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Spironolactone monitoring — GPhC CRA MCQ

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ModerateCardiovascular TherapeuticsSpironolactone monitoringGPhC CRA

A 76-year-old patient with heart failure is prescribed spironolactone 25 mg daily. Their current medicines include ramipril, bisoprolol and furosemide. Recent eGFR is 48 mL/min/1.73 m² and potassium is 4.9 mmol/L. What monitoring is required?

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Correct answer: A — Monitor renal function and potassium closely after starting

Spironolactone can cause hyperkalaemia, particularly when combined with an ACE inhibitor or in renal impairment. Renal function and electrolytes should be checked after initiation and dose changes. The baseline potassium is near the upper range, so this is a high-risk supply requiring careful review. INR, peak flow and dose-by-dose glucose checks do not address the main risk.

Reference: BNF