A study was conducted over six months at Shri B. M. Patil Medical College to understand the prescribing patterns for drugs in Acute Coronary Syndrome (ACS) patients, given the global prominence of Coronary Artery Disease (CAD) as a cause of death. 120 patients were observed, with the majority being male and aged 60-69. Smoking and hypertension emerged as primary risk factors. Despite adherence to some ACC/AHA guidelines, the study identified gaps, including prevalent drug-related problems across age and gender. Interventions frequently involved stopping a drug or adjusting its dose. The study underscores the need to modify the hospital’s drug formulary and raise awareness among physicians about rational drug use. It also emphasizes the role of clinical pharmacists in improving drug use and enhancing patient care.