It causes venodilation and produces modest reductions in heart rate (through increased vagal tone) and systolic BP. In patients with symptoms despite antianginal treatment, morphine (1 mg to 5 mg IV) may be administered during intravenous nitroglycerin therapy with BP monitoring. The morphine dose may be repeated every 5 to 30 minutes to relieve symptoms and maintain the patient s comfort. Its use should not preclude the use of other anti-ischemic therapies with proven benefits in patients with NSTE-ACS. To our knowledge, no RCTs have assessed the use of morphine in patients with NSTE-ACS or defined its optimal administration schedule. Observational studies have demonstrated increased adverse events associ- ated with the use of morphine sulfate in patients with ACS and acute decompensated HF.232,233,236 Although these reports were observational, uncontrolled studies limited by selection bias, they raised important safety concerns. Although constipation, nausea, and/or vomiting occur in >20% of patients, hypotension and respiratory depression are the most serious complications of excessive use of mor- phine. Naloxone (0.4 mg to 2.0 mg IV) may be adminis- tered for morphine overdose with respiratory or circulatory depression. Traditional NSAIDs and selective cyclooxygenase (COX)-2 inhibitors markedly block endothelial prostacyclin production, which leads to unopposed platelet aggregation by platelet-derived thromboxane A2 . Both types of NSAIDs prevent the beneficial actions of aspirin and interfere with the inhibition of COX-1, thromboxane A2 production, and platelet aggregation. Because of their inhibitory activity on the ubiq- uitous COXs, NSAIDs have an extensive adverse side effect profile, particularly renal and gastrointestinal. 