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MCQs of Sedation

1. Anxiolytics are used to treat:

Neurosis

Psychosis

Narcolepsy

Bipolar disorders

2. Anxiolytic agents should:

Produce drowsiness, encourage the onset and maintenance of a state of sleep

Relieve pain

Reduce anxiety and exert a calming effect

Improve mood and behavior in patient with psychotic symptoms

3. Anxiolytics are also useful for:

All are corrected

Treatment of epilepsy and seizures

Insomnia

Muscle relaxation in specific neuromuscular disorders

4. Indicate the agents of choice in the treatment of most anxiety states:

Barbiturates

Benzodiazepines

Lithium salts

Phenothiazines

5. The choice of benzodiazepines for anxiety is based on:

All are corrected

A relatively high therapeutic index

Availability of flumazenil for treatment of overdose

A low risk of physiologic dependence

6. Which of the following anxiolitics is a benzodiazepine derivative:

Buspirone

Chloral hydrate

Clordiazepoxide

Meprobamate

7. Indicate the benzodiazepine, which has the shortest elimination half-life:

Quazepam

Triazolam

Diazepam

Clorazepate

8. Which of the following benzodiazepines has the shortest duration of action?

σ� Triazolam

 Clorazepate

σ� Prazepam

 Clordiazepoxide

9. Which of the following benzodiazepines is less likely to cause cumulative and residual effects with multiple doses?

σ� Clorazepate

 Quazepam

σ� Lorazepam

σ� Prazepam

10. Anxiolytic dosage reduction is recommended:

σ� All are corrected

σ� In patients taking cimetidine

 In elderly patients

σ� In patients with hepatic dysfunction

11. Which of the following benzodiazepines is preferred for elderly patients?

 Clorazepate

σ� Clordiazepoxide

 Prazepam

σ� Triazolam

12. Which of the following anxiolytics is preferred in patient with limited hepatic function?

σ� Buspirone

σ� Quazepam

σ� Diazepam

 Chlordiazepoxide

13. Indicate the mechanism of hypnotic benzodiazepine action:

σ� Increasing the duration of the GABA-gated Cl-channel openings

σ� Directly activating the chloride channels

σ� All are corrected

σ� Increasing the frequency of Cl-channel opening events

14. Which of the following anxiolytics is a partial agonist of brain 5-HT1A receptors?

σ� Buspirone

σ� Alprozolam

σ� Chlorazepat

σ� Lorazepam

15. Indicate the competitive antagonist of benzodiazepine receptors:

σ� Flumazenil

 Diazepam

 Picrotoxin

σ� Buspirone

16. Indicate the agent, which interferes with GABA binding:

σ� Chlordiazepoxide

σ� Thiopental

σ� Bicuculline

σ� Picrotoxin

17. Antianxiety agents have:

 All are corrected

σ� Sedative and hypnotic activity

σ� Muscle relaxing and anticonvulsant effects

σ� Amnesic properties

18. Which of the following disadvantages does not limit using benzodiazepines as antianxiety agents?

 The formation of active metabolites

σ� Tendency to develop psychologic dependence

σ� A high risk of drug interactions based on liver enzyme induction

σ� Synergic CNS depression with concomitant use of other drugs

19. Indicate the anxiolitic agent, which relieves anxiety without causing marked sedative effects:

σ� Diazepam

σ� Clorazepate

σ� Buspirone

 Chlordiazepoxid

20. Which of the following anxiolytics has minimal abuse liability?

σ� Flumazenil

σ� Oxazepam

σ� Buspirone

σ� Alprazolam

21. In contrast to benzodiazepines, buspirone:

σ� Has more marked hypnotic, anticonvulsant, or muscle relaxant properties

σ� Interact directly with gabaergic system

σ� Causes less psychomotor impairment and does not affect driving skills

σ� Has maximal abuse liability

22. Which of the following sedative-hypnotic drugs does not potentiate the CNS depressant effects of ethanol, phenothiazines, or tricyclic antidepressants?

