Alprazolam MCQs With Answer

Alprazolam is a commonly used benzodiazepine important for anxiety and panic disorder management, making Alprazolam MCQs With Answer essential study material for B.Pharm students. This concise, keyword-rich introduction covers mechanism of action at GABA-A receptors, pharmacokinetics (absorption, CYP3A4 metabolism, half-life), clinical indications, adverse effects, dependence, withdrawal and drug interactions. Questions focus on dosing, formulations, special population adjustments, toxicity management and counselling points relevant to pharmacy practice and exams. Detailed MCQs reinforce core concepts needed for dispensing, therapeutics and safe medication use. Answers are provided to aid revision and self-assessment. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary mechanism of action of alprazolam?

• Direct agonist at GABA-B receptors causing potassium efflux
• Positive allosteric modulation of GABA-A receptors increasing chloride influx
• Inhibition of serotonin reuptake in presynaptic neurons
• Antagonism at NMDA receptors reducing glutamate activity

Correct Answer: Positive allosteric modulation of GABA-A receptors increasing chloride influx

Q2. Alprazolam belongs to which pharmacological class?

• Selective serotonin reuptake inhibitors
• Benzodiazepines
• Barbiturates
• Beta blockers

Correct Answer: Benzodiazepines

Q3. Which enzyme primarily metabolizes alprazolam?

• CYP2D6
• CYP1A2
• CYP3A4
• CYP2C19

Correct Answer: CYP3A4

Q4. The usual pharmacological effect of alprazolam in anxiety is:

• Long-term antidepressant action
• Rapid anxiolysis and sedation
• Peripheral vasodilation reducing blood pressure
• Anticholinergic activity

Correct Answer: Rapid anxiolysis and sedation

Q5. Which of the following is a common adverse effect of alprazolam?

• Hypertension
• Excessive sedation and drowsiness
• Hyperreflexia
• Severe hyperglycaemia

Correct Answer: Excessive sedation and drowsiness

Q6. Alprazolam is contraindicated or used with caution in which population?

• Healthy young adults with normal liver function
• Pregnant and breastfeeding women
• Patients with seasonal allergies
• Patients receiving topical antibiotics

Correct Answer: Pregnant and breastfeeding women

Q7. Abrupt discontinuation of alprazolam after long-term use may lead to:

• Gastrointestinal bleeding
• Withdrawal symptoms including anxiety, insomnia and seizures
• Improved cognitive performance
• Permanent weight loss

Correct Answer: Withdrawal symptoms including anxiety, insomnia and seizures

Q8. Which drug can significantly increase alprazolam plasma concentrations by CYP3A4 inhibition?

• Rifampicin
• Ketoconazole
• Carbamazepine
• St. John’s Wort

Correct Answer: Ketoconazole

Q9. Which agent is used as an antidote for benzodiazepine overdose including alprazolam?

• Naloxone
• Flumazenil
• Atropine
• Physostigmine

Correct Answer: Flumazenil

Q10. Alprazolam’s approximate elimination half-life in healthy adults is:

• 1–2 hours
• 6–12 hours
• 11–16 hours
• 24–48 hours

Correct Answer: 11–16 hours

Q11. Which of the following clinical uses is FDA-approved for alprazolam?

• Major depressive disorder
• Panic disorder with or without agoraphobia
• Chronic neuropathic pain
• Attention deficit hyperactivity disorder

Correct Answer: Panic disorder with or without agoraphobia

Q12. Combining alprazolam with which substance greatly increases risk of respiratory depression?

• Acetaminophen
• Alcohol
• Vitamin C
• Topical steroid

Correct Answer: Alcohol

Q13. Alprazolam’s onset of action after oral administration is generally:

• Delayed (>8 hours)
• Slow (4–6 hours)
• Rapid (within 1 hour)
• Immediate (within seconds)

Correct Answer: Rapid (within 1 hour)

Q14. Which formulation of alprazolam provides prolonged drug release?

• Immediate-release tablet
• Extended-release tablet
• Intravenous solution
• Topical cream

Correct Answer: Extended-release tablet

Q15. Which pharmacodynamic property contributes to alprazolam tolerance with chronic use?

• Increased GABA-A receptor sensitivity
• Down-regulation of GABA-A receptor function
• Permanent enhancement of chloride channels
• Irreversible binding to benzodiazepine site

Correct Answer: Down-regulation of GABA-A receptor function

Q16. Alprazolam is categorized as which schedule or class regarding potential for abuse in many countries?

• Over-the-counter (no control)
• Controlled substance with abuse potential
• Non-addictive supplement
• Restricted only to hospital use

Correct Answer: Controlled substance with abuse potential

Q17. Which laboratory test is most useful to monitor alprazolam therapy routinely?

