Patients with NSTE-ACS with continuing ischemic pain should receive sublingual nitroglycerin (0.3 mg Table 6. Summary of Recommendations for Early Hospital Care Recommendations COR LOE References Oxygen Administer supplemental oxygen only with oxygen saturation <90%, respiratory distress, or other high-risk features for hypoxemia I C N/A Nitrates Administer sublingual NTG every 5 min 3 for continuing ischemic pain and then assess need for IV NTG I C 216 218 Administer IV NTG for persistent ischemia, HF, or hypertension I B 219 224 Nitrates are contraindicated with recent use of a phosphodiesterase inhibitor III: Harm B 225 227 Analgesic therapy IV morphine sulfate may be reasonable for continued ischemic chest pain despite maximally tolerated anti-ischemic medications NSAIDs (except aspirin) should not be initiated and should be discontinued during hospitalization for NSTE-ACS because of the increased risk of MACE associated with their use III: Harm B 35, 234 Beta-adrenergic blockers Initiate oral beta blockers within the first 24 h in the absence of HF, low-output state, risk for cardiogenic shock, or other contraindications to beta blockade I A 240 242 Use of sustained-release metoprolol succinate, carvedilol, or bisoprolol is recommended for beta-blocker therapy with concomitant NSTE-ACS, stabilized HF, and reduced systolic function I C N/A Re-evaluate to determine subsequent eligibility in patients with initial contraindications to beta blockers I C N/A It is reasonable to continue beta-blocker therapy in patients with normal LV function with NSTE-ACS IIa C 241, 243 IV beta blockers are potentially harmful when risk factors for shock are present III: Harm B 244 CCBs Administer initial therapy with nondihydropyridine CCBs with recurrent ischemia and contraindications to beta blockers in the absence of LV dysfunction, increased risk for cardiogenic shock, PR interval >0.24 s, or second- or third-degree atrioventricular block without a cardiac pacemaker I B 248 250 Administer oral nondihydropyridine calcium antagonists with recurrent ischemia after use of beta blocker and nitrates in the absence of contraindications I C N/A CCBs are recommended for ischemic symptoms when beta blockers are not successful, are contraindicated, or cause unacceptable side effects* I C N/A Long-acting CCBs and nitrates are recommended for patients with coronary artery spasm I C N/A Immediate-release nifedipine is contraindicated in the absence of a beta blocker III: Harm B 251, 252 Cholesterol management Initiate or continue high-intensity statin therapy in patients with no contraindications I A 269 273 Obtain a fasting lipid profile, preferably within 24 h IIa C N/A *Short-acting dihydropyridine calcium channel antagonists should be avoided. 