σ� Buspirone

σ� Chloralhydrate

σ� Diazepam

σ� Phenobarbital

23. Limitation of buspirone is:

 Impairment of mentation or motor functions during working hours

σ� A low therapeutic index

σ� An extremely slow onset of action

σ� A high potential of development of physical dependence

24. Which drugs may be used as antianxiety agents?  BETA-blocking drugs  Clonidine - a partial agonist of alfa2 receptors  Tricyclic antidepressants  All are corrected

 All are corrected

σ� BETA-blocking drugs

σ� Clonidine - a partial agonist of alfa2 receptors

σ� Tricyclic antidepressants

25. Which of the following benzodiazepines is more likely to cause “hangover” effects such as drowsiness, dysphoria, and mental or motor depression the following day?

σ� Oxazepam

σ� Lorazepam

σ� Clorazepat

σ� Triazolam

26. Additive CNS depression can be predicted if benzodiazepines are used with:

 All are corrected

σ� Ethanol

σ� Morphine

σ� Clorpromazine

27. Which dosage of benzodiazepines for 60-90 days may produce severe withdrawal symptoms?

σ� 50-60 mg/d

σ� Less than 400 mg/d

σ� More than 800 mg/d

σ� Less than 40 mg/d

28. Restlessness, anxiety, orthostatic hypotension, generalized seizures, severe tremor, vivid hallucination, and psychosis are possible symptoms of:

σ� None of all

σ� Tolerance

σ� Withdrawal

σ� Drug interactions between barbiturate and diazepam

29. Flumazenil is used to:

 All are corrected

σ� Reverse the CNS depressant effects of hypnotic benzodiazepines overdose

σ� Hasten recovery following use of hypnotic benzodiazepines in anesthetic and diagnostic procedure

