Disulfiram MCQs With Answer: Disulfiram is an aldehyde dehydrogenase inhibitor used in aversion therapy for chronic alcoholism. This concise, student-focused introduction highlights mechanism of action, pharmacokinetics, dosing, metabolism to diethyldithiocarbamate, major adverse effects (hepatotoxicity, neuropathy, psychosis), disulfiram–alcohol reaction, interactions, contraindications (pregnancy, severe cardiac or hepatic disease), monitoring (LFTs) and counselling points. Content is tailored for B.Pharm students to deepen clinical pharmacology, therapeutics, and safety understanding while preparing for exams and practice. Practical points include dosing schedules, hepatic monitoring, recognition of delayed reactions, and counselling strategies to ensure adherence and safety. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What is the primary mechanism of action of disulfiram that produces its aversive effect?
- Inhibition of alcohol dehydrogenase
- Inhibition of aldehyde dehydrogenase
- Stimulation of GABA receptors
- Blockade of opioid receptors
Correct Answer: Inhibition of aldehyde dehydrogenase
Q2. What is the main therapeutic indication for disulfiram?
- Treatment of opioid dependence
- Smoking cessation aid
- Aversion therapy in chronic alcoholism
- Antidepressant for alcohol-induced depression
Correct Answer: Aversion therapy in chronic alcoholism
Q3. Which toxic metabolite accumulates when a patient on disulfiram consumes ethanol?
- Acetone
- Formaldehyde
- Acetaldehyde
- Ethyl sulfate
Correct Answer: Acetaldehyde
Q4. What is the usual maintenance dose of disulfiram for adults?
- 62.5 mg daily
- 250 mg daily
- 1000 mg daily
- 10 mg daily
Correct Answer: 250 mg daily
Q5. How soon after an oral dose does disulfiram begin to inhibit aldehyde dehydrogenase clinically?
- Within 1–2 hours
- After 7 days
- After 1 month
- After 6 hours only if food is present
Correct Answer: Within 1–2 hours
Q6. For how long can the pharmacologic effect of disulfiram persist after discontinuation?
- Less than 24 hours
- 2–3 days
- Up to 2 weeks
- More than 6 months
Correct Answer: Up to 2 weeks
Q7. Which organ toxicity is most closely associated with disulfiram therapy and requires monitoring?
- Renal toxicity
- Hepatotoxicity
- Pulmonary fibrosis
- Pancreatitis
Correct Answer: Hepatotoxicity
Q8. In which of the following situations is disulfiram contraindicated?
- Stable angina well controlled by medication
- Pregnancy
- History of mild seasonal allergies
- Short-term antibiotic therapy with penicillin
Correct Answer: Pregnancy
Q9. The unpleasant symptoms of the disulfiram–alcohol reaction are primarily due to:
- Increased ethanol levels in the blood
- Accumulation of acetaldehyde
- Direct CNS depression by disulfiram
- Dehydration caused by disulfiram
Correct Answer: Accumulation of acetaldehyde
Q10. Disulfiram is primarily metabolized to which active metabolite?
- Diethylthiourea
- Diethyldithiocarbamate
- Ethyl glucuronide
- Acetylcysteine
Correct Answer: Diethyldithiocarbamate
Q11. Which laboratory parameter is most important to monitor during disulfiram therapy?
- Serum creatinine
- Liver function tests (LFTs)
- Fasting blood glucose
- Thyroid function tests
Correct Answer: Liver function tests (LFTs)
Q12. Which antibiotic is classically associated with a disulfiram-like reaction and should be used cautiously with alcohol?
- Amoxicillin
- Metronidazole
- Cefalexin
- Azithromycin
Correct Answer: Metronidazole
Q13. Which medication is an alternative therapy for alcohol dependence that acts as an opioid antagonist?
- Acamprosate
- Naltrexone
- Bupropion
- Diazepam
Correct Answer: Naltrexone
Q14. Which neurological adverse effect has been reported with prolonged disulfiram use?
