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NSAID AKI triple whammy — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentNSAID AKI triple whammyGPhC CRA

A 49-year-old man taking ramipril, indapamide and metformin asks for diclofenac tablets for knee pain during a heatwave. He reports reduced oral intake and dark urine. What is the most appropriate action?

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Correct answer: E — Avoid oral NSAID supply and advise urgent review because AKI risk is increased

ACE inhibitor or ARB therapy, diuretics and NSAIDs together increase AKI risk, particularly during dehydration. Dark urine and reduced intake suggest current dehydration, making oral NSAID supply unsafe. Gastric protection would not address renal risk. Increasing the diuretic would worsen dehydration and AKI risk.

Reference: BNF; NICE CKS AKI