ADC Practice Question — Ibuprofen and COX-2 inhibitors

If this patient required an NSAID for dental pain, which specific combination risk makes this particularly dangerous?

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. Jean Campbell, a 79-year-old woman, presents for a routine dental review. Her medication list includes warfarin for atrial fibrillation, amlodipine 10 mg for hypertension, metformin 500 mg twice daily for Type 2 diabetes, omeprazole 20 mg daily, and fluoxetine 20 mg daily for depression. She complains of a persistent dry mouth, bleeding gums, and a sore area under her upper denture. On examination, she has generalised gingival enlargement, erythema under the denture consistent with denture-associated candidiasis, and reduced salivary flow. If this patient required an NSAID for dental pain, which specific combination risk makes this particularly dangerous?

A. NSAID + warfarin increases bleeding risk, NSAID + fluoxetine (SSRI) further impairs platelet function — the combination creates very high bleeding risk from multiple mechanisms
B. NSAID + metformin causes lactic acidosis
C. NSAID + fluoxetine causes serotonin toxicity
D. NSAID + omeprazole is a dangerous combination that should be avoided
E. NSAIDs are safe in this patient because omeprazole protects the stomach

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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: A

This patient has three medications affecting haemostasis: warfarin (anticoagulant), fluoxetine (SSRI — impairs platelet function per TG ), and adding an NSAID would create a third mechanism of bleeding risk. TG states NSAIDs increase bleeding in patients on antithrombotics. TG lists concurrent SSRIs as a risk factor for increased GI toxicity with NSAIDs. Paracetamol is the only safe analgesic option.

Source: Ch 23: Warfarin + SSRI + NSAID = very high bleeding risk from multiple mechanisms

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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If this patient required an NSAID for dental pain, which specific combination risk makes this particularly dangerous?

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