ADC Practice Question — Vasoconstrictors in local anaesthetics

For future dental procedures, what would be the most…

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 33-year-old software engineer, presents for extraction of her lower right wisdom tooth. She mentions she might be pregnant but hasn't confirmed it yet. During the procedure, you administer 3.6 mL of 2% lidocaine with adrenaline via inferior alveolar nerve block. Five minutes after injection, Priya becomes restless and anxious, complaining of ringing in her ears and dizziness. Her speech becomes slightly slurred and she appears drowsy. For future dental procedures, what would be the most appropriate local anaesthetic choice for Priya?

A. Multiple small injections of articaine with adrenaline
B. Prilocaine at maximum recommended dose
C. Higher concentration lidocaine for better efficacy
D. Lidocaine without adrenaline at reduced dose
E. Bupivacaine with adrenaline for longer duration

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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, use the lowest effective dose and do not exceed maximum recommended dose. Solutions without vasoconstrictors may be indicated when systemic effects have occurred.

Source: Ch 8: Dose considerations and alternatives

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 Vasoconstrictors in local anaesthetics 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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