Drugs for Hyperlipidemia and Coagulation

Question 1

what drugs reduce the formation of fibrin clots?

Answer 1

Vitamin K antagonists, unfractionated heparins, low molecular weight heparins (LMWH), direct thrombin inhibitors, Factor Xa inhibitors

Question 2

what drugs are antiplatelet

Answer 2

COX inhibitors
ACP receptor inhibitors Glycoprotein IIb/IIIa inhibitors

Question 3

Describe thrombolytics

Answer 3

Thrombolytics: These drugs break down clots.
*Alteplase (tPA), *Reteplase (Retavase),
*Tenecteplase (TNKase

Question 4

Describe Hemostatics (Antifibrinolytics)

Answer 4

These drugs
promote clot stability and prevent excessive
bleeding.
*Tranexamic acid, *Aminocaproic acid (Amicar)

Question 5

Describe Vitamin K drugs

Answer 5

It’s used as an antidote for Warfarin
overdose or excessive anticoagulation.
*Phytonadione (Vitamin K1)

Question 6

What is the MOA of Warfarin, clinical indications, and side effects?

Answer 6

*MOA: Inhibit vitamin K-dependent clotting factors (II, VII, IX, X)
*Common side effects: Bleeding, Skin necrosis (rare), Teratogenesis, hemorrhage, bruising
*clinical indications: long term anticoagulant therapy, acute VTE, atrial fib

Question 7

Describe Warfarin and INR

Answer 7

*A normal INR is 1, and the target INR in oral anticoagulant therapy is
different depending on the condition for which anticoagulation is
required.

Question 8

What is the MOA of Heparin, clinical indications, and side effects?

Answer 8

*MOA: Enhance activity of antithrombin, inhibiting thrombin and Factor Xa
*Common side effects: Bleeding, Heparin-induced thrombocytopenia (HIT), osteoporosis, hemorrhage, bruising
*indications: DVT, PE, surgery, acute coronary syndromes

Question 9

In general, what is the MOA of direct thrombin inhibitors, clinical uses, and SE?

Answer 9

*MOA: directly inhibit thrombin (factor IIa) which reduces the risk of blood clots
*clinical use: stroke prevention, DVT, thrombocytopenia, PCI
*SE: bleeding and GI

Question 10

Describe the following direct thrombin inhibitor: Dabigatran

Answer 10

Dabigatran
MOA: Inhibit thrombin directly
Common side effects: Bleeding, GI symptoms
Argatroban is another direct thrombin inhibitor

Question 11

In general, what are Factor Xa inhibitors, MOA, Indications, and side effects?

Answer 11

*MOA: Factor Xa inhibitors work by selectively inhibiting
the activity of Factor Xa, which is a crucial enzyme in the coagulation cascade. By doing this, they
disrupt the conversion of prothrombin to
thrombin, thereby decreasing clot formation.
*indications: DVT, PE, stroke prevention
*SE: bleeding, pain in the limbs, dizziness, abdominal pain

Question 12

what is an antidote for Factor Xa Inhibitors?

Answer 12

Andexanet alfa (Andexxa) has been approved for emergency situations where rapid reversal of Factor Xa inhibitor
anticoagulation is needed due to life-threatening or
uncontrolled bleeding.

Question 13

What are factor Xa Inhibiting drugs?

Answer 13

*Rivaroxaban (Xarelto)
* Apixaban (Eliquis)

Question 14

In general, what are Antiplatelet drugs MOA, Indications, and side effects?

Answer 14

*MOA: Antiplatelet drugs work by preventing platelets (small blood
cells responsible for clotting) from sticking together. They target
various pathways in the platelet aggregation process
*clinical indications: Angina, atrial fib, CAD, PCI, Stroke, MI
*SE: bleeding, GI issues, tinnitus, TTP (Clopidogrel)

Question 15

List antiplatelet drugs

Answer 15

*Aspirin (ASA): Inhibits an enzyme called cyclooxygenase,
preventing the synthesis of thromboxane A2, a substance that
causes platelets to clump together.
*Clopidogrel (Plavix): Prevents platelets from sticking together by
inhibiting a receptor called P2Y12.
*icagrelor (Brilinta) & Prasugrel (Effient): Similar to Clopidogrel
but with different pharmacokinetics and pharmacodynamics.
*Dipyridamole: Used in combination with aspirin; it inhibits
Phosphodiesterase (PDE) enzyme there by increases the levels
of cAMP inside platelets, inhibiting the platelet aggregation.

