24. Travelers Flashcards
Select the term that best describes bismuth subsalicylate:
A. Osmotic agent
B. Stool softener
C. Anti-diarrheal
D. Laxative
E. Bulk forming agent
C. Caution: bismuth is a salicylate, and can cause salicylate toxicity (with overdose) and should not be used in children with suspected viral infection (due to risk of Reye’s syndrome). Darkening of the stool and blackening of the tongue are common side effects of this drug.
Which of the following statements concerning Yellow Fever are correct? (Select ALL that apply.)
A. HIV patients with a CD4+ count less than 200/mm3 should not receive the yellow fever vaccine.
B. Patients using at least 5 mg of prednisone-equivalent daily for at least 7 days should not receive the yellow fever vaccine.
C. Patients using steroid inhalers at medium or high doses for asthma should not receive the yellow fever vaccine.
D. Patients with a hypersensitivity to eggs should not receive the yellow fever vaccine.
E. Patients receiving Enbrel, Humira or Remicade should not receive the yellow fever vaccine.
A, D, E. ACIP recommends that women wait at least 4 weeks post yellow fever vaccination before attempting to become pregnant. In addition to hypersensitivity to eggs, a hypersensitivity to any chicken products or gelatin will prohibit vaccination. Note the requirements to be considered “immunosuppressed” as outlined in the Immunizations chapter. Receiving strong immune-suppressing agents, including some chemotherapeutic regimens, will make the recipient immune-compromised. This is a live vaccine, and immunocompromised patients may get the disease.
Malaria prevention is provided by the following primary measure:
A. Vaccination by injection
B. Oral medications taken before and following travel to an infected region
C. Oral medications taken prior to travel and through the first full day of the trip.
D. Oral medications taken prior to travel and through the first full week of the trip.
E. Vaccination by oral medication
B.
Which of the following statements concerning Yellow Fever are correct? (Select ALL that apply.)
A. Infected patients should be protected from further bites.
B. Yellow fever vaccine is inactivated and comes as injection only.
C. Yellow fever virus is found in parts of South America and Africa; vaccination is recommended to high-risk regions in these areas.
D. Transmission is from mosquito bites.
E. If the patient has a fever or aches from yellow fever, aspirin and NSAIDs are preferred analgesics.
A, C, D. Yellow fever vaccine is a live vaccine. Do not use NSAIDs due to bleeding risk.
Which of the following diseases are transmitted by mosquito bites? (Select ALL that apply.)
A. Dengue
B. African Sleeping Sickness
C. Japanese Encephalitis
D. Malaria
E. Yellow Fever
A, C, D, E. African sleeping sickness is transmitted by the bite of a Tsetse fly.
Mefloquine (Larium) is an antimalarial known for the following toxicities:
A. SJS and TEN rash
B. Neurotoxicity and psychiatric symptoms
C. Risk of meningitis
D. Risk of triggering autoimmune disease
E. Risk of gout, including in patients with no previous gout history
B. Side effects include psychiatric symptoms (anxiety, paranoia, depression, hallucinations, and psychosis) and neurologic symptoms (seizures, dizziness or vertigo, tinnitus, and loss of balance). Remember that psychiatric and neurologic tend to go together because nerves affect the brain which causes both of these symptoms. It is also the only one safe during pregnancy and for children. Mefloquine and Chloroquine (Aralen) both need to be started 1-2 weeks prior to travel while Atovaquone/Proguanil (Malarone) and Primaquine can be started 1-2 days prior to travel.
Which of the following statements concerning dengue are correct? (Select ALL that apply.)
A. Dengue is transmitted by infected stool passed along, primarily, through fecal contact.
B. The Japanese encephalitis vaccine should be recommended to travelers to Asian countries to reduce the risk of contracting Dengue.
C. The majority of dengue infections are contracted from mosquito bites.
D. Dengue infection can be fatal.
E. There is no vaccine to prevent dengue; protection from mosquitos is essential.
C, D, E. DEET is preferred on exposed skin and clothing.
How are Vivotif Berna capsules stored?
A. On the shelf of the pharmacy.
B. In the refrigerator.
C. In the freezer.
D. The vaccine powder is frozen and the diluent is stored in the refrigerator.
E. The vaccine comes from one central distribution center in each state and is sent overnight when needed.
B. The capsules are kept refrigerated. There are not that many capsules that require refrigeration, and it is important to know the ones that do in order to avoid wasting valuable and expensive medications.
