ADC Practice Question — Techniques and complications

For future dental procedures in this patient, what planning consideration is most important regarding prilocaine use?

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. For future dental procedures in this patient, what planning consideration is most important regarding prilocaine use?

A. Pre-medicate with methylene blue before any local anaesthetic
B. Keep total prilocaine dose well below 600mg threshold and seek specialist advice
C. Avoid prilocaine completely and use only topical anaesthetics
D. Switch to articaine which has no methaemoglobinaemia risk
E. Use standard prilocaine doses but with continuous pulse oximetry

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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 particularly at doses greater than 600mg has been linked to methaemoglobinaemia, and patients with G6PD deficiency should seek advice from their managing clinician about which drugs to avoid.

Source: Ch 8: Prilocaine dose limits and specialist consultation

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 Techniques and complications 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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For future dental procedures in this patient, what planning consideration is most important regarding prilocaine use?

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