Anxiolytic and Hypnotic Drugs.docx

Anxiolytic and Hypnotic Drugs 1\. \*\*What is the main therapeutic use of sedatives?\*\* \- A) To produce sleep \- B) To reduce anxiety \- C) To reduce CNS depression \- D) To increase CNS stimulation \*\*Answer\*\*: B) To reduce anxiety 2\. \*\*Which of the following is a defining feature of...

Anxiolytic and Hypnotic Drugs 1\. \*\*What is the main therapeutic use of sedatives?\*\* \- A) To produce sleep \- B) To reduce anxiety \- C) To reduce CNS depression \- D) To increase CNS stimulation \*\*Answer\*\*: B) To reduce anxiety 2\. \*\*Which of the following is a defining feature of hypnotic drugs?\*\* \- A) Encourage drowsiness \- B) Increase anxiety \- C) Produce euphoria \- D) Improve memory retention \*\*Answer\*\*: A) Encourage drowsiness 3\. \*\*What distinguishes a hypnotic drug from a sedative?\*\* \- A) Sedatives only work on GABA receptors \- B) Hypnotics involve more pronounced CNS depression \- C) Sedatives cause sleep \- D) Hypnotics stimulate CNS activity \*\*Answer\*\*: B) Hypnotics involve more pronounced CNS depression : 4\. \*\*What does the term \'tolerance\' refer to?\*\* \- A) The increase in drug effect with repeated use \- B) Development of psychological dependence \- C) A reduced drug effect with repeated use \- D) Physical dependence on a drug \*\*Answer\*\*: C) A reduced drug effect with repeated use 5\. \*\*What is a characteristic of drug dependence?\*\* \- A) Reduced drug effectiveness \- B) Increased drug efficacy \- C) Development of withdrawal symptoms \- D) Cross-tolerance to other drug classes \*\*Answer\*\*: C) Development of withdrawal symptoms 6\. \*\*Cross-tolerance is when a patient:\*\* \- A) Develops tolerance to other drugs within the same class \- B) Exhibits withdrawal from different drug classes \- C) Shows enhanced effect from related drugs \- D) Is immune to withdrawal symptoms \*\*Answer\*\*: A) Develops tolerance to other drugs within the same class 7\. \*\*What is the main pharmacokinetic factor determining how sedative-hypnotics enter the CNS?\*\* \- A) Half-life \- B) Lipophilicity \- C) Protein binding \- D) Water solubility \*\*Answer\*\*: B) Lipophilicity 8\. \*\*Which class of drugs crosses the placental barrier during pregnancy, potentially affecting the fetus?\*\* \- A) Z-drugs \- B) Barbiturates \- C) Benzodiazepines \- D) All of the above \*\*Answer\*\*: D) All of the above 9\. \*\*Which metabolic pathway do most benzodiazepines undergo for clearance?\*\* \- A) Phase 1 oxidation \- B) Phase 2 glucuronidation \- C) Direct renal excretion \- D) Hepatic hydroxylation \*\*Answer\*\*: A) Phase 1 oxidation 10\. \*\*What are the primary metabolites of alprazolam and triazolam?\*\* \- A) Active metabolites \- B) Inactive metabolites \- C) Direct excretion metabolites \- D) All of the above \*\*Answer\*\*: A) Active metabolites 11\. \*\*What is the half-life of phenobarbital?\*\* \- A) 1-2 days \- B) 4-5 days \- C) 10-12 hours \- D) Less than 1 day \*\*Answer\*\*: B) 4-5 days 12\. \*\*How does zolpidem differ from older barbiturates?\*\* \- A) Longer half-life \- B) Rapid metabolism to inactive metabolites \- C) Higher potential for dependence \- D) Shorter duration of action \*\*Answer\*\*: B) Rapid metabolism to inactive metabolites 13\. \*\*What is the mechanism of action of GABAA receptor activation?\*\* \- A) Depolarization of the neuron \- B) Hyperpolarization by chloride ions \- C) Activation of potassium channels \- D) Inhibition of sodium channels \*\*Answer\*\*: B) Hyperpolarization by chloride ions 14\. \*\*Which subunit of the GABAA receptor is responsible for benzodiazepine binding?\*\* \- A) Alpha subunit \- B) Gamma subunit \- C) Beta subunit \- D) Both alpha and gamma subunits \*\*Answer\*\*: D) Both alpha and gamma subunits 15\. \*\*What is the effect of benzodiazepines on the frequency of GABAA channel opening?