Long-Acting Nitrate, Antianginal

Question 1

Brand name for Isosorbide mononitrate?

Answer 1

Imdur

Question 2

Dosage Form?

Answer 2

Oral tablet ER, oral tablet immediate release

Question 3

indications?

Answer 3

Angina, prophylaxis

Question 4

MOA?

Answer 4

Isosorbide mononitrate (ISMN) is the active 5-mononitrate metabolite of isosorbide dinitrate. Nitroglycerin and other organic nitrates are converted to NO by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle.

Question 5

Contraindication?

Answer 5

Hypersensitivitiesto nitrates, concurrent use PDEIs, concurrent use with riociguat

Question 6

Common ADRs?

Answer 6

Dizziness and headaches

Question 7

Less Common ADR?

Answer 7

Bradycardia, flushing, hypotension, nausea, orthostatic hypotension, tachycardia, vomiting

Question 8

Rare and serious ADR?

Answer 8

Severe hypotension, syncope

Question 9

Monitoring?

Answer 9

Efficacy Monitoring Parameters. Decreased use of sublingual nitroglycerin, reduction in angina episodes.

Toxicity Monitoring Parameters. Report signs/symptoms of hypotension, problematic headaches, or decreasing efficacy (drug tolerance) to prescriber

Question 10

Key Counseling Point?

Answer 10

It is best to take this medicine on an empty stomach with at least half a glass of water. Swallow the extended-release tablet whole. Do not break, crush, or chew it. This medicine can cause headaches, which is a sign that the medicine is working. Acetaminophen may be used to relieve the headache. Talk with your doctor if the headache is severe. This medicine can cause dizziness. Avoid driving, using machines, or doing anything else that could be dangerous if not alert. Stand up slowly if this medicine causes light-headedness from orthostatic hypotension. Do not stop using this medicine suddenly without asking a health-care provider. The dose may need to be slowly decreased before stopping it completely. Avoid concomitant use of PDEIs as this may increase risk of severe hypotension. Avoid drinking alcohol while taking this drug. Scored tablets may be split. Doses of immediate release formulation should be taken at least 7 h apart.