What are disulfiram and disulfiram-like reactions? Disulfiram (disulfiram) is an alcohol withdrawal drug that is taken to produce severe physical discomfort even after consuming a small amount of alcohol for the purpose of withdrawal. The mechanism of action of disulfiram is – disulfiram in combination with ethanol can inhibit acetaldehyde dehydrogenase in the liver, so that after the oxidation of ethanol to acetaldehyde in the body, it cannot continue to decompose and oxidize, resulting in the accumulation of acetaldehyde in the body and a series of reactions (ethanol into the body, first in the liver by the action of ethanol dehydrogenase into acetaldehyde, acetaldehyde and then by Acetaldehyde is then converted to acetic acid by the action of acetaldehyde dehydrogenase, and acetic acid enters the raffinate cycle and is finally converted to water and carbon dioxide and discharged. The acetaldehyde dehydrogenase can be inhibited by disulfiram, so that acetaldehyde can not be oxidized to acetic acid, resulting in the accumulation of acetaldehyde in the body). Many antibacterial drugs have similar effects to disulfiram. If you drink alcohol after using the drug, facial flushing, conjunctival congestion, blurred vision, severe pulsation of the blood vessels in the head and neck or pulsating headache, dizziness, nausea, vomiting, sweating, dry mouth, chest pain, myocardial infarction, acute heart failure, respiratory distress, acute liver injury, convulsions and death, etc. During physical examination, there may be a drop in blood pressure, heart rate When examined, there may be a decrease in blood pressure, an increase in heart rate (up to 120 beats/min) and normal or partial changes in ECG (such as ST-T changes), which is a disulfiram-like reaction. The severity of the reaction is proportional to the dose of the drug and the amount of alcohol consumed, and is more severe in the elderly, children, people with cardiovascular disease and those sensitive to ethanol. What drugs can cause disulfiram-like reactions? Cefoperazone, cefoperazone sulbactam, ceftriaxone, cefazolin (Pioneer V), cefradil (Pioneer VI), cefmetazole, cefminox, cephalexin, cefmenoxime, cefamandole, cefadroxil (Pioneer IV), cefaclor, etc. Among them, cefoperazone causes the most reports of disulfiram-like reactions and is the most sensitive, such as patients who eat wine heart chocolate after using The disulfiram-like reactions can also occur when patients eat alcoholic chocolate, take patchouli, or even treat the skin with alcohol alone. The common feature of these cephalosporins in chemical structure is the presence of methylthiotetrazole (thiomethyltetrazole) substituent at the 3-position of the 7-amino cephalosporanic acid (7-ACA) ring of the parent nucleus, which competes with coenzyme I for the active center of acetaldehyde dehydrogenase and prevents the continued oxidation of acetaldehyde, leading to the accumulation of acetaldehyde and thus causing a disulfiram-like reaction. The appearance of precordial pain with ECG ST-T changes is due to the increased sympathetic excitability caused by the methylthiotetrazole substituent, resulting in faster heart rate and increased myocardial oxygen consumption, which shortens myocardial diastole and decreases coronary perfusion pressure, leading to reduced perfusion flow. (Cefotaxime, ceftazidime, cefsulodin, ceftizoxime, cefixime, cefixime, do not cause disulfiram-like reactions when alcohol is consumed during application because they do not contain methionine tetrazolium group.) ②Nitroimidazoles such as metronidazole (methotrexate), tinidazole, ornidazole, Secnidazole. ③ other antibacterial drugs such as furazolidone (dysentery), chloramphenicol, ketoconazole, ashwagandha, etc. First aid and care: Once the disulfiram-like reaction occurs, the drug and ethanol-containing products should be discontinued promptly. Treatment can be gastric lavage to remove ethanol from the stomach, reduce ethanol absorption, dexamethasone injection or naloxone injection and other symptomatic treatment, intravenous infusion of glucose solution, vitamin C and other liver protection treatment to promote ethanol metabolism and excretion. Patients with angina need to improve coronary circulation, and those with decreased blood pressure can apply antihypertensive drugs, which can be relieved within a few hours. ①Patients should be resuscitated while taking medical history, immediately put the patient in a flat position, administer oxygen, take vital signs and record them. ②For patients in shock, quickly establish intravenous access, quickly replenish crystalloids, give dopamine and other antihypertensive drugs if necessary, and actively treat to shorten the period of hypotension. ③Give cardiac monitoring to patients with pre-existing cardiovascular diseases and closely observe the changes of heart rate and heart rhythm. ④Patients diagnosed with disulfiram-like reaction should also undergo electrocardiogram, blood routine and electrolyte examination to exclude delay in treatment due to coexistence of multiple diseases. ⑤ Because of the sudden onset and obvious symptoms, patients and family members are nervous and fearful. The nurse should comfort the patient, reassure the family, explain the cause of the disease, introduce successful cases, and do a good job of psychological guidance so that they can actively cooperate with treatment and care. (6) Treatment is fast-acting and short-course, with symptoms gradually relieved from 4h to 12h. Prevention: It is necessary for medical and nursing staff to have sufficient awareness and attention to the withdrawal of sulfur-like reactions in the process of applying antibacterial drugs. ① During the treatment process, patients must be carefully asked about their medication history and allergy history, ask about their drinking habits, and at the same time, strictly grasp the indications for medication, reasonably select drugs, prevent the tendency of abuse, reasonably combine and match, and not use drugs containing ethanol at the same time. When using drugs that can cause disulfiram-like reactions, the nurse should not start the drip too fast, and closely observe, have a sense of rescue, once the allergic reaction immediately stop rescue, ② patients using drugs that can cause disulfiram-like reactions, patients should be informed to avoid drinking or eating ethanol-containing products (including beverages, food, drugs) during the use of the above antibacterial drugs and within 14 days after discontinuation, such as white wine (ii) The patient should avoid drinking alcohol or consuming ethanol-containing products (including beverages, food, drugs) such as white wine, yellow wine, beer, chocolate with wine core, patchouli, hydrocortisone injection, skin disinfection or scrubbing with alcohol to cool down, especially for the elderly and patients with cardiovascular disease. ③ Once disulfiram-like reactions occur, the drug should be discontinued and ethanol-related products should be stopped in time.