PASSPOINTPRO D345 • Psychopharmacology
D345
ANXIETY, SEDATIVE &
HYPNOTIC MEDICATIONS
100 Questions with Answers & Explanations
100 A-D 7
QUESTIONS MCQ FORMAT CORE DOMAINS
Benzodiazepines • Buspirone • Hydroxyzine • Z-Drugs • Ramelteon • Orexin Antagonists • Safety
,D345 ANXIETY, SEDATIVE & HYPNOTIC MEDICATIONS PASSPOINTPRO
Test Overview
This focused D345 test covers anxiety and insomnia pharmacology through mixed clinical scenarios. It
emphasizes benzodiazepines, buspirone, hydroxyzine, performance-anxiety pharmacology, Z-drugs,
ramelteon, orexin antagonists, low-dose doxepin, withdrawal, overdose safety, drug interactions, and patient
teaching.
Format 100 multiple-choice questions with four options (A-D).
Feedback The correct answer and a focused explanation appear immediately after every
question.
Core GABA-A modulation, 5-HT1A partial agonism, H1 blockade, melatonin receptors,
pharmacology orexin signaling, kinetics, and clinical selection.
Safety focus Dependence, withdrawal, seizures, respiratory depression, falls, complex sleep
behaviors, next-day impairment, and high-risk drug combinations.
Current-safety note: This test reflects the FDA benzodiazepine boxed warning for abuse, misuse, addiction, physical dependence,
and withdrawal; the boxed warning for serious complex sleep behaviors with zolpidem, zaleplon, and eszopiclone; and current
labeling considerations for buspirone, ramelteon, suvorexant, and flumazenil.
1. What is the most useful first step when a patient reports that a hypnotic “stopped
working” after months of use?
A. Abruptly stop every sedative regardless of drug or duration
B. Automatically double the dose
C. Add alcohol at bedtime
D. Reassess diagnosis, adherence, tolerance, substances, and ongoing need before increasing the dose
Answer: D - Reassess diagnosis, adherence, tolerance, substances, and ongoing need before
increasing the dose
Explanation: Loss of benefit may reflect tolerance, a new medical or psychiatric contributor, substance use,
timing problems, or an incorrect diagnosis. Reassessment is safer than automatic dose escalation.
2. Which condition is a contraindication to suvorexant?
A. Narcolepsy
B. Remote appendectomy
C. Stable seasonal allergies
D. Corrected myopia
Answer: A - Narcolepsy
Explanation: Suvorexant blocks orexin signaling and is contraindicated in narcolepsy, a disorder already
characterized by impaired orexin-mediated wake stability in many patients.
100-Question Test • Answers & explanations included Page 2
, D345 ANXIETY, SEDATIVE & HYPNOTIC MEDICATIONS PASSPOINTPRO
3. A patient on fluvoxamine is prescribed ramelteon. What medication-review problem
should be identified?
A. Fluvoxamine eliminates ramelteon absorption
B. Fluvoxamine can greatly increase ramelteon exposure and the combination is contraindicated
C. Ramelteon blocks all SSRI effects
D. The combination causes benzodiazepine withdrawal
Answer: B - Fluvoxamine can greatly increase ramelteon exposure and the combination is
contraindicated
Explanation: Fluvoxamine strongly inhibits CYP1A2 and markedly increases ramelteon exposure. Current
ramelteon labeling states they should not be used together.
4. A patient taking suvorexant reports severe next-day sleepiness. What is the most
appropriate interpretation?
A. The medication improves driving despite sleepiness
B. Next-day impairment cannot occur with orexin antagonists
C. The symptom proves the drug is ineffective
D. Daytime impairment is a recognized CNS-depressant effect and should prompt reassessment
Answer: D - Daytime impairment is a recognized CNS-depressant effect and should prompt
reassessment
Explanation: Suvorexant can impair next-day alertness and motor coordination, with risk influenced by dose,
timing, other depressants, and individual susceptibility. Safety-sensitive activities should be avoided when
impaired.
5. Which group of benzodiazepines is commonly remembered as undergoing
glucuronidation and having fewer oxidative active-metabolite concerns?
A. Lorazepam, oxazepam, and temazepam
B. Alprazolam, triazolam, and midazolam
C. Zolpidem, zaleplon, and eszopiclone
D. Diazepam, clonazepam, and flurazepam
Answer: A - Lorazepam, oxazepam, and temazepam
Explanation: Lorazepam, oxazepam, and temazepam are largely conjugated by glucuronidation and are less
dependent on hepatic oxidative metabolism. This can be useful when hepatic function or metabolic interactions
are concerns.
6. Which strategy best reduces risk when a hypnotic is prescribed?
A. Use the lowest effective dose for the shortest necessary duration while reassessing ongoing need
B. Combine two sedative-hypnotics routinely
C. Continue indefinitely without follow-up
D. Automatically escalate the dose every week
Answer: A - Use the lowest effective dose for the shortest necessary duration while reassessing
ongoing need
Explanation: Hypnotics should be individualized and periodically reassessed. Minimizing exposure and avoiding
unnecessary combinations reduces risk of tolerance, impairment, and adverse events.
