Pharm Anxiety Sedative Hypnotics
Navigating the intricate landscape of anxiety disorders and their treatment is a complex task. Assessing and providing appropriate medications requires careful consideration. If you're up for the challenge, test your knowledge with our "Pharm Anxiety Sedative Hypnotic Drugs" quiz.
Anxiety disorders stem from multifaceted origins, and the use of sedative-hypnotic drugs like benzodiazepines is common. This quiz poses scenarios where you'll need to diagnose and prescribe medications accurately.
Remember, proper diagnosis and treatment are best left to healthcare professionals. This quiz is designed to provide insights into the world of pharmaceutics related to anxiety and sedative-hypnotic drugs. However, Read moreconsult with experts for comprehensive patient care.
If you're intrigued by the intricate interplay of medications and anxiety management, this quiz can be an informative journey. Test your knowledge, but remember that real-life situations require expert guidance. Best of luck on this enlightening exploration!
Questions and Answers
- 1.
Match each sedative-hypnotic drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): A partial agonist at 5-HT1A receptors
- A.
Alprazolam
- B.
Buspirone
- C.
Clonazepam
- D.
Flumazenil
- E.
Flunitrazepam
- F.
Lorazepam
- G.
Midazolam
- H.
Phenobarbital
- I.
Thiopental
- J.
Zolpidem
Correct Answer
B. BuspironeExplanation
Buspirone is a partial agonist at 5-HT1A receptors.Rate this question:
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- 2.
Directions: questions 1-6 Match each sedative hypnotic drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): A competitive antagonist at benzodiazepine receptors
- A.
Alprazolam
- B.
Buspirone
- C.
Clonazepam
- D.
Flumazenil
- E.
Flunitrazepam
- F.
Lorazepam
- G.
Midazolam
- H.
Phenobarbital
- I.
Thiopental
- J.
Zolpidem
Correct Answer
D. FlumazenilExplanation
Flumazenil is a competitive antagonist at benzodiazepine receptors.Rate this question:
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- 3.
Directions: questions 1-6 Match each sedative hypnotic drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): A sedative hypnotic drug with negligible effects on sleep architecture and stages
- A.
Alprazolam
- B.
Buspirone
- C.
Clonazepam
- D.
Flumazenil
- E.
Flunitrazepam
- F.
Lorazepam
- G.
Midazolam
- H.
Phenobarbital
- I.
Thiopental
- J.
Zolpidem
Correct Answer
J. ZolpidemExplanation
Zolpidem is a sedative hypnotic drug that has negligible effects on sleep architecture and stages.Rate this question:
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- 4.
Directions: questions 1-6 Match each sedative hypnotic drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): The most frequently used drug to induce general anesthesia
- A.
Alprazolam
- B.
Buspirone
- C.
Clonazepam
- D.
Flumazenil
- E.
Flunitrazepam
- F.
Lorazepam
- G.
Midazolam
- H.
Phenobarbital
- I.
Thiopental
- J.
Zolpidem
Correct Answer
I. ThiopentalExplanation
Thiopental is the most frequently used drug to induce general anesthesia.Rate this question:
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- 5.
Directions: questions 1-6 Match each sedative hypnotic drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): A benzodiazepine with a very short half life (.2 hours)
- A.
Buspirone
- B.
Clonazepam
- C.
Flumazenil
- D.
Flunitrazepam
- E.
Lorazepam
- F.
Midazolam
- G.
Phenobarbital
- H.
Thiopental
- I.
Zolpidem
Correct Answer
F. MidazolamExplanation
Midazolam is a benzodiazepine with a very short half-life of 0.2 hours. It is commonly used as a sedative and hypnotic medication due to its fast onset of action and short duration of effects.Rate this question:
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- 6.
Directions: questions 1-6 Match each sedative hypnotic drug with the appropriate description (each lettered option can be selected once, more than once, or not at all): An anxiolytic drug with negligible abuse liability
- A.
Alprazolam
- B.
Buspirone
- C.
Clonazepam
- D.
Flumazenil
- E.
Flunitrazepam
- F.
