Cardiac Medication Module (contains Rx and non-Rx components)

Aspirin 81 mg chewable tablets
Nitroglycerin sublingual tablets, 0.4 mg, sealed bottle of 25 or 100 tablets, or nitroglycerin spray. 60-spray canister
Clopidogrel 75 mg tablets
Atenolol 25 mg tablets (beta-blocker)

Do not use enteric-coated (EC) tablets, which are slower to work than chewable tablets. A larger number of aspirin can be carried to treat fever, inflammation, and pain. Not for use in children or during preg nancy. This medication is used to prevent platelet aggregation during a heart attack. Aspirin treatment reduced mortality by 23% in acute myocardial infarction (MI) in a published trial called ISIS-2. Aspirin
is a platelet cycloxygenase inhibitor (see also clopidogrel, below).



Once the seal on the bottle is open, the medication must be used within 6 months, regardless of its original expiration date. Brand name Nitrostat is stable for 24 months after the bottle is opened, or until the expiration date on the bottle, whichever is earlier. Nitro glycerin is degraded more rapidly by heat and moisture. In tropical environments it is better to carry nitroglycerin spray. This remains stable for 2 years, even with use. It needs to be primed with a spray before use. Meta-analysis of pre-thrombolytic-era nitrate trials found that nitroglycerin treatment resulted in a 35% reduction in mortality from acute MI (vasodilator).



This is another platelet inhibitor. This medication is very expensive, so stocking a kit with more than 10 becomes an economic challenge. The CURE trial showed that clopidogrel therapy resulted in an 18% reduction in MI, death, or stroke in patients with acute coronary syndrome (ACS) and non-ST elevated MI treated medically. This medication is a platelet ADP-receptor inhibitor, so it works differently than aspirin, and the effects are additive when both are taken.

If someone has a history of phlebitis, pulmonary embolism, they should be on this medication routinely for 6 months from the episode. Persons with cardiac stents need to be on it for life.



Atenolol is a beta-blocker. ISIS-I and MIAMI trials showed that beta-blocker therapy resulted in a 13% reduction in mortality with either atenolol or metoprolol. Its use reduces heart rate, blood pressure, and ischemia, raises ventricular fibrillation threshold, and reduces the likelihood of malignant ventricular arrhythmias and sud den death. Do not give if the person has a slow heart rate (below 60 beats per minute).


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