Zolpidem MCQs With Answer

Zolpidem MCQs With Answer is a focused study resource tailored for B. Pharm students preparing for pharmacology exams and clinical practice. This collection covers zolpidem pharmacology, mechanism of action at GABA-A receptors, pharmacokinetics, dosing strategies, adverse effects, drug interactions (notably CYP3A4), special populations, formulations (immediate-release, extended-release, sublingual, spray), dependence potential, and safety alerts such as complex sleep behaviors. Each question emphasizes clinical relevance and exam-style reasoning to deepen understanding and retention. Ideal for revision, self-assessment, and rapid concept checks, these MCQs will strengthen your competence in hypnotic therapy. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which receptor subtype is primarily associated with zolpidem’s hypnotic effect?

• GABA-A receptor containing alpha1 subunit
• GABA-B receptor
• NMDA receptor
• Serotonin 5-HT2A receptor

Correct Answer: GABA-A receptor containing alpha1 subunit

Q2. Zolpidem is best classified as which type of hypnotic?

• Non-benzodiazepine imidazopyridine
• Benzodiazepine
• Barbiturate
• Melatonin receptor agonist

Correct Answer: Non-benzodiazepine imidazopyridine

Q3. The primary mechanism by which zolpidem enhances inhibitory neurotransmission is:

• Positive allosteric modulation of GABA-A receptors
• Direct agonism at GABA-A chloride channel
• Inhibition of GABA reuptake transporters
• Blocking glutamate release

Correct Answer: Positive allosteric modulation of GABA-A receptors

Q4. Which cytochrome P450 isoenzyme is most involved in zolpidem metabolism?

• CYP3A4
• CYP2D6
• CYP1A2
• CYP2C9

Correct Answer: CYP3A4

Q5. The approximate elimination half-life of immediate-release zolpidem in healthy adults is:

• About 2–3 hours
• About 8–12 hours
• About 24 hours
• Less than 30 minutes

Correct Answer: About 2–3 hours

Q6. Which formulation of zolpidem is designed to provide initial and sustained plasma levels for sleep maintenance?

• Extended-release (CR) formulation
• Immediate-release tablet
• Sublingual tablet for middle-of-the-night use
• Intravenous injection

Correct Answer: Extended-release (CR) formulation

Q7. A key FDA safety warning for zolpidem concerns which of the following behaviors?

• Complex sleep behaviors such as sleepwalking and sleep-driving
• Severe photosensitivity reactions
• Permanent hearing loss
• Acute pancreatitis

Correct Answer: Complex sleep behaviors such as sleepwalking and sleep-driving

Q8. For initial treatment of insomnia in older adults, recommended zolpidem dosing is typically:

• Lower than for younger adults (e.g., 5 mg)
• Higher than for younger adults
• Same as pediatric dosing
• Contraindicated in all older adults

Correct Answer: Lower than for younger adults (e.g., 5 mg)

Q9. Which adverse effect is most commonly reported with zolpidem use?

• Daytime drowsiness and dizziness
• Hypertension
• Severe hyperglycemia
• Ototoxicity

Correct Answer: Daytime drowsiness and dizziness

Q10. Zolpidem has the greatest selectivity for which GABA-A subunit-associated pharmacologic effect?

• Hypnotic/sedative effect via alpha1 subunit
• Muscle relaxation via alpha2 subunit
• Anxiolysis via alpha3 subunit
• Anticonvulsant effect via delta subunit

Correct Answer: Hypnotic/sedative effect via alpha1 subunit

Q11. Which of the following interactions increases zolpidem plasma levels and risk of sedation?

• Coadministration with a strong CYP3A4 inhibitor (e.g., ketoconazole)
• Coadministration with a CYP3A4 inducer (e.g., rifampin)
• Coadministration with a PPI (e.g., omeprazole)
• Coadministration with vitamin C supplements

Correct Answer: Coadministration with a strong CYP3A4 inhibitor (e.g., ketoconazole)

Q12. Which statement about zolpidem and next-day driving impairment is correct?

