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NSAID risk in heart failure — GPhC CRA MCQ

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ModerateMusculoskeletal TherapeuticsNSAID risk in heart failureGPhC CRA

A 68-year-old woman with osteoarthritis asks for diclofenac tablets. She has heart failure, BP 162/94 mmHg and takes furosemide, ramipril and bisoprolol. What is the most appropriate alternative?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: ATopical NSAID or paracetamol with clinical review

Oral NSAIDs can worsen heart failure, blood pressure control and renal function, especially with ACE inhibitor and diuretic therapy. Topical NSAIDs reduce systemic exposure and may be suitable for localised osteoarthritis pain. Persistent or severe pain should be reviewed for broader management.

Reference: BNF; NICE CKS