ADC Practice Question — Oral candidiasis

patient has denture-associated candidiasis. If topical…

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. The patient has denture-associated candidiasis. If topical miconazole oral gel were considered, what critical drug interaction must be checked?

A. Miconazole interacts with metformin, causing dangerous hypoglycaemia
B. Miconazole interacts with omeprazole, reducing its acid-suppressing efficacy
C. Miconazole interacts with fluoxetine to cause serotonin toxicity
D. Miconazole may be systemically absorbed and inhibits warfarin metabolism, significantly increasing the INR and bleeding risk
E. There are no significant drug interactions with miconazole oral gel as it is a topical preparation

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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: D

According to TG, miconazole may be systemically absorbed, so drug interactions are possible. The miconazole-warfarin interaction is clinically significant and potentially dangerous — miconazole inhibits CYP2C9 (the primary enzyme metabolising warfarin), significantly increasing the INR and bleeding risk. TG notes topical nystatin or amphotericin B have negligible systemic absorption and no such interaction risk.

Source: Ch 16: Miconazole — systemic absorption possible, interacts with warfarin to increase INR

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 are Oral candidiasis questions structured in the ADC written exam?

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

Should I memorise guidelines word-for-word for Oral candidiasis?

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

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patient has denture-associated candidiasis. If topical…

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