Pharmacotherapy for Sleep Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Pharmacotherapy for Sleep Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 1: A 35-year-old male patient presents to surgery emergency with painful erection for past 7 hours. He has a history of mood disorder and was recently prescribed a medication by treating psychiatrist. Which is the likely offending drug?
- A. Venlafaxine
- B. Tianeptine
- C. Trazodone (Correct Answer)
- D. Mirtazapine
Pharmacotherapy for Sleep Disorders Explanation: ***Trazodone***
- **Trazodone** is a commonly known antidepressant that can cause **priapism** as a side effect, especially at higher doses, due to its alpha-adrenergic blocking activity. [1]
- The patient's presentation of a **painful erection lasting 7 hours** after starting a new psychiatric medication strongly points towards a drug-induced cause, for which trazodone is a well-established culprit. [1]
*Venlafaxine*
- **Venlafaxine** is an SNRI antidepressant that generally does not cause priapism as a recognized side effect.
- Its adverse effect profile primarily includes nausea, insomnia, and sexual dysfunction (e.g., erectile dysfunction, anorgasmia), rather than prolonged erections.
*Tianeptine*
- **Tianeptine** is an atypical antidepressant that is not known to cause priapism.
- It works by enhancing serotonin reuptake and is more commonly associated with side effects such as nausea, constipation, and dizziness.
*Mirtazapine*
- **Mirtazapine** is a tetracyclic antidepressant that works by blocking alpha-2 adrenergic receptors and certain serotonin receptors.
- While it can cause sedation and weight gain, priapism is not a typical or recognized side effect of mirtazapine.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 2: Which of the following statements about ramelteon is false?
- A. Is a substrate of CYP1A2
- B. Approved for treatment of insomnia
- C. Has high addiction liability (Correct Answer)
- D. Agonist at MT1 and MT2 receptors
Pharmacotherapy for Sleep Disorders Explanation: ***Has high addiction liability***
- Ramelteon is a **melatonin receptor agonist** that does not bind to GABA receptors, distinguishing it from benzodiazepines and Z-drugs (zolpidem, eszopiclone, zaleplon).
- Its mechanism of action leads to a **very low risk of abuse and dependence**, contrary to the statement.
*Is a substrate of CYP1A2*
- Ramelteon is extensively metabolized in the liver, primarily by **CYP1A2**, which is accurate.
- This metabolic pathway can lead to drug interactions if co-administered with **CYP1A2 inhibitors** (e.g., fluvoxamine), which can significantly increase ramelteon concentrations.
*Approved for treatment of insomnia*
- Ramelteon is indeed indicated for the **treatment of insomnia**, particularly for difficulties with **sleep onset**.
- It works by mimicking the action of **melatonin**, promoting the regulation of the sleep-wake cycle.
*Agonist at MT1 and MT2 receptors*
- Ramelteon acts as a **selective agonist** at the **melatonin MT1 and MT2 receptors** in the suprachiasmatic nucleus.
- Activation of these receptors helps to modulate the **circadian rhythm**, thereby promoting sleep.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 3: Which drug selectively acts on GABA-A receptors to induce sleep with minimal effects on sleep architecture?
- A. Zolpidem (Correct Answer)
- B. Phenobarbitone
- C. Buspirone
- D. Diazepam
Pharmacotherapy for Sleep Disorders Explanation: ***Zolpidem***
- **Zolpidem** is a non-benzodiazepine hypnotic that selectively binds to the **omega-1 subtype of GABA-A receptors**, primarily mediating sedation.
- This selective action results in sleep induction with **minimal disruption of normal sleep architecture**, making it preferable for insomnia.
*Phenobarbitone*
- **Phenobarbitone** is a barbiturate that non-selectively enhances GABA-A receptor activity, leading to global CNS depression.
- It significantly **disturbs sleep architecture**, reducing REM sleep and slow-wave sleep, and carries a higher risk of dependence and overdose.
*Buspirone*
- **Buspirone** is an anxiolytic that acts as a partial agonist at **5-HT1A serotonin receptors** and has no direct activity at GABA-A receptors.
- It treats generalized anxiety disorder but does **not induce sleep** and is not used as a hypnotic.
*Diazepam*
- **Diazepam** is a benzodiazepine that non-selectively binds to various subunits of the GABA-A receptor, enhancing GABAergic transmission.
- While it induces sleep, it also **significantly alters sleep architecture** (reducing REM and slow-wave sleep) and has a longer half-life, increasing the risk of daytime sedation.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 4: Diazepam poisoning is treated by:
- A. Resins
- B. Hemofiltration
- C. Charcoal
- D. Flumazenil (Correct Answer)
Pharmacotherapy for Sleep Disorders Explanation: ***Flumazenil***
- **Flumazenil** is a **benzodiazepine receptor antagonist** that competitively binds to the benzodiazepine binding site on the GABA-A receptor, reversing the effects of diazepam.