It is an oral, live, attenuated vaccine and consists of 4 capsules, 1 taken every other day. Take each capsule with cool liquid (not warm because it may kill the bacteria). The oral vaccine should not be considered if patients are on antibiotics or has extremely sensitive stomach (may vomit it up). Should be completed 1 weeks prior to travel and is not used in children
Choose the correct statement concerning terms for disease transmission:
A. In malaria, the mosquito is the vector that carries the pathogen from one host (an infected human) to another host.
B. In malaria, the mosquito is the host and the human is the vector.
C. In malaria, the mosquito is the host and contaminated water is the vector.
D. In malaria, the mosquito is the vector that carries the pathogen from one vector (an infected human) to another vector (another infected human).
E. In malaria, the mosquito is the host and the human is the reservoir.
A. The host harbors the pathogen and the vector transmits it; they may be the same or different. An example of when they are different: the host for bubonic plaque during the world pandemic was rats. When a mosquito bit the infected rat, it then transmitted the pathogen to a human. The rat was the host and the mosquito was the vector.
Which of the following statements concerning primaquine is correct? (Select ALL that apply.)
A. It is effective for p. vivax.
B. Patients must be tested for G6PD deficiency prior to treatment with primaquine.
C. It cannot be used during pregnancy.
D. Patients must be tested for protein C deficiency prior to treatment with primaquine.
E. Primaquine is taken for 1-2 days pre-travel and for 7 days post-travel.
A, B, C, E. Mefloquine is a safe option during pregnancy and for children. All other anti-malarials cannot be used in pregnancy: Atovaquone/Proguanil (Malarone), Chloroquine (Aralen).
What is the source of the majority of cases of typhoid fever?
A. Mosquito bite
B. Body fluids from an infected host
C. Contaminated food or water
D. Blood transfusions
E. Airborne transmission from coughing or sneezing
C. The food or water is contaminated from the feces of an infected person. Occasionally, transmission is from sexual contact (body fluids).
Select the correct statement concerning acetazolamide: (Select ALL that apply.)
A. The brand name is Imodium.
B. Acetazolamide is contraindicated in a sulfa allergy.
C. Acetazolamide is a well-tolerated, commonly-used agent.
D. Patients using acetazolamide must use proper protection from sun exposure.
E. All patients that require the use of this agent must also be diligent to stay well hydrated.
B, D, E. The brand name of acetazolamide is Diamox Sequels. The brand name of loperamide is Imodium. Loperamide is an anti-diarrheal agent.
Which of the following statements concerning mefloquine is correct?
A. The brand name is Malarium.
B. There is now a high degree of resistance to this primary anti-malarial medication.
C. There is a little resistance to this primary anti-malarial medication.
D. The use of this drug is without significant toxicities, however there is a high degree of resistance.
E. Doxycycline is preferred over mefloquine for most patients.
B.
Side effects include psychiatric symptoms (anxiety, paranoia, depression, hallucinations, and psychosis) and neurologic symptoms (seizures, dizziness or vertigo, tinnitus, and loss of balance). Remember that psychiatric and neurologic tend to go together because nerves affect the brain which causes both of these symptoms. It is also the only one safe during pregnancy and for children. Mefloquine and Chloroquine (Aralen) both need to be started 1-2 weeks prior to travel while Atovaquone/Proguanil (Malarone) and Primaquine can be started 1-2 days prior to travel.
An elderly female takes the following medications: hydrochlorothiazide 25 mg once daily, atenolol 50 mg once daily and raloxifene 60 mg once daily. She has asked the pharmacist to get a travel exception to refill her medications early. She is taking a plane trip to visit her homeland and will be gone for 5 weeks. The plane trip will take nearly a day to complete. The pharmacist instructs the patient to walk up and down the aisle of the plane regularly or do exercises while sitting in which she tightens and releases the muscles in her legs and calves. Which of the following statements are correct? (Select ALLthat apply.)
A. The pharmacist is helping the patient avoid incontinence episodes.
B. The pharmacist is helping the patient avoid clotting in the lower extremities.
C. The patient, fortunately, is using a medication regimen that has low clotting risk.
D. The patient’s age puts her at increased clotting risk.
E. The long flight duration puts her at increased clotting risk.
B, D, E. Raloxifene has high clotting risk; however, it is used and when it is used the pharmacist should make sure that the patient understands the risk and ways to mitigate it, such as avoiding long periods of immobility.
Typhoid fever can be severe and life-threatening. To help patients avoid illness pharmacists should recommend the following measures to reduce risk of typhoid infection: (Select ALL that apply.)
A. Staying at home with the windows closed.
B. Covering skin with protective clothing and DEET.
C. Washing hands frequently.
D. Safe food and water precautions to avoid contaminated sources.
E. Vaccination, completed prior to travel.
C, D, E. Typhoid is not spread by insect bites. It is spread from the feces of an infected individual.
