TRANSKRIPT 🔗
WEBVTT
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We're gonna talk about travel pharmacology.
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We're gonna talk about medicines motion sickness, diarrhea, altitude, sun, insects, and more.
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So, first of all, today we are going to talk about a fascinating area of pharmacology that we don't always think of as a separate topic.
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When we travel, travel our medicines, they travel with us.
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The environment, food, sleep, hydration, routine, everything changes and affects our body in different kinds of manners depending from person to person.
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And suddenly the medicines that we use casually at home they become much more important and very much complicated.
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Now I want to take you on a little journey today.
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Suppose you have planned a trip, then you pack everything, and then finally you think medicines I'll buy wherever I go, wherever whenever I need them.
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So, first of all, don't travel without your regular medicines.
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Now, people forget when the trip gets delayed, luggage gets lost, and the medicine is sometimes not easily available at the destination.
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So carry enough for the entire trip.
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First of all, you have to make a medication list.
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That should include the generic name, the strength, the dose, frequency, then why you are taking it.
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Some important allergies and some relevant medical conditions.
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That is very, very important.
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And especially if you are traveling internationally, the medicines in the original label packaging can make the things very, very easy.
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Suppose you open your purse or your small bag and you find 10 loose tablets, and then you suddenly your mind brainstorming occurs.
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What are these for?
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And then you are not sure which one is for your headache, which one is for the blood pressure.
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And never never do that.
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It's a very difficult, complicated situation.
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Now, in a basic medical travel kit, what should be there?
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We want a very small, sensible health kit.
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So there should be basic wound care supplies, packages, calls, tape, appropriate wound cleaning supplies, then thermometer.
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Thermometer is a very, very essential tool when especially when you're traveling to a colder area, especially when you're traveling to with the kids, it becomes very, very important.
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Then ORS.
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It is one of the very essential things because electrolyte depletion occurs in the strong heat and all these kinds of things.
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Diarrhea, vomiting, excessive sweating can all result in fluid and electrolyte depletion.
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A very simple analysis antiparatic paracetamol is very appropriate when it is used correctly at most of the places.
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Appropriate antihistaminic, but you have to remember that some antihistaminics they can actually cause drowsiness also.
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So be careful and be cautious with their use.
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Then sun protection is a very important thing.
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Now, this is actually included in the pharmacology discussion because it protects the skin.
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Now, first of all, let's talk about the motion sickness.
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Suppose you're traveling on a high altitude, sitting in a car, and the road is winding, and suddenly somebody in the car or you yourself may say stop the car.
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The motion sickness occurs.
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You should know the basic cause of that.
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There's a mismatch between the sensory information coming from the eyes, inner ear, and the sensory system involved in the balance.
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So, medicines they are used for motion sickness, they work primarily by reducing the effects of histamine, cholinergic signaling involved in the vestibular pathways.
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That is very, very important.
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Some examples of antihistaminics are meclasine, diamondhydrinate, promethazine, but there's a catch.
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These all cause drowsiness, so better use citrosin.
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You can use citrosin, which is the latest one in the second generation antihistaminic.
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Now, people have reported it also causes drowsiness, but you have to be cautious with the use.
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So medicine that prevents motion sickness may impair the ability to drive.
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So now if you are taking that medicine, please don't go for driving.
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And if you are prone to motion sickness, then prevention is generally more useful than waiting in until and unless you're severely nauseated.
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So that is very important.
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Don't get severely nauseated.
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Better take the medicine before the travel.
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Next important basic problem during travel that people suffer from and you may also suffer from is the traveler's diarrhea.
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Why does it happen?
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What is the cause of it?
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Different food, different water, different organisms, different
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hygienic conditions, especially in hotels and the places you stay outside your home.
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The gastrointestinal tract may not be impressed.
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But then you should always remember one important thing: diarrhea does not automatically mean antibiotics.
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The first priority in many uncomplicated cases is simple hydration.
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Yes, it really helps.
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And that's where I told you that you should always carry ORS.
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Now, some people may also ask, what about laburamite?
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Well, I would definitely say that entire motility drugs they can reduce the stool frequency in selected adults, but they are not perfect for every kind of situation.
