Sedatuves And Hypnotics MCQ Flashcards
Which of the following best explains why barbiturates are more dangerous than benzodiazepines in overdose?
A. Barbiturates act on GABAb receptors instead of GABAa
B. Barbiturates do not require GABA to activate their receptor
C. Benzodiazepines cause respiratory depression at low doses
D. Benzodiazepines induce liver enzymes and increase toxicity
E. Barbiturates cannot cross the blood-brain barrier
B. Barbiturates do not require GABA to activate their receptor
Which of the following best describes how benzodiazepines modulate GABA neurotransmission?
A. They increase the duration of GABA receptor channel opening
B. They inhibit chloride influx and decrease IPSP amplitude
C. They mimic GABA to directly activate the receptor
D. They increase frequency of chloride channel opening and enhance IPSPs
E. They block glutamate to reduce excitatory transmission
D. They increase frequency of chloride channel opening and enhance IPSPs
Which agent is a benzodiazepine receptor antagonist used to reverse sedation or overdose?
A. Diazepam
B. Flumazenil
C. Triazolam
D. Beta-carboline
E. Eszopiclone
B. Flumazenil
What is the mechanism of zolpidem (Ambien)?
A. Acts as a full agonist at GABAa receptor
B. Inhibits glutamate via NMDA antagonism
C. Binds benzodiazepine site to promote sleep, with minimal effect on sleep stages
D. Binds serotonin receptors to block REM sleep
E. Acts on GABAb receptors to induce muscle relaxation
C. Binds benzodiazepine site to promote sleep, with minimal effect on sleep stages
Which of the following drugs has the longest half-life and greatest risk for hangover sedation?
A. Triazolam
B. Oxazepam
C. Lorazepam
D. Flurazepam
E. Zolpidem
D. Flurazepam
Which statement about the differences between barbiturates and benzodiazepines is TRUE?
A. Barbiturates are safer due to their selective CNS action
B. Benzodiazepines induce CYP450 enzymes and increase drug metabolism
C. Barbiturates can mimic GABA at high concentrations, increasing risk
D. Benzodiazepines shorten the duration of chloride channel opening
E. Barbiturates are less likely to cause CNS depression when combined with alcohol
C. Barbiturates can mimic GABA at high concentrations, increasing risk
What is the mechanism of action of disulfiram (Antabuse) in alcohol treatment?
A. It blocks alcohol dehydrogenase
B. It inhibits aldehyde dehydrogenase, causing acetaldehyde buildup
C. It enhances dopamine release to reduce cravings
D. It inhibits NMDA receptors to reduce excitatory effects
E. It blocks opioid receptors to blunt alcohol reinforcement
B. It inhibits aldehyde dehydrogenase, causing acetaldehyde buildup
Which of the following best describes zero-order kinetics, as seen with alcohol metabolism?
A. Elimination rate is proportional to drug concentration
B. Drug is eliminated in half-lives
C. Constant amount is eliminated per unit time regardless of dose
D. Saturable process that speeds up with higher doses
E. It only occurs in the kidneys
C. Constant amount is eliminated per unit time regardless of dose
Which enzyme system becomes more active in chronic alcohol use and increases drug metabolism?
A. Aldehyde dehydrogenase
B. Monoamine oxidase
C. Microsomal ethanol oxidizing system (MEOS)
D. Acetylcholinesterase
E. Monoamine transporter
C. Microsomal ethanol oxidizing system (MEOS)
What makes eszopiclone (Lunesta) unique among hypnotics?
A. It is an inverse agonist at the BZD receptor
B. It inhibits NMDA receptors to induce REM sleep
C. It is approved for long-term insomnia treatment (>42 days)
D. It is a GABA mimetic at high doses
E. It causes significant rebound insomnia
C. It is approved for long-term insomnia treatment (>42 days)
A 68-year-old patient is prescribed flurazepam for insomnia. The next day, he complains of grogginess and confusion. What is the most likely explanation?
A. Drug is too weak to induce deep sleep
B. It produces REM rebound and nightmares
C. Long half-life leads to next-day sedation, especially in elderly
D. Flurazepam has no CNS depressant effects
E. The patient has developed withdrawal symptoms
C. Long half-life leads to next-day sedation, especially in elderly
Which of the following is most likely to occur when alcohol is taken with tolbutamide (a sulfonylurea)?
