A 64 years old male experiences uncontrolled angina attacks that limits his ability to do household chores.He is adherent to a maximized dose of beta blocker with a low heart rate and a low blood pressure.He was unable to tolerate an increase in isosorbide mononitrate due to headache.Which is the most appropriate addition to his antianginal therapy ?
A)Aspirin
B)Amlodipine
C)Verapamil
D)Ronalozine
Answer :D
Ronalozine is the best answer.the patients blood pressure is low,so verapamil and amlodipine may drop blood pressure furher.Verapamil may also decrease heart rate .Ronalozine can be used when other agents are maximized,especially when blood pressure is well controlled.the patient will need a baselineECG and lab work to ensure safe use of this medication .
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