Paracetamol alcohol dependence — GPhC CRA MCQ
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Correct answer: A — Withhold supply and urgently clarify because riociguat with a PDE5 inhibitor is contraindicated
Option A is correct: soluble-guanylate-cyclase stimulation by riociguat and PDE5 inhibition by sildenafil produce additive hypotension, and the combination is contraindicated. Option B cannot remove a mechanism-based contraindication by spacing. Option D invents a metabolic mechanism and unsafe dose workaround. Option E substitutes a blood-pressure threshold for the contraindication. Option C remains contraindicated because tadalafil is also a PDE5 inhibitor.
Reference: Adempas SmPC: https://www.medicines.org.uk/emc/product/5334/smpc