechanism by which NSAIDs like Naproxen reduce pain and inflammation?

A dentist is treating a patient for a dental abscess and prescribes Metronidazole. Which of the following should the patient be strictly warned to avoid?

A 68-year-old patient on daily low-dose Aspirin therapy (81 mg) requires a routine dental extraction. What is the most appropriate instruction for the patient?

Which antibiotic is considered the first-line choice for a non-allergic patient with an odontogenic infection (dentoalveolar abscess) requiring systemic therapy?

A patient experiences an immediate (Type I) hypersensitivity reaction after a penicillin injection, presenting with wheezing and hypotension. What is the first-line medication and route of administration for management?

Local anesthetics block nerve conduction by which specific mechanism?

A patient with 'uncontrolled' hyperthyroidism (Graves' disease) presents for emergency treatment. Which of the following should be avoided if possible?