Psychopharmacology: Alcohol Deterrent Therapy

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ALCOHOL DETERRENT THERAPY
Deterrent agents are given to desensitize the individual to the effects of alcohol & Abstinence. The Most commonly Used Drug is Disulfiram or Tetraethyl thiuram disulfide or Antabuse.
HISTORY
Disulfiram (tetraethyl thiuram disulfide) was discovered in 1930s, when it was observed that  workers in the rubber industry developed unpleasant reactions to alcohol intake, due to accidental absorption of antioxidant Disulfiram.
Disulfiram
·         Disulfiram is used to ensure Abstinence in the Treatment of Alcohol Dependence. Its Main effect is to Produce a rapid & Violently Unpleasant Reaction in a Person who ingests even a Small amount of alcohol While Taking Disulfiram.
·         Disulfiram is a medicine used in the long term treatment of patients with alcohol misuse.
·         lt produces extremely unpleasant reactions in a person who ingests even a small amount of alcohol while taking Disulfiram.This effect is used in the treatment of patients with alcohol problems.
·         It's Chemical name is Tetraethylthiuram disulfide
·         The knowledge that taking alcohol will be unpleasant serves as a reinforcement or additional support to their decision not to drink.  
·         It also Protects them from giving in to sudden urges to drink, or pressure from friends.lt is supplied in tablets of 250mg. The ususal dosage ranges from 125 to 500mg a day. The dosage should not usually exceed 500mg a day.lt should be taken before bed time to avoid drowsiness in day time.
METABOLISM
Disulfiram is completely absorbed from the stomach after oral administration.lt is broken down in the liver & excreted in the urine. One or two weeks may be needed before Disulfiram is totally eliminated from the body after the last dose has been taken. So the Disulfiram effect may last up to two weeks.
CONTRAINDICATIONS
·         Children
·         Pregnant Women
·         Recent "Heart Attack"
·         Liver Damage (Cirrhosis of Liver & Acute Hepatitis)
·         Fits (Epileptic Seizures)
·         Psychosis
·         Major Depression
·         Recent Stroke
·         Patients Unwilling to take, or those who do not know that they are being given.
SIDE EFFECTS
In some people, Disulfiram in the absence of alcohol can produce:
·         Lethargy, Drowsiness -45%
·         Decreased Memory -40%
·         Headache – 35%
·         Itching -33%
·         Decreased Sleep -27%          
·         Dizziness -22%
·         Sexual Problems -10%
·         Peripheral Neuropathy -Tingling & Numbness of hands & Legs.  
·         Worsening Depression & Psychosis in some patients.
·         Less than 10 patients out of a 100 taking Disulfiram, develop serious side effects, which require withdrawal of the drug.
DISULFIRAM- ETHANOL REACTION
·         Disulfiram interferes with the normal breakdown of alcohol in the body by producing a marked increase in a normal breakdown product of alcohol called Acetaldehyde.
·         The increase in the acetaldehyde is 10 times higher than in the normally occurring metabolism of alcohol.
·         The accumulation of acetaldehyde produce a vast array of unpleasant reactions. This is the so called Disulfiram -Alcohol Reaction.
The reactions are Characterized by:
·         Throbbing headache  
·         Facial flushing  
·         Blurring of vision
·         Giddiness
·         Chest Pain
·         Difficulty in Breathing
·         Nausea & Vomiting  
·         Sweating
·         Thirst
·         Low Blood Pressure & Shock -Which untreated may rarely lead to death.
·         The reaction occurs almost immediately after the ingestion of just one drink
Disulfiram ACTION
It is an Aldehyde Dehydrogenase inhibitor that interferes with the metabolism of alcohol & Produces a marked increase in blood acetaldehyde levels. Accumulation of acetaldehyde (more than 10 times which occurs in the normal metabolism of alcohol) produces a wide array of Unpleasant reactions Called Disulfiram-ETHANOL REACTION (DER).
Characterized by Nausea, Throbbing headache, Hypotension, Sweating, thirst, Chest Pain, tachycardia, Vertigo, blurred Vision associated with Severe Anxiety.
