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ACE inhibitor hyperkalaemia — GPhC CRA MCQ

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EasyCardiovascular TherapeuticsACE inhibitor hyperkalaemiaGPhC CRA

A 72-year-old woman has been prescribed ramipril 2.5mg daily for heart failure. Her blood test from this morning shows potassium 5.9 mmol/L and eGFR 38 mL/min/1.73m2. She asks to collect the first supply. What is the most appropriate action?

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Correct answer: C — Do not supply and contact the prescriber urgently

Ramipril can increase serum potassium and worsen renal function, particularly in heart failure and chronic kidney disease. A potassium of 5.9 mmol/L before starting is clinically significant and should be discussed urgently with the prescriber. Supplying without clarification could increase the risk of dangerous hyperkalaemia. A repeat test after starting is important, but it is not enough to address this baseline abnormality.

Reference: BNF; NICE CKS