Unstable angina / non ST elevation myocardial infarction medical regimen and use of medications

Overview of Medical Regimen and Use of Medications in Unstable/NSTEMI
In most cases, the inpatient anti-ischemic medical regimen used in the nonintensive phase should be continued after discharge, and the antiplatelet/anticoagulant medications should be changed to an outpatient/oral regimen. The selection of a medical regimen should be individualized to the specific needs of each patient based on the in-hospital findings and events, the risk factors for CAD, drug tolerability, and recent procedural interventions.

An easy way to remember the checklist of interventions at the time of discharge is by mnemonic ABCDE :
 * A- ASA, antianginal and ACE inhibitors
 * B- Beta blockers and blood pressure
 * C- Cholesterol and cigarettes
 * D- Diet and diabetes
 * E- Exercise and education

Both the patient and family should be informed about symptoms of worsening myocardial ischemia and MI and should be instructed in how and when to seek emergency care and assistance if such symptoms occur. Enrollment in a cardiac rehabilitation (see Cardiac Rehabilitation) program after discharge can enhance patient education and compliance with the medical regimen.

==ACC / AHA Guidelines (DO NOT EDIT) ==

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Class I
1. Medications required in the hospital to control ischemia should be continued after hospital discharge in patients with UA / NSTEMI who do not undergo coronary revascularization, patients with unsuccessful revascularization, and patients with recurrent symptoms after revascularization. Upward or downward titration of the doses may be required. (Level of Evidence: C)

2. All post UA / NSTEMI patients should be given sublingual or spray NTG and instructed in its use. (Level of Evidence: C)

3. Before hospital discharge, patients with UA / NSTEMI should be informed about symptoms of worsening myocardial ischemia and MI and should be instructed in how and when to seek emergency care and assistance if such symptoms occur. (Level of Evidence: C)

4. Before hospital discharge, post UA / NSTEMI patients and/or designated responsible caregivers should be provided with supportable, easily understood, and culturally sensitive instructions with respect to medication type, purpose, dose, frequency, and pertinent side effects. (Level of Evidence: C)

5. In post UA / NSTEMI patients, anginal discomfort lasting more than 2 or 3 min should prompt the patient to discontinue physical activity or remove himself or herself from any stressful event. If pain does not subside immediately, the patient should be instructed to take 1 dose of NTG sublingually. If the chest discomfort/pain is unimproved or worsening 5 min after 1 NTG dose has been taken, it is recommended that the patient or a family member/friend call 911 immediately to access EMS. While activating EMS access, additional NTG (at 5-min intervals 2 times) may be taken while lying down or sitting. (Level of Evidence: C)

6. If the pattern or severity of anginal symptoms changes, which suggests worsening myocardial ischemia (e.g., pain is more frequent or severe or is precipitated by less effort or now occurs at rest), the patient should contact his or her physician without delay to assess the need for additional treatment or testing. (Level of Evidence: C)}}