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NAPLEX 2024 > 21. Travelers > Flashcards

21. Travelers Flashcards

1
Q

Travel vacations should be documented on the International Certificate of Vaccination or Prophylaxis (ICVP) card, sometimes called the ___

A

Yellow Card

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2
Q

T/F: Medications and medical supplies should be packed in check in luggage

A

False - carry on luggage

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3
Q

CDC’s Health Information for International Travel on the CDC website is also known as the ____

A

Yellow Book

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4
Q

Traveler’s diarrhea is very common but if blood is mixed in with the stool, it is classified as ___

A

Dysentery (often with fever, considered severe)

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5
Q

T/F: more than 80% of Traveler’s diarrhea cases are viral

A

False - bacterial

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6
Q

What is the primary pathogens for traveler’s diarrhea?

A

E.coli
others: Campylobacter jejuni, Shigella species, and Salmonella species

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7
Q

Define persistent traveler’s diarrhea

A

≥ 14 days

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8
Q

Prophylaxis for traveler’s diarrhea

A

Bismuth subsalicylate (BSS) - pepto bismol
reduces incidence by 50%

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9
Q

Bismuth subsalicylate is often used for traveler’s diarrhea ppx. Which patients should NOT use this as ppx?

A

Aspirin allergy
Pregnancy
Renal insufficiency
Gout
Ulcer
Pt on anticoagulants, probenecid, methotrexate

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10
Q

Abx ppx for traveler’s diarrhea is typically not recommended unless at high risk (e.g immunosuppressed, significant comorbidities) or performance reasons (e.g. professional athlete). If abx ppx indicated, what is typically used?

A

Rifaximin (preferred)

Alt: azithromycin and rifamycin

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11
Q

Primary antimotility drug used for acute TD is ___

A

loperamide (Imodium A-D)
4mg after first loose stool and 2mg after each subsequent loose stool
Max dose 16mg/day by Rx or 8mg/day by OTC

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12
Q

What dose of loperamide is typically used for acute diarrhea

A

4mg after first loose stool and 2mg after each subsequent loose stool
Max dose 16mg/day by Rx or 8mg/day by OTC

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13
Q

What is the max dose of loperamide per day

A

Max dose 16mg/day by Rx or 8mg/day by OTC
Up to 2 days

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14
Q

MOA loperamide

A

Decreases urgency and frequency of bowel movements - helps people to continue travel activities

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15
Q

Patient has diarrhea and has been taking loperamide. At what point should they consult a provider?

A

If symptoms remain after 48hrs

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16
Q

Bismuth subsalicylate is FDA approved for OTC use in children ___ yo but has been used off label in younger children ___ yo as long as they had no recent or current viral infections (d/t risk of ____)

A

≥12yo
≥3 yo
Reye’s syndrome

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17
Q

Bismuth subsalicylate is another treatment option of traveler’s diarrhea. Can reduce stools based by ~40%. What are side effects/warnings?

A

Black tongue/stools
Risk of Reye’s syndrome in children
Salicylate toxicity

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18
Q

Which option is preferred for treatment of traveler’s diarrhea in both children and adults: loperamide or bismuth subsalicylate

A

Loperamide (greater reduction in # of diarrheal stools passed and shortened duration of acute diarrhea)

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19
Q

For moderate and severe traveler’s diarrhea, abx may be used. Which ones are preferred?

A

Moderate: Azithromycin or a quinolone (if low resistance, rifaximin alternative
Severe: azithromcyine, quinolone or rifximin alternatives

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20
Q

Which abx is preferred for severe traveler’s diarrhea and dysentery?

A

Azithromcyin

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21
Q

Which abx cannot be used to treat infections in which invasive pathogens such as Campylobacter jejuni and Salmonella are suspected?

A

Rifaximin and rifamycin

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22
Q

W

A
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23
Q

Typhoid fever is caused by ____

A

Salmonella typhi

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24
Q

__ are the only source Salmonella typhi and spread through ____

A

Humans
food or water contaminated by feces of someone with either an acute infection or from a chronic, asymptomatic carrier

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25
Q

S/sx of typhoid fever

A

Fatigue and increasing fever over 3-4 days
HA, malaise, anorexia, rash, and enlargement of the liver/spleen.
Intestinal hemorrhage or perforation can occur 2-3 weeks later and be fatal

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26
Q

What are some typhoid vaccine examples

A

Vivotif - oral, life-attenuated vaccine
Typhim Vi - inactivated IM injection

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27
Q

The oral typhoid vaccine (Vivotif) should be completed ___ prior to travel while the IM vaccine (Typhim Vi) must be given____ before the expected exposure

A

≥ 1 week
≥2 weeks

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28
Q

Cholera is a bacterial infection caused by ___

A

Vibrio cholerae

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29
Q

The most common symptom of cholera is ___

A

watery stools, referred to “rice-water stools”

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30
Q

Recommended vaccine for cholera

A

Live-attenuated vaccine (Vaxchora) - single, oral liquid dose at least 10 days before travel, approved in ages 2-64yo

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31
Q

What is the CDC recommendation for polio vaccination?