\*\* \- A) Increase frequency \- B) Decrease frequency \- C) Block opening \- D) No effect \*\*Answer\*\*: A) Increase frequency 16\. \*\*Which receptor subunits do benzodiazepines bind to on the GABAA receptor?\*\* \- A) Alpha and beta subunits \- B) Beta and gamma subunits \- C) Alpha and gamma subunits \- D) Alpha and delta subunits \*\*Answer\*\*: C) Alpha and gamma subunits 17\. \*\*Which subunit do \"Z-drugs\" selectively bind to on the GABAA receptor?\*\* \- A) Alpha-2 subunit \- B) Alpha-3 subunit \- C) Alpha-1 subunit \- D) Alpha-5 subunit \*\*Answer\*\*: C) Alpha-1 subunit 18\. \*\*How do benzodiazepines modulate GABAA receptors?\*\* \- A) Increase the duration of channel opening events \- B) Increase the frequency of channel opening events \- C) Directly activate GABA receptors \- D) Block GABA receptor activity \*\*Answer\*\*: B) Increase the frequency of channel opening events 1\. \*\*Which benzodiazepines are commonly used for seizure control?\*\* \- A) Clonazepam, lorazepam, and diazepam \- B) Alprazolam, midazolam, and diazepam \- C) Zolpidem, zaleplon, and eszopiclone \- D) Temazepam, triazolam, and clonazepam \*\*Answer\*\*: A) Clonazepam, lorazepam, and diazepam 2\. \*\*Which barbiturate is still used today to manage generalized seizures?\*\* \- A) Phenobarbital \- B) Amobarbital \- C) Secobarbital \- D) Thiopental \*\*Answer\*\*: A) Phenobarbital 3\. \*\*Which class of drugs is not effective in treating seizures?\*\* \- A) Benzodiazepines \- B) Barbiturates \- C) Z-drugs \- D) Antihistamines \*\*Answer\*\*: C) Z-drugs 4\. \*\*What is a possible effect of hypnotic drugs on respiration?\*\* \- A) Increased respiratory rate \- B) Respiratory depression \- C) Enhanced lung function \- D) Minimal effect in healthy individuals \*\*Answer\*\*: B) Respiratory depression 5\. \*\*Which group of patients is more vulnerable to respiratory depression when taking sedative-hypnotic drugs?\*\* \- A) Patients with sleep apnea \- B) Patients with cardiovascular disease \- C) Patients with hepatic impairment \- D) All of the above \*\*Answer\*\*: D) All of the above 6\. \*\*Which organ is most affected by sedative-hypnotic drugs at higher doses?\*\* \- A) Brain \- B) Lungs \- C) Kidneys \- D) Liver \*\*Answer\*\*: A) Brain 7\. \*\*What is a common feature of sedative-hypnotics when used long-term?\*\* \- A) Tolerance \- B) Increased efficacy \- C) Enhanced receptor sensitivity \- D) Reduced risk of withdrawal \*\*Answer\*\*: A) Tolerance 8\. \*\*Which benzodiazepine has the highest risk of causing daytime anxiety due to its short half-life?\*\* \- A) Triazolam \- B) Diazepam \- C) Lorazepam \- D) Clonazepam \*\*Answer\*\*: A) Triazolam 9\. \*\*What can occur if benzodiazepines are abruptly discontinued?\*\* \- A) Euphoria \- B) Hyperactive reflexes and seizures \- C) Improved sleep quality \- D) Weight gain \*\*Answer\*\*: B) Hyperactive reflexes and seizures 10\. \*\*What is a major clinical toxicity concern with benzodiazepine use in the elderly?\*\* \- A) Anterograde amnesia \- B) Cognitive improvement \- C) Increased appetite \- D) Improved motor skills \*\*Answer\*\*: A) Anterograde amnesia 11\. \*\*Which sedative-hypnotic class is most associated with confusional states in elderly patients?\*\* \- A) Barbiturates \- B) Z-drugs \- C) Benzodiazepines \- D) Antihistamines \*\*Answer\*\*: C) Benzodiazepines 12\. \*\*What condition is a warning sign of potential sedative-hypnotic overdose?\*\* \- A) Sleepwalking \- B) Hyperactivity \- C) Increased alertness \- D) Sleep paralysis \*\*Answer\*\*: A) Sleepwalking 13\. \*\*Which sedative-hypnotic class is associated with neonatal respiratory depression?