Lorazepam MCQs With Answer

Lorazepam MCQs With Answer is a focused review for B. Pharm students covering lorazepam’s pharmacology, clinical uses, dosing, adverse effects, interactions, and monitoring. This concise, keyword-rich introduction highlights lorazepam as an intermediate-acting benzodiazepine used in anxiety, status epilepticus, premedication, and alcohol withdrawal. Expect questions on mechanism of action at GABA-A receptors, hepatic glucuronidation metabolism, absence of active metabolites, IV formulations and propylene glycol toxicity, flumazenil reversal, contraindications, and special-population dosing. These MCQs are designed to deepen understanding for exams and clinical practice. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which mechanism best describes how lorazepam produces its clinical effects?

• Direct agonism of GABA-B receptors increasing K+ efflux
• Positive allosteric modulation of GABA-A receptors increasing Cl- channel opening frequency
• Inhibition of monoamine oxidase increasing neurotransmitter levels
• Blockade of NMDA receptors reducing excitatory transmission

Correct Answer: Positive allosteric modulation of GABA-A receptors increasing Cl- channel opening frequency

Q2. Lorazepam binds to which site on the GABA-A receptor complex?

• Between the α and γ subunits at the benzodiazepine binding site
• At the orthosteric GABA binding site on the β subunit
• Inside the chloride pore blocking ion flow
• At the picrotoxin binding site producing antagonism

Correct Answer: Between the α and γ subunits at the benzodiazepine binding site

Q3. Which clinical indication is lorazepam commonly used for in emergency medicine?

• Long-term control of chronic pain
• Acute management of status epilepticus
• First-line treatment for major depressive disorder
• Antipsychotic therapy for schizophrenia

Correct Answer: Acute management of status epilepticus

Q4. Which pharmacokinetic property distinguishes lorazepam from many other benzodiazepines?

• It is primarily metabolized by hepatic cytochrome P450 oxidation producing active metabolites
• It undergoes direct hepatic glucuronidation without active metabolites
• It is excreted unchanged in bile without hepatic metabolism
• It is metabolized to long-acting active metabolites prolonging effects

Correct Answer: It undergoes direct hepatic glucuronidation without active metabolites

Q5. Which statement about lorazepam’s elimination is correct?

• Its metabolites are lipophilic and accumulate in adipose tissue
• Renal excretion of lorazepam glucuronide is the primary route of elimination
• It is eliminated mainly through enterohepatic recycling
• Active metabolites are the main contributors to its duration of action

Correct Answer: Renal excretion of lorazepam glucuronide is the primary route of elimination

Q6. Compared to diazepam, lorazepam is best characterized as:

• Long-acting with many active metabolites
• Short-acting with no active metabolites and primarily glucuronidated
• Prodrug requiring hepatic activation to an active form
• Not effective for seizure control

Correct Answer: Short-acting with no active metabolites and primarily glucuronidated

Q7. Which adverse effect is most characteristic of benzodiazepines like lorazepam?

• Hypertension and tachycardia as primary toxicity
• Excessive sedation and risk of respiratory depression when combined with opioids
• Severe hepatotoxicity with single-dose use
• Profound anticholinergic effects causing dry mouth and constipation

Correct Answer: Excessive sedation and risk of respiratory depression when combined with opioids

Q8. Which agent is used as a specific antagonist for lorazepam overdose?

• Naloxone
• Flumazenil
• Atropine
• Physostigmine

Correct Answer: Flumazenil

Q9. Why is flumazenil use in benzodiazepine overdose sometimes contraindicated?

• It prolongs benzodiazepine half-life through enzyme inhibition
• It may precipitate seizures in benzodiazepine-dependent or mixed overdose patients
• It causes irreversible sedation when combined with benzodiazepines
• It has no effect on benzodiazepine binding and is therefore ineffective

Correct Answer: It may precipitate seizures in benzodiazepine-dependent or mixed overdose patients

Q10. Which clinical situation is a relative contraindication to lorazepam use?

• Acute narrow-angle glaucoma
• Essential hypertension controlled with ACE inhibitors
• Hypothyroidism on stable replacement therapy
• Mild seasonal allergic rhinitis

Correct Answer: Acute narrow-angle glaucoma

Q11. Lorazepam’s onset of action when administered intravenously is typically:

• Several hours due to slow absorption
• Rapid, within minutes
• Delayed by enterohepatic circulation
• Dependent on renal excretion only

Correct Answer: Rapid, within minutes

Q12. A key clinical advantage of lorazepam over long-acting benzodiazepines in elderly patients is:

• No sedation at therapeutic doses
• Absence of active metabolites reducing prolonged accumulation
• Complete lack of interaction with other CNS depressants
• Guaranteed safety in severe hepatic failure

Correct Answer: Absence of active metabolites reducing prolonged accumulation

Q13. Which formulation excipient in IV lorazepam preparations can cause toxicity with prolonged infusion?

