Deck 12: Sedative-Hypnotic Drugs and Alcohol

Question 1

Use the stages of the sleep cycle to select the stage that corresponds with the ability to dream.

A) NREM stage 1
B) REM
C) NREM stage 2
D) None of these are correct.

Answer 1

REM

Question 2

Differentiate between the recommended therapies for insomnia and sedation,and select the therapy of choice for patients suffering from insomnia that is complicated with anxiety or stressful situations.

A) Benzodiazepines
B) Barbiturates
C) Miscellaneous hypnotic drugs
D) None of these are correct.

Answer 2

Benzodiazepines

Question 3

Explain the effects of the barbiturates on the sleep cycle.

A) Barbiturates decrease stage 2 sleep, increase stages 3 and 4 sleep, and suppress REM sleep.
B) Barbiturates decrease stage 2 sleep, decrease stages 3 and 4 sleep, and suppress REM sleep.
C) Barbiturates increase stage 2 sleep, decrease stages 3 and 4 sleep, and suppress REM sleep.
D) Barbiturates increase stage 2 sleep, increase stages 3 and 4 sleep, and suppress REM sleep.

Answer 3

Barbiturates increase stage 2 sleep, decrease stages 3 and 4 sleep, and suppress REM sleep.

Question 4

Explain the main characteristic of the NREM stage of the sleep cycle.

A) In NREM sleep stage 1, individuals are relaxed and aware of their surroundings, but their eyes are closed.
B) In NREM sleep stages 3 and 4, individuals are in a deeper stage of sleep that is particularly important for physical rest and restoration.
C) In NREM sleep stage 2, individuals are unaware of their surroundings but can be awakened easily.
D) All of these are correct.

Question 5

Using the Physicians' Desk Reference,you determine that a common adverse effect that an elderly patient may experience while taking zolpidem (Ambien) is:

A) Confusion and memory disturbances
B) Convulsions
C) Slurred speech
D) None of these are correct.

Question 6

Identify the main characteristic of the REM stage of the sleep cycle.

A) Periods of rapid eye movement.
B) Dreaming
C) Increased autonomic system activity
D) All of these are correct.

Question 7

Using the Drug Facts and Comparisons manual,you determine that ramelteon (Rozerem) is classified as a:

A) Controlled substance
B) Melatonin antagonist
C) Melatonin agonist
D) None of these are correct.

Question 8

Eszopiclone (Lunesta) is a hypnotic agent with a rapid onset of action,intermediate duration of action,and a half-life of 6 hours.Using half-life,at approximately what time would a dose administered to a patient at 8 a.m.be reduced to 50 percent?

A) 4 p.m.
B) 12 p.m.
C) 2 p.m.
D) 6 p.m.

Question 9

A patient informs you that she has been taking more phenobarbital than the doctor prescribed because she cannot sleep with the amount he prescribed.She also states that now if she doesn't take the drug,she becomes very anxious,starts to have tremors,and begins to have unusual thoughts that she is being watched.Using your knowledge of the sedative-hypnotic drugs,how would you explain to this patient that she has developed a physical dependency on phenobarbital?

A) The anxiety, tremors, and paranoid behavior are signs of withdrawal, which occurs when the patient has taken larger than therapeutic dosages for more than 1 to 2 months.
B) The anxiety, tremors, and paranoid behavior are normal with the use of phenobarbital.
C) The anxiety, tremors, and paranoid behavior are completely unrelated to the use of phenobarbital.
D) None of these are correct.

Question 10

Identify the clinical indication for the use of a sedative.

A) Mental relaxation and sleep disorders
B) Reduction of anxiety and sleep disorders
C) Mental relaxation and reduction in desire for physical activity
D) Reduction of anxiety and desire for physical activity

Question 11

The statement that best explains automatism is:

A) Drug-induced hangover effect resulting from benzodiazepine use
B) Drug-induced heightened tolerance resulting from benzodiazepine use
C) Drug-induced confusion that can lead to barbiturate drug overdose
D) None of these are correct.

Question 12

Use critical thinking to determine the cause of the nausea, vomiting, and headache that an alcoholic patient is experiencing while taking disulfiram.

A) Acetaldehyde is accumulating in the blood, causing this reaction to occur.
B) The patient may be drinking alcoholic beverages again while taking disulfiram.
C) The patient may be using OTC products that contain alcohol while taking disulfiram.
D) All of these are correct.

Question 13

Explain the key difference between drugs classified as barbiturates and drugs classified as nonbarbiturates.

A) Nonbarbiturates are CNS depressants that contain the barbituric acid ring structure in their chemical makeup.
B) Barbiturates decrease the activity of GABA, and nonbarbiturates increase the activity of GABA.
C) Barbiturates are CNS depressants that contain the barbituric acid ring structure in their chemical makeup.
D) None of these are correct.

Question 14

Using duration of action as a guide,select the group of hypnotic drugs that are listed in order from lowest to greatest duration of action.

A) Zaleplon, estazolam, flurazepam
B) Zolpidem, flurazepam, temazepam
C) Temazepam, zolpidem, flurazepam
D) Zolpidem, temazepam, zaleplon

Question 15

When comparing the sedative and hypnotic drug classes,you determine that:

A) Sedatives produce mental relaxation and hypnotics induce and maintain sleep.
B) Sedatives induce and maintain sleep and hypnotics produce mental relaxation.
C) Sedatives work like hypnotics producing mental relaxation.
D) None of these are correct.

Question 16

Differentiate between the FDA pregnancy categories,and determine the proper category for the barbiturates.

