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Flashcards in 24. Travelers Deck (30):
1

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.

2

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.

2

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. 

3

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.

4

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.

5

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.

5

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.

6

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

7

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.

8

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).

8

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).

9

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.

9

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.

11

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.

12

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.

12

Select the term that best describes loperamide:

A. Osmotic agent
B. Stool softener
C. Anti-diarrheal
D. Laxative
E. Bulk forming agent
 

C. Avoid use in infants or young children without a pediatrician authorization. Instruct parents on proper hydration with either diarrhea or vomiting.

14

A family is about to leave to visit their relatives in Europe. The grandparents are going on the trip. The grandmother has heart failure and hypertension. The grandfather has hypertension, high cholesterol and a history of depression and anxiety. The pharmacist is asked how to prepare their medications to bring with them on the trip. Which of the following statements represent correct advice? (Select ALL that apply.)

A. Pack your medicine bottles in a suitcase that will be put in the baggage compartment (so they stay cool) and remove all patient identifiers prior to placing them in the suitcase.
B. Bring your medicine bottles with you on the plane.
C. Bring a copy of your prescriptions (a list) and include on the list your medical conditions.
D. Send the medicines ahead of you on a different plane so they are at your destination when you arrive.
E. Check with your health care insurance company to find out your coverage in other countries prior to departure.
 

B, C, E. They may also need to be prepared to discuss with the TSA when going through security if they have medications that exceed the amount allowed for liquids; they allow exceptions for medications. The medication should be labeled.

16

A young man has become engaged to a fellow pharmacy student from Burkina Faso. They are traveling together to visit her parents in her home country. He will be required to present the following proof of yellow fever vaccine in order to enter Burkina Faso:

A. The International Certificate of Vaccination (the green card)
B. The International Certificate of Vaccination (the yellow card)
C. The International Certificate of Vaccination (the pink card)
D. The International Certificate of Vaccination (the red card)
E. The International Certificate of Vaccination (the white card)
 

B.

17

Which of the following statements concerning typhoid fever is correct?

A. A vaccine is available that provides nearly complete resistance to the disease, but most travelers do not receive the vaccine.
B. The vaccine comes as an injection only of live virus; avoid use in patients with severe immunosuppression.
C. The vaccine causes many neurological and psychiatric complications.
D. A vaccine is available but it does not provide complete protection; avoiding contaminated food and water is required for all travelers to high-risk regions.
E. The vaccine name is IXIARO.
 

D. Since the vaccine does not provide complete coverage it is necessary to avoid consumption of contaminated food or water.

18

Which agent is occasionally used for prevention or treatment of altitude sickness?

A. Acetazolamide
B. Lomotil
C. Immodium
D. Sulfinpyrazone
E. Mesalamine
 

A. Avoid use in infants or young children without a pediatrician authorization. Instruct parents on proper hydration with either diarrhea or vomiting.  Major side effects include photosensitivty and dehydration.  Avoid in sulfa allery.

Lomotil & Immodium are anti-diarrheals

Sulfinpyrazone treats gout

Mesalamine treats inflammatory bowel disease called ulcerative colitis

19

A patient will travel to a different country. He wants to take antibiotics to prevent traveler's diarrhea. What is the current Centers for Disease Control (CDC) recommendation concerning candidates for traveler's diarrhea prophylaxis?

A. Patients who request prophylaxis should receive it; recommend azithromycin.
B. Patients who request prophylaxis should receive it; recommend rifaximin.
C. Not recommended, except for very young children and those 60 years and older.
D. Not recommended, except for people with liver disease or heart failure.
E. Not recommended, except perhaps for short-term travelers who are high-risk (such as those who are immune-compromised) or who are taking critical trips during which even a short bout of diarrhea could impact the purpose of the trip.
 

E. Prophylaxis for traveler's diarrhea is not routinely recommended, except perhaps for short-term travelers who are at high risk (such as those who are immunocompromised)

21

Which of the following diseases are transmitted by insect bites? (Select ALL that apply.)

A. Dengue
B. African Sleeping Sickness
C. Japanese Encephalitis
D. Malaria
E. Yellow Fever
 

A, B, C, D, E. 

