Hypnotics

Question 1

Contraindications for zopiclone

Answer 1

Unstable myasthenia gravis
Severe sleep apnoea
Breastfeeding
Respiratory failure

Question 2

Side effects of zopiclone

Answer 2

Metallic taste
Heartburn
Lightening of sleep on withdrawal

Question 3

Mechanism of action of flumazenil

Answer 3

Selective competitive GABA A receptor antagonist

Question 4

Administration method of flumazenil

Answer 4

IV

Question 5

Half-life of flumazenil

Answer 5

60 minutes

Question 6

Agents blocked by flumazenil

Answer 6

Benzodiazepines

Zopiclone

Question 7

Duration of effect of flumazenil

Answer 7

20-50 minutes

Question 8

Long acting benzodiazepines

Answer 8

Diazepam
Chlordiazepoxide
Clonazepam
Flurazepam

Question 9

Short acting benzodiazepines

Answer 9

Lorazepam
Oxazepam
Temazepam
Alprazolam

Question 10

Very short acting benzodiazepine

Answer 10

Triazolam

Question 11

Use for triazolam

Answer 11

Used in anaesthesia

Question 12

Side effect profile of short vs. long acting benzodiazepines

Answer 12

Short acting have more severe withdrawal phenomena, rebound insomnia, and anterograde amnesia
Long acting have more daytime sedation

Question 13

Z drug which is known for having a hangover effect due to its active metabolites

Answer 13

Zopiclone

Question 14

Z drug which is used for sleep maintenance rather than sleep initiation issues

Answer 14

Zopiclone

Question 15

Z drugs which are used for sleep initiation issues rather than maintenance of sleep

Answer 15

Zolpidem

Zaleplon

Question 16

Absorption of benzodiazepines

Answer 16

Complete

Question 17

Time to peak concentration of diazepam after a single dose

Answer 17

30-90 minutes

Question 18

Protein binding of benzodiazepines

Answer 18

70-99%

Question 19

Impact of benzodiazepines on sleep cycle

Answer 19

Suppress REM sleep

Question 20

Amnesia which can be caused by benzodiazepines

Answer 20

Anterograde amnesia

Question 21

Paradoxical reaction seen with benzodiazepine use

Answer 21

Aggressive behaviour
Sexual disinhibition
Hyperactivity
Hostility
Vivid dreams

Question 22

Drug factors increasing the risk of a paradoxical reaction with benzodiazepine use

Answer 22

Benzodiazepine with a short half life
High dose
IV administration

Question 23

Patient factors increasing the risk of a paradoxical reaction with benzodiazepine use

Answer 23

Extremes of age
Learning disability
History of aggression or poor impulse control

Question 24

Teratogenic effect of diazepam

Answer 24

Cleft lip and palate

Question 25

Effect of pregabalin on GABA

Answer 25

None - it is a GABA analogue

Question 26

Time to steady state for pregabalin

Answer 26

24-48 hours

Question 27

Bioavailability of pregabalin

Answer 27

High

Question 28

Most toxic benzodiazepine in overdose

Answer 28

Alprazolam

Question 29

Antiepileptic medication licensed for treatment of generalised anxiety disorder

Answer 29

Pregabalin

Question 30

Protein binding of diazepam

Answer 30

98%

Question 31

Subunit of the GABA receptor benzodiazepines and Z drugs act on

Answer 31

Omega 1 subunit

Question 32

Subunit of voltage gated calcium channels pregabalin acts on

Answer 32

Alpha-2-delta subunit

Question 33

Time to maximum plasma concentration for pregabalin

Answer 33

1 hour

Question 34

Binding of pregabalin to plasma proteins

Answer 34

Does not bind

Question 35

Effect of prolonged use on the euphoric effects of pregabalin

Answer 35

Disappear with prolonged use

Question 36

Impact of flumazenil on risk of seizures

Answer 36

Increases risk

Question 37

Risk factors for developing a paradoxical reaction to benzodiazepines

Answer 37

Learning disability
Extremes of age
History of aggression or poor impulse control
Use of a benzodiazepine with a short half life
IV administration
Use of a high dose