- It is used in cases of severe benzodiazepine overdose causing **respiratory depression** or **severe sedation**.
*Resins*
- **Resins**, such as **cholestyramine**, are typically used to bind toxins or drugs in the **gastrointestinal tract** that undergo enterohepatic recirculation.
- They are generally not effective for reversing the central nervous system depression caused by a benzodiazepine overdose.
*Hemofiltration*
- **Hemofiltration** is a form of renal replacement therapy used to remove small and middle molecular weight substances from the blood.
- While it can remove some drugs, **diazepam** is highly **lipophilic** and extensively **protein-bound**, making it poorly amenable to removal by hemofiltration.
*Charcoal*
- **Activated charcoal** is used to prevent the absorption of ingested toxins from the gastrointestinal tract.
- It is effective when administered soon after ingestion but does not reverse the established effects of an absorbed drug like diazepam in an overdose situation.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 5: Which of the antidepressants is used in low doses as a hypnotic?
- A. fluoxetine
- B. fluvoxamine
- C. bupropion
- D. trazodone (Correct Answer)
Pharmacotherapy for Sleep Disorders Explanation: ***trazodone***
- **Trazodone** is an antidepressant that is frequently prescribed off-label at low doses as a **hypnotic** due to its potent **histamine H1 receptor antagonism** and **alpha-1 adrenergic blocking effects**, inducing sedation.
- Its sedative properties differentiate it from other antidepressants that are primarily stimulating.
*fluoxetine*
- **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** known for its **activating** effects, making it a poor choice for a hypnotic.
- It is more likely to cause **insomnia** and agitation rather than sedation.
*fluvoxamine*
- **Fluvoxamine** is another **SSRI** primarily used for **obsessive-compulsive disorder (OCD)**.
- Like other SSRIs, its primary action is not sedation, and it can sometimes lead to **sleep disturbances**.
*bupropion*
- **Bupropion** is a **norepinephrine-dopamine reuptake inhibitor (NDRI)** known for its **stimulating effects** and lack of sexual side effects.
- It is often avoided in patients with **insomnia** due to its activating properties and is not used as a hypnotic.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 6: Drug of choice for night terrors:
- A. Tricyclic antidepressant
- B. Meprobamate
- C. Diazepam
- D. Clonazepam (Correct Answer)
Pharmacotherapy for Sleep Disorders Explanation: ***Clonazepam***
- **Clonazepam**, a benzodiazepine, is the **drug of choice** for night terrors due to its ability to suppress Stage 3 and 4 **slow-wave sleep**, where night terrors occur.
- Its sedative and anxiolytic effects help to calm the patient and reduce the frequency and severity of these episodes.
*Tricyclic antidepressant*
- While some **tricyclic antidepressants** (TCAs) have sedative properties, they are generally not the first-line treatment for night terrors.
- Their side effect profile and potential to alter other sleep stages make them less suitable than benzodiazepines for this specific parasomnia.
*Meprobamate*
- **Meprobamate** is an anxiolytic and sedative drug that is largely historical and has been replaced by safer and more effective alternatives like benzodiazepines.
- It has a higher risk of dependence and side effects compared to modern treatments for sleep disorders.
*Diazepam*
- **Diazepam** is another benzodiazepine, but **clonazepam** is generally preferred for night terrors due to its longer half-life and specific efficacy in suppressing slow-wave sleep.
- While diazepam could offer some relief, clonazepam is considered more effective for sustained management of this condition.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 7: The shortest-acting benzodiazepine is:
- A. Alprazolam
- B. Lorazepam
- C. Diazepam
- D. Midazolam (Correct Answer)
Pharmacotherapy for Sleep Disorders Explanation: ***Midazolam***
- **Midazolam** is known for its **rapid onset** and very **short duration of action**, making it suitable for procedures requiring quick sedation and recovery.
- Its **high lipid solubility** allows for rapid entry into the CNS, and its rapid metabolism contributes to its short half-life.
*Alprazolam*
- **Alprazolam** has an intermediate half-life among benzodiazepines, typically around 11-15 hours, which is longer than midazolam.
- It is primarily used for the short-term management of **anxiety disorders** and panic attacks.
*Lorazepam*
- **Lorazepam** has an intermediate to long half-life, ranging from 10 to 20 hours, and is often preferred for managing anxiety and insomnia due to its consistent efficacy.
- It has a slower onset of action compared to midazolam and is metabolized via **glucuronidation**, which is less affected by liver dysfunction.