Dengue: Mosquito

African Sleeping Sickness: Tsetse Fly

Japanese Encephalitis: Mosquito

Malaria: Mosquito

Yellow Fever: Mosquito

 

22

Select the correct term for the Center for Disease Control's standard resource for travel information:

A. The Orange Book
B. The Pink Book
C. The Yellow Book
D. The Black Box
E. The Green Book
 

C. The Orange Book is the FDA's list of approved drug products with therapeutic equivalences (generic equivalents) and the Pink Book is the CDC's resource on the epidemiology and prevention of vaccine-preventable disease.

24

Which of the following statements concerning Japanese encephalitis are correct? (Select ALL that apply.)

A. Japanese encephalitis infection can be asymptomatic, or cause severe disease.
B. Transmission is from mosquito bites.
C. The vaccine is a two-dose series that should be completed at least one week prior to travel.
D. Travelers likely do not need to be vaccinated if they are visiting an at-risk region for a short visit of a week or two.
E. The vaccine for Japanese encephalitis is called Diamox.
 

A, B, C, D. The vaccine for Japanese encephalitis is called IXIARO.  The vaccine is recommended for travelers > 17 years who plan to spend at least 1 month in endemic areas during JE virus transmission season or extended exposure to the outdoors (campers).

Diamox is acetazolamide used for altitude sickness.

25

A patient will travel to a different country. She wishes to avoid traveler's diarrhea. Choose the appropriate recommendations: (Select ALL that apply.)

A. Safe beverages include those that are bottled and sealed or carbonated.
B. The safest way to avoid traveler's diarrhea is to avoid eating in public restaurants entirely.
C. Foods that are freshly cooked and served piping hot are safer than foods that may have been sitting for some time in the kitchen or in a buffet.
D. Other risky foods include raw or undercooked meat and seafood, and unpeeled raw fruits and vegetables.
E. Avoid beverages diluted with nonpotable water (reconstituted fruit juices, ice, and milk) and foods washed in nonpotable water, such as salads.
 

A, C, D, E. To avoid traveler's diarrhea, patients are advised to avoid: risky foods such as raw or undercooked meat and seafood and raw fruits/vegetables, beverages diluted with nonpotable water, and foods that have been sitting around in a buffet

26

Which of the following side effects or toxicities can occur with the use of bismuth subsalicylate? (Select ALL that apply.)

A. Bleeding risk, especially in patients using anticoagulants.
B. Ringing or hallow-sound in ears with over-use.
C. Lightened, clay-colored stool
D. Swollen tongue
E. Reye's syndrome, if used for a viral infection in a young child
 

A, B, E. Bismuth subsalicylate can cause darkened tongue or stool.

27

Which of the following statements concerning atovaquone/proguanil is correct?

A. The brand name is Solodyn.
B. It is poorly tolerated and is the drug of last resort.
C. It cannot be used during pregnancy.
D. The brand name is Mefloquine.
E. It is dosed four times daily.
 

C. Atovaquone/Proguanil (Malarone) cannot be used during pregnancy.

Brand name is Malarone.

It is dosed once daily like all other anti-malarial drugs EXCEPT Mefloquine which is dosed once weekly.

28

Malaria is transmitted by various strains of this type of mosquito:

A. Coquilettidia
B. Culex
C. Aednia
D. Orthopodomylinii
E. Anopheles
 

E. 

29

Which country requires meningococcal vaccination prior to travel at certain times of the year?

A. The United States
B. Greece
C. Italy
D. Saudi Arabia
E. Syria
 

D. The government of Saudi Arabia requires the vaccine for travel to their country during the period of the Hajj and Umrah pilgrimages, which put many people in close proximity, with risk of disease transmission.

30

Mefloquine is dosed on this schedule:

A. Take only if suspected to be bitten by infected mosquito.
B. Begin 12 weeks prior to travel, take 4 weeks post-travel.
C. Begin 8 weeks prior to travel, take 4 weeks post-travel.
D. Begin 2 weeks prior to travel, take 4 weeks post-travel.
E. Take daily during the trip; begin on day of departure.
 

D. 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.

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