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NSAID contraindications — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsNSAID contraindicationsGPhC CRA

A 62-year-old woman presents to the pharmacy requesting ibuprofen tablets for knee osteoarthritis pain. She takes lisinopril 10 mg, amlodipine 5 mg, and aspirin 75 mg daily. She has a history of peptic ulcer disease. What is the most appropriate advice?

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Correct answer: C — Refuse the sale and advise her to see her GP, as ibuprofen is not appropriate given her history and current medications

Oral ibuprofen is contraindicated in this patient for multiple reasons: a history of peptic ulcer disease (increased GI bleeding risk, compounded by concomitant aspirin), concurrent use of an ACE inhibitor (risk of renal impairment and hyperkalaemia with the triple whammy of NSAID + ACE inhibitor + diuretic/aspirin). The patient should be referred to her GP for appropriate analgesia, which might include topical NSAIDs, paracetamol, or other approaches.

Reference: BNF; NICE CKS Osteoarthritis; NICE CKS NSAIDs