Introduction: Hypnotics MCQs With Answer provides B.Pharm students a focused, practical review of hypnotic pharmacology, therapeutic uses, adverse effects, mechanisms, and clinical considerations. This set emphasizes key drug classes—benzodiazepines, Z‑drugs, barbiturates, melatonin agonists, orexin antagonists, and antihistamines—plus concepts like GABA-A modulation, receptor subunits, pharmacokinetics, metabolism, tolerance, dependence, withdrawal, drug interactions, and overdose management. Expect questions on dosing in special populations, REM and sleep architecture effects, and antidotes such as flumazenil. Mastery of these topics strengthens clinical decision-making and safe dispensing. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which mechanism best describes how benzodiazepines exert their hypnotic effect?
- Increase duration of GABA-A receptor chloride channel opening
- Increase frequency of GABA-A receptor chloride channel opening
- Act as direct GABA-A receptor agonists at high affinity sites
- Block glutamate NMDA receptors
Correct Answer: Increase frequency of GABA-A receptor chloride channel opening
Q2. Which hypnotic class preferentially binds the alpha-1 subunit of the GABA-A receptor and is associated with sedation?
- Benzodiazepines (e.g., diazepam)
- Barbiturates (e.g., phenobarbital)
- Z-drugs (e.g., zolpidem)
- Melatonin receptor agonists (e.g., ramelteon)
Correct Answer: Z-drugs (e.g., zolpidem)
Q3. Which barbiturate effect distinguishes it from benzodiazepines at high doses?
- Increase in REM sleep duration
- Direct activation of GABA-A receptor leading to respiratory depression
- Selective binding to alpha-2 GABA-A subunits
- Competitive antagonism of benzodiazepine binding site
Correct Answer: Direct activation of GABA-A receptor leading to respiratory depression
Q4. Which hypnotic is recommended in patients with hepatic impairment due to primary glucuronidation metabolism?
- Diazepam
- Lorazepam
- Triazolam
- Flurazepam
Correct Answer: Lorazepam
Q5. Which agent is a selective melatonin MT1/MT2 receptor agonist used for sleep onset insomnia?
- Suvorexant
- Ramelteon
- Zaleplon
- Phenobarbital
Correct Answer: Ramelteon
Q6. Which statement about zolpidem is true?
- Causes prolonged active metabolites in elderly leading to daytime sedation
- Has high affinity for benzodiazepine binding site on all GABA-A subunits equally
- Preferentially binds alpha-1 GABA-A subunit producing hypnotic effect
- Is reversed by naloxone in overdose
Correct Answer: Preferentially binds alpha-1 GABA-A subunit producing hypnotic effect
Q7. Flumazenil is an antagonist used to reverse benzodiazepine effects; which is a major caution when using it?
- May precipitate seizures in chronic benzodiazepine users or tricyclic overdose
- Causes irreversible hepatic injury
- Increases barbiturate half-life
- Is ineffective after oral benzodiazepine ingestion
Correct Answer: May precipitate seizures in chronic benzodiazepine users or tricyclic overdose
Q8. Which hypnotic is an orexin receptor antagonist indicated for insomnia characterized by difficulty maintaining sleep?
- Suvorexant
- Eszopiclone
- Temazepam
- Diphenhydramine
Correct Answer: Suvorexant
Q9. Which adverse effect is most commonly associated with long-term benzodiazepine use?
- Progressive renal failure
- Dependence, tolerance, and withdrawal symptoms
- Marked increase in REM sleep leading to vivid dreams only
- Permanent improvement in sleep architecture
Correct Answer: Dependence, tolerance, and withdrawal symptoms
Q10. Which antihistamine is commonly used as an over-the-counter hypnotic due to anticholinergic sedation?
- Diphenhydramine
- Loratadine
- Fexofenadine
- Cetirizine
Correct Answer: Diphenhydramine
Q11. Which hypnotic has the shortest elimination half-life and is useful for sleep-onset insomnia with minimal next-day sedation?
- Zaleplon
- Flurazepam
- Clonazepam
- Long-acting barbiturate
Correct Answer: Zaleplon
Q12. A benzodiazepine with active metabolites that accumulate and prolong effects is:
- Alprazolam
- Diazepam
- Lorazepam
- Oxazepam
Correct Answer: Diazepam
Q13. Which hypnotic class is associated with significant REM suppression and potential for tolerance and fatal overdose when combined with alcohol?
- Benzodiazepines
- Z-drugs
- Barbiturates
- Melatonin agonists
Correct Answer: Barbiturates
Q14. Which drug interaction increases benzodiazepine plasma levels by inhibiting CYP3A4?
- Rifampin
- Carbamazepine
- Ketoconazole
- St. John’s Wort
Correct Answer: Ketoconazole
Q15. Which hypnotic is preferred in elderly patients due to shorter half-life and minimal active metabolites?
- Flurazepam
- Triazolam
- Lorazepam
- Chlordiazepoxide
Correct Answer: Lorazepam
Q16. Rebound insomnia after stopping a hypnotic is most likely seen with which agent?
