Unstable angina / non ST elevation myocardial infarction analgesics


 * Associate Editors-In-Chief: ; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Smita Kohli, M.D.;

Mechanism of Benefit

 * Morphine causes venodilation and can produce modest reductions in heart rate (through increased vagal tone) and systolic blood pressure to further reduce myocardial oxygen demand.
 * Morphine sulfate has potent analgesic and anxiolytic effects, as well as hemodynamic effects, that are potentially beneficial in Unstable angina/NSTEMI.

Indications

 * Morphine sulfate is reasonable for patients whose symptoms are not relieved despite nitroglycerine (NTG) (e.g., after 3 serial sublingual NTG tablets) or whose symptoms recur despite adequate anti-ischemic therapy.

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

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Class I
1. Because of the increased risks of mortality, reinfarction, hypertension, heart failure, and myocardial rupture associated with their use, non steroidal anti-inflammatory drugs (NSAIDs), except for ASA, whether non selective or cyclo oxygenase (COX)-2–selective agents, should be discontinued at the time a patient presents with Unstable angina / NSTEMI. (Level of Evidence: C)

Class IIa
1. In the absence of contradictions to its use, it is reasonable to administer morphine sulfate intravenously to Unstable angina / NSTEMI patients if there is uncontrolled ischemic chest discomfort despite NTG, provided that additional therapy is used to manage the underlying ischemia. (Level of Evidence: B)

Class III
1.Non steroidal anti-inflammatory drugs (except for ASA), whether non selective or COX-2–selective agents, should not be administered during hospitalization for Unstable angina / NSTEMI because of the increased risks of mortality, reinfarction, hypertension, HF, and myocardial rupture associated with their use. (Level of Evidence: C)}}