• Sodium chloride
• Propylene glycol
• Albumin
• Polyethylene glycol 4000

Correct Answer: Propylene glycol

Q14. In status epilepticus, a common initial IV lorazepam dosing recommendation for adults is:

• 0.1 mg/kg up to 4 mg IV bolus
• 10 mg/kg as a single bolus
• 0.01 mg total irrespective of weight
• 100 mg as an infusion over 24 hours

Correct Answer: 0.1 mg/kg up to 4 mg IV bolus

Q15. Which property makes lorazepam preferred for IV use in many acute care settings?

• Formation of long-acting active metabolites that prolong sedation
• Reliable anticonvulsant effect and intermediate duration without active metabolites
• Requirement for metabolic activation making onset slower
• No risk of respiratory depression in any setting

Correct Answer: Reliable anticonvulsant effect and intermediate duration without active metabolites

Q16. Which interaction is least likely with lorazepam compared to other benzodiazepines?

• Significant cytochrome P450-mediated drug interactions
• Pharmacodynamic potentiation with alcohol
• Increased sedation with opioids
• Enhanced effect with other CNS depressants

Correct Answer: Significant cytochrome P450-mediated drug interactions

Q17. Which adverse reaction reflects paradoxical response to lorazepam?

• Marked drowsiness and slowed reaction time
• Increased agitation, hostility, or aggression
• Mild dry mouth and blurred vision
• Transient hypertension immediately after dosing

Correct Answer: Increased agitation, hostility, or aggression

Q18. Regarding dependence and withdrawal, which statement is true for lorazepam?

• Physical dependence never occurs with therapeutic use
• Tolerance and withdrawal can occur after weeks to months of regular use
• Withdrawal symptoms are limited to mild headache only
• Sudden discontinuation is universally safe and recommended

Correct Answer: Tolerance and withdrawal can occur after weeks to months of regular use

Q19. Which monitoring concern is most important when administering lorazepam IV in ICU patients?

• Monitoring for hyperglycemia as the main toxicity
• Observation for respiratory depression and hypotension
• Checking for QT prolongation on ECG within 5 minutes
• Frequent liver biopsy to assess hepatic injury

Correct Answer: Observation for respiratory depression and hypotension

Q20. Which population requires dose reduction and cautious use of lorazepam?

• Young healthy adults aged 20–30 with no comorbidities
• Elderly patients due to increased sensitivity and fall risk
• Individuals with seasonal allergies only
• Patients with only controlled hyperlipidemia

Correct Answer: Elderly patients due to increased sensitivity and fall risk

Q21. Which receptor subunit is most associated with the sedative effects of benzodiazepines?

• GABA-A α1 subunit
• GABA-B subunit
• NMDA NR2B subunit
• Glycine receptor alpha subunit

Correct Answer: GABA-A α1 subunit

Q22. Lorazepam is classified pharmacologically as a:

• Benzodiazepine
• Barbiturate
• Selective serotonin reuptake inhibitor
• Beta blocker

Correct Answer: Benzodiazepine

Q23. Which statement about lorazepam and pregnancy is most appropriate?

• It is entirely safe and recommended throughout pregnancy
• Use in pregnancy is associated with potential fetal risk and should be avoided unless necessary
• It prevents labor and is used as a tocolytic
• It causes no neonatal withdrawal or floppy infant syndrome

Correct Answer: Use in pregnancy is associated with potential fetal risk and should be avoided unless necessary

Q24. For lorazepam oral tablets, the time to peak plasma concentration is approximately:

• Within 1–2 hours
• 24–48 hours
• Immediately in less than 1 minute
• After 7–10 days of dosing

Correct Answer: Within 1–2 hours

Q25. A pharmacodynamic interaction to watch for with lorazepam is co-administration with:

• CNS stimulants producing antagonism of effects
• Other CNS depressants producing additive sedation and respiratory depression
• Vitamin supplements that decrease its bioavailability
• Nonsteroidal anti-inflammatory drugs reducing efficacy

Correct Answer: Other CNS depressants producing additive sedation and respiratory depression

Q26. Which laboratory finding may indicate propylene glycol toxicity from prolonged IV lorazepam infusion?