Lorazepam
- G.
Midazolam
- H.
Phenobarbital
- I.
Thiopental
- J.
Zolpidem
Correct Answer
B. BuspironeExplanation
Buspirone is an anxiolytic drug that is often prescribed for the treatment of anxiety disorders. It is known to have negligible abuse liability, meaning that it is less likely to be misused or cause addiction compared to other sedative hypnotic drugs. This makes it a safer option for long-term use in patients who require ongoing anxiety management.Rate this question:
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- 7.
A 54-year-old man was admitted to the hospital for a laparoscopic hernia repair under general anesthesia. A suitable dose of diazepam was given IV and the patient lost consciousness in two minutes. He regained consciousness about 45 minutes later. Knowing that the half-life of diazepam is about 40 hours, which of the following phrases best explains the short action of the drug?
- A.
Rapid metabolism of the drug within the CNS
- B.
Rapid excretion of the drug by the kidney
- C.
Redistribution of the drug from CNS to other tissues
- D.
Biotransformation of the drug to active metabolites by the liver
- E.
Development of a rapid tolerance to drug effects
Correct Answer
C. Redistribution of the drug from CNS to other tissuesExplanation
Answer: C
Redistribution of a drug from its site of action into other tissues or sites. is a main factor in
terminating drug effect primarily when a highly lipid-soluble drug that acts on the brain is
administered rapidly by intravenous injection. A good example of this is the use of IV injection of
diazepam (a highly lipid-soluble drug) to induce loss of consciousness. Because blood flow to
the brain is so high, the drug reaches its maximal concentration in brain within a minute of its
intravenous injection. After injection is concluded, the plasma concentration falls as diazepam l diffuses into other tissues, such as muscle.
A, D) Diazepam is extensively metabolized in the liver (not in the brain) to desmethyldiazepam
and oxazepam. Both metabolites are active, therefore the biotransformation cannot explain the
short action of the drug.
B) The renal excretion of diazepam is about 1%.
E) Tolerance can develop to the action of benzodiazepines, but only after a chronic treatment of
several days.Rate this question:
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- 8.
A 35-year-old man complained to his physician of attacks of intense terror during sleep, such as feeling crushed, and often wakes up with scream, but cannot remember any specific dream. He also felt anxious and restless from time to time during the day. Which of the following drugs would show good short-term decrease of patient’s symptoms?
- A.
Lithium
- B.
Temazepam
- C.
Haloperidol
- D.
Imipramine
- E.
Phenobarbital
Correct Answer
B. TemazepamExplanation
Answer: B
The patient’s symptoms indicate that he is suffering from insomnia characterized by difficulty in
maintaining sleep during the night because of nightmares. A benzodiazepine hypnotic is
preferable in this patient because of the need for anxiolytic properties in addition to hypnotic
efficacy. Moreover benzodiazepines tend to decreased the slow waves sleep were nightmares
are more frequent. Therefore a medium-acting benzodiazepine like temazepam, which can
maintain sleep throughout the night, should be appropriate for this patient.
A, C, D, E) These drugs are devoid of hypnotic propertiesRate this question:
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- 9.
A 62-year-old woman recently diagnosed with generalized anxiety disorder had been on a treatment with venlafaxine but the therapy was stopped because of a persistent headache that the psychiatrist thought drug related. A treatment with buspirone was started. Which of the following brain regions was most likely involved in the therapeutic effect of the drug?
- A.
Auditory cortex
- B.
Amygdala
- C.
Putamen
- D.
Nucleus accumbens
- E.
Area postrema
Correct Answer
B. AmygdalaExplanation
Answer: B
A neurocircuit arising from the output pathways of the central nucleus of amygdala is believed to
mediate fear and anxiety responses. Therefore amygdala seems the central processing unit for
fear and anxiety. Buspirone was shown to exert anxiolytic actions, even if it is a second choice
drug for anxiety since its efficacy is modest and its onset of effect is delayed (2 weeks or longer).
The molecular mechanism of action of the drug is still uncertain (likely it acts at a partial agonist
at 5-HT 1A receptors), but amygdala is most likely involved in buspirone action , given the
central role of amygdala in anxiety disorders.
