Commonly prescribed drugs in community

Please note this information is for educational purposes only and prescriptions should not be based on this. OSCEstop takes no responsibility for use of this information.

Antihypertensives

Oral hypoglycaemics

NB: aim HbA1c 48-58mmol/mol; only metformin and insulin are known to be safe in pregnancy; all drugs should be temporarily discontinued in ketoacidosis; metformin should be temporarily discontinued in lactic acidosis, perioperatively, and if using iodinated contrast agents.

Asthma ladder

COPD ladder

Inhaled therapy

Abbreviations: SABA = short-acting β₂ agonist; SAMA = short-acting muscarinic antagonist; LABA = long-acting β₂ agonist; LAMA = long-acting muscarinic antagonist; ICS = inhaled corticosteroid

• SABA/SAMA nebulisers – may also be considered in severe disease

Common inhalers

Tablets

• Mucolytics, e.g. carbocisteine
• Theophylline

Hormone replacement therapy

• Routes of administration
  • Systemic (for systemic symptoms, e.g. vasomotor): usually transdermal oestorgen (e.g. gel or patch) – women with a uterus on transdermal oestrogen preparations must still take progesterone separately as discussed below 
  • Vaginal oestrogen (for local symptoms, e.g. urogenital atrophy, vaginal dryness): tablet, cream, pessary or vaginal ring
• Types of systemic therapy
  • No uterus → oestrogen-only HRT (usually transdermal, i.e. gels or patches)
  • Uterus present (oestrogen as above but also need progesterone, usually as oral micronised progesterone, e.g. utrogestan)
    • Perimenopausal → cyclical HRT (oestrogen given every day, and progesterone given for 12 days of each 28 day cycle – to induce bleed)
    • Post-menopausal (i.e. no periods for >1 year or been on cyclical HRT for >1 year) → continuous combined HRT(continuous oestrogen and progesterone – no bleed)

NB: the Mirena coil can also suffice as the progesterone component.

Contraindications: undiagnosed PV bleeding, pregnancy/breastfeeding, oestrogen-dependent cancer, active liver disease, uncontrolled hypertension, history of breast cancer, history of venous thromboembolism, recent stroke/MI/angina

Side effects: vaginal bleeding, premenstrual syndrome, breast tenderness, leg cramps, nausea/bloating

Long-term risks: increased VTE risk (except transdermal preparations), increased stroke risk, increased breast cancer risk with time, increased ovarian cancer risk if used >5 years, increased endometrial cancer risk (but only with unopposed oestrogen), coronary artery disease (if started >10 years after menopause)

Antidepressants 

Lipid-lowering drugs

Heart failure

• Treat cause where possible 
• Diuretic (e.g. furosemide, bumetanide) if fluid overloaded
• Treatments with prognostic benefit for heart failure with reduced ejection function (use all)
  • ACE inhibitor or angiotensin receptor-neprilysin inhibitor (e.g. sacubitril/valsartan)
  • β-blocker (e.g. bisoprolol)
  • Aldosterone antagonist (e.g. eplerenone) 
  • SGLT2-inhibitor (e.g. dapagliflozin, empagliflozin)
• Control specific causes/associated conditions (e.g. hypertension, AF, obesity, diabetes, myocardial ischaemia) for heart failure with preserved ejection function
• Non-pharmacological treatments
  • Cardiac resynchronisation therapy device: considered if QRS significantly prolonged
  • Implantable cardioverter defibrillator: considered if risk of ventricular arrhythmias