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If there is blood in the stool, high fever, then there is severe illness, other concerning features.
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Don't simply suppress the symptoms, seek medical attention.
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Antibiotics, well, they're also useful in selected cases, depending upon the clinical situation, depending upon the severity, destination, patient factors.
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Just don't pull out a random antibiotic from your travel bag and take it whenever you get diarrhea.
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That's a very wrong habit and strategy that you may enforce upon yourself.
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Then, this is not a responsible use of medicine.
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And when you are a medical person, medical person, you should be aware of the responsible use of medicines also.
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So, traveler's diarrhea, the first important way to treat it is hydration with ORS.
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And yes, if the condition demands, seek medical attention, go for antibiotic, go for a loperamite and all these kinds of things.
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Next important problem: vomiting and dehydration.
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Suppose the diarrhea is accompanied with the vomiting, you're losing fluids from both the ends, and then there is risk of dehydration.
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Then there's a fluid and electrolyte replacement is very, very much an important such a situation.
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Anti-emetic medicines they are appropriate in selected circumstances, but you don't need to forget the underlying problem.
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Now, if you think that anti-emetic will correct your dehydration, you're actually going wrong.
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Severe dehydration, persistent vomiting, inability to keep the fluids down, blood and stool of vomit, severe abdominal pain, altered consciousness.
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All these are the signs and symptoms that you should go for a real quick medical evaluation.
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Next important problem during travel that almost everybody faces indigestion, acidity.
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Suppose you're eating out of the house.
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Whenever the food changes, the oil changes, the spices changes, and then you think you paid for the food, and three hours later, what do you suffer from?
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Acidity.
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Travel can change the meal timing, portion sizes, food choices.
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And some people use antacids, not some, actually, many people use antacids, acid suppressing medicines.
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But then I would always say occasional symptoms are one thing, recurrent or severe symptoms, they are another problem.
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If there are persistent symptoms indefinitely, over-the-counter medicines, treating yourself with a lot of antacids, without understanding what is the basic underlying problem, that's not the right strategy.
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Go for medical treatment.
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Next important point when you travel, you go at a high altitude.
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Altitude pharmacology is very important to understand.
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You're going from the sea level to the high altitude destination.
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Say you're going to some hill station, Himalayas.
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What happens?
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Atmospheric pressure, it falls as the altitude increases.
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There's a lower inspired oxygen pressure, and many people develop generally all the people traveling from the lands, planes, they develop acute mountain sickness.
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That is a very big problem.
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Headache, dizziness, fatigue, nausea, sleep disturbances.
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And the base best option many people use is the acetazolamide.
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Now, this is a beautiful example of a subject pharmacology because you have to understand the mechanism that really makes a lot of sense.
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Acetazolamide, it inhibits carbonic anhydrase and that promotes renal bicarbonate loss.
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It produces a mild metabolic acidosis that stimulates ventilation and it helps to improve acclimatization.
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So mechanism giving a physiological effect that giving a clinical benefit.
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No, no pill is like that.
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Gradual ascent, acclimatization is the strategy and the thing to keep in mind.
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It is a very crucial thing.
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And if somebody is facing or you are facing severe symptoms, particularly neurological symptoms, breathlessness, go for medical attention.
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Next important problem during travel sun heat, phototoxicity.
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Suppose you're traveling in a dry,
sunny, desert area like Rajasthan, or you're going to a tropical beach.
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Sometimes you are hiking.
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Heat can itself create a lot of health problems.
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Hydration becomes very, very important.
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Now, some medicines actually increase the sensitivity to light, and then they lead to photo sensitivity reactions.
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So these photosensitivity reactions can be phototoxicity or it can be photoallergy.
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You have to differentiate between the two.
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It can be phototoxicity, it can be photoallergy.
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Now when you're taking a medicine or you're giving a medicine, being a medical to somebody else, and you're planning significant sun exposure, you cannot avoid it.
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It's worth knowing the photosensitivity warnings of the medicine.
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Sun protection is not an optional thing, it's very important in the uh area with a lot of heat.
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Protective clothing, shade, sunscreen, everything matters.
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It's not a makeup, it's a pharmacologically essential medicinal thing to protect your skin.
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Then, next important problem many people face during travel: insects, mosquitoes.