• High anion gap metabolic acidosis
• Isolated hyperkalemia without acidosis
• Marked ALT/AST elevation within 5 minutes
• Polycythemia on complete blood count

Correct Answer: High anion gap metabolic acidosis

Q27. Which effect of lorazepam is especially useful in alcohol withdrawal management?

• Its strong opioid receptor blockade
• Anxiolytic and anticonvulsant properties that reduce withdrawal seizures
• Direct alcohol metabolism acceleration
• Antimuscarinic actions that reduce tremor

Correct Answer: Anxiolytic and anticonvulsant properties that reduce withdrawal seizures

Q28. When converting chronic benzodiazepine therapy to lorazepam for tapering, the rationale is:

• Use a benzodiazepine with no dependence potential
• Switch to an agent with predictable kinetics and absence of active metabolites to simplify tapering
• Choose lorazepam because it enhances CYP enzymes for faster clearance
• Stop all benzodiazepines abruptly and start lorazepam high-dose

Correct Answer: Switch to an agent with predictable kinetics and absence of active metabolites to simplify tapering

Q29. Which sign suggests benzodiazepine withdrawal after abrupt cessation of lorazepam?

• Improved sleep quality and calm mood
• Rebound anxiety, insomnia, and possible seizures
• Immediate permanent resolution of panic disorder
• Increased appetite and weight gain only

Correct Answer: Rebound anxiety, insomnia, and possible seizures

Q30. Which of the following best reflects lorazepam’s abuse and scheduling status in many countries?

• It is an over-the-counter supplement with no regulation
• It is a controlled substance with potential for dependence and abuse
• It is banned worldwide with no clinical use
• It is classified as an antibiotic controlled by pharmacy labs

Correct Answer: It is a controlled substance with potential for dependence and abuse

Q31. Which organ impairment most directly affects lorazepam’s metabolite elimination?

• Renal impairment affecting excretion of lorazepam glucuronide
• Pulmonary impairment preventing drug absorption
• Dermatologic disease preventing topical absorption
• Peripheral vascular disease increasing clearance

Correct Answer: Renal impairment affecting excretion of lorazepam glucuronide

Q32. In patients with severe hepatic impairment, lorazepam dosing considerations include:

• No adjustment since it is completely unaffected by hepatic function
• Caution and possible dose reduction because glucuronidation may be impaired
• Immediate discontinuation only, with no alternatives
• Doubling the dose to overcome reduced metabolism

Correct Answer: Caution and possible dose reduction because glucuronidation may be impaired

Q33. Which symptom would most likely prompt immediate discontinuation of lorazepam in a patient on chronic therapy?

• Developing mild dry eyes
• Emergence of severe respiratory depression or profound sedation
• Intermittent mild headache after dosing
• Slight transient nausea once a month

Correct Answer: Emergence of severe respiratory depression or profound sedation

Q34. Which statement about lorazepam’s effect on memory is correct?

• It enhances long-term memory consolidation
• It may cause anterograde amnesia, especially at higher doses
• It selectively improves procedural memory in all patients
• It has no cognitive effects at therapeutic doses

Correct Answer: It may cause anterograde amnesia, especially at higher doses

Q35. Which dosing strategy reduces withdrawal risk when stopping long-term lorazepam therapy?

• Abrupt cessation after chronic use
• Gradual dose taper over weeks to months
• Switching overnight to a high dose of a barbiturate
• Replacing lorazepam with alcohol to self-taper

Correct Answer: Gradual dose taper over weeks to months

Q36. Which is a common non-respiratory adverse effect of lorazepam?

• Constipation due to strong opioid activity
• Cognitive impairment and impaired psychomotor performance
• Severe hypothyroidism within hours
• Profound diuresis and dehydration

Correct Answer: Cognitive impairment and impaired psychomotor performance

Q37. Which clinical test or monitoring is most relevant when initiating lorazepam in a frail elderly patient?

• Frequent assessment of sedation level and fall risk
• Monitoring of serum lorazepam concentrations daily
• Immediate pulmonary function testing every hour
• Continuous EEG monitoring for all elderly patients

Correct Answer: Frequent assessment of sedation level and fall risk

Q38. Which factor contributes to faster CNS penetration and onset of action for a benzodiazepine like lorazepam?

• High hydrophilicity preventing blood-brain barrier crossing
• Moderate lipophilicity facilitating rapid brain uptake
• Extensive protein binding preventing brain access
• Large molecular weight limiting diffusion

Correct Answer: Moderate lipophilicity facilitating rapid brain uptake

Q39. For procedural sedation in short outpatient procedures, lorazepam is used because it:

• Has unpredictable recovery and prolonged hangover effects
• Provides anxiolysis and amnesia with intermediate duration of action
• Is a stimulant that enhances patient cooperation
• Is ineffective for sedation but used for analgesia

Correct Answer: Provides anxiolysis and amnesia with intermediate duration of action

Q40. Which clinical trial endpoint would best assess lorazepam’s efficacy in generalized anxiety disorder?

