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Spironolactone hyperkalaemia — GPhC CRA MCQ

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HardCardiovascular TherapeuticsSpironolactone hyperkalaemiaGPhC CRA

A 78-year-old woman taking furosemide 40mg daily and ramipril 5mg daily is prescribed spironolactone 25mg daily for heart failure. Her latest potassium is 5.3mmol/L and eGFR is 32mL/min/1.73m2. What monitoring is required?

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Correct answer: C — Query initiation and arrange close U&E monitoring because hyperkalaemia risk is high

Spironolactone can cause clinically important hyperkalaemia, especially with ACE inhibitors, renal impairment and high baseline potassium. This prescription should be queried or risk-assessed before initiation, with close U&E monitoring if used. Lipids, HbA1c and urate are not the key safety checks for this decision. A low dose does not remove the need for monitoring in this high-risk patient.

Reference: BNF; NICE CKS Heart failure