Exam 2 Stoetling's Book Benzos questions

Question 1

What are the five principal pharmacologic effects of benzodiazepines?
a. Antihistamine, anticonvulsant, anterograde amnesia, anxiolysis, and sedation
b. Anterograde amnesia, sedation, anticonvulsant actions, spinal cord–mediated skeletal muscle relaxation, and anxiolysis
c. Sedation, anticonvulsant actions, antihistamine, anxiolysis, and retrograde amnesia
d. Anterograde amnesia, skeletal muscle relaxation, antihistamine, anticonvulsant actions, and anxiolysis

Answer 1

Answer: b. Anterograde amnesia, sedation, anticonvulsant actions, spinal cord–mediated skeletal muscle relaxation, and anxiolysis.

Question 2

Which of the following is true about benzodiazepines and skeletal muscle relaxation?
a. Benzodiazepines produce adequate skeletal muscle relaxation for surgical procedures
b. Benzodiazepines do not produce adequate skeletal muscle relaxation for surgical procedures
c. Benzodiazepines only produce skeletal muscle relaxation for minor surgical procedures
d. Benzodiazepines increase the need for neuromuscular blocking drugs during surgical procedures

Answer 2

Answer: b. Benzodiazepines do not produce adequate skeletal muscle relaxation for surgical procedures.

Question 3

Why are benzodiazepines widely used in clinical practice?
a. Because they have no side effects
b. Because they produce adequate skeletal muscle relaxation for surgical procedures
c. Because of their efficacy for anxiety and insomnia
d. Because they are more effective than opioids

Answer 3

Answer: c. Because of their efficacy for anxiety and insomnia.

Question 4

How do benzodiazepines produce their pharmacologic effects?
a. By activating the GABAA receptors
b. By increasing the number of GABAA receptors in the brain
c. By enhancing the affinity of GABAA receptors for GABA
d. By inhibiting the production of GABA

Answer 4

Answer: c. By enhancing the affinity of GABAA receptors for GABA.

Question 5

What is the role of the γ subunit in benzodiazepine binding to the GABAA receptor?
a. It is required for benzodiazepine binding
b. It inhibits benzodiazepine binding
c. It increases the potency of benzodiazepines
d. It is not involved in benzodiazepine binding

Answer 5

Answer: a. It is required for benzodiazepine binding.

Question 6

How do benzodiazepines produce their pharmacologic effects?
a) By activating the GABAA receptors
b) By enhancing the affinity of the receptors for GABA
c) By producing more frequent channel openings without affecting the receptors
d) By inhibiting the GABAA receptors

Answer 6

Answer: b) By enhancing the affinity of the receptors for GABA

Question 7

Which subunits of the GABAA receptor are required for benzodiazepine binding?
a) Alpha and beta
b) Alpha and gamma
c) Beta and gamma
d) Gamma and delta

Answer 7

Answer: b) Alpha and gamma

Question 8

Which subunit-containing GABAA receptors are important for sedation?
a) Alpha 1 and alpha 5
b) Alpha 2 and alpha 5
c) Alpha 3 and alpha 5
d) Alpha 4 and alpha 5

Answer 8

Answer: a) Alpha 1 and alpha 5

Question 9

What is the basis for pharmacologic synergy between benzodiazepines, barbiturates, and alcohol?
a) They all activate the GABAA receptors
b) They all enhance the affinity of the receptors for GABA
c) They all act on physically separate binding sites of the GABAA receptor
d) They all inhibit the uptake, distribution, metabolism, and elimination of GABA

Answer 9

Answer: c) They all act on physically separate binding sites of the GABAA receptor

Question 10

What is the reason for the low toxicity and clinical safety of benzodiazepines?
a) They have a built-in ceiling effect that prevents them from exceeding the physiologic maximum of GABA inhibition
b) They have a high binding affinity to plasma proteins
c) They are poorly absorbed from the gastrointestinal tract
d) They have a low lipid solubility and cannot cross the blood-brain barrier

Answer 10

Answer: a) They have a built-in ceiling effect that prevents them from exceeding the physiologic maximum of GABA inhibition

Question 11

What is the most common side effect in patients treated with benzodiazepines?
A. Decreased motor coordination
B. Anterograde amnesia
C. Fatigue and drowsiness
D. Impairment of cognitive function

Answer 11

Answer: C

Question 12

How long does sedation usually last in patients chronically treated with benzodiazepines?
A. 1 week
B. 2 weeks
C. 3 weeks
D. 4 weeks

