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Spironolactone hyperkalaemia risk — GPhC CRA MCQ

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EasyCardiovascular TherapeuticsSpironolactone hyperkalaemia riskGPhC CRA

A 74-year-old man with heart failure is prescribed spironolactone 25 mg daily in addition to ramipril. His most recent potassium was 4.8 mmol/L and eGFR 42 mL/min/1.73 m². The GP asks what to check after starting. What monitoring is required?

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Correct answer: E — Urea and electrolytes, especially potassium and creatinine

Spironolactone can cause hyperkalaemia and worsening renal function, especially with ACE inhibitors and reduced eGFR. Urea, electrolytes and renal function should be monitored after initiation and dose changes. The other tests do not address the principal risks.

Reference: BNF