IHD Treatment Guideline
Treatment:
This is a sample prescription for the intern doctors for the treatment of IHD (STEMI and Non-STEMI). The Brand Names of the drugs mentioned below are from different drug manufacturers of Bangladesh.
| Guideline | Admission | Release |
| Limit physical activities at least for 12 hours | Absolute bed rest | |
| Diet: restrict sodium intake | Diet: Soft and liquid | |
| Oxygen in patients with respiratory distress and oxygen saturation ≤94% | O2 inhalation 4L/min
stat and SOS |
|
| Tab. Aspirin 150-325 mg PO administered as soon as possible on admission.
Tab. Clopidogrel 300 mg stat and followed by 150 mg daily for 1 week and 75 mg daily thereafter. |
Tab. LOPIREL PLUS1
4 tabs stat by crushing then 0+1+0 (a/m) |
Tab. LOPIREL PLUS1
0+1+0 (খাবার পর) – চলবে |
| Tab. Nitroglycerine 0.3-0.6 mg sublingual | Tab. TROCER 2.6 SR2
1+0+1+0 |
|
| Spray TROCER
2 puffs S/L stat and SOS |
Spray TROCER
জিহ্বার নিচে দুই চাপ নিবেন |
|
| Continuous treatment with an oral β-blocker reduces long-term mortality | Tab. METOPROL XL 50mg3
½+0+ ½ |
Tab. BETALOC 25mg3
1+0+1 – চলবে |
| Tab. ANGINOX 20mg4
1+0+1 (a/m) |
||
| Irrespective of serum cholesterol concentrations, all patients should receive statin therapy after acute coronary syndrome | Tab. ANZITOR 20mg5
0+0+1 |
Tab. ANZITOR 10mg5
0+0+1 – চলবে |
| If no hypotension or contraindications and uncomplicated MI given Tab. Enalapril 5 mg 2 times a day PO | Tab. RAMORIL 2.5mg6
0+0+1 |
Tab. RAMORIL 2.5mg6
0+0+1 – চলবে |
| Tab. NEXUM 20
1+0+1 (b/m) |
Tab. NEXUM 20
1+0+1 (খাবার আধা ঘণ্টা পুর্বে) – ১৫ দিন |
|
| Sedation with a benzodiazepine agent may help if anxiety is present | Tab. EPICLON 0.5mg7
0+0+1 |
Tab. EPICLON 0.5mg7
0+0+1 – ১৫ দিন |
| Inj. Enoxaparin 1 mg/kg subcutaneously 12 hourly for 3-5 days | Inj. CLEXANE 60mg
1 PFS S/C around the umbilicus BD |
|
| If severe pain:
Morphine 15mg diluted with 14mℓ of water for injection or sodium chloride 0.9%. Give 1mℓ/min IV until pain relieved. (Initially, morphine sulphate 5–10 mg) |
||
| If within 6 hours of onset of pain and ST segment elevation above baseline or new LBBB on ECG.
Streptokinase 1.5 million IU diluted in 100mℓ dextrose 5% or sodium chloride 0.9% IV over 30–60 minutes. |
Inj. STK9 1.5 million IU
Dissolved in 100 cc N/S IV @ 100 microdrops/min |
| 1 | LOPIREL PLUS – Incepta | Aspirin + Clopidogrel
75mg + 75mg |
| 2 | TROCER 2.6 SR – Incepta
|
Glyceryl Trinitrate (nitroglycerine) |
| 3 | METOPROL XL – Beximco (50/100mg)
BETALOC – Drug Int. (25/50 mg) |
Metoprolol Tartrate ( blocker). Avoid in pregnancy, asthma, COPD, peripheral vascular disease, heart failure (pulmonary oedema), hypotension (systolic BP < 105 mmHg) or bradycardia (heart rate < 65/min).
|
| 4 | ANGINOX 20mg – General Pharma | Trimetazidine Dihydrochloride (anti-anginal & anti-ischemic drug) |
| 5 | ANZITOR – Square (10/20/40mg)
|
Atorvastatin (statin, anti-anginal & anti-ischemic drug) |
| 6 | RAMORIL – Incepta (1.5/2.5/5/10mg)
|
Ramipril (ACEi) |
| 7 | EPICLON – General (0.5/1/2mg)
|
Clonazepam (Benzodiazepine hypnotic, adjunct anti-epileptic) |
| 8 | CLEXANE – Sanofi (20/40/60/80mg)
CLOTINEX – Square (40/60/80mg)
|
Enoxaparin (anti-coagulant) |
| 9 | STK– Incepta (4500/-)
STREPTASE– Sanofi Aventis (3464/-) S-KINASE – Popular (3000/-)
|
Streptokinase (fibrinolytics) |
Advice:
| Guideline | Admission | Release |
| Cessation of smoking | Cessation of smoking | ধূমপান সম্পূর্ণ বন্ধ। |
| Initiate or maintain lifestyle modifi cation–weight-control, increased physical activity, alcohol moderation, sodium reduction, and emphasis on increased consumption of fresh fruits, vegetables, and low-fat diary products. | পাতে লবণ খাবেন না। | |
| Patient should avoid non steroidal anti-inflammatory drugs like ibuprofen and diclofenac, as they may precipitate angina. | ||
| Coronary angiography should be considered with a view to revascularisation in all patients at moderate or high risk |
Reference:
- Standard treatment guidelines of the Kingdom of Swaziland. Swaziland: Ministry of Health; 2012.
- Primary Care 101 Guideline 2013/14: The National Department of Health Private Bag x828 Pretoria 0001; 2013.
- Papadakis MA, McPhee SJ, Rabow MW. CURRENT Medical Diagnosis and Treatment 2017: McGraw-Hill Education; 2016.
- Walker BR, Colledge NR, Ralston S, Penman ID. Davidson’s Principles and Practice of Medicine: Churchill Livingstone/Elsevier; 2014.