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Spironolactone monitoring — GPhC CRA MCQ

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HardCardiovascular TherapeuticsSpironolactone monitoringGPhC CRA

A man aged 68 years presents a new prescription for spironolactone 25mg daily for heart failure. His latest discharge summary shows eGFR 31mL/min/1.73m2 and potassium 5.2mmol/L after an admission with decompensated heart failure. What monitoring is required?

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Correct answer: B — Check renal function and potassium before supply is confirmed with the prescriber

Spironolactone can worsen hyperkalaemia and renal impairment, particularly in heart failure and reduced eGFR. Baseline potassium and renal function should be reviewed before initiation and repeated soon after starting or changing dose. A potassium of 5.2mmol/L is already raised, so the pharmacist should clarify safety with the prescriber rather than supply routinely. Liver, calcium and thyroid tests do not address the principal immediate risk.

Reference: BNF; NICE CKS Heart failure