Answer 12

Answer: B

Question 13

What should patients be instructed to do when ingesting benzodiazepines?
A. Take them after meals
B. Take them with antacids
C. Take them before meals
D. Take them during meals

Answer 13

Answer: C

Question 14

What is the effect of chronic administration of benzodiazepines on systemic blood pressure, heart rate, and cardiac rhythm?
A. Adversely affects them
B. Improves them
C. No effect
D. Not mentioned in the text

Answer 14

Answer: C

Question 15

Why should benzodiazepines be avoided in patients with chronic lung disease characterized by hypoventilation and/or decreased arterial oxygenation?
A. They may decrease absorption from the gastrointestinal tract
B. They may interact with other medications to have adverse effects
C. They adversely affect systemic blood pressure, heart rate, or cardiac rhythm
D. Effects on ventilation may be absent

Answer 15

Answer: D

Question 16

What may occur when benzodiazepines are used in combination with other CNS depressant drugs?
A. Anterograde amnesia
B. Decreased motor coordination
C. Impairment of cognitive function
D. All of the above

Answer 16

Answer: D

Question 17

What is a potential side effect of acute administration of benzodiazepines, especially when combined with alcohol?
A. Hypertension
B. Bradycardia
C. Anterograde amnesia
D. None of the above

Answer 17

Answer: C

Question 18

Which of the following substances do benzodiazepines have synergistic sedative effects with?
A) Caffeine
B) Nicotine
C) Alcohol
D) All of the above

Answer 18

Answer: C) Alcohol

Question 19

What effect do benzodiazepines have on anesthetic requirements?
A) They increase anesthetic requirements.
B) They decrease anesthetic requirements.
C) They have no effect on anesthetic requirements.
D) They make anesthetics ineffective.

Answer 19

Answer: B) They decrease anesthetic requirements.

Question 20

What is the effect of benzodiazepines on the analgesic actions of opioids?
A) They enhance the analgesic actions of opioids.
B) They reduce the analgesic actions of opioids.
C) They have no effect on the analgesic actions of opioids.
D) They cause opioids to become toxic.

Answer 20

Answer: B) They reduce the analgesic actions of opioids.

Question 21

Which benzodiazepines may be preferentially selected in elderly patients?
A) Diazepam
B) Alprazolam
C) Lorazepam, oxazepam, and temazepam
D) All benzodiazepines are equally suitable for elderly patients.

Answer 21

Answer: C) Lorazepam, oxazepam, and temazepam

Question 22

What is the effect of long-term benzodiazepine administration on elderly patients?
A) It has no effect on cognitive decline.
B) It slows cognitive decline.
C) It accelerates cognitive decline.
D) It reverses cognitive decline.

Answer 22

Answer: C) It accelerates cognitive decline.

Question 23

Which symptom is associated with benzodiazepine withdrawal in the elderly?
A) Confusion
B) Euphoria
C) Excitement
D) None of the above

Answer 23

Answer: A) Confusion

Question 24

Do benzodiazepines affect the risk of hemorrhagic complications in patients with severe, chemotherapy-induced thrombocytopenia?
A) Yes, they increase the risk of hemorrhagic complications.
B) Yes, they decrease the risk of hemorrhagic complications.
C) No, they have no effect on the risk of hemorrhagic complications.
D) It is unclear if they affect the risk of hemorrhagic complications.

Answer 24

Answer: D) It is unclear if they affect the risk of hemorrhagic complications.

Question 25

What is midazolam? a) An opioid b) A water-soluble benzodiazepine c) A muscle relaxant d) A local anesthetic

Answer 25

Answer: b) A water-soluble benzodiazepine

Question 26

Why has midazolam replaced diazepam for use in preoperative medication and conscious sedation? a) It is cheaper b) It is more potent c) It has fewer side effects d) It is easier to administer

Answer 26

Answer: c) It has fewer side effects

Question 27

What is the pH of the parenteral solution of midazolam used clinically? a) 2.0 b) 3.5 c) 5.0 d) 7.0

Answer 27

Answer: b) 3.5

Question 28

What is the effect of physiologic pH on midazolam? a) It opens the ring b) It closes the ring c) It converts midazolam to a water-soluble drug d) It has no effect on midazolam

Answer 28

Answer: b) It closes the ring

Question 29

What is the elimination half-time of midazolam? a) 1-4 hours b) 4-8 hours c) 8-12 hours d) 12-24 hours

Answer 29

Answer: a) 1-4 hours

Question 30

Why is the context-sensitive half-time of midazolam shorter than that of diazepam? a) Midazolam undergoes rapid absorption from the gastrointestinal tract b) Midazolam is considered to have a slow effect-site equilibration time c) The clearance of midazolam is more rapid than that of diazepam d) Midazolam is extensively bound to plasma proteins