\*\* \- A) Barbiturates \- B) Antihistamines \- C) Benzodiazepines \- D) Buspirone \*\*Answer\*\*: C) Benzodiazepines 14\. \*\*Which drug carries the highest risk for fetal deformation during pregnancy?\*\* \- A) Zolpidem \- B) Buspirone \- C) Diazepam \- D) Secobarbital \*\*Answer\*\*: C) Diazepam 15\. \*\*Which sedative-hypnotic agent is least likely to cause teratogenicity during pregnancy?\*\* \- A) Buspirone \- B) Zaleplon \- C) Phenobarbital \- D) Eszopiclone \*\*Answer\*\*: A) Buspirone Here are PANCE-style questions generated from slides 26 through 43 of the \"Anxiolytic and Hypnotic Drugs\" PowerPoint: 1\. \*\*What is a known risk of benzodiazepine use during pregnancy?\*\* \- A) Neonatal hypoglycemia \- B) Fetal deformation and increased risk of miscarriage \- C) Increased fetal muscle tone \- D) Excessive birth weight \*\*Answer\*\*: B) Fetal deformation and increased risk of miscarriage 2\. \*\*What risk is associated with barbiturate use during pregnancy?\*\* \- A) Hypoglycemia \- B) Fetal respiratory depression \- C) Increased cardiac function \- D) Hyperactivity in the fetus \*\*Answer\*\*: B) Fetal respiratory depression 3\. \*\*What is a safer anxiolytic option for pregnant women?\*\* \- A) Diazepam \- B) Z-drugs \- C) Buspirone \- D) Phenobarbital \*\*Answer\*\*: C) Buspirone 4\. \*\*Which medication reverses the sedative actions of benzodiazepines?\*\* \- A) Naloxone \- B) Flumazenil \- C) Suvorexant \- D) Ramelteon \*\*Answer\*\*: B) Flumazenil 5\. \*\*Why might flumazenil need to be re-dosed when reversing benzodiazepine overdose?\*\* \- A) It has a short half-life \- B) It causes rebound sedation \- C) It enhances the effects of benzodiazepines \- D) It increases CNS depression \*\*Answer\*\*: A) It has a short half-life 6\. \*\*What is a potential risk of flumazenil administration in chronic benzodiazepine users?\*\* \- A) Hypertension \- B) Seizures \- C) Tachycardia \- D) Hypoglycemia \*\*Answer\*\*: B) Seizures 7\. \*\*Which drug class most commonly interacts with benzodiazepines to produce additive CNS depression?\*\* \- A) Antihistamines \- B) Antihypertensive agents \- C) Opioids \- D) Antipsychotics \*\*Answer\*\*: C) Opioids 8\. \*\*What effect does combining benzodiazepines with alcohol have?\*\* \- A) Decreased sedation \- B) Increased risk of respiratory depression \- C) Increased alertness \- D) Hyperactivity \*\*Answer\*\*: B) Increased risk of respiratory depression 9\. \*\*Which of the following medications can potentiate the sedative effects of benzodiazepines?\*\* \- A) Antihistamines \- B) Beta-blockers \- C) Diuretics \- D) NSAIDs \*\*Answer\*\*: A) Antihistamines 10\. \*\*Which lifestyle modification is recommended for sleep problems?\*\* \- A) Avoid exercise \- B) Increase screen time before bed \- C) Go to bed at the same time each night \- D) Avoid sunlight exposure during the day \*\*Answer\*\*: C) Go to bed at the same time each night 11\. \*\*What might the persistence of insomnia after 7-10 days of treatment indicate?\*\* \- A) The patient is not using their medication correctly \- B) Presence of an underlying psychiatric or medical illness \- C) Increased CNS tolerance \- D) Drug resistance \*\*Answer\*\*: B) Presence of an underlying psychiatric or medical illness 12\. \*\*Which of the following is NOT recommended for long-term treatment of insomnia?\*\* \- A) Melatonin \- B) Benzodiazepines \- C) Proper sleep hygiene \- D) Cognitive Behavioral Therapy \*\*Answer\*\*: B) Benzodiazepines 13\. \*\*What is a common side effect of short-acting benzodiazepines like triazolam?\*\* \- A) Rebound insomnia \- B) Weight gain \- C) Hyperactivity \- D) Weight loss \*\*Answer\*\*: A) Rebound insomnia 14\. \*\*Which benzodiazepine is used for procedural sedation?