DRUG ORDER (Generic name, Dosage, Route, Frequency, etc.

) Isosorbide mononitrate 60mg/tab 1 tab OD at HS PO Isosorbide dinitrate 5 mg PRN for chest pain

PHARMACOLOGIC ACTION OF DRUG Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

INDICATIONS AND CONTRAINDICATIONS Indications Dinitrate: Treatment and prevention of angina pectoris Mononitrate: Prevention of angina pectoris Contraindications Contraindicated with allergy to nitrates, severe anemia, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, narrow-angle glaucoma, postdural hypotension

ADVERSE EFFECTS OF THE DRUG CNS: Headache, apprehension, restlessness, weakness, vertigo, dizziness, faintness CV: Tachycardia, retrosternal discomfort, palpitations, hypotension, syncope, collapse, orthostatic hypotension, angina, rebound hypertension, atrial fibrillation, postdural hypertension Dermatologic: Rash, exfoliative dermatitis, cutaneous vasodilation with flushing GI: Nausea, vomiting, incontinence of urine and feces, abdominal pain, diarrhea GU: Dysuria, impotence, urinary frequency Other: Muscle twitching, pallor, perspiration, cold sweat, arthralgia, bronchitis

DESIRED ACTION ON THE CLIENT Relief of angina pectoris

NURSING RESPONSIBILITIES /PRECAUTIONS Assess for pain: duration, time started, activity being performed, character, intensity Assess orthostatic hypotension, blood pressure at baseline and during treatment

Precautions: pregnancy, lactation, acute MI, CHF, postural hypotension, severe renal, hepatic disease