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Pharm 130 > Lyme Disease > Flashcards

Lyme Disease Flashcards

1
Q

what do the chemical secretions a tick secrete facilitate

A

feeding

  • one blocks sensation of pain
  • one blocks sensation of irritation
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2
Q

acute irritant reactions may occur with tick

  • what look like
  • when develop
  • when resolve
A

Red welt or itchy raised lesion

develops after tick falls off

resolves in 48 hours

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3
Q

acute irritant reactions may occur with tick

  • what look like
  • when develop
  • when resolve
A

Red welt or itchy raised lesion

develops after tick falls off

resolves in 48 hours

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4
Q

Management of a tick bite (3)

A

ice or cool compress

oral analgesics or antihistamines

close monitoring for s/sx of lyme disease x 30 days

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5
Q

how long should you monitor for signs of lymes disease after a tick bite

A

30 days

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6
Q

criteria for acquiring lyme disease from tick bite (2)

A

1) patient must have been bitten by a tick that is infected with B. burdorferi
2) the tick must have been attached for at least 24 hours

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7
Q

when criteria for acquiring lyme disease are met what is risk of developing lyme disease

A

less than 4%

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8
Q

sources of data lyme disease surveillance

A

active and passive tick monitoring

-documented infections are underestimation due to undetected or unreported cases

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9
Q

West canada tick with lyme disease

A

western blacklegged tick

- ixodes pacificus

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10
Q

eastern canada tick that can carry lyme disease

A

blacklegged tick

-Ixodes scapularis

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11
Q

Lyme diesease risk areas

- how often check risk of practice area

A

annually

  • PHAC interactive Map
  • detailed map from provincial health authorities
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12
Q

Can lyme disease be found outside documented areas?

A

yest, tciks can travel with their hosts

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13
Q

determination of duration of tick attachment

A

when last in at-risk area

degree of tick engorgement

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14
Q

what do you do if patient unsure how long tick attached

A

consider attached 24 hours

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15
Q

what type of ticks cary lyme disease

A

only black legged ticks transmit lyme disease

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16
Q

what changes in ticks after feeding

A

colour, size, shape

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17
Q

what does most of feeding adult of nymph

A

nymphs do most of feeding because they are smaller and harder to find

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18
Q

PEP

A

post exposure prophylaxis

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19
Q

PEP in children younger than 12yrs pregnant or lactating, evidence of active lyme disease

  • what drug/dose
  • endpoint/time period
A

doxycycline 200mg x 1 dose

0.4% incidence (relative to 3.2% placebo) of (endpoint) development of erythema migrans at site of tick bite (at 3wks and 6wks)

20
Q

Doxycycline

  • what type of drug
  • what schedule
A

tetracycline antibiotic

available by Rx only

21
Q

doxycycline dosage forms (2)

- what is only available through special access program

A

oral tablets and capsules

-IV formulation only available through special access program

22
Q

doxycycline drug interactions (3)

A

oral anticoagulants
hepatic enzyme inducers
isotretinoin

23
Q

doxycycline MoA

-what consideration/counsil point

A

binds to divalent cations (ex. Ca, Fe)
forms non-absorbable complex
- wait 2hrs before/after dosing doxy with Ca and Fe (and other divalent cation) supplements

24
Q

doxycycline AEs (5)

A 
allergy
superinfection
photosensitivity
N/V
esophagitis and esophageal ulcer
25
Q

doxycycline: notes on AEs
- photosensitivity
- esophagitis and esophageal ulcer

A

Photosensitivity
- high risk of LD is sumer, photosensitivity risk, causes redening of skin

esophagitis and esophageal ulcer
- only if take for a long time

26
Q

are patients at risk of doxycycline AEs for LD treatment

A

for single dose (as in LD treatment) most of the AEs are not issues

most ppl tolerate doxycycline well

27
Q

doxycycline in kids

- CPS (what trimesters/nursing/children)

A

bc tetracyclines can bind Ca2+ in developing bones or teeth, CPS cautions use in

  • pregnancy esp in 2nd and 3rd trimester
  • long term use in nursing people (dose 1X for LD)
  • children less than 8 years of age
28
Q

doxycycline of all tetracyclines, what is doxycycline’s binding efficiency

A

less strong than most

29
Q

doxycycline in children AAP

  • use in children
  • how many days

**how many doses for LD

A

doxycycline can be given to children of any age for durations less than 21 days

30
Q

Should you give doxycycline to children

A

use AAP

  • give it to children
  • counsel parents on potential risks
31
Q

pharmacist prescribing for LD, important consideration for referral

A

this is an urgent issue, do not refer unnecessarily

32
Q

RPh Rx’ing for LD PEP, 3 steps

A

1) confirm eligibility for PEP
2) rule out contraindications
3) Rx doxycycline 200mg po x 1 dose

33
Q

1) confirm eligibility for PEP (4)

A
  • documented tick bite acquired in at risk area
  • tick attached at least 24 hours (or engorged)
  • tick removed within past 72 hours
    + longer? may have missed window for PEP
  • no evidence of active LD
34
Q

signs of active LD

A

rash or bruise, fever, headache

35
Q

2) rule out contraindications (2)

A

Allergy

SOGC suggests PEP can be considered during pregnancy

36
Q

3) Rx doxycycline 200mg po x 1 dose

- what about in children

A

in children

- 4mg/kg po x 1 dose (maximum 200mg)

37
Q

child dose of doxycycline

A

4mg/kg/dose

38
Q

doxycycline maximum dose in children

A

200mg

39
Q

implementation and follow up: for ALL patients regardless of PEP or not (3)

A

counsel on tick bite avoidance

advise to monitor for lyme disease symptoms for 30 days

notify primary care provider to ensure appropriate follow-up

40
Q

how long should patients monitor for lyme disease symptoms

A

30 days

41
Q

implementation and follow up: patients not qualifying for PEP

A

reassure low risk for infection

- likelyhood of infection increases with attachment time

42
Q

Urgent referral

A

any patient with symptoms suggestive of LD

43
Q

what avoids progression to disseminated disease

A

early tx

44
Q

in order to develop LD:

A

patient must have B. brudorferi-infected tick attached for at least 24 hours

45
Q

doxycycline PEP effectiveness

A

87% effective at preventing clinical LD

46
Q

statement on doxycycline in pregnancy

A

although historically contraindicated, current evidence suggests that children and pregnant ppl can be offered doxycycline PEP

Pharm 130 (13 decks)

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