Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)
Pharmacology
Easy
What is the drug of choice for alcohol withdrawal symptoms?
Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)
Explanation
- Chlordiazepoxide is a long-acting benzodiazepine, which is the gold-standard and first-line treatment for alcohol withdrawal syndrome (AWS).
- It works by potentiating the effects of the inhibitory neurotransmitter GABA at GABA-A receptors, which substitutes for the effect of alcohol.
- This action reduces the central nervous system hyperexcitability that causes symptoms like agitation, tremors, and anxiety.
- Most importantly, it is effective in preventing life-threatening complications of withdrawal, such as seizures and delirium tremens.
Why Other Options Were Wrong
- Option B: Labetalol is a beta-blocker that only treats the peripheral autonomic symptoms of withdrawal, such as high blood pressure and rapid heart rate. It does not address the underlying CNS hyperexcitability.
- Option C: Metoclopramide is an antiemetic used for nausea and vomiting. It has no effect on the primary neurological symptoms of withdrawal and can be dangerous as it may lower the seizure threshold.
- Option D: Digoxin is a cardiac glycoside used to treat heart failure and control the heart rate in atrial fibrillation. It has no therapeutic role in the management of alcohol withdrawal.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Pharmacological management of alcohol withdrawal syndrome to guide bedside assessment, documentation, and the next nursing action.
- Nurses must be proficient in using a standardized tool, such as the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar), to objectively score withdrawal severity and guide the administration of benzodiazepines.
- A critical nursing responsibility is to monitor for signs of over-sedation and respiratory depression, which are potential adverse effects of the high doses of benzodiazepines sometimes required to control severe withdrawal.
- What if? If a patient in alcohol withdrawal has severe liver failure, a different benzodiazepine like Lorazepam or Oxazepam would be preferred. These drugs are metabolized through glucuronidation, a process less affected by liver disease, reducing the risk of drug accumulation and prolonged sedation compared to Chlordiazepoxide.
How to Approach the Question
- First, identify the core clinical condition presented in the question: 'alcohol withdrawal symptoms'.
- Recall the underlying pathophysiology of alcohol withdrawal, which is a state of central nervous system (CNS) hyperexcitability due to the abrupt cessation of alcohol's depressant effects.
- Understand that the treatment goal is to substitute the effect of alcohol with a cross-tolerant medication that also acts as a CNS depressant to prevent severe symptoms.
- Evaluate the drug classes of the options provided: Chlordiazepoxide (benzodiazepine/CNS depressant), Labetalol (beta-blocker), Metoclopramide (antiemetic), and Digoxin (cardiac glycoside).
- Based on the pathophysiology, conclude that the benzodiazepine is the only class of drug listed that directly and effectively treats the root cause of alcohol withdrawal symptoms.
Concept Tested & Keywords
- Concept Tested: Pharmacological management of alcohol withdrawal syndrome.
- Stem keywords: drug of choice, alcohol withdrawal symptoms
- Lead-in keywords: What is
- Negative lead-in flag: false
Question ID
Qjh6nVq1aKDtvdKdAKQW_V
Reference Book
E6 Pharmacology Katzung 16e p. 632-634
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 907-909
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 4253-4255
Practise the full Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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