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NSAID contraindication in renal impairment — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsNSAID contraindication in renal impairmentGPhC CRA

A patient with an acute gout flare has eGFR 38 mL/min/1.73 m², takes ramipril and previously developed an NSAID-associated acute kidney injury. They ask to buy ibuprofen while awaiting routine review. What is the best response?

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Reveal the answer and explanation

Correct answer: B — Decline NSAID supply and arrange prescriber selection of colchicine or oral prednisolone

Option B is correct: NICE allows an NSAID, colchicine or a short oral corticosteroid, but selection must reflect comorbidity and co-prescriptions; CKD plus prior NSAID-associated AKI and an ACE inhibitor makes unsupervised NSAID use a poor choice. Option C adds gastric protection and monitoring but still exposes this high-risk patient to avoidable renal injury. Option D falsely treats naproxen as renally preferable. Option E can worsen gout and is not flare therapy. Option A reduces exposure but does not remove renal risk.

Reference: NICE NG219: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations