A patient is taking disulfiram therapy and ingested alcohol. Which of the following clinical features would b… - PGIMER Sangrur NO - 2023

PGIMER Sangrur NO - 2023

Pharmacology

Easy

Appeared in: PGIMER Sangrur NO - 2023

Explanation

Disulfiram blocks the enzyme aldehyde dehydrogenase, which is necessary for the metabolism of alcohol.
This blockage leads to a rapid and toxic accumulation of acetaldehyde in the blood when alcohol is consumed.
The high levels of acetaldehyde cause a characteristic reaction known as the Disulfiram-Alcohol Reaction (DER).
Key features of DER include intense vasodilation, leading to facial and neck flushing and a drop in blood pressure (hypotension).
The body compensates for the hypotension with a rapid heart rate (tachycardia).
Gastrointestinal distress, particularly severe nausea and vomiting, is also a hallmark of this reaction.

Option A: While vomiting is a symptom of the disulfiram-alcohol reaction, diarrhea and weight loss are not characteristic of the acute phase. Weight loss is a potential long-term outcome of alcoholism or its treatment, not an immediate reaction symptom.
Option C: A throbbing headache is a very common symptom of the disulfiram-alcohol reaction. However, diplopia (double vision) is not a classic or frequently reported sign. Blurred vision is more common. This option is less complete and specific than the correct answer.
Option D: This option is incorrect because a well-defined set of symptoms occurs when alcohol is ingested while a patient is on disulfiram therapy. Option B accurately describes these symptoms.

Clinical Relevance

Nursing practice connection: Use the key finding related to Disulfiram-Alcohol Reaction (DER) to guide bedside assessment, documentation, and the next nursing action.
Patient education is the most critical nursing role. Nurses must emphatically warn patients to avoid all forms of alcohol, including 'hidden' alcohol in products like mouthwash, cough syrups, aftershave lotions, and certain food preparations.
A severe disulfiram-alcohol reaction is a medical emergency. Nurses must be able to recognize the signs of cardiovascular collapse (severe hypotension, chest pain, arrhythmias) and initiate supportive care immediately.
It is crucial to inform patients that the effects of disulfiram can last for up to two weeks after the last dose, meaning they must continue to avoid alcohol for this period.

How to Approach the Question

First, identify the key elements in the question: a patient is taking 'disulfiram' and has 'ingested alcohol'. The question asks for the resulting 'clinical features'.
Recall the mechanism of action for disulfiram. It is an alcohol-aversive agent that works by inhibiting the enzyme aldehyde dehydrogenase.
Connect the mechanism to the pathophysiology. Inhibition of this enzyme leads to the accumulation of a toxic substance, acetaldehyde, when alcohol is consumed.
Recall the classic symptoms of acetaldehyde toxicity (the disulfiram-alcohol reaction). These are primarily autonomic and gastrointestinal.
Systematically evaluate each option against the known symptoms: flushing, sweating, throbbing headache, nausea, vomiting, tachycardia, and hypotension.
Option B includes several of the most prominent and classic symptoms (nausea, flushing, tachycardia, low BP), making it the best fit.

Concept Tested & Keywords

Concept Tested: Disulfiram-Alcohol Reaction (DER)
Stem keywords: disulfiram therapy, ingested alcohol, clinical features, reaction
Lead-in keywords: Which of the following
Negative lead-in flag: false

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