σ� Reverse benzodiazepine-induced respiratory depression

30. Flumazenil given intravenously:

 Has duration of action longer than 6 hours

σ� Has intermediate onset and duration of action about 2 hours

σ� Acts rapidly but has a short half-life

σ� Has an effect lasting 3-5 hours

31. All are true about Minimal sedation, except

 Unaffected cardiovascular function

σ� Normal response to normal stimulation

σ� Possibly impaired cognitive function

σ� Affected ventilatory function

32. All are true regarding Moderate sedation, except

 Airway is patent

σ� Verbal commands are effective

σ� Cardiovascular function is affected

 Spontaneous ventilation is adequate

33. All are false about Moderate sedation, except

 Inadequate ventilation

σ� Obstructed airway

σ� Painful provocation is needed

σ� Unaffected cardiovascular function

34. All are true about Deep sedation, except

 Possibly inadequate spontaneous ventilation

σ� Painful stimulation is needed

σ� Possibly impaired ventilatory function

σ� Easily aroused patient

35. All are true about Deep sedation, except

 Depression of consciousness is drug-induced

σ� Cardiovascular function is maintained

σ� Patient is easily aroused

σ� Assistance might be required for patent airway maintaining

36. All are true about General anesthesia, except

 Impaired ventilator function

σ� Loss of consciousness

σ� Painful stimulation is needed

σ� Patient is not able to be aroused

37. All are true about General anesthesia, except

 Positive pressure ventilation may be required

σ� Possibly impaired cardiovascular function

σ� Assistance might be required for patent airway maintaining

σ� Patient is not easily to be aroused

38. Good effects of Benzodiazepines are all, except

σ� Anticonvulsant

σ� Amnesia

σ� Anxiolysis

σ� Airway clearing

39. All are good effects of Benzodiazepines, except

σ� Anxiety reliever

σ� Anticonvulsant

σ� Sedation

σ� Vision enhancement

40. The incorrect group of Benzodiazepines is

σ� Short-acting

 Extra long-acting

σ� Intermediate-acting

σ� Long-acting

41. The duration of action of Benzodiazepines is dependent on

σ� The half-life

σ� The patient’s body

 The complete-life

σ� The active component

42. The duration of action of Benzodiazepines is dependent on

 Dose of drug

σ� The patient’s body

σ� Activeness of organs

σ� The metabolic fate

43. Classification of action of Midazolam

 Extra long-acting

σ� Short-acting

σ� Intermediate-acting

σ� Long-acting

44. Classification of action of Triazolam

 Extra long-acting

σ� Short-acting

σ� Intermediate-acting

σ� Long-acting

45. Classification of action of Diazepam

σ� Extra long-acting

σ� Short-acting

σ� Intermediate-acting

σ� Long-acting

46. Classification of action of Lorazepam

 Extra long-acting

σ� Short-acting

σ� Intermediate-acting

σ� Long-acting

47. Classification of action of Alprazolam

σ� Long-acting

σ� Short-acting

σ� Intermediate-acting

σ� Extra long-acting

48. Drug class of Midazolam is all, except

 Long-acting

σ� Benzodiazepines

σ� Sedative

 Anesthesia adjunct

49. Mechanism of actions of Midazolam is all, except

 Amnesia

σ� Anxiolysis

σ� Hypnosis

σ� Fatigue

50. All are mechanism of actions of Midazolam, except

σ� Anxiolysis

σ� Anticonvulsant

σ� Muscle relaxant

σ� Vision enhancement

51. The incorrect use of Midazolam is for

 Postoperative sedation

σ� Conscious sedation

 GA induction

σ� Intubation

52. The incorrect use of Midazolam is for

σ� Sedation of diagnostic endoscope

σ� Intubation

 LA replacement

σ� Amnesia

53. All are true about pharmacokinetics of Midazolam, except

σ� Can be removed through hemodialysis

σ� 97% protein binding

σ� Primarily excreted in urine

σ� Well-absorbed after IM administration

54. All are true about pharmacokinetics of Midazolam, except

σ� Well-absorbed after IM administration

σ� Half-life: 30 minutes to 2 hours

 Metabolized in the liver to active metabolite

σ� 97% protein binding

55. All are frequent side effects of Midazolam, except

 Hiccups

σ� Decreased respiratory rate

σ� Pain during injection

σ� Nausea

56. All are frequent side effects of Midazolam, except

 Pain during injection

σ� Hypotension

σ� Oxygen desaturation

σ� Hiccough

57. The occasional side effect of Midazolam is

 Hiccups

σ� Nausea

σ� Vomiting

σ� Hypotension

58. The occasional side effect of Midazolam is

σ� Pain during injection

σ� Paradoxical CNS reaction

σ� Headache

σ� Coughing

59. The rare side effect of Midazolam is

 Paradoxical CNS reaction

σ� Coughing

σ� Hypertension

σ� Decreased respiratory rate

60. The rare side effect of Midazolam is

 Tenderness at the injection site

σ� Vomiting

σ� Hypotension

σ� Oxygen desaturation

61. All are the contraindications of use of Midazolam, except