- Peripheral neuropathy
- Cerebral hemorrhage
- Myasthenia gravis
- Parkinsonism only in overdose
Correct Answer: Peripheral neuropathy
Q15. If a severe disulfiram–alcohol reaction occurs, the immediate management is:
- Administration of flumazenil
- Immediate hemodialysis
- Supportive symptomatic treatment; no specific antidote
- Give high-dose naloxone
Correct Answer: Supportive symptomatic treatment; no specific antidote
Q16. Pharmacologically, disulfiram is classified as:
- GABA agonist
- Aldehyde dehydrogenase inhibitor used for aversion therapy
- NMDA receptor antagonist
- Monoamine oxidase inhibitor
Correct Answer: Aldehyde dehydrogenase inhibitor used for aversion therapy
Q17. Disulfiram should be used with extreme caution in patients with which cardiac condition?
- Mild mitral valve prolapse
- Severe coronary artery disease
- Mild sinus bradycardia
- Intermittent premature atrial contractions
Correct Answer: Severe coronary artery disease
Q18. Before initiating disulfiram therapy, a patient should abstain from alcohol for at least:
- 12 hours
- 48 hours
- 7 days
- 1 hour
Correct Answer: 12 hours
Q19. Disulfiram’s inhibition of aldehyde dehydrogenase is best described as:
- Competitive and reversible
- Noncompetitive and reversible
- Irreversible
- Allosteric activation
Correct Answer: Irreversible
Q20. Concomitant use of disulfiram may increase blood levels and effects of which commonly monitored drug?
- Warfarin
- Metformin
- Insulin
- Acetaminophen
Correct Answer: Warfarin
Q21. The most practical method to assess patient adherence to disulfiram therapy in clinic is:
- Routine liver biopsy
- Measuring serum disulfiram levels weekly
- Supervised dosing and pill counts
- Regular urine ethyl glucuronide testing
Correct Answer: Supervised dosing and pill counts
Q22. What is the usual route of administration for disulfiram tablets?
- Intravenous infusion
- Intramuscular injection
- Oral
- Transdermal patch
Correct Answer: Oral
Q23. Disulfiram may exacerbate which psychiatric condition and therefore requires caution?
- Anxiety disorders only
- Psychosis
- Seasonal affective disorder exclusively
- Mild ADHD
Correct Answer: Psychosis
Q24. Which of the following represents the common pharmaceutical formulation and strength of disulfiram available for oral use?
- 250 mg tablet
- 50 mg syrup
- 100 mg/5 mL injection
- Transdermal 10 mg patch
Correct Answer: 250 mg tablet
Q25. The typical clinical features of an acute disulfiram–alcohol reaction include:
- Flushing, tachycardia, nausea and vomiting
- Sedation and miosis
- Polyuria and polydipsia only
- High fever and rash without cardiovascular signs
Correct Answer: Flushing, tachycardia, nausea and vomiting
Q26. Disulfiram’s metabolite can inhibit which enzyme involved in catecholamine synthesis, contributing to neuropsychiatric effects?
- Tyrosine hydroxylase
- Dopamine β-hydroxylase
- Monoamine oxidase A
- Phenylethanolamine N-methyltransferase
Correct Answer: Dopamine β-hydroxylase
Q27. How should disulfiram be handled in a patient with significant hepatic impairment?
- Use at double the usual dose
- Preferentially initiated without monitoring
- Contraindicated or used with extreme caution and monitoring
- No adjustment necessary
Correct Answer: Contraindicated or used with extreme caution and monitoring
Q28. How quickly can a disulfiram–alcohol reaction begin after ingestion of ethanol?
- Within 5–30 minutes
- Only after 24 hours
- After 3–5 days
- Only if blood alcohol >0.20% immediately
Correct Answer: Within 5–30 minutes
Q29. Which of the following is NOT a typical sign of a disulfiram–alcohol reaction?
- Flushing and headache
- Hypotension and tachycardia
- Euphoria and sense of well-being
- Nausea and vomiting
Correct Answer: Euphoria and sense of well-being
Q30. Important counselling advice for patients on disulfiram includes:
- They can safely use any over-the-counter mouthwash containing alcohol
- Avoid alcohol in beverages, foods, and some hygiene products to prevent reactions
- There is no need for liver monitoring during therapy
- It is safe to use during pregnancy
Correct Answer: Avoid alcohol in beverages, foods, and some hygiene products to prevent reactions
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