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Now, I would not simply say take an entire malarial with you.
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It's a very broader thing.
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Prevention comes first.
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Depending upon the destination, you have to carry insect repellents, appropriate clothing, mosquito nets, environmental measures, and specific vaccination if you need it, and profile access if it is there indicated.
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In malaria, endemic travel, chemoprophile axis.
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It is recommended depending upon the destination and also depending upon the traveler who is traveling.
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Very important.
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Now the right entire malarial depends on where you are traveling.
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I repeat, very important point the right medicine, the right prophylactic entire malarial depends on where you are traveling.
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You just cannot choose a tablet when somebody says, I took this tablet last year, so you also take that.
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No, this is the wrong way to take any tablet.
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Resistant patterns, recommendations, they differ from place to place.
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And travel medicine is very, very location specific.
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You have to keep this thing in mind.
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Next important problem people face during travel allergies, insect bites.
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If you have to sit
a lot outdoors, you're not planning to stay indoors, then you should be very well prepared for allergies and insect bites.
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You can develop itching.
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Some antihistaminic may be useful in a very mild or moderate case.
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But then you can also have a local mild reaction.
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And you need to understand the difference between the local mild reaction versus anaphylaxis.
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Go for sinus symptoms.
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If there is difficult breathing, swelling of the tongue and the throat, wheezing.
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You know, wheezing?
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It is the whistling sound in the breathing.
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Collapse, severe systemic symptoms.
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That's an emergency.
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Being a medical, you should be able to recognize what is emergency and what is normal, what is mild, what is moderate, what is severe.
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For people with a non risk of anaphylaxis, epinephrine, adrenaline, auto injector should be carried.
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When available and appropriate, it should be there because they are belong to a completely different category from ordinary travel medicine.
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And of course, they should know how to use it.
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Or if they're traveling with a physician, the physician should know how to use it.
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Next important problem during travel jet lag and sleep medicines.
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Sleep is a very big problem in your travel.
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You have traveled different time zones.
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You are traveling internationally, you're exhausted, you reach your place of stay, and then 3 a.m.
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you're wide awake.
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What do people do?
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They go for a sleeping pill.
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Yes.
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But let's pause here.
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I need to pause here and tell you something.
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Sleeping pills, sedative medicines can cause drowsiness, impaired coordination, faults, cognitive impairment, dependence with the medicines.
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And if you think this is the right strategy, it's not a right strategy.
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And if people have a habit of drinking, also they are combining sedatives with alcohol, it is so damn dangerous.
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Then don't turn your travel insomnia into an excuse for casual sedative use.
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You should not do that.
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It's very easy for people to do that, but you should not do that.
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Light exposure, sleep timing, adjustment to the new schedule, they
are important parts of managing a jet lag.
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And you might be knowing about a medicine called melatonin.
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It plays a role in some selected circumstances.
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Not every person should take it.
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And it's not a universal sleeping solution, also, but yes, it plays a role somewhere in helping out our circadian rhythm.
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Now let's talk about another big problem: travel with alcohol and medicines.
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People travel, people celebrate, then people take alcohol, and they continue their medicines without thinking about anything which is the biggest pharmacological problem that is drug interactions.
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Alcohol actually interacts with a lot of medicines.
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Potentially, it worsens the sedation, it impairs the coordination, and it contributes to a lot of adverse effects.
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So when you are taking your regular medicines, you need to know about all the interactions before you travel and don't wait for the emergency resort.
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Next important thing when you keep in mind when you are traveling with children, children are not small adults.
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The medicine and doses they depend upon weight.
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Liquid medicines come in different concentrations.
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So if you think 5 ml of one preparation does not necessarily contain the same amount of drug as 5 ml of another preparation.
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This is why parents need to look at the mg/ml concentration.
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And then you the parents need to use the appropriate measuring device.
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Don't use your homespoons.
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Use the measuring device that comes with the medicine bottle.
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And don't divide the tablet or break the tablet into half and give it to your child.
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This is also a wrong strategy and habit parents sometimes get into.
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Generally, these days, parents are very, very aware and they are not doing some silly mistakes like this.
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But still, those who do not know about it, they need to be told about it.
