Diazepam MCQs With Answer

Diazepam MCQs With Answer set is tailored for B.Pharm students seeking a concise, high-yield review of diazepam pharmacology. This collection covers diazepam mechanism of action, pharmacokinetics, active metabolites, clinical indications (anxiety, seizures, muscle spasm, status epilepticus), dosing, adverse effects, drug interactions, special population considerations, overdose management and antidote use. Questions emphasize receptor pharmacodynamics, CYP-mediated metabolism, formulation differences and monitoring for safety in elderly, hepatic impairment and polypharmacy. Use these targeted MCQs to strengthen clinical reasoning and exam preparedness with practical, curriculum-relevant scenarios and focused facts. Now let’s test your knowledge with 50 MCQs on this topic.

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

• Inhibition of monoamine oxidase
• Blockade of NMDA receptors
• Enhancement of GABA_A receptor-mediated chloride influx
• Activation of opioid receptors

Correct Answer: Enhancement of GABA_A receptor-mediated chloride influx (Enhancement of GABA_A receptor-mediated chloride influx)

Q2. Diazepam most directly binds to which site on the GABA_A receptor?

• Barbiturate binding site
• Benzodiazepine binding site between α and γ subunits
• Picrotoxin binding site
• GABA orthosteric binding site

Correct Answer: Benzodiazepine binding site between α and γ subunits (Benzodiazepine binding site between α and γ subunits)

Q3. Which effect is primarily mediated via α1-subunit containing GABA_A receptors?

• Anxiolysis
• Sedation and hypnotic effects
• Muscle relaxation
• Anticonvulsant activity

Correct Answer: Sedation and hypnotic effects (Sedation and hypnotic effects)

Q4. Which active metabolite of diazepam contributes to its prolonged action?

• Flumazenil
• Nordiazepam (desmethyldiazepam)
• Lorazepam
• Clonazepam

Correct Answer: Nordiazepam (desmethyldiazepam) (Nordiazepam (desmethyldiazepam))

Q5. Which cytochrome P450 isoenzymes primarily metabolize diazepam?

• CYP1A2 and CYP2E1
• CYP2D6 and CYP2C9
• CYP3A4 and CYP2C19
• CYP4A11 and CYP2A6

Correct Answer: CYP3A4 and CYP2C19 (CYP3A4 and CYP2C19)

Q6. Which pharmacokinetic property of diazepam explains its rapid onset after IV administration?

• Low plasma protein binding
• High water solubility
• High lipid solubility and rapid CNS redistribution
• Slow hepatic clearance

Correct Answer: High lipid solubility and rapid CNS redistribution (High lipid solubility and rapid CNS redistribution)

Q7. Typical elimination half-life range for diazepam (parent drug) in adults is approximately:

• 1–3 hours
• 6–12 hours
• 20–50 hours
• 200–300 hours

Correct Answer: 20–50 hours (20–50 hours)

Q8. Which clinical use is NOT a standard indication for diazepam?

• Acute anxiety and panic
• Status epilepticus initial control
• Chronic pain as sole therapy
• Muscle spasm management

Correct Answer: Chronic pain as sole therapy (Chronic pain as sole therapy)

Q9. Which formulation of diazepam is commonly used for rapid control of seizures in pediatric or home settings?

• Transdermal patch
• Rectal gel
• Nasal spray only
• Oral immediate-release tablet exclusively

Correct Answer: Rectal gel (Rectal gel)

Q10. What is the recommended immediate antidote for benzodiazepine overdose in a monitored setting?

• Naloxone
• Flumazenil
• Activated charcoal
• Physostigmine

Correct Answer: Flumazenil (Flumazenil)

Q11. Which patient group requires dose reduction and careful monitoring when using diazepam?

• Young healthy adults
• Pediatric patients only
• Elderly patients and those with hepatic impairment
• Patients with hyperthyroidism

Correct Answer: Elderly patients and those with hepatic impairment (Elderly patients and those with hepatic impairment)

Q12. Co-administration of diazepam with which drug class increases risk of severe respiratory depression?

• Proton pump inhibitors
• Opioid analgesics
• H2 receptor antagonists
• Antibiotics without CNS effects

Correct Answer: Opioid analgesics (Opioid analgesics)

Q13. Which statement about diazepam tolerance and dependence is correct?

• Tolerance never develops to sedative effects
• Physical dependence can develop after weeks to months of regular use
• Dependence is impossible with low doses
• Tapering is unnecessary when stopping chronic therapy

Correct Answer: Physical dependence can develop after weeks to months of regular use (Physical dependence can develop after weeks to months of regular use)

Q14. Which of the following is a common adverse effect of diazepam?