• Therapeutic drug monitoring of serum levels routinely for all patients
• Complete blood count weekly
• Routine liver function tests only when clinically indicated
• Daily ECG monitoring

Correct Answer: Routine liver function tests only when clinically indicated

Q18. In elderly patients, alprazolam dosing should be adjusted because of:

• Faster metabolic clearance
• Increased sensitivity and risk of sedation and falls
• Enhanced renal excretion of drug metabolites
• Improved tolerance leading to higher effective doses

Correct Answer: Increased sensitivity and risk of sedation and falls

Q19. The major hepatic metabolite pathway of alprazolam produces:

• Active metabolites with strong anticonvulsant action
• Inactive hydroxylated metabolites excreted in urine
• Direct glucuronides excreted in bile
• Conversion to benzodiazepine antagonists

Correct Answer: Inactive hydroxylated metabolites excreted in urine

Q20. Which symptom is NOT typical of alprazolam withdrawal?

• Rebound anxiety
• Insomnia
• Seizures
• Persistent hyperglycaemia

Correct Answer: Persistent hyperglycaemia

Q21. Which interaction decreases alprazolam plasma levels?

• Coadministration with ketoconazole
• Coadministration with erythromycin
• Coadministration with rifampicin
• Coadministration with diltiazem

Correct Answer: Coadministration with rifampicin

Q22. Alprazolam’s action at the GABA-A receptor is mediated via binding to:

• The benzodiazepine recognition site between alpha and gamma subunits
• The orthosteric GABA binding site
• The glutamate binding pocket
• The intracellular kinase domain

Correct Answer: The benzodiazepine recognition site between alpha and gamma subunits

Q23. Which clinical scenario is a major precaution for alprazolam use?

• Mild intermittent headaches
• Severe sleep apnea or respiratory insufficiency
• Seasonal allergic rhinitis
• Mild isolated hypertension

Correct Answer: Severe sleep apnea or respiratory insufficiency

Q24. For panic disorder, typical initial adult dosing of alprazolam immediate-release is:

• 0.25–0.5 mg three times daily
• 10 mg once daily
• 50 mg twice daily
• 0.01 mg/kg hourly

Correct Answer: 0.25–0.5 mg three times daily

Q25. Which statement about alprazolam and pregnancy is correct?

• Safe and recommended throughout pregnancy
• Associated with neonatal withdrawal and possible congenital anomalies; avoid if possible
• Increases fetal IQ and development
• Has no placental transfer

Correct Answer: Associated with neonatal withdrawal and possible congenital anomalies; avoid if possible

Q26. Which condition may be treated off-label with alprazolam?

• Severe bacterial infection
• Adjunctive treatment for severe chemotherapy-induced nausea
• Short-term management of acute anxiety in palliative care
• Primary treatment of hypertension

Correct Answer: Short-term management of acute anxiety in palliative care

Q27. Co-prescription of alprazolam with strong opioids requires caution due to:

• Risk of renal stones
• Increased risk of CNS depression and fatal respiratory depression
• Complete antagonism of opioid effect
• Reduced opioid bioavailability

Correct Answer: Increased risk of CNS depression and fatal respiratory depression

Q28. Which monitoring advice should a pharmacist give to a patient starting alprazolam?

• Drive and operate heavy machinery until you know how the drug affects you
• No need to avoid alcohol while taking alprazolam
• Take with grapefruit juice to enhance absorption
• Stop the drug abruptly if you feel sleepy

Correct Answer: Drive and operate heavy machinery until you know how the drug affects you

Q29. Which sign suggests alprazolam overdose?

• Hyperactive reflexes and agitation only
• Excessive sedation, slurred speech, respiratory depression
• Sharp, localized chest pain exclusively
• Isolated high fever without CNS signs

Correct Answer: Excessive sedation, slurred speech, respiratory depression

Q30. Which of the following best describes tolerance to alprazolam’s effects?

• Tolerance develops uniformly to anxiolytic and anticonvulsant effects
• Tolerance develops to sedative effects more rapidly than anxiolytic effects
• Tolerance never develops
• Tolerance only occurs with parenteral use

Correct Answer: Tolerance develops to sedative effects more rapidly than anxiolytic effects

Q31. In hepatic impairment, alprazolam dosing should be:

• Increased due to enhanced clearance
• Unchanged; no adjustment needed
• Reduced and titrated cautiously
• Switched to a CYP3A4 inducer

Correct Answer: Reduced and titrated cautiously

Q32. The most appropriate tapering strategy after long-term alprazolam use is to:

• Stop abruptly to avoid prolonged side effects
• Switch immediately to alcohol to reduce withdrawal
• Gradually reduce dose over weeks to months to minimize withdrawal risk
• Double the dose for a week before stopping

Correct Answer: Gradually reduce dose over weeks to months to minimize withdrawal risk

Q33. Which symptom is an early sign of alprazolam therapeutic effect in anxiety?

• Marked increase in blood pressure
• Reduction in subjective anxiety and muscle tension
• Complete loss of appetite
• Immediate euphoria lasting weeks

Correct Answer: Reduction in subjective anxiety and muscle tension

Q34. Which laboratory finding is most likely unrelated to alprazolam use?

• Mild transient liver enzyme changes
• Marked leukopenia in all patients
• No routine electrolyte disturbance directly caused
• Normal renal function unless comorbid disease

Correct Answer: Marked leukopenia in all patients

Q35. Which counseling point is essential regarding storage and misuse prevention?

