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Ketorolac renal risk — FRCA Primary MCQ

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ModeratePharmacologyKetorolac renal riskFRCA Primary

A dehydrated older patient with chronic kidney disease is being considered for ketorolac after emergency surgery. Which adverse effect is the main concern?

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Correct answer: E — Reduced renal prostaglandin-mediated perfusion

NSAIDs reduce prostaglandin synthesis, which can compromise afferent arteriolar vasodilatation and renal perfusion in susceptible patients. Increased hepatic glucuronidation is not the hazardous mechanism. Activation of fibrinolysis would suggest tranexamic acid failure, not NSAID toxicity. The same prostaglandin inhibition also explains bleeding and gastric risks.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; BNF