case about drugs Contraindications

63 year old woman traveling to Peru . Lima , Cuzco, Macchu Pichu, Amazon. 2 week trip. Leaves in 2 weeks.
Past Medical History: Osteoporosis, Rheumatoid Arhtritis
Medications: Alendronate, 70mg once weekly
                    Methotrexate 20mg once weekly
     Allergies: Sulfa Drugs
Vaccine History: No vaccines for 20yrs.
________________________
Vaccines?
1.Flu shot  (first recommend)
2. Hepatitis A( second recommend)
3. typhoid(food related bacteria, the third recommend)
4. pneumococcal polysaccharaide vaccine(PPV23) (for all adults >=65 yrs of age and for persons 2-64 yrs of age with underlying medical conditions)

no requirement vaccine
routine vaccine
1. Td(if there is a baby around less than 2 months, should get Tdp)
2. MMR

Antimalaria?
mefloquine is best chocie for long term travel.
malarone should be used for the short duration. prophylaxis should begin 1-2 days before travel to malarious areas and should be taken daily, at the same time each day, while in ther malarious areas, and daily for 7 days after leaving the area.

Traverler's Diarrhea
ciprofloxacin should be avoid to use.
Renal tubular transport of methotrexate may be inhibited by concomitant administration of ciprofloxacin potentially leading to increased plasma levels of methotrexate. This might increase the risk of methotrexate associated toxic reactions. Therefore, patients under methotrexate therapy should be carefully monitored when concomitant ciprofloxacin therapy is indicated. (http://www.rxlist.com/cipro-drug.htm)


arithromycin

Other Recommendations
altitude sickness
Acetazolamide should not be given to pregnant women or those with a history of sulfa allergy.
Dexamethasone is very effective for prevention and treatment of AMS and HACE, and perhaps HAPE as well. 4mg every 6 hours for adults.