Deck 12: Sedative-Hypnotic Drugs and Alcohol

Question 1

Select the therapy of choice for patients suffering from insomnia that is complicated with anxiety or stressful situations.

A) Benzodiazepines
B) Barbiturates
C) Amphetamines
D) None of the above

Answer 1

Benzodiazepines

Question 2

A comparison of sedatives with hypnotics reveals that:

A) sedatives produce mental relaxation, while hypnotics induce and maintain sleep.
B) sedatives induce and maintain sleep, while hypnotics produce mental relaxation.
C) sedatives work like hypnotics to increase mental alertness.
D) none of these are correct.

Answer 2

sedatives produce mental relaxation, while hypnotics induce and maintain sleep.

Question 3

Identify the clinical use of a sedative.

A) Production of hypnosis
B) Increase of CNS activity
C) Reduction of the desire for physical activity
D) Induction and maintenance of sleep

Answer 3

Reduction of the desire for physical activity

Question 4

Select the group that contains hypnotic drugs listed in order of increasing duration of action.

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

Question 5

Identify the clinical indication for the use of benzodiazepines.

A) Reduction of anxiety
B) Increase in mental alertness
C) Increase in desire for physical activity
D) Decrease in drowsiness

Question 6

Select the stage of the sleep cycle that corresponds with the ability to dream.

A) NREM stage 1
B) REM
C) NREM stage 2
D) None of the above

Question 7

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 8

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

A) Flurazepam is a long-acting hypnotic that forms several active metabolites, while temazepam is an intermediate-acting hypnotic that does not form any important active metabolites.
B) Flurazepam is a short-acting hypnotic that forms several active metabolites, while temazepam is a long-acting hypnotic that does not form active metabolites.
C) Flurazepam is an intermediate-acting hypnotic that does not form active metabolites, while temazepam is a short-acting hypnotic that forms several active metabolites.
D) Both flurazepam and temazepam form important active metabolites, but they differ in their duration of action.

Question 9

Explain the key difference between barbiturates and nonbarbiturates.

A) Unlike barbiturates, 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) Unlike nonbarbiturates, barbiturates are CNS depressants that contain the barbituric acid ring structure in their chemical makeup.
D) None of the above are correct.

Question 10

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 the above

Question 11

Identify the possible cause of nausea, vomiting, and headache that an alcoholic patient is experiencing while taking disulfiram.

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

Question 12

Ramelteon (Rozerem)is classified as a _____.

A) controlled substance
B) melatonin antagonist
C) melatonin agonist
D) barbiturate

Question 13

Use your critical-thinking skills to determine a 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 14

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 the above are correct.

Question 15

Explain the relationship between gamma-aminobutyric acid and sedative-hypnotic drugs.

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

Question 16

A patient informs you that she has been taking more phenobarbital than the doctor prescribed because the amount that he prescribed was not helping her sleep.She also says that when she does not take the drug,she becomes very anxious,has tremors,and feels like she is being watched.Using your knowledge of sedative-hypnotic drugs,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 a 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 the above are correct.

Question 17

Which of the following is a common adverse effect that an elderly patient may experience while taking zolpidem (Ambien)?

A) Confusion and memory disturbances
B) Convulsions
C) Slurred speech and drowsiness
D) None of the above

Question 18

Which of the following best explains automatism?

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 the above

Question 19

Explain the effects of barbiturates on the sleep cycle when used as hypnotics.

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.

Question 20

Identify the FDA pregnancy category of barbiturates.

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

Question 21

Kendall is on a week's course of a medication for a sleep disorder.After completing the course,she immediately discontinues its use.For the next few days,Kendall keeps having nightmares and is unable to sleep.She also feels very restless and anxious.Identify the medication that Kendall was most probably taking.

A) Temazepam
B) Phenobarbital
C) Eszopiclone
D) Zaleplon

Question 22

In which of the following patients is the use of barbiturates contraindicated?

A) Raphael, a 30-year-old man, who has acute intermittent porphyria
B) Fatima, a 26-year-old woman, who has insomnia
C) Roger, a 34-year-old man, who had a minor surgery a week ago
D) Wendy, a 40-year-old woman, who is hypoglycemic

Question 23

In large doses,barbiturates lead to cardiovascular and central nervous system depression.Select the reason for the occurrence of this depression.

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, decrease in kidney function, irregular breathing, and hypoxia.
D) None of the above are correct.

Question 24

Which of the following products is indicated for patients who have difficulty falling asleep but not staying asleep?

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

Question 25

Select the drug class that has a decreased pharmacological effect as a result of the concurrent use of barbiturates.

A) Oral anticoagulants
B) Proton pump inhibitors
C) Multivitamins
D) None of the above

Question 26

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 a 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 the above are correct.

Question 27

Stella,a 60-year-old woman who has trouble sleeping,is prescribed secobarbital once a day for two weeks.The medication achieves its desired effect and Stella sleeps well during the first three days of medication.On the fourth day,Stella consumes her daily dosage twice because she does not remember consuming it the first time.On the fifth day,Stella consumes more than thrice the daily recommended dosage for the same reason.This phenomenon of consuming more than the required dosage of a medication is termed _____.

A) astigmatism
B) drug tolerance
C) drug addiction
D) automatism

Question 28

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 the above are correct.

Question 29

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 the above are correct.

Question 30

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 has difficulty in 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 the above

Question 31

Select the adverse effect associated with the use of barbiturates.

A) Drowsiness
B) Lethargy
C) Lack of coordination
D) All of the above

Question 32

Steve has a sleep disorder and is prescribed pentobarbital for two weeks.After the first week,Steve notices that the medication has a diluted effect,and he is unable to feel the same hypnotic effects of the drug as he did during the first week.This effect is termed _____.

A) drug addiction
B) REM rebound
C) drug tolerance
D) automatism

Question 33

Maria,a 30-year-old woman,visits Dr.Knowles with complaints of fatigue and sleeplessness.Dr.Knowles prescribes a drug to Maria to help her sleep better,which would also help reduce the fatigue.After discontinuation of the drug,Maria is unable to sleep properly at night because of nightmares and anxiety.Identify the most probable cause for this effect.

A) REM rebound
B) GABA_A inhibition
C) GABA_A receptor-mediated sodium influx
D) Automatism

Question 34

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

A) Greater therapeutic dosages taken on a regular basis for less than 2 weeks
B) Greater therapeutic dosages taken on a regular basis for more than 2 years
C) Greater therapeutic dosages taken on a regular basis for more than 1 to 2 months
D) None of the above

Question 35

Among the following,select the drug product that is a short-acting hypnotic and does not produce active metabolites.

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