From the Guidelines
The medications in MONA, a common acronym used in acute coronary syndrome management, include Morphine, Oxygen, Nitroglycerin, and Aspirin. These medications are used to reduce myocardial oxygen demand, improve oxygen supply, decrease pain, and prevent further clot formation during suspected heart attacks. The specific dosages and administration routes are as follows:
- Morphine: typically 2-4 mg IV, repeated as needed, for pain relief and anxiety reduction 1.
- Oxygen: administered to maintain saturation above 90%, typically via nasal cannula at 2-4 L/min 1.
- Nitroglycerin: 0.4 mg sublingual tablet every 5 minutes for up to 3 doses, or IV infusion at 5-200 mcg/min, to dilate coronary arteries and reduce cardiac workload 1.
- Aspirin: 162-325 mg chewed, to provide immediate antiplatelet effects 1. It is essential to note that modern guidelines have evolved to use these medications more selectively based on individual patient presentation rather than automatically administering all four components to every patient with chest pain 1. Key considerations include:
- Morphine should be used with caution in unstable angina (UA)/NSTEMI due to an association with increased mortality in a large registry 1.
- Nitrates should not be administered to patients with hypotension or to those who received a phosphodiesterase inhibitor 1.
- Aspirin should be given as soon as possible to all patients with suspected ACS, unless the patient has a known aspirin allergy or active gastrointestinal hemorrhage 1.
From the Research
Medications in MONA
The medications in MONA are:
- Morphine
- Oxygen
- Nitroglycerin
- Aspirin These medications are used to treat acute coronary syndromes, as discussed in the study 2.
Rationale for Each Medication
- Morphine is used for pain relief
- Oxygen is used to increase oxygen supply to the heart
- Nitroglycerin is used to reduce blood pressure and decrease the heart's workload
- Aspirin is used as an antiplatelet agent to prevent blood clots
Notes on MONA
The MONA mnemonic is considered outdated, and a new mnemonic, THROMBINS2, has been proposed to reflect contemporary management of acute coronary syndromes 2.
Other Studies
Other studies 3, 4, 5, 6 discuss the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of osteoarthritis and rheumatoid arthritis, but do not provide information on the medications in MONA.