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ACE inhibitor monitoring — GPhC CRA MCQ

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ModerateCardiovascular TherapeuticsACE inhibitor monitoringGPhC CRA

A 70-year-old man started ramipril 2.5mg once daily two weeks ago for hypertension. His creatinine has increased from 88 micromol/L to 128 micromol/L and potassium is 5.8mmol/L. He feels well and has no ankle swelling. What monitoring is required?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Withhold ramipril and seek prescriber review of renal function and potassium

A substantial rise in creatinine and hyperkalaemia after ACE inhibitor initiation require prompt clinical review. Potassium 5.8mmol/L is above the usual threshold where continuing without review would be unsafe. The pharmacist should not escalate RAAS blockade and should consider interacting medicines, dehydration and renal artery stenosis risk.

Reference: BNF; NICE CKS