ADC Practice Question — Local anaesthetic agents and properties

What is the most appropriate local anaesthetic choice for this patient's extraction procedure?

Pharmacology questions in the ADC written exam test applied prescribing decisions, not rote recall of drug names. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Priya Sharma, a 27-year-old woman who is 12 weeks pregnant, presents to your dental practice for extraction of her impacted lower left third molar. She has a history of glucose-6-phosphate dehydrogenase (G6PD) deficiency and mentions that certain medications can cause her problems. She is otherwise healthy with no cardiovascular conditions. You are considering your local anaesthetic options and are concerned about using adrenaline during pregnancy. The procedure will likely require significant anaesthesia including a mandibular block and local infiltration. What is the most appropriate local anaesthetic choice for this patient's extraction procedure?

A. Mepivacaine 3% without vasoconstrictor
B. Prilocaine 4% without vasoconstrictor
C. Lidocaine 2% with adrenaline 1:80,000
D. Prilocaine 3% with felypressin
E. Articaine 4% with adrenaline 1:100,000

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: D

According to TG, prilocaine with felypressin is first-line for routine dental procedures when adrenaline is contraindicated, and felypressin is safe for dental use during pregnancy.

Source: Ch 13: Alternative vasoconstrictors

Remy's study tip — For pharmacology vignettes, read the patient’s medical history and allergies BEFORE looking at the drug options.

Exam preparation FAQ

How should I prepare for Pharmacology & Therapeutics in the ADC exam?

Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

How do I approach an unfamiliar Local anaesthetic agents and properties vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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