• Hypertension
• Excessive drowsiness and dizziness
• Hyperreflexia
• Increased appetite only

Correct Answer: Excessive drowsiness and dizziness (Excessive drowsiness and dizziness)

Q15. In hepatic impairment, diazepam dosing should be:

• Unchanged due to renal elimination
• Increased to overcome reduced effect
• Reduced or used with caution due to decreased clearance
• Abolished and replaced by barbiturates

Correct Answer: Reduced or used with caution due to decreased clearance (Reduced or used with caution due to decreased clearance)

Q16. Which test or monitoring parameter is most relevant when assessing diazepam accumulation risk?

• Electrolyte panel
• Liver function tests
• Fasting blood glucose
• ECG only

Correct Answer: Liver function tests (Liver function tests)

Q17. Which drug is a potent CYP3A4 inhibitor likely to increase diazepam plasma concentrations?

• Rifampicin
• Carbamazepine
• Ketoconazole
• Phenobarbital

Correct Answer: Ketoconazole (Ketoconazole)

Q18. Which metabolic pathway converts diazepam into oxazepam (a conjugatable metabolite)?

• Direct glucuronidation of diazepam
• N-demethylation to nordiazepam followed by hydroxylation
• Oxidation to temazepam only
• Phase II sulfation exclusively

Correct Answer: N-demethylation to nordiazepam followed by hydroxylation (N-demethylation to nordiazepam followed by hydroxylation)

Q19. For status epilepticus in adults, which statement about IV diazepam is correct?

• IV diazepam has slow onset and is rarely used
• IV diazepam is used for rapid seizure termination but has short duration due to redistribution
• IV diazepam is the only recommended long-term anticonvulsant
• Oral diazepam is preferred for status epilepticus

Correct Answer: IV diazepam is used for rapid seizure termination but has short duration due to redistribution (IV diazepam is used for rapid seizure termination but has short duration due to redistribution)

Q20. Which statement about flumazenil use in diazepam overdose is TRUE?

• Flumazenil is safe in chronic benzodiazepine users without risk
• Flumazenil may precipitate seizures in patients with long-term benzodiazepine use or mixed overdose
• Flumazenil acts as a benzodiazepine agonist
• Flumazenil is indicated for opioid overdose

Correct Answer: Flumazenil may precipitate seizures in patients with long-term benzodiazepine use or mixed overdose (Flumazenil may precipitate seizures in patients with long-term benzodiazepine use or mixed overdose)

Q21. Which contraindication is classically listed for diazepam?

• Open-angle glaucoma
• Acute narrow-angle glaucoma
• Hypertension
• Benign prostatic hyperplasia only

Correct Answer: Acute narrow-angle glaucoma (Acute narrow-angle glaucoma)

Q22. Diazepam is classified pharmacologically as which of the following?

• Barbiturate
• Benzodiazepine
• Beta blocker
• Anticholinergic

Correct Answer: Benzodiazepine (Benzodiazepine)

Q23. Which physicochemical property of diazepam enhances its penetration into the CNS?

• High water solubility
• High protein binding only
• High lipid solubility
• High molecular weight preventing BBB crossing

Correct Answer: High lipid solubility (High lipid solubility)

Q24. Which route provides the fastest systemic onset for diazepam?

• Oral tablet
• Rectal gel
• Intravenous injection
• Topical application

Correct Answer: Intravenous injection (Intravenous injection)

Q25. Which adverse effect is particularly concerning in elderly patients treated with diazepam?

• Lower risk of falls
• Increased risk of cognitive impairment and falls
• Marked hypertension improvement
• Enhanced hepatic regeneration

Correct Answer: Increased risk of cognitive impairment and falls (Increased risk of cognitive impairment and falls)

Q26. Which statement best describes diazepam’s protein binding?

• Diazepam is not protein bound
• Diazepam is highly protein bound (~98%)
• Diazepam is moderately protein bound (~50%)
• Diazepam binding is negligible in overdose

Correct Answer: Diazepam is highly protein bound (~98%) (Diazepam is highly protein bound (~98%))

Q27. Which benzodiazepine property explains prolonged effects with chronic use?

