Hypnotics Quiz Flashcards
Which statement is NOT correct?
A) Chlordiazeopxide (librium), diazepam (valium), and clorazepate (tranxene) are all metabolized via complex pathways to oxazepam (serax)
B) Lorazepam and oxazepam are metabolized solely by conjugation (simple metabolism)
C) Since xanax and halcion are the shortest acting of the benxodiazepines they are considered the safest and the drug of choice for anxiety and hypnosis
D) Temazepam is metabolized mainly by conjugation
C
Which statement is MOST correct?
A) Zolpidem, zaleplon, and eszopiclone are considered to be non-benzodiazepines because they do not bind to the GABA receptor
B) The mechaism of action of benzodiazepine anti-anxiety effects appears to be based on disinhibition
C) Barbiturates and alcohol bind to the same site on the GABA receptor as benzodiazepines
D) Barbiturates and alcohol have a wider safety margin than benzodiazepines because in addition to facilitating the GABA receptor their pharmacologic effects are off-set via interference with membrane fluidity, and barbiturates also depress glutamate activity
B
Which statement is correct?
A) Differences between various benzodiazepines on various stages of sleep are of theoretical rather than clinical importance
B) Non pharmacologic treatments of insomnia such as observation of proper sleep hygiene, healthy diet and proper exercise should be recommended only to patients after prescribing a long term and high dose benzo regimen
C) Primary insomnia is the most common type of sleep disorder
D) Most medical conditions when left untreated result in a state of fatigue and help to restore proper sleep patterns
A
Most benzodiazepines with the exception of the triazole type agents have wide safety margins and a large therapeutic index. Nevertheless benzos do have important side effects when used as hypnotic agents. Identify the most important side effects.
A) Rebound insomnia
B) Daytime hangover
C) Tolerance, compulsive use, dependence
D) Respiratory depression in patients having moderate to severe respiratory disease
E) All of the above
E
Ramelteon is a melatonin agonist. Which statement about ramelteon is NOT correct?
A) Proven benefits are for improvement in sleep onset (10 minutes vs placebo) but not for sleep maintenance
B) Clinical trials demonstrated superior efficacy over melatonin and superior safety over benzos
C) Studies of ramelteon in patients > 65 years failed to demonstrate hypnotic efficacy
D) There was no overall increase in adverse effects patients treated with ramelteon, but there was not an statistically significant increase in any specific adverse effect
B
Identify the preferred medication for the pharmacologic treatment of chronic generalized anxiety not associated with MDD.
A) Diazepam
B) Buspirone
C) Ambien
D) Xanax
B
Identify the preferred medication for the pharmacologic treatment of chronic generalized anxiety disorder, also associated with MDD.
A) Mirtazapine
B) Gabapentin
C) Lorazepam
D) Melatonin
A
Which medication has the strongest evidence to manage benzodiazepine discontinuation syndrome?
A) Buprenorphine
B) Gabapentin
C) Buspirone
D) Phenytoin
C
