Which drug is used for alcohol withdrawal symptoms?

NORCET 3 - 2022 (Shift-1)

Pharmacology

Easy

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

Chlordiazepoxide is a long-acting benzodiazepine, which is the first-line drug class for managing acute alcohol withdrawal syndrome (AWS).
It works by enhancing the effect of the inhibitory neurotransmitter GABA, which calms the hyperexcited central nervous system that results from abrupt alcohol cessation.
The primary goal of using chlordiazepoxide is to manage symptoms like anxiety, agitation, and tremors, and to prevent life-threatening complications such as withdrawal seizures and delirium tremens.

Option A: Disulfiram is an aversive therapy agent. It does not treat withdrawal symptoms but is used to maintain abstinence in detoxified patients.
Option C: Acarbose is an oral hypoglycemic agent used to manage type 2 diabetes mellitus. It has no role in the treatment of alcohol withdrawal.
Option D: Naltrexone is an opioid antagonist used for relapse prevention after detoxification is complete. It is not used for managing acute withdrawal symptoms.

Visual 1: Flowchart: Management of Alcohol Withdrawal Syndrome. This visual can illustrate the process from initial assessment using the CIWA-Ar scale, to the administration of benzodiazepines, and the importance of supportive care like thiamine administration.
Visual 2: Infographic: CIWA-Ar Scale. This would detail the 10 parameters assessed (e.g., tremor, anxiety, sweating, hallucinations) and the scoring system that guides treatment decisions for mild, moderate, and severe withdrawal.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological management of acute alcohol withdrawal syndrome to guide bedside assessment, documentation, and the next nursing action.
Nurses must be proficient in using the CIWA-Ar scale to objectively assess withdrawal severity and titrate benzodiazepine doses. This prevents both under-medication (risking seizures) and over-sedation (risking respiratory depression).
A critical nursing safety measure is to administer thiamine before any glucose-containing IV fluids. Giving glucose first can deplete the body's remaining thiamine stores and precipitate Wernicke's encephalopathy, an acute and severe neurological emergency.
What if? If a patient in alcohol withdrawal has severe liver disease (e.g., cirrhosis), a shorter-acting benzodiazepine like Lorazepam or Oxazepam is preferred. These drugs are metabolized outside the liver, reducing the risk of toxic metabolite accumulation that can occur with long-acting agents like chlordiazepoxide.

How to Approach the Question

First, identify the key phrase in the question: 'alcohol withdrawal symptoms'. This specifies the acute phase of management, not long-term abstinence.
Next, analyze the options based on their primary mechanism of action in the context of alcohol use disorder.
Recall that benzodiazepines are the gold standard for treating acute alcohol withdrawal because they are cross-tolerant with alcohol and effectively manage CNS hyperexcitability.
Evaluate each option: Chlordiazepoxide is a benzodiazepine. Disulfiram is for aversion therapy. Naltrexone is for craving reduction. Acarbose is for diabetes.
This process of elimination confirms that Chlordiazepoxide is the only option indicated for the acute management of alcohol withdrawal symptoms.

Concept Tested & Keywords

Concept Tested: Pharmacological management of acute alcohol withdrawal syndrome.
Stem keywords: drug, alcohol withdrawal symptoms
Lead-in keywords: Which
Negative lead-in flag: false

QUhItLMZdbeo1Cw5A2H56U