UA/NSTEMI (NSTE ACS) Anti-Ischemic and other Treatment
–Morphine sulfate 2 to 4 mg IV PRN for severe pain. May repeat dose of 2 to 8 mg at 5 to 15-minute intervals.
–Oxygen via nasal cannula to keep SaO2 > 92%
–Nitroglycerin (NTG) 0.3-0.6 mg SL q5min PRN chest pain. Max: 3 doses within 15 minutes.
–Aspirin. The first tab is 325 (chew), then 81mg QD after that. Avoid enteric coated Aspirin.
–Beta-blocker. Metoprolol tartrate 25mg po q6h
–ACE. Watch BP. May wait to see BB work if concerned about BP or start low dose, e.g. Lisinopril 5mg po BID
–Statin. High-intensity statin for all patients with ACS – atorvastatin 80mg po Qbedtime or rosuvastatin 20-40 mg daily.
–Heparin. For all patients with non-ST elevation ACS, start anticoagulation ASAP after you’ve made the diagnosis. Will start heparin instead of Lovenox. Heparin is easily reversible if needed. 60 U/kg IVB (max 4000 U); 12 U/kg/hr (max 1000 U/hr initially).