This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: ACE Inhibitors, Subject name: Pharmacology
Spironolactone should not be given with - 
Select and explain. 
A. Chlorothiazide, B. b-blocker, C. ACE inhibitors, D. Amlodipine
C: ACE inhibitors
Answer: C: ACE inhibitors 
Explanation: Ans. is 'c' i.e., ACE inhibitors o Spironolactone is a potassium sparing diuretic, therefore, it can cause hyperkalemia decreasing the potassium diuresis.o ACE inhibitors can also cause hyperkalemia by inhibiting the production of angiotensin I, an inmmediate precursor of angiotensin II. Angiotensin causes excretion of K+ by increasing the secretion of aldosterone (Normally aldosterone enhances absortion of Na+ in distal tubules in exhange of active secretion of K+).o ACE inhibitors decrease potassium excretion by inhibiting the generation of Angiotensin.o Therefore, More pronoundced hyperkalemia can occur in patients receiving ACE inhibitors with sprironolactone