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Naplex 2023 > Travelers > Flashcards

Travelers Flashcards

1
Q

International Certificate of Vaccination Prophylaxis

A

“yellow card”
document travel vaccinations

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2
Q

where should meds/supplies be packed

A

carry-on

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3
Q

how diseases spread when traveling

A

1) food/water
2) blood/bodily fluids
3) insects

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4
Q

information for international travel

A

“yellow book”
through CDC

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5
Q

diseases through contaminated water/food

A

TD
typhoid fever
cholera
polio
hepatitis A

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6
Q

dysentery

A

stool with blood
often with systemic symptoms
severe diarrhea

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7
Q

travelers’ diarrhea prophylaxis non-antibiotic drug

A

bismuth subsalicylate 524-1050 mg PO 4 times daily (meals + bedtime)

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8
Q

travelers’ diarrhea prophylaxis antibiotic

A

rifaximin preferred
use only if high risk of complications from TD (immunosuppressed, significant comorbidities) or performance reason (pro athlete)

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9
Q

mild travelers’ diarrhea treatment

A

loperamide or bismuth subsalicylate

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10
Q

moderate travelers’ diarrhea treatment

A

loperamide +/- antibiotics

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11
Q

moderate travelers’ diarrhea treatment antibiotic

A

azithromycin or quinolone (if low resistance)

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12
Q

moderate travelers’ diarrhea treatment antibiotic alternative

A

rifaximin

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13
Q

severe TD treatment (dysentery) treatment

A

antibiotics +/- loperamide

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14
Q

severe TD treatment antibiotic preferred

A

azithromycin

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15
Q

severe TD treatment antibiotic alternative

A

rifaximin or quinolones

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16
Q

common causes of TD

A

bacteria
primarily E. coli

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17
Q

TD prevention tips

A

“boil it, cook it, peel it or forget it”
avoid food sitting on buffet
drink bottled water or boil for approx 1 min
avoid ice

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18
Q

CI to taking Pepto-Bismol for TD treatment/prevention

A

ASA allergy
pregnancy
renal insufficiency
gout
using anticoagulants

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19
Q

TD treatment

A

hydration (inc fluid + salt) is essential for all (oral rehydration solution is preferred)
loperamide: antimotility for acute diarrhea; dec frequency/urgency; 4 mg after 1st loose stool + 2 mg after each subsequent loose stool up to 16 mg/day by Rx or 8 mg/day OTC; self-treat for up to 2 days
BSS: another option; counsel on black tongue/stools
antibiotic: azithromycin preferred for severe/dysentery; quinolones or rifaximin also available

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20
Q

thyroid fever cayses

A

Salmonella typhi

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21
Q

how typhoid fever is spread

A

food/water contaiminated by feces of human with acute infection or chronic, asymptomatic carrier

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22
Q

typhoid vaccines

A

recommended
still need food/water precautions + was hands bc not fully effective

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23
Q

Vivotif

A

oral
live-attenuated typhoid vaccine
complete 1 wk or more before travel

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24
Q

Typhim Vi

A

IM injection
typhoid vaccine
complete 2 wks or more before travel

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25
Q

cholera cause

A

Vibrio cholerae

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26
Q

most common cholera symptom

A

water diarrhea - “rice-water stools”

27
Q

Vaxchora

A

live-attenuated cholera vaccine

28
Q

polio vaccine recommendations

A

childhood in US
CDC - single lifetime booster dose for adults before travel to regions where poliovirus is circulating

29
Q

hepatitis A

A

take when going from developed countries to developing countries

30
Q

diseases spread through blood/bodily fluids

A

hepatitis B
meningococcal meningitis

31
Q

hepatitis B

A

risk is low for those who do not participate in high-risk behaviors

32
Q

high risk for hepatitis B

A

receiving medical care
provide medical care
unprotected sexual encounters
piercings/tattoos

33
Q

how long does it take to give hepatitis series

A

3 shots over 6 months
give as many as possible before trip and complete upon return if needed

34
Q

meningococcal meningitis symptoms

A

symptoms: fevere, severe unrelenting headache, nausea, stiff neck/nuchal rigidity

35
Q

meningococcal meningitis diagnosis

A

lumbar puncture

36
Q

how meningococcal meningitis is spread

A

respiratory secretions

37
Q

meningitis high risk regions

A

meningitis Belt of Africa
Hajj and Umrah pilgrimages in Saudi Arabia require vaccine for travel

38
Q

meningitis vaccines

A

quadrivalt Menactra and Menveo

39
Q

diseases spread by insects

A

dengue
Japanese encephalitis
malaria
yellow fever
zika

40
Q

insect bites

A

mainly from mosquitos
avoid insect bites: mosquito repellents with 20-50% DEET exposed skin; use permethrin on clothing but not on skin

41
Q

dengue

A

from mosquitos
severe - can have severe bleeding
protect from mosquito bites

42
Q

Japanese encephalitis

A

from mosquitos
reduce exposure to mosquitoes
Ixiaro for travelers <2 mo old going to extended outdoors exposures or at least 1 mo in endemic area during JE season

43
Q

Malaria source

A

Anopheles mosquito to human host

44
Q

most common malaria species

A

P. vivax

45
Q

most deadly malaria species

A

P. falciparum

46
Q

malaria prophylaxis

A

recommended bc can be fatal
look at region-specific recommendations
can cause nausea; take with water, food, or milk

47
Q

malaria quick starts

A

initiate 1-2 days before travel
daily meds
avoid in pregnancy
cause nausea
doxycycline (Doryx/Vibramycin)
Atovaquone/Proguanil
Primaquine

48
Q

primaquine notes

A

stop 1 week after travel; don’t use in G6PD deficiency

49
Q

malaria advanced starts

A

weekly regiment
safe in kids and pregnancy (except Tafenoquine
start 1-2 weeks before travel
chloroquine
Mefloquine
Tafenoquine

50
Q

chloroquine notes

A

stop 4 weeks after travel
renal toxicity/visual changes

51
Q

Mefloquine notes

A

start >=2 weeks before travel
stop 4 weeks after travel
don’t use in underling psych conditions, seizures, arrhythmias

52
Q

Tafenoquine notes

A

not used in G6PD deficiency

53
Q

how yellow fever is spread

A

mosquitos - reduce exposure

54
Q

what meds are CI in yellow fever

A

ASA/NsAIDs - inc bleeding risk

55
Q

what is available to prevent yellow fever

A

live-attenuate YF-VAX
documented on ICVP “yellow card” - valid after 10 days

56
Q

what makes YF-VAX CI

A

allergy to eggs
severely immunocompromised

57
Q

who is recommended to get YF-VAX

A

only if traveling to high risk area/required to travel
serious ADRs

58
Q

how is Zika spread

A

primarily mosquito
sexual and blood transfusion transmission reported

59
Q

what can happen to babies with Zika mom

A

infants born with microcephaly

60
Q

how to prevent Zika

A

no vaccine
avoid mosquito
use condoms with those who possibly have Zika

61
Q

how to prevent DVT in travel

A

compression stocking in long trips
perform lower leg exercises when sitting

62
Q

primary prophylaxis for acute mountain sickness

A

acetazolamide - start day before

63
Q

acetazolamide side effects

A

polyuria
photosensitivity

64
Q

who is CI for acetazolamide

A

sulfa allergy

Naplex 2023 (21 decks)

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