Nurse Alice is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products?
A. Carbonated beverages
B. Aftershave lotion
C. Toothpaste
D. Cheese
Correct Answer: B. Aftershave lotion
Disulfiram may be given to clients with chronic alcohol abuse who wish to curb impulse drinking. Disulfiram works by blocking the oxidation of alcohol, inhibiting the conversion of acetaldehyde to acetate. As acetaldehyde builds up in the blood, the client experiences noxious and uncomfortable symptoms. Even alcohol rubbed onto the skin can produce a reaction. The client receiving disulfiram must be taught to read ingredient labels carefully to avoid products containing alcohol such as aftershave lotions. Close monitoring of adverse events is necessary, in particular, in patients with polysubstance abuse. Patients taking disulfiram require monitoring for signs and symptoms of hepatitis, including fatigue, weakness, anorexia, nausea, vomiting, jaundice, malaise, and dark urine.
Option A: Disulfiram is one of three drugs approved by the FDA for the treatment of alcohol dependence. It is a second-line option (acamprosate and naltrexone are first-line treatments) in patients with sufficient physician supervision. Disulfiram is safe and efficient in supervised short-term and long-term treatment of individuals dependent on alcohol but who are motivated to discontinue alcohol use.
Option C: Disulfiram irreversibly inhibits aldehyde dehydrogenase (ALDH1A1) by competing with nicotinamide adenine dinucleotide (NAD) at the cysteine residue in the active site of the enzyme. ALDH1A1 is a hepatic enzyme of the major oxidative pathway of alcohol metabolism converting ethanol to acetaldehyde. At therapeutic doses of disulfiram, alcohol consumption results in increased serum acetaldehyde, causing diaphoresis, palpitations, facial flushing, nausea, vertigo, hypotension, and tachycardia.
Option D: Patients receiving metronidazole, paraldehyde, alcohol, or alcohol-containing preparations (sauces, cough mixtures, vinegar) should not receive disulfiram and should be educated in advance to avoid a disulfiram-alcohol reaction. Never administer to a patient if alcohol use is suspected or without the patient’s consent and understanding of disulfiram-alcohol reaction.