Psychopharmacology: benzodiazepines in elderly: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Psychopharmacology: benzodiazepines in elderly

Sample item

An 80-year-old needs short-term treatment for anxiety and insomnia. Why is a long-acting benzodiazepine such as diazepam undesirable?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Accumulation of active metabolites causes sedation, falls and confusion

In older adults, reduced clearance and increased volume of distribution make long-acting benzodiazepines accumulate, raising the risk of falls, fractures, delirium and cognitive impairment. If a benzodiazepine is needed, a short-acting agent like lorazepam at low dose is chosen for a brief period.

Option by option

  • A. It is hepatotoxic in all patients

    It is not hepatotoxic in all patients.

  • B. Accumulation of active metabolites causes sedation, falls and confusion (correct)

    Correct. Accumulation leads to sedation, falls and confusion.

  • C. It causes agranulocytosis

    Agranulocytosis is not a feature.

  • D. It has no effect on anxiety

    It does treat anxiety, which is the problem of accumulation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Accumulation of active metabolites causes sedation, falls and confusion. In older adults, reduced clearance and increased volume of distribution make long-acting benzodiazepines accumulate, raising the risk of falls, fractures, delirium and cognitive impairment.

Why is "It is hepatotoxic in all patients" not the answer?

It is not hepatotoxic in all patients.

Why is "It causes agranulocytosis" not the answer?

Agranulocytosis is not a feature.

Why is "It has no effect on anxiety" not the answer?

It does treat anxiety, which is the problem of accumulation.

What concept does this question test?

It tests Psychopharmacology: benzodiazepines in elderly in Psychiatry. If a benzodiazepine is needed, a short-acting agent like lorazepam at low dose is chosen for a brief period.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Psychopharmacology: benzodiazepines in elderly?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.