A patient on long-term Spironolactone therapy for congestive heart failure is prescribed an ACE inhibitor (Lisinopril) for refractory hypertension. What life-threatening electrolyte imbalance must the nurse monitor for due to the synergistic action of these two medications?
Answer and explanation
Correct answer: D. Hyperkalemia
- Step 1: Spironolactone is an aldosterone antagonist that prevents potassium excretion in the cortical collecting tubule.
- Step 2: ACE inhibitors reduce circulating angiotensin II and aldosterone synthesis; combining them produces synergistic potassium retention, significantly increasing the risk of severe, life-threatening hyperkalemia (> 5.5 mmol/L).
Answer
Hyperkalemia.
Why not the others: 'Hypokalemia' occurs with loop and thiazide diuretics, not potassium-sparing agents; 'Hyponatremia' is a potential risk but is not the primary acute fatal cardiovascular threat; 'Hypomagnesemia' occurs with loop diuretics and aminoglycosides.
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