• Store alprazolam with household chemicals for potency
• Keep medication in a secure place to prevent diversion and misuse
• Share remaining tablets with family members if unused
• Flush all unused tablets immediately down the toilet

Correct Answer: Keep medication in a secure place to prevent diversion and misuse

Q36. Which benzodiazepine property most influences alprazolam’s clinical duration?

• Water solubility only
• Elimination half-life and formulation
• Topical absorption rate
• Binding to plasma albumin exclusively

Correct Answer: Elimination half-life and formulation

Q37. In a mixed overdose with tricyclic antidepressants, use of flumazenil is:

• Always safe and recommended
• Potentially hazardous due to seizure risk and should be avoided
• Required to reverse anticholinergic effects
• Ineffective because flumazenil is an opioid antagonist

Correct Answer: Potentially hazardous due to seizure risk and should be avoided

Q38. Which pharmacokinetic property explains once-daily dosing of extended-release alprazolam?

• High renal clearance requiring frequent dosing
• Slow release from formulation maintaining plasma levels
• Rapid hepatic metabolism making once-daily ineffective
• Poor oral absorption

Correct Answer: Slow release from formulation maintaining plasma levels

Q39. Which symptom may indicate paradoxical reaction to alprazolam?

• Calm, sedated behavior
• Increased agitation, aggression or insomnia
• Marked weight gain
• Loss of hearing

Correct Answer: Increased agitation, aggression or insomnia

Q40. For a patient on chronic alprazolam, which strategy reduces dependence risk most effectively?

• Use the lowest effective dose for the shortest possible duration
• Increase dose intermittently to avoid tolerance
• Combine with alcohol to reduce dose requirements
• Take alternate-day high doses

Correct Answer: Use the lowest effective dose for the shortest possible duration

Q41. Alprazolam is listed as a preferred agent in which acute psychiatric situation?

• Acute severe psychosis as monotherapy
• Short-term control of severe acute anxiety or panic attacks
• Long-term maintenance of bipolar mania
• Primary treatment for schizophrenia

Correct Answer: Short-term control of severe acute anxiety or panic attacks

Q42. Which over-the-counter product may interact with alprazolam by inducing CYP enzymes and lowering levels?

• Grapefruit juice
• St. John’s Wort
• Kava kava
• Milk thistle

Correct Answer: St. John’s Wort

Q43. Which statement about alprazolam pharmacology is TRUE?

• It directly activates GABA-A receptors without GABA presence
• It enhances GABAergic inhibition but requires GABA for effect
• It blocks chloride channels reducing inhibition
• It selectively inhibits dopamine reuptake

Correct Answer: It enhances GABAergic inhibition but requires GABA for effect

Q44. Which patient report should prompt immediate evaluation for alprazolam adverse effects?

• Occasional mild dry mouth
• Difficulty breathing or severe drowsiness
• Mild transient headache after dosing
• Regular bowel movements

Correct Answer: Difficulty breathing or severe drowsiness

Q45. Which of the following best describes alprazolam’s effect on cognition with acute use?

• Improved attention and reaction time
• Possible impairment of memory and psychomotor performance
• Permanent cognitive enhancement
• No central nervous system effects

Correct Answer: Possible impairment of memory and psychomotor performance

Q46. Which strategy is recommended when switching a patient from another benzodiazepine to alprazolam?

• Stop the first benzodiazepine abruptly and start high-dose alprazolam
• Use equivalent dosing and a carefully planned cross-taper to avoid withdrawal
• Combine both agents at full doses indefinitely
• Switch to alprazolam without adjusting doses because all benzodiazepines are identical

Correct Answer: Use equivalent dosing and a carefully planned cross-taper to avoid withdrawal

Q47. Which effect is least likely when alprazolam is used at therapeutic doses?

• Anxiolysis
• Respiratory depression in healthy adults at normal doses
• Mild sedation
• Amnestic effects

Correct Answer: Respiratory depression in healthy adults at normal doses

Q48. Which statement regarding alprazolam and liver enzyme inducers is correct?

• Inducers like carbamazepine reduce alprazolam levels and may require dose increase
• Inducers increase alprazolam levels causing toxicity
• Inducers have no effect on alprazolam metabolism
• Inducers permanently inhibit alprazolam excretion

Correct Answer: Inducers like carbamazepine reduce alprazolam levels and may require dose increase

Q49. Which clinical monitoring is most important during long-term alprazolam therapy?

• Monitor for signs of dependence, misuse, cognitive impairment and fall risk
• Daily complete metabolic panel regardless of symptoms
• Monthly brain MRI scans
• No monitoring required after initial prescription

Correct Answer: Monitor for signs of dependence, misuse, cognitive impairment and fall risk

Q50. Which describes an appropriate pharmacist action if a patient reports daytime drowsiness on alprazolam?

• Advise immediate doubling of the dose at night
• Assess timing and dose, consider dose reduction or switching formulation and counsel on safety precautions
• Recommend stopping all other prescribed medications without consulting the prescriber
• Suggest consuming alcohol to offset sedation

Correct Answer: Assess timing and dose, consider dose reduction or switching formulation and counsel on safety precautions

G S Sachin

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