A patient is taking disulfiram therapy and ingested alcohol. Which of the following signs are visible with the reaction that will happen?

1. A

   Diarrhea, vomiting, weight loss

2. B

   Nausea, face and neck flushing, tachycardia and low BP

3. C

   Headache, diplopia

4. D

   None of them

Appeared in: PGIMER NO - 2020

Explanation

• This option correctly identifies the hallmark signs of a disulfiram-alcohol reaction: nausea, flushing, tachycardia, and hypotension.
• The reaction is caused by the accumulation of acetaldehyde, a toxic byproduct of alcohol metabolism, which occurs because disulfiram blocks the enzyme aldehyde dehydrogenase.
• Flushing of the face and neck is often the first and most visible sign, appearing within minutes of alcohol consumption.
• The cardiovascular effects, including a rapid heart rate (tachycardia) and a drop in blood pressure (hypotension), are due to widespread vasodilation caused by acetaldehyde.

Why Other Options Were Wrong

• Option A: While vomiting is a part of the reaction, diarrhea and weight loss are not typical signs of the acute disulfiram-alcohol reaction. Weight loss would be a long-term finding, not an immediate one.
• Option C: Although a throbbing headache is a key symptom, this option is incomplete. It omits the more critical and life-threatening cardiovascular signs (tachycardia, hypotension) and the highly characteristic flushing. Also, 'blurred vision' is more commonly cited than 'diplopia'.
• Option D: This option is incorrect because Option B provides an accurate and classic description of the signs of a disulfiram-alcohol reaction.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pharmacology: Disulfiram-Alcohol Reaction (Acetaldehyde Syndrome) to guide bedside assessment, documentation, and the next nursing action.
• Patient education is the most critical nursing intervention. The nurse must teach the patient to avoid all forms of alcohol, including hidden sources like mouthwash, cough syrups, aftershave lotions, and certain food sauces.
• It is crucial to inform the patient that the effects of disulfiram can last for up to two weeks after the last dose. A reaction can occur if alcohol is consumed anytime within this window.
• Patients should be advised to carry a medical alert card or wear a bracelet stating they are on disulfiram therapy, which is vital in case of an emergency where they cannot communicate.

How to Approach the Question

• First, identify the core subject of the question: the interaction between disulfiram and alcohol.
• Recall the mechanism of action of disulfiram. It is an alcohol-aversive agent that works by blocking the enzyme aldehyde dehydrogenase.
• Predict the physiological consequence of this blockage when alcohol is consumed. This leads to a buildup of the toxic substance acetaldehyde.
• Recall the cluster of symptoms associated with this toxic buildup, known as acetaldehyde syndrome.
• Evaluate each option to see which one best matches the classic signs of acetaldehyde syndrome: flushing, nausea/vomiting, headache, and cardiovascular changes like tachycardia and hypotension.
• Eliminate options that contain incorrect or less characteristic symptoms (like diarrhea, weight loss) or are incomplete.

Concept Tested & Keywords

• Concept Tested: Pharmacology: Disulfiram-Alcohol Reaction (Acetaldehyde Syndrome)
• Stem keywords: disulfiram therapy, ingested alcohol, reaction
• Lead-in keywords: signs
• Negative lead-in flag: false

Question ID

QpaW_XXt0cWWDxEaj4GSSb

Copy ID

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 1 p. 302-304

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2184-2186