Chapter 24: Travelers

How are Vivotif Berna capsules stored?

B In the refrigerator.

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.)

B - Bring medicine bottles on the plane. C Bring a copy of prescriptions (a list) and include on the list all medical conditions. E Check with a health care insurance company to find out if coverage applies in other countries prior to departure.

Mefloquine is dosed on this schedule:

Begin 2-3 weeks prior to travel, take 4 weeks post-travel.

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

Bleeding risk, especially in patients using anticoagulants B Ringing or hollow-sound in ears with over-use Reye's syndrome, if used for a viral infection in a young child

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.)

C Washing hands frequently. D Safe food and water precautions to avoid contaminated sources. E Vaccination, completed prior to travel.

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

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.

What is the source of the majority of cases of typhoid fever?

Contaminated food or water

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

Dengue C Japanese Encephalitis D Malaria E Yellow Fever

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

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

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

HIV patients with a CD4+ count less than 200/mm3 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.

Which of the following statements concerning mefloquine is correct?

It can be used in pregnancy.

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

It cannot be used during pregnancy.

Which of the following statements concerning primaquine is correct? (Select ALL that apply.)

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. E Primaquine is taken for 1-2 days pre-travel and for 7 days post-travel.

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

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.

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

Safe beverages include those that are bottled and sealed or carbonated. 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.

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

Saudi Arabia

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:

The International Certificate of Vaccination (the yellow card)

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

The Yellow Book

Which of the following statements concerning typhoid fever is correct?

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.

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

Acetazolamide

Select the correct statement concerning acetazolamide: (Select ALL that apply.)

Acetazolamide is contraindicated in a sulfa allergy. 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.

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

Anopheles

Select the term that best describes bismuth subsalicylate:

Anti-diarrheal

Select the term that best describes loperamide:

Anti-diarrheal

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

Infected patients should be protected from further bites. 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.

Choose the correct statement concerning terms for disease transmission:

In malaria, the mosquito is the vector that carries the pathogen from one host (an infected human) to another host.

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?

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.

Malaria prevention is provided by the following primary measure:

Oral medications taken before and following travel to an infected region

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 ALL that apply.)

The pharmacist is helping the patient avoid clotting in the lower extremities. D The patient's age puts her at increased clotting risk. E The long flight duration puts her at increased clotting risk.