SlideShare a Scribd company logo
The treating physician decided to start the
patient on medical management for NSTEMI.
State the required pre- and in hospital
pharmacological agents to manage the
patients
The goals of management are:
• Immediate relief of ongoing ischemia and angina
• Prevention of recurrent ischemia and angina
• Prevention of serious adverse cardiac events
Pre hospital management
History
suggestive of
ACS
Aspirin 300mg
stat
Sublingual GTN
• Pain management
ECG and
Biomarker
suggestive of ACS
Clopidogrel
300mg stat
• Anti-platelet,
reduce
thrombosis
ECG & cardiac
biomarker
inconclusive
Low risk pt.
• Referred as
outpatient
Intermediate
• Admitted to ward
Morphine
• IV 2-5mg together
with concomitant
intravenous anti-
emetic
• For pain relief
Oxygen
• Maintain SPO2 >
90%
• Increase myocardial
oxygenation
Beta Blocker
• First 24 hours - ORAL
• Metroprolol 25mg BD
Aspirin
• 300mg loading dose of
solube/chewable
aspirin
• Maintenance dose:
100mg daily enteric
coated aspirin
In hospital
management
(MOBA)
Early treatment
In hospital treatment
Oral Antiplatelet
agent
• Adenosine Diphosphate Receptor Antagonist
• Prasugrel – loading dose 60mg, maintenance
10mg/day
• More effective for patient with diabetes, but cannot
be given if patients weight <60kg
• Alternative, give clopidogrel 300-600mg (loading
dose), 75mg/day (maintenance dose)
Anticoagulant
• Unfractionated heparin
• IV bolus 60IU/kg (no adjustment)
• Low molecular weight heparin – Enoxaparin
• 30mg IV bolus, sc 1.0mg/kg/hour for every 12 hour
• Anti Xa inhibitor – Fondaparinux
• 2.5mg sc daily
• Anti 2a inhibitor – Bivalirudin
• 0.1mg/kg bolus & 0.25mg/kg/hour infusion
Anti-
ischemic
• Nitrates
• Sublingual for ongoing chest pain
• IV
• Beta-blocker
• Calcium channel blocker
• Verapamil/Diiltazem
• For patient intolerance to Beta
blocker
ACE
inhibitor/
ARB
• Not to be given to this patient
(worsening renal function)
Reference
• Clinical Practice Guideline UA/NSTEMI Malaysia
(2011) page 23-36

More Related Content

Recently uploaded

Male reproduction physiology by Suyash Garg .pptx
Male reproduction physiology by Suyash Garg .pptxMale reproduction physiology by Suyash Garg .pptx
Male reproduction physiology by Suyash Garg .pptx
suyashempire
 
The cost of acquiring information by natural selection
The cost of acquiring information by natural selectionThe cost of acquiring information by natural selection
The cost of acquiring information by natural selection
Carl Bergstrom
 
Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...
Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...
Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...
Creative-Biolabs
 
Microbiology of Central Nervous System INFECTIONS.pdf
Microbiology of Central Nervous System INFECTIONS.pdfMicrobiology of Central Nervous System INFECTIONS.pdf
Microbiology of Central Nervous System INFECTIONS.pdf
sammy700571
 
Farming systems analysis: what have we learnt?.pptx
Farming systems analysis: what have we learnt?.pptxFarming systems analysis: what have we learnt?.pptx
Farming systems analysis: what have we learnt?.pptx
Frédéric Baudron
 
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...
Sérgio Sacani
 
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆
Sérgio Sacani
 
MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...
MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...
MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...
ABHISHEK SONI NIMT INSTITUTE OF MEDICAL AND PARAMEDCIAL SCIENCES , GOVT PG COLLEGE NOIDA
 
Gadgets for management of stored product pests_Dr.UPR.pdf
Gadgets for management of stored product pests_Dr.UPR.pdfGadgets for management of stored product pests_Dr.UPR.pdf
Gadgets for management of stored product pests_Dr.UPR.pdf
PirithiRaju
 
Direct Seeded Rice - Climate Smart Agriculture
Direct Seeded Rice - Climate Smart AgricultureDirect Seeded Rice - Climate Smart Agriculture
Direct Seeded Rice - Climate Smart Agriculture
International Food Policy Research Institute- South Asia Office
 
