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ACE inhibitor monitoring — GPhC CRA MCQ

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HardCardiovascular TherapeuticsACE inhibitor monitoringGPhC CRA

Two weeks after ramipril initiation for hypertension, serum creatinine has risen from 100 to 132 micromol/L, eGFR has fallen from 60 to 44 mL/min/1.73 m² and potassium is 4.8 mmol/L. The patient reports recent poor fluid intake. What is the best next step?

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Correct answer: A — Correct volume depletion and repeat renal tests within 1–2 weeks

Creatinine has increased by 32% and eGFR has fallen by about 27%, crossing the SPS action thresholds of more than 30% and more than 25%, respectively. Investigate reversible causes such as volume depletion and nephrotoxic or vasodilator medicines, and repeat renal function within one to two weeks. If the deterioration persists despite correction, reduce or stop the ACE inhibitor and recheck within five to seven days.

Reference: NHS SPS ACE inhibitor monitoring: https://sps.nhs.uk/monitorings/ace-inhibitors-and-angiotensin-ii-receptor-blockers-monitoring/