Supportive pharmacology Indications and current debate
Aspirin 150 – 325 mg oral
(ESC, 2008 )
Platelet aggregation inhibitor
Oxygen therapy
ESC (2008)
BTS (2008)
Recommends administering oxygen therapy
to those who are breathless or showing
signs of heart failure
Recommend that oxygen should not be
used to treat breathlessness but
hypoxaemia:
• only be given for hypoxaemic patients to
maintain saturations of 94 – 98% or
88 – 92% initially for patients at risk of
hypercapnic respiratory failure
• be delivered via nasal specula at 2 – 6 l/min
or simple face mask at 5 – 10 l/min
Nurses should give oxygen as prescribed
and document clearly the rate of oxygen
administered and oxygen saturations
achieved
Pain relief with IV
morphine (AHA, 2008 ).
Diamorphine 2.5 – 5.0 mg IV
is given at 1 mg/min
followed by 2.5 mg doses
until pain is relieved
(Jowett and Thompson,
2007 ).
Comfort of the patient and reduced
workload of the myocardium
• Both pain and anxiety will stimulate
sympathetic nervous response resulting
in peripheral vasoconstriction, increased
venous return and subsequently
increased myocardial workload
These drugs need to be given by
appropriately trained staff, clearly
documented following local controlled drug
policy and their effects monitored and
documented to guide further treatment
Metoclopramide 5 – 10 mg
or cyclizine 50 mg IV
Can be given with morphine to reduce the
risk of nausea and vomiting (Cam, 2002 )
Clopidogrel
300 – 600 mg loading dose
followed by 75 mg daily
thereafter
Patients undergoing PPCI
There is confl icting guidance on whether
clopidogrel should be given for STEMI
patients receiving thrombolysis. The ESC
(2008) recommends a loading dose of
300 mg if < 75 years followed by 75 mg daily
dose for all patients following STEMI for
12 months. However, NICE (2007) does not
recommend the routine administration of
clopidogrel and if clopidogrel is started
during the acute phase it should be
reviewed after four weeks. Health
practitioners