*Diazepam*
- **Diazepam** has a very long duration of action due to its **active metabolites** (like desmethyldiazepam), with a half-life extending up to 100 hours.
- It is used for conditions requiring prolonged anxiolytic, sedative, or anticonvulsant effects, but not for its short duration.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 8: Modafinil is primarily used for the treatment of which of the following conditions?
- A. Narcolepsy (Correct Answer)
- B. Sexual dysfunction
- C. Depression
- D. Anxiety
Pharmacotherapy for Sleep Disorders Explanation: ***Narcolepsy***
- **Modafinil** is a **eugeroic** (wakefulness-promoting agent) specifically approved and widely used for the treatment of excessive daytime sleepiness associated with **narcolepsy**.
- Its mechanism involves increasing **dopamine** and **norepinephrine** levels, and modulating **orexin** pathways, promoting alertness without significant psychomotor stimulation.
*Sexual dysfunction*
- While sometimes explored off-label for certain types of sexual dysfunction, **modafinil** is not a primary or approved treatment for this condition.
- Primary treatments for sexual dysfunction often involve specific medications like **PDE5 inhibitors** or hormone therapy, depending on the cause.
*Depression*
- **Modafinil** is not a primary antidepressant, although it can be used as an **adjunctive therapy** in some cases to combat residual fatigue or hypersomnia associated with depression.
- Standard treatment for depression involves **selective serotonin reuptake inhibitors (SSRIs)**, **serotonin-norepinephrine reuptake inhibitors (SNRIs)**, or other classes of antidepressants.
*Anxiety*
- **Modafinil** is a stimulant-like drug and can sometimes **exacerbate anxiety** in susceptible individuals due to its catecholaminergic effects.
- Primary treatments for anxiety disorders include **selective serotonin reuptake inhibitors (SSRIs)**, **benzodiazepines** (for acute relief), and psychotherapy.
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 9: Somnambulism is mostly seen in which age group?
- A. Adolescents
- B. All age groups
- C. Children (Correct Answer)
- D. Adults
Pharmacotherapy for Sleep Disorders Explanation: ***Correct Option: Children***
- Somnambulism (sleepwalking) is **most commonly seen in children**, with peak incidence between **4-12 years of age**
- Approximately **15-40% of children** experience at least one episode of sleepwalking
- Occurs during **slow-wave sleep (NREM stage 3)**, which is more prominent in childhood
- Episodes typically **decrease and resolve by adolescence** as sleep architecture matures
*Incorrect Option: Adolescents*
- While sleepwalking can persist into adolescence, the **prevalence significantly decreases** during teenage years
- Most children who sleepwalk stop by the time they reach adolescence
*Incorrect Option: All age groups*
- Though somnambulism can technically occur at any age, it is **NOT equally distributed** across age groups
- The frequency is **significantly higher in children** compared to other age groups
*Incorrect Option: Adults*
- Adult-onset sleepwalking is **relatively rare (1-4% prevalence)**
- When it occurs in adults, it may be associated with underlying conditions (medications, sleep deprivation, psychiatric disorders, or neurological conditions)
- Childhood somnambulism has much higher prevalence rates
Pharmacotherapy for Sleep Disorders Indian Medical PG Question 10: What is the primary characteristic feature of Klein-Levin syndrome?
- A. Insomnia
- B. Anxiety
- C. Depression
- D. Hypersomnia (Correct Answer)
Pharmacotherapy for Sleep Disorders Explanation: ***Hypersomnia***
- **Hypersomnia** is the cardinal and primary characteristic feature of Klein-Levin syndrome, characterized by recurrent episodes of excessive sleepiness lasting days to weeks.
- During these episodes, individuals may sleep for **16 to 20 hours a day** and are extremely difficult to awaken.
- Episodes are often accompanied by **cognitive disturbances** (confusion, derealization), **behavioral changes** (apathy, hyperphagia, hypersexuality), but **hypersomnia remains the defining feature**.
- Normal functioning returns between episodes.
*Insomnia*
- **Insomnia** (difficulty falling or staying asleep) is the opposite of the key symptom seen in Klein-Levin syndrome.
- Klein-Levin syndrome is a disorder of excessive sleep, not sleep deprivation.
*Anxiety*
- **Anxiety** may occur as a secondary feature or during the distress of episodes, but it is not the primary characteristic feature.
- The core pathology manifests as profound sleep disturbance, not an anxiety disorder.
*Depression*
- **Depression** is sometimes observed during or after episodes of Klein-Levin syndrome, but it is not the primary defining feature.
- The diagnostic hallmark is the **recurrent hypersomnia with associated cognitive and behavioral symptoms**, not mood disturbance.
More Pharmacotherapy for Sleep Disorders Indian Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
