The first-line drug for acute myocardial infarction in dental emergency is: (PSC - Lumbini 2083)

 # The first-line drug for acute myocardial infarction in dental emergency is: (PSC - Lumbini 2083)

 A. Nitroglycerin

B. Aspirin

C. Atorvastatin

D. Metoprolol

The correct answer is B. Aspirin.

In a dental emergency setting, the pharmacological priority for an acute myocardial infarction (AMI) is halting the expansion of the coronary thrombus:

Aspirin: This is the definitive first-line therapeutic drug for a suspected AMI. Standard protocol mandates the immediate administration of 160–325 mg of non-enteric-coated, chewable aspirin. It acts as a rapid antiplatelet agent by irreversibly inhibiting the cyclooxygenase-1 (COX-1) enzyme, blocking the synthesis of thromboxane A2. This prevents further platelet aggregation and is the primary chairside intervention proven to reduce patient mortality.   

Nitroglycerin: While sublingual Nitroglycerin (0.4 mg) is the first-line emergency drug for angina pectoris, it is not the primary disease-modifying drug for an established infarction. During an AMI, it provides symptomatic pain relief by acting as a vasodilator that reduces venous return (preload) and myocardial oxygen demand, but it does not stop the underlying thrombotic event.   

Atorvastatin & Metoprolol: These are critical hospital-administered medications utilized following an MI, but they are not acute, first-line emergency drugs kept in a standard clinical emergency armamentarium.

Which anticoagulant is most commonly monitored using INR? (PSC - Lumbini 2083)

 # Which anticoagulant is most commonly monitored using INR? (PSC - Lumbini 2083)

A. Aspirin

B. Heparin

C. Warfarin

D. Clopidogrel

The correct answer is C. Warfarin.

 Warfarin is a Vitamin K antagonist whose therapeutic efficacy and bleeding risk must be routinely monitored using the International Normalized Ratio (INR). Antiplatelets (like Aspirin and Clopidogrel) do not require routine INR monitoring. 

The first line drug for anaphylaxis is: (PSC - Lumbini 2083)

 # The first line drug for anaphylaxis is: (PSC - Lumbini 2083)

A. Diphenhydramine

B. Epinephrine

C. Hydrocortisone

D. Oxygen

The correct answer is B. Epinephrine.

Intramuscular epinephrine (typically 0.3 to 0.5 mg of a 1:1,000 solution injected into the anterolateral thigh) is the absolute first-line drug of choice. It acts as a physiological antagonist to systemic mediators of anaphylaxis, reversing peripheral vasodilation, reducing tissue edema, and inducing bronchodilation.

The first step in any medical emergency is: (PSC - Lumbini 2083)

The first step in any medical emergency is: (PSC - Lumbini 2083)

A. Call for help

B. Assess airway, breathing, circulation (ABC)

C. Administer drugs

D. Start CPR

The correct answer is B. Airway, breathing, circulation (ABC)

Current Basic Life Support (BLS) protocols dictate that upon identifying an unresponsive patient, the immediate first step is to call for help (activate emergency response), followed instantly by the primary assessment of Circulation, Airway, and Breathing (CAB in modern AHA guidelines, historically ABC).