\*\* \- A) Triazolam \- B) Midazolam \- C) Diazepam \- D) Lorazepam \*\*Answer\*\*: B) Midazolam 15\. \*\*Which short-acting benzodiazepine is associated with complex sleep-related behaviors like sleepwalking?\*\* \- A) Temazepam \- B) Alprazolam \- C) Triazolam \- D) Oxazepam \*\*Answer\*\*: C) Triazolam 1\. \*\*Which GABAA receptor subunit do \"Z-drugs\" like zolpidem primarily target?\*\* \- A) Alpha-2 \- B) Alpha-1 \- C) Beta-2 \- D) Gamma-1 \*\*Answer\*\*: B) Alpha-1 2\. \*\*Which \"Z-drug\" is associated with the least daytime sedation?\*\* \- A) Zaleplon \- B) Zolpidem \- C) Eszopiclone \- D) Temazepam \*\*Answer\*\*: A) Zaleplon 3\. \*\*What is the primary therapeutic use of zolpidem?\*\* \- A) Treatment of seizures \- B) Reduction of anxiety \- C) Treatment of insomnia \- D) Muscle relaxation \*\*Answer\*\*: C) Treatment of insomnia 4\. \*\*Which barbiturate is commonly used in the treatment of seizures?\*\* \- A) Amobarbital \- B) Thiopental \- C) Phenobarbital \- D) Secobarbital \*\*Answer\*\*: C) Phenobarbital 5\. \*\*What is the mechanism of action of barbiturates on the GABAA receptor?\*\* \- A) Increase the duration of chloride channel opening \- B) Increase the frequency of chloride channel opening \- C) Block chloride channels \- D) Inhibit sodium channels \*\*Answer\*\*: A) Increase the duration of chloride channel opening 6\. \*\*Why are barbiturates less commonly used for insomnia compared to newer agents like Z-drugs?\*\* \- A) Higher risk of dependence \- B) Shorter half-life \- C) Better safety profile \- D) Less effective in producing sleep \*\*Answer\*\*: A) Higher risk of dependence 7\. \*\*What is the mechanism of action of buspirone?\*\* \- A) Full agonist at the 5-HT1a receptor \- B) Antagonist at the dopamine receptor \- C) Inhibitor of norepinephrine reuptake \- D) GABA agonist \*\*Answer\*\*: A) Full agonist at the 5-HT1a receptor 8\. \*\*What is a major advantage of buspirone over benzodiazepines?\*\* \- A) Faster onset of action \- B) No risk of dependence or withdrawal \- C) Stronger sedative effect \- D) Effective for immediate anxiety relief \*\*Answer\*\*: B) No risk of dependence or withdrawal 9\. \*\*How long does it typically take for buspirone to achieve its full therapeutic effect?\*\* \- A) 1 day \- B) 3 days \- C) 3-4 weeks \- D) 1 week \*\*Answer\*\*: C) 3-4 weeks 10\. \*\*What is the primary mechanism of action of orexin antagonists like suvorexant?\*\* \- A) Inhibition of GABA receptors \- B) Inhibition of orexin A and B signaling \- C) Increase of serotonin levels \- D) Blockade of histamine receptors \*\*Answer\*\*: B) Inhibition of orexin A and B signaling 11\. \*\*What is the most common side effect of suvorexant?\*\* \- A) Respiratory depression \- B) Seizures \- C) Daytime somnolence \- D) Sleep paralysis \*\*Answer\*\*: C) Daytime somnolence 12\. \*\*What condition is suvorexant primarily used to treat?\*\* \- A) Anxiety disorders \- B) Insomnia \- C) Depression \- D) Epilepsy \*\*Answer\*\*: B) Insomnia 13\. \*\*Which first-generation antihistamine is commonly used to treat insomnia?\*\* \- A) Cetirizine \- B) Hydroxyzine \- C) Loratadine \- D) Ranitidine \*\*Answer\*\*: B) Hydroxyzine 14\. \*\*Why are first-generation antihistamines not recommended for chronic treatment of insomnia?\*\* \- A) High risk of dependence \- B) Short duration of action \- C) Poor evidence of efficacy \- D) Increased risk of seizures \*\*Answer\*\*: C) Poor evidence of efficacy 15\. \*\*Which patient population should avoid the use of diphenhydramine for insomnia?\*\* \- A) Pregnant women \- B) Children under 5 \- C) Elderly patients \- D) Patients with asthma \*\*Answer\*\*: C) Elderly patients 1\. \*\*Which benzodiazepine is commonly used for the prevention of alcohol withdrawal symptoms?