Question 16

In general, what are thrombolytic drugs MOA, Indications, and side effects?

Answer 16

*MOA: Thrombolytics activate the conversion of plasminogen to
plasmin. Plasmin then degrades fibrin, which is a primary component of clots. This results in the dissolution of the clot.
*SE: Bleeding, allergic reaction, re-occlusion
*indications: AMI, PE,DVT

Question 17

List thrombolytic drugs

Answer 17

*Alteplase (tPA, Activase): A recombinant tissue plasminogen
activator.
*Reteplase: Another form of tissue plasminogen activator.
*Tenecteplase: A modified form of alteplase.
*Streptokinase: This is a bacterial enzyme that indirectly activates
plasminogen.
*Urokinase: Derived from human cells and directly activates
plasminogen.

Question 18

What are PT considerations for antiplatelets and anticoagulation drugs?

Answer 18

*Techniques like dry needling, electroacupuncture, or deep tissue mobilization could increase the risk of
hematoma formation.
*Regularly inspect areas where manual techniques have been used for any sign of hematoma

Question 19

In general, what are statins MOA, Indications, and side effects?

Answer 19

*MOA: Inhibit HMG-CoA reductase enzyme, which plays a central role in the production of cholesterol.
*Indications: to lower LDL cholesterol
*SE: muscle pain and weakness, fatigue, rhabdomyolysis

Question 20

What are common statin medications?

Answer 20

-statin
* Atorvastatin *Simvastatin
*Lovastatin
*Pravastatin
*Rosuvastatin

Question 21

In general, what are bile acid sequestrants MOA, Indications, and side effects?

Answer 21

*MOA: Bind to bile acids in the intestines forming a complex that is excreted in the feces. By binding these acids and promoting their excretion, the liver compensates by converting more cholesterol into bile acids leading to reduced cholesterol (LDL).
*Indications: primary hypercholesterolemia
*SE: GI side effects like constipation, bloating, indigestion, nausea

Question 22

List out bile acid sequestrants

Answer 22

*Cholestyramine
*Colestipol
*Colesevelam

Question 23

In general, what are cholesterol absorption inhibitors MOA, Indications, and side effects?

Answer 23

Ezetimibe
*MOA: Ezetimibe selectively inhibits the intestinal absorption of cholesterol and related phytosterols. It works at the small intestine by blocking a specific transporter, thereby decreasing the amount of cholesterol that’s
absorbed from the diet.
*Indications: Primary hyperlipidemia, homozygous familial hypercholesterolemia (really high cholesterol)
*side effects: diarrhea, joint pain, sinusitis, fatigue

Question 24

In general, what are PCSK9 Inhibitors MOA, Indications, and side effects?

Answer 24

Evolocumab Alirocumab
*MOA: PCSK9 inhibitors are monoclonal antibodies that bind to and inhibit the action of PCSK9. By doing so, they increase the availability of LDL
receptors on the liver, leading to enhanced clearance of LDL-C from the blood.
*Indications: Familial hypercholesterolemia, atherosclerotic cardiovascular disease, homozygous familial hypercholesterolemia
*SE: nasopharyngitis, injection site reaction, flu symptoms, back pain

Question 25

In general, what are Fibrates MOA, Indications, and side effects?

Answer 25

Fenofibrate
Gemfibrozil
*MOA: Fibrates activate peroxisome proliferator-activated
receptors (PPARs), which regulate
genes involved in lipid metabolism (lower triglycerides)
*Indications: hypertriglyceridemia
mixed dyslipidemia
*SE: GI symptoms like nausea, stomach upset, diarrhea, elevated liver enzyme, myopathy, increased creatinine levels, gallstones, skin rash

Question 26

what are PT considerations for patients using statins

Answer 26

Some patients on hyperlipidemia medications statins might experience statin-associated muscle symptoms (SAMS). It’s vital for therapists to differentiate between musculoskeletal pain due to therapy/exercise and pain due to statin use.

Question 27

What are PT considerations for patients using hyperlipidemia medications?

Answer 27

Monitoring BP and HR