Travel sickness Flashcards
(113 cards)
1
Q
What are the risks of illnesses for travellers?
A
- Food or water born pathogens
- Systemic febrile illness e.g. malaria, typhoid
- dermatological problems caused by insects
2
Q
What are the main risks of death for travellers?
A
- Lack of medical expertise
- poor road conditions
- swimming in unfamiliar waters
- extreme environmental conditions
- Men are 4 times more likely to die from trauma
3
Q
What is the ABCD guide to malaria?
A
A= Awareness of risk- area of travel, activities, duration of stay
B= Bite Prevention
C= Chemoprophylaxis- Take antimalarial medication
D= Diagnosis- if high temperature of 38 or higher or develop symptoms seek medical attention
4
Q
What causes traveller’s diarrhoea?
A
Many different bacteria, viruses and parasites worldwide.
5
Q
What is the most common illness in those travelling from resource-rich to resource-poor countries?
A
Traveller’s diarrhoea (20-50% of travellers)
6
Q
How can you contract traveller’s diarrhoea?
A
- Eating contaminated food or liquids. Mostly if foods have not been heated properly or left out at room temperature (pathogens are inactivated above 60 degrees).
7
Q
Who is more at risk of diarrhoea?
A
- The very young
- the elderly
- those with special needs
- people adventurous with eating
8
Q
Symptoms of traveller’s diarrhoea:
A
- Passage of 3 or more unfound stools in a 24-hour period.
- Often accompanied by abdominal pain, fever, nausea, vomitting
9
Q
How long does travellers diarrhoea usually last?
A
3-4 days
10
Q
When should an individual seek medical advice for a traveller’s diarrhoea?
A
- If symptoms don’t improve within a few days
- If passing blood or mucus
- Developing a fever
- Dehydration
11
Q
What is the most important aspect of managing travellers’ diarrhoea?
A
Maintaining adequate fluids.
Can give oral rehydration powders such as Dioralyte or Electolade.
Or can give normal fluids with a sugar solution of 8 teaspoons of sugar and 1/2 teaspoon of salt to 1L of water.
12
Q
When is Loperamide used for traveller’s diarrhoea?
A
if frequent diarrhoea is inconvenient e.g. long bus rides or meetings
13
Q
When can Loperamide not be used for traveller’s diarrhoea?
A
-If the patient has ulcerative colitis
- If they have a fever
- If they have bloody diarrhoea
14
Q
What age can you give Loperamide?
A
Should be used with caution and under specialist supervision in those under 12.
15
Q
When would antibiotics be considered for traveller’s diarrhoea?
A
- If they gave a serious underlying medical condition or would seriously disrupt travel plans.
16
Q
Which antibiotics are generally used for traveller’s diarrhoea?
A
Ciprofloxacin- generally the drug of choice as one dose of 500mg.
May use azithromycin
17
Q
What is prickly heat?
A
Occurs when swear glands become blocked
18
Q
What is the usual treatment for prickly heat?
A
A first-generation anti-histamine such as Diphenhydramine.
19
Q
What are the symptoms of heat exhaustion?
A
Heavy sweating
Tiredness
headaches
nausea
vomitting
fainting
20
Q
When can heat exhaustion develop into heat stroke?
A
When fluids are NOT replaced and if the core body temperature is reduced.
21
Q
What advice should be given on sunscreens?
A
- Broad spectrum protection against UVB and UVA
- Minimum SPF of 15
- Four-star rating
- If swimming or sweating should chose a water-resistant preparation
22
Q
What advice should be given about sun exposure?
A
- sun screeen!!
- Avoid peak radiation levels (between 11-3 in the UK)
- Apply sunscreen 30 minutes before exposure and continue to reapply
23
Q
What is deep vein thrombosis (DVT)?
A
A blood clot in one of the body’s deep veins, often in the lower leg. This can be fatal if it travels to the lungs.
24
Q
What can cause DVT?
A
A period of inactivity e.g. after operations or long travel.
25
What is 'economy class syndrome'?
- DVT caused after long journeys via planes, trains or road. Also known as 'travel-related DVT'.
26
What are the symptoms of DVT?
- Pain
- Swelling and heavy feeling in legs
- Red and painful to touch
- may become dark and swollen if vein is completely blocked.
27
What is the serious complication of DVT?
