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Bisphosphonate counselling — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsBisphosphonate counsellingGPhC CRA

A heart-failure patient took ramipril at 08:00 today and is prescribed sacubitril/valsartan to start this evening. What is the correct intervention?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Do not overlap them; start sacubitril/valsartan no sooner than 36 hours after the last ramipril dose

Option A is correct: ACE-inhibitor and neprilysin inhibition must not overlap, and sacubitril/valsartan begins at least 36 hours after the last ACE-inhibitor dose to reduce angioedema risk. Option E provides inadequate washout. Option C invents a once-daily exception. Option D deliberately combines contraindicated treatments. Option B adds an unauthorised intermediate regimen and still shortens the washout.

Reference: Entresto SmPC: https://www.medicines.org.uk/emc/product/5074/smpc