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Infections > TBL > Flashcards

TBL Flashcards

1
Q

What is the cause of traveller’s diarrhea?

A

Parasites, bacterium or viruses

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2
Q

What are some of the organisms that cause traveller’s diarrhea in rich countries?

A

Enteroviruses, enterotoxigenic E. coli
(ETEC), non-typhoidal Salmonella spp, Campylobacter spp, Giardia, and
Cryptosporidium

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3
Q

What are some of the organisms that cause traveller’s diarrhea in poor countries?

A

Entamoeba, Shigella, Salmonella Typhi and Paratyphi, and Vibrio cholerae

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4
Q

Why is it difficult to diagnose traveller’s diarrhea once they have returned home?

A

Most people experience such mild diarrhea/self limiting that they would not go to the Doctor.
A sample may not be taken
Difficult to identify the causative organism

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5
Q

What are some of the risk factors of traveller’s diarrhea?

A

Those travelling from a rich to a poor country (20-50% affected)
The young
The elderly
Those with special needs

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6
Q

How is traveller’s diarrhea caused?

A

Under-cooked food
Food left out for some time
Contaminated liquid

or diarrhea caused by stress, a change in diet, increased alcohol consumption and hot weather

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7
Q

What are the main indicative symptoms of traveller’s diarrhea?

A

3 loose stools in 24 hours
or any number of stools accompanied by abdominal pain, nausea or vomitting
Normally starts in the first week of arrival and last 3-4 days

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8
Q

Who can’t take loperamide?

A

If the traveller has active ulcerative
colitis, a fever or bloody diarrhoea. Loperamide should be used with caution and
only under specialist supervision in children under the age of 12 years.

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9
Q

Which antibiotic is recommended to be taken alongside loperamide?

A

Ciprofloxacin (500mg) as a single dose

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10
Q

If oral rehydration powders aren’t available what is recommended?

A

A salt and sugar solution of 8 level teaspoons of sugar and ½ teaspoon of salt to a litre of clean water.

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11
Q

When should the patient refer to a Doctor for traveller’s diarrhea?

A

If symptoms do not improve within a few
days, they are passing blood and/or mucous, or develop a fever

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12
Q

How does prickly heat occur?

A

When the sweat glands become blocked.

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13
Q

How can prickly heat be treated?

A

First generation anti-histamine

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14
Q

Who is most at risk of heat exhaustion?

A

Elderly
Those exercising in the sun
Patients with high blood pressure

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15
Q

What are some of the symptoms of heat exhaustion?

A

Heavy sweating, tiredness, headache,
nausea and vomiting and fainting.

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16
Q

How can heat exhaustion develop into a medical emergency?

A

If fluids are not replaced and the core body temperature is reduced

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17
Q

How does photo sensitivity occur?

A

When certain drugs are ingested or agents
applied to the skin and then exposed to visible light or UV radiation

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18
Q

What conditions can be benefited by UV radiation?

A

Psoriasis and topical skin sensitivities as it induces immunosupression in localized tissue

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19
Q

List 4 sunscreen advice points you would provide to patients.

A

Sunscreens should have a broad spectrum protection against UVB and
UVA
They should have a minimum SFP of 15 and a four star rating (giving 90%
protection against UVB)
Even in the UK they should avoid peak radiation levels between 11am
and 3pm
They should apply sunscreen 30 minutes before exposure to strong
sunlight and re-apply frequently: never allow the skin to burn and only
use “in date” preparations

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20
Q

When can deep vein thrombosis occur whilst travelling?

A

In any period of long inactivity such as a long flight, road trip

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21
Q

What is the main symptom of a pulmonary embolism?

A

Getting very short of breath, chest pain, coughing up blood, sudden collapse

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22
Q

List 5 methods of reducing the risk of developing DVT whilst travelling.

A

Avoid dehydration
Wear non-restrictive clothing
Try to walk around as much as possible
Wearing fitted compression socks of 15 to 30mmHg of pressure to the legs
Regularly flexing and extending the ankle

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23
Q

Which groups of people would be contra-indicated against receiving booster travelling vaccines?

A

Pregnant women with live vaccines (unless advised otherwise).
Influenza and yellow fever vaccines should not be given to those with a
confirmed anaphylactic reaction to egg protein
Anybody who suffered with a severe anaphylaxis to previous antigen vaccine
Acutely unwell patients

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24
Q

Four pieces of travelling advice for those with existing medical conditions?

A

They should tell their travel insurer about the condition
 Ask their doctor how the trip might affect them
 Carry a doctor’s letter and a copy of any prescription
 Learn key words and phrases in local languages for the condition,
medication and emergency help

In addition ensure their medication is legal in the country they are travelling to

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25
Q

Where can the appropriate information be found on taking controlled drugs abroad?