A

Single lifetime booster dose of inactivated poliovirus vaccine at least 4 weeks prior to travel for adults who have previously completed polio vaccine series and traveling to regions where poliovirus is circulating

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32
Q

Most people in US received polio vaccine but may need to get a booster dose if traveling to which countries?

A

Afghanistan, Myanmar (Burma) Guinea, Laos, Nigeria, Madagascar, Pakistan, and Ukraine

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33
Q

What types of travelers are at highest risk of hep A?

A

People from developed countries who travel to developing countries

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34
Q

Travel Vaccine: Inactivated Vaccine list

A

Hepatitis A (Havrix, VAQTA)
Hepatitis B (Engerix-B, Heplisav-B, Recombivax HB)
Hepatitis A/B (Twingrix)
Japanese encephalitis (Ixiaro)
Meningococcus (Menactra, Menveo, Menquadfi)
Polio (IPOL)
Typhoid-IM (Typhin Vi)

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35
Q

Travel Vaccines: Live Vaccine list

A

Cholera-PO (Vaxchora)
Typhoid-PO (Vivotif)
Yellow fever-SC (YF-VAX)

Note: live vaccines typically avoided in people who are immunocompromised

36
Q

Hepatitis B is transmitted through ___

A

contact with contaminated blood or other body fluids

37
Q

The 3 dose hepatitis B vaccine takes ___ to complete

A

6 months

38
Q

Hepatitis B vaccination is extremely important for travels who plan to _____

A

receive medical care
Volunteer to provide medical work
Unprotected sexual encounters with new partners
Piercings/tattoos

39
Q

If a traveler is unable to receive all 3 doses of hep B vaccine before departure, what is the recommendation?

A

Administer as many doses as possible before departure and complete series upon return

In instances of high risk, an accelerated series can be administered; when a 3 dose accelerated series is used, a booster dose is required at 1 year for long-term immunity

40
Q

S/sx of meningococcal meningitis

A

fever, severe and unrelenting HA, nausea, stiff neck (nuchal rigidity) and mental status changes

41
Q

How is dx of meningococcal meningitis made?

A

Lumpar puncture

42
Q

How is meningitis spread

A

By respiratory secretions

43
Q

High risk regions for meningitis

A

Meningitis belt of Afria during the dry season (Dec-June)
Gov of Saudi Arabia requires vaccination for travel during annual Hajj and Umrah pilgrimages

44
Q

Current recommendations include only the quadrivalent vaccines for meningitis: ___

A

Menactra
Menveo
MenQuadfi

45
Q

The quadrivalent vaccines for meningitis only cover which bacterial types?

A

ACWY

46
Q

No recommendations to use serogroup ___ meningococcal vaccines for travelers

A

B

47
Q

Insects that transmit disease are ___

A

vectors

48
Q

A ___ is any place (such as an animal, insect, soil, or plant) in which the disease lives and can multiply

A

Reservoir

49
Q

The primary insects that transmit infections to travelers are ___, which transmit diseases such as ___

A

Mosquitos
Japanese encephalitis, yellow fever, dengue, malaria, and Zika virus

50
Q

To avoid insect bites, it is recommended to use proper application of mosquito repellents containing ____ on exposed skin.
You can also use ___ to treat clothing, gear, and bed nets but do NOT apply directly on skin

A

20-50% DEET (also protects against ticks)
Permethrin

51
Q

____ is transmitted by Aedes aegypti and Aedes albopictus mosquitoes

A

Dengue

52
Q

Severe dengue can include what s/sx

A

shock, severe bleeding, or organ failure

53
Q

Treatment for dengue

A

Supportive, no specific meds to treat degue infections
Protection from mosquito bites is essential

54
Q

___ is a live-attenuated recombinant vaccine recommended to only those wtih a past dengue infection

A

Dengvaxia

55
Q

Japanese encephalitis is transmitted by ___

A

mosquitoes

56
Q

___ vaccine is recommended for travelers who are planning extended exposure to the outdoors (e.g. camping) or who plan to spend at least 1 month in endemic areas during Japanese encephalitis virus transmission season

A

Ixiaro

57
Q

Malaria is transmitted by ___

A

the Anopheles mosquito
Once in a human host, it multiplies first in the liver and then into RBCs, multiplying and destroying them

58
Q

Classic s/sx of malaria

A

shaking, chills, high fever, flu-like illness

59
Q

____ is the most common of 4 human malaria species

A

Plasmodium vivax
4 species include P. flalciparum, P. malariae, P. ovale, P. vivax

60
Q

Which malaria species causes 50% of malaria cases in India and is becoming increasingly resistant to malaria drugs?

