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NSAID triple whammy — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsNSAID triple whammyGPhC CRA

A man taking ramipril and bendroflumethiazide with chronic kidney disease asks to buy ibuprofen during a heatwave. What is the most important interaction to flag?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Ibuprofen may increase acute kidney injury risk with ACE inhibitor, diuretic and dehydration

NSAIDs reduce renal prostaglandin-mediated perfusion and risk rises with ACE inhibitor and diuretic use. In this scenario, the pharmacist should prioritise safe supply, appropriate counselling and timely referral or clarification where needed. This is the single best answer because the other options would either delay assessment, ignore a clinically significant risk, or create an unsafe legal or professional outcome.

Reference: BNF; NICE CKS