ADC Practice Question — Local anaesthetic agents and properties

At what dose of prilocaine does the risk of methaemoglobinaemia become particularly significant?

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. At what dose of prilocaine does the risk of methaemoglobinaemia become particularly significant?

A. Greater than 600 mg
B. Greater than 300 mg
C. Any dose in G6PD deficient patients
D. Greater than 450 mg
E. Greater than 800 mg

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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

According to TG, prilocaine, particularly at doses greater than 600 mg, has been linked to methaemoglobinaemia.

Source: Ch 13: Prilocaine dosage 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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