Transcript Pharmacology Tutoring for Sedative Hypnotics and Antiemetics

Sedative
Hypnotics
Tutoring
By Alaina Darby
– Which of the following is not a sedative property?
a.
b.
c.
d.
Decrease activity
Moderate excitement
Produce drowsiness
Calms recipient
– During which of the following sleep stages does one experience
light sleep?
a.
b.
c.
d.
Stage 1
Stage 2
Stage 3
Stage 4
– Which of the following is true of sleep cycles and their stages?
a.
b.
c.
d.
The physiological state in REM sleep is indicative of wakefulness
The first cycle can last from 5-15 minutes
Cycles decrease in length throughout the night
A normal night’s sleep usually includes 6 cycles
– Which of the following correctly outlines the pattern of a normal
sleep cycle?
a.
b.
c.
d.
Waking, stage 1, 2, 3, 4, 3, 2, 1, REM
Waking, stage 1, 2, 3, 4, 3, 2, REM
Waking, stage 1, 2, 3, 4, REM
Waking, stage 4, 3, 2, 1, REM
– Which of the following describes the manner in which the
progressive effects of CNS depressants from drowsiness to fatal
depression are produced?
a.
b.
c.
d.
Concentration dependent
Metabolization dependent
Response dependent
Dose dependent
– Which of the following is not a CNS effect of benzodiazepines?
a.
b.
c.
d.
Sedation
Muscle relaxation
Neuromuscular blocker
Anterograde amnesia
– Which of the following does not describe how benzodiazepines
exert their effects?
a. They are specific for certain GABA channel subunits
b. They increase frequency of channel opening
c. They decrease time spent in all stages but increase the number of
stages
d. They increase total sleep time
– Respiration becomes a concern of benzodiazepines particularly in
all but which of the following?
a.
b.
c.
d.
Impaired renal function
Children
Ethanol users
Impaired hepatic function
– Which accurately describes the metabolization of
benzodiazepines?
a. Mainly occurs through cytochrome P450 in the kidneys
b. Glucuronidation produces active metabolites
c. It includes a three stage process with each stage being
progressively slower
d. Triazolam and alprazolam do not undergo hydroxylation at R3
– Which of the following causes a drug interaction with a
mechanism other than the inhibition of CYP3A4?
a.
b.
c.
d.
Erythromycin
Ketoconazole
Oral contraceptives
Ritonavir
– Which of the following is the closest to an ideal hypnotic?
a.
b.
c.
d.
Triazolam
Alprazolam
Midazolam
Estazolam
– Which of the following is a paradoxical side effect of
benzodiazepines?
a.
b.
c.
d.
Lassitude
Paranoia and depression
Motor incoordination
Anterograde amnesia
– Which of the following is true of benzodiazepines?
a. Short-acting benzodiazepines are rapidly metabolized and more
likely to cause rebound insomnia
b. Short-acting benzodiazepines are slowly metabolized and more
likely to cause rebound insomnia
c. Long-acting benzodiazepines are rapidly metabolized and more
likely to cause rebound insomnia
d. Long-acting benzodiazepines are slowly metabolized and more
likely to cause rebound insomnia
– Estrazolam is classified into which of the following categories?
a.
b.
c.
d.
Ultra-short acting
Short-acting
Intermediate-acting
Long-acting
– A benzodiazepine has a half-life of 12 hours. Into which of the
following categories would it be classified?
a.
b.
c.
d.
Ultra-short acting
Short-acting
Intermediate-acting
Long-acting
– How do benzodiazepine agonists bind?
a. Nonspecifically on the GABA receptor
b. Specifically to the alpha and beta subunits on the GABA receptor
c. Specifically to different subunits on the GABA receptor depending
on the drug
d. Specifically to the alpha1 subunit on the GABA receptor
– Which of the following is true of benzodiazepine agonists?
a.
b.
c.
d.
The dose of zaleplon should be half of what it is in men
Risk of next day driving is a concern when taking eszopiclone
All benzodiazepine agonists should only be taken for 7-10 days
Zolpidem is the most likely of these drugs to produce hangover at
therapeutic doses
– Which of the following is not a concern for benzodiazepine
agonists?
a.
b.
c.
d.