A

The Home Office website has embassy details

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26
Q

What is the risk of a diabetic patient contracting malaria?

A

May result in hypoglycemia and loss of consciousness

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27
Q

If a diabetic patient is travelling through more than 5 time zones what considerations should they make?

A

If travelling east- the day will be shorter therefore need to reduce insulin tablets and carbohydrate intake
If travelling west- day will be longer therefore need to increase insulin tablets and carbohydrate intake

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28
Q

If somebody has not got a functioning spleen where should they not travel?

A

Malaria countries

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29
Q

Which anti-malarial drugs can epileptics not take?

A

Chloroquine and mefloquine as they can cause seizures

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30
Q

What drugs reduce doxycyclines half life?

A

Barbiturates, carbamazepine and phenytoin

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31
Q

Apart from epileptic which other patients cannot take mefloquine?

A

Those with a history of depression or anxiety.
Patients with cardiac arrhythmias or
those taking anti-arrhythmic drugs or beta-blocker

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32
Q

What anti-malarials are safe to be taken during pregnancy?

A

Chloroquine and proguanil are considered safe in pregnancy (even
though less effective), as is mefloquine in the second and third trimester

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33
Q

When should mefloquine not be taken by the Mother and infant?

A

If the baby weighs under 7kg (and is still breast-fed)

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34
Q

If patients are taking anti-coagulants what should they do to prepare to travel?

A

They should stick to a regime 3 weeks before travelling so their INR is stabilised

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35
Q

Which drugs can increase the effects of warfarin?

A

Proguanil and doxycycline

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36
Q

How can a patient with respiratory disease prepare to travel?

A

As travel can cause exacerbated symptoms of respiratory disease particularly secondary chest infection in COPD ensure influenza and pneumonia vaccines are kept up to date.
Contact airlines to ensure additional oxygen supplies are available during flight as it can cause hypoxia in those with cardio-pulmonary disease.

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37
Q

Which condition may add to the haemolysis cause by malaria?

A

Thalassaemia and sickle cell disease

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38
Q

Is chloroquine suitable for G6PD deficiency?

A

It can cause red cell damage but prophylatic doses are too low to have an effect

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39
Q

Is doxycycline suitable in for Acute porphyrias?

A

No it is contra-indicated

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40
Q

Which demographics are more prone to experience symptoms of motion sickness?

A

Women especially when on their period
Those who suffer from migraines
Children aged 3-12 years old

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41
Q

What are some of the symptoms of motion sickness?

A

Drowsiness
Cold sweats
Nausea and vomiting
Pallor and fainting

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42
Q

How can the symptoms of motion sickness be prevented?

A

Focusing on a fixed point in the horizon
Lying horizontally
Avoid looking down
Avoid a stuffy environment

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43
Q

What are some of the OTC medications for motion sickness?

A

Cyclizine (Valoid) 50mg 4 to 6 hrs
Hyoscine tablets (Scopolamine) 0.3 - 0.6mg 4 to 6 hrs
Promethazine (Avomine) 25mg 24 to 30 hrs
Meclizine (Sealegs) 25mg 6 to 12 hrs
Cinnarizine (Stugeron) 30mg 6 to 8 hrs

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44
Q

How does hyoscine work?

A

By blocking some of the nerve signals sent from the vestibular system to the inner ear which can cause nausea

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45
Q

What the indications for hyoscine patches?

A

Suitable for 10 years and above
To be applied before travelling and changed every 3 days

46
Q

Can you take hyoscine before driving?

A

No because it can cause side effects such as blurred vision and drowsiness

47
Q

What are some of the other side effects of hyoscine?

A

dry mouth
dizziness
constipation
Rarer side effects include:
nausea
vomiting
mental confusion, particularly in elderly people

48
Q

When should hyoscine be used with caution?

A

In children
In the elderly
Those with kidney or liver problems
Those with heart problems
Those with a history of gastro-oesophageal reflux disease

49
Q

Which three anti-histamines are recommended for motion sickness?

A

Promethazine
Cyclizine
Cinnarizine

50
Q

What are some of the side effects of these anti-histamines?

A

Drowsiness
headaches
Pins and needles
Dry mouth
Blurred vision

51
Q

What other non-pharmacological treatments be recommended for motion sickness?

A

Eating ginger
Acupressure bands

52
Q

At what altitude does acute mountain sickness occur?

A

2500-3000m normally but it can occur from 1500m upwards

53
Q

At what point does acute mountain sickness occur?

A

6-12 hours after arriving at the altitude symptoms can begin to occur but it can be as delayed as 24 hours after

54
Q

Is acute mountain sickness dangerous?