 Patient with epilepsy

σ� Patient with shock

σ� Patient with coma

σ� Patient with acute glaucoma

62. All are drugs contraindicated with Midazolam, except

 Indinavir

σ� Nelfinavir

σ� Ritonavir

σ� Erythromycin

63. Inadequate or excessive dosage or improper administration may result in all, except

σ� Voluntary movements

σ� Cerebral hypoxia

σ� Agitation

σ� Hyperactivity

64. All are symptoms of overdose of Midazolam, except

σ� Confusion

σ� Loss of coordination

 Drowsiness

σ� Unable to speak

65. All are therapeutic effects of Lorazepam, except

 Airway assisting

σ� Anticonvulsant

σ� Antiemetic effects

σ� Anxiolysis

66. All are therapeutic effects of Lorazepam, except

σ� Sedation

 Memory enhancement

σ� Anxiolysis

σ� Muscle relaxant

67. All are the drug uses of Lorazepam, except

 Acute alcohol withdrawal symptoms

σ� Treatment of anxiety

σ� Muscle spasm

σ� Alcohol toxication

68. All are pharmacokinetics of Lorazepam, except

σ� Primary excreted in urine

σ� Well-absorbed after PO or IV administration

σ� 97% protein binding

 Metabolized in liver

69. All are pharmacokinetics of Lorazepam, except

 Well-absorbed after PO or IV administration

σ� Not removed by hemodialysis

σ� Half-life 10 to 20 hours

σ� Metabolized in kidney

70. Frequent side effect of Lorazepam is

 Headache

σ� Somnolence

σ� Hypotension

σ� Hypertension

71. Frequent side effect of Lorazepam is

 Paradoxical CNS restlessness

σ� Ataxia

σ� Blurred vision

σ� Slurred speech

72. Frequent side effect of Lorazepam is

 Hypotension

σ� Headache

σ� Confusion

σ� Paradoxical CNS excitement

73. Occasional side effect of Lorazepam is

 Hypertension

σ� Somnolence

σ� Ataxia

σ� Blurred vision

74. Occasional side effect of Lorazepam is

 Ataxia

σ� Slurred speech

σ� Paradoxical CNS restlessness

σ� Confusion

75. Occasional side effect of Lorazepam is

 Hypertension

σ� Hypotension

σ� Paradoxical CNS excitement

σ� Somnolence

76. Rare side effect of Lorazepam is

 Confusion

σ� Nausea

σ� Paradoxical CNS restlessness in elderly

σ� Hypotension

77. All are conditions contradicted to the use of Lorazepam, except

 Diabetics

σ� Severe uncontrolled pain

σ� Glaucoma

σ� Preexisting CNS depression

78. All are the results of Lorazepam overdose, except

 Hearing disorder

σ� Somnolence

σ� Confusion

σ� Coma

79. All are therapeutic effects of Diazepam, except

σ� Increase level of alertness

σ� Anxiolysis

σ� Elevation of seizure threshold

σ� Skeletal muscle relaxation

80. All are drug uses of Diazepam, except

 Skeletal muscle spasm

σ� Anxiety

σ� Acute alcohol withdrawal

 Local anesthesia replacement

81. All are drug uses of Diazepam, except

 Alcohol toxin reliever

σ� Conscious sedation

σ� Adjunct in seizure disorders

σ� Skeletal muscle spasm

82. All are pharmacokinetics of Diazepam, except

 Not removed by hemodialysis

σ� Well-absorbed from the GI tract

σ� Widely distributed

σ� Excreted in urine

83. All are pharmacokinetics of Diazepam, except

σ� 98% protein binding

σ� Half-life 5 t0 10 hours

σ� Metabolized in the liver

σ� Widely distributed

84. Frequent side effect of Diazepam is

 Headache

σ� Slurred speech

σ� Orthostatic hypotension

σ� Somnolence

85. Frequent side effect of Diazepam is

 Hypoactivity

σ� Diarrhea

σ� Fatigue

σ� Blurred vision

86. Frequent side effect of Diazepam is

 Hyperactivity

σ� Constipation

 Ataxia

σ� Nervousness in children

87. Occasional side effect of Diazepam is

 Excitement

σ� Somnolence

σ� Constipation

σ� Hyperactivity

88. Occasional side effect of Diazepam is

 Pain with IM injection

σ� Fatigue

σ� Blurred vision

σ� Ataxia

89. Occasional side effect of Diazepam is

σ� Nausea

σ� Hyperactivity

σ� Orthostatic hypertension

σ� Diarrhea

90. Rare side effect of Diazepam is

 Nausea

σ� Headache

σ� Slurred speech

σ� Nervousness in children

91. Rare side effect of Diazepam is

σ� Somnolence

σ� Excitement in elderly

σ� Blurred vision

σ� Hypoactivity

92. Rare side effect of Diazepam is

σ� Constipation

σ� Ataxia

σ� Hyperactivity

σ� Fatigue

93. All are conditions contraindicated to Diazepam, except

 Alcohol withdrawal symptoms

σ� Coma

σ� Glaucoma

σ� Preexisting CNS depression

94. All are conditions contraindicated to Diazepam, except

 Glaucoma

σ� Respiratory depression

σ� Severe uncontrolled pain

 Status epilepticus

95. All are drugs which help prolong the effects of Diazepam, except

σ� Cimetidine

σ� Fluconazole

σ� Erythromycin

σ� Saquinavir

96. All are drugs which help prolong the effects of Diazepam, except

σ� Rifamycin

σ� Clarithromycin

 Ketoconazole

σ� Saquinavir

97. IV administration of Diazepam might produce all, except

 Urinary frequency

σ� Swelling

