NSAID gastroprotection — GPhC CRA MCQ

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HardGastrointestinal TherapeuticsNSAID gastroprotectionGPhC CRA

A patient is beginning sodium zirconium cyclosilicate for hyperkalaemia. Which concurrent oral medicine specifically requires administration at least 2 hours before or after it because absorption is pH-dependent?

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Reveal the answer and explanation

Correct answer: B — Ketoconazole

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

A does not require separation on the basis tested. B is listed among medicines whose exposure was not clinically altered in the interaction studies. C likewise does not require this pH-related separation. D is correct: sodium zirconium cyclosilicate transiently raises gastric pH, so ketoconazole and other medicines with clinically meaningful pH-dependent bioavailability should be given at least 2 hours before or after it. E is not subject to the stated spacing rule.

Reference: Lokelma sodium zirconium cyclosilicate SmPC. https://www.medicines.org.uk/emc/product/10059/smpc