Treatment
ÎÎThe use of extended-release forms of nondihydropyridine calcium
channel blockers instead of a beta blocker may be considered in
patients with UA/NSTEMI. (IIb-B)
ÎÎImmediate-release dihydropyridine calcium channel blockers in the
presence of adequate beta blockade may be considered in patients
with UA/NSTEMI with ongoing ischemic symptoms or hypertension.
(IIb-B)
ÎÎNitrates should NOT be administered to UA/NSTEMI patients with
systolic blood pressure <90 mm Hg or ≥30 mm Hg below baseline,
severe bradycardia (<50 beats per minute), tachycardia (>100 beats
per minute) in the absence of symptomatic HF, or right ventricular
infarction. (III-C)
ÎÎNTG or other nitrates should NOT be administered to patients with
UA/NSTEMI who had received a phosphodiesterase inhibitor for
erectile dysfunction within 24 h of sildenafil or 48 h of tadalafil use.
The suitable time for the administration of nitrates after vardenafil has
not been determined. (III-C)
ÎÎImmediate-release dihydropyridine calcium channel blockers should
NOT be administered to patients with UA/NSTEMI in the absence of a
beta blocker. (III-A)
ÎÎAn intravenous ACE inhibitor should NOT be given to patients
within the first 24 h of UA/NSTEMI because of the increased risk of
hypotension. A possible exception may be patients with refractory
hypertension. (III-B)
ÎÎIt may be harmful to administer IV beta blockers to UA/NSTEMI
patients who have contraindications to beta blockade, signs of HF or
low-output state, or other risk factors for cardiogenic shock. (III-A)
ÎÎNSAIDs (except for ASA), whether nonselective or COX-2–selective
agents, should NOT be administered during hospitalization for UA/
NSTEMI because of the increased risks of mortality, reinfarction,
hypertension, HF, and myocardial rupture associated with their use.
(III-C)
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