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ACE inhibitor during acute kidney injury — GPhC CRA MCQ

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HardCardiovascular TherapeuticsACE inhibitor during acute kidney injuryGPhC CRA

A 73-year-old on furosemide 40 mg and ramipril 10 mg has one week of vomiting. BP is 92/58 mmHg, eGFR has fallen from 62 to 29 mL/min/1.73 m² and potassium is 5.4 mmol/L. Which coordinated action is most appropriate?

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Correct answer: A — Arrange same-day assessment; temporarily withhold ramipril pending review

Vomiting, hypotension, acute renal deterioration and hyperkalaemia indicate possible acute kidney injury and volume depletion. NICE advises considering temporary interruption of ACE inhibitors during vomiting until the condition improves and stabilises. This patient needs same-day assessment of fluids, renal function and the whole regimen; the pharmacist should not independently increase the diuretic or switch within the same renin–angiotensin class.

Reference: NICE NG148: https://www.nice.org.uk/guidance/ng148/chapter/Recommendations