Lippincott Chapter 9: Anxiolytic and Hypnotic Drugs

Question 1

Choose the ONE best answer.
9.1 Which one of the following statements is correct regarding
benzodiazepines?
A. Benzodiazepines directly open chloride
channels.
B. Benzodiazepines show analgesic actions.
C. Clinical improvement of anxiety requires 2 to 4
weeks of treatment with benzodiazepines.
D. All benzodiazepines have some sedative effects.
E. Benzodiazepines, like other CNS depressants,
readily produce general anesthesia.

Answer 1

Correct answer = D. Although all benzodiazepines can
cause sedation, the drugs labeled “benzodiazepines” in
Figure 9.1 are promoted for the treatment of sleep disorder.
Benzodiazepines enhance the binding of GABAA to its recep-
tor, which increases the permeability of chloride. The benzo-
diazepines do not relieve pain but may reduce the anxiety
associated with pain. Unlike the tricyclic antidepressants and
the monoamine oxidase inhibitors, the benzodiazepines are
effective within hours of administration. Benzodiazepines do
not produce general anesthesia and, therefore, are relatively
safe drugs with a high therapeutic index.

Question 2

9.2 Which one of the following is a short-acting hypnotic?
A. Phenobarbital.
B. Diazepam.
C. Chlordiazepoxide.
D. Triazolam.
E. Flurazepam.

Answer 2

Correct answer = D. Triazolam is a short-acting drug. It has
little daytime sedation. The other drugs listed are longer
acting

Question 3

9.3 Which one of the following statements is correct regarding
the anxiolytic and hypnotic agents?
A. Phenobarbital shows analgesic properties.
B. Diazepam and phenobarbital induce the cytochrome
P450 enzyme system.
C. Phenobarbital is useful in the treatment of acute
intermittent porphyria.
D. Phenobarbital induces respiratory depression, which
is enhanced by the consumption of ethanol.
E. Buspirone has actions similar to those of the
benzodiazepines.

Answer 3

Correct answer = D. Barbiturates and ethanol are a poten-
tially lethal combination. Phenobarbital is unable to alter the
pain threshold. Only phenobarbital strongly induces the syn-
thesis of the hepatic cytochrome P450 drug-metabolizing
system. Phenobarbital is contraindicated in the treatment of
acute intermittent porphyria. Buspirone lacks the anticonvul-
sant and muscle-relaxant properties of the benzodiazepines
and causes only minimal sedation.

Question 4

9.4 A 45-year-old man who has been injured in a car accident
is brought into the emergency room. His blood alcohol
level on admission is 275 mg/dL. Hospital records show a
prior hospitalization for alcohol-related seizures. His wife
confirms that he has been drinking heavily for 3 weeks.
What treatment should be provided to the patient if he
goes into withdrawal?
A. None.
B. Lorazepam.
C. Pentobarbital.
D. Phenytoin.
E. Buspirone.

Answer 4

Correct answer = B. It is important to treat the seizures
associated with alcohol withdrawal. Benzodiazepines, such
as chlordiazepoxide, diazepam, or the shorter-acting loraz-
epam, are effective in controlling this problem. They are less
sedating than pentobarbital or phenytoin

Question 5

9.5 Which one of the following is a short-acting hypnotic
and better for sleep induction compared to sleep
maintenance?
A. Temazepam.
B. Flurazepam.
C. Zaleplon.
D. Buspirone.
E. Escitalopram.

Answer 5

Correct answer = C. Zaleplon has the shortest half-life and
duration of action. Buspirone and escitalopram are not
effective hypnotic agents. Temazepam and flurazepam have
longer durations of action and will reduce nighttime awak-
enings but will have a greater risk of daytime sedation or
hangover effect compared to zaleplon

Question 6

9.6 Which of the following agents has a rapid anxiolytic effect
and would be best for the acute management of anxiety?
A. Buspirone.
B. Venlafaxine.
C. Lorazepam.
D. Escitalopram.
E. Duloxetine.

Answer 6

Correct answer = C. The benzodiazepines have same-dose,
first-dose efficacy for anxiety, whereas the other agents
require 2 to 8 weeks for clinically significant improvement
in anxiety.

Question 7

9.7 Which of the following sedative–hypnotic agents utilizes
melatonin receptor agonism as the mechanism of action
to induce sleep?
A. Zolpidem.
B. Eszopiclone.
C. Estazolam.
D. Ramelteon.
E. Diphenhydramine.

Answer 7

Correct answer = D. Ramelteon is the only melatonin recep-
tor agonist to promote sleep, especially in sleep-phase
disrupted sleep. Zolpidem, eszopiclone, and estazolam all
utilize the benzodiazepine receptor, and diphenhydramine
is a histamine receptor antagonist.

Question 8

9.8 All of the following agents for the management of
insomnia are controlled substances and may have a risk
for addiction or dependence except:
A. Zaleplon.
B. Flurazepam.
C. Doxepin.
D. Zolpidem.
E. Triazolam.

Answer 8

Correct answer = C. Only doxepin, a tricyclic agent with
significant antihistaminergic properties, is considered to
have no risk of addiction or dependence, whereas the other
agents listed all have DEA schedule IV designations with
some risk for addiction or dependence, especially when
used for extended periods.

Question 9

9.9 All of the following agents may cause cognitive
impairment, including memory problems when used at
recommended doses except:
A. Diphenhydramine.
B. Zolpidem.
C. Alprazolam.
D. Phenobarbital.
E. Ramelteon.

Answer 9

Correct answer = E. All of the above listed agents, except
ramelteon, have been associated with cognitive impair-
ments, including memory impairment. Diphenhydramine
likely causes its cognitive problems from its anticholinergic
and antihistaminergic effects. Zolpidem, alprazolam, and
phenobarbital are well-known causes of cognitive impair-
ment, including anterograde amnesia. Ramelteon has
safety data extending to 6 months and is a noncontrolled
hypnotic agent acting as a melatonin receptor agonist. It is
not considered to have a risk for cognitive impairment as
compared to the other agents listed.

Question 10

9.10 Which agent is best used in the Emergency Room
setting for patients who are believed to have received
too much of a benzodiazepine drug or taken an
overdose of benzodiazepines?
A. Diazepam.
B. Ramelteon.
C. Flumazenil.
D. Doxepin.
E. Naloxone.

Answer 10

Correct answer = C. Flumazenil is only indicated to reverse
the effects of benzodiazepines via antagonizing the benzo-
diazepine receptor. It should be used with caution due to a
risk of seizures if the patient has been a long time recipi-
ent of benzodiazepines or if the overdose attempt was with
mixed drugs. Naloxone is an opioid receptor antagonist.
The other agents are not efficacious in reversing effects of
benzodiazepines.