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Next important problem: the extreme case.
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Now you're not traveling with your kids, you're traveling with your grandparents.
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And the biggest challenge for you is polypharmacy.
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Suppose an elderly person is taking blood pressure medicine, diabetes medicine, anticoagulant, statin, painkiller, and a lot of other medicines.
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Then you add on with the travel, apart from the medicinal aspect, you are adding on the environmental factors like heat, dehydration, change tight, long journeys, different sleeping patterns, and every all the environment is suddenly very different for elderly people.
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So biggest tip or the biggest best idea for travel with the elderly people is carry their complete medication list and sufficient amount of medicine, and they should be very, very cautious for taking about ODC medicines, and they should always check for interactions and contraindications.
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Now let's talk about another aspect air travel and medicines.
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Suppose you are flying, your relatives are flying.
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You have to keep the essential medicines in your hand luggage, and for prescription medicines, particularly when you are traveling internationally, check the relevant airline, the destination country requirements beforehand.
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Some medicines that are in routine in one country, like in India, they can be controlled or they might be restricted to some other place or country.
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So you need to check it before you are traveling.
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So international travel is not that you are casually thinking, can I buy this medicine there?
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Can I carry this medicine there?
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No, you need to check everything about it.
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Now let's make your final travel kit.
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The first aid you need to carry bandages, gauze, tape, wound care supplies, gloves, basic medicines, analgesic, antipyretic, or appropriate anti-histamine, and yes, over-the-counter drugs, which you may need, which you frequently need.
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Your personal medicines or medicines for your kids or your elderly people or your relatives.
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Always carry extra supply, medication list, allergy information.
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You should know about everything.
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Travel specific motion sickness if you really need it to take it.
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Then destination specific malaria prophylaxis when indicated, insect repellent, sun protection.
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You need to carry basic equipment like thermometer, measuring device for the kids' medicine and the elderly people and yours also.
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Don't rely upon spoons, household spoons, which is a very wrong strategy.
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And sometimes you may need BP monitoring equipment, some other personal monitoring.
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Equipment which you regularly use.
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Some don'ts which you should always avoid.
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Don't carry loose, unidentified tablets.
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Carry them in the packet or strip.
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Don't share prescription medications.
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--> 00:22:21.119
Don't start antibiotics randomly.
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Just because you do it every time at home, you're not going to do it at travel.
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Stop this habit and make a sensible and responsible use of medication.
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And don't rely upon this information.
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Suppose a medicine worked in your last trip or your relative's last trip, it will work for you also.
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Better check it twice and go for it.
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And when you recognize, learn to identify the seriousness of the situation.
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If you need a medical attention, go for it.
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Don't rely on your travel kit.
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Identify the medical emergency situations with your sign and symptoms.
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Now let's see.
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Motion sickness medicines can cause.
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The answer is drowsiness.
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Second question: First priority in many uncomplicated cases of travelers' diarrhea, go for hydration and ORS, not antibiotics.
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Is every diarrhea during travel to be treated with antibiotics?
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The answer is no.
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A very common drug used for acute mountain sickness.
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Know the drug Acetosolamide.
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Are children small adults?
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No, they are not.
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Should essential medicines go into checked luggage?
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Ideally, they should.
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Essential medicines should be kept with your carry-on baggage.
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What is more important than carrying 20 medicines?
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The most important thing is to know what you actually need and when you need medical help.
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And very important more than that is to recognize the emergency situation.
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So we have talked about motion sickness, we have talked about traveler's diarrhea, vomiting, dehydration, altitude sickness, mosquitoes allergies, sun exposure, jet lag, children, elderly people, prescription medicines.
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And just let's get to know about the beauty of the subject.
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It's not only that drug X blocks the receptor Y, it's also what happens when a human being takes medicine in the real world and how the medicines are to be appropriately, sensibly, responsibly used in the real world.
00:24:53.599 --> 00:24:58.640
And travel is a very good example, very good situation when you need to learn about everything.
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So don't only pack your clothes and essentials, but also pack your medicines, and you should know when to use them safely.
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Hope you enjoyed today's topic about travel pharmacology and share it with someone who really needs this information.
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Till the next time, thank you.
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Take care, bye bye.