Exam 2 Stoetling's Book Benzos questions Flashcards
What are the five principal pharmacologic effects of benzodiazepines?
a. Antihistamine, anticonvulsant, anterograde amnesia, anxiolysis, and sedation
b. Anterograde amnesia, sedation, anticonvulsant actions, spinal cord–mediated skeletal muscle relaxation, and anxiolysis
c. Sedation, anticonvulsant actions, antihistamine, anxiolysis, and retrograde amnesia
d. Anterograde amnesia, skeletal muscle relaxation, antihistamine, anticonvulsant actions, and anxiolysis
Answer: b. Anterograde amnesia, sedation, anticonvulsant actions, spinal cord–mediated skeletal muscle relaxation, and anxiolysis.
Which of the following is true about benzodiazepines and skeletal muscle relaxation?
a. Benzodiazepines produce adequate skeletal muscle relaxation for surgical procedures
b. Benzodiazepines do not produce adequate skeletal muscle relaxation for surgical procedures
c. Benzodiazepines only produce skeletal muscle relaxation for minor surgical procedures
d. Benzodiazepines increase the need for neuromuscular blocking drugs during surgical procedures
Answer: b. Benzodiazepines do not produce adequate skeletal muscle relaxation for surgical procedures.
Why are benzodiazepines widely used in clinical practice?
a. Because they have no side effects
b. Because they produce adequate skeletal muscle relaxation for surgical procedures
c. Because of their efficacy for anxiety and insomnia
d. Because they are more effective than opioids
Answer: c. Because of their efficacy for anxiety and insomnia.
How do benzodiazepines produce their pharmacologic effects?
a. By activating the GABAA receptors
b. By increasing the number of GABAA receptors in the brain
c. By enhancing the affinity of GABAA receptors for GABA
d. By inhibiting the production of GABA
Answer: c. By enhancing the affinity of GABAA receptors for GABA.
What is the role of the γ subunit in benzodiazepine binding to the GABAA receptor?
a. It is required for benzodiazepine binding
b. It inhibits benzodiazepine binding
c. It increases the potency of benzodiazepines
d. It is not involved in benzodiazepine binding
Answer: a. It is required for benzodiazepine binding.
How do benzodiazepines produce their pharmacologic effects?
a) By activating the GABAA receptors
b) By enhancing the affinity of the receptors for GABA
c) By producing more frequent channel openings without affecting the receptors
d) By inhibiting the GABAA receptors
Answer: b) By enhancing the affinity of the receptors for GABA
Which subunits of the GABAA receptor are required for benzodiazepine binding?
a) Alpha and beta
b) Alpha and gamma
c) Beta and gamma
d) Gamma and delta
Answer: b) Alpha and gamma
Which subunit-containing GABAA receptors are important for sedation?
a) Alpha 1 and alpha 5
b) Alpha 2 and alpha 5
c) Alpha 3 and alpha 5
d) Alpha 4 and alpha 5
Answer: a) Alpha 1 and alpha 5
What is the basis for pharmacologic synergy between benzodiazepines, barbiturates, and alcohol?
a) They all activate the GABAA receptors
b) They all enhance the affinity of the receptors for GABA
c) They all act on physically separate binding sites of the GABAA receptor
d) They all inhibit the uptake, distribution, metabolism, and elimination of GABA
Answer: c) They all act on physically separate binding sites of the GABAA receptor
What is the reason for the low toxicity and clinical safety of benzodiazepines?
a) They have a built-in ceiling effect that prevents them from exceeding the physiologic maximum of GABA inhibition
b) They have a high binding affinity to plasma proteins
c) They are poorly absorbed from the gastrointestinal tract
d) They have a low lipid solubility and cannot cross the blood-brain barrier
Answer: a) They have a built-in ceiling effect that prevents them from exceeding the physiologic maximum of GABA inhibition
What is the most common side effect in patients treated with benzodiazepines?
A. Decreased motor coordination
B. Anterograde amnesia
C. Fatigue and drowsiness
D. Impairment of cognitive function
Answer: C
How long does sedation usually last in patients chronically treated with benzodiazepines?
A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks
Answer: B
What should patients be instructed to do when ingesting benzodiazepines?
