Chapter 21: Travelers Flashcards
Travel health information, including travel health insurance recommendations, is available on the CDCs travel website where the ____ is located
Yellow Book
Which drugs can be used for TD prevention
Bismuth subsalicylate
Antibiotics if indicated
Bismuth subsalicylate should be avoided in which patients
Aspirin allergy Pregnancy renal insufficiency gout anyone taking anticoagulants
If antibiotic ppx is indicated for TD, which antibiotic is preferred
Rifaximin
Which drugs can be used for mild TD treatment
loperamide or BSS
How does loperamide work
Decreases the frequency and urgency of bowel movements
Loperamide dose for Rx and OTC
Rx: 4 mg after the first loose stool, up to a max dose of 16 mg/day
OTC: 8 mg/day
Loperamide can be used as self-treatment for up to how many days
2 days
Which drugs can be used for moderate TD treatment
Loperamide +/- antibiotics (quinolones if low resistance, azithromycin or rifaximin)
Which drugs can be used for severe TD treatment (including dysentery)
antibiotics (azithromycin preferred, quinolones or rifaximin as alternatives) +/- loperamide
What is the BSS dose for TD ppx
524-1050 mg PO QID (with meals and HS)
Which bacterium causes Typhoid Fever
Salmonella typhi
How is typhoid fever spread
food or water contaminated by the feces of someone with either an acute infection or from a chronic, asymptomatic carrier
What are the names of the Typhoid vaccines and their route of administration
Vivotif (oral, live attenuated) - remember this by the word “vivo” which means to live
Typhim Vi (inactivated IM)
remember - vivotif is the only one with an O in its name for oral
When should the oral typhoid vaccine be completed
> /= 1 week prior to travel
When should the IM typhoid vaccine be completed
> /= 2 weeks before the expected exposure
Which bacterium causes Cholera
Vibrio cholerae
What is the most common symptom of cholera
watery diarrhea, which is referred to as “rice-water stools”
What is the name for the cholera vaccine & route of administration
Vaxchora; oral solution
The CDC recommends how many booster doses for poliovirus vaccine at least 4 weeks prior to travel for adults who have previously completed a poliovirus vaccine series & who are traveling to regions where poliovirus is circulating
1 booster dose
Where should vaccination of Poliovirus be documented
On an International Certificate of Vaccination or Prophylaxis (ICVP), which also records Yellow Fever vaccine
How long does the Hep B vaccine series take to complete
3-dose series takes 6 months to complete
What should be done if a traveler is unable to complete the Hep B series before departure
Administer as many doses as possible before departure and complete the series upon return
What are the symptoms of meningococcal meningitis
Fever, severe and unrelenting HA, nausea, stiff neck (nuchal rigidity), and mental status change - all require urgent treatment
Which meningococcal vaccines are quadrivalent
Menactra and Menveo
Which diseases can mosquitos transmit to travelers
Japanese encephalitis, yellow fever, dengue, malaria and zika virus
To avoid mosquito bites, proper repellent should contain which active ingredient on exposed skin
DEET
What should be used to treat clothing, gear and bed nets, but should NOT be applied directly to the skin
Permethrin
Severe dengue can include
severe bleeding
What is the Japanese encephalitis vaccine called
Ixiaro
Which malaria species is the most common
P. vivax
Which malaria species is the most deadly
P. falciparum
What is a common side effect of malaria drugs
Nausea - taking with sufficient water, food or milk decreases nausea
What are the quick start medications for malaria ppx & how long in advance should they be started before travel
How many times a day are they taken
Atovaquone/Proguanil
Doxycycline ** (know this one)
Primaquine (avoid in G6PD Deficiency)
1-2 days
Once daily
Quick start drugs for malaria ppx must be avoided in which population(s)
pregnancy
What are the advance start medications for malaria ppx & how long in advance do they need to be started?
How often are they taken
Chloroquine
Mefloquine
Tafenoquine (avoid in G6PD deficiency)
1-2 weeks prior to travel
once weekly
T/F: Advance start medications for malaria ppx are safe in children & pregnancy
True
Mefloquine should not be used in
Underlying psych conditions
Seizures
Arrhythmias
When should chloroquine therapy be stopped for malaria ppx
4 weeks after travel
Side effects of chloroquine
Retinal toxicity, visual changes
What symptomatic treatments cannot be used for Yellow Fever
ASA and other NSAIDs d/t increased risk of bleeding
What is the vaccine for Yellow Fever called
YF-VAX
When is the Yellow Card valid
if the vaccination is completed at least 10 days before arrival
Yellow Fever vaccine is contraindicated with
hypersensitivity to eggs
(eggs are yellow)**
What is the biggest concern with Zika virus
infants born with microcephaly
What is the primary ppx medication for Acute Mountain Sickness (AMS) & what is the brand name
When should it be used?
acetazolamide (Diamox)
Start the day before the day of descent
What is the most common SE of acetazolamide
polyuria
Acetazolamide is CI with
sulfa allergy
