Pharmacology: M-O-N-A-B
Tuesday, December 30, 2025
Pharmacology: M-O-N-A-B
NCLEX Memory Hints © BrainyNurses.com
Acute coronary syndrome (ACS) includes coronary artery disease, stable and unstable angina, and acute myocardial infarction (AMI). AMI may be an ST segment elevation MI (STEMI) which is a complete occlusion of a vessel, or a Non-STEMI which is a partial occlusion of a vessel.
There are significant complications of AMI which include cardiogenic shock, heart failure, recurrent MI, pericarditis, mitral valve insufficiency, and ventricular rupture. Dysrhythmias can be atrial due to heart failure or ventricular due to myocardial irritability.
The clinical manifestations vary for ACS depending on multiple factors including gender and a history of diabetes. The classic ones include chest pain, pallor, cool and clammy, increased blood pressure, fatigue, weakness, nausea and vomiting, and signs of heart failure.
General Management of ACS
While pain relief is a priority in the management of ACS, the blood pressure must be carefully maintained to ensure coronary perfusion. Hypertension is expected with an AMI due to activation of the sympathetic nervous system. If a patient presents with hypotension, it signifies decompensated cardiogenic shock due to the loss of significant muscle mass.
Oxygen is not an automatic treatment in ACS. Hyperoxia can lead to harmful effects including vasoconstriction of the coronary and peripheral blood vessels. Vasoconstriction of the coronary vessels leads to decreased coronary perfusion and possible extension of the AMI. Peripheral vasoconstriction leads to increased afterload and work of the heart.
M-O-N-A is a frequent “Memory Hint” used in the management of acute coronary syndrome. Other aspects include a repeat 12-Lead ECG to monitor for changes, thrombolytics if indicated, coagulation modifiers, and emergent catheterization with percutaneous transluminal coronary angioplasty (PTCA).
M-O-N-A-B
While M-O-N-A is used frequently, this is expanded to include the use of beta blockers as the “B” which has been shown to reduce mortality in ACS.
Morphine if the BP is stable. If hypotension is present or if it develops with the administration of nitroglycerine, the treatment is to give fluid and consider the use of fentanyl for pain.
Oxygen only if the saturation is < 90% or there is evidence of heart failure or complaints of dyspnea.
Nitroglycerine sublingual initially followed by an intravenous nitroglycerin infusion.
Aspirin (chewable) at a dose of 325 mg.
Beta blockers with a target heart rate of 60 BPM and a SBP > 90 mm Hg.
Summary
For the NCLEX exam, knowledge of the clinical manifestations and management of ACS is essential. Due to the incidence of complications and potential harm, blood pressure, pulse rate, and oxygen are carefully monitored along with other parameters.
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