MCQ Quiz: Self-Care – Sleep Disorders

The self-care management of sleep disorders is a common challenge encountered in community pharmacy practice and a key “Transcending Concept” covered in the PharmD curriculum. As future pharmacists, it is essential to guide patients toward safe and effective non-prescription options, counsel them on appropriate use, and recognize when a medical referral is necessary. This quiz will test your knowledge on OTC sleep aids, herbal supplements, and the non-pharmacological bedrock of sleep management: sleep hygiene, all based on topics from your patient care and skills lab courses.

1. What is the first-line recommendation for any patient presenting with insomnia?

• A. A prescription hypnotic
• B. An over-the-counter antihistamine
• C. Cognitive Behavioral Therapy for Insomnia (CBT-I) and proper sleep hygiene
• D. Melatonin at the highest available dose

Answer: C. Cognitive Behavioral Therapy for Insomnia (CBT-I) and proper sleep hygiene

2. The primary active ingredient in most over-the-counter (OTC) sleep aids, such as ZzzQuil and Unisom SleepGels, is:

• A. Melatonin
• B. Ibuprofen
• C. Diphenhydramine
• D. Pseudoephedrine

Answer: C. Diphenhydramine

3. What is the pharmacological mechanism of action for OTC antihistamines used for sleep, like diphenhydramine and doxylamine?

• A. They are antagonists at the H1-histamine receptor
• B. They are agonists at melatonin receptors
• C. They potentiate the effects of GABA
• D. They block the reuptake of serotonin

Answer: A. They are antagonists at the H1-histamine receptor

4. A patient should be counseled that tolerance to the sedative effects of first-generation antihistamines can develop in as little as:

• A. 1-2 years
• B. 3-4 months
• C. A few days of consecutive use
• D. Tolerance does not develop

Answer: C. A few days of consecutive use

5. Due to their potent anticholinergic properties, OTC antihistamines should be avoided or used with extreme caution in which patient population?

• A. Young adults
• B. Athletes
• C. Elderly patients
• D. Patients with hyperlipidemia

Answer: C. Elderly patients

6. A patient with which of the following conditions should be advised to avoid using an OTC antihistamine for sleep?

• A. Benign Prostatic Hyperplasia (BPH) and narrow-angle glaucoma
• B. Hypertension
• C. Migraines
• D. Acid reflux

Answer: A. Benign Prostatic Hyperplasia (BPH) and narrow-angle glaucoma

7. Melatonin is a dietary supplement often used for sleep. Its primary role is to:

• A. Act as a potent sedative for middle-of-the-night awakenings.
• B. Regulate the circadian rhythm, making it most useful for conditions like jet lag.
• C. Act as a powerful muscle relaxant.
• D. Relieve anxiety associated with insomnia.

Answer: B. Regulate the circadian rhythm, making it most useful for conditions like jet lag.

8. What is the most appropriate counseling point regarding the timing of melatonin administration?

• A. Take it upon waking in the morning.
• B. Take it 30-60 minutes before desired bedtime.
• C. Take it with a large, high-fat meal.
• D. Take it in the middle of the night if you wake up.

Answer: B. Take it 30-60 minutes before desired bedtime.

9. Valerian root is a popular herbal supplement used for insomnia. Its proposed mechanism involves interaction with which neurotransmitter system?

• A. Dopamine
• B. Serotonin
• C. GABA
• D. Acetylcholine

Answer: C. GABA

10. A “paradoxical reaction” is a known, though uncommon, side effect of which herbal sleep aid?

• A. Melatonin
• B. Valerian
• C. Chamomile
• D. Kava

Answer: B. Valerian

11. Which of the following is a key component of good sleep hygiene?

• A. Taking long naps in the evening.
• B. Using a smartphone or tablet in bed to relax.
• C. Maintaining a consistent sleep-wake schedule, even on days off.
• D. Drinking a glass of wine before bed to aid sleep.

Answer: C. Maintaining a consistent sleep-wake schedule, even on days off.

12. A patient asks for an OTC sleep aid. The pharmacist’s first step, according to the PPCP, should be to:

• A. Recommend the most expensive product.
• B. Collect information about their sleep problem, health conditions, and current medications.
• C. Tell them to see a doctor immediately.
• D. Hand them a box of diphenhydramine.