Juaristi, Jon. - El canon espanol. El legado de la cultura española a la civi...
Juaristi, Jon. - El canon espanol. El legado de la cultura española a la civi...Juaristi, Jon. - El canon espanol. El legado de la cultura española a la civi...
Juaristi, Jon. - El canon espanol. El legado de la cultura española a la civi...
frank0071
 
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)
eitps1506
 
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptx
BIRDS  DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptxBIRDS  DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptx
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptx
goluk9330
 
23PH301 - Optics - Optical Lenses.pptx
23PH301 - Optics  -  Optical Lenses.pptx23PH301 - Optics  -  Optical Lenses.pptx
23PH301 - Optics - Optical Lenses.pptx
RDhivya6
 
AJAY KUMAR NIET GreNo Guava Project File.pdf
AJAY KUMAR NIET GreNo Guava Project File.pdfAJAY KUMAR NIET GreNo Guava Project File.pdf
AJAY KUMAR NIET GreNo Guava Project File.pdf
AJAY KUMAR
 
Summary Of transcription and Translation.pdf
Summary Of transcription and Translation.pdfSummary Of transcription and Translation.pdf
Summary Of transcription and Translation.pdf
vadgavevedant86
 
gastroretentive drug delivery system-PPT.pptx
gastroretentive drug delivery system-PPT.pptxgastroretentive drug delivery system-PPT.pptx
gastroretentive drug delivery system-PPT.pptx
Shekar Boddu
 
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfMending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
Selcen Ozturkcan
 
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDS
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSJAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDS
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDS
Sérgio Sacani
 
Compexometric titration/Chelatorphy titration/chelating titration
Compexometric titration/Chelatorphy titration/chelating titrationCompexometric titration/Chelatorphy titration/chelating titration
Compexometric titration/Chelatorphy titration/chelating titration
Vandana Devesh Sharma
 

Recently uploaded (20)

Male reproduction physiology by Suyash Garg .pptx
Male reproduction physiology by Suyash Garg .pptxMale reproduction physiology by Suyash Garg .pptx
Male reproduction physiology by Suyash Garg .pptx
 
The cost of acquiring information by natural selection
The cost of acquiring information by natural selectionThe cost of acquiring information by natural selection
The cost of acquiring information by natural selection
 
Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...
Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...
Mechanisms and Applications of Antiviral Neutralizing Antibodies - Creative B...
 
Microbiology of Central Nervous System INFECTIONS.pdf
Microbiology of Central Nervous System INFECTIONS.pdfMicrobiology of Central Nervous System INFECTIONS.pdf
Microbiology of Central Nervous System INFECTIONS.pdf
 
Farming systems analysis: what have we learnt?.pptx
Farming systems analysis: what have we learnt?.pptxFarming systems analysis: what have we learnt?.pptx
Farming systems analysis: what have we learnt?.pptx
 
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...
 
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆
SDSS1335+0728: The awakening of a ∼ 106M⊙ black hole⋆
 
MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...
MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...
MICROBIAL INTERACTION PPT/ MICROBIAL INTERACTION AND THEIR TYPES // PLANT MIC...
 
Gadgets for management of stored product pests_Dr.UPR.pdf
Gadgets for management of stored product pests_Dr.UPR.pdfGadgets for management of stored product pests_Dr.UPR.pdf
Gadgets for management of stored product pests_Dr.UPR.pdf
 
Direct Seeded Rice - Climate Smart Agriculture
Direct Seeded Rice - Climate Smart AgricultureDirect Seeded Rice - Climate Smart Agriculture
Direct Seeded Rice - Climate Smart Agriculture
 
Juaristi, Jon. - El canon espanol. El legado de la cultura española a la civi...
Juaristi, Jon. - El canon espanol. El legado de la cultura española a la civi...Juaristi, Jon. - El canon espanol. El legado de la cultura española a la civi...
Juaristi, Jon. - El canon espanol. El legado de la cultura española a la civi...
 
