Treatment
Patient Education
ÎÎBeyond the detailed instructions for daily exercise, give patients
specific instruction on activities (eg, heavy lifting, climbing stairs,
yard work, and household activities) that are permissible and those
that should be avoided. Specific mention should be made regarding
resumption of driving, return to work, and sexual activity. (I-C)
Influenza
ÎÎPatients with cardiovascular disease should have an annual influenza
vaccination. (I-B)
Depression
ÎÎIt is reasonable to consider screening UA/NSTEMI patients for
depression and refer/treat when indicated. (IIa-B)
Nonsteroidal Anti-Inflammatory Drugs
ÎÎAt the time of preparation for hospital discharge, assess the patient's
need for treatment of chronic musculoskeletal discomfort and use a
stepped-care approach for selection of treatments. Begin pain relief
with acetaminophen, small doses of narcotics, or nonacetylated
salicylates. (I-C)
ÎÎIt is reasonable to use nonselective NSAIDs, such as naproxen, if
initial therapy with acetaminophen, small doses of narcotics, or
nonacetylated salicylates is insufficient. (IIa-C)
ÎÎConsider NSAIDs with increasing degrees of relative COX-2
selectivity for pain relief only for situations in which intolerable
discomfort persists despite attempts at stepped-care therapy with
acetaminophen, small doses of narcotics, nonacetylated salicylates, or
nonselective NSAIDs. In all cases, use the lowest effective doses for
the shortest possible time. (IIb-C)
ÎÎDo NOT administer NSAIDs with increasing degrees of relative
COX-2 selectivity to UA/NSTEMI patients with chronic musculoskeletal
discomfort when therapy with acetaminophen, small doses of
narcotics, nonacetylated salicylates, or nonselective NSAIDs provides
acceptable levels of pain relief. (III-C)
Hormone Therapy
ÎÎDo NOT give hormone therapy with estrogen plus progestin, or
estrogen alone, de novo to postmenopausal women after UA/NSTEMI
for secondary prevention of coronary events. (III-A)
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