DOSAGE: Adult: PO (Monoket) 10-20 mg bid, 7 hr apart; (Imdur) initiate at 30-60 mg/day as a single dose, increase q3day as needed; may increase to 120 mg/day; max 240 mg/dayPT EDUCATION: Teach patient that tolerance may occur if taken over long periods; to prevent, allow intervals of 12-14 hr/day without product, Advise patientto treat headache with OTC analgesics, Instruct patient to not skip or double doses; if dose is missed take when remembered if 2 hr before next dose (dinitrate), 6 hr before next dose (sus rel), or 8 hr before next dose (mononitrate), Caution patient to avoid alcohol and OTC medications unless approved by prescriber, Inform patient that product may be taken before stressful activity: exercise, sexual activity, Advise patient that SL tab may sting mucous membranes, Caution patient to avoid driving and hazardous activities if dizziness occurs, Advise patient to comply with complete medical regimen, Caution patient to make position changes slowly to prevent orthostatic hypotension, Teach patient not to use with avanafil, sildenafil, tadalafil, vardenafil with nitrates; may cause serious drop in B/P, Teach patient not to discontinue abruptly; may cause heart attack, Teach patient to use at beginning of angina symptoms, may repeat every 15 min; if no relief seek medical attention immediatelyFC: Antianginal CC: Nitrate. TU: Relief and prevention of angina pectoris USE: Treatment, prevention of chronic stable angina pectoris DOSAGE: Hypertension: Adult: PO 50 mg bid, or 100 mg/day; may give 100-450 mg in divided doses; ext rel 25-100 mg qday, titrate at weekly intervals, max 400 mg/day Geriatric: PO 25 mg/day initially, increase weekly as needed Myocardial infarction Adult: IV BOL (early treatment) 5 mg q2min × 3 doses, then 50 mg PO 15 min after last dose and q6hr × 48 hr (late treatment); PO maintenance 50-100 mg bid for 1-3 yr Heart failure (NYHA class II/III) Adult: PO ext rel 25 mg qd × 2 wk (class II); 12.5 mg qd (class III) Angina Adult: PO 100 mg/day as a single dose or in 2 divided doses, increase qwk as needed, or 100 mg ext rel tab daily, max 400 mg/day ext relPT EDUCATION: BBW: Teach patient not to discontinue product abruptly; taper over 2 wk; may cause precipitate angina if stopped abruptly, Teach patient not to use OTC products containing α-adrenergic stimulants (such as nasal decongestants, cold preparations); to avoid alcohol, smoking and to limit sodium intake as prescribed, Teach patient how to take pulse and B/P at home; advise when to notify prescriber, Teach patient to rise from sitting slowly to decreased orthostatic hypotension, Instruct patient to comply with weight control, dietary adjustments, modified exercise program, Tell patient to carry/wear emergency ID to identify product being taken, allergies; tell patientproduct controls symptoms but does not cure, Caution patient to avoid hazardous activities if dizziness, drowsiness is present, to avoid driving until product response is known, Teach patient to report symptoms of HF; difficult breathing, especially with exertion or when lying down, night cough, swelling of extremities or bradycardia, dizziness, confusion, depression, fever, decreased vision, Teach patient to take product as prescribed, not to double doses or skip doses; take any missed doses as soon as remembered if at least 4 hr until next dose, Advise patient to monitor blood glucose closely if diabetic, monitor for hypo/hyperglycemia, Advise patient to report Raynaud’s symptomsFC: Antihypertensive, antianginal CC: β1-Adrenergic blocker TU: Decreased B/P, heart rate, AV conduction USE: Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, New York Heart Association class II, III heart failure, cardiomyopathy NAME: Isosorbide mononitrate (Rx) / Monoket / ImdurNAME: Metoprolol (Rx) / Toprol-XL ACTION: Relaxation of vascular smooth muscle, which leads to decreased preload, afterload, thus decreasing left ventricular end-diastolic pressure, and systemic vascular resistance and reducing cardiac O2 demandSIDE EFFECTS: Vascular headache, flushing, dizziness, weakness, Orthostatic hypotension, tachycardia, collapse, syncope, Nausea, vomiting,Pallor, sweating, rash, Twitching, hemolytic anemia, methemoglobinemia, tolerance, xerostomiaNURSING CONSIDERATIONS: [1] Assess for angina pain: duration, time started, activity being performed, character, intensity [2] Monitor for orthostatic B/P, pulse at baseline, during treatment and periodically thereafter [3] Beers: Use with caution in older adults, may exacerbate episodes of syncopeCONTRAINDICTATION: Hypersensitivity to this product or nitrates, severe anemia, closed-angle glaucomaNURSING CONSIDERATIONS: [1] BBW : Abrupt withdrawal: may cause MI, ventricular dysrhythmias, myocardial ischemia; taper dose over 7-14 days [2] Hypertension/angina: monitor ECG directly when giving IV during initial treatment [3] Monitor B/P during beginning treatment, periodically thereafter; pulse; note rate, rhythm, quality; check apical/radial pulse before administration; notify prescriber of any significant changes (pulse <40 bpm), if cardiac output is decreased, atropine may be needed; ECG q 5-15 min during and after use [4] Check for baselines in renal, liver function tests before therapy begins and periodically thereafter [5] Assess for edema in feet, legs daily; monitor I&O, daily weight; check for jugular vein distention, crackles bilaterally, dyspnea (HF) [6] Pregnancy/breastfeeding: Use only if clearly needed, excreted in breast milk in small quantities, the American Academy of Pediatrics considers this product to becompatible with breastfeedingACTION: Lowers B/P by β-blocking effects; reduces elevated renin plasma levels; blocks β2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses, negative chronotropic effectSIDE EFFECTS: Insomnia, dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue, weakness, HF, palpitations, dysrhythmias, cardiac arrest, hypotension, bradycardia, pulmonary/peripheral edema, chest pain, Blurred vision, Nausea, vomiting, colitis, cramps, diarrhea, constipation, flatulence, dry mouth, hiccups, Impotence, urinary frequency, Agranulocytosis, eosinophilia, thrombocytopenic purpura, Rash, purpura, alopecia, dry skin, urticaria, pruritus, Bronchospasm, dyspnea, wheezing, Hyper/hypoglycemiaANTIDOTE: Lavage, IV atropine for bradycardia, digoxin, O2,