\*\* \- A) Clonazepam \- B) Chlordiazepoxide \- C) Alprazolam \- D) Zolpidem \*\*Answer\*\*: B) Chlordiazepoxide 2\. \*\*What is a common long-acting benzodiazepine used for treating status epilepticus?\*\* \- A) Lorazepam \- B) Diazepam \- C) Oxazepam \- D) Eszopiclone \*\*Answer\*\*: B) Diazepam 3\. \*\*Which long-acting benzodiazepine is converted to desmethyldiazepam as a major metabolite?\*\* \- A) Temazepam \- B) Clonazepam \- C) Diazepam \- D) Triazolam \*\*Answer\*\*: C) Diazepam 4\. \*\*Which symptom is commonly associated with benzodiazepine withdrawal?\*\* \- A) Euphoria \- B) Panic attacks \- C) Weight gain \- D) Hypersomnia \*\*Answer\*\*: B) Panic attacks 5\. \*\*What life-threatening symptom can occur due to abrupt discontinuation of benzodiazepines?\*\* \- A) Hallucinations \- B) Seizures \- C) Myocardial infarction \- D) Stroke \*\*Answer\*\*: B) Seizures 6\. \*\*How should benzodiazepine withdrawal be managed?\*\* \- A) Immediate discontinuation \- B) Rapid taper over 2 days \- C) Slow taper over time \- D) Conversion to barbiturates \*\*Answer\*\*: C) Slow taper over time 7\. \*\*Which melatonin receptor agonist is used for sleep onset insomnia?\*\* \- A) Suvorexant \- B) Ramelteon \- C) Zolpidem \- D) Temazepam \*\*Answer\*\*: B) Ramelteon 8\. \*\*What is the main mechanism of action of melatonin receptor agonists like ramelteon?\*\* \- A) Agonism at GABA receptors \- B) Antagonism of serotonin receptors \- C) Agonism at MT1 and MT2 receptors \- D) Blockade of alpha-1 receptors \*\*Answer\*\*: C) Agonism at MT1 and MT2 receptors 9\. \*\*Which drug should not be used in combination with ramelteon due to significant drug interactions?\*\* \- A) Fluvoxamine \- B) Diazepam \- C) Buspirone \- D) Eszopiclone \*\*Answer\*\*: A) Fluvoxamine 10\. \*\*Which Z-drug is associated with the least amount of next-day somnolence?\*\* \- A) Zolpidem \- B) Eszopiclone \- C) Zaleplon \- D) Diazepam \*\*Answer\*\*: C) Zaleplon 11\. \*\*What is a common adverse effect of Z-drugs like zolpidem and eszopiclone?\*\* \- A) Seizures \- B) Daytime anxiety \- C) Complex sleep behaviors \- D) Weight gain \*\*Answer\*\*: C) Complex sleep behaviors 12\. \*\*Which Z-drug is specifically used to treat both sleep onset and middle-of-the-night awakening?\*\* \- A) Zaleplon \- B) Zolpidem SL (Edluar) \- C) Eszopiclone \- D) Triazolam \*\*Answer\*\*: B) Zolpidem SL (Edluar) 13\. \*\*Which barbiturate is still commonly used for seizure control?\*\* \- A) Secobarbital \- B) Thiopental \- C) Phenobarbital \- D) Amobarbital \*\*Answer\*\*: C) Phenobarbital 14\. \*\*What is the primary mechanism of action of barbiturates?\*\* \- A) Increase in the duration of GABA-gated chloride channel openings \- B) Blockage of sodium channels \- C) Activation of serotonin receptors \- D) Decrease in norepinephrine release \*\*Answer\*\*: A) Increase in the duration of GABA-gated chloride channel openings 15\. \*\*Why are barbiturates less commonly used than benzodiazepines for insomnia?\*\* \- A) Shorter duration of action \- B) Lower risk of dependence \- C) Higher potential for toxicity and dependence \- D) Poor efficacy for sleep maintenance \*\*Answer\*\*: C) Higher potential for toxicity and dependence 16\. \*\*What is the primary therapeutic use of suvorexant?\*\* \- A) Anxiety disorders \- B) Sleep onset insomnia \- C) Seizure control \- D) Muscle relaxation \*\*Answer\*\*: B) Sleep onset insomnia 17\. \*\*Which orexin receptor is blocked by suvorexant to promote sleep?\*\* \- A) Orexin 1 receptor \- B) Orexin 2 receptor \- C) Both orexin 1 and 2 receptors \- D) GABA receptor \*\*Answer\*\*: C) Both orexin 1 and 2 receptors 18\. \*\*Which side effect is commonly associated with orexin antagonists like suvorexant?