Medication

DRUG AND ACTION	CLINICAL CONSIDERATIONS
Aspirin Antiplatelet drug; blocks prostaglandin synthesis and thromboxane A2 formation	Administer as soon as acute coronary syndrome (ACS) is suspected. Give patient 160 to 325 mg; if not already taking aspirin, have him chew  this dose. If patient is allergic to aspirin, give clopidogrel or ticlopidine instead.
Clopidogrel (Plavix), ticlopidine (Ticlid) Antiplatelet drugs that inhibit platelet aggregation	Alternatives for patients who cannot use aspirin. Recent research indicates that using clopidogrel and aspirin concurrently reduces risk of myocardial infarction (MI), stroke, and death.
Unfractionated heparin, low-molecular-weight heparin (dalteparin [Fragmin], enoxaparin [Lovenox]) Potentiate antithrombin III activity, inactivate thrombin, prevent conversion of fibrinogen to fibrin	Unfractionated heparin Weight-adjusted dosage is given to achieve therapeutic partial thromboplastin time (PTT) and activated clotting time. Reversible with protamine sulfate. Low-molecular-weight heparin PTT is not monitored. Give by S.C. injection. Effects are not reversible.
Glycoprotein (GP) IIb/IIIa inhibitors (abciximab [ReoPro], tirofiban [Integrilin], eptifibatide [Aggrastat]) Block GP sites on platelets, preventing platelet aggregation	Indicated for intermediate- or high-risk ACS or with percutaneous coronary intervention. Each drug has specific indications and dosage ranges. Consult package insert for specifics.
Fibrinolytics (alteplase [TPA, Activase], tenecteplase [TNKase], streptokinase [Streptase], reteplase [r-PA,  Retevase]) Break up the fibrin meshwork in clots	Indicated in ST-segment elevation ACS only. Certain agents require weight-adjusted dose.
Beta-adrenergic blockers (metoprolol [Lopressor], atenolol [Tenormin]) Reduce cardiac output and heart rate, reduce ventricular remodeling, and decrease endothelial dysfunction	Start all ACS patients on a beta-adrenergic blocker as tolerated. As ordered, titrate dosage to meet therapeutic goals: heart rate, 60 beats/minute; blood pressure (BP), greater than 90 mm Hg systolic.
Angiotensin-converting enzyme Inhibitors (captopril [Capoten], enalapril [Vasotec]) Decrease endothelial dysfunction and prevent conversion of angiotensin I to angiotensin II	Indicated for patients with heart failure, those with a heart rate above 100 beats/minute, and those with an anterior MI, hypertension, or diabetes. Start with a drug with a short half-life, such as captopril, within 24 hours  to treat acute MI; on discharge, switch to a longer-acting drug, such as lisinopril or enalapril.
Nitroglycerin Dilates peripheral vessels, relaxes vascular smooth muscle, and decreases preload	Can be given sublingually, I.V., orally, or via spray in an acute care setting. Do not allow BP to drop below 90 mm Hg systolic. Switch the patient to a topical patch or an oral form for long-term use.
Morphine Acts as an analgesic and sedative	Indicated in acute care setting only; not for prolonged use. Give until patient is free from chest pain or to relieve pulmonary congestion. Monitor BP, level of consciousness, and respiratory rate.
Other Medications Thrombolytic agents, such as tissue plasma activator (Activase), streptokinase (Streptase), and reteplase (Retavase), reestablish blood flow in coronary vessels by dissolving thrombus. No effect on the underlying stenosis that precipitated the thrombus to form Administered I.V. or intracoronary Antiarrhythmics, such as lidocaine (Xylocaine), decrease the ventricular irritability that occurs after MI.