Lyme Disease

Question 1

what do the chemical secretions a tick secrete facilitate

Answer 1

feeding

• one blocks sensation of pain
• one blocks sensation of irritation

Question 2

acute irritant reactions may occur with tick

• what look like
• when develop
• when resolve

Answer 2

Red welt or itchy raised lesion

develops after tick falls off

resolves in 48 hours

Question 3

acute irritant reactions may occur with tick

• what look like
• when develop
• when resolve

Answer 3

Red welt or itchy raised lesion

develops after tick falls off

resolves in 48 hours

Question 4

Management of a tick bite (3)

Answer 4

ice or cool compress

oral analgesics or antihistamines

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

Question 5

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

Answer 5

30 days

Question 6

criteria for acquiring lyme disease from tick bite (2)

Answer 6

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

Question 7

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

Answer 7

less than 4%

Question 8

sources of data lyme disease surveillance

Answer 8

active and passive tick monitoring

-documented infections are underestimation due to undetected or unreported cases

Question 9

West canada tick with lyme disease

Answer 9

western blacklegged tick

- ixodes pacificus

Question 10

eastern canada tick that can carry lyme disease

Answer 10

blacklegged tick

-Ixodes scapularis

Question 11

Lyme diesease risk areas

- how often check risk of practice area

Answer 11

annually

• PHAC interactive Map
• detailed map from provincial health authorities

Question 12

Can lyme disease be found outside documented areas?

Answer 12

yest, tciks can travel with their hosts

Question 13

determination of duration of tick attachment

Answer 13

when last in at-risk area

degree of tick engorgement

Question 14

what do you do if patient unsure how long tick attached

Answer 14

consider attached 24 hours

Question 15

what type of ticks cary lyme disease

Answer 15

only black legged ticks transmit lyme disease

Question 16

what changes in ticks after feeding

Answer 16

colour, size, shape

Question 17

what does most of feeding adult of nymph

Answer 17

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

Question 18

PEP

Answer 18

post exposure prophylaxis

Question 19

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

• what drug/dose
• endpoint/time period

Answer 19

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)

Question 20

Doxycycline

• what type of drug
• what schedule

Answer 20

tetracycline antibiotic

available by Rx only

Question 21

doxycycline dosage forms (2)

- what is only available through special access program

Answer 21

oral tablets and capsules

-IV formulation only available through special access program

Question 22

doxycycline drug interactions (3)

Answer 22

oral anticoagulants
hepatic enzyme inducers
isotretinoin

Question 23

doxycycline MoA

-what consideration/counsil point

Answer 23

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

Question 24

doxycycline AEs (5)

Answer 24

allergy
superinfection
photosensitivity
N/V
esophagitis and esophageal ulcer

Question 25

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

Answer 25

Photosensitivity - high risk of LD is sumer, photosensitivity risk, causes redening of skin esophagitis and esophageal ulcer - only if take for a long time

Question 26

are patients at risk of doxycycline AEs for LD treatment

Answer 26

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

Question 27

doxycycline in kids | - CPS (what trimesters/nursing/children)

Answer 27

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

Question 28

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

Answer 28

less strong than most

Question 29

doxycycline in children AAP - use in children - how many days **how many doses for LD

Answer 29

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

Question 30

Should you give doxycycline to children

Answer 30

use AAP - give it to children - counsel parents on potential risks

Question 31

pharmacist prescribing for LD, important consideration for referral

Answer 31

this is an urgent issue, do not refer unnecessarily

Question 32

RPh Rx'ing for LD PEP, 3 steps

Answer 32

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

Question 33

1) confirm eligibility for PEP (4)

Answer 33

- 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

Question 34

signs of active LD

Answer 34

rash or bruise, fever, headache

Question 35

2) rule out contraindications (2)

Answer 35

Allergy SOGC suggests PEP can be considered during pregnancy

Question 36

3) Rx doxycycline 200mg po x 1 dose | - what about in children

Answer 36

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

Question 37

child dose of doxycycline

Answer 37

4mg/kg/dose

Question 38

doxycycline maximum dose in children

Answer 38

200mg

Question 39

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

Answer 39

counsel on tick bite avoidance advise to monitor for lyme disease symptoms for 30 days notify primary care provider to ensure appropriate follow-up

Question 40

how long should patients monitor for lyme disease symptoms

Answer 40

30 days

Question 41

implementation and follow up: patients not qualifying for PEP

Answer 41

reassure low risk for infection | - likelyhood of infection increases with attachment time

Question 42

Urgent referral

Answer 42

any patient with symptoms suggestive of LD

Question 43

what avoids progression to disseminated disease

Answer 43

early tx

Question 44

in order to develop LD:

Answer 44

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

Question 45

doxycycline PEP effectiveness

Answer 45

87% effective at preventing clinical LD

Question 46

statement on doxycycline in pregnancy

Answer 46

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