\*\* \- A) Daytime somnolence \- B) Seizures \- C) Hallucinations \- D) Tachycardia \*\*Answer\*\*: A) Daytime somnolence 19\. \*\*Which first-generation antihistamine is commonly used off-label for insomnia?\*\* \- A) Loratadine \- B) Hydroxyzine \- C) Cetirizine \- D) Fexofenadine \*\*Answer\*\*: B) Hydroxyzine 20\. \*\*Why are first-generation antihistamines not recommended for long-term treatment of insomnia?\*\* \- A) High risk of dependence \- B) Poor efficacy and adverse side effects \- C) Increased risk of hypertension \- D) Strong REM rebound \*\*Answer\*\*: B) Poor efficacy and adverse side effects 21\. \*\*Which patient population should avoid diphenhydramine due to increased risk of side effects?\*\* \- A) Pediatric patients \- B) Pregnant women \- C) Elderly patients \- D) Patients with diabetes \*\*Answer\*\*: C) Elderly patients 1\. \*\*Which antihistamine is frequently used for treating insomnia?\*\* \- A) Hydroxyzine \- B) Cetirizine \- C) Loratadine \- D) Fexofenadine \*\*Answer\*\*: A) Hydroxyzine 2\. \*\*What is a common adverse effect associated with using first-generation antihistamines like diphenhydramine for insomnia?\*\* \- A) Hypertension \- B) Daytime sedation \- C) Insomnia rebound \- D) Seizures \*\*Answer\*\*: B) Daytime sedation 3\. \*\*Which population is generally advised to avoid first-generation antihistamines like diphenhydramine?\*\* \- A) Pregnant women \- B) Children \- C) Elderly patients \- D) Patients with anxiety \*\*Answer\*\*: C) Elderly patients 4\. \*\*What is the primary mechanism of action of buspirone?\*\* \- A) GABA agonist \- B) Full agonist at 5-HT1a receptors \- C) Antagonist at serotonin receptors \- D) Blocker of norepinephrine reuptake \*\*Answer\*\*: B) Full agonist at 5-HT1a receptors 5\. \*\*How long does it typically take for buspirone to achieve full therapeutic effects?\*\* \- A) 1-2 days \- B) 3-4 weeks \- C) 1 week \- D) 24 hours \*\*Answer\*\*: B) 3-4 weeks 6\. \*\*Why is buspirone considered advantageous over benzodiazepines for chronic anxiety treatment?\*\* \- A) It has a faster onset of action \- B) It carries no risk of dependence or withdrawal \- C) It is stronger in sedation \- D) It works immediately to relieve anxiety \*\*Answer\*\*: B) It carries no risk of dependence or withdrawal \#\#\# Slide 45 - Melatonin and Related Drugs 7\. \*\*What is the primary function of melatonin in sleep regulation?\*\* \- A) It decreases sleep latency and enhances REM sleep \- B) It induces wakefulness \- C) It regulates the circadian rhythm and induces sleep \- D) It increases daytime alertness \*\*Answer\*\*: C) It regulates the circadian rhythm and induces sleep 8\. \*\*Which melatonin receptor agonist is used specifically for sleep onset insomnia?\*\* \- A) Zolpidem \- B) Ramelteon \- C) Zaleplon \- D) Eszopiclone \*\*Answer\*\*: B) Ramelteon 9\. \*\*What is a contraindication for using ramelteon?\*\* \- A) Pregnancy \- B) Severe renal impairment \- C) Concurrent use with fluvoxamine \- D) Alcohol use \*\*Answer\*\*: C) Concurrent use with fluvoxamine 10\. \*\*What is the mechanism of action of suvorexant, an orexin antagonist?\*\* \- A) It blocks GABA receptors \- B) It inhibits the action of orexins A and B \- C) It enhances melatonin production \- D) It increases serotonin levels \*\*Answer\*\*: B) It inhibits the action of orexins A and B 11\. \*\*What is a common adverse effect of orexin antagonists like suvorexant?\*\* \- A) Sleep paralysis \- B) Weight loss \- C) Insomnia \- D) Increased daytime alertness \*\*Answer\*\*: A) Sleep paralysis 12\. \*\*Which sleep condition is suvorexant primarily used to treat?\*\* \- A) Anxiety \- B) Narcolepsy \- C) Sleep onset and maintenance insomnia \- D) Seizures \*\*Answer\*\*: C) Sleep onset and maintenance insomnia