A pulmonary embolism- is when part of the clot breaks off and travels to the lungs.
Most common symptom is difficulty breathing and shortness of breath.
28
What are the symptoms of a pulmonary embolism?
- shortness of breath
- chest pain
- coughing up blood
- sudden collapse
29
How can you reduce the risk of developing DVT?
- Stop smoking
- maintain a healthy weight
During travel:
- Stay hydrated
- Wear loose-fitting clothing
- Properly fitted compression socks
- Regularly flex and extend ankles
- reduce luggage in footwells to maximise leg room
- walk around as much as possible
30
When can the vaccine guidelines be contraindicated?
- Confirmed anaphylactic reaction to a previous dose of the same vaccine
- If anaphylactic to egg protein, should not be given influenza or yellow fever vaccines
- Pregnant or immunosuppressed- need specialist advice first
- Acutely unwell patients
31
What vaccines should those with an allergy to egg protein avoid?
- influenza
- yellow fever
32
What precautions should travellers with pre-existing conditions take?
- Tell their travel insurer
- Talk to their doctor
- Carry a doctors letter and copy of prescription
- Learn key words in the local language to do with their condition.
- Take enough medication
33
Points of interest when travelling with diabetes:
- No greater risk of contracting malaria- however, an infection may cause hypoglycaemia
- Travelling to a different location will change day length so carbohydrate and insulin intake may need to be modified ( east= shorten and reduce, west= longer and increase)
- Adjustment of medication only necessary of travelling through 5 or more time zones
34
Points of interest when travelling with
splenectomy:
- Avoid malaria epidemic countries
would suffer more if infected with malaria
35
Points of interest when travelling with Epilepsy:
- Should be okay if well-controlled
- Limitations in malaria chemoprophylaxis as chloroquine and mefloquine exacerbate the condition
36
Points of interest when travelling with a psychiatric illness:
- Travel may trigger stress and anxiety
- Mefloquine is contraindicated in those with. history of depression and anxiety
37
Points of interest when travelling if immunocompromised:
Refer to GP for advice on appropriate chemoprophylaxis and immunization options.
38
Points of interest when travelling pregnant or breastfeeding:
- Pregnancy increases the risk of malaria- increase in maternal and neonatal death
- refer to GP
- Can be given chloroquine and proguanil (need a 5mg folic acid supplement) and mefloquine if 2nd or 3rt trimester
- if baby is less than 7kg, mefloquine should not be taken by them or the mother
39
If taking proguanil when pregnant, what other medication is required?
A daily 5mg Folic acid supplement
40
Points of interest when travelling with cardiovascular disease:
If requiring anticoagulants, these should be started up to 3 weeks before departure to stabilise INR readings (international normalised readings).
advice should be given on reducing the chance of DVT
41
Who should avoid taking mefloquine?
Those with:
- Cardiac arrhythmias
- taking anti-arrhythmic drugs
- taking beta-blockers
42
Points of interest when travelling with respiratory diseases:
- Travel can exacerbate symptoms
-May increase secondary chest infections in COPD patients
- have up to date influenza and pneumonia immunisation
43
What groups are more likely to get motion sickness?
- Women- especially if pregnant or menstruating
- Those who experience migraines
- Children aged 3-12 years
44
What are the symptoms of motion sickness?
* Drowsiness
* Cold sweats
* Nausea and vomiting
* Pallor and fainting
45
How can you prevent motion sickness?
* Lying horizontally
* Keeping the head fixed with the eyes on the horizon
* Avoid reading while travelling
* Try distraction (e.g. games, toys, music)
* Avoid a stuffy or smoky atmosphere and the smell of food
46
What class of medication can be used for motion sickness?
An anti-emetic
47
What dose and duration of action does cyclizine (valoid) have for motion sickness?
50 mg
4-6 hours
48
What dose and duration of action does Hyoscine (Scopolamine) have for motion sickness?
0.3-0.6mg
4-6 hours
49
What dose and duration of action does Promethazine (Avomine) have for motion sickness?
25mg
24-30 hours
50
What dose and duration of action does Meclizine (Sealegs) have for motion sickness?
25mg
6-12 hours
51
What dose and duration of action does cinnarizine (Sturgeon) have for motion sickness?
30mg
6-8 hours
52
How does Hyoscine (scopolamine) work to treat motion sickness?
