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NSAID triple whammy — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsNSAID triple whammyGPhC CRA

A 69-year-old man with hypertension takes ramipril and bendroflumethiazide. He asks to buy ibuprofen tablets for knee pain after gardening. His eGFR is 48mL/min/1.73m2 on the PMR. What is the most important interaction to flag?

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Correct answer: E — NSAID with ACE inhibitor and diuretic increases acute kidney injury risk

The combination of an NSAID, ACE inhibitor and diuretic is associated with increased acute kidney injury risk, particularly in older people or CKD. Safer analgesic options and non-pharmacological measures should be considered. The patient should be referred if pain is severe, persistent or associated with red flags.

Reference: BNF; NICE CKS