Mrs Chan, an 80 year old widow had recently been diagnosed to have atrial fibrillation. She was prescribed digoxin, metoprolol and warfarin by a cardiologist.

a) Regarding digoxin:

i) What was its purpose? (1 mark)

ii) name ONE cardiovascular and ONE non-cardiovascular adverse effect. (2 marks)

b) Regarding metoprolol:

i) What was its purpose? (1 mark)

ii) name ONE cardiovascular, ONE respiratory and ONE nervous system adverse effect. (3 marks)

c) Regarding warfarin:

i) what was its purpose? (1 mark)

ii) what should the patient be told about warfarin therapy? (5 marks)

Mrs Chan had seen an advertisement about a new type of blood-thinning drug, which was said to be better than warfarin.

d) How do these new oral anti-coagulants work? (3 marks)

e) List FOUR advantages of these new oral anticoagulants over warfarin (4 marks)