The disulphiram therapy is indicated in?

Appeared in: AIIMS Patna NO - 2020

Explanation

Disulfiram is an alcohol-aversive agent used in the management of chronic alcoholism.
It is prescribed for motivated patients who have already undergone detoxification and are committed to maintaining abstinence.
The therapy works by causing a severe, unpleasant physical reaction (acetaldehyde syndrome) if any alcohol is consumed, thus acting as a powerful deterrent.
Its primary goal is to support long-term sobriety by creating a negative association with alcohol.

Option A: Disulfiram is strictly contraindicated in patients with acute alcohol intoxication. Administering it to someone who has recently consumed alcohol can trigger a severe, potentially fatal reaction.
Option B: Disulfiram's mechanism of action is specific to the alcohol metabolism pathway (inhibiting aldehyde dehydrogenase). It has no therapeutic effect on cannabis dependence.
Option C: Disulfiram is not used to treat anxiety disorders. The physical symptoms of the disulfiram-alcohol reaction (e.g., palpitations, shortness of breath, dizziness) can mimic or induce a panic attack, worsening anxiety.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological management of substance abuse helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A critical nursing responsibility is comprehensive patient education. Patients must be warned about hidden sources of alcohol in products like mouthwash, aftershave lotions, certain sauces, and vinegar, as even small amounts can trigger a reaction.
Before initiating therapy, a thorough patient assessment is required, including liver function tests, as disulfiram is hepatotoxic. It is contraindicated in patients with severe myocardial disease or psychosis.
What if? If a patient on disulfiram therapy also takes metronidazole, they are at risk for a similar disulfiram-like reaction, as metronidazole also inhibits aldehyde dehydrogenase. Co-administration should be avoided.

How to Approach the Question

First, identify the core of the question, which is asking for the specific indication of 'disulphiram therapy'.
Recall or look up the drug 'disulfiram'. Recognize it as a key medication used in substance abuse treatment.
Analyze its mechanism of action: it interferes with alcohol metabolism.
Evaluate the options based on this mechanism. 'Chronic alcoholism' is the only condition related to alcohol metabolism where a deterrent therapy would be used.
Eliminate the other options: 'Acute intoxication' is a contraindication, while 'Cannabis dependence' and 'Anxiety disorder' are unrelated to disulfiram's mechanism.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 1215-1217

E6 Pharmacology KD Tripathi Essentials 9e Part 2 p. 156-158

E6 Pharmacology Nurses Shanbhag 3e p. 150-152

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