A) Pregnancy Category B
B) Pregnancy Category C
C) Pregnancy Category D
D) Pregnancy Category X

Question 17

Identify the clinical indication for the use of benzodiazepines.

A) Mental relaxation and sleep disorders
B) Reduction of anxiety and sleep disorders
C) Mental relaxation and reduction in desire for physical activity
D) Reduction of anxiety and desire for physical activity

Question 18

Explain the relationship between GABA and the sedative-hypnotic drug agents.

A) Sedative-hypnotic agents increase the GABA receptor-mediated chloride influx into nerves, inhibiting neuronal activity.
B) Sedative-hypnotic agents decrease the GABA receptor-mediated chloride influx into nerves, enhancing neuronal activity.
C) Sedative-hypnotic agents increase the GABA receptor-mediated sodium influx into nerves, inhibiting neuronal activity.
D) Sedative-hypnotic agents decrease the GABA receptor-mediated potassium influx into nerves, inhibiting neuronal activity.

Question 19

Use critical thinking to determine the pharmacokinetic effect of barbiturates as a result of enzyme induction.

A) Enzyme induction leads to slower metabolism of the barbiturate in the liver and increased duration of action.
B) Enzyme induction leads to faster metabolism of the barbiturate in the liver and decreased duration of action.
C) Enzyme induction leads to slower metabolism of the barbiturate in the liver and decreased duration of action.
D) None of these are correct.

Question 20

Use critical thinking to determine the major difference between flurazepam and temazepam.

A) Flurazepam is a long-acting hypnotic that forms several active metabolites, and temazepam is an intermediate-acting hypnotic that does not form active metabolites.
B) Flurazepam is a short-acting hypnotic that forms several active metabolites, and temazepam is a long-acting hypnotic that does not form active metabolites.
C) Flurazepam is an intermediate-acting hypnotic that forms several active metabolites, and temazepam is a short-acting hypnotic that does not form active metabolites.
D) Both flurazepam and temazepam are intermediate-acting hypnotics that form active metabolites.

Question 21

Select the adverse effects associated with the use of the barbiturate class of drugs.

A) Drowsiness and dry mouth
B) Lethargy
C) Lack of coordination
D) All of these are correct.

Question 22

Differentiate between triazolam (Halcion),temazepam (Restoril),flurazepam (Dalmane),and estazolam (ProSom),and select the drug product that is a short-acting hypnotic and does not produce active metabolites.

A) Temazepam
B) Triazolam
C) Flurazepam
D) Estazolam

Question 23

Flurazepam (Dalmane) is classified as a long-acting benzodiazepine.The antianxiety effects of flurazepam are usually evident the day after taking the flurazepam dose.Select the precaution that you will emphasize to the patient when you give him the prescription the doctor has written.

A) Avoid hazardous activities.
B) Do not take other antianxiety agents at the same time.
C) Do not drink alcohol while taking flurazepam.
D) All of these are correct.

Question 24

In large doses,barbiturates lead to cardiovascular and central nervous system depression.Use critical thinking to select the reason this depression occurs.

A) Reduced activity in the medulla oblongata increases sympathetic control of the blood vessels, leading to hypertension, kidney failure, and irregular breathing.
B) Increased activity in the medulla oblongata decreases sympathetic control of the blood vessels, leading to hypotension, kidney failure, and irregular breathing.
C) Reduced activity in the medulla oblongata removes sympathetic control of the blood vessels, leading to hypotension, kidney failure, irregular breathing, and hypoxia.
D) None of these are correct.

Question 25

Select the correct indication of use for zaleplon (Sonata).

A) Zaleplon is used in individuals who have difficulty falling asleep, but it does not increase total sleep time.
B) Zaleplon is used in individuals who have difficulty falling asleep and need to stay asleep longer.
C) Zaleplon decreases awakenings during the night and increases total sleep time.
D) None of these are correct.

Question 26

An elderly patient requests that the physician prescribe her chloral hydrate in place of zaleplon or zolpidem.You research the drug and find that chloral hydrate is an old drug related to alcohol that is still being used today,primarily in the elderly.The usual dosage range is 500-1000 mg.The patient states that she is having difficulty swallowing tablets because they stick to her tongue.Select the dosage form of chloral hydrate that is commercially available and could be prescribed for this patient.

A) Rectal suppositories
B) Syrup
C) Capsules
D) All of these are correct.

Question 27

Select the contributing factor that leads to physical dependency while taking barbiturates.

A) Greater therapeutic dosages taken on a regular basis for more than 1 year
B) Greater therapeutic dosages taken on a regular basis for more than 6 months.
C) Greater therapeutic dosages taken on a regular basis for more than 1 to 2 months
D) None of these are correct.

Question 28

Differentiate between secobarbital,amobarbital,pentobarbital,and phenobarbital,and select the product indicated for patients who have difficulty falling asleep but not staying asleep.

A) Secobarbital
B) Amobarbital
C) Pentobarbital
D) Phenobarbital

Question 29

Select the primary mechanism of action of disulfiram (Antabuse).

A)Disulfiram slows the conversion of acetaldehyde to acetyl coenzyme A.
B)Disulfiram speeds the conversion of acetaldehyde to acetyl coenzyme A.
C)Disulfiram increases the rate of metabolism of alcohol.
D)None of these are correct.

Question 30

Barbiturates affect the rate of metabolism of certain drugs.Select the drug class that has a decreased pharmacological effect as a result of concurrent use of barbiturates.

A) Oral anticoagulants
B) Proton pump inhibitors
C) Multivitamins
D) None of these are correct.