Substance Abuse and Abuse Q 54
Nurse Wilma is teaching a client about disulfiram (Antabuse), which the client is taking to deter his use of alcohol. She explains that using alcohol when taking this medication can result in:
A. Abdominal cramps and diarrhea
B. Drowsiness and decreased respiration
C. Flushing, vomiting, and dizziness
D. Increased pulse and blood pressure
Correct Answer: C. Flushing, vomiting, and dizziness
Disulfiram (Antabuse) prevents complete alcohol metabolism in the body. Therefore when alcohol is consumed, the client has a hypersensitivity reaction. Flushing, vomiting, and dizziness are associated with the incomplete breakdown of alcohol metabolites. Disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) to treat chronic alcohol dependence. In its pure state, disulfiram is a white to off-white, odorless, almost tasteless powder, which is soluble in water and alcohol. Disulfiram, an alcohol-aversive or alcohol-sensitizing agent, causes an acutely toxic physical reaction when mixed with alcohol.
Option A: The disulfiram-alcohol reaction usually begins about 10 to 30 minutes after alcohol is ingested. Its adverse effects range from moderate to severe. Intensity varies with individual patient characteristics. The reaction is generally proportional to the amounts of disulfiram and alcohol ingested. Mild effects may occur at blood alcohol concentrations of 5 to 10 mg/100 mL. At 50 mg/100 mL, effects usually are fully developed. When the concentration reaches 125 to 150 mg/100 mL, unconsciousness may occur.
Option B: About 80 to 95 percent of ingested disulfiram is absorbed from the gastrointestinal tract and rapidly distributed to tissues and organs. It is then metabolized to various mixed disulfides. The unabsorbed fraction is excreted. Disulfiram is irreversibly bound to ALDH. It can take up to 2 weeks for the body to synthesize sufficient unbound enzymes to metabolize alcohol adequately. This is why alcohol ingestion may produce unpleasant symptoms for up to 2 weeks after a patient has taken the last dose of disulfiram.
Option D: The consensus panel concludes that disulfiram is most effective for patients who have undergone detoxification or are in the initiation stage of abstinence, especially when they are committed to abstinence and receive adequate, ongoing supervision. Disulfiram may not reduce the urge to drink alcohol. However, it may assist in motivating the patient not to drink. As with other medications, general efficacy also increases when disulfiram is administered in conjunction with intensive behavioral interventions.