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Excessive somnolence, low heart rate, and low blood pressure
21%
3/14
Fever, tachycardia, HTN, tremor, elevated CPK, “lead pipe” rigidity
29%
4/14
Dry mouth, blurred vision, urinary retention.
0%
0/14
Restlessness, confusion, tremulousness, psychosis, and generalized seizure
43%
6/14
Darting and writhing of face, tongue, or head
Select Answer to see Preferred Response
Benzodiazepines are commonly used for the treatment of anxiety. Restlessness, confusion, tremulousness, psychosis, and generalized seizure are all symptoms consistent with withdrawal from benzodiazepines. Benzodiazepines are sedative hypnotic medications commonly used in the treatment of anxiety. Symptoms of withdrawal usually begin several days into one's hospital course. The symptoms of benzodiazepine withdrawal include anxiety, restlessness, confusion, disorientation, tremulousness, generalized seizures, psychosis, tachycardia, elevated blood pressure, and hyperthermia. Benzodiazepines work to potentiate GABA by increasing the frequency of chloride channel openings. Unfortunately, many patients can become dependent on these medications and will require increasing amounts to achieve the clinical effect (tolerance). Ebell reviews the use of benzodiazepines as an effective treatment for alcohol withdrawal, particularly in reducing withdrawal seizures. Some of the longer acting benzodiazepines tend to be particularly helpful in the prevention of delirium. The American Society of Addiction Medicine has made the recommendation that benzodiazepines should be the first-line agent for the treatment of alcohol withdrawal. Lader et al. report on how benzodiazepine harm may be reduced. They note that approximately one-third of long-term users (greater than 6 months) manifest signs and symptoms of withdrawal when attempting to cease benzodiazepine therapy. In order to reduce harm that could come from chronic use of benzodiazepines, physicians should focus on alternative treatments, both psychological and pharmacological, before jumping to using benzodiazepines. Additionally, benzodiazepines should only be used short-term, and they are not considered a first-line medication for anxiety. Illustration A depicts the mechanism of benzodiazepines. Illustration B summarizes several different scenarios of patients taking benzodiazepines; note the appropriate tapering schedules associated with each situation. Incorrect Answers: Answer 1: These physical findings would not be related to benzodiazepine withdrawal. Answer 2: This is a description of neuromuscular malignant syndrome. Answer 3: This is a description of the side effect profile of anticholinergic medications. Answer 5: This is a description of tardive dyskinesia.
5.0
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