The decision to administer nitrates should not preclude therapy with other proven mortality-reducing interventions such as beta blockers. Intravenous nitroglycerin is beneficial in patients with HF, hypertension, or symptoms that are not relieved with sublin- gual nitroglycerin and administration of a beta blocker.219,221 224 Patients who require intravenous nitroglycerin for >24 hours may require periodic increases in the infusion rate and use of nontolerance-producing regimens (eg, intermittent dosing) to maintain efficacy. In current practice, most patients who require continued intravenous nitroglycerin for the relief of angina undergo prompt coronary angiography and revascular- ization. Topical or oral nitrates are acceptable alternatives to intravenous nitroglycerin for patients who do not have refrac- tory or recurrent ischemia.229,230 Side effects of nitrates include headache and hypotension. Nitrates should not be adminis- tered to patients with hypotension or to those who received a phosphodiesterase inhibitor and are administered with caution to patients with right ventricular infarction.231 See Online Data Supplement 9 for additional information on nitrates. 4.1.2.2. Analgesic Therapy: Recommendations Class IIb 1. In the absence of contraindications, it may be reason- able to administer morphine sulfate intravenously to patients with NSTE-ACS if there is continued ischemic chest pain despite treatment with maximally tolerated (Level of Evidence: B) Class III: Harm 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) (ex- cept 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.234,235 (Level of Evidence: B) The role of morphine sulfate was re-evaluated for this CPG revision, including studies that suggest the potential for adverse events with its use.232 Morphine sulfate has potent analgesic and anxiolytic effects, as well as hemodynamic actions, that are potentially beneficial in NSTE-ACS. It causes venodilation and produces modest reductions in heart rate (through increased vagal tone) and systolic BP. 