Which combination of medications should not be used as the primary pain management for chest pain with suspected ACS or STEMI?

• A. Morphine and Acetaminophen
• B. Oxygen and Aspirin
• C. Ketamine and Acetaminophen
• D. Fentanyl and Ibuprofen

Answer: (C)

In chest pain with suspected ACS or STEMI, the goal is to relieve pain without increasing myocardial oxygen demand or destabilizing blood pressure. Ketamine is not ideal in this setting because it often causes a rise in heart rate and blood pressure through sympathetic stimulation, which can raise myocardial workload and worsen ischemia. Acetaminophen, while safe, provides only modest analgesia for acute, severe ischemic chest pain and is not sufficient as primary pain control on its own. Together, they don’t offer reliable, hemodynamically safe pain relief for ACS/STEMI, making this combination inappropriate as the primary approach. If analgesia is needed, agents like fentanyl are preferred due to potent pain relief with more controllable hemodynamic effects, while NSAIDs are avoided in ACS.