100-Question Test • Answers & explanations included Page 3
D345
ANXIETY, SEDATIVE &
HYPNOTIC MEDICATIONS
100 Questions with Answers & Explanations
100 A-D 7
QUESTIONS MCQ FORMAT CORE DOMAINS
Benzodiazepines • Buspirone • Hydroxyzine • Z-Drugs • Ramelteon • Orexin Antagonists • Safety
,D345 ANXIETY, SEDATIVE & HYPNOTIC MEDICATIONS PASSPOINTPRO
Test Overview
This focused D345 test covers anxiety and insomnia pharmacology through mixed clinical scenarios. It
emphasizes benzodiazepines, buspirone, hydroxyzine, performance-anxiety pharmacology, Z-drugs,
ramelteon, orexin antagonists, low-dose doxepin, withdrawal, overdose safety, drug interactions, and patient
teaching.
Format 100 multiple-choice questions with four options (A-D).
Feedback The correct answer and a focused explanation appear immediately after every
question.
Core GABA-A modulation, 5-HT1A partial agonism, H1 blockade, melatonin receptors,
pharmacology orexin signaling, kinetics, and clinical selection.
Safety focus Dependence, withdrawal, seizures, respiratory depression, falls, complex sleep
behaviors, next-day impairment, and high-risk drug combinations.
Current-safety note: This test reflects the FDA benzodiazepine boxed warning for abuse, misuse, addiction, physical dependence,
and withdrawal; the boxed warning for serious complex sleep behaviors with zolpidem, zaleplon, and eszopiclone; and current
labeling considerations for buspirone, ramelteon, suvorexant, and flumazenil.
1. What is the most useful first step when a patient reports that a hypnotic “stopped
working” after months of use?
A. Abruptly stop every sedative regardless of drug or duration
B. Automatically double the dose
C. Add alcohol at bedtime
D. Reassess diagnosis, adherence, tolerance, substances, and ongoing need before increasing the dose
Answer: D - Reassess diagnosis, adherence, tolerance, substances, and ongoing need before
increasing the dose
Explanation: Loss of benefit may reflect tolerance, a new medical or psychiatric contributor, substance use,
timing problems, or an incorrect diagnosis. Reassessment is safer than automatic dose escalation.
2. Which condition is a contraindication to suvorexant?
A. Narcolepsy
B. Remote appendectomy
C. Stable seasonal allergies
D. Corrected myopia
Answer: A - Narcolepsy
Explanation: Suvorexant blocks orexin signaling and is contraindicated in narcolepsy, a disorder already
characterized by impaired orexin-mediated wake stability in many patients.
100-Question Test • Answers & explanations included Page 2
, D345 ANXIETY, SEDATIVE & HYPNOTIC MEDICATIONS PASSPOINTPRO
3. A patient on fluvoxamine is prescribed ramelteon. What medication-review problem
should be identified?
A. Fluvoxamine eliminates ramelteon absorption
B. Fluvoxamine can greatly increase ramelteon exposure and the combination is contraindicated
C. Ramelteon blocks all SSRI effects
D. The combination causes benzodiazepine withdrawal
Answer: B - Fluvoxamine can greatly increase ramelteon exposure and the combination is
contraindicated
Explanation: Fluvoxamine strongly inhibits CYP1A2 and markedly increases ramelteon exposure. Current
ramelteon labeling states they should not be used together.
4. A patient taking suvorexant reports severe next-day sleepiness. What is the most
appropriate interpretation?
A. The medication improves driving despite sleepiness
B. Next-day impairment cannot occur with orexin antagonists
C. The symptom proves the drug is ineffective
D. Daytime impairment is a recognized CNS-depressant effect and should prompt reassessment
Answer: D - Daytime impairment is a recognized CNS-depressant effect and should prompt
reassessment
Explanation: Suvorexant can impair next-day alertness and motor coordination, with risk influenced by dose,
timing, other depressants, and individual susceptibility. Safety-sensitive activities should be avoided when
impaired.
5. Which group of benzodiazepines is commonly remembered as undergoing
glucuronidation and having fewer oxidative active-metabolite concerns?
A. Lorazepam, oxazepam, and temazepam
B. Alprazolam, triazolam, and midazolam
C. Zolpidem, zaleplon, and eszopiclone
D. Diazepam, clonazepam, and flurazepam
Answer: A - Lorazepam, oxazepam, and temazepam
Explanation: Lorazepam, oxazepam, and temazepam are largely conjugated by glucuronidation and are less
dependent on hepatic oxidative metabolism. This can be useful when hepatic function or metabolic interactions
are concerns.
6. Which strategy best reduces risk when a hypnotic is prescribed?
A. Use the lowest effective dose for the shortest necessary duration while reassessing ongoing need
B. Combine two sedative-hypnotics routinely
C. Continue indefinitely without follow-up
D. Automatically escalate the dose every week
Answer: A - Use the lowest effective dose for the shortest necessary duration while reassessing
ongoing need
Explanation: Hypnotics should be individualized and periodically reassessed. Minimizing exposure and avoiding
unnecessary combinations reduces risk of tolerance, impairment, and adverse events.
100-Question Test • Answers & explanations included Page 3
