Patients presenting with acute coronary syndromes without ST elevation on their electrocardiogram continue to contribute an important healthcare burden. Medical treatments to control symptoms include nitrates and beta-blockers. Morphine is a very effective analgesic although its use may be associated with adverse outcomes. Oral antiplatelet therapies including aspirin and clopidogrel form a cornerstone of prognostically modifying therapy. Similarly, the intravenous IIb/IIIa antagonists have emerged as having an important role in patients undergoing coronary intervention. Low molecular weight heparins are more convenient to use than unfractionated heparin and may be more effective. Care should be taken to avoid mixing the two antithrombins as this contributes to increased bleeding risk. Statins can impact on short-term outcomes when given during the acute admission; and this benefit is augmented if high doses are used.