A. Take them after meals
B. Take them with antacids
C. Take them before meals
D. Take them during meals
Answer: C
What is the effect of chronic administration of benzodiazepines on systemic blood pressure, heart rate, and cardiac rhythm?
A. Adversely affects them
B. Improves them
C. No effect
D. Not mentioned in the text
Answer: C
Why should benzodiazepines be avoided in patients with chronic lung disease characterized by hypoventilation and/or decreased arterial oxygenation?
A. They may decrease absorption from the gastrointestinal tract
B. They may interact with other medications to have adverse effects
C. They adversely affect systemic blood pressure, heart rate, or cardiac rhythm
D. Effects on ventilation may be absent
Answer: D
What may occur when benzodiazepines are used in combination with other CNS depressant drugs?
A. Anterograde amnesia
B. Decreased motor coordination
C. Impairment of cognitive function
D. All of the above
Answer: D
What is a potential side effect of acute administration of benzodiazepines, especially when combined with alcohol?
A. Hypertension
B. Bradycardia
C. Anterograde amnesia
D. None of the above
Answer: C
Which of the following substances do benzodiazepines have synergistic sedative effects with?
A) Caffeine
B) Nicotine
C) Alcohol
D) All of the above
Answer: C) Alcohol
What effect do benzodiazepines have on anesthetic requirements?
A) They increase anesthetic requirements.
B) They decrease anesthetic requirements.
C) They have no effect on anesthetic requirements.
D) They make anesthetics ineffective.
Answer: B) They decrease anesthetic requirements.
What is the effect of benzodiazepines on the analgesic actions of opioids?
A) They enhance the analgesic actions of opioids.
B) They reduce the analgesic actions of opioids.
C) They have no effect on the analgesic actions of opioids.
D) They cause opioids to become toxic.
Answer: B) They reduce the analgesic actions of opioids.
Which benzodiazepines may be preferentially selected in elderly patients?
A) Diazepam
B) Alprazolam
C) Lorazepam, oxazepam, and temazepam
D) All benzodiazepines are equally suitable for elderly patients.
Answer: C) Lorazepam, oxazepam, and temazepam
What is the effect of long-term benzodiazepine administration on elderly patients?
A) It has no effect on cognitive decline.
B) It slows cognitive decline.
C) It accelerates cognitive decline.
D) It reverses cognitive decline.
Answer: C) It accelerates cognitive decline.
Which symptom is associated with benzodiazepine withdrawal in the elderly?
A) Confusion
B) Euphoria
C) Excitement
D) None of the above
Answer: A) Confusion
Do benzodiazepines affect the risk of hemorrhagic complications in patients with severe, chemotherapy-induced thrombocytopenia?
A) Yes, they increase the risk of hemorrhagic complications.
B) Yes, they decrease the risk of hemorrhagic complications.
C) No, they have no effect on the risk of hemorrhagic complications.
D) It is unclear if they affect the risk of hemorrhagic complications.
Answer: D) It is unclear if they affect the risk of hemorrhagic complications.
What is midazolam?
a) An opioid
b) A water-soluble benzodiazepine
c) A muscle relaxant
d) A local anesthetic
Answer: b) A water-soluble benzodiazepine
Why has midazolam replaced diazepam for use in preoperative medication and conscious sedation?
a) It is cheaper
b) It is more potent
c) It has fewer side effects
d) It is easier to administer
Answer: c) It has fewer side effects
What is the pH of the parenteral solution of midazolam used clinically?
a) 2.0
b) 3.5
c) 5.0
d) 7.0
Answer: b) 3.5
What is the effect of physiologic pH on midazolam?
a) It opens the ring
b) It closes the ring
c) It converts midazolam to a water-soluble drug
d) It has no effect on midazolam
Answer: b) It closes the ring
What is the elimination half-time of midazolam?
a) 1-4 hours
b) 4-8 hours
c) 8-12 hours
d) 12-24 hours
Answer: a) 1-4 hours
Why is the context-sensitive half-time of midazolam shorter than that of diazepam?
a) Midazolam undergoes rapid absorption from the gastrointestinal tract
b) Midazolam is considered to have a slow effect-site equilibration time
c) The clearance of midazolam is more rapid than that of diazepam
d) Midazolam is extensively bound to plasma proteins
Answer: c) The clearance of midazolam is more rapid than that of diazepam
What is the effect of cardiopulmonary bypass on the plasma concentration of midazolam?
a) It decreases the plasma concentration
b) It increases the plasma concentration
c) It has no effect on the plasma concentration
d) It converts midazolam to a highly lipid-soluble drug
Answer: a) It decreases the plasma concentration
Is the elimination half-time, Vd, and clearance of midazolam altered by renal failure?