• Residual impairment can occur, especially with higher doses or extended-release forms
• Zolpidem never causes next-day impairment
• It always improves next-day psychomotor performance
• Only oral spray formulations cause residual effects

Correct Answer: Residual impairment can occur, especially with higher doses or extended-release forms

Q13. In case of zolpidem overdose causing severe sedation, which antagonist may be considered?

• Flumazenil
• Naloxone
• Atropine
• Protamine sulfate

Correct Answer: Flumazenil

Q14. Which patient population requires dose reduction and cautious use of zolpidem due to slower clearance?

• Patients with hepatic impairment
• Young healthy adults
• Patients with hyperthyroidism
• Patients using oral contraceptives only

Correct Answer: Patients with hepatic impairment

Q15. Which formulation of zolpidem can be used for middle-of-the-night awakenings with at least 4 hours remaining in bed?

• Sublingual low-dose tablet
• Extended-release tablet
• Intravenous infusion
• Transdermal patch

Correct Answer: Sublingual low-dose tablet

Q16. Which controlled substance schedule does zolpidem fall under in many countries (e.g., US)?

• Schedule IV
• Schedule I
• Schedule II
• Schedule III

Correct Answer: Schedule IV

Q17. Zolpidem’s primary metabolites are mainly excreted via:

• Renal excretion of inactive metabolites
• Fecal elimination of unchanged drug
• Exhalation as volatile metabolites
• Secretion in bile as active metabolites

Correct Answer: Renal excretion of inactive metabolites

Q18. Which sleep architecture change is commonly associated with zolpidem use?

• Reduced sleep latency and minimal suppression of REM sleep
• Marked REM suppression with REM rebound
• Severe reduction of slow-wave sleep only
• Complete elimination of REM sleep

Correct Answer: Reduced sleep latency and minimal suppression of REM sleep

Q19. Which is an important counseling point for patients starting zolpidem?

• Take immediately before bedtime with at least 7–8 hours available for sleep
• Take with a high-fat meal to increase absorption
• Double doses if sleep does not improve on first night
• Mix with alcohol if anxious about sleeping

Correct Answer: Take immediately before bedtime with at least 7–8 hours available for sleep

Q20. Chronic use of zolpidem can lead to which clinical concern?

• Tolerance and potential dependence
• Permanent improvement in sleep architecture
• Guaranteed weight loss
• Increased long-term cognitive enhancement

Correct Answer: Tolerance and potential dependence

Q21. Which statement about zolpidem dosing differences between genders is historically noted?

• Women may require lower doses due to slower clearance and higher plasma levels
• Women universally tolerate higher doses than men
• Men should never exceed 2 mg per dose
• No dosing differences have ever been observed

Correct Answer: Women may require lower doses due to slower clearance and higher plasma levels

Q22. Which adverse psychiatric event has been reported with zolpidem use?

• Confusional episodes and abnormal dreams
• Persistent euphoria and mania in all users
• Guaranteed improvement in mood disorders
• Immediate onset schizophrenia

Correct Answer: Confusional episodes and abnormal dreams

Q23. When combined with other central nervous system depressants, zolpidem’s sedative effect is:

• Potentiated, increasing risk of respiratory depression
• Completely blocked
• Unaffected by opioids or alcohol
• Reversed by antihistamines

Correct Answer: Potentiated, increasing risk of respiratory depression

Q24. Which pharmacokinetic property is accelerated when zolpidem is taken with food?

• Onset of absorption is delayed
• Elimination half-life is drastically shortened
• Bioavailability becomes zero
• Protein binding decreases to zero

Correct Answer: Onset of absorption is delayed

Q25. In hepatic impairment, zolpidem dose adjustments are needed because:

• Clearance is reduced, increasing exposure
• Hepatic disease causes greater renal excretion
• Metabolism is unaffected by liver function
• It is converted to nonactive metabolites that require no change

Correct Answer: Clearance is reduced, increasing exposure

Q26. Which monitoring parameter is most relevant during chronic zolpidem therapy?

• Signs of tolerance, dependence, daytime impairment, and adverse effects
• Serum zolpidem concentration weekly
• Monthly liver biopsy
• Routine audiometry testing

Correct Answer: Signs of tolerance, dependence, daytime impairment, and adverse effects

Q27. Zolpidem is contraindicated in patients with which sleep disorder?