DON'TS DURING Disulfiram THERAPY
·         Even a small amount of alcohol will bring on the unpleasant Disulfiram -Alcohol Reaction.
·         The person taking Disulfiram should not use or have the Alcohol containing preparation such as: Cough Syrups, Vitamin Tonics, Ayurveda Tonics, After Shave lotion, Perfumes, Spirits, Spirit based Paints, glues, thinners, etc., and fermented foods.
·         The  Disulfiram -Alcohol Reaction may occur as long as one or two weeks after the last dose of Disulfiram.
           MYTHS RELATED           
Some patients hear false information regarding the Disulfiram -Alcohol Reaction.
It does not cause:
·         Vomiting Blood
·         Passing blood in the urine or Stool
·         Swelling all over the body
·         Going Mad
·         Going Blind
·         The above symptoms usually will not occur in Disulfiram -Alcohol Reaction.        
HOW DOES IT HELP
Disulfiram helps a person:
·         To start a period of being sober.
·         To give cover over a high risk period.
·         To resist impulses to drink.
·         To reduce drinking days.
·         To help the organs recuperate & the individual to change his life style.
           (By prolong abstinence a person can learn new coping skills & the damaged organ can return to normal state).
DURATION
·         For long-term recovery & to learn new ways of coping with life, a period of abstinence needs to be at least 1 & probably 2 years.
·         So it is appropriate to take Disulfiram tablet for at least 6 months & probably up to 2 years.
TIMINGS
·         It is convenient to take Disulfiram in the morning hours after coffee or breakfast.
·         Disulfiram treatment is more effective if supervised by the wife of the patient or a close family member.
·         Taken before bed time to avoid drowsiness.
·         Effective begins within 12 hours first dose remains 7 -10 days after last dose.
A GOOD OUTCOME REQUISITES
·         The person is highly motivated.
·         Daily use of Disulfiram under supervision.  
·         Abstinence prior to treatment.
·         Regular contact with the doctor or treating team.    
TREATMENT FOR REACTION
·         The patient should always carry identification cards describing the Disulfiram -Alcohol Reaction.
·         If any person develops Disulfiram -Alcohol Reaction: Stop Disulfiram Immediately go to the near by doctor and show the card.
·         For further information, they can contact duty psychiatrist.
·         If Disulfiram -Alcohol Reaction is severe, the person might need admission to a hospital or nursing home so that his pulse and blood pressure can be monitored and symptomatic treatment with intravenous fluids may be given.
·         Inj. Avil for the allergic reaction and dopamine to elevate the blood pressure may be required according to the patient’s symptoms.
NURSES RESPONSIBILITY
·         An informed Consent should be taken before Starting treatment.
·         Ensure that at least 12 hours have elapsed since the last ingestion of Alcohol before Administering the Drug.
·         Patient should be warned against Ingestion of any alcohol-containing preparations such as Cough Syrups, Sauces, Aftershave Lotions, Etc.,
·         Caution patient against taking CNS Depressants & Over-the-Counter(OTC)  Medications during Disulfiram therapy.
·         Instruct The Patient to avoid driving or other activities requiring alertness.
·         Patients should be warned that the Disulfiram- alcohol Reaction might continue for as long as for 2 weeks after the last dose of Disulfiram.
 NURSES RESPONSIBILITY
·         Patients should carry identification cards describing Disulfiram-alcohol reaction & listing the name & phone number of the physician to be called.

·         Emphasize the Importance of Follow-Up visits to the physician to monitor progress in long- term therapy.

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notes.nursium.com: Psychopharmacology: Alcohol Deterrent Therapy
Psychopharmacology: Alcohol Deterrent Therapy
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https://notes.nursium.com/2017/06/psychopharmacology-alcohol-deterrent.html
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