DAANCE Pharmacology Cheat Sheet: The Drugs You Must Know Cold

Pharmacology is the largest domain on the DAANCE at roughly 35% of scored questions. If you can only master one area deeply, make it this one. Here's the condensed reference — organized how the questions are actually asked on exam day.

Local Anesthetics

You need to know max dose per kg, onset, and duration for each.

| Drug | Max Dose | Onset | Duration | |------|----------|-------|----------| | Lidocaine 2% plain | 4.4 mg/kg (max 300 mg) | 2–3 min | 1–2 hr | | Lidocaine 2% with epi 1:100k | 7 mg/kg (max 500 mg) | 2–3 min | 2–3 hr | | Articaine 4% with epi 1:100k | 7 mg/kg | 1–2 min | 3–6 hr (soft tissue) | | Bupivacaine 0.5% with epi | 1.3 mg/kg (max 90 mg) | 6–10 min | 4–8 hr | | Mepivacaine 3% plain | 6.6 mg/kg (max 400 mg) | 1.5–2 min | 20–40 min (pulp) |

Exam trick: pediatric patients use weight-based dosing without exception. A 20 kg child getting 2% lidocaine with epi has a max of 140 mg — not 500 mg. Questions exploit this.

Sedatives and Hypnotics

Benzodiazepines

• Midazolam (Versed) — IV onset 1–2 min, half-life 2–6 hr. Most common for conscious sedation.
• Diazepam (Valium) — slower onset, longer half-life. Metabolites stay active for days.
• Reversal: Flumazenil (Romazicon) — 0.2 mg IV, may repeat up to 1 mg total. Watch for re-sedation as flumazenil wears off faster than the benzodiazepine.

Opioids

• Fentanyl — onset 1–2 min, duration 30–60 min. 100x potency of morphine.
• Meperidine (Demerol) — rarely used in modern dental anesthesia.
• Reversal: Naloxone (Narcan) — 0.04–0.4 mg IV, titrate to respiratory function. Duration shorter than fentanyl — re-dosing common.

Propofol

• IV only. Onset 40 seconds. Duration 3–10 min. No reversal agent exists. Support ventilation and wait it out.
• Dose-dependent respiratory depression. Narrow therapeutic window.

Ketamine

• Dissociative anesthetic. Preserves airway reflexes and respiratory drive better than propofol.
• Causes sympathetic stimulation — HR and BP rise. Avoid in uncontrolled hypertension.
• Emergence phenomena (vivid dreams, hallucinations) — pretreat with midazolam.

Emergency Drugs

Know these cold. The exam will test dose, indication, and route.

| Drug | Indication | Dose (Adult) | Route | |------|-----------|--------------|-------| | Epinephrine | Anaphylaxis | 0.3–0.5 mg | IM (anterolateral thigh) | | Epinephrine | Cardiac arrest | 1 mg | IV push q3–5 min | | Diphenhydramine | Allergic reaction (mild/moderate) | 25–50 mg | IV/IM | | Hydrocortisone | Anaphylaxis (adjunct) | 100–500 mg | IV | | Albuterol | Bronchospasm | 2.5 mg nebulized | Inhalation | | Atropine | Bradycardia | 0.5–1 mg | IV | | Dantrolene | Malignant hyperthermia | 2.5 mg/kg | IV (repeat q5 min up to 10 mg/kg) | | Glucose 50% | Hypoglycemia | 25 g (50 mL) | IV | | Nitroglycerin | Angina | 0.4 mg | SL |

Malignant Hyperthermia: the Highest-Stakes Question

MH is rare but almost always on the exam. Key points:

• Earliest sign: rising end-tidal CO2. Not temperature. Questions exploit this constantly.
• Trigger agents: succinylcholine and volatile inhalational anesthetics. Not a concern in most office-based DA practices, but you need to know it.
• Treatment sequence: stop trigger → dantrolene 2.5 mg/kg IV → 100% O2 → active cooling → treat acidosis and hyperkalemia → transfer to ED.

Anaphylaxis: The One You'll Actually See

• First-line treatment is always epinephrine. Not diphenhydramine, not steroids.
• IM into the anterolateral thigh, not IV (except in cardiac arrest).
• Call 911 first if anaphylaxis is suspected. Don't wait to see if diphenhydramine alone works.

Reversal Agents Quick Reference

| Drug | Reverses | Dose | |------|----------|------| | Flumazenil | Benzodiazepines | 0.2 mg IV, titrate up to 1 mg | | Naloxone | Opioids | 0.04–0.4 mg IV, titrate | | Dantrolene | Malignant hyperthermia | 2.5 mg/kg IV |

Neither flumazenil nor naloxone is a "one and done." Both have shorter durations than the drugs they reverse. Monitor the patient for re-sedation or recurrent respiratory depression for at least 2 hours after reversal.

How to Actually Study This

Reading this cheat sheet once is worthless. Active recall is what works:

1. Cover the answer column. Force yourself to say the max dose, onset, and duration before looking.
2. Calculate drug math without a calculator. The exam doesn't provide one. Practice "7 mg/kg × patient weight" until it's automatic.
3. Use spaced repetition. You need to revisit these same facts 5–7 times across your study period. Once is not enough.

CertCleared's Pro tier runs all pharmacology content through an FSRS spaced-repetition engine that schedules your next review of each drug based on how well you recalled it. Cards you miss come back sooner; cards you know cold space out further. Over 6 weeks that compounds into dense retention without your having to manually plan review sessions.