Why is this patient at increased risk for the…
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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According to TG, certain individuals with genetic predisposition (G6PD deficiency) are more susceptible to methaemoglobinaemia, even at therapeutic doses of local anaesthetics.
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