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Stable angina and rate-limiting calcium-channel blocker — GPhC CRA MCQ

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HardCardiovascular TherapeuticsStable angina and rate-limiting calcium-channel blockerGPhC CRA

A 66-year-old man with stable angina takes bisoprolol 5mg daily and GTN spray. A new prescription for verapamil modified-release 240mg daily is presented after he reported ankle swelling with amlodipine. His pulse in the pharmacy is 54/min and he feels light-headed on standing. What is the most appropriate alternative?

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

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Correct answer: B — Discuss a non-rate-limiting antianginal option with the prescriber

Verapamil with a beta-blocker can cause significant bradycardia, AV block and hypotension. The low pulse and light-headedness make the interaction clinically immediate. A prescriber should consider another antianginal strategy rather than adding verapamil.

Reference: BNF; NICE CKS