A

No in most cases the symptoms are self-limiting (do not last more than 1/2 days if further ascent does not occur).
However in 10% of cases it can develop to high-altitude cerebral oedema and possibly high-altitude pulmonary oedema which are life threatening and person should descend immediately.

55
Q

What are the key symptoms of acute mountain sickness?

A

Headache, fatigue, loss of appetite and nausea.

56
Q

What are the key symptoms of high-altitude cerebral oedema?

A

Lethargy, confusion and ataxia (poor muscle control) in addition of acute mountain sickness symptoms.

57
Q

What are the key symptoms of high-altitude pulmonary oedema?

A

Shortness of breath (which develops to even at rest) and dry cough

58
Q

What is the recommended treatment of acute mountain sickness?

A

Paracetamol, ibuprofen, aspirin to relieve headache
Anti-emetics for sickness
Do not leave the person unattended in case symptoms progress
If symptoms do not improve descend by 500m-1000m

59
Q

Which vaccination proof is essential for Hajj and Umrah pilgrimages?

A

Vaccination proof of the quadrivalent vaccine against meningitis which has
been issued not more than 3 years and no less than 10 days prior to arrival in
Saudi Arabia.

60
Q

Which other vaccinations are recommended for Hajj and Umrah pilgrimages?

A

Seasonal influenza vaccines
5 doses of tetanus vaccine
5 doses of polio vaccine (more than 10 years requires a booster)
MMR vaccine

61
Q

What are some of the effects of jet lag?

A

Sleep disturbance, loss of appetite, nausea and sometimes vomiting, bowel changes (e.g. constipation), general malaise,
tiredness and poor concentration

62
Q

List 5 ways jet lag can be prevented.

A

On arriving take sleeping tablets
Taking regular melatonin
Breaking up long journeys
Drinking lots of water
Stretch and exercise as much as possible to avoid swollen ankles

63
Q

When do signs of rabies begin to appear?

A

20-90 days after being infected

64
Q

What the first symptoms of rabies?

A

Fever, head and muscle ache
· Extreme tiredness.
· Numbness and tingling can occur at the site of the bite/scratch.

65
Q

List 3 symptoms of furious rabies.

A

Seizures
Hyperactivity
Confusion

66
Q

How do you die from rabies?

A

After the symptoms of furious rabies has developed, additional symptoms such as throat spasms, inability to drink also develops. Eventually you lose control of muscles and are paralyzed from the site of the bite/ scratch across the body until you fall into a coma and then death.

67
Q

How many people die each year from rabies?

A

50,000 and 60,000 people

68
Q

How many vaccines are needed for rabies?

A

3 to be taken at least 21 days before travel

69
Q

When is the rabies vaccine recommended?

A

You live, travel frequently to or spend long periods in countries with rabies.
· You cycle or run in risk areas.
· Your work puts you at risk.

70
Q

What is dengue fever?

A

A viral illness spread by day-biting mosquitoes.

71
Q

What are some of the symptoms of dengue fever?

A

Fever
* Intense joint and muscle pain
* Nausea and vomiting
* Red rash
Severe headache

72
Q

Where is dengue fever most common?

A

Africa, Asia, the Caribbean, Central and South
America and the Western Pacific

73
Q

How can dengue fever be treated?

A

Paracetamol, ibuprofen - to relieve pain
Rest
Drinking plenty of fluids

74
Q

What are the red flag symptoms of dengue?

A

Tiny bloods spots or large patches of blood under your skin, bleeding from the
gums or nose, persistent vomiting and severe abdominal pain, vomiting blood or
black, tarry stools indicate dengue hemorrhagic fever.

75
Q

What are the four species of Plasmodium parasite that causes malarial infection in humans?

A

P. falciparum, P. vivax, P. ovale and P. malariae

76
Q

How do the four species of plasmodium differ?

A

They differ in their life cycle, clinical manifestations and morphology (structural features).

77
Q

Where is p. vivax most common?

A

South America and Southeast Asia

78
Q

Where is p. vivax dormant?

A

In the liver and can be reactivated after months leading to the attack of blood stage

79
Q

Which stage do most anti-malarials target?

A

Human blood stage

80
Q

What is the role of gametocytes in malarial transmission?

A

Gametocytes are the sexual form of the parasite which can be formed when the parasite is in an infected person’s blood. They draw up the infected blood infecting the parasite and hence continuing the cycle.

81
Q

Describe the asexual stage of malaria.

A

The female Anopheles mosquito injects sporozoites into the blood stream of the patient.
Sporozoites are then rapidly uptaken by hepatocytes.
Parasites develop and form schizonts from which several thousand merozoites form.
Hepatocytes rupture releasing merozoites into the bloodstream rapidly destroying the red blood cells.
Clinical symptoms of malaria begin.

82
Q

Describe the sexual stage of malaria.