- Eszopiclone after long-term use
- Ramelteon after single dose
- Zaleplon after a single use
- Suvorexant with gradual taper
Correct Answer: Eszopiclone after long-term use
Q17. Which hypnotic is contraindicated or used with extreme caution in pregnancy due to teratogenic and neonatal withdrawal risks?
- Melatonin
- Barbiturates
- Ramelteon
- Zaleplon
Correct Answer: Barbiturates
Q18. Which laboratory parameter is most relevant to monitor when prescribing long-term hypnotics with hepatic metabolism?
- Serum creatinine
- ALT and AST levels
- Serum amylase
- Hemoglobin and hematocrit
Correct Answer: ALT and AST levels
Q19. Which statement correctly compares benzodiazepines and barbiturates?
- Benzodiazepines increase channel opening duration; barbiturates increase frequency
- Benzodiazepines have a higher risk of lethal respiratory depression in overdose compared to barbiturates
- Barbiturates can directly activate GABA-A receptors at high doses, increasing overdose risk
- Both classes are equally safe when combined with alcohol
Correct Answer: Barbiturates can directly activate GABA-A receptors at high doses, increasing overdose risk
Q20. Which hypnotic is least likely to produce significant next‑day psychomotor impairment when used appropriately for sleep onset?
- Flurazepam
- Zaleplon
- Long-acting benzodiazepine
- High-dose diphenhydramine
Correct Answer: Zaleplon
Q21. Which clinical use is NOT an approved indication for zolpidem?
- Short-term management of insomnia
- Treatment of chronic generalized anxiety disorder
- Difficulty initiating sleep
- Short-term sleep disturbances
Correct Answer: Treatment of chronic generalized anxiety disorder
Q22. Which hypnotic is metabolized predominantly by CYP enzymes and may interact with potent inducers like carbamazepine?
- Temazepam (conjugated metabolism)
- Lorazepam (glucuronidation)
- Zolpidem (CYP-mediated metabolism)
- Oxazepam (conjugation)
Correct Answer: Zolpidem (CYP-mediated metabolism)
Q23. Which adverse effect is particularly associated with Z-drugs such as zolpidem and eszopiclone?
- Severe anticholinergic dry mouth only
- Complex sleep-related behaviors like sleepwalking and sleep-driving
- Profound daytime hypotension in all patients
- Permanent improvement in sleep latency
Correct Answer: Complex sleep-related behaviors like sleepwalking and sleep-driving
Q24. Which of the following hypnotics is primarily useful for sleep maintenance rather than sleep induction due to intermediate half-life?
- Triazolam
- Zaleplon
- Temazepam
- Zolpidem immediate-release
Correct Answer: Temazepam
Q25. Which statement about melatonin and ramelteon is correct?
- They act on GABA receptors directly to produce sedation
- They are controlled substances with high abuse potential
- They regulate circadian rhythm via MT1/MT2 receptors and are not sedative GABA modulators
- They cause severe respiratory depression in overdose
Correct Answer: They regulate circadian rhythm via MT1/MT2 receptors and are not sedative GABA modulators
Q26. Which pharmacologic strategy reduces withdrawal severity when discontinuing long-term benzodiazepines?
- Switch abruptly to a short-acting benzodiazepine
- Taper gradually, possibly substituting a long-acting benzodiazepine
- Start high-dose barbiturate to replace effects
- Give flumazenil repeatedly to prevent symptoms
Correct Answer: Taper gradually, possibly substituting a long-acting benzodiazepine
Q27. In a patient with insomnia and obstructive sleep apnea, which hypnotic should be used cautiously because it may worsen respiratory depression?
- Melatonin
- Benzodiazepines and Z-drugs
- Ramelteon
- Low-dose doxylamine
Correct Answer: Benzodiazepines and Z-drugs
Q28. Which monitoring or counseling point is most important when dispensing hypnotics to elderly B.Pharm patients?
- Encourage high daytime dosing for cumulative effect
- Warn about increased fall risk, next-day sedation, and drug interactions
- Advise to double the dose if sleep not improved first night
- No need for dose adjustment with renal or hepatic impairment
Correct Answer: Warn about increased fall risk, next-day sedation, and drug interactions
Q29. Which laboratory or clinical sign suggests benzodiazepine overdose rather than opioid overdose?
- Severe pinpoint pupils (miosis)
- Marked respiratory depression with nonreactive pinpoint pupils
- Sedation with ataxia but relatively preserved respiratory drive
- Hyperreflexia and dilated pupils
Correct Answer: Sedation with ataxia but relatively preserved respiratory drive
Q30. Which practice is recommended as first-line management for chronic insomnia before initiating pharmacologic hypnotics?
- Start a short course of high-dose benzodiazepine immediately
- Implement cognitive behavioral therapy for insomnia (CBT-I) and sleep hygiene
- Prescribe long-acting barbiturates for sleep consolidation
- Use over-the-counter antihistamines indefinitely
Correct Answer: Implement cognitive behavioral therapy for insomnia (CBT-I) and sleep hygiene
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com