College of Nursing: Cebu Normal University

Republic of the Philippines
Cebu Normal University

Osmeña Blvd., Cebu City, 6000, Philippines
College of Nursing
Telephone No.: (+63 32) 254
4837 Email: cn@cnu.edu.ph
Website: www.cnu.edu.ph
DRUG STUDY
Patient’s Initials: __not indicated____ Date of Admission: November 19, 2021 Diagnosis: Multi Organ Dysfunction Syndrome_
Age: 60 years old Height/Weight: BMI: 40.2________________________ Clinical Intervention: _____________________
Sex: Female ______Ward: _________ Bed No.: Name of Physician: ________ ______________
Drug Information
Classification
Mechanism of Action
Indication
Contraindication
Side Effects
Nursing Responsibilities
Generic Name:
Isosorbide Mononitrate
Trade Name:
Ismo, Imdur, Monoket
Minimum Dose:
20 mg b.i.d.
Maximum Dose:
240 mg daily
Patient’s Dose:
60 mg by mouth daily
Certification Date: 1 February 2021

Recertification due date: 24 January 2024
SDF-CON-304-071-00
For verification of the certificate please
access www.gcl-intl.com (Certification Page 1 of 3
check and type the registration number)
Registration No. 52Q18778

College of Nursing
Route:
Oral
Frequency:
OD
Availability/Form
Tablet, sustained release-tablet
Contents:
The active substance is isosorbide mononitrate. Each tablet contains either 10mg, 20mg or 40mg of the active substance. The other ingredients are lactose monohydrate, compressible sugar,
sodium starch glycollate, magnesium stearate and colloidal silicon dioxide.
Pharmacologic Classification:
Nitrate Vasodilator
Therapeutic Classification:
Antianginal
Pregnancy Category: C
Pharmacodynamics or Mechanism of Action:
Like all organic nitrates, isosorbide mononitrate acts as a donor of nitric oxide (NO). NO causes a relaxation of vascular smooth muscle via the stimulation of guanylyl cyclase and the subsequent
increase of intracellular cyclic guanosine monophosphate (cGMP) concentration. A cGMP-dependent protein kinase is thus stimulated, with resultant alteration of the phosphorylation of various
proteins in the smooth muscle cell. This eventually leads to the dephosphorylation of the light chain of myosin and the lowering of smooth muscle tone.
SDF-CON-304-071-00

College of Nursing
Pharmacokinetics:
Absorption: Completely and rapidly absorbed from GI tract; 93% reaches systemic circulation.
Onset: 1 h. Peak: Regular release 30–60 min; sustained release 3–4 h.
Duration: Regular release 5–12 h; sustained release 12 h.
Metabolism:In liver by denitration and conjugation to inactive metabolites.
Elimination: Primarily by
kidneys. Half-Life: 4–5 h.
General Indication/s:
Prophylactic treatment of angina pectoris
Patient’s Indication:
Prophylactic treatment of angina pectoris
 Hypersensitivity to nitrates
 severe anemia
 closed-angle glaucoma
 recent MI
 postural hypotension, head trauma
 cerebral hemorrhage (increases intracranial pressure)
(per system preferably)
 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.
SDF-CON-304-071-00

College of Nursing
 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.

Before Drug Administration:
 Do not crush or chew sustained release tablets. May break tablets in two and take with adequate fluid (4–8 oz).
 Assess the following: Allergy to nitrates, severe anemia, GI hypermobility, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, pregnancy, lactation
 Give oral preparations on an empty stomach, 1 hr before or 2 hr after meals; take with meals if severe, uncontrolled headache occurs.
 Keep life support equipment readily available if overdose occurs or cardiac condition worsens.
During Drug Administration:

 Monitor cardiac status, frequency and severity of angina, and BP.
 Monitor lab tests: Periodic serum electrolytes.
After Drug Administration:

 Assess for and report possible S&S of toxicity, including orthostatic hypotension, syncope, dizziness, palpitations, light-headedness, severe headache, blurred vision, and difficulty
breathing.
 Do not withdraw drug abruptly; doing so may precipitate acute angina.
 Avoid alcohol ingestion and aspirin unless specifically permitted by prescriber.
 Advice patient to report blurred vision, persistent or severe headache, rash, more frequent or more severe angina attacks, fainting.
SDF-CON-304-071-00