• Only renal excretion without metabolism
• Active metabolites with long half-lives and tissue accumulation
• Complete lack of metabolism
• Rapid elimination prevents accumulation

Correct Answer: Active metabolites with long half-lives and tissue accumulation (Active metabolites with long half-lives and tissue accumulation)

Q28. Co-administration of rifampicin with diazepam will most likely cause:

• Increased diazepam plasma levels
• No change in diazepam levels
• Decreased diazepam plasma levels due to enzyme induction
• Immediate hepatic failure

Correct Answer: Decreased diazepam plasma levels due to enzyme induction (Decreased diazepam plasma levels due to enzyme induction)

Q29. Which of the following is the most appropriate approach to stop long-term diazepam therapy?

• Stop abruptly to prevent dependence
• Taper dose gradually to reduce withdrawal risk
• Switch immediately to an opioid
• Double the dose for one week then stop

Correct Answer: Taper dose gradually to reduce withdrawal risk (Taper dose gradually to reduce withdrawal risk)

Q30. Which symptom is characteristic of benzodiazepine withdrawal?

• Hyporeflexia without agitation
• Insomnia, anxiety, tremor and in severe cases seizures
• Bradycardia and hypotension only
• Marked hyponatremia as sole feature

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

Q31. Which clinical use of diazepam exploits its muscle relaxant property?

• Treatment of bacterial infections
• Management of spasticity and muscle spasms
• Lipid-lowering therapy
• Antiviral prophylaxis

Correct Answer: Management of spasticity and muscle spasms (Management of spasticity and muscle spasms)

Q32. Which laboratory parameter is most likely to be altered by chronic high-dose diazepam use?

• Serum creatinine exclusively
• Liver enzymes (AST/ALT) in hepatic injury
• Plasma glucose dramatically
• Serum potassium markedly

Correct Answer: Liver enzymes (AST/ALT) in hepatic injury (Liver enzymes (AST/ALT) in hepatic injury)

Q33. Which statement about diazepam use during pregnancy is correct?

• It is completely safe throughout pregnancy
• It is associated with potential teratogenicity and neonatal issues; use only if clearly needed
• It is the preferred anxiolytic in pregnancy
• It has no effects on fetus or newborn

Correct Answer: It is associated with potential teratogenicity and neonatal issues; use only if clearly needed (It is associated with potential teratogenicity and neonatal issues; use only if clearly needed)

Q34. Which structural class does diazepam belong to?

• Thiophene derivatives
• Benzodiazepines with a benzene and diazepine ring
• Sulfonylureas
• Amphenicols

Correct Answer: Benzodiazepines with a benzene and diazepine ring (Benzodiazepines with a benzene and diazepine ring)

Q35. Which clinical scenario favors using lorazepam over diazepam for status epilepticus?

• Need for very rapid onset only
• Patient with severe hepatic impairment where lorazepam’s metabolism is simpler
• Requirement for long-acting active metabolites
• When rectal administration is preferred

Correct Answer: Patient with severe hepatic impairment where lorazepam’s metabolism is simpler (Patient with severe hepatic impairment where lorazepam’s metabolism is simpler)

Q36. Which of the following best explains why diazepam may accumulate in chronic therapy?

• Rapid renal clearance without metabolism
• Conversion to inactive water-soluble metabolites only
• High lipid solubility, extensive distribution and active metabolites with long half-life
• Minimal tissue distribution limits accumulation

Correct Answer: High lipid solubility, extensive distribution and active metabolites with long half-life (High lipid solubility, extensive distribution and active metabolites with long half-life)

Q37. Which interaction is most likely when diazepam is given with cimetidine?

• Decreased diazepam levels due to induction
• No interaction expected
• Increased diazepam levels due to CYP inhibition by cimetidine
• Immediate seizure risk reduction

Correct Answer: Increased diazepam levels due to CYP inhibition by cimetidine (Increased diazepam levels due to CYP inhibition by cimetidine)

Q38. Which parameter is a primary determinant of diazepam’s duration of action after a single IV dose?

• Renal excretion half-life only
• Redistribution from brain to peripheral tissues
• Protein intake of the patient
• Time of day of administration

Correct Answer: Redistribution from brain to peripheral tissues (Redistribution from brain to peripheral tissues)

Q39. Which statement about benzodiazepine receptor subtypes is relevant to diazepam’s clinical effects?

• All effects are mediated by a single identical receptor subtype
• Different α subunits confer different clinical effects such as sedation vs anxiolysis
• Only peripheral receptors are involved
• Diazepam acts only on ionotropic glutamate receptors

Correct Answer: Different α subunits confer different clinical effects such as sedation vs anxiolysis (Different α subunits confer different clinical effects such as sedation vs anxiolysis)

Q40. Which is an expected pharmacodynamic interaction between diazepam and alcohol?