A

P. vivax

61
Q

Which malaria species is the most deadly

A

P. falciparum

62
Q

Malaria drugs cause nausea - what are some ways to help with that?

A

take with sufficient water, food, or milk

63
Q

Malaria quick start ppx regimens (1-2 days prior to travel, best for when traveling with short notice)

A

Doxycycline (Doryx, Vibramycin) - stop 4 weeks after travel (preferred in hiking/camping)
Atovaquone/Proguanil (Malarone) - stop 1 week after travel (good coverage)
Primaquine - stop 1 week after travel (most effective again P. vivax, do NOT use in G6PD deficiency)

64
Q

What are some common things among malaria ppx drugs for quick starts

A

Daily regimens
Avoid in pregnancy
Cause nausea, take with food, milk, water

65
Q

Which malaria ppx drugs must be started 1-2 weeks prior to travel?

A

Chloroquine
Mefloquine

66
Q

Typical malaria ppx regimen with chloroquine

A

Start 1-2 weeks prior to travel
Stop 5 weeks after travel
weekly dosing

67
Q

Typical malaria ppx regimen with mafloquine

A

Start ≥2 weeks prior to travel
Stop 4 weeks after travel
Weekly dosing

68
Q

Side effects for chloroquine

A

Retinal toxicity/visual changes - contraindicated if previous hx
Others: exacerbation of psoriasis, serious skin rash,
blue-grey skin pigmentation (rare with short-term use)

69
Q

When is primaquine NOT used

A

G6PD deficiency (Requires screening prior to use d/t risk of hemolytic anemia)
Pregnancy/breastfeeding

70
Q

When is mefloquine NOT used

A

Underlying psychiatric conditions
Seizures
Arrhythmias

71
Q

Which malaria ppx medication requires a loading dose 3 days before travel?

A

Tafenoquine (Arakoda)
LD taken daily for 3 days, weekly dosing

72
Q

Which malaria ppx meds cannot be used in G6PD deficiency?

A

Primaquine
Tafenoquine

73
Q

Yellow fever is caused by ____ and transmitted by ___

A

Virus
mosquitoes

74
Q

___ cannot be used in yellow fever d/t increased risk of bleeding

A

Aspirin and other NSAIDs

75
Q

___ vaccine i available to prevent yellow fever and stop transmission

A

Live-attenuated vaccine (YF-VAX)

76
Q

When patients get the yellow fever vaccine, they receive a ICVP (yellow card). At what point is that yellow card considered valid?

A

10 days after date of vaccination
single dose of vaccine provides life-long protection and adequate for most travelers

77
Q

YF-VAX is contraindicated ____

A

with hypersensitivity to eggs and in people who are severely immunocompromised

78
Q

T/F: Yellow fever vaccine is recommended for all travelers

A

False - only in travelers at high risk of exposure or who require proof of vaccination to enter a country

79
Q

Zika virus is transmitted primarily by ____

A

the Aedes species mosquito
Sexual and possible blood transfusion-associated transmission have been reported

80
Q

The most pressing concern with Zika virus arose in 2016 when Brazil observed a marked increase in the number of infants born with ____

A

microcephaly

81
Q

T/F: There is no vaccine for Zika virus

A

True

82
Q

What can reduce transmission risk for Zika virus?

A

Avoiding mosquito bites and using condoms during sexual contact with people with possible Zika virus infection

CDC recommends against pregnant women traveling to any area with ongoing transmission of Zika virus (birth defects)

83
Q

What helps reduce risk of DVT/PE prevention in traveling patients?

A

Compression stockings
Walk around
Perform lower leg exercising when sitting

84
Q

Primary ppx med for acute mountain sickness

A

Acetazolamide (Diamox) 125mg BID, started day before (preferred) or on the day of sscent

Higher doses are used for treatment

85
Q

What are side effects of acetazolamide

A

Polyuria
Photosensitivity
Others: taste alteration, risk of dehydration, urticaria, and possibility of severe skin rashes

86
Q

Acetazolamide is contraindicated with __ allergy

A

Sulfa

NAPLEX 2024 (74 decks)

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