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)
 
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptx
BIRDS  DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptxBIRDS  DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptx
BIRDS DIVERSITY OF SOOTEA BISWANATH ASSAM.ppt.pptx
 
23PH301 - Optics - Optical Lenses.pptx
23PH301 - Optics  -  Optical Lenses.pptx23PH301 - Optics  -  Optical Lenses.pptx
23PH301 - Optics - Optical Lenses.pptx
 
AJAY KUMAR NIET GreNo Guava Project File.pdf
AJAY KUMAR NIET GreNo Guava Project File.pdfAJAY KUMAR NIET GreNo Guava Project File.pdf
AJAY KUMAR NIET GreNo Guava Project File.pdf
 
Summary Of transcription and Translation.pdf
Summary Of transcription and Translation.pdfSummary Of transcription and Translation.pdf
Summary Of transcription and Translation.pdf
 
gastroretentive drug delivery system-PPT.pptx
gastroretentive drug delivery system-PPT.pptxgastroretentive drug delivery system-PPT.pptx
gastroretentive drug delivery system-PPT.pptx
 
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfMending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdf
 
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDS
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSJAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDS
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDS
 
Compexometric titration/Chelatorphy titration/chelating titration
Compexometric titration/Chelatorphy titration/chelating titrationCompexometric titration/Chelatorphy titration/chelating titration
Compexometric titration/Chelatorphy titration/chelating titration
 

Featured

How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024
Albert Qian
 
Social Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie InsightsSocial Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie Insights
Kurio // The Social Media Age(ncy)
 
Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024
Search Engine Journal
 
5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary
SpeakerHub
 
ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd
Clark Boyd
 
Getting into the tech field. what next
Getting into the tech field. what next Getting into the tech field. what next
Getting into the tech field. what next
Tessa Mero
 
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search IntentGoogle's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Lily Ray
 
How to have difficult conversations
How to have difficult conversations How to have difficult conversations
How to have difficult conversations
Rajiv Jayarajah, MAppComm, ACC
 
Introduction to Data Science
Introduction to Data ScienceIntroduction to Data Science
Introduction to Data Science
Christy Abraham Joy
 
Time Management & Productivity - Best Practices
Time Management & Productivity -  Best PracticesTime Management & Productivity -  Best Practices
Time Management & Productivity - Best Practices
Vit Horky
 
The six step guide to practical project management
The six step guide to practical project managementThe six step guide to practical project management
The six step guide to practical project management
MindGenius
 
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
RachelPearson36
 
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...
Applitools
 
12 Ways to Increase Your Influence at Work
12 Ways to Increase Your Influence at Work12 Ways to Increase Your Influence at Work
12 Ways to Increase Your Influence at Work
GetSmarter
 
ChatGPT webinar slides
ChatGPT webinar slidesChatGPT webinar slides
ChatGPT webinar slides
Alireza Esmikhani
 
More than Just Lines on a Map: Best Practices for U.S Bike Routes
More than Just Lines on a Map: Best Practices for U.S Bike RoutesMore than Just Lines on a Map: Best Practices for U.S Bike Routes
More than Just Lines on a Map: Best Practices for U.S Bike Routes
Project for Public Spaces & National Center for Biking and Walking
 
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...
DevGAMM Conference
 
Barbie - Brand Strategy Presentation
Barbie - Brand Strategy PresentationBarbie - Brand Strategy Presentation
Barbie - Brand Strategy Presentation
Erica Santiago
 
Good Stuff Happens in 1:1 Meetings: Why you need them and how to do them well
Good Stuff Happens in 1:1 Meetings: Why you need them and how to do them wellGood Stuff Happens in 1:1 Meetings: Why you need them and how to do them well
Good Stuff Happens in 1:1 Meetings: Why you need them and how to do them well
Saba Software
 
Introduction to C Programming Language
Introduction to C Programming LanguageIntroduction to C Programming Language
Introduction to C Programming Language
Simplilearn
 

Featured (20)

How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024
 
Social Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie InsightsSocial Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie Insights
 
Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024
 
5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary
 
ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd
 
Getting into the tech field. what next
Getting into the tech field. what next Getting into the tech field. what next
Getting into the tech field. what next
 
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search IntentGoogle's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search Intent
 
How to have difficult conversations
How to have difficult conversations How to have difficult conversations
How to have difficult conversations
 
Introduction to Data Science
Introduction to Data ScienceIntroduction to Data Science
Introduction to Data Science
 
Time Management & Productivity - Best Practices
Time Management & Productivity -  Best PracticesTime Management & Productivity -  Best Practices
Time Management & Productivity - Best Practices
 
The six step guide to practical project management
The six step guide to practical project managementThe six step guide to practical project management
The six step guide to practical project management
 
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
 
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...
Unlocking the Power of ChatGPT and AI in Testing - A Real-World Look, present...
 