A

A small percentage of merozoites, differentiate into male and female gametocytes, which are taken up by the mosquito in her blood meal. These infect the parasite which then infects the next person.
Male and female gametocytes fuse within the mosquito forming diploid zygotes, which in turn become ookinetes.
Ookinetes migrate to the midgut of the insect, pass through the gut wall and form oocysts.
Meiotic division of oocysts form sporozoites are formed, which then migrate to the salivary glands of the female Anopheles mosquito.

83
Q

When do symptoms of malaria usually occur?

A

10-15 days after bite

84
Q

What are some of the clinical symptoms of malaria?

A

a high temperature (fever) of 38°C (100.4F) or above
 sweats and chills
 generally feeling unwell
 muscle pains
 headaches
 cough
 diarrhea

85
Q

What are some of the complications of malaria?

A

breathing problems (fluid in the lungs)
 liver failure and jaundice
 shock
 spontaneous bleeding
 abnormally low blood sugar
 kidney failure
 swelling and rupturing of spleen
 dehydration

86
Q

Which type of plasmodium causes cerebral malaria?

A

P. falciparum (also causes kidney damage)

87
Q

How can malaria be treated?

A

Targetting the mosquito (DTT insecticide)
Targeting the erythocytic stage

88
Q

What do anti-folates target?

A

The cell cytosol

89
Q

How do anti-folates work?

A

Antifolate antimalarial drugs interfere with folate metabolism, a pathway essential to malaria parasite survival, they prevent the biosynthesis of amino acids and nucleotides

90
Q

What are the specific targets of anti-folate metabolism?

A

De novo biosynthesis of folates and dihydrofolate reductase

91
Q

What class of drug is Proguanil?

A

Dihydrofolate reductase inhibitor

92
Q

What is proguanil combined with usually?

A

Atovaquone which is sold under the tradename Malarone

93
Q

How does Atovaquone work?

A

Selectively inhibits the parasitic mitochondrial electron transport chain

94
Q

Why is anti-malarials targetting the food vacuole a good drug target?

A

The food vacoule is required by the parasites for the digestion of haemoglobin which provides the parasite with the amino acids required for its own protein synthesis.

95
Q

What proteases are found in the food vacuole?

A

Plasmepsins (aspartic acid protease)
- Falcipains (cysteine protease)
- Falcilysins (metallo protease)

96
Q

How do parasites detoxify the toxic heme group released through the digestion of haemoglobin?

A

Sequestration of the free heme into hemozoin, or the malarial pigment (so called because it has an intense purple colour)
- Degradation facilitated by hydrogen peroxide within the food vacuole
- Glutathione-dependent degradation which occurs in the parasite’s cytoplasm

97
Q

How does quinoline accumlate in the food vacuole?

A

This accumulation may involve ion trapping following protonation, specific transport,
and/or binding to a receptor (eg. heme)

98
Q

What can traveller’s do to prevent malaria?

A

Loose fitting clothing
Repellents on exposed skin
Mosquito nets

99
Q

What should the Pharmacist advise patients with young children travelling to malarious countries?

A

Young children under 5 are more likely to suffer from complications from malaria.
Instruct the parent to protect the children from insect bites and that they should be given malaria chemoprophylaxis.
Malaria chemoprophylaxis doses should be given according to body weight/ age group

100
Q

What should be covered in collecting a medical history for somebody travelling to a malarious country?

A

Full history for each traveller
Any special needs that may be affected by foreign travel
Check traveller’s medication for possible interactions and contraindications
with malaria prophylaxis or live vaccines
Travelling affects administration schedules, as well as the storage and
transportation of refrigerated medication such as insulin

101
Q

Can pregnant women travel to malarious countries?

A

No it should be avoided and if they are trying to conceive

102
Q

Which class of drug’s does doxycycline reduce the effectivity of?

A

Contraceptives

103
Q

Why should you ask about date of travel, transport and destination details?

A

Chemoprophylaxis doses need to be given at a suitable time
Urban areas are better protected from malaria
Prolonged periods of inactivity, dehydration and pre-existing risk factors can
increased the risk of deep vein thrombosis during travel

104
Q

How much protection does 50% DEET have?

A

Up to 12 hours

105
Q

How much protection does 20% DEET have?

A

1-3 hours

106
Q

What does DEET reduce the efficacy of?

A

Sunscreen, but not the other way round

107
Q

What are two alternatives to DEET?

A

Lemon eucalyptus and picaridin

108
Q

What stage does casual prophylaxis target?

A

The liver stage and it prevents progression to the erythrocytic stage of infection

109
Q

Where does Suppressive prophylaxis act?

A

Erythrocytic stage of infection and continues for 28 days after

110
Q

What treatment is used for relapsing malaria?

A

Primaquine or tagenoquine

Infections (16 decks)

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