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ACEi-MRA hyperkalaemia risk — GPhC CRA MCQ

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ModerateCardiovascular TherapeuticsACEi-MRA hyperkalaemia riskGPhC CRA

A pharmacist is checking a prescription for a 78-year-old woman with CKD stage 3b (eGFR 38 mL/min/1.73m2). She has been prescribed spironolactone 25 mg daily in addition to her existing ramipril 5 mg daily for heart failure. What is the most important monitoring concern?

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Correct answer: E — Serum potassium and renal function, as the combination significantly increases the risk of hyperkalaemia

Both ramipril (ACE inhibitor) and spironolactone (mineralocorticoid receptor antagonist) independently increase the risk of hyperkalaemia. The combination significantly amplifies this risk, particularly in patients with impaired renal function. The BNF advises monitoring serum potassium and renal function within one week of starting or changing dose, and regularly thereafter. In this patient with CKD stage 3b, close monitoring is essential.

Reference: BNF; NICE NG106 Heart Failure