• Severe sleep apnea where respiratory depression risk is high
• Primary snoring without sleep fragmentation
• Insomnia due to acute stressful events only
• Delayed sleep phase syndrome

Correct Answer: Severe sleep apnea where respiratory depression risk is high

Q28. Which of the following best describes the onset of action for immediate-release zolpidem?

• Rapid onset within 15–30 minutes
• Onset after 6–8 hours
• Onset only after continuous dosing for one week
• No sedative effect even at high doses

Correct Answer: Rapid onset within 15–30 minutes

Q29. Which laboratory test is routinely required before initiating zolpidem?

• No specific laboratory test is routinely required
• Baseline plasma zolpidem level
• Serum amylase and lipase
• Routine HIV screening

Correct Answer: No specific laboratory test is routinely required

Q30. Compared to benzodiazepines, zolpidem’s advantage often cited is:

• Greater selectivity for hypnotic effects with less muscle relaxation
• Stronger anticonvulsant properties
• Higher risk of respiratory failure at therapeutic doses
• Longer half-life producing next-day sedation consistently

Correct Answer: Greater selectivity for hypnotic effects with less muscle relaxation

Q31. Which patient instruction reduces risk of middle-of-the-night impairment after zolpidem use?

• Ensure at least 7–8 hours available for sleep before dosing
• Take zolpidem immediately after waking up during the night
• Combine with alcohol to promote deeper sleep
• Use while driving if drowsy

Correct Answer: Ensure at least 7–8 hours available for sleep before dosing

Q32. Zolpidem’s abuse potential is related to:

• Sedative and euphoric effects at higher doses or in susceptible individuals
• Its inability to cross the blood–brain barrier
• Its pure peripheral nervous system activity
• Guaranteed aversive reactions deterring misuse

Correct Answer: Sedative and euphoric effects at higher doses or in susceptible individuals

Q33. Which co-prescribed medication class would most likely decrease zolpidem levels?

• CYP3A4 inducers such as carbamazepine or rifampin
• CYP3A4 inhibitors such as itraconazole
• MAO inhibitors
• H2 antagonists

Correct Answer: CYP3A4 inducers such as carbamazepine or rifampin

Q34. Abrupt discontinuation of chronic zolpidem use can precipitate:

• Withdrawal symptoms including rebound insomnia and anxiety
• Immediate and permanent seizure disorder in all patients
• Sudden improvement in sleep without symptoms
• Painless hair loss only

Correct Answer: Withdrawal symptoms including rebound insomnia and anxiety

Q35. Which formulation provides a rapid but low-dose option for middle-of-the-night awakenings?

• Sublingual low-dose tablet
• Extended-release 12.5 mg tablet only
• Transdermal patch delivering continuous dose
• Intramuscular injection

Correct Answer: Sublingual low-dose tablet

Q36. For a patient with renal impairment, zolpidem dosing generally requires:

• No major adjustment for mild-to-moderate renal impairment, but caution and monitoring
• Immediate discontinuation in all renal disease stages
• Switch to intravenous formulation only
• Doubling the usual dose to achieve effect

Correct Answer: No major adjustment for mild-to-moderate renal impairment, but caution and monitoring

Q37. Which CNS symptom should prompt immediate evaluation when a patient is on zolpidem?

• Hallucinations, severe confusion, or aggressive behavior
• Mild transient thirst
• Improved concentration
• Stable mood without changes

Correct Answer: Hallucinations, severe confusion, or aggressive behavior

Q38. Zolpidem’s onset and short half-life make it particularly useful for which insomnia symptom?

• Sleep-onset insomnia
• Chronic early morning awakening only
• Insomnia due to narcolepsy exclusively
• Primary hypersomnia

Correct Answer: Sleep-onset insomnia

Q39. Which statement is true regarding zolpidem use during pregnancy and lactation?

