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Pharmacology: INBDE study notes and practice questions

Pharmacology on the INBDE is about choosing and monitoring drugs for dental patients: the right antibiotic or analgesic, what interacts with what, and which adverse effects you must anticipate. Questions are usually clinical, not memorization of structures.

1,130 practice questions · 47 patient cases

Practice Pharmacology

Where it fits in the official INBDE blueprint

Oral Health Management (medication use and complications). Nearest foundation knowledge area: FK 8. See the content outline for the official weights. This mapping is approximate: real items combine a clinical area with a foundation area.

What this area tests

High-yield checklist

Common traps

These notes are original study aids, not official exam content. Confirm clinical details against current guidelines.

Sample questions

1. What is the maximum epinephrine dose generally recommended for a patient with significant cardiovascular disease (e.g., uncontrolled or significant hypertension)?

  1. 0.04 mg per appointment
  2. 0.2 mg per appointment
  3. 0.5 mg per appointment
  4. 1.0 mg per appointment
Show answer and explanation

Correct answer: A. 0.04 mg per appointment

For cardiac-risk patients, epinephrine is limited to about 0.04 mg per visit (equivalent to roughly two cartridges of 1:100,000), versus up to 0.2 mg for a healthy adult.Other options: 0.2 mg is the healthy-adult maximum; 0.5 and 1.0 mg far exceed safe limits.Key exam takeaway: Epinephrine max: ~0.2 mg healthy adult; ~0.04 mg cardiac-risk patient.

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2. Which of the following opioids is classified as FULLY SYNTHETIC?

  1. Hydromorphone
  2. Oxycodone
  3. Buprenorphine
  4. Fentanyl
Show answer and explanation

Correct answer: D. Fentanyl

Fentanyl is fully synthetic — entirely man-made with no plant-derived precursors. Fully synthetic opioids: fentanyl, meperidine, tramadol, methadone, alfentanil.
  • A. Hydromorphone = SEMI-SYNTHETIC (from morphine).
  • B. Oxycodone = SEMI-SYNTHETIC (from thebaine).
  • C. Buprenorphine = SEMI-SYNTHETIC (from thebaine) — used for pain and opioid use disorder.
  • D. CORRECT. Fentanyl = fully synthetic opioid. Lab-created. ~100x more potent than morphine.

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3. What is the mechanism of action of Lisinopril?

  1. Blocks aldosterone receptors to flush water and sodium
  2. Inhibits ACE, preventing conversion of angiotensin I to angiotensin II
  3. Blocks beta-adrenergic receptors to reduce heart rate
  4. Directly dilates arterioles by blocking calcium channels
Show answer and explanation

Correct answer: B. Inhibits ACE, preventing conversion of angiotensin I to angiotensin II

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor. Its mechanism of action is to block ACE, the enzyme that converts angiotensin I (an inactive peptide) to angiotensin II (a potent vasoconstrictor). By preventing angiotensin II formation, lisinopril causes vasodilation and reduces aldosterone secretion, thereby lowering blood pressure and reducing cardiac workload. A common side effect relevant to dentistry is a dry, persistent cough (due to bradykinin accumulation) and rarely angioedema. The original option stating 'inhibits conversion of angiotensinogen' was factually incorrect—ACE converts angiotensin I to angiotensin II, not angiotensinogen.

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4. A patient with pemphigus vulgaris asks which vitamin supplement could potentially worsen their condition if taken in excess. Which vitamin is most relevant?

  1. Vitamin B3 (niacin)
  2. Vitamin B12
  3. Vitamin C
  4. Vitamin E
Show answer and explanation

Correct answer: D. Vitamin E

Pemphigus vulgaris (PV) is an autoimmune blistering disease driven by autoantibodies against desmoglein 3, causing intraepithelial blistering. Vitamin E at high doses has immunomodulatory and potentially pro-inflammatory effects that may upregulate immune responses, potentially exacerbating autoimmune activity. High-dose Vitamin E has been associated with disease flares in autoimmune conditions and has shown pro-oxidant effects at supraphysiologic doses. In contrast, Vitamin D deficiency is COMMON in PV and correlates with disease severity — maintaining adequate Vitamin D is actually beneficial. Vitamins B3 and B12 are water-soluble and excreted; Vitamin C is also water-soluble and not linked to PV exacerbation. The clinically significant answer for worsening PV through excess supplementation is Vitamin E.

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5. Drug-induced gingival enlargement most commonly affects which area of the gingiva?

  1. Mucogingival junction
  2. Free gingival margin and interdental papillae
  3. Attached gingiva only
  4. Alveolar mucosa
Show answer and explanation

Correct answer: B. Free gingival margin and interdental papillae

Drug-induced gingival enlargement (DIGE) typically begins in the interdental papillae and the free gingival margin, and in severe cases may extend to cover the clinical crowns of the teeth. The anterior facial gingiva is most commonly affected. The enlargement involves both the free gingiva and the attached gingiva in advanced cases. Pure DIGE has a fibrotic, firm, pale pink appearance, while enlargement exacerbated by inflammation appears redder and bleeds more easily. The mucogingival junction and alveolar mucosa are generally not primarily involved.

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6. What is the therapeutic (normal/target) range for INR in a patient taking warfarin?

  1. 2.0–3.0
  2. 1.5–2.0
  3. 1.0–2.0
  4. 3.5–4.5
Show answer and explanation

Correct answer: A. 2.0–3.0

For most standard indications (such as atrial fibrillation or DVT prophylaxis), the target therapeutic INR range on warfarin is 2.0–3.0. Higher target ranges (e.g., 2.5–3.5) are used for specific higher-risk indications like certain mechanical heart valves, but 2.0–3.0 is the standard/most commonly cited range.

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7. The patient needs extraction of teeth. What is the appropriate treatment modification?

  1. Continue the aspirin; no dose change needed
  2. Stop aspirin 7 days before extraction
  3. Double the clonazepam dose on the day of extraction
  4. Add prophylactic antibiotic
Show answer and explanation

Correct answer: A. Continue the aspirin; no dose change needed

Low-dose aspirin (81 mg) should NOT be discontinued before routine dental extractions. The bleeding risk is negligible and the cardiovascular/ thromboembolic risk of stopping the medication outweighs the minor bleeding risk. Local hemostatic measures (sutures, pressure, gelfoam) are sufficient.

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8. All have both SEDATIVE and ANALGESIC properties EXCEPT:

  1. Nitrous oxide
  2. Propofol
  3. Opioids (fentanyl)
  4. Ketamine
Show answer and explanation

Correct answer: B. Propofol

PROPOFOL = pure sedative/hypnotic (GABA-A receptor) with NO intrinsic analgesia. Provides excellent sedation but does not relieve pain. Nitrous oxide = sedative + analgesic (opioid-like). Ketamine = dissociative sedation + profound analgesia (NMDA antagonist). Opioids = analgesics + sedation.

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Patient cases

All Pharmacology questions (1,130)