ADC Practice Question — Local anaesthetic toxicity

Given this patient's cardiac condition and G6PD deficiency, what is the most appropriate first-line local anaesthetic choice?

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. Given this patient's cardiac condition and G6PD deficiency, what is the most appropriate first-line local anaesthetic choice?

A. Mepivacaine 2% with adrenaline 1:100,000
B. Prilocaine 3% with felypressin
C. Lidocaine 2% with adrenaline 1:80,000
D. Avoid all local anaesthetics due to G6PD deficiency
E. Articaine 4% with adrenaline 1:200,000

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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, prilocaine with felypressin is first-line for routine dental procedures when adrenaline is contraindicated, and felypressin has minimal effects on the myocardium.

Source: Ch 8: Local anaesthetics contraindications

Remy's study tip — For pharmacology vignettes, read the patient’s medical history and allergies BEFORE looking at the drug options.

Exam preparation FAQ

Should I memorise guidelines word-for-word for Local anaesthetic toxicity?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

How are Local anaesthetic toxicity questions structured in the ADC written exam?

ADC Local anaesthetic toxicity questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

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Given this patient's cardiac condition and G6PD deficiency, what is the most appropriate first-line local anaesthetic choice?

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