A. Hyperglycemia due to increased gluconeogenesis
B. Severe hypoglycemia due to additive effects
C. Decreased absorption of tolbutamide
D. Flushing and nausea due to GABA inhibition
E. Inhibition of serotonin reuptake
B. Severe hypoglycemia due to additive effects
A patient with a history of alcohol use disorder is treated with naltrexone. What is the intended mechanism?
A. Enhances dopamine to replace alcohol reward
B. Blocks opioid receptors to reduce craving and reinforcement
C. Inhibits aldehyde dehydrogenase to cause aversion
D. Inhibits serotonin to reduce mood symptoms
E. Enhances GABA to reduce withdrawal symptoms
B. Blocks opioid receptors to reduce craving and reinforcement
What distinguishes triazolam from other hypnotics, making it useful in transient insomnia?
A. Long half-life and high REM suppression
B. Low lipid solubility and slow onset
C. Short half-life and minimal residual sedation
D. Ability to increase sleep stage 3 and 4
E. Anticonvulsant and muscle relaxant properties
C. Short half-life and minimal residual sedation
Which of the following describes Wernicke’s encephalopathy, a complication of chronic alcoholism?
A. Reversible hepatitis caused by alcohol
B. Psychiatric disorder caused by withdrawal
C. Thiamine deficiency leading to confusion, ataxia, and ophthalmoplegia
D. Hyperglycemia and euphoria due to disulfiram use
E. Damage to cerebellum causing intention tremor only
C. Thiamine deficiency leading to confusion, ataxia, and ophthalmoplegia
A 78-year-old woman is prescribed triazolam for insomnia. The next morning, she is confused and has no memory of nighttime behaviors. What is the most likely explanation?
A. Benzodiazepines cause REM rebound
B. Triazolam is metabolized slowly in elderly patients
C. Short-acting benzodiazepines can cause anterograde amnesia
D. The drug interacts with acetylcholine receptors in the hippocampus
E. She is experiencing alcohol withdrawal
C. Short-acting benzodiazepines can cause anterograde amnesia
A 45-year-old man is brought to the ER after taking an unknown sedative. He is drowsy but arousable, and vitals are stable. Flumazenil is administered, and he seizes. Which of the following is the most likely cause?
A. He took zolpidem and flumazenil blocked its receptor
B. He overdosed on phenobarbital, which flumazenil enhances
C. He had chronic benzodiazepine use and flumazenil precipitated withdrawal
D. Flumazenil is contraindicated in all sedative overdoses
E. His seizure was unrelated to the drug interaction
C. He had chronic benzodiazepine use and flumazenil precipitated withdrawal
A patient with a history of alcohol use disorder is hospitalized. On day 2, he becomes tremulous, hypertensive, and agitated. What is the most appropriate pharmacologic treatment?
A. Naloxone
B. Diazepam
C. Disulfiram
D. Propanolol
E. Naltrexone
B. Diazepam
A patient presents with symptoms of acute alcohol withdrawal. Which of the following benzodiazepines is safest in a patient with advanced liver disease?
A. Diazepam
B. Chlordiazepoxide
C. Lorazepam
D. Clonazepam
E. Flurazepam
C. Lorazepam
A 60-year-old man with insomnia is prescribed flurazepam. He reports confusion and sedation the next day. Which property of flurazepam is responsible for this side effect?
A. Rapid hepatic metabolism
B. Anticholinergic activity
C. Short half-life and rapid redistribution
D. Long half-life and active metabolites
E. Serotonin antagonism
D. Long half-life and active metabolites
A woman with chronic alcoholism is found confused with horizontal nystagmus and unsteady gait. Which vitamin is most urgently needed?
A. Niacin
B. Thiamine
C. Pyridoxine
D. Folic acid
E. Riboflavin
B. Thiamine
A 35-year-old woman takes zolpidem nightly for 2 months. When she tries to stop, she experiences rebound insomnia. What is the most appropriate recommendation?
A. Stop zolpidem immediately and start fluoxetine
B. Increase the dose for 2 weeks before tapering
C. Switch to triazolam as a safer long-term alternative
D. Taper the dose gradually to prevent rebound symptoms
E. Add diphenhydramine and continue zolpidem
D. Taper the dose gradually to prevent rebound symptoms
A 50-year-old man being treated for alcohol dependence reports that drinking now makes him flushed, nauseated, and lightheaded. Which drug is he most likely taking?
A. Acamprosate
B. Disulfiram
C. Naltrexone
D. Flumazenil
E. Diazepam
B. Disulfiram
