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NSAID renal risk — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsNSAID renal riskGPhC CRA

A 77-year-old man takes ramipril and bendroflumethiazide. He asks to buy diclofenac tablets for acute back pain after doing DIY. His eGFR is 45 mL/min/1.73 m². What is the most appropriate action?

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Correct answer: A — Avoid oral NSAID and suggest safer analgesia or referral

ACE inhibitor or ARB therapy plus diuretic and NSAID exposure increases acute kidney injury risk, particularly in older people with CKD. Safer analgesia and non-pharmacological measures should be considered. Persistent or severe pain warrants referral.

Reference: BNF; NICE CKS