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Spironolactone monitoring — GPhC CRA MCQ

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HardCardiovascular TherapeuticsSpironolactone monitoringGPhC CRA

A 74-year-old man with heart failure with reduced ejection fraction brings a new prescription for spironolactone 25mg daily. He already takes ramipril 10mg daily and furosemide 40mg daily. His latest bloods show eGFR 44mL/min/1.73m2 and potassium 5.3mmol/L. What monitoring is required?

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Correct answer: C — check renal function and potassium before supply discussion and arrange close follow-up monitoring

Spironolactone can cause hyperkalaemia, especially with ACE inhibitors and reduced renal function. A potassium of 5.3mmol/L is already high and should prompt clarification with the prescriber before starting treatment. Renal function and potassium require baseline assessment and early repeat monitoring after initiation or dose change. INR, PEFR and HbA1c do not address the main risk in this case.

Reference: BNF; NICE CKS: Heart failure