• Use only if potential benefits justify potential risks; caution advised
• Safe and recommended for all pregnant patients
• Guaranteed to improve fetal outcomes
• Completely contraindicated with no exceptions

Correct Answer: Use only if potential benefits justify potential risks; caution advised

Q40. Which metabolic change occurs with chronic use of potent CYP3A4 inhibitors in a patient taking zolpidem?

• Increased zolpidem plasma concentration and prolonged effects
• Reduced zolpidem concentrations and decreased effect
• Immediate conversion to active benzodiazepines
• Complete inactivation making it ineffective

Correct Answer: Increased zolpidem plasma concentration and prolonged effects

Q41. Which adverse effect is specifically linked to complex sleep-related behaviors with zolpidem?

• Engaging in activities while not fully awake (e.g., sleep-driving)
• Severe hypertension during sleep
• Excessive salivation only
• Permanent visual loss

Correct Answer: Engaging in activities while not fully awake (e.g., sleep-driving)

Q42. Which lab or diagnostic test would be most useful if a patient on zolpidem presents with daytime somnolence?

• Clinical review of medication timing, dose, and use of other CNS depressants
• Routine zolpidem plasma monitoring every hour
• Immediate chest X-ray for all cases
• Mandatory brain MRI

Correct Answer: Clinical review of medication timing, dose, and use of other CNS depressants

Q43. Which statement best reflects zolpidem’s effect on REM sleep compared to benzodiazepines?

• Zolpidem tends to preserve REM sleep better than many benzodiazepines
• Zolpidem completely abolishes REM sleep
• Benzodiazepines enhance REM more than zolpidem
• Neither drug class affects REM sleep

Correct Answer: Zolpidem tends to preserve REM sleep better than many benzodiazepines

Q44. Which clinical scenario is a relative contraindication to prescribing zolpidem?

• History of complex sleep behaviors or severe respiratory compromise
• Mild transient insomnia related to occasional jet lag with no risks
• Short-term situational insomnia with no prior adverse reactions
• Patients with well-controlled hypertension only

Correct Answer: History of complex sleep behaviors or severe respiratory compromise

Q45. Which strategy is recommended to minimize dependence when using zolpidem?

• Use lowest effective dose for the shortest duration, with monitoring and periodic reassessment
• Use increasing doses every week indefinitely
• Combine with alcohol to prevent tolerance
• Never reassess need for therapy once started

Correct Answer: Use lowest effective dose for the shortest duration, with monitoring and periodic reassessment

Q46. Which symptom profile suggests zolpidem withdrawal in a patient who stopped abruptly?

• Rebound insomnia, anxiety, tremor, and in severe cases seizures
• Persistent euphoria and lack of sleep need
• No symptoms; immediate normalization of sleep
• Improved appetite and weight gain only

Correct Answer: Rebound insomnia, anxiety, tremor, and in severe cases seizures

Q47. The oral bioavailability of zolpidem is approximately:

• High (around 70–80%) with rapid absorption
• Negligible (<1%) due to first-pass elimination
• 100% only with intravenous administration
• Always increases with food to 200%

Correct Answer: High (around 70–80%) with rapid absorption

Q48. Which patient education point is important regarding alcohol use and zolpidem?

• Avoid alcohol because it potentiates sedation and respiratory depression
• Alcohol reduces zolpidem side effects and is encouraged
• Alcohol has no interaction with zolpidem
• Alcohol will accelerate zolpidem clearance making it less effective

Correct Answer: Avoid alcohol because it potentiates sedation and respiratory depression

Q49. Which of the following is a marketed alternative formulation of zolpidem intended for patients who have difficulty swallowing?

• Oral spray and sublingual tablets
• Intramuscular depot injections only
• Transdermal patches exclusively
• Rectal suppositories only

Correct Answer: Oral spray and sublingual tablets

Q50. When counseling a patient about discontinuing long-term zolpidem, the pharmacist should recommend:

• Gradual tapering and consideration of nonpharmacologic sleep measures
• Abrupt stoppage without supervision to prevent dependence
• Immediate switch to high-dose benzodiazepines without taper
• Doubling the dose for one week before stopping

Correct Answer: Gradual tapering and consideration of nonpharmacologic sleep measures

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