Isosorbide Mononitrate (Imdu

A Drug Study Presented to the Fa

of the Nursing Department
Rizza Lei Loreto, MT, RN

In Partial Fulfillment of the

Requirements in NCM 212 – R
OXYGENATION / FLUIDS & ELECTROLYT

By

Fhey Bernadette M. Beltran, St

BSN – 3C

November 9, 2022
Generic Name: Isosorbide Mononitrate
Brand Name: Imdur, ISMO, Monoket
Drug Classification:

• Pharmacotherapeutic: Nitrate;
• Clinical: Antianginal
Mode of Action: Isosorbide may interact with nitrate recepto
membranes. By interacting with receptors’ sulfhydryl groups, d
oxide activates the enzyme guanylate cyclase, increasing
guanosine monophosphate (cGMP). An increased cGMP l
muscle by forcing calcium out of muscles cells, causing va
output by reducing mainly preload and afterload. As for the The
smooth muscle of arterial, venous vasculature. Decreases p
demand.
Pregnancy Category: C
Suggested dose (by manufacturer):

• ER (Expanded Release) Tablets: Initial: 30 – 60mg O

several days to 120mg OD; Increase after several days
• Immediate Release Tablets: Initial: 5 – 20mg BID give
tolerance development)
• SL Tablets: 2.5 – 5mg repeated every 5 to 10 minutes
doses in a 15-30 minutes period.
• Maximum Daily Single Dose: 240mg
Indication: Angina and Renal and Hepatic Impairment.
Contraindication:

• History of severe adverse reactions (acute liver diseas

induced hepatitis, arthritis, chills, drug fever)
• Hypersensitivity to Isoniazid or its component.
Side Effects:

• Frequent: Headache (may be severe), occurs mostly i

rapidly in intensity, usually disappears during continued
Tingling at oral point of dissolution.
• Occasional: Transient flushing of face/neck, di
hypotension, nausea, vomiting, restlessness, GI upset,
Adverse Effects:

• CNS: Agitation, Confusion, Dizziness, Headache, Inso

Vertigo, Weakness.
• CV: Arrythmias, Orthostatic Hypotension, Palpitations,
• EENT: Blurred Vision, Diplopia, sublingual burning.
• GI: Abdominal Pin, Diarrhea, Indigestion, Nausea, Vom
• GU: Dysuria, Impotence, Urinary Frequency.
• HEME: Hemolytic Anemia
• MS: Arthralgia, Muscle Twitching.
• RESP: Bronchitis, Pneumonia, Upper Respiratory Trac
 • SKIN: Diaphoresis, Flushing, Rash
Drug Interactions:
DRUGS

• Phosphodiesterase inhibitor: Sildenafil, Tadalafil, Va

hypotension, myocardial ischemia, syncope, and possi
• Riociguat: increases risk for hypotension
• Vasodilators: Additive effects
HERBAL

• St. John’s Wort: decreases concentration or effect of

FOOD (Not Known.)
LAB VALUES

• Increase: Urine catecholamine, Urine Vanillymandelic a

Nursing Responsibilities:
1. Assess if the patient has any allergies to the drug.
R: Isosorbide contains inactive ingredients, which caus
problems that might impose greater risks.
2. Use isosorbide cautiously in a patients with hypovolem
R: Patient is prone to have hypotensive episodes and m
3. Give drug 1 hour before or 2 hours after meals.
R: With this, it prevents the patient to experience adver
headaches.
4. Keep isosorbide protected from heat and light
R: Exposure to heat might contribute to lose the potenc
the minimum temperature and some may change form
5. Teach patient and family to recognize signs and sympt
pain, fullness or pressure, which commonly is accompa
Pain may radiate down the left arm or into the neck or
those with diabetes mellitus or hypertension that may e
 R: By doing this, it allows the patient to better understa
onset of different side effects brough by the action of th
6. Caution patient not to crush or chew isosorbide E.R. ca
specifically ordered to do so by the physician.
R: Doing so can release all of the drug at once, increas
7. Instruct the patient to place the S.L tablet under the ton
let is dissolve.
R: Moisture in mouth promotes drug absorption and tha
indicates drug effectiveness.
8. Administer acetaminophen, as prescribed.
R: This is to relieve pain, for which headache may expe
vasodilating effects.
9. Monitor blood pressure often during isosorbide therapy
R: Hypotension is expected to occur due to the effects
10. Inform patient not to discontinue the use of drug abrup
R: Abrupt discontinuation of drug may cause angina an
Myocardial Infarction.
11. Teach patient to change position slowly and change in
dizziness and headache occurs.
R: Sudden change of position may trigger the onset of
12. Advise patient to avoid potentially hazardous activities
R: This triggers CNS adverse effects, if not followed.
13. Urge patient to avoid alcohol consumption.
R: By products of alcohol can cause hypotension and t
lightheaded, or sleepy, and may even trigger heart failu
References:
Drugs & Medications. (2020). Isosorbide Mononitrate uses, s
on November 8, 2022, from https://www.webmd.com/
5048/isosorbide-mononitrate-oral/isosorbide-mononitr
Isosorbide: MedlinePlus Drug Information (2019). Medlineplu
8, 2022, from https://medlineplus.gov/druginfo/meds/a
Jones & Bartlett Learning. (2020). 2021 Nurse’s Drug Handb
Retrieved on November 8, 2022, from
https://books.google.com.ph/books?id=XBAFEAAAQB
+Handbook&source=gbs_navlinks_s
Keep Medicines Safe (2019). Keeping Medicines Safe. Retri
https://www.findapharmacy.com.au/advice/keeping-m
Kizior, R. J., & Hodgson, B. B. (2022). Saunders Nursing Dru
Elsevier Health Sciences, pp 640-641.