- Ramipril (ACE Inhibitor) – Angiotensin converting enzyme (ACE) inhibitors are usually used for MI patients especially if there is evidence of impaired left ventricular function on echocardiography or the patient has symptoms of heart failure. Usually started once the patient is stable.
- Bisoprolol (Beta blocker) – 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
- Aspirin (Antiplatelet) – All patients with a diagnosis of NSTEMI should be prescribed aspirin 75mg a day. It should be continued for life unless not tolerated
- Clopidrogel (Antiplatelet) – All patients with a diagnosis of NSTEMI should be prescribed
- Statins (Statin) – 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. Sometimes atorvastatin is used if cholesterol levels are not controlled or according to local guidelines
- GTN Spray (Nitrates) – All patients diagnosed with an ACS should have a GTN spray even if they dont have a history of angina and have had no further chest pain since admission. Patients need to be educated about its use, particularly what to do if it chest pain continues (see chest pain advice CHSS advice)
- Metformin (Non-cardiac) – often other non-cardiac medications will require review after a cardiac event. However good diabetic control is vitally important to Jean
- Herbal Pain Relief (Non-cardiac)- often other non-cardiac medications will require review after a cardiac event. Many patients will take herbal or alternative medications alongside conventional medications. It is important to ask this as an additional medication review question.
- Paracetamol (Non-cardiac)- Paracetamol is usually safe but other non-cardiac medications will require review after a cardiac event.
- Adcal (Non-cardiac)- often other non-cardiac medications will require review after a cardiac event.
Pulse point
When commencing any new or reviewed medication regimen especially with the elderly there are often side effects to consider and monitoring that should be commenced. This usually includes titration of medications, regular blood reviews (specifically U&Es) and observations (Blood pressure and manual pulse)
Some patients require some discussion with family and friends (if the patient gives consent) in order to address concerns and provide information regarding medications.e.g. elderly, learning disability, reduced cognition.
British National Formulary
Scottish Intercollegiate Guidelines Network (SIGN)
Page last reviewed: 27 Jul 2020