Answer: B. Collect information about their sleep problem, health conditions, and current medications.

13. What is a common side effect of first-generation antihistamines that can impair a patient’s ability to function the next day?

• A. Increased alertness
• B. Residual sedation or “hangover” effect
• C. Improved memory
• D. Weight loss

Answer: B. Residual sedation or “hangover” effect

14. A patient reports their insomnia has lasted for two months and is causing significant distress. What is the appropriate recommendation?

• A. Recommend long-term use of diphenhydramine.
• B. Suggest they try valerian root and melatonin together.
• C. This is an exclusion for self-treatment; the patient should be referred to a physician.
• D. Recommend they drink chamomile tea.

Answer: C. This is an exclusion for self-treatment; the patient should be referred to a physician.

15. Under the Dietary Supplement Health and Education Act (DSHEA) of 1994, manufacturers of supplements like melatonin can make:

• A. Claims that their product cures insomnia.
• B. Claims that their product is FDA-approved.
• C. Structure/function claims, such as “helps promote restful sleep.”
• D. Claims that their product is safer than any prescription medication.

Answer: C. Structure/function claims, such as “helps promote restful sleep.”

16. Which herbal supplement, sometimes used for its calming effects, can cause allergic reactions in individuals with an allergy to ragweed?

• A. Valerian
• B. Kava
• C. Melatonin
• D. Chamomile

Answer: D. Chamomile

17. What is the maximum duration for which an OTC sleep aid should be recommended for self-treatment?

• A. One year
• B. Six months
• C. One month
• D. 7-10 consecutive nights

Answer: D. 7-10 consecutive nights

18. A patient complains of difficulty falling asleep but has no problem staying asleep. Which formulation would be most appropriate if a product were to be recommended?

• A. A long-acting antihistamine.
• B. A controlled-release melatonin product.
• C. An immediate-release, short-acting product.
• D. Any product is acceptable.

Answer: C. An immediate-release, short-acting product.

19. Why is it important to ask a patient about their caffeine and alcohol intake when they complain of insomnia?

• A. It is not important information.
• B. Both substances can significantly disrupt sleep architecture and contribute to insomnia.
• C. To recommend they increase their intake.
• D. To assess their socioeconomic status.

Answer: B. Both substances can significantly disrupt sleep architecture and contribute to insomnia.

20. A patient reports a strange, unpleasant odor from their valerian root capsules. The pharmacist should advise them that:

• A. The product is definitely contaminated and should be discarded.
• B. This is a characteristic odor of the valerian plant (“dirty socks”) and is likely normal.
• C. They are imagining the smell.
• D. This indicates the product is extra potent.

Answer: B. This is a characteristic odor of the valerian plant (“dirty socks”) and is likely normal.

21. The “teach-back” method is a useful counseling tool. After explaining how to use a sleep aid, a pharmacist could ask:

• A. “Do you have any questions?”
• B. “To make sure I was clear, can you tell me how you are going to use this product?”
• C. “You understood that, right?”
• D. “Just read the box.”

Answer: B. “To make sure I was clear, can you tell me how you are going to use this product?”

22. Which of the following is an “exclusion for self-treatment” for insomnia?

• A. A 25-year-old with occasional trouble sleeping after a stressful day.
• B. A 45-year-old with jet lag.
• C. A 55-year-old whose insomnia may be secondary to symptoms of untreated sleep apnea (e.g., loud snoring, gasping).
• D. A healthy adult who has trouble sleeping for two nights.

Answer: C. A 55-year-old whose insomnia may be secondary to symptoms of untreated sleep apnea (e.g., loud snoring, gasping).

23. Which statement on a melatonin supplement label is a legally permissible structure/function claim?

• A. “Cures insomnia”
• B. “Treats Delayed Sleep Phase Syndrome”
• C. “Helps maintain a normal sleep cycle”
• D. “Prevents sleep apnea”

Answer: C. “Helps maintain a normal sleep cycle”

24. The sedative effect of doxylamine is generally considered to be _________ that of diphenhydramine at equivalent doses.

