Anxiolytic and Hypnotic Agents

Multiple Choice Questions.

1. Drugs that are used to alter a patient’s response to the environment are called
a. hypnotics.
b. sedatives.
c. antiepileptics.
d. anxiolytics.

The correct answer is d. anxiolytics. Anxiolytics are drugs that are used to reduce anxiety and alter a patient’s response to their environment. Hypnotics and sedatives are drugs that induce sleep or reduce agitation. Antiepileptics are drugs used to treat seizures.

2. The benzodiazepines are the most frequently used anxiolytic drugs because
a. they are anxiolytic at doses much lower than those needed for sedation or hypnosis.
b. they can also be stimulating.
c. they are more likely to cause physical dependence than older anxiolytic drugs.
d. they do not affect any neurotransmitters.

The correct answer is a. they are anxiolytic at doses much lower than those needed for sedation or hypnosis. Benzodiazepines are preferred as anxiolytic drugs because they are effective at much lower doses than those required for inducing sedation or hypnosis. They act by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, which results in a reduction of anxiety. While benzodiazepines can cause physical dependence with long-term use, they are not more likely to do so than older anxiolytic drugs. Some benzodiazepines can have stimulating effects, but this is not a reason why they are most frequently used as anxiolytic drugs.

3. Barbiturates cause liver enzyme induction, which could lead to
a. rapid metabolism and loss of effectiveness of other drugs metabolized by those enzymes.
b. increased bile production.
c. CNS depression.
d. the need to periodically lower the barbiturate dose to
avoid toxicity.

The correct answer is a. rapid metabolism and loss of effectiveness of other drugs metabolized by those enzymes. Barbiturates are known to cause liver enzyme induction, which can accelerate the metabolism of other drugs that are metabolized by those same enzymes. This can result in a loss of effectiveness of these other drugs and can even lead to drug interactions that can be harmful or life-threatening. Increased bile production (option b) is not a common effect of barbiturates, while CNS depression (option c) is a well-known effect of these drugs. The need to periodically lower the barbiturate dose to avoid toxicity (option d) is also a common concern when using these drugs, but it is not directly related to their liver enzyme-inducing properties.

4. A person who could benefit from an anxiolytic drug for short-term treatment of insomnia would not be prescribed
a. zolpidem.
b. chloral hydrate.
c. buspirone.
d. meprobamate.

The correct answer is c. buspirone. Buspirone is not typically used to treat insomnia, as it has a slower onset of action and is not as effective at inducing sleep as other drugs that are specifically indicated for insomnia. Zolpidem (option a) is a commonly used sleep aid that can also have anxiolytic effects. Chloral hydrate (option b) and meprobamate (option d) are older drugs that are sometimes used for short-term treatment of insomnia and anxiety, but they are not as commonly used as some of the newer drugs in these classes.

5. Anxiolytic drugs block the awareness of and reaction to the environment. This effect would not be beneficial
a. to relieve extreme fear.
b. to moderate anxiety related to unknown causes.
c. in treating a patient who must drive a vehicle for a living.
d. in treating a patient who is experiencing a stress
reaction.

The correct answer is c. in treating a patient who must drive a vehicle for a living. Anxiolytic drugs can produce a variety of effects on the patient’s awareness of and reaction to the environment, ranging from mild sedation to complete loss of consciousness. While these effects can be beneficial in some cases, such as in relieving extreme fear (option a) or moderating anxiety related to unknown causes (option b), they can be detrimental in situations where the patient’s ability to drive or operate machinery is critical. Therefore, treating a patient who must drive a vehicle for a living (option c) with an anxiolytic drug may not be appropriate. An anxiolytic drug may be beneficial in treating a patient who is experiencing a stress reaction (option d), but the decision to use such a drug would depend on the specific circumstances and the patient’s overall health status.

6. Mr. Jones is the chief executive officer of a large company and has been experiencing acute anxiety attacks. His physical examination was normal, and he was diagnosed with anxiety. Considering his occupation and his need to be alert and present to large groups on a regular basis, the following anxiolytic would be a drug of choice for Mr. Jones:
a. phenobarbital
b. diazepam
c. clorazepate
d. buspirone

The correct answer is d. buspirone. Given Mr. Jones’ occupation and need to be alert and present to large groups on a regular basis, an anxiolytic drug with minimal sedative effects would be the drug of choice. While all of the drugs listed can be used as anxiolytics, phenobarbital (option a) and diazepam (option b) are known to have sedative effects and can impair alertness and cognition, making them less than ideal choices for Mr. Jones. Clorazepate (option c) is less sedating than phenobarbital and diazepam, but it can still cause drowsiness and impair cognitive function. Buspirone (option d) is a non-benzodiazepine anxiolytic drug that does not have sedative effects and is well-suited for individuals who need to remain alert and attentive.

7. The benzodiazepines react with
a. GABA-receptor sites in the RAS to cause inhibition of neural arousal.
b. norepinephrine-receptor sites in the sympathetic nervous system.
c. acetylcholine-receptor sites in the parasympathetic nervous system.
d. monoamine oxidase to increase norepinephrine breakdown.

The correct answer is a. GABA-receptor sites in the RAS to cause inhibition of neural arousal. Benzodiazepines are a class of drugs that act as positive allosteric modulators of the GABA-A receptor, which is an inhibitory receptor in the central nervous system. When benzodiazepines bind to the GABA-A receptor, they enhance the effect of GABA and increase the inhibitory tone of the central nervous system, leading to sedative, anxiolytic, and anticonvulsant effects. The RAS (reticular activating system) is a group of nuclei in the brainstem that play a key role in regulating arousal and wakefulness, and the inhibition of neural arousal in this system is one of the mechanisms by which benzodiazepines produce their effects. Benzodiazepines do not react with norepinephrine-receptor sites in the sympathetic nervous system (option b), acetylcholine-receptor sites in the parasympathetic nervous system (option c), or monoamine oxidase (option d).

8. A pediatric patient is prescribed phenobarbital preoperatively to relieve anxiety and produce sedation. After giving the injection, you should assess the patient for
a. acute Stevens–Johnson syndrome.
b. bone marrow depression.
c. paradoxical excitement.
d. withdrawal syndrome.

The correct answer is c. paradoxical excitement. Phenobarbital is a barbiturate that can produce sedative effects by enhancing the activity of GABA, an inhibitory neurotransmitter in the central nervous system. However, in some patients, especially pediatric patients, barbiturates can produce paradoxical excitement instead of sedation, which is characterized by restlessness, agitation, and hyperactivity. Therefore, after giving phenobarbital to a pediatric patient preoperatively, it is important to assess the patient for paradoxical excitement, as this may require additional sedation or alternative anxiolytic medications to achieve the desired effect. Acute Stevens-Johnson syndrome (option a) and bone marrow depression (option b) are not expected adverse effects of phenobarbital at therapeutic doses, and withdrawal syndrome (option d) is a potential adverse effect of prolonged use of phenobarbital or other barbiturates, but it is not a concern in a single preoperative dose.