Travel Health Flashcards
What causes motion sickness?
The vestibular system in the inner ear is responsible for balance and motion, which the brain receives as signals.
During motion sickness, the brain receives conflicted signals from the vestibular system as well as the eyes.
When do you refer someone who is experiencing motion sickness?
If their symptoms continue even after travel (labyrinthitis)
What pharmacological options are available for motion sickness?
- Hyoscine - 1 patch every 3 days, or 0.3-0.6mg every 4-6h
- Antihistamines - take 1-2h before journey
- Promethazine - 25mg
- Cyclizine - 50mg
- Cinnarizine - 30mg
What are some non-pharmacological options for motion sickness?
- Ginger
- Acupressure bands
- Minimise head movements
- Avoid large meals/alcohol
- Fix vision on a stable object
What is deep vein thrombosis (DVT) and how can it occur in travel?
It is a blood clot that develops in one of the deep veins in the calf/leg.
It can occur during long journeys (long periods of sitting), and periods of inactivity.
What are the symptoms of DVT?
- Pain/swelling of leg
- Redness of skin
- Aches in affected area
- Pulmonary embolism - where bits of the clot break apart & travel around the body, blocking a blood vessel in the lungs
What are the pharmacological treatments for DVT?
- Anticoagulants - heparin or warfarin
2. Graduated compression hosiery
What are the non-pharmacological treatments/preventions for DVT?
- Raising the leg to prevent pooling of blood
- Wearing loose/comfortable clothing
- Avoid excess alcohol/sleeping pills
What factors can cause jet-lag?
- Disrupted circadian rhythm
- O2 levels - lower air pressure can reduce the amount of O2 in the blood
- East & west
- Other factors: stress, dehydration, alcohol, lack of sleep
What are the pharmacological treatments for jet-lag?
- Melatonin - not used in the UK
2. Sleeping tablets
What are the non-pharmacological treatment options for jet-lag?
- Change sleep routine before travelling
- Limit caffeine/rest well during flight
- Avoid napping when arriving
What is the difference between UVA, UVB, and UVC light?
UVA: for tanning/ageing
UVB: for sunburn
UVC: filtered out by the ozone layer
- REMEMBER (UV)A FOR AGEING, (UV)B FOR SUNBURN
Who are more at risk of developing a sunburn?
- Fair skinned people (low melanin)
- Countries close to the equator
- <6yrs or >80yrs
- High altitudes
- Prolonged sun exposure
- Snow/ice/water
How can one prevent sunburn?
- Avoid direct sun
2. Sunscreens - physical (deflect/block UVA/UVB) or chemical (absorb UVA/UVB light)
What does SPF stand for and what does it indicate?
SPF: sun protection factor
It indicates the level of protection against UVB light
What treatments are considered for a sunburn?
- Water
- Moisturiser
- Painkillers
- Burn cream/dressings
When do you refer someone who has a sunburn?
If they have severe blistering, or systemic effects
What symptoms would a patient come to you with if you suspect they have skin cancer?
- Small lumps
- Flat or firm red spots
- Lumps with scaly tops
- Abnormal moles and freckles
What is prickly heat also known as?
Miliaria
Who are most likely to develop a prickly heat rash?
- Babies/children
- Overweight people
- Illness/immobility
What causes prickly heat?
- Excessive sweating
- Dead skin cells + bacteria collect in sweat glands
- Sweat glands become blocked
- Sweat then traps beneath the skin in pockets
- These pockets then burst and release the sweat
- This causes a stinging/prickling sensation
What is the treatment for prickly heat?
- Avoid excessive heat/humidity
- Wear loose clothing
- Keep skin cool
- Calamine lotion
- Hydrocortisone cream
How does malaria spread in the body?
- Infected female mosquito bites a person
- Parasite enters the blood and travels to the liver where it develops
- It then re-enters the blood and infects RBCs
- Infected RBCs burst and release more parasites
What factors can affect the levels of exposure to malaria?
- Temperature, seasons
- Rural vs urban locations
- Accommodation
- Types of activity
- Length of stay
What does ABCD of malaria prevention stand for?
A: awareness of the risk
B: bite prevention
C: chemoprophylaxis
D: diagnosis
What drugs are taken as malaria prophylaxis, and what are their doses/frequencies?
- Proguanil - 200mg daily
- 1 week before, during, and 4 weeks after travel - Chloroquine - 310mg weekly
- 1 week before, during, and 4 weeks after travel - Mefloquine - 250mg weekly
- 3 weeks before, during, and 4 weeks after travel - Doxycycline - 100mg daily
- 2 days before, during, and 4 weeks after travel - Malarone - atovaquone 250mg + proguanil 100mg
- 1 tablet daily
- 1-2 days before, during, and 1 week after travel
- Its P version is maloff protect
What are some symptoms of an insect bite/sting?
- Red/swollen/itchy
- Blisters
- Pus
- Flu-like symptoms if infected
What complications can arise from insect bites/stings?
- Infections
- Lyme disease
- West Nile virus
- Malaria
What are some pharmacological treatment options for insect bites/stings?
- Antihistamines
- Antibiotics if infected
- Hydrocortisone 1% cream/ointment
- Topical anaesthetic
What strength of DEET (Jungle Formula) is used as an insect repellant?
30-50%
What is considered as travellers diarrhoea?
If there are >3 loose stools in 24h, plus one of the symptoms:
- Nausea
- Vomiting
- Abdominal cramps
- Blood/mucus in stools
How can travellers diarrhoea be treated?
- Rehydration with sachets (dioralyte, 1-2 sachets after each loose stool)
- Loperamide (4mg initially, then 2mg for up to 5 days taken after each loose stool)
How can someone avoid obtaining travellers diarrhoea?
- Good hygiene measures
- Thoroughly cook food
- Ensure water is boiled and cooled
- Purify water by either boiling, chemical purification (iodine or halogens), or filtration
- Peel fruits and wash vegetables thoroughly
What are some factors to consider before giving advice on travel vaccines?
- Where they are going + for how long
- Age + health
- What they will be doing there
- Where they are staying
What are some common vaccinations that can be administered for a traveller?
- Polio, tetanus
- Hepatitis A/B
- Cholera
- Yellow fever
- Tuberculosis
Where can someone find more information about travellers vaccines?
NHS Fit for Travel website.
What is the role of the pharmacist in relation to travellers advice?
- Give effective health promotion to the public
- Administer vaccines/antimalarials
- Discuss/provide pharmaceutical & non-drug advice + supplies
- Raise awareness on travel medicine
