Lecture 14: Minor Ailments & Responding to Symptoms in Community Pharmacy | Travel Health

High risk patient groups

• Children

• Elderly

• Pregnant women

• Immunocompromised

• Health conditions e.g. respiratory, renal/hepatic impairment, diabetics

Travel sickness

• Vey common, sickness when travelling due to brains inability to process conflicting sensory information

• Can affect anyone in any mode of tranpsort, more common in young children, women and migraine sufferes

• Symptoms: nausea, vomiting, dizziness, sweating, drowsiness, headache, pallor

Management of travel sickness

• Ideally stop motion causing sickness

• Prevent travel sickness by taking medication prior to travel

• Choice based on length/duration of action

• Sedating antihistamines e.g. Cinnarizine 15mg tablets (P)

• Anticholinergic e.g. Hyoscine hydrobromide 300mcg tablets (P)

• Acupressure bands - limited evidence

Sun protection

• Natural way of getting vitamin D and elevates mood

• Sun damages skin by UV radiation - causes skin tanning and skin burns

• Skin cells, melanocytes produces melanin on exposure to UV light which causes darkening of skin

• UV radiation main cause of skin cancer, damages DNA within skin cells

• Avoid excessive skin exposure

• Wear sunglasses, long sleeve tops 

Sunscreens

• SPF 50+ provides highest protection

• Apply generously to all areas of skin that are exposed, apply 20-30 mins before sun exposure, reapply if going into water, apply before insect repellants/ moisturiser

Sunburn

• Inflammatory response to excessive UV radiation that damages the skin, usually settles within 7 days

• Symptoms: red skin, hot to touch, sore, peels away after a few days

• Sel-care - get out of sun exposure, cool skin by cold shower/bath/compress, drink plenty of cool fluids

Travellers’ Diarrhoea

• Passing unformed stools 3 or more times in 24 hours with wither abdominal pain, nausea/ vomiting, fever

• Mainly caused by bacteria usuallu E.coli, Camplyobacter, Salmonella and Shigella, spread by consumptin of contaminated food or water

• Increased risk in less developed countries, poor hygiene

• Usually occurs in first week of travel

• Advise hand hygiene, food hygiene and drinking clean water

Management of travellers’ diarrhoea

• Self-limiting, usually lasts 3-5 days

• Prevent dehydration - drink plenty of fluids especially young/elderly

• Oral rehydration salts

• Mild/moderate symptoms: antimotility drug e.g. imodium (GSL/P)

• Antibiotic use not routinely recommended

• Prophylaxis in high risk patients - Ciprofloxacin (POM)

• Self-care - wash hands with soap and water, drink bottled water, cook food thoroughly 

Deep vein thrombosis (DVT)

• Long distance travel, increased periods of immobility, slower blood flow increases risk of blood clots in a deep vein

• Pulmonary embolism (PE) - blood clot blocks blood vessel in lungs

• Risk factors - history of DVT/PE, heart/lung disease, over 60 years old, obesity, pregnancy

• Symptoms of DVT - redness, swelling in 1 leg, warm skin, throbbing pain in 1 leg, swollen veins

• Symptoms of PE - difficulty breathing, chest pain, coughing up blood

• Seek immediate heplp

Preventative meausres for DVT

• Move around as much as possible

• Do calf excercises

• Stay well hydrated

• Avoid excessive alcohol

• Increased risk - anti embolism stockings/graduated compression stockings/flight socks

• Aspirin not recommended for prophylaxis of travel DVT/PE

Malaria

• Parasitic infection transmitted to humans by bite of an infected femal anopheles mosquito

• Mainly occurs in tropcial regions, most cases in Africa

• Preventable and curable if diagnosed and treated promptly

• Potentially life-treatening disease

• Risk of severe disease for pregnant women, children, elderly, immunocompromised

ABCD of malaria prevention 

• A - awareness of risk

• B - bite prevention

• C - chemoprophylaxis: use of appropriate malaria prevention tablets

• D - diagnosis: prompt diagnosis and treatment

Bite prevention

• Guaranteed way to avoid contracting malaria

• Insect repellent’s - stop mosquitoes landing on skin

• Clothing - prevents mosquitoes reaching skin, wear loose fitting clothes with long sleeves, high neckline

• Accomodation - keep dopors/windows closed in the evening/night

Insect repellents

• Repels mosquitoes from landing on skin

• DEET - most effective and commonly used insect repellent

• Concentration of 50% recommended for malaria areas

• Above 50%, not to be applied directly to skin as causes skin irritation

• Less than 50%, apply more frequently

Mosquito nets

• Create barrier betwen mosquito/insects and skin, especially when sleeping

• More effective if impreganated with insecticide

• Nets can be retreated with insecticide

Chemoprophylaxis

• Antimalarial tablets don’t prevent mosquito bites but help to stop spread of infection and symptoms

• No regemin is 100% effective but antimalarial medication with bite prevention measures provides significant protection

• Ensure appropriate for destination according to guidelines, tailored to individual

• Full clinical history - medical conditions, current medication, allergies

• Antimalarial tablets taken before, during and after visiting the malaria area

• Differ in dosage, side effects, regimen

Malaria diagnosis

• Any illness especially fever, cold, flu like symptoms that occur within 1 year and especially within the first 3 months of return may be malaria

• Advise patients seeks immediate help and specifically mention risk of exposure to malaria

• Even if recommended precautions against malaria were taken

Symptoms of malaria

• Headache

• Dry cough

• Vomiting, nausea

• Fever, shivering, jaundice

• Pain, fatigue, convulsions

Travel vaccinations

• Reduce risk of contracting certain diseases from other countries by being vaccinated

• Vaccinations are available to protect against: Hepatitis A, Meningococcal meningitis, Poliomyelitis, Tetanus, Typhoid fever, Yellow fever

• Available form GP, private travel clinics

First Aid Kit

• Tailored to specific individual, destination

• Wound care - bandages, dressings, plasters, blister plasters, steri strips, gauze, sterile saline solution, antiseptic wipes, sling, tweezers safety pins, scissors, disposable gloves, setrile eye wash

• Thermometer

• Pain killers e.g. paracetamol, ibuprofen

• Antihistamines e.g. loratadine

• Antihistamine/corticosteroid creams e.g. mepyramine

Other considerations

• When taking medication abroad, check rules of the country you’re travelling to, contact embassy

• Carry medication in hand luggage, keep in original packaging, ensure sufficient supplies

• Carry a list of prescribed medication

• Controlled drugs - letter from GP

• Copy of vaccine records

• Proof of travel health insurance

• Contact card - details of next of kin