A, C, D, E) (see explanation above)Rate this question:
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- 10.
A 66-year-old female who recently lost her husband told her physician that she was not sleeping at night. Further questioning indicated that she did not have depression or substance abuse. The physician decided to start a short treatment with a drug that acts by increasing the inhibitory action of short interneurons in several brain areas. Which of the following drug was most likely prescribed?
- A.
Diazepam
- B.
Buspirone
- C.
Paroxetine
- D.
Oxazepam
- E.
Clomipramine
- F.
Haloperidol
Correct Answer
D. OxazepamExplanation
Answer: D
By increasing GABA activity all benzodiazepines enhanced the inhibitory action of GABAergic
neurons, which are mainly short interneurons in several brain areas. When used as hypnotics
drugs with short or intermediate action are preferred.
A) Diazepam is not used as hypnotic since it has a long half life and therefore is more prone to
cause day time drowsiness.
B, C, E, F) These drugs are not used as hypnotics.Rate this question:
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- 11.
A 47-year-old woman complained to her physician that she could get to sleep when she went to bed but woke up several times during the night an never felt refreshed in the morning. The woman had no medical problems and took no medications. Which of the following drugs would be appropriate for this patient?
- A.
Flunitrazepam
- B.
Buspirone
- C.
Eszopiclone
- D.
Fluoxetine
- E.
Haloperidol
- F.
Imipramine
Correct Answer
C. EszopicloneExplanation
Answer: C Non-benzodiazepines acting on GABA receptors (the so called Z-hypnotics) are today preferred in case of insomnia since they do not alter the sleep architecture and stages, do not have significant anxiolytic, and anticonvulsant properties and have a lower risk of dependence compared with the short acting benzodiazepines. Different hypnotic drugs should be used according to the type of insomnia presented by the patient. When there is difficulty in falling asleep a short-acting drug is appropriate, when there is difficulty in maintaining sleep during the night a medium acting drug like eszopiclone (t½ of 4-7 hours) is appropriate, like in the present case. A) Flunitrazepam is a long-acting benzodiazepine and is therefore not appropriate as an hypnotic because of the risk of daytime sedation and drowsiness. B, D, E, F) These drugs have negligible hypnotic activity.Rate this question:
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- 12.
A 25-year-old man, suffering from cerebral palsy and seizures secondary to a head injury, was admitted to the hospital for a control visit. He was spastic and unable to walk. Medical history indicated that, for the month prior to the visit to the hospital, his seizures had not been well controlled. Which of the following drugs would be appropriate to improve his seizure and muscle spasm?
- A.
Buspirone
- B.
Lithium
- C.
Donepezil
- D.
Haloperidol
- E.
Fluoxetine
- F.
Diazepam
Correct Answer
F. DiazepamExplanation
Answer: F
All benzodiazepines have anticonvulsant and muscle relaxant activity. The latter is at least partly
related to the enhancement of GABA-induced inhibition of synaptic transmission in the spinal
cord, because they are effective in patients with cord transection. Since the condition of the
patient is a chronic one, a long-acting benzodiazepine is most appropriate.
A, B, C, D, E) All these drugs are devoid of muscle relaxant properties.Rate this question:
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- 13.
A 66-year-old man, who had been an heavy smoker for 30 years, was undergoing bronchoscopy for a suspected bronchogenic carcinoma. Before starting the intervention the anesthesiologist administered a drug in order to prevent the situational anxiety and to provide anterograde amnesia of the procedure. Which of the following drugs was most likely given?
- A.
Buspirone
- B.
Chlorpromazine
- C.
Zolpidem
- D.
Triazolam
- E.
Haloperidol
Correct Answer
D. TriazolamExplanation
Answer: D
In addition to the anxiolytic effect, benzodiazepines, given at high doses, can cause anterograde
amnesia, that is impairment of memory for events occurring after the administration of the drug.
This action is particularly useful when the patient has to undergo a disturbing diagnostic
procedure, like in the present case. Since the intervention is brief, a short acting benzodiazepine
like triazolam is most appropriate.
