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What is What are the MEDICAL CONTROL MAY ORDER for Acute Coronary Syndrome- Adult  and explain in detail?
1. Additional doses of above medications 2.  Intravenous (IV) morphine is effective for severe pain in a patient with an acute coronary syndrome. For example, give morphine 5 -10 mg IV at 1-2 mg/minute, repeat if necessary; morphine 2.5 - 5 mg for older or frail patients. 3. An IV antiemetic, e.g. metoclopramide 10 mg or cyclizine 25 mg, is usually administered at the same time as, or immediately prior to, IV morphine. 4. Dispersible aspirin 324 mg, should be given to all patients with an acute coronary syndrome, including those already taking aspirin; if enteric coated aspirin is the only formulation available the patient should chew the tablet. Treatment with aspirin in all patients unless there are contraindications. 5. Clopidogrel 300 mg (75 mg for patients aged over 75 years) given immediately along with aspirin, is recommended for patients with an acute coronary syndrome who also have evidence of ischaemia on ECG N.B. Clopidogrel may not be routinely available in general practices as it is not able to be obtained under a Practitioner s Supply Order RED FLAG - Caution 1. Avoid nitroglycerin in ALL patients who have used a phosphodiesterase inhibitor such as: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) within the last 48 HOURS. These medications are often used for erectile dysfunction and pulmonary hypertension. Also avoid use in patients receiving intravenous epoprostenol (Flolan) which is also used for pulmonary hypertension. Administer nitrates with extreme caution, if at all, to patients with inferior-wall STEMI or suspected right ventricular (RV) involvement because these patients require adequate RV preload. THE PATIENT SHOULD BE IMMEDIATELY REFERRED TO HOSPITAL