A nurse is planning care for a client who is withdrawing from alcohol. Which of the following medications should the nurse plan to administer during the acute phase of alcohol withdrawal?

Choice A reason: Varenicline is a partial nicotinic acetylcholine receptor agonist used for smoking cessation. It reduces cravings and withdrawal symptoms associated with nicotine dependence but has no role in managing acute alcohol withdrawal. Alcohol withdrawal involves hyperexcitability of the central nervous system due to the sudden absence of GABAergic stimulation, and Varenicline does not address this pathophysiology. Choice B reason: Diazepam, a benzodiazepine, is the drug of choice for acute alcohol withdrawal. Benzodiazepines enhance GABA activity, counteracting the excitatory state caused by alcohol cessation. They reduce the risk of seizures, delirium tremens, and autonomic instability. Diazepam’s long half-life provides smoother withdrawal coverage and reduces rebound symptoms. Clinically, it is administered under close monitoring to titrate sedation and prevent complications. Choice C reason: Disulfiram is an aversive agent used for long-term alcohol abstinence. It inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde when alcohol is consumed, leading to unpleasant symptoms such as flushing, nausea, and palpitations. However, it is contraindicated during acute withdrawal because it does not relieve withdrawal symptoms and may worsen the client’s condition if alcohol is ingested. Choice D reason: Acamprosate is used for maintaining abstinence after detoxification. It modulates glutamatergic neurotransmission, reducing cravings and preventing relapse. However, it is not effective in treating acute withdrawal symptoms such as tremors, seizures, or delirium. Its role is supportive in long-term recovery, not immediate stabilization.