Family Nurse Practitioner Exam

What complication can occur if NSAIDs are used excessively in patients taking diuretics?

1. Acute renal failure

2. Hypotension

3. Gastrointestinal bleeding

4. Electrolyte imbalance

The correct answer is: Acute renal failure

Excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients taking diuretics can lead to acute renal failure due to the way NSAIDs affect kidney function. NSAIDs inhibit cyclooxygenase (COX) enzymes, which are involved in the production of prostaglandins. Prostaