Antianxiety agents MCQs With Answer

Introduction

Antianxiety agents (anxiolytics) are a core topic in pharmacology for B.Pharm students, covering drug classes such as benzodiazepines, buspirone, SSRIs, SNRIs, beta‑blockers, barbiturates and gabapentinoids. Understanding mechanisms of action (GABA modulation, 5‑HT1A agonism), pharmacokinetics (half‑life, active metabolites), therapeutic uses, adverse effects, dependence, withdrawal and drug interactions is essential for safe dispensing and clinical counseling. This review emphasizes key concepts: onset and duration, receptor selectivity, contraindications in pregnancy and the elderly, and management of overdose. Focused practice with clinically oriented MCQs reinforces memory and application. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which mechanism best describes how benzodiazepines produce their anxiolytic effect?

• Directly opening GABA-A chloride channels without GABA
• Increasing the frequency of GABA-A receptor chloride channel opening
• Blocking GABA reuptake transporters
• Antagonizing NMDA glutamate receptors

Correct Answer: Increasing the frequency of GABA-A receptor chloride channel opening

Q2. Buspirone’s primary pharmacological action responsible for anxiolysis is:

• Selective serotonin reuptake inhibition
• Partial agonism at 5-HT1A receptors
• Antagonism at GABA-A receptors
• Beta‑adrenergic blockade

Correct Answer: Partial agonism at 5-HT1A receptors

Q3. Which benzodiazepine is least likely to accumulate in elderly patients due to lack of active metabolites?

• Diazepam
• Chlordiazepoxide
• Lorazepam
• Clorazepate

Correct Answer: Lorazepam

Q4. Flumazenil is used in benzodiazepine overdose because it is:

• A GABA-A receptor agonist
• A benzodiazepine receptor antagonist
• A CYP3A4 inducer
• An inverse agonist at benzodiazepine sites

Correct Answer: A benzodiazepine receptor antagonist

Q5. Which statement correctly contrasts barbiturates and benzodiazepines?

• Barbiturates increase frequency, benzodiazepines increase duration of channel opening
• Both act as selective 5-HT1A agonists
• Barbiturates increase duration of GABA-A channel opening and can directly activate the channel at high doses
• Benzodiazepines directly open chloride channels without GABA

Correct Answer: Barbiturates increase duration of GABA-A channel opening and can directly activate the channel at high doses

Q6. Which anxiolytic is preferred for performance (situational) anxiety due to rapid onset and effect on somatic symptoms?

• Propranolol
• Buspirone
• Fluvoxamine
• Pregabalin

Correct Answer: Propranolol

Q7. A patient on diazepam develops increased sedation when started on erythromycin. The most likely mechanism is:

• Cytochrome P450 inhibition reducing diazepam clearance
• Induction of renal excretion of diazepam
• Competition at GABA-A receptor causing additive antagonism
• Increased biliary excretion of diazepam

Correct Answer: Cytochrome P450 inhibition reducing diazepam clearance

Q8. Which adverse effect is most characteristic of long‑term benzodiazepine therapy?

• Ototoxicity
• Dependence and withdrawal syndrome
• Permanent renal failure
• Thyroid dysfunction

Correct Answer: Dependence and withdrawal syndrome

Q9. Which agent is NOT primarily used as an anxiolytic but may treat generalized anxiety disorder off‑label or when others fail?

• Hydroxyzine
• Barbiturates (e.g., phenobarbital)
• Prazosin
• Pepcid (famotidine)

Correct Answer: Hydroxyzine

Q10. Which class of antidepressants is commonly first-line pharmacotherapy for chronic anxiety disorders due to efficacy and safety?

• Tricyclic antidepressants
• Monoamine oxidase inhibitors
• Selective serotonin reuptake inhibitors (SSRIs)
• Typical antipsychotics

Correct Answer: Selective serotonin reuptake inhibitors (SSRIs)

Q11. Pregabalin’s anxiolytic activity is primarily due to binding to:

• GABA-A receptor benzodiazepine site
• Alpha2-delta subunit of voltage-gated calcium channels
• Serotonin transporter (SERT)
• Dopamine D2 receptors

Correct Answer: Alpha2-delta subunit of voltage-gated calcium channels

Q12. Which benzodiazepine property explains rapid onset of action for acute anxiety?

• High water solubility and slow CNS penetration
• High lipid solubility and rapid CNS penetration
• Strong plasma protein binding preventing brain access
• Renal excretion without hepatic metabolism

Correct Answer: High lipid solubility and rapid CNS penetration

Q13. In pregnancy, which anxiolytic is most strongly associated with congenital malformations and is generally avoided?

• Benzodiazepines (first trimester risk)
• Buspirone
• SSRIs (all are safe)
• Propranolol

Correct Answer: Benzodiazepines (first trimester risk)

Q14. Which of the following describes a common feature of benzodiazepine withdrawal?

• Bradycardia and hypothermia
• Insomnia, anxiety rebound, tremor and, in severe cases, seizures
• Hypersalivation and miosis
• Hypoglycemia and metabolic acidosis

Correct Answer: Insomnia, anxiety rebound, tremor and, in severe cases, seizures

Q15. Which laboratory or clinical monitoring is most relevant when initiating an SSRI for anxiety in a B.Pharm counseling role?

• Serum sodium for hyponatremia risk
• Liver biopsy
• Random blood glucose for immediate changes
• Serum creatine kinase

Correct Answer: Serum sodium for hyponatremia risk

Q16. Which statement about buspirone is true regarding onset of therapeutic effect?