• Antagonism of CNS depression
• Synergistic CNS and respiratory depression
• Reduced sedative effect of diazepam
• No clinically relevant interaction

Correct Answer: Synergistic CNS and respiratory depression (Synergistic CNS and respiratory depression)

Q41. Which formulation allows outpatient administration of diazepam for intermittent seizures in children?

• Intramuscular depot only
• Rectal diazepam gel
• Intravenous infusion at home routinely
• Transdermal patch exclusively

Correct Answer: Rectal diazepam gel (Rectal diazepam gel)

Q42. Which metabolic product is directly conjugated to form an excretable metabolite from diazepam metabolism?

• Desmethyldiazepam (nordiazepam) then oxazepam which is glucuronidated
• Lorazepam via sulfation
• Benzodiazepine unchanged excreted in urine
• Diazepam converted to barbiturate

Correct Answer: Desmethyldiazepam (nordiazepam) then oxazepam which is glucuronidated (Desmethyldiazepam (nordiazepam) then oxazepam which is glucuronidated)

Q43. Which counseling point is most important when dispensing diazepam to ambulatory patients?

• Take with grapefruit juice to enhance absorption
• Avoid operating machinery or driving until effects are known
• Stop immediately after one dose if feeling sedated
• Only take on an empty stomach

Correct Answer: Avoid operating machinery or driving until effects are known (Avoid operating machinery or driving until effects are known)

Q44. Which adverse neonatal effect is associated with maternal diazepam use near delivery?

• Neonatal withdrawal and respiratory depression
• Enhanced neonatal alertness
• Increased birth weight
• Improved APGAR scores

Correct Answer: Neonatal withdrawal and respiratory depression (Neonatal withdrawal and respiratory depression)

Q45. Which monitoring is essential during IV diazepam administration for procedural sedation?

• Only blood glucose monitoring
• Continuous respiratory and cardiovascular monitoring (respiratory rate, oxygen saturation, blood pressure)
• No monitoring required for single doses
• Only liver enzymes immediately

Correct Answer: Continuous respiratory and cardiovascular monitoring (respiratory rate, oxygen saturation, blood pressure) (Continuous respiratory and cardiovascular monitoring (respiratory rate, oxygen saturation, blood pressure))

Q46. Which statement about diazepam’s distribution is TRUE?

• It remains confined to plasma due to low tissue uptake
• It distributes widely into adipose tissue because of high lipophilicity
• It is exclusively distributed to bone
• It cannot cross the placenta

Correct Answer: It distributes widely into adipose tissue because of high lipophilicity (It distributes widely into adipose tissue because of high lipophilicity)

Q47. In an overdose with mixed benzodiazepine and tricyclic antidepressant ingestion, flumazenil is:

• Always safe and indicated
• Contraindicated because it may precipitate seizures due to TCA co-ingestion
• Irrelevant since TCAs block flumazenil
• An opioid agonist alternative

Correct Answer: Contraindicated because it may precipitate seizures due to TCA co-ingestion (Contraindicated because it may precipitate seizures due to TCA co-ingestion)

Q48. Which dosing consideration is appropriate for B.Pharm students to counsel elderly patients about diazepam?

• Elderly usually require higher doses
• Start with lower doses and titrate slowly to avoid excessive sedation
• No difference from young adults
• Use IM route exclusively in elderly

Correct Answer: Start with lower doses and titrate slowly to avoid excessive sedation (Start with lower doses and titrate slowly to avoid excessive sedation)

Q49. Which of the following best describes diazepam’s clinical role in alcohol withdrawal?

• Ineffective for alcohol withdrawal symptoms
• Used to control agitation, tremor and reduce the risk of seizures
• Primary agent to treat chronic liver disease
• Contraindicated in all alcohol withdrawal cases

Correct Answer: Used to control agitation, tremor and reduce the risk of seizures (Used to control agitation, tremor and reduce the risk of seizures)

Q50. Which statement about therapeutic drug monitoring of diazepam is correct?

• Routine plasma level monitoring is required for all patients
• Monitoring is rarely needed but may help in suspected overdose, adherence issues or interactions
• Levels directly predict clinical response in anxiety disorders always
• Urine levels are useless for diazepam detection

Correct Answer: Monitoring is rarely needed but may help in suspected overdose, adherence issues or interactions (Monitoring is rarely needed but may help in suspected overdose, adherence issues or interactions)

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