Unstable angina non ST elevation myocardial infarction medical regimen and use of medications: Difference between revisions
Smitakohli (talk | contribs) No edit summary |
No edit summary |
||
| Line 5: | Line 5: | ||
{{Editor Join}} | {{Editor Join}} | ||
==Overview of Medical Regimen and Use of Medications in | ==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 : | 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. | ||
*A- ASA, | |||
*B- Beta blockers and blood pressure | An easy way to remember the checklist of interventions at the time of discharge is by mnemonic '''ABCDE''' : | ||
*C- Cholesterol and cigarettes | *A- [[ASA]], [[antianginal]] and [[ACE inhibitors]] | ||
*D- Diet and diabetes | *B- [[Beta blockers]] and [[blood pressure]] | ||
*C- [[Cholesterol]] and cigarettes | |||
*D- Diet and [[diabetes]] | |||
*E- Exercise and education | *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 program after discharge can enhance patient education and compliance with the medical regimen. | 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 [[Unstable angina / non ST elevation myocardial infarction cardiac rehabilitation | Cardiac Rehabilitation]]) program after discharge can enhance patient education and compliance with the medical regimen. | ||
==ACC / AHA Guidelines (DO NOT EDIT) <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine |journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6 |accessdate=2011-04-13}}</ref>== | |||
{{cquote| | {{cquote| | ||
===Class I=== | ===Class I=== | ||
| Line 28: | Line 30: | ||
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) | 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) | 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)}} | 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)}} | ||
| Line 36: | Line 38: | ||
==Sources== | ==Sources== | ||
*The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, | *The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B |title=ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine |journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6 |accessdate=2011-04-13}}</ref> | ||
==References== | ==References== | ||
{{reflist | {{reflist}} | ||
{{SIB}} | {{SIB}} | ||
Revision as of 19:24, 13 April 2011
|
WikiDoc Resources for Unstable angina non ST elevation myocardial infarction medical regimen and use of medications |
|
Articles |
|---|
|
Media |
|
Evidence Based Medicine |
|
Clinical Trials |
|
|
|
Guidelines / Policies / Govt |
|
FDA on Unstable angina non ST elevation myocardial infarction medical regimen and use of medications CDC on Unstable angina non ST elevation myocardial infarction medical regimen and use of medications
|
|
Books |
|
News |
|
Commentary |
|
Definitions |
|
Patient Resources / Community |
|
|
|
Healthcare Provider Resources |
|
Continuing Medical Education (CME) |
|
International |
|
|
|
Business |
|
Experimental / Informatics |
| Cardiology Network |
 Discuss Unstable angina non ST elevation myocardial infarction medical regimen and use of medications further in the WikiDoc Cardiology Network |
| Adult Congenital |
|---|
| Biomarkers |
| Cardiac Rehabilitation |
| Congestive Heart Failure |
| CT Angiography |
| Echocardiography |
| Electrophysiology |
| Cardiology General |
| Genetics |
| Health Economics |
| Hypertension |
| Interventional Cardiology |
| MRI |
| Nuclear Cardiology |
| Peripheral Arterial Disease |
| Prevention |
| Public Policy |
| Pulmonary Embolism |
| Stable Angina |
| Valvular Heart Disease |
| Vascular Medicine |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
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) [1]
| “ |
Class I1. 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) |
” |
See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
References
- ↑ 1.0 1.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". Journal of the American College of Cardiology. 50 (7): e1–e157. doi:10.1016/j.jacc.2007.02.013. PMID 17692738. Retrieved 2011-04-13. Unknown parameter
|month=ignored (help)