Discharge Prescription after NSTEMI and Stenting

You are the foundation doctor on the cardiology ward. Your patient, Patient B-217, is a 63-year-old man admitted three days ago with a non-ST-elevation myocardial infarction (NSTEMI). He underwent percutaneous coronary intervention to the right coronary artery with a single drug-eluting stent. Coronary angiography showed a 90% stenosis of the right coronary artery with good flow distally; the left system was normal. The procedure was uncomplicated, and he is now ready for discharge.

His current medications on admission from his GP are aspirin 75 mg once daily, omeprazole 20 mg once daily, and no other regular medicines. He has a history of hypertension diagnosed 10 years ago, a small duodenal ulcer diagnosed 6 years ago and treated with omeprazole, and a transient ischaemic attack (TIA) 18 months ago from which he made a full recovery. He takes no other prescribed or over-the-counter medicines and has no known drug allergies.

On examination today, his blood pressure is 128/78 mmHg, heart rate 68 bpm regular, respiratory rate 14 per minute, temperature 36.8°C. He is afebrile, no heart failure, and his chest is clear. His weight is 80 kg. His ECG shows sinus rhythm with no ischaemic changes. His echocardiogram performed on day two shows a left ventricular ejection fraction of 45% with no significant valvular disease.

Investigations: serum creatinine 1.2 mg/dL (106 µmol/L), eGFR 58 mL/min/1.73m². Liver function tests are normal. Full blood count and electrolytes are normal. Random glucose is normal.

He is tolerating his current medication and is pain-free. The cardiology consultant asks you to write his discharge prescription. It must include dual antiplatelet therapy with the correct duration, a high-intensity statin, a beta-blocker, an ACE inhibitor, and appropriate gastroprotection. The patient is to be discharged today.