A) Buspirone is an anxiolytic drug, but the effect develops slowly (in 1-2 weeks) and anterograde
amnesia does not occur.
B, C, E) These drugs cause negligible anxiolytic effects and negligible anterograde amnesia.Rate this question:
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- 14.
A 34-year-old woman rushed to the emergency room complaining that, ‘out of the blue’, she had been seized by overwhelming symptoms. She felt light-headed, dizzy and feared of losing control or going crazy. She also felt nausea, a lump in her throat, shortness of breath and palpitations. The woman had never had similar symptoms in the past and denied past or present use of any illicit drugs or alcohol. A preliminary diagnosis was made and a drug was given IV to offset the patient’s symptoms. Which of the following drugs was most likely given?
- A.
Venlafaxine
- B.
Thiopental
- C.
Buspirone
- D.
Midazolam
- E.
Eszopiclone
Correct Answer
D. MidazolamExplanation
Answer: D
The symptoms of the patient indicate that she was most likely suffering of a panic attack.
Benzodiazepines are the most effective, safe and commonly prescribed drugs for the rapid relief
of the acute anxiety symptoms. Since a panic attack usually last no more than 30 minutes, a
short acting benzodiazepine, like midazolam is appropriate.
A) Selective serotonin-norepinephrine reuptake inhibitors are today drugs of first choice for
anxiety disorders, but they cannot be used when an acute relief is needed since their onset of
action is delayed.
B, C, E) These drug are not effective in case of panic attack.Rate this question:
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- 15.
Benzodiazepines have many different effects on the CNS. However they are devoid of which of the following effects?
- A.
Sedative
- B.
Hypnotic
- C.
Muscle relaxant
- D.
Antipsychotic
- E.
Anticonvulsant
Correct Answer
D. AntipsychoticExplanation
Answer: D
Psychotic disorders (which include schizophrenic disorders, manic disorders, acute idiopathic
psychotic illnesses , etc.) are characterized by major disturbances in reasoning, often with
marked agitation, delusions and hallucinations. Virtually all drugs effective in psychotic disorders
block dopamine receptors and reduce dopaminergic neurotransmission in the forebrain.
Benzodiazepines do not block dopamine receptors and are ineffective as antipsychotics.
A, B, C, E) All benzodiazepines have sedative, hypnotic, muscle relaxant and anticonvulsant
properties.Rate this question:
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- 16.
A 66-year-old man was brought to the hospital by his daughter who referred that he has been confused and lethargic during the last two days. Past history of the patient was significant for a transient ischemic attack three years ago, and for a long-lasting habit of drinking large quantities of grapefruit juice. Recently the patient became anxious and fearful of imminent death, and the physician prescribed alprazolam, two tablets daily. Which of the following phrases best explains the most likely cause of the patient’s symptoms?
- A.
Grapefruit juice induced inhibition of alprazolam metabolism
- B.
Increased brain sensitivity to alprazolam due to previous ischemic attack
- C.
Grapefruit juice induced decrease of alprazolam elimination by the kidney
- D.
Increased brain sensitivity to alprazolam due to old age
- E.
Grapefruit juice induced increase of alprazolam intestinal absorption
Correct Answer
A. Grapefruit juice induced inhibition of alprazolam metabolismExplanation
Answer: A
It has been shown that a constituent of grapefruit juice can inhibit the P450 3A, one of the
enzymes of the P450 system involved in the metabolism of several drugs including
benzodiazepines. The interaction is clinically important, and at least one case of death due to
drug-grapefruit juice interaction is reported in the literature.
B) The transient ischemic attack was too remote to suggest a relationship between brain
ischemia and increased sensitivity to benzodiazepines.
D) Old age can increase brain sensitivity to CNS depressants, but the well know action of
grapefruit juice on drug metabolism makes the interaction more likely.
C, E) Grapefruit juice does not have these effect.Rate this question:
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- 17.
