A 24-year-old woman with PCOS and bothersome hirsutism is started on spironolactone 100 mg daily. Which counselling point regarding this drug is MOST important?

• A Reliable contraception is essential because antiandrogens can cause feminization (undervirilization) of a male fetus ✓
• B It may cause virilization of a female fetus if taken during pregnancy
• C It can safely be continued throughout pregnancy as it lowers maternal testosterone
• D It should be stopped if hyperkalemia develops on routine monitoring

Explanation

Spironolactone blocks androgen receptors, and exposure in utero can produce ambiguous or feminized genitalia in a genetically male fetus, so effective contraception is mandatory while taking it. Option C is therefore exactly wrong. Hyperkalemia is a genuine concern, but it warrants dose adjustment rather than automatic discontinuation in healthy young women, so D is not the key counselling point. Virilization of female fetuses would require an androgenic drug, the opposite pharmacology.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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