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NSAID risk in CKD and heart failure — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsNSAID risk in CKD and heart failureGPhC CRA

A 72-year-old woman with osteoarthritis, CKD stage 3b, heart failure, and hypertension asks to buy diclofenac tablets after topical gel gave partial relief. She takes ramipril and furosemide. What is the most appropriate action?

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Correct answer: D — Avoid oral diclofenac and discuss safer pain management options

Oral NSAIDs can worsen renal function and heart failure, and the combination with an ACE inhibitor and diuretic increases acute kidney injury risk. Diclofenac also carries cardiovascular risk. Safer options include optimising topical therapy, paracetamol where suitable, non-pharmacological measures, or referral.

Reference: BNF; NICE CKS