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1. The current diagnostic criteria for primary insomnia require all of the following, EXCEPT:

A. Occur in the absence of known medical or psychiatric causes B. Complaints of both falling asleep and staying asleep C. Insomnia symptoms must occur for at least one month D. Insomnia symptoms must cause distress or daytime impairment

2. Which one of the following is correct regarding complaints about insomnia:

A. Waking up too early is more common than waking up in the middle of the night B. Difficulty falling asleep is more common than feelings of non-refreshing sleep C. Sleep complaints are very common, but a diagnosis of primary insomnia is found in only 10% of adults D. Waking up too early is more common than difficulty falling asleep

3. The daytime consequences of insomnia include all of the following, EXCEPT:

A. Greater risk of falls for older adults B. Increased risk of accidents C. Increased risk of dementia for older adults D. Increased use of health care resources

4. Which one of the following medical conditions is commonly associated with sleep complaints:

A. Polyuria from prostate or urinary disorders B. Chronic pain of fibromyalgia C. Chronic renal disease D. All of the above

5. Which one of the following drugs is commonly associated with sleep complaints:

A. L-dopa B. Bupropion C. Furosemide at bedtime D. All of the above

6. Which one of the following is correct regarding zolpidem when compared with temazepam:

A. It lacks temazepam's muscle relaxant and anticonvulsant effects B. It is more effective for comorbid, chronic insomnia C. Rebound insomnia is equally likely with both drugs D. The onset of hypnotic effect is the same

7. Which one of the following benzodiazepines has the slowest onset of effect:

A. Quazepam B. Temazepam C. Triazolam D. Estazolam

8. Which one of the following hypnotic drugs would be best for a patient who sleeps well through the night, but only has difficulty falling asleep:

A. Eszopiclone B. Flurazepam C. Zaleplon D. Zolpidem

9. Which of the following describes the difference between zolpidem immediate release (IR) tablets and controlled release (CR) zolpidem:

A. CR Zolpidem releases one-third of its dose after approximately 4 hours B. Zolpidem IR has a longer duration of effect C. The elimination half-life of CR Zolpidem is longer D. Clinical studies have demonstrated that CR Zolpidem is more effective for maintaining sleep

10. The 2013 U.S. Food and Drug Administration (FDA) safety announcement about zolpidem included all of the following, EXCEPT:

A. The risk of next morning impairment of activities is greater with the extended-release formulations B. Women and men are at equal risk of next morning impairment with zolpidem C. The new recommended dose is 5 mg for immediate-release tablets D. The new recommended dose is 6.25 mg for extended-release tablets

11. The hypnotic drug best suited for middle-of-the-night administration, as well as for those with unpredictable awakenings that require alertness within a few hours of drug use is which of the following:

A. Temazepam B. Zaleplon C. Eszopiclone D. Melatonin

12. Which of the following hypnotic drugs is best suited for those who expect to spend 8 hours or more in bed after ingestion:

A. Temazepam B. Zaleplon C. Eszopiclone D. Melatonin

13. Melatonin is an appropriate and effective treatment for which of the following conditions:

A. Primary insomnia B. Non-24-hour sleep-wake syndrome C. Insomnia in older adults D. Delayed sleep phase syndrome

14. All but which one of the following is a potential advantage of ramelteon:

A. Demonstrated efficacy for improving sleep onset for up to 6 months B. Adverse effects are similar in frequency to those seen with placebo C. It is not a controlled substance D. Demonstrated efficacy for improving total sleep time for up to 6 months

15. Which one of the following hypnotic drugs has been most associated with causing priapism:

A. Trazodone B. Ramelteon C. Quetiapine D. Zaleplon

16. The American Geriatrics Society (AGS) 2012 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults includes all but which of the following:

A. Temazepam B. Zolpidem C. Trazodone D. Diphenhydramine

17. Which one of the following medications has demonstrated sustained hypnotic efficacy for up to 12 weeks of treatment:

A. Diphenhydramine B. Doxepin C. Valerian D. Amitriptyline

18. Which one of the following is correct regarding orexins, orexin antagonists, and their role in sleep:

A. Orexins promote sleep in the lateral hypothalamus B. Orexin antagonists share with benzodiazepines a likely side effect profile of cognitive impairment, impaired motor coordination, and abuse liability C. Orexin antagonists may have the potential for narcolepsy-like effects D. Orexin antagonists suppress REM sleep

19. A woman, aged 62 years, arrives at your pharmacy asking which over-the-counter (OTC) sleep aid is best. After discussing symptoms, which of the following factors would prompt you to refer her to her physician for evaluation rather than recommend an OTC sleep aid:

A. Her sleep difficulty has persisted for 5 weeks B. Her sleep difficulty is impairing work performance C. She believes her sleep difficulty is related to her worsening osteoarthritis D. All of the above

20. A woman, aged 62 years, arrives at your pharmacy asking which OTC sleep aid is best. Which of the following is not a component of useful sleep hygiene counseling:

A. Avoid heavy meals or excessive fluids near bedtime B. Exercising just before bedtime can increase sleepiness C. Set a regular time to go to bed and awaken D. Avoid caffeine in the evening