A. Yes
B. No
Answer: B
How does fentanyl affect the hepatic clearance of midazolam?
A. It increases the hepatic clearance rate
B. It inhibits the hepatic clearance rate
C. It has no effect on the hepatic clearance rate
D. It increases the renal clearance rate
Answer: B
Which drugs can inhibit cytochrome P450 enzymes and slow down the metabolism of midazolam?
A. Antifungal drugs
B. Calcium channel blockers
C. Erythromycin
D. All of the above
Answer: D
What happens to the glucuronide metabolite of midazolam in patients with renal insufficiency?
A. It is rapidly conjugated to 1-hydroxymidazolam
B. It has no pharmacologic activity
C. It may have synergistic sedative effects with the parent compound
D. It is subsequently cleared by the liver
Answer: C
What is the principal metabolite of midazolam?
A. 1-hydroxymidazolam glucuronide
B. 4-hydroxymidazolam
C. Inactive metabolite
D. 1-hydroxymidazolam
Answer: D
What effect does midazolam have on cerebral blood flow?
a. It increases cerebral blood flow
b. It has no effect on cerebral blood flow
c. It decreases cerebral blood flow
d. It depends on the dosage
Answer: c. It decreases cerebral blood flow
Is midazolam a suitable alternative to barbiturates for induction of anesthesia in patients with intracranial pathology?
a. Yes
b. No
c. It depends on the severity of the intracranial pathology
d. It depends on the patient’s age
Answer: a. Yes
What is the potential side effect of midazolam in patients with severe head trauma?
a. Decreased intracranial compliance
b. Undesirable increase in ICP
c. Improvement of neurologic outcome
d. Paradoxical excitement
Answer: b. Undesirable increase in ICP
What is the treatment for paradoxical excitement in patients receiving midazolam?
a. Diazepam
b. Fentanyl
c. Flumazenil
d. Thiopental
Answer: c. Flumazenil
Does midazolam have a depressant effect on ventilation?
a. Yes, but only in patients with chronic obstructive pulmonary disease
b. Yes, but only in combination with fentanyl
c. No
d. Yes, especially with rapid injection of large doses
Answer: d. Yes, especially with rapid injection of large doses
What effect does midazolam have on systemic blood pressure?
a. It increases systemic blood pressure
b. It has no effect on systemic blood pressure
c. It decreases systemic blood pressure
d. It depends on the dosage
Answer: c. It decreases systemic blood pressure
Does midazolam prevent blood pressure and heart rate responses evoked by intubation of the trachea?
a. Yes
b. No
c. It depends on the patient’s age
d. It depends on the patient’s medical history
Answer: b. No
Which drug is usually used for induction of anesthesia faster than midazolam?
A. Fentanyl
B. Thiopental
C. Propofol
D. Opioids
Answer: B. Thiopental
What is the context-sensitive half-time for midazolam during the maintenance of anesthesia?
A. Increases modestly with an increasing duration of administration
B. Decreases with an increasing duration of administration
C. Remains constant with an increasing duration of administration
D. None of the above
Answer: A. Increases modestly with an increasing duration of administration
What is paradoxical vocal cord motion?
A. A cause of organic upper airway obstruction
B. A cause of nonorganic upper airway obstruction
C. A side effect of midazolam
D. A complication of intubation
Answer: B. A cause of nonorganic upper airway obstruction
What is the recommended dose of midazolam for treating paradoxical vocal cord motion?
A. 0.1-0.2 mg/kg IV
B. 0.5-1 mg IV
C. 1-2.5 mg IV
D. 2-5 mg IV
Answer: B. 0.5-1 mg IV