Blocks some of the nerve signals sent from the vestibular system in the inner ear that can cause nausea and vomiting.
53
What are the side effects of Hyoscine?
* drowsiness
* blurred vision
* dry mouth
* dizziness
* constipation
54
Can you drive if taking hyoscine for motion sickness?
No
55
What are the cautions for hyoscine?
* a history of kidney or liver problems
* a history of heart problems
* a history of gastro-oesophageal reflux disease
also those who are children or elderly
56
Which 3 antihistamines used for motion sickness can cause drowsiness?
- promethazine
- cyclizine
- cinnarizine
57
What complementary therapies can be used for motion sickness?
- Ginger supplements
- Acupressure bands
58
What are the three syndromes associated with altitude illness?
- Acute mountain sickness (AMS)
- High-altitude cerebral oedema (HACE)
- High-a;altitude pulmonary oedema (HAPE)
59
What is the most common altitude illness?
AMS is the most common, and usually occurs at altitudes of 2500-3500m (8,200-11,500ft) but can occur at lower altitudes between 1500 – 2500m (5,000- 8,200ft)
60
What are the symptoms of altitude illness?
- headache
- fatigue
- loss of appetite
- nausea
symptoms will usually resolve in 1-2 days
61
In what percentage of cases does AMS progress to HACE?
less than 10%
62
What are the symptoms of HACE?
- lethargy
- confusion
- ataxia (poor muscle control)
as well as the original AMS symptoms
63
What are the symptoms of HAPE?
- shortness of breath
- dry cough
64
What should an individual do if they experience symptoms of HAPE or HACE?
- They should descend immediately as it can progress rapidly and often is fatal.
65
What treatments can be used for AMS?
- Pain killers such as paracetamol or aspirin can be used to relieve headaches
- anti-emetics can be used to relieve nausea
66
What is Hajj and Umrah pilgrimage?
A pilgrimage to mecca often made by Muslims in saudi arabia.
67
What is required in order for people to enter the Umrah or Hajj pilgrimage?
- A certificate of vaccination of a quadrivalent (has an immune response against 4 different antigens) vaccine against meningitis
- this vaccine must be no more than 3 years old or less than days prior to arrival in Saudi Arabia.
- Should have the recommended immunisations for life in UK e.g. 5 doses of tetanus and polio.
- if it has been over 10 years since the Polio vaccine, need a booster
68
What are circadian rhythms?
They are used to regulate our sleep patterns
69
What are the symptoms of jet lag?
- sleep disturbance
- loss of apetite
- nausea
- vomiting
- bowel changes
- malaise
- tiredness
70
What causes rabies?
Rabies is caused by a virus spread via animal saliva from a bite or scratch.
71
When do signs of rabies usually appear?
20-90 days after being bitten or scratched.
72
What are the initial symptoms of rabies?
- fever
- head and muscle ache
- extreme tiredness
- numbers or tingling at sight of bite or scratch
73
What is the treatment of rabies?
There is no treatment.
Clean the wound and disinfect it.
A course of the rabies vaccine- 4 doses over a month if not vaccinated and 2 doses a few days apart if you have
74
What are the symptoms of furious rabies?
- Anxiety
- confusion and hallucinations
- hyperactivity
- seizures
- fear of water
- throat spasms and inability to drink
- extreme terror
coma and death follow within days
75
What are the symptoms of dumb rabies?
- weakness
- paralysis
- muscles are gradually paralysed and coma slowly develops
- heart and lungs fail
- death occurs within weeks
76
How many people die of rabies worldwide?
50,000-60,000 per year
77
How many courses does the rabies vaccine have?
It is a course of 3 injections that need to be started at least 3 weeks before travel.
78
When may you be advised to have a rabies vaccination?
- If you live or frequently travel to countries with rabies
- if you cycle or run in at risk areas
- if at risk with your job
79
How is dengue fever spread?
by day-biting mosquitos
- the chance if being. bitten is highest just before sunset and a couple hours after sunrise.
80
What are the symptoms of dengue fever?
- fever
- intense joint and muscle pain
- Nausea and vomiting
- Red rash
- Severe headache
81
How long does it take for symptoms of dengue fever to appear?
Usually 5-8 days after being. bitten
82
What is the treatment for dengue fever?
- no specific treatrment
- take paracetamol (Avoid NSAIDs)
- drink plenty of fluids and rest
83
What is the potentially fatal complication of dengue fever?
