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NSAIDs in heart failure — GPhC CRA MCQ

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HardCardiovascular TherapeuticsNSAIDs in heart failureGPhC CRA

A 76-year-old man with heart failure and ankle swelling asks to buy ibuprofen for shoulder pain. He takes bisoprolol, ramipril, furosemide and spironolactone. His latest eGFR is 41mL/min/1.73m2 and potassium is 5.0mmol/L. What is the most important interaction to flag?

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Correct answer: C — avoid ibuprofen and discuss safer analgesia or prescriber review

NSAIDs can worsen heart failure, reduce renal function and increase hyperkalaemia risk, especially with ACE inhibitors, diuretics and mineralocorticoid antagonists. This patient already has CKD and borderline potassium. OTC ibuprofen supply is unsafe without review and safer analgesia should be discussed. Altering heart failure medicines from the counter would be inappropriate.

Reference: BNF; NICE CKS: Heart failure