If an inadequate response occurs or nitrates are contraindicated in ACS, what is the next course of action?

In the context of Acute Coronary Syndromes (ACS), when there is an inadequate response to initial treatment or when nitrates are contraindicated, administering opioids is an appropriate next step. Opioids like morphine can provide effective pain relief and help reduce anxiety, which can be particularly beneficial for patients experiencing significant chest pain due to ACS.

Pain management is critical in ACS as it can help alleviate stress on the heart and potentially improve the patient's overall stability. Opioids can also lead to vasodilation, which may help improve myocardial oxygen supply and reduce demand. This dual mechanism is significant in the context of ACS where myocardial ischemia is a concern.

While beta-blockers are used in the management of ACS, they may not be suitable for immediate relief if nitrates are also contraindicated, and the patient's condition may require more urgent intervention. Continuing nitrates would not be apt since the question specifically states their contraindication. Requesting further assistance may be necessary, but the focus should first be on providing pain relief and stabilizing the patient. Thus, administering opioids is the most suitable immediate course of action in this scenario.