A 54 year old chronic alcoholic man was admitted in the hospital for a fractured femur 2 days ago. He now has tremors, is profusely sweating, apprehensive and fearful. What is the SINGLE most appropriate treatment?
A. Acamprosate
B. Chlordiazepoxide
C. Lorazepam
D. Lofexidine
E. Procyclidine
Acute Alcohol Withdrawal Patients often present with anxiety, tremor, hyperactivity, sweating, nausea and retching, tachycardia, hypertension and mild pyrexia. Symptoms peak at at 12-30 hours and subside by 48 hours
Medications used in alcoholics • Benzodiazepines for acute withdrawal (NHS commonly uses Chlordiazepoxide) Chlordiazepoxide is used as sedation • IV Pabrinex (Thiamine) (vitamin B1) is used to prevent Wernicke’s encephalopathy which is a neuropsychiatric disorder caused by thiamine deficiency which is most commonly seen in alcoholics • Disulfiram: promotes abstinence - alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase. Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms. Example of when to use disulfiram in PLAB: 40 year old man wants medication to serve as a deterrent when he takes alcohol Acamprosate: reduces craving, improves abstinence in placebo controlled trials. Example of when to use disulfiram in PLAB: 40 year old man wants some medication to help him reduce cravings