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Spironolactone hyperkalaemia — GPhC CRA MCQ

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HardCardiovascular TherapeuticsSpironolactone hyperkalaemiaGPhC CRA

A 69-year-old woman with heart failure takes ramipril 10mg daily, bisoprolol 5mg daily and furosemide 40mg daily. Spironolactone 25mg daily was started 10 days ago. Her blood tests today show potassium 6.0mmol/L and eGFR 39mL/min/1.73m2, with increasing fatigue. What monitoring is required?

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Correct answer: C — Urgent potassium and renal function reassessment with prescriber review

This is clinically significant hyperkalaemia after starting spironolactone in a patient also taking an ACE inhibitor. Renal impairment further increases risk, and urgent prescriber review is required. Potassium and renal function are the immediate monitoring priorities. Routine metabolic monitoring or INR testing would not address the acute risk.

Reference: BNF; NICE CKS Heart failure