• A. More potent than
• B. Less potent than
• C. Equal to
• D. The opposite of

Answer: A. More potent than

25. A key sleep hygiene recommendation is to avoid using the bed for activities other than:

• A. Watching TV and eating.
• B. Working on a laptop and paying bills.
• C. Sleep and intimacy.
• D. Arguing with a partner.

Answer: C. Sleep and intimacy.

26. A patient who is breastfeeding asks if it is safe to take diphenhydramine for sleep. The pharmacist should advise that:

• A. It is completely safe.
• B. The drug can pass into breast milk and may cause sedation in the infant; it is generally not recommended.
• C. She should take double the dose.
• D. It will increase her milk supply.

Answer: B. The drug can pass into breast milk and may cause sedation in the infant; it is generally not recommended.

27. The term “hypnotic” refers to a substance that:

• A. Reduces anxiety
• B. Induces sleep
• C. Relieves pain
• D. Improves mood

Answer: B. Induces sleep

28. A patient is taking a prescription medication that is a substrate of CYP2D6. What is the concern if they also take diphenhydramine?

• A. There is no concern.
• B. Diphenhydramine can inhibit CYP2D6, potentially increasing the levels of the other medication.
• C. Diphenhydramine induces CYP2D6, decreasing the levels of the other medication.
• D. The interaction only occurs with doxylamine.

Answer: B. Diphenhydramine can inhibit CYP2D6, potentially increasing the levels of the other medication.

29. What is a major quality control concern with melatonin supplements?

• A. They always contain less melatonin than the label claims.
• B. Studies have found that the actual content of melatonin can vary significantly from what is stated on the label, and some products contain serotonin.
• C. They are rigorously tested by the FDA before marketing.
• D. They are all free of contaminants.

Answer: B. Studies have found that the actual content of melatonin can vary significantly from what is stated on the label, and some products contain serotonin.

30. The primary role of the pharmacist in self-care is to:

• A. Act as a salesperson.
• B. Ensure patient safety and promote the appropriate, evidence-based use of non-prescription products.
• C. Diagnose the patient’s condition.
• D. Prescribe medication.

Answer: B. Ensure patient safety and promote the appropriate, evidence-based use of non-prescription products.

31. The “hangover” effect from a sleep aid is an example of what type of adverse effect?

• A. An idiosyncratic reaction
• B. An allergic reaction
• C. A residual pharmacodynamic effect
• D. A drug-disease interaction

Answer: C. A residual pharmacodynamic effect

32. Which of the following is a key question to ask when assessing a patient’s sleep complaint?

• A. “What is your favorite color?”
• B. “How long have you been having this problem?”
• C. “Do you enjoy your job?”
• D. “What is your political affiliation?”

Answer: B. “How long have you been having this problem?”

33. What does the “S” in the SCHOLAR-MAC acronym for patient assessment stand for?

• A. Sleepiness
• B. Seriousness
• C. Symptoms
• D. Self-Care

Answer: C. Symptoms

34. A patient should be referred to a physician if their insomnia persists despite _________ of self-treatment with an OTC product.

• A. 1 day
• B. 3 days
• C. 10 days
• D. 30 days

Answer: C. 10 days

35. A patient taking diphenhydramine should be advised to avoid which activity?

• A. Reading a book
• B. Driving a car or operating heavy machinery
• C. Light housework
• D. Watching a movie

Answer: B. Driving a car or operating heavy machinery

36. Combining an OTC antihistamine sleep aid with a prescription opioid is dangerous due to:

• A. The risk of serotonin syndrome.
• B. The risk of additive CNS and respiratory depression.
• C. The risk of hypertensive crisis.
• D. The risk of liver failure.

Answer: B. The risk of additive CNS and respiratory depression.

37. Which of the following is a physical sign of good sleep hygiene?

• A. A television and computer in the bedroom.
• B. A bedroom that is dark, quiet, and at a comfortable, cool temperature.
• C. A bright alarm clock facing the bed.
• D. Piles of work-related papers on the nightstand.

Answer: B. A bedroom that is dark, quiet, and at a comfortable, cool temperature.

38. The use of the term “natural” on a supplement label is:

• A. A guarantee of safety and effectiveness.
• B. A legally defined term that means the product is organic.
• C. An unregulated marketing term that does not equate to safety.
• D. An indication that the product is FDA-approved.