Dengue haemorrhagic fever
84
What are the warning signs for Dengue haemorrhagic fever?
- blood spots
- blood under skin
- bleeding from gums or nose
- persistent vomiting
- severe abdominal pain
- vomiting blood
- black and tarry stool
85
What causes malaria?
The parasite Plasmodium
86
How is malaria transmitted?
Via a female anopheline mosquito that bites to take a blood meal.
87
What are the four species of malaria parasites that infect humans?
Plasmodium falciparum: most widespread and dangerous form of malaria, malignant tertian malaria
Plasmodium vivax: benign tertian malaria
Plasmodium ovale: benign tertian malaria
Plasmodium malariae: quartan malaria
88
What are the symptoms of malaria?
- High temperature of 38 degrees or over
- sweats and chills
- a general feeling of being unwell
- muscle pains
- headache
- cough
- diarrhoea
89
What are the complications of malaria?
* breathing problems (fluid in the lungs)
* liver failure and jaundice
* shock
* spontaneous bleeding
* abnormally low blood sugar
* kidney failure
* swelling and rupturing of spleen
* dehydration
* cerebral malaria (infected RBCs block the small blood vessels leading to the brain)
o brain swelling/damage
o seizure
o coma
90
How long does it take for malaria symptoms to appear~?
10-15 days after bite
91
What is the most fatal type of malaria?
P. falciparum
92
What advice should be given to travellers to reduce the chance of being bitten by a mosquito?
- Wear loose-fitting clothing
- Use repellents
- use mosquito nets
93
What factors should be discussed when discussing a trip with a patient (Malaria prophylaxis record)?
Traveller's details
Medical history and conditions
Female travellers- check pregnancy or trying for a baby
Details of the trip
Date of arrival
Transport
Nature of activities
Accommodation
Availability of medical facilities
Budget for travel
Insurance
94
What are the two primary targets of antifolate metabolism?
- de novo biosynthesis of folates
- dihydrofolate reductase (DHFR)
95
Why is the malaria parasite particularly sensitive to antifolates?
Because it has such a high rate of replication, there is a high demand for nucleotides to act as precursors for DNA synthesis.
96
How often is sulphadoxine taken for malaria?
Once a week as is very stable in the body
97
What medication is used in combination with sulphadoxine?
Pyrimethamine (a dihydrofolate reductase inhibitor)
98
What class of medicines is sulphadoxine?
A sulfonamide but is a Dihydropteroate synthetase inhibitor.
99
What type of medication is proguanil?
A dihydrofolate reductase inhibitor
100
What does the brand of drug 'Malarone' contain?
Proguanil and atovaquone
101
What type of medicine is Malarone?
A prophylactic
102
What is the mechanism of action of atovaquone?
Atovaquone selectively inhibits the parasitic mitochondrial electron transport chain.
103
Where does the malaria parasite obtain the necessary macromolecules and biochemicals needed for growing and reproducing?
The host
104
Why is producing antimalarials that affect the food vacuole a good drug target?
The food vacuole is a special organelle for the digestion of the host haemoglobin. This breakdown of haemoglobin is needed to provide the amino acids necessary for the parasite to synthesise its own proteins. Therefore, disrupting this process is a great drug target.
105
What pH is it in the food vacuole?
pH 5-5.4 (acidic)
106
What are the three ways the parasite can detoxify the toxic heme group released after the breakdown of haemoglobin?
- Sequestration of the free haem group into hemozoin- intense purple colour
- degradation- facilitated by hydrogen peroxide within the food vacuole
- glutathione-dependent degradation which occurs in the parasite's cytoplasm
107
What was the first ever antimalarial?
Quinine
108
What are some examples of synthetic quinolones?
- Mefloquine
- Chloroquine
- Amodiaquine
109
What is the mechanism of chloroquine?
Inhibits the formation of hemozoin (Hz) from the heme released by the digestion of haemoglobin. This fee heme then lyses membranes and leads to parasite death.
110
What has led to increased chloroquine resistance?
The decreased accumulation of chloroquine in the food vacuole.
111
Where does Artemisinins originate from?
The plant Artemisia annua.
112
What was initially very special about artemisinins?
That artemisinin was active against chloroquine-resistant strains of malaria.
113
What age can you give Hyoscine for tr
