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Generic Monoket (Isosorbide mononitrate 10/20mg)
- Denomination
Ismo, Monoket, Imdur
- Active Substance
Isosorbide Mononitrate
- Indications for Use.
Stenocardia (preventive measures). Chronic heart failure, hypertension in “lesser” circulation, “pulmonary” heart (treatment within a combined therapy). Spasm of peripheral arteries.
- Action
The drug reduces preload (by means of enlargement peripheral veins) and afterload (due to the reduction of a general peripheral vascular resistance), decreases myocardial oxygen demand, enlarges coronary arteries and improves coronary bloodstream, favors its redistribution.
- Posology and Administration
Isosorbide Mononitrate is indicated for a long-time treatment. A dose should be determined individually.
The drug should be taken orally without chewing, rinsing it with a small quantity of liquid.
The treatment will be started from a low dose, and then slowly it should be increased up to the necessary level.
The starting dose is 10-20 mg 2 times a day or 40-50 mg once daily in the morning after breakfast.
If necessary the drug’s dose may be increased to 20-40 mg twice daily or up to 80-100 mg once daily (for prolonged forms) on the 3-5-th day of treatment. When there is 2 times daily administration it is recommended “asymmetric” scheme: first intake at once after awakening, the second one after 6 - 7 hours.
The treatment duration defines the doctor. Cessation of the treatment should not be abrupt, but it should be gradual, as “rebound-effect” is not excluded.
- Counterindications
Acute phase of myocardial infarction; insult to the brain; evidenced drop of arterial tension; hypersensitivity to the drug.
- Should Be Taken with Precautions, if…
In cases of arterial hypotension Isosorbide Mononitrate is used only under medical control. If the drug is administered specially through monitoring of patients who suffer from aortal and/or mitral stenosis - caution is needed. The drug should not be used to stop a stenocardia attack.
Simultaneous use of Isosorbide Mononitrate with hypotensive drugs, antidepressants or alcohol may result in an abrupt drop of tension.
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Interface with Other Medications
On the matter of parallel administration of drugs consult your attending doctor.
- Overdosing
Symptoms: significant drop of arterial tension, sensation of compression of the head, pulsing headache, evidenced perspiration, and skin integument is cold and covered with clammy sweat, quick heartbeat, bradycardia, asequence (block), rough breathing, bloody flux, vomiting, dizziness, mental fog, coma, fever, paralysis, disorders of vision.
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Side Effects
Headache; low arterial tension; rapid heart; drowsiness; nausea, vomiting.
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Pregnancy and Lactation
The use of the drug in pregnancy is possible only in the cases when a supposed favor exceeds an eventual negative affection on the fetus. During the treatment breastfeeding should be stopped.
- Driving
It is not recommended to drive vehicles and be engaged in other potentially hazardous activities in the period of treatment.
HEART MALFORMATIONS IN BABIES: CORRECTIVE SURGERY FOR HOLES IN THE HEART
If it is decided to go ahead with surgery, this should only be attempted using a total bypass of the whole cardiopulmonary system. In other words the heart-lung machine must take over the work of the heart long enough for the hole to be closed.
Make no mistake about my position on any form of surgery to the heart. It may be technically feasible and scientifically clever to perform these feats, but the patient must come first. The mere fact that a hole can be closed using open-heart procedures does not of itself warrant their use. The long- and short-term risks and benefits have to be weighed up cautiously. Indeed, some ventricular septal defects are so small that they do not affect the patient's health, and sometimes they actually close themselves spontaneously; usually this takes place in the first year or two of life.
Holes in the heart can be closed in two ways. Either the edges can be pulled together and sutured directly or one can use a 'patch' of plastic material or of the body's own tissue, such as a piece of pericardium (the tissue surrounding the heart). In the past we used to correct ventricular septal defects by cutting into the right ventricles, but this is not very desirable, especially when the right ventricle is already under abnormal pressure. Today, unless the septal defect is in a very awkward place, we repair it by cutting into the right atrium and approaching the ventricular septum through the tricuspid valve.
When to operate? Because of the high risk of the shunt's direction reversing, treatment is urgent. If the shunt does reverse the defect becomes inoperable because, once the shunt is from right to left, the hole in the septum acts as a safety valve, relieving the pressure in the right ventricle. If the aperture is closed the patient will go into severe right-heart failure and die.
Not so long ago, when it was very risky to operate on the hearts of very young children, a stop-gap operation was carried out. A plastic band was put around the pulmonary artery to narrow it so the resistance in the pulmonary circuit was increased (although it still remained lower than in the systemic circulation), and thereby the rate of the initial left-to-right shunt was reduced. This meant that the lungs did not become flooded to such an extent that pulmonary resistance became higher than the systemic resistance, and so a reversal in the direction of the shunt was avoided. Today, now that we can operate on babies only a few hours old and weighing only 1-1.5 kg, this interim procedure has been virtually abandoned.
The procedures for atrial-septal-defect operations are very similar. However, because the atrial septum is thinner than the ventricular septum, it is usually sutured directly, rather than patched. Because there is little danger оf shunt-reversal with atrial septal defects, correction is usually delayed until the child is bigger and stronger. The symptoms of these defects are relatively benign, so it is more important that operations are carried out only when the surgical team have the skill to guarantee virtually 100 percent success. Properly performed, however, closures of atrial septal defects are spectacularly effective, and deaths uncommon.
*17/353/5*
CARDIO & BLOOD
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