Answer: C. An unregulated marketing term that does not equate to safety.

39. A patient is having trouble sleeping because they work the night shift. This is an example of:

• A. Transient insomnia.
• B. A circadian rhythm disorder.
• C. Primary insomnia.
• D. Sleep apnea.

Answer: B. A circadian rhythm disorder.

40. The most evidence-based use for melatonin is for:

• A. Middle-of-the-night awakenings.
• B. Anxiety.
• C. Circadian rhythm disorders like jet lag.
• D. Long-term treatment of chronic insomnia.

Answer: C. Circadian rhythm disorders like jet lag.

41. The anticholinergic effects of diphenhydramine can cause or worsen which of the following?

• A. Diarrhea
• B. Excessive salivation
• C. Constipation and dry mouth
• D. Bradycardia

Answer: C. Constipation and dry mouth

42. A patient asks for a product containing “PM” in the name (e.g., Tylenol PM). The pharmacist should identify that the “PM” ingredient is typically:

• A. A pain reliever.
• B. A cough suppressant.
• C. An antihistamine like diphenhydramine.
• D. A decongestant.

Answer: C. An antihistamine like diphenhydramine.

43. The first step in helping a patient self-manage their insomnia should always be:

• A. Recommending a product.
• B. Assessing their current sleep hygiene and recommending improvements.
• C. Telling them to double their caffeine intake.
• D. Suggesting a prescription medication.

Answer: B. Assessing their current sleep hygiene and recommending improvements.

44. What is a key reason that chronic insomnia (lasting > 3 months) is an exclusion for self-treatment?

• A. OTC products are too expensive for long-term use.
• B. It is often secondary to an undiagnosed medical or psychiatric condition that requires a physician’s evaluation.
• C. Tolerance to OTC products develops quickly.
• D. Both B and C.

Answer: D. Both B and C.

45. Which of the following statements about herbal sleep aids is true?

• A. They are all proven to be safe and effective.
• B. They are regulated by the FDA for quality and purity before marketing.
• C. Their quality, purity, and potency can be inconsistent between products and batches.
• D. They are completely free of side effects.

Answer: C. Their quality, purity, and potency can be inconsistent between products and batches.

46. A patient reports success with chamomile tea for relaxation before bed. The pharmacist should advise:

• A. That this is a dangerous practice.
• B. That this is a generally safe and reasonable non-pharmacological approach for mild issues, but to be aware of potential allergies.
• C. That they should switch to a prescription medication immediately.
• D. That the tea will interact with all of their other medications.

Answer: B. That this is a generally safe and reasonable non-pharmacological approach for mild issues, but to be aware of potential allergies.

47. The “Plan” step of the PPCP for a patient with a self-care sleep complaint involves:

• A. Collecting information from the patient.
• B. Formulating a recommendation, which may include a product, non-pharmacological advice, and a plan for follow-up or referral.
• C. Assessing the patient’s problem list.
• D. Only documenting the encounter.

Answer: B. Formulating a recommendation, which may include a product, non-pharmacological advice, and a plan for follow-up or referral.

48. Why is it important to ask a patient if their bed partner has noticed any unusual sleep behaviors (e.g., snoring, gasping)?

• A. To assess for signs of potentially serious, undiagnosed conditions like sleep apnea.
• B. It is not relevant information.
• C. To gather gossip.
• D. To determine if the bed partner is the cause of the problem.

Answer: A. To assess for signs of potentially serious, undiagnosed conditions like sleep apnea.

49. The pharmacology of all OTC sleep aids relies on:

• A. Crossing the blood-brain barrier.
• B. Modulating the GABA receptor.
• C. Agonizing melatonin receptors.
• D. Being a controlled substance.

Answer: A. Crossing the blood-brain barrier.

50. The ultimate goal of self-care counseling for sleep disorders is to:

• A. Sell a product.
• B. Empower the patient with the knowledge to improve their sleep safely and to understand when professional medical care is needed.
• C. Ensure the patient uses a sleep aid every night for the rest of their life.
• D. Make a medical diagnosis of the sleep disorder.

Answer: B. Empower the patient with the knowledge to improve their sleep safely and to understand when professional medical care is needed.