What does MONA therapy stand for in acute coronary syndrome management?

• A. Morphine, Oxygen, Nitrates, Aspirin
• B. Morphine, Oxygen, Nitroglycerin, Antibiotics
• C. Morphine, Oxygen, Beta-blocker, Diuretic
• D. Antibiotics, Oxygen, Nitrates, Aspirin

Answer: (A)

In acute coronary syndrome, MONA is a mnemonic for immediate initial therapy: Morphine, Oxygen, Nitrates, and Aspirin.

Morphine provides pain relief and reduces sympathetic stimulation, which lowers heart rate and blood pressure and decreases myocardial oxygen demand. Oxygen is given if the patient is hypoxemic to improve oxygen delivery to the heart; it isn’t routinely beneficial for everyone, only when there’s low oxygen saturation or respiratory distress. Nitrates, such as nitroglycerin, dilate vessels to reduce preload and myocardial oxygen demand and help relieve chest pain; they’re used with attention to blood pressure and any contraindications like hypotension or recent use of certain erectile dysfunction medications. Aspirin is an antiplatelet that irreversibly inhibits platelet aggregation, helping prevent further clot propagation and reducing mortality when started promptly in ACS, provided there’s no allergy or high risk of bleeding.

The other options include medicines not part of MONA (for example, antibiotics) or include drugs like beta-blockers or diuretics that aren’t part of the initial MONA sequence. The combination that matches Morphine, Oxygen, Nitrates, and Aspirin is the best answer.