• It provides immediate relief within minutes
• It typically requires 2–4 weeks to show anxiolytic efficacy
• It acts as a long-acting benzodiazepine substitute in withdrawal within 24 hours
• It causes profound sedation on first dose

Correct Answer: It typically requires 2–4 weeks to show anxiolytic efficacy

Q17. When counseling about benzodiazepine use, which advice is most important to reduce risk of adverse effects?

• Avoid concurrent alcohol or opioids due to additive CNS depression
• Double the dose if anxiety recurs
• Take with grapefruit juice to enhance effect
• Stop abruptly after any use to prevent tolerance

Correct Answer: Avoid concurrent alcohol or opioids due to additive CNS depression

Q18. Which pharmacokinetic feature explains why diazepam has a long duration of action?

• Rapid renal excretion of unchanged drug
• Formation of active, long‑half‑life metabolites
• Complete first‑pass hepatic inactivation
• Exclusive metabolism by monoamine oxidase

Correct Answer: Formation of active, long‑half‑life metabolites

Q19. Flunitrazepam is classified as a benzodiazepine; which unique concern is associated with such agents illicitly used?

• Increased risk of hypertensive crisis
• Use as “date‑rape” drugs due to profound amnesia and sedation
• Induction of serotonin syndrome
• Severe hyperthermia

Correct Answer: Use as “date‑rape” drugs due to profound amnesia and sedation

Q20. Which is the best pharmacological approach for acute severe anxiety with risk of seizure during benzodiazepine withdrawal?

• Start a benzodiazepine taper using a long‑acting agent
• Immediate initiation of MAOI therapy
• Switch to typical antipsychotics only
• Use beta‑blockers as monotherapy

Correct Answer: Start a benzodiazepine taper using a long‑acting agent

Q21. Which drug interaction increases risk when combining SSRIs with other serotonergic agents in anxiety treatment?

• Risk of serotonin syndrome with triptans or MAOIs
• Reduced SSRI effect with MAOIs
• Enhanced clearance of SSRIs by grapefruit juice
• SSRIs neutralize benzodiazepine sedative effects

Correct Answer: Risk of serotonin syndrome with triptans or MAOIs

Q22. Which anxiolytic is least likely to cause cognitive impairment or sedation at therapeutic doses?

• Diazepam
• Alprazolam
• Buspirone
• Phenobarbital

Correct Answer: Buspirone

Q23. Which receptor subunit selectivity is associated with benzodiazepine anxiolysis versus sedation, according to subunit pharmacology?

• Alpha1 subunit mediates anxiolysis, alpha2/alpha3 sedation
• Alpha2/alpha3 subunits mediate anxiolysis, alpha1 mediates sedation
• Delta subunit is responsible for anxiolysis
• Gamma subunit causes tolerance

Correct Answer: Alpha2/alpha3 subunits mediate anxiolysis, alpha1 mediates sedation

Q24. A patient with hepatic impairment requires anxiolytic therapy. Which choice is preferable due to minimal hepatic metabolism?

• Diazepam
• Oxazepam or lorazepam
• Clonazepam
• Chlordiazepoxide

Correct Answer: Oxazepam or lorazepam

Q25. Which pharmacologic property makes pregabalin useful in generalized anxiety disorder?

• Direct agonism at GABA-B receptors
• Modulation of calcium channel alpha2-delta subunit reducing excitatory neurotransmitter release
• Serotonin reuptake inhibition
• Competitive NMDA antagonism

Correct Answer: Modulation of calcium channel alpha2-delta subunit reducing excitatory neurotransmitter release

Q26. Which adverse effect is specifically associated with SSRIs when used to treat anxiety?

• Dependence with severe withdrawal in one dose
• Sexual dysfunction and possible delayed onset of anxiolysis
• Immediate sedation like benzodiazepines
• Significant cholestatic jaundice in all patients

Correct Answer: Sexual dysfunction and possible delayed onset of anxiolysis

Q27. In treating panic disorder, which combination is commonly used during initial phase to provide rapid relief while waiting for SSRI effect?

• Beta‑blocker plus buspirone
• Benzodiazepine short course plus SSRI
• Barbiturate plus MAOI
• Pregabalin plus tricyclic antidepressant

Correct Answer: Benzodiazepine short course plus SSRI

Q28. Which characteristic is typical of benzodiazepine tolerance development?

• Tolerance develops uniformly to anxiolytic, sedative, and anticonvulsant effects
• Tolerance develops faster to hypnotic and sedative effects than to anxiolytic effects
• No tolerance occurs even after years of therapy
• Tolerance only occurs with intravenous use

Correct Answer: Tolerance develops faster to hypnotic and sedative effects than to anxiolytic effects

Q29. For a patient on long‑term benzodiazepines, which tapering strategy is recommended to minimize withdrawal?

• Abrupt cessation after 2 weeks
• Switch to a long‑acting benzodiazepine and slowly reduce dose over weeks to months
• Replace with barbiturate immediately
• Double dose then stop after one week

Correct Answer: Switch to a long‑acting benzodiazepine and slowly reduce dose over weeks to months

Q30. Which statement best reflects the pharmacist’s role regarding antianxiety agents?

• Pharmacists only dispense and do not counsel on adverse effects or interactions
• Pharmacists ensure appropriate selection, counsel on side effects, interactions, dependence risk and adherence
• Pharmacists can prescribe benzodiazepines without monitoring
• Pharmacists should advise patients to double doses if anxiety persists

Correct Answer: Pharmacists ensure appropriate selection, counsel on side effects, interactions, dependence risk and adherence

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