ADAT Dental Pharmacology 3 — Questions and Answers
Question 1: Which sedative-hypnotic drug is most commonly used for conscious sedation in dental offices in the US?
- Diazepam
- Midazolam (Correct answer)
- Triazolam
- Lorazepam
Correct answer: Midazolam
Midazolam is most commonly used for IV conscious sedation due to its rapid onset, short duration, and amnestic properties.
Question 2: A dental patient reports taking bisphosphonates for osteoporosis. What is the primary concern with invasive dental procedures?
- Increased bleeding risk
- Medication-related osteonecrosis of the jaw (MRONJ) (Correct answer)
- Impaired wound healing due to anemia
- Increased infection risk from immunosuppression
Correct answer: Medication-related osteonecrosis of the jaw (MRONJ)
Bisphosphonates impair osteoclast function and bone remodeling, increasing the risk of MRONJ after invasive dental procedures.
Question 3: What is the reversal agent for benzodiazepine overdose during dental sedation?
- Naloxone
- Flumazenil (Correct answer)
- Physostigmine
- Atropine
Correct answer: Flumazenil
Flumazenil is a competitive benzodiazepine receptor antagonist that rapidly reverses benzodiazepine-induced sedation.
Question 4: Which class of antibiotics should be avoided in patients with a history of penicillin anaphylaxis due to potential cross-reactivity?
- Macrolides
- Tetracyclines
- First-generation cephalosporins (Correct answer)
- Fluoroquinolones
Correct answer: First-generation cephalosporins
First-generation cephalosporins share similar R1 side chains with penicillins, conferring the highest cross-reactivity risk among cephalosporins.
Question 5: Nitrous oxide used in dental sedation acts primarily by which mechanism?
- GABA-A receptor potentiation
- NMDA receptor antagonism and endogenous opioid release (Correct answer)
- Alpha-2 adrenergic agonism
- Serotonin reuptake inhibition
Correct answer: NMDA receptor antagonism and endogenous opioid release
Nitrous oxide produces sedation and analgesia primarily through NMDA receptor antagonism and stimulation of endogenous opioid release.
Question 6: Which antibiotic regimen is recommended by the AHA for infective endocarditis prophylaxis before dental procedures in high-risk patients who are allergic to penicillin?
- Metronidazole 500 mg PO 1 hour before
- Clindamycin 600 mg PO 30–60 minutes before
- Azithromycin 500 mg PO 1 hour before (Correct answer)
- Doxycycline 100 mg PO 1 hour before
Correct answer: Azithromycin 500 mg PO 1 hour before
The AHA recommends azithromycin or clarithromycin 500 mg PO for penicillin-allergic patients requiring IE prophylaxis (clindamycin was removed from 2021 guidelines).
ADAT Dental Pharmacology 3
Which sedative-hypnotic drug is most commonly used for conscious sedation in dental offices in the US?