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Spironolactone hyperkalaemia — GPhC CRA MCQ

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EasyCardiovascular TherapeuticsSpironolactone hyperkalaemiaGPhC CRA

A 71-year-old man with heart failure is prescribed spironolactone 25 mg daily in addition to ramipril 10 mg, bisoprolol 5 mg, and furosemide 40 mg. His latest blood results show potassium 5.6 mmol/L and eGFR 42 mL/min/1.73m². What is the most appropriate action?

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Correct answer: B — Contact the prescriber as spironolactone should not be started with potassium above 5.0 mmol/L

Spironolactone should not be initiated if serum potassium is above 5.0 mmol/L due to the risk of life-threatening hyperkalaemia. This risk is compounded by concurrent ACE inhibitor use and renal impairment. The prescriber must be contacted to address the hyperkalaemia before considering aldosterone antagonist therapy. Simply switching to eplerenone does not resolve the underlying hyperkalaemia risk.

Reference: NICE NG106 Heart Failure; BNF