ADC Practice Question — Local anaesthetic agents and properties

Why is this patient at increased risk for the complication that has developed?

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.

Dimitrios Papadopoulos, a 61-year-old Greek-Australian man, presents to your dental practice for multiple posterior restorations. He has a history of unstable angina (recent chest pain episodes), type 2 diabetes mellitus, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. His medications include metformin, aspirin, and sublingual GTN. He weighs 75kg. You plan extensive treatment requiring significant local anaesthesia. His cardiologist has advised avoiding adrenaline-containing preparations due to his cardiac condition. Why is this patient at increased risk for the complication that has developed?

A. His age makes him more susceptible to all local anaesthetic complications
B. The felypressin component increases methaemoglobinaemia risk
C. His cardiac medications interact with prilocaine
D. Diabetes increases the risk of methaemoglobinaemia
E. G6PD deficiency increases susceptibility to methaemoglobinaemia even at therapeutic doses

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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: E

According to TG, certain individuals with genetic predisposition (G6PD deficiency) are more susceptible to methaemoglobinaemia, even at therapeutic doses of local anaesthetics.

Source: Ch 8: G6PD and methaemoglobinaemia risk

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 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.

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.

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Why is this patient at increased risk for the complication that has developed?

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