Answer 30

Answer: c) The clearance of midazolam is more rapid than that of diazepam

Question 31

What is the effect of cardiopulmonary bypass on the plasma concentration of midazolam? a) It decreases the plasma concentration b) It increases the plasma concentration c) It has no effect on the plasma concentration d) It converts midazolam to a highly lipid-soluble drug

Answer 31

Answer: a) It decreases the plasma concentration

Question 32

Is the elimination half-time, Vd, and clearance of midazolam altered by renal failure? A. Yes B. No

Answer 32

Answer: B

Question 33

How does fentanyl affect the hepatic clearance of midazolam? A. It increases the hepatic clearance rate B. It inhibits the hepatic clearance rate C. It has no effect on the hepatic clearance rate D. It increases the renal clearance rate

Answer 33

Answer: B

Question 34

Which drugs can inhibit cytochrome P450 enzymes and slow down the metabolism of midazolam? A. Antifungal drugs B. Calcium channel blockers C. Erythromycin D. All of the above

Answer 34

Answer: D

Question 35

What happens to the glucuronide metabolite of midazolam in patients with renal insufficiency? A. It is rapidly conjugated to 1-hydroxymidazolam B. It has no pharmacologic activity C. It may have synergistic sedative effects with the parent compound D. It is subsequently cleared by the liver

Answer 35

Answer: C

Question 36

What is the principal metabolite of midazolam? A. 1-hydroxymidazolam glucuronide B. 4-hydroxymidazolam C. Inactive metabolite D. 1-hydroxymidazolam

Answer 36

Answer: D

Question 37

What effect does midazolam have on cerebral blood flow? a. It increases cerebral blood flow b. It has no effect on cerebral blood flow c. It decreases cerebral blood flow d. It depends on the dosage

Answer 37

Answer: c. It decreases cerebral blood flow

Question 38

Is midazolam a suitable alternative to barbiturates for induction of anesthesia in patients with intracranial pathology? a. Yes b. No c. It depends on the severity of the intracranial pathology d. It depends on the patient's age

Answer 38

Answer: a. Yes

Question 39

What is the potential side effect of midazolam in patients with severe head trauma? a. Decreased intracranial compliance b. Undesirable increase in ICP c. Improvement of neurologic outcome d. Paradoxical excitement

Answer 39

Answer: b. Undesirable increase in ICP

Question 40

What is the treatment for paradoxical excitement in patients receiving midazolam? a. Diazepam b. Fentanyl c. Flumazenil d. Thiopental

Answer 40

Answer: c. Flumazenil

Question 41

Does midazolam have a depressant effect on ventilation? a. Yes, but only in patients with chronic obstructive pulmonary disease b. Yes, but only in combination with fentanyl c. No d. Yes, especially with rapid injection of large doses

Answer 41

Answer: d. Yes, especially with rapid injection of large doses

Question 42

What effect does midazolam have on systemic blood pressure? a. It increases systemic blood pressure b. It has no effect on systemic blood pressure c. It decreases systemic blood pressure d. It depends on the dosage

Answer 42

Answer: c. It decreases systemic blood pressure

Question 43

Does midazolam prevent blood pressure and heart rate responses evoked by intubation of the trachea? a. Yes b. No c. It depends on the patient's age d. It depends on the patient's medical history

Answer 43

Answer: b. No

Question 44

Which drug is usually used for induction of anesthesia faster than midazolam? A. Fentanyl B. Thiopental C. Propofol D. Opioids

Answer 44

Answer: B. Thiopental

Question 45

What is the context-sensitive half-time for midazolam during the maintenance of anesthesia? A. Increases modestly with an increasing duration of administration B. Decreases with an increasing duration of administration C. Remains constant with an increasing duration of administration D. None of the above

Answer 45

Answer: A. Increases modestly with an increasing duration of administration

Question 46

What is paradoxical vocal cord motion? A. A cause of organic upper airway obstruction B. A cause of nonorganic upper airway obstruction C. A side effect of midazolam D. A complication of intubation

Answer 46

Answer: B. A cause of nonorganic upper airway obstruction

Question 47

What is the recommended dose of midazolam for treating paradoxical vocal cord motion? A. 0.1-0.2 mg/kg IV B. 0.5-1 mg IV C. 1-2.5 mg IV D. 2-5 mg IV

Answer 47

Answer: B. 0.5-1 mg IV