Treatment Guidelines By

National Institute of Health

and Care Excellence
Presented by :
Group 11
 SABA
Asthma Albuterol
Pharmacological Treatment for Under 5 Years Levalbuterol
New Patients With Suspected
or Confirmed Asthma
Inhaled
Maintenance
Cortecosteroids
Therapy
1. Beclomethasone
Use SABA as a Moderate dose of ICS 2. Budenoside
3. Ciclesonide
reliever Therapy (8 week trials)
4. Fluticasone
Stop after 8 weeks, if 5. Mometasone
6. Triamcinolone

Symptoms not Resolved but Resolved but

resolved reoccurred within reoccurred beyond
8 weeks 4 weeks
Alternative Diagnosis
Restart low dose ICS Again Repeat 8 weeks trial

If Symptoms Uncontrolled
Add on therapy: Low If Uncontrolled
pediatric dose of ICS + Stop LTRA & Consult asthma specialist
LTRA
 Pharmacological Treatment for Under 5-16 Years
Reliever Therapy Leukotriene Receptor
Antagonists (LTRAs)
Maintenance
SABA Therapy
1. Montelukast
2. Zafirlukast
3. Zileuton
Start
Moderate P. dose Seek advice &
Low Pediatric Long Acting Beta-
of ICS + LABA consider either 2 Agonists (LABA)
dose of ICS
1. Arformoterol
2. Formoterol
3. Indacaterol
ICS + LTRA Shift from High P.D of ICS + 4. Olodaterol
maintenance SABA reliever 5. Salmeterol
(Review for 4-8 therapy to MART Therapy
weeks)

Or
Start Low pediatric
STOP LTRA dose ICS + LABA Theophylline
Trial
 Pharmacological Treatment for 17 & Above Long Acting Anti-
Reliever Therapy Cholinergic (LAMA)
1. Aclidinium
SABA 2. Glycopyrrolate
Maintenance Therapy 3. Tiotropium
4. Umeclidinium

High dose of ICS

Seek advice or
Low dose of ICS + SABA reliever
consider therapy

Moderate dose of Or
L.D of ICS + ICS + LABA
LTRA (4-8weeks LAMA Or
(With or without
review) LTRA) Theophylline

L.D of ICS + Shift to MART

LABA (consider ( With or without
LTRA Use) LTRA)
 NICE Hypertension Classification
St • Clinical blood pressure is
ag • 140/90 mmHg or Higher
e
1
St • Clinical blood pressure is
ag • 160/100 mmHg
e
2
• Clinical systolic B.P 180 mmHg
Se
ve • Clinical diastolic B.P 110 mmHg
re
 Hypertension Treatment Guidelines
People with age Under 55 and
Not of Black Origin People with 55 or over age or Black
people without Type 2 Diabetes
Step 1: ACEIs / ARB
Step 1: CCB or TLD
Step 2 :ACEIs \ ARBs + CCB\TLD Step 2: CCB or TLD + ACEIs / ARBs

Step 3: CCB +ACEIs\ ARB + TLD Angiotensin Calcium Channel

Converting Ezyme Angiotensin II
Blockers
Inhibitors Receptor Blockers
1. Amlodipine
Step 4: CCB + ACEIs \ ARB + TLD 1. Captopril 1. Losartan
2. Nifedipine
2. Enalapril 2. Valsartan
3. Verapamil
3. Lisinopril 3. Telmisartan
K+ level > 4.5 mmol/L K+ level < 4.5 mmol/L 4. Diltiazem

Thiazide Like Diuretics

Alpha or B.Blockers Spironolactone Chlorthiazide
1. Hydrochlorothiazide
Doxazosin Atenolol 2. Chlorothiazide
Prazosin Bisoprolol 3. Indapamide
Terazosin Metoprolol 4. Metolazone
Drug Brand Name Strength Dose
ACE Inhibitors
Captopril Capoten 12.5 / 25 / 12.5mg(bid)-50mg (tid) Once hour before meal
50mg
Enalapril Renitec 5 / 10 / 20mg 2.5-40mg once daily In morning best,
Lisinopril Zestril 5 / 10 / 20mg 10-80mg once daily
ARBs
Losartan Eziday 25 / 50mg 25-100mg once daily Empty / full stomach
Irbisartan Arbi 150 / 300mg 150-300mg once daily
Valsartan 80 / 160 / 320 80-320mg daily
mg
Calcium Channel Blockers With meal
Amlodipine Sofvasc, 5 / 10 mg 5-10mg once daily
Lodopin
Nifedipine Nifedil 30 / 60mg 30-60mg daily
Verapamil Calan 40 / 80mg 40-120mg TID
SR: 240mg SR: Once daily
Diltiazem Herbesser 30 / 60mg 30-120mg TID
SR: 90,180mg SR: 90-180MG BID
Drug Brand Name Strength Dose
Thiazide Like Diuretics
Hydrochlorothiazide Diuza 12.5 / 25mg 1 tab at morning In morning, with
food
Beta-Blockers
Propranolol Inderal Tab: 10 / 40 mg 80-320mg,
Cap: 80 / 160 mg Two/Three divided
dose,
Cap: Once daily
Atenolol Zodip, Normitab 50/100mg 50-100 mg 1 daily
Bisoprolol Concor 5 / 10mg 5-20mg Daily
Metoprolol Merol 25/ 50/100mg 100-400mg Daily
Nebivolol Byscard 2.5 / 5 / 10mg 2.5-10mg Daily
Alpha Blockers
Doxazosin Cardura 2 / 4 mg 1-16mg Daily
Terazosin Hytrin 2 / 5 /10 mg 1-20mg daily