Table of Contents
Antihypertensives
Oral hypoglycaemics
NB: 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.
NB: aim HbA1c 48-58mmol/mol
Asthma ladder
COPD ladder
Combination inhalers
- Seretide = salmeterol + fluticasone
- Symbicort = formoterol + budesonide
- Fostair = formoterol + beclometasone
- Trimbow = formoterol + beclomethasone + glycopyrronium
Abbreviations
- LABA = long-acting β2 agonist
- LAMA = long-acting muscarinic antagonist
- ICS = inhaled corticosteroid
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
