Naloxone can be administered in doses of 0.1 to 0.2 mg IV every 15 minutes when indicated to reverse the narcotic effects of morphine, and atropine 0.5 to 1.5 mg IV may be administered to counter excessive mor- phine-related bradycardia. Epidemiological studies and retrospective analyses of RCTs have suggested that nonsteroidal anti-inflammatory drugs and selective cyclooxygenase II enzyme (COX-2) inhibitors may be associated with an increased risk of death, reinfarction, car- diac rupture, hypertension, renal insufficiency, and HF.448 451 Nonsteroidal anti-inflammatory drugs and COX-2 inhibitors are contraindicated in patients with STEMI. They should not be initiated in the acute phase and should be discontinued in patients using them before hospitalization. 9. Complications After STEMI 9.1. Cardiogenic Shock 9.1.1. Treatment of Cardiogenic Shock: Recommendations Class I 1. Emergency revascularization with either PCI or CABG is recommended in suitable patients with cardiogenic shock due to pump failure after STEMI irrespective of the time delay from MI onset.212,379,452 (Level of Evidence: B) 2. In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI and cardiogenic shock who are unsuitable candidates for either PCI or CABG.81,453,454 (Level of Evidence: B) Class IIa 1. The use of intra-aortic balloon pump (IABP) coun-ter- pulsation can be useful for patients with cardiogenic shock after STEMI who do not quickly stabilize with (Level of Evidence: B) Class IIb 1. Alternative LV assist devices for circulatory support may be considered in patients with refractory cardio- genic shock. (Level of Evidence: C) Cardiogenic shock in patients with STEMI may be caused by extensive LV infarction or by mechanical complications, including papillary muscle rupture, ventricular septal rup- ture, free-wall rupture with tamponade, and RV infarction. The onset of cardiogenic shock due to mechanical compli- cations after STEMI is bimodal; most cases occur within 24 hours. 