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ISOSORBIDE MONONITRATE

Generic Name ISOSORBIDE


MONONITRATE

Brand Name Ismo, Imdur,


Monoket

Classification CARDIOVASCULAR AGENT; NITRATE VASODILATOR


General Action Isosorbide mononitrate is a long-acting metabolite of the coronary
vasodilator isosorbide dinitrate. It decreases preload as measured by
pulmonary capillary wedge pressure (PCWP), and left ventricular end
volume and diastolic pressure (LVEDV), with a consequent reduction in
myocardial oxygen consumption.
Dose and Route Prevention of Angina
Adult: PO Regular release (ISMO, Monoket) 20 mg b.i.d. 7 h apart;
Sustained release (Imdur) 30–60 mg every morning, may increase up to
120 mg once daily after several days if needed (max: dose 240 mg)

Indications or Prevention of angina. Not indicated for acute attacks.


Purposes
Side effects CNS: Headache, agitation, anxiety, confusion, loss of coordination,
hypoesthesia, hypokinesia, insomnia or somnolence, nervousness, migraine
headache, paresthesia, vertigo, ptosis, tremor.
CV: Aggravation of angina, abnormal heart sounds, murmurs, MI,
transient hypotension, palpitations.
Hematologic: Hypochromic anemia, purpura, thrombocytopenia,
methemoglobinemia (high doses).
GI: Nausea, vomiting, dry mouth, abdominal pain, constipation, diarrhea,
dyspepsia, flatulence, tenesmus, gastric ulcer, hemorrhoids, gastritis,
glossitis.
Metabolic: Hyperuricemia, hypokalemia.
GU: Renal calculus, UTI, atrophic vaginitis, dysuria, polyuria, urinary
frequency, decreased libido, impotence.
Respiratory: Bronchitis, pneumonia, upper respiratory tract infection,
nasal congestion, bronchospasm, coughing, dyspnea, rales, rhinitis.
Skin: Rash, pruritus, hot flashes, acne, abnormal texture.
Special Senses: Diplopia, blurred vision, photophobia, conjunctivitis.
Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma,
postural hypotension, head trauma, cerebral hemorrhage (increases
intracranial pressure). Safe use during pregnancy [(category C) and
(category B) for sustained form] or lactation is not established.
Nursing Assessment & Drug Effects
Responsibilities
 Monitor cardiac status, frequency and severity of angina, and BP.
 Assess for and report possible S&S of toxicity, including orthostatic
hypotension, syncope, dizziness, palpitations, light-headedness,
severe headache, blurred vision, and difficulty breathing.
 Lab tests: Monitor serum electrolytes periodically.

Patient & Family Education

 Do not crush or chew sustained release tablets. May break tablets in


two and take with adequate fluid (4–8 oz).
 Do not withdraw drug abruptly; doing so may precipitate acute
angina.
 Maintain correct dosing interval with twice daily dosing.
 Note: Geriatric patients are more susceptible to the possibility of
developing postural hypotension.
 Avoid alcohol ingestion and aspirin unless specifically permitted by
physician.
 Do not breast feed while taking this drug without consulting
physician.