ADC Practice Question — Ibuprofen and COX-2 inhibitors

Beyond warfarin, which other medication this patient takes also increases her bleeding risk during dental procedures?

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.

Mrs. Li Wei, a 78-year-old woman, presents with a fractured upper left canine that requires extraction. Her medical history includes atrial fibrillation managed with warfarin, and she takes fluoxetine 20 mg daily for depression. She lives alone and mentions she has been taking Panadol Extra (paracetamol 500 mg + caffeine 65 mg) from the chemist for the pain, two tablets four times daily. Her INR from this morning is 4.1. Beyond warfarin, which other medication this patient takes also increases her bleeding risk during dental procedures?

A. Caffeine from the Panadol Extra
B. Fluoxetine, as SSRIs impair platelet function
C. None of her other medications affect bleeding risk; warfarin is the sole concern
D. Paracetamol at the dose she is taking
E. Fluoxetine, as it interacts with warfarin to increase the INR above the therapeutic range

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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: B

According to TG, SSRIs (including fluoxetine, paroxetine, sertraline) are among the medications that impair platelet function beyond antithrombotics. The combination of warfarin (anticoagulant) + fluoxetine (impaired platelet function) creates additive bleeding risk that must be considered in procedural planning.

Source: Ch 23: SSRIs impair platelet function — additive bleeding risk with antithrombotics

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 Ibuprofen and COX-2 inhibitors 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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