Q10 List 4 anticoagulants.Explain the side effects of anti coagulants.

A10 heparin.
warfarin (Coumadin)
rivaroxaban (Xarelto)
dabigatran (Pradaxa)
apixaban (Eliquis)
edoxaban (Savaysa)
enoxaparin (Lovenox)
fondaparinux (Arixtra)

Side effects:
passing blood in your urine.
passing blood when you poo or having black poo.
severe bruising.
prolonged nosebleeds.
bleeding gums.
vomiting blood or coughing up blood.
heavy periods in women.

Q11 Name 2 anti platelet agents. Write the indications for anti platelet
agents

aspirin, also called Cartia, Aspro, Aspec.

clopidogrel, also called Plavix.
prasugrel, also called Effient.
ticagrelor, also called Brilinta.
dipyridamole, also called Persantine.

Indications:
Acute coronary syndrome.
Post percutaneous coronary intervention (PCI) with stenting.
Mechanical heart valves in combination with warfarin.
Acute ischemic stroke.
Post percutaneous intervention of peripheral arterial disease.

Q12 What are thrombolytics.Write the indications and side effects of thrombolytics.

Thrombolysis, also called fibrinolytic therapy, is the breakdown (lysis) of blood clots formed in
blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and in
cases of severe venous thromboembolism (massive pulmonary embolism or extensive deep
vein thrombosis).

The main complication is bleeding (which can be dangerous), and in some situations
thrombolysis may therefore be unsuitable. Thrombolysis can also play an important part in
reperfusion therapy that deals specifically with blocked arteries.

Indications
Acute myocardial infarction (AMI)
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
Acute ischemic stroke (AIS)
Acute peripheral arterial occlusion.
Occlusion of indwelling catheters.
Intracardiac thrombus formation.

Side effects:
Besides risk of serious internal bleeding, other possible risks include:
Bruising or bleeding at the access site.
Damage to the blood vessel.
Migration of the blood clot to another part of vascular system.
Kidney damage in patients with diabetes or other pre-existing kidney disease.

Q13 Classify hypolipidemics.Write the action and side effects of any one.

Hypolipidemic agents, cholesterol-lowering drugs or antihyperlipidemic agents, are a diverse

group of pharmaceuticals that are used in the treatment of high levels of fats (lipids), such as
cholesterol, in the blood (hyperlipidemia). They are called lipid-lowering drugs. These are drugs
which lower the level of lipids and lipoproteins in blood.The several classes of hypolipidemic
drugs may differ in both their impact on the cholesterol profile and adverse effects. For example,
some may lower the "bad cholesterol" low density lipoprotein (LDL) more so than others, while
others may preferentially increase high density lipoprotein (HDL), "the good cholesterol".
Clinically, the choice of an agent depends on the patient's cholesterol profile, cardiovascular
risk, and the liver and kidney functions of the patient, evaluated against the balancing of risks
and benefits of the medications. In the United States, this is guided by the evidence-based
guideline most recently updated in 2018 by the American College of Cardiology & American
Heart Association. [1]

Established Edit
Statins (HMG-CoA reductase inhibitors) are particularly well suited for lowering LDL, the
cholesterol with the strongest links to vascular diseases. In studies using standard doses,
statins have been found to lower LDL-C by 18% to 55%, depending on the specific statin being
used. A risk exists of muscle damage (myopathy and rhabdomyolysis) with statins.
Hypercholesterolemia is not a risk factor for mortality in persons older than 70 years and risks
from statin drugs are more increased after age 85.[2]
Fibrates are indicated for hypertriglyceridemia. Fibrates typically lower triglycerides by 20% to
50%. Level of the good cholesterol HDL is also increased. Fibrates may decrease LDL, though
generally to a lesser degree than statins. Similar to statins, the risk of muscle damage exists.
Niacin, like fibrates, is also well suited for lowering triglycerides by 20–50%. It may also lower
LDL by 5–25% and increase HDL by 15–35%. Niacin may cause hyperglycemia and may also
cause liver damage. The niacin derivative acipimox is also associated with a modest decrease
in LDL.
Lecithin has been shown to effectively decrease cholesterol concentration by 33%, lower LDL
by 38% and increase HDL by 46%. [3]
Bile acid sequestrants (resins, e.g. cholestyramine) are particularly effective for lowering LDL-C
by sequestering the cholesterol-containing bile acids released into the intestine and preventing
their reabsorption from the intestine. It decreases LDL by 15–30% and raises HDL by 3–5%,
with little effect on triglycerides, but can cause a slight increase. Bile acid sequestrants may
cause gastrointestinal problems and may also reduce the absorption of other drugs and
vitamins from the gut.
Ezetimibe is a selective inhibitor of dietary cholesterol absorption.
Lomitapide is a microsomal triglyceride transfer protein inhibitor.
Phytosterols may be found naturally in plants. Similar to ezetimibe, phytosterols reduce the
absorption of cholesterol in the gut, so they are most effective when consumed with meals.
However, their precise mechanism of action differs from ezetimibe.
Omega-3 supplements taken at high doses can reduce levels of triglycerides.[4] They are
associated with a very modest increase in LDL (~5%).
PCSK9 inhibitors[5][6] are monoclonal antibodies for refractory cases. They are used in
combination with statins.

Action of statin:
Statins are a widely prescribed class of drugs to lower cholesterol. Their mode of action is
primarily via inhibition of HMG-CoA (hydroxymethylglutaryl-coenzyme A) reductase, the
rate-limiting enzyme in the cholesterol biosynthesis pathway.

Side effects of statin:

headache.
dizziness.
feeling sick.
feeling unusually tired or physically weak.
digestive system problems, such as constipation, diarrhoea, indigestion or farting.
muscle pain.
sleep problems.
low blood platelet count.