Use in psychotic patients
Effects from withdrawal
Thoughts of suicide
Use in pregnancy and nursing
– Which of the following is classified as a benzodiazepine antagonist
and can be used to reverse sedative effects after a diagnostic
procedure?
a.
b.
c.
d.
Chlordiazepoxide
Flumazenil
Ramelteon
Meprobomate
– Which of the following is not a sleep stage effect of barbiturates?
a.
b.
c.
d.
Increased total sleep time
Decreased sleep latency
Increased REM and stage 3-4 sleep
Decreased number of awakenings
– How do barbiturates produce their action?
a. Increase duration of GABA channel opening and antagonize AMPA
receptors
b. Increase frequency of GABA channel opening and antagonize
AMPA receptors
c. Increase duration of GABA channel opening and agonize AMPA
receptors
d. Increase frequency of GABA channel opening and agonize AMPA
receptors
– Which of the following is true of the effects that barbiturates
produce throughout the body?
a. Respiration may be severely depressed at hypnotic doses
b. Blood pressure is slightly increased
c. Combination with cytochrome P450 enzymes may inhibit steroid
metabolism
d. The induction of liver enzymes decreases the metabolism of other
drugs
– Which of the following is not true of the use of barbiturates for
hypnotic purposes?
a. They are often administered by IV
b. Their onset of action may range from 10-60 minutes
c. The onset of action is delayed by the presence of food
d. They distribute to highly-perfused tissues first
– Which of the following is not a side effect of barbiturates?
a.
b.
c.
d.
Hangover
Paradoxical excitement
Increased pain perception
Nausea and vomiting
– Which of the following is the primary contraindication for
barbiturates?
a.
b.
c.
d.
Pregnancy
Elderly
Porphyria
Liver failure
– Which of the following is not true of ramelteon?
a.
b.
c.
d.
It is approved for long term use
It may cause rebound insomnia
It is a melatonin receptor agonist
It may cause missed menstrual period or disinterest in sex
– Which of the following would be limited to the hospital setting?
a.
b.
c.
d.
Paraldehyde
Chloral hydrate
Etomidate
Meprobamate
– What would not be a characteristic of a perfect hypnotic?
a. Increased duration of sleep
b. Absence of rebound insomnia
c. Lack of drug interactions
d. Minimal next day effects
– Sally is dealing with the death of her father, and has had trouble sleeping
for the last week. How would her insomnia be classified and what would be
the method of treating it?
a. Transient insomnia treated with a low dose of hypnotic for 2-3 days
b. Short-term insomnia treated with a low dose of hypnotic for 2-3 days
c. Long-term insomnia treated with an adjunct hypnotic intermittently for
7-10 days
d. Short-term insomnia treated with an adjunct hypnotic intermittently for
7-10 days
– How should insomnia lasting longer than 3 weeks be treated?
a.
b.
c.
d.
Benzodiazepine
Barbiturate
Nonpharmacological
Benzodiazepine agonist
– What would not typically be a consideration in the treatment of
insomnia in older patients?
a.
b.
c.
d.
Increased body water
Decreased renal function
Polyphasic sleep patterns
Increased body fat
– Which of the following is true of the mechanisms of barbiturates and
benzodiazepines in terms of GABA channel opening?
a. Barbiturates increase frequency while benzodiazepines increase
duration of channel opening
b. Barbiturates increase duration while benzodiazepines increase
frequency of channel opening
c. Barbiturates and benzodiazepines both increase frequency of channel
opening
d. Barbiturates and benzodiazepines both increase duration of channel
opening
– Which of the following is true of barbiturates and benzodiazepines
in terms of mechanism?
a.
b.
c.
d.
Barbiturates require GABA and benzodiazepines do not
Benzodiazepines require GABA and barbiturates do not
Barbiturates and benzodiazepines both require GABA
Neither barbiturates nor benzodiazepines require GABA
– How should benzodiazepines be prescribed?
a.
b.
c.
d.
Long acting for sleep onset insomnia and short acting for anxiety
Short acting for sleep onset insomnia and long acting for anxiety
Long acting for sleep onset insomnia and for anxiety
Short acting for sleep onset insomnia and for anxiety