Heart Education Awareness Resource and Training through eLearning (HEARTe)
Discharge medication
QUIZ: What medications will Joan now be regularly prescribed?
Right with explanation
Wrong with explanation
Aspirin – All patients with a diagnosis of NSTEMI should be prescribed aspirin 75mg a day. It should be continued for life unless not tolerated.
Clopidogrel – All patients with a diagnosis of NSTEMI should be prescribed a second antiplatelet drug in addition to aspirin. This could be clopidogrel, ticagrelor or prasugrel. The dose of clopidogrel is 75mg daily although 150mg may be given for the first 7 days after PCI. The duration of treatment will depend on local protocols but is usually between 3 and 12 months. If Ticagrelor is used instead, the maintenance dose is 90mg twice daily and if Prasugrel is used, the dose is 5-10mg once daily (10mg for Joan).
Bisoprolol – A beta-blocker should be used long-term to reduce the chances of a further cardiac event, assuming the patient is not bradycardic or hypotensive or has a contraindication such as asthma. The dose should be adjusted to control heart rate at around 60 beats per minute. Other beta-blockers may be used instead.
Simvastatin – All ACS patients should be discharged on a statin. The usual dose of simvastatin is 40mg at night although this may be reduced if other medicines interact with it. Atorvastatin, up to 80mg once daily, may be used instead.
Ramipril – Angiotensin converting enzyme (ACE) inhibitors are usually used after a STEMI, especially if there is evidence of impaired heart function on echocardiography or the patient develops heart failure.
Spironolactone or eplerenone – Only used if there are signs or symptoms of heart failure post-MI. Should be considered for Joan.
GTN spray – Angiotensin converting enzyme (ACE) inhibitors are usually used after a STEMI, especially if there is evidence of impaired heart function on echocardiography or the patient develops heart failure.
Fondaparinux or Enoxaparin – This should have been discontinued after PCI. Although some patients may continue on enoxaparin DVT prophylaxis until discharge.
Amlodipine – Only used if the patient has persistent angina after PCI or is for medical management only. May also be used if the patient is hypertensive despite a beta-blocker and ACE inhibitor. Not required for Joan at present.
Verapamil – Only used if the patient has persistent angina after PCI or is for medical management only. May also be used if the patient is hypertensive despite a beta-blocker and ACE inhibitor. Not required for Joan at present
Furosemide – Only used if there are signs or symptoms of pulmonary or peripheral oedema. The smallest dose possible that controls oedema should be used. Not needed for Joan at present.
Isosorbide mononitrate – Only used if the patient has persistent angina after PCI or is for medical management only. Not required for Joan at present.
Nicorandil – Only used if the patient has persistent angina after PCI or is for medical management only. Not required for Joan at present.
Lansoprazole – Gastro protection is not routinely prescribed in patients on dual antiplatelet therapy although it should be considered in patients with, or with a history of, dyspepsia. Joan has had no problems with dyspepsia so not required at present.
Pulse point
These medications will be discussed with the cardiac rehabilitation team including the rationale for for commencing secondary prevention medication regimes.
