This chapter outlines the best current therapy of post-herpetic neuralgia (PHN) and herpes zoster (HZ) and the exciting promise of the zoster prevention vaccine. The clinical findings, on examining a patient with PHN, demonstrate three main features to the pain. There is a constant, steady burning pain, electric shock-like pains reminiscent of trigeminal neuralgia, and the skin is often very sensitive or painful to summating touch stimuli such as skin stroking. There are three possible approaches to managing PHN: the treatment of established PHN, the prevention of PHN by early and aggressive treatment of HZ, and the prevention of HZ and PHN by vaccination. Drugs such as Tricyclic antidepressants (TCAs), gabapentinoids, and opioids affect all features of the pain. An important question for clinicians is how satisfactory these drugs are for PHN patients in ordinary practice in terms of pain relief and disability, tolerability of side effects, and long-term benefit.

This chapter reviews pharmacological agents with a focus on the clinical aspects of their use. There are two groups of pharmacological agents for ovarian stimulation: the first group includes injectable gonadotropins and the second group includes oral agents that are estrogen modulators. Enclomiphene is the more potent antiestrogenic isomer and the one primarily responsible for the ovulation-stimulation actions of clomiphene citrate (CC). It is important to stress the two main prerequisites for the success of CC ovarian stimulation: presence of reasonable estrogen levels in the body and an intact hypothalamic/pituitary axis capable of producing endogenous gonadotropins. Aromatase activity is present in many normal tissues, such as the ovaries, the brain, muscle, liver, breast tissue, as well as in pathological tissues such as malignant breast tumors. The short half-life of letrozole and absence of estrogen receptor antagonism result in a very favorable profile for infertility treatment compared with CC.

Venous thromboembolism (VTE) is the leading direct cause of maternal mortality in the UK, but many cases are potentially preventable. Risk factors for VTE should be identified pre-pregnancy, or at least early in pregnancy, and reassessed throughout pregnancy and the puerperium, as level of risk may change. Pregnancy itself is a risk factor for VTE, and additional risk factors include previous VTE, thrombophilia, and obesity. Thromboprophylaxis should be introduced depending on the level of risk. Guidelines are given for both ante-natal and post-natal management and in particular for the highest risk period immediately postpartum. Thromboprophylaxis involves both nonpharmacological and pharmacological measures, and the various modalities and drugs that can be used are discussed in this chapter. Non-pharmacological measures include appropriate hydration, early mobilization after surgery or delivery, graduated compression stockings (TEDS), and pneumatic compression boots. Aspirin, heparin, and warfarin are the main pharmacological agents to be used in thromboprophylaxis.