• Reduction in seizure frequency over 24 hours
• Decrease in standardized anxiety rating scale scores over several weeks
• Improvement in cancer survival at 5 years
• Change in blood glucose levels after dosing

Correct Answer: Decrease in standardized anxiety rating scale scores over several weeks

Q41. Which metabolic pathway is primarily responsible for clearance of lorazepam?

• N-acetylation in the kidney
• Glucuronidation in the liver
• CYP3A4-mediated hydroxylation to active metabolites
• Sulfation followed by biliary excretion

Correct Answer: Glucuronidation in the liver

Q42. Which clinical feature distinguishes lorazepam from midazolam for ICU sedation?

• Lorazepam has a shorter duration than midazolam in all settings
• Lorazepam has no active metabolites and a more predictable recovery than midazolam
• Lorazepam is an opioid used for analgesia rather than sedation
• Midazolam does not cause respiratory depression whereas lorazepam does

Correct Answer: Lorazepam has no active metabolites and a more predictable recovery than midazolam

Q43. Which is an important counseling point for patients starting lorazepam outpatient therapy?

• Avoid driving or operating machinery until effects are known
• Double the dose if one dose is missed to maintain control
• Mix with alcohol to enhance anxiolytic benefit safely
• Discontinue abruptly when symptoms resolve

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

Q44. Which describes a pharmacological rationale for preferring lorazepam in patients with multi-drug regimens involving CYP inhibitors?

• It is extensively metabolized by CYP enzymes and will be unaffected by inhibitors
• It is primarily glucuronidated, so major CYP inhibitors have less impact on its clearance
• It induces CYP enzymes reducing levels of other drugs
• It irreversibly binds plasma proteins preventing interactions

Correct Answer: It is primarily glucuronidated, so major CYP inhibitors have less impact on its clearance

Q45. Which sign suggests oversedation in a patient receiving lorazepam?

• Increased alertness and increased speech rate
• Slow respiratory rate, decreased responsiveness, and hypoventilation
• Enhanced coordination and hyperactivity
• Marked hypertension and tachypnea only

Correct Answer: Slow respiratory rate, decreased responsiveness, and hypoventilation

Q46. Which dosing advice is appropriate when prescribing lorazepam to a patient with chronic kidney disease?

• No monitoring or dose adjustment is ever needed
• Use caution; metabolites are renally excreted and monitoring for accumulation is advisable
• Always double the dose due to reduced renal clearance
• Replace lorazepam with a long-acting benzodiazepine to avoid accumulation

Correct Answer: Use caution; metabolites are renally excreted and monitoring for accumulation is advisable

Q47. Which clinical advantage does lorazepam have for seizure clusters compared with oral therapy alone?

• IV or IM lorazepam provides rapid anticonvulsant action necessary for acute control
• Oral lorazepam is always faster than IV administration
• Lorazepam lacks anticonvulsant properties and is used only for anxiety
• It permanently cures epilepsy after a single dose

Correct Answer: IV or IM lorazepam provides rapid anticonvulsant action necessary for acute control

Q48. Which statement about lorazepam’s role in anesthesia is correct?

• It is not used in perioperative care
• It is used for premedication to reduce anxiety and produce anterograde amnesia
• It is a primary inhalational anesthetic agent
• It universally prevents postoperative nausea and vomiting

Correct Answer: It is used for premedication to reduce anxiety and produce anterograde amnesia

Q49. Which effect would you expect if lorazepam is combined with an opioid analgesic in a patient?

• Mutual antagonism leading to reduced analgesia and sedation
• Additive CNS depression increasing risk of respiratory compromise
• Complete blockade of opioid receptor preventing analgesia
• Enhanced hepatic metabolism reducing both drug levels

Correct Answer: Additive CNS depression increasing risk of respiratory compromise

Q50. Which exam-focused tip about lorazepam should B. Pharm students remember?

• It is metabolized by CYP3A4 into many active metabolites
• Key facts: benzodiazepine class, GABA-A positive modulator, glucuronidation metabolism, no active metabolites, uses include anxiety and status epilepticus
• It is primarily an anticholinergic drug used for Parkinson’s disease
• It is only available as a topical formulation with no systemic effects

Correct Answer: Key facts: benzodiazepine class, GABA-A positive modulator, glucuronidation metabolism, no active metabolites, uses include anxiety and status epilepticus

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