Review Question - QID 105764

The patient in this vignette, if not given some form of benzodiazepine during her hospitalization, is at risk for acute withdrawal, which can result in generalized tonic-clonic seizures.

Hospitalizations are a common culprit of initiating substance withdrawal in patients when they are no longer able to self-medicate. Abrupt cessation of short-acting benzodiazepines, in this case alprazolam, may cause delirium or seizures. It is essential to recognize which patients are at risk for withdrawal so that proper precautions can be taken.

Gliatto writes that short-acting benzodiazepines can be used in the short-term treatment of generalized anxiety disorder (GAD) but are often continued for months to years. It is preferable to reduce the use of benzodiazepines by adding buspirone or another antidepressant.

Closser et al. describe an effective method of treating alprazolam withdrawal by using a long-acting benzodiazepine, in this case chlordiazepoxide, to accomplish a rapid, well-tolerated withdrawal. Chlordiazepoxide was substituted for alprazolam and gradually decreased. In this study, the authors reports no seizures or other serious side effects.

Incorrect Answers:
Answer 2: Respiratory depression is a risk of benzodiazepine intoxication, not withdrawal.
Answer 3: Vertical nystagmus is seen most commonly with PCP intoxication not benzodiazepine withdrawal
Answer 4: Rebound sedation is a common presentation of stimulant withdrawal.
Answer 5: Rebound hypertension is seen with anxiolytic withdrawal, not hypotension.