Pharmacology · single question
A hypertensive patient takes amitriptyline and propranolol. What is the primary dental concern?
Show answer and explanation
Correct answer: C. Selection of local anesthetic and vasoconstrictor
- A. Incorrect. These drugs do not alter anesthetic onset time.
- B. Incorrect. Neither drug affects haemostasis.
- C. Correct. Both drugs interact dangerously with epinephrine. Amitriptyline (a TCA) blocks noradrenaline reuptake, potentiating the pressor effect. Propranolol is a NON-selective beta blocker, so unopposed alpha stimulation can cause a hypertensive crisis with reflex bradycardia. Limit epinephrine and aspirate carefully.
- D. Incorrect. Osteonecrosis risk relates to bisphosphonates and antiresorptive/antiangiogenic agents.