A 25-year-old man was brought into the emergency room in an unconscious state by his roommate. The roommate stated that the man was very depressed during the last few days and that he had been drinking whisky all day. The roommate also said he found an empty, not labeled drug bottle next to him on the bed. Which of the following drug most likely caused the patient’s intoxication?
- A.
Ramelteon
- B.
Diazepam
- C.
Amphetamine
- D.
Amitriptyline
- E.
Lithium
- F.
Fluoxetine
Correct Answer
B. DiazepamExplanation
Answer: B
Poisoning by benzodiazepines is not usually life threatening but can be very serious when these
drug are combined with alcohol because the additive depressant effects on CNS.
A, C, D, E, F) These drugs either do not cause additive effects when given concomitantly with
alcohol.Rate this question:
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- 18.
A 61-year-old obese man complained of difficulty in falling asleep and asked his physician for a sleeping pill. The man had been recently diagnosed with obstructive sleep apnea, most likely due to obesity. Which of the following drugs would be contraindicated for this patient?
- A.
Temazepam
- B.
Acetazolamide
- C.
Imipramine
- D.
Medroxyprogesterone
- E.
Protriptyline
Correct Answer
A. TemazepamExplanation
Answer: A
Sleep apnea is a breathing disorder characterized by frequent and prolonged (>15 seconds)
pauses in breathing that occur during sleep. Typical symptoms of sleep apnea include alteration
in sleep pattern with loud snoring, excessive daytime sleepiness and severe shortness of breath
on exertion. In sleep apnea the sensitivity of the respiratory center to carbon dioxide is
decreased. Sedative-hypnotics drugs are generally contraindicated in this disorder since they
further decrease the sensitivity of respiratory center to hypercapnia.
B, C, D, E) All these drugs have been used in sleep apnea with modest results.Rate this question:
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- 19.
A 45-year-old man recently diagnosed with a panic disorder, had started a treatment which sertraline but the drug caused some sexual dysfunction and the physician decided to switch to alprazolam, two tablet daily. Which of the following molecular actions on neuron membranes most likely mediated the therapeutic effect of the drug in the patient’s disorder?
- A.
Decreased outward Na+ current
- B.
Increased inward Cl- current
- C.
Decreased outward K+ current
- D.
Increased inward Ca++ current
- E.
Increased inward H+ current
Correct Answer
B. Increased inward Cl- currentExplanation
Answer: B
Benzodiazepines bind to receptors located at the interface between alpha and gamma subunits
of the GABA-A receptor-chloride ion channel macromolecular complex. The binding increases
the affinity of the GABA-A receptor for GABA, which in turn causes an increased frequency of
chloride channel opening. Since extracellular chloride concentration is about 120 mM and
intracellular chloride concentration is about 20 mM, chloride channel opening will increase
inward Cl- current.
This in turn will increase the negative charges inside the cell so causing hyperpolarization of cell
membrane.
B, C, D, E) Benzodiazepines do not affect these currents. Moreover all these actions would
cause depolarization, not hyperpolarization of cell membrane.Rate this question:
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- 20.
A 42-year-old man, suffering from rectal bleeding, was admitted to the hospital for a colonoscopy. An IV injection of diazepam was given before the procedure to induce a conscious sedation. Which of the following symptoms did the patient most likely experience upon recovery from sedation?
- A.
Nausea and vomiting
- B.
Increased respiratory rate
- C.
Anterograde amnesia
- D.
Limb muscle spasms
- E.
Delusional thoughts
Correct Answer
C. Anterograde amnesiaExplanation
Answer: C
A classical effect of benzodiazepines (mainly when high doses are give) is the anterograde
amnesia, i.e. loss of memory for events occurring during the drug’s duration of action. The effect
is exploited therapeutically, since the patient cannot remember the unpleasant sensations felt
during endoscopic or surgical procedures.
A) Actually benzodiazepines have some, thought very mild, antiemetic properties
B, D) Benzodiazepines tend to cause effects opposite to those listed.
E) Delusion and hallucinations are exceedingly rare effects of benzodiazepines.Rate this question:
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Sep 19, 2023Quiz Edited by
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Sep 04, 2012Quiz Created by
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