σ� Pain

σ� Thrombophlebitis

98. IV administration of Diazepam might produce all, except

σ� Swelling

σ� Carpel tunnel syndrome

 Diarrhea

σ� Thrombophlebitis

99. All are general considerations of Diazepam using in dental field, except

 Allow the patient to walk independently to and from the operation room

σ� Assessment of saliva flow

σ� Lower dose for geriatric patients

σ� Avoid using it for patients with history of drug abuse

100. All are general considerations of Diazepam using in dental field, except

 Stop the procedure if the patient feels sleepy

σ� Ask the patient’s family to drive the patient to and from dental clinic

σ� Physical dependence might occur with chronic administration

σ� Psychological dependence might occur with chronic administration

101. All are the assessment of the patient prior to sedation, except

 Examination

σ� History

σ� Treatment plan

σ� Social status

102. All are ideal properties of sedative agents, except

 Quick recovery

σ� No respiratory depression

σ� Cheap

σ� Delayed onset

103. All are ideal properties of sedative agents, except

 Delayed recovery

σ� No side effects

σ� Easy to administer

σ� Anxiolysis

104. All are true about oral sedation, except

 It is used to alleviate fear

σ� Simple way of providing mild preoperative sedation

σ� Premedication

 It cannot be used with other sedation methods

105. All are true about oral sedation, except

 Considerable individual variation in response is advantageous

σ� It can be used alone

σ� Common oral sedation is Benzodiazepine

 It is used to alleviate anxiety

106. All are true about inhalation sedation, except

 Good for treating anxious children

σ� It is 50% drug management

σ� It is 50% behavior management

 Decrease of use in recent years

107. Stages of clinical effects of inhalation sedation include all, except

 Stage of analgesia

σ� Stage of excitement

σ� Stage of surgical anesthesia

σ� Stage of unconsciousness

108. All are indications of inhalation sedation, except

 Patient with epilepsy

σ� Patient with hypoactivity gagging reflexes

σ� Patient with physical special needs

σ� Patient with mental special needs

109. All are true of inhalation sedation, except

 Acceptable to most patients

σ� Non-invasive

σ� Require only nasal mask and electronic monitoring

 Rapid onset

110. All are true of inhalation sedation, except

 No fasting

σ� Delayed onset so patient can be well-prepared

σ� Rapid recovery

 No amnesia

111. All are true of inhalation sedation, except

 Anxiolysis

σ� Need electronic monitoring

σ� The whole procedure is remembered

 Not invasive

112. The best method for conscious sedation now is

 Inhalation sedation

σ� Oral sedation

σ� Intramuscular sedation

σ� Intravenous sedation

113. The initial intravenous sedation in dentistry was done using

 Triazolam

σ� Midazolam

σ� Diazepam

σ� Lorazepam

114. All are true about Midazolam used as intravenous sedation, except

σ� Painless on injection

σ� It is easier to control the incremental dosage

σ� It is a water-soluble at a pH of less than 3

 It is lipid-soluble at physiological pH

115. All are true about Midazolam used as intravenous sedation, except

 It is metabolized in liver

σ� It acts more rapidly than Diazepam

 It has a much more reliable patient response than Diazepam

σ� Quite painful on injection

116. All are true about Diazepam used as intravenous sedation, except

 Risk of rebound sedation

σ� Elimination half-life of 43 hours

σ� Patients were sedated to some extent for up to 2 days

σ� Soluble in water

117. All are false about Diazepam used as intravenous sedation, except

 Patients were sedated to some extent for up to 3 days

σ� Painless on injection

σ� Elimination half-life of 24 hours

σ� Production of active metabolites

118. All are psychosocial indications for IV sedation with Midazolam, except

 Patients who have considerable difficulty with vasovagal attacks prior to and during dentistry

σ� Patients with anxiety

σ� Patients with phobia related to dental instruments

σ� Patients with asthma

119. All are medical indications for IV sedation with Midazolam, except

 Patients with hypertension

σ� Patients with epilepsy

σ� Patients with mild ischemic heart disease

σ� Patients with anxiety related to dental instruments

120. All are contraindications for IV sedation, except

σ� Uncooperative patients

σ� Severe systemic disease

σ� Unwilling patients

σ� Children aged 17

121. All are contraindications for IV sedation, except

 Patients with severe chronic obstructive airway disease

σ� Patients with history of psychiatric treatment

σ� Patients with asthma

σ� Patients with severe physical special needs

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