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Lepirudin is a synthetic version produced by recombinant DNA technology, which has to be given by injection. It is used specifically in patients that have developed hypersensitivity to heparin. The chief adverse effect of anticoagulants is haemorrhage; hypersensitivity reactions are also possible. Platelet inhibitors are most effective in preventing arterial thrombosis. Aspirin reduces platelet aggregation by inhibiting the enzyme cyclo-oxygenase, which is necessary for the formation of thromboxane A in patients with heart disease such as angina and arrhythmia as well as those with previous thrombotic disease.
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Primaquine is usually taken in combination with chloroquine. Primaquine has few side effects limited to gastrointestinal disturbances, although it can cause haemolysis in susceptible individuals. These drugs prevent infection of red blood cells. Treatment should begin one or two weeks before travelling to areas where malaria is endemic and be continued for at least four weeks after returning. No form of malaria prophylaxis is completely effective and other precautions should be taken. However, should an infection occur the symptoms are usually less severe.
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Cortisol has many target tissues and has a variety of metabolic actions: increase in circulating blood glucose due to decrease in uptake by tissues other than the brain and increase in gluconeogenesis; increase protein breakdown, particularly in muscle, making amino acids available for repair and gluconeogenesis; lipolysis providing fatty acids for alternative energy supply. Cortisol also has anti-inflammatory and immunosuppressive actions, which under physiological conditions help to limit response to injury and infection.
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