College of Nursing
References
Accord Healthcare Limited. (2014, September 9). Isosorbide mononitrate. Retrieved from EMC: https://www.medicines.org.uk/emc/product/6115/smpc
Dexcel Pharma. (2017, December 27). Isosorbide Mononitrate Tablets. Retrieved from EMC: https://www.medicines.org.uk/emc/product/2697/pil#gref
RNpedia. (n.d.). isosorbide nitrates Nursing Considerations & Management. Retrieved from RNpedia: https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/isosorbide-nitrates/
Wilson, B. M., Shannon, M. T., & Shields, K. M. (2015). Pearson Nurse's Drug Guide. United States: Pearson Education
PRODUCT ASSESSMENT RUBRICS FOR DRUG STUDY
Student Name: Segarra, Louie Year/Section: BSN-4B Date: 11/23/21 Score: /30
Directions: Please select the appropriate rating using the following descriptions:
Element Very Satisfactory Satisfactory Needs Improvement Comments

Drug ☐ Accurately presented all of the patient and drug information ☐ Accurately presented most of the patient and drug ☐ Accurately presented some of the patient and drug information
Information (name [brand & generic], dosage [patient’s dose; min. & max], information related to the case. 1 missing information or error related to the case. 2 or more missing information or errors noted.
(10%) frequency, route, availability, contents) related to the case. [3] noted. [2] [1]
Classification ☐ Accurately presented the classification (therapeutic and ☐ Accurately presented the classification related to the drug ☐ Inaccurately presented the classification related to the drug.
(10%) pharmacologic) related to the drug. [3] but with 1 irrelevant information or error noted. [2] Classification is not relevant to the drug. [1]
☐ Accurately presented the indication/s (general & patient- ☐ Accurately presented the indication/s related to the drug ☐ Inaccurately presented the indication/s related to the drug.
Indication (10%) specific) related to the drug. [3] but with 1 irrelevant information or error noted. [2] Indication is not relevant to the drug. [1]
Mechanism of ☐ Accurately presented the mechanism of action ☐ Accurately presented the mechanism of action of the drug ☐ Inaccurately presented the mechanism of action of the drug.
Action (10%) (pharmacokinetics, pharmacodynamics) of the drug. [3] but with 1 irrelevant information or error noted. [2] Mechanism of action is not relevant to the drug. [1]
☐ Accurately presented all of the common contraindications ☐ Accurately presented most of the common ☐ Accurately presented some of the common contraindications
Contraindication related to the drug. [3] contraindications related to the drug. 1 missing information or related to the drug. 2 or more missing information or errors noted.
(10%) error noted. [2] [1]

SDF-CON-304-071-00

College of Nursing
Side Effects ☐ Accurately presented all of the common side effects related ☐ Accurately presented most of the common side effects ☐ Accurately presented some of the common side effects related
(10%) to the drug. [3] related to the drug. 1-2 missing information or errors noted. to the drug. 3 or more missing information or errors noted. [1]
[2]
Nursing ☐ Accurately presented all of the common nursing ☐ Accurately presented most of the common nursing ☐ Accurately presented some of the common nursing
Responsibilities responsibilities (before, during, and after) related to the drug. [9] responsibilities related to the drug. 1-2 missing information or responsibilities related to the drug. 3 or more missing information
(30%) errors noted. [7] or errors noted. [3]
☐ Presented at least 2 sources that are updated (within 5 years), ☐ Presented only one source that is updated (within 5 years), ☐ No source was presented. Sources are not updated (more than 5
References relevant, and credible. [3] relevant, and credible. Other sources are not updated, credible years), relevant, and credible. [1]
(10%) or relevant. [2]
Sub-score = = =
Evaluated by:
Signature over Printed Name of Clinical Instructor

SDF-CON-304-071-00

College of Nursing: Cebu Normal University

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Republic of the Philippines

Cebu Normal University

Certification Date: 1 February 2021

Registration No. 52Q18778

Registration No. 52Q18778

Onset: 1 h. Peak: Regular release 30–60 min; sustained release 3–4 h.

Duration: Regular release 5–12 h; sustained release 12 h.

Metabolism:In liver by denitration and conjugation to inactive metabolites.

Registration No. 52Q18778

 Hematologic: Hypochromic anemia, purpura, thrombocytopenia, methemoglobinemia (high doses).

 Skin: Rash, pruritus, hot flashes, acne, abnormal texture.

 Special Senses: Diplopia, blurred vision, photophobia, conjunctivitis.

During Drug Administration:

After Drug Administration:

 Do not withdraw drug abruptly; doing so may precipitate acute angina.

 Avoid alcohol ingestion and aspirin unless specifically permitted by prescriber.

Registration No. 52Q18778

PRODUCT ASSESSMENT RUBRICS FOR DRUG STUDY

Element Very Satisfactory Satisfactory Needs Improvement Comments

Certification Date: 1 February 2021

Registration No. 52Q18778

Signature over Printed Name of Clinical Instructor

Certification Date: 1 February 2021

Registration No. 52Q18778

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