A 62 year old patient with a history of asthma and vasospastic angina states that he gets chest pain both with exertion and at rest, about ten times per week. One sublingual nitroglycerin tablet always relieves his symptoms, but this medication gives him an awful headache every time he takes it
Calcium channel blockers are preferred for vasospastic angina.
β-Blockers can actually worsen vasospastic angina; furthermore, nonselective β-blockers should be avoided in patients with asthma.
The nitroglycerin spray would also be expected to cause headache, so this is not the best choice.
Ranolazine is not indicated for immediate relief of an angina attack, nor is it a first-line option.