Is the MONA sequence still recommended for ACS, and what components are commonly used today?

• A. MONA order strictly recommended in that order.
• B. MONA includes magnesium as first step.
• C. MONA is outdated as a rigid order; modern practice emphasizes antiplatelet therapy, anticoagulation, nitrates, oxygen as needed, and prompt reperfusion.
• D. MONA has no role in ACS management.

Answer: (C)

The thing being tested is how ACS care has evolved from a fixed sequence to a flexible, evidence-based approach. The old MONA idea isn’t followed as a rigid order anymore. Instead, the emphasis is on starting antithrombotic therapy promptly—giving aspirin now and adding a P2Y12 inhibitor if not already given—along with anticoagulation, and addressing chest pain with nitrates as long as there’s no hypotension or shock. Oxygen is reserved for patients who are hypoxemic or in heart failure, not automatically given to everyone. Crucially, reperfusion therapy should be pursued as soon as possible—PCI is preferred when available, with thrombolysis as an option if timely PCI isn’t available. Morphine is no longer routinely used for all ACS patients due to potential side effects and interaction with antiplatelet therapy. So the best answer captures that MONA is outdated as a rigid sequence, and current practice centers on antiplatelet therapy, anticoagulation, nitrates, oxygen as needed, and prompt reperfusion. Components commonly used today include aspirin, a P2Y12 inhibitor, an anticoagulant, nitrates, oxygen only if indicated, and rapid reperfusion strategies.