12 Ways to Increase Your Influence at Work
12 Ways to Increase Your Influence at Work12 Ways to Increase Your Influence at Work
12 Ways to Increase Your Influence at Work
 
ChatGPT webinar slides
ChatGPT webinar slidesChatGPT webinar slides
ChatGPT webinar slides
 
More than Just Lines on a Map: Best Practices for U.S Bike Routes
More than Just Lines on a Map: Best Practices for U.S Bike RoutesMore than Just Lines on a Map: Best Practices for U.S Bike Routes
More than Just Lines on a Map: Best Practices for U.S Bike Routes
 
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...
Ride the Storm: Navigating Through Unstable Periods / Katerina Rudko (Belka G...
 
Barbie - Brand Strategy Presentation
Barbie - Brand Strategy PresentationBarbie - Brand Strategy Presentation
Barbie - Brand Strategy Presentation
 
Good Stuff Happens in 1:1 Meetings: Why you need them and how to do them well
Good Stuff Happens in 1:1 Meetings: Why you need them and how to do them wellGood Stuff Happens in 1:1 Meetings: Why you need them and how to do them well
Good Stuff Happens in 1:1 Meetings: Why you need them and how to do them well
 
Introduction to C Programming Language
Introduction to C Programming LanguageIntroduction to C Programming Language
Introduction to C Programming Language
 

Management of NSTEMI according to CPG Malaysia

  • 1. The treating physician decided to start the patient on medical management for NSTEMI. State the required pre- and in hospital pharmacological agents to manage the patients The goals of management are: • Immediate relief of ongoing ischemia and angina • Prevention of recurrent ischemia and angina • Prevention of serious adverse cardiac events
  • 2. Pre hospital management History suggestive of ACS Aspirin 300mg stat Sublingual GTN • Pain management ECG and Biomarker suggestive of ACS Clopidogrel 300mg stat • Anti-platelet, reduce thrombosis ECG & cardiac biomarker inconclusive Low risk pt. • Referred as outpatient Intermediate • Admitted to ward
  • 3. Morphine • IV 2-5mg together with concomitant intravenous anti- emetic • For pain relief Oxygen • Maintain SPO2 > 90% • Increase myocardial oxygenation Beta Blocker • First 24 hours - ORAL • Metroprolol 25mg BD Aspirin • 300mg loading dose of solube/chewable aspirin • Maintenance dose: 100mg daily enteric coated aspirin In hospital management (MOBA) Early treatment
  • 4. In hospital treatment Oral Antiplatelet agent • Adenosine Diphosphate Receptor Antagonist • Prasugrel – loading dose 60mg, maintenance 10mg/day • More effective for patient with diabetes, but cannot be given if patients weight <60kg • Alternative, give clopidogrel 300-600mg (loading dose), 75mg/day (maintenance dose) Anticoagulant • Unfractionated heparin • IV bolus 60IU/kg (no adjustment) • Low molecular weight heparin – Enoxaparin • 30mg IV bolus, sc 1.0mg/kg/hour for every 12 hour • Anti Xa inhibitor – Fondaparinux • 2.5mg sc daily • Anti 2a inhibitor – Bivalirudin • 0.1mg/kg bolus & 0.25mg/kg/hour infusion
  • 5. Anti- ischemic • Nitrates • Sublingual for ongoing chest pain • IV • Beta-blocker • Calcium channel blocker • Verapamil/Diiltazem • For patient intolerance to Beta blocker ACE inhibitor/ ARB • Not to be given to this patient (worsening renal function)
  • 6. Reference • Clinical Practice Guideline UA/NSTEMI Malaysia (2011) page 23-36

Editor's Notes

  1. https://www.slideshare.net/SAMAslides/acute-coronary-syndromes-by-seema-nour
  2. **Our patient is classified in red box The patient came with chest pain. The ECG and cardiac biomarker also showed the sign of ACS. Thus, a loading dose of aspirin or clopidogrel is given to patient to prevent platelet aggregation (thrombus formation).
  3. Enteric coated not recommended for initial dosing because slow onset of action
  4. The patient had history of DM type 2. It is best to give prasugrel according to CPG Malaysia 2011. However, the patients weight is 58kg. So need to opt. for another type of antiplatelet, clopidogrel The patient has high creatinine clearance, indicating kidney problem (CKD). Some anticoagulant need dose adjustment according to CPG. Bivalirudin and fondaparinux seemto be associated with less bleedingthan heparin or enoxaparin.
  5. The patient has high creatinine clearance. Thus cannot give ACE/ARB because it worsen renal function.