2
MONA-B
MONA-B for ST Wave Elevated Myocardial Infarction
Rapid treatment is essential for patients with a ST wave elevated myocardial infarction.
MONA-B is a mnemonic often used in treatment for chest pain and means morphine, oxygen,
nitroglycerin, aspirin, and beta blocker. However, this is not the order in which treatment should
be provided for patients and is just a mnemonic to help with remembering. Oxygen should be
provided first, then nitrates, followed by aspirin, and morphine last (O’Gara et.al, 2013).
The “O” for oxygen indicates the need to focus on fixing the oxygen supply and demand
within the myocardial cells if they are mismatched. This can be done by increasing supply and
decreasing the demand or placing the patient on bed rest and providing the patient with
supplemental oxygen (Doshi, et. al, 2010).
Next “N” or nitroglycerin is utilized and is an anti-ischemic medication. This medication
will increase oxygen supply and decrease oxygen demand in the patient. It is a coronary
vasodilator which will increase myocardial blood flow, therefore increasing oxygen delivery to
the patient. Also, nitroglycerin will mediate peripheral vasodilation and decrease preload which
in turn decreases oxygen demand. Nitroglycerin should be administered at 0.4 mg SL every 5
minutes for a max of 3 doses. If this shows to be ineffective IV medication can be initiated and
titrated every 3 to 5 minutes until the ischemia subsides; this should not exceed 200mcg per
minute. This medication is generally well tolerated however if systolic pressures are below 90
mm Hg it should no longer be used in treatment (Doshi, et.al, 2010).
“A” or aspirin is given to the patient to help thin the blood by breaking down platelets
and assisting to eliminate any possible clots that could possibly be contributing to the event.
When the individual is not in a medical setting and 911 is called aspirin may be given
immediately while waiting for the ambulance to arrive. Clopidogrel, a thienopyridne-derivative
3
MONA-B
antiplatelet medication, can be used in place of aspirin. Studies have shown that this is just as
effective as aspirin and should be used when aspirin is not tolerated (O’Gara et.al, 2013).
Morphine, “M”, can be given last to help reduce pain and anxiety. Morphine also helps
decrease oxygen demand, slows the heart rate, and has a “vasodilating” effect. Even with these
effects it is generally only given if the nitrates do not eliminate the chest pain or to help eliminate
anxiety for the patient (Doshi, et. al, 2010).
Beta-blockers lower myocardial oxygen demand directly. This is done by decreasing the
myocardial work load and is very beneficial in patients with ST elevations. Due to studies
showing that beta-blockers use had fewer patients with reinfarction or cardiac arrest. Therefore,
it is still recommended for use within the first 24 hours by the American College of
Cardiology/American Heart Association (ACC/AHA) (O’Gara et.al, 2013).
4
MONA-B
References
Doshi, A. A., Iskyan, K., O’Neill, J. M., & Sawyer, K. N. (2010). Evaluation and management of
non-ST-segment elevation Acute Coronary Syndromes in the emergency department.
Emergency Medicine Practice: EBMedicine.net. 12(1). 1-29. Retrieved from
https://www.ebmedicine.net/media_library/aboutUs/EMP%20sample%20+%20flier
%20for%20ACEP%20sample%20page.pdf
O’Gara, P.T., Kushner, F. G, Ascheim, D. D., Casey, D. E., Chung, M. K., de Lemos, J. A.,
Ettinger, S. M., Fang, J. C., Fesmire, F. M., Frankilin, B. A., Granger, C. B., Krumholz,
H. M., Linderbaum, J. A., Morrow, D. A., Newby, K., Ornato, J. P., Ou, N., Radford, M.
J., Tamis-Holland, J. E., Tommaso, C. L., Tracy, C. M., Woo, J., & Zhao, D. X. (2013).
2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction.
Journal of the American College of Cardiology. 61(4). 78-140. Retrieved from
http://content.onlinejacc.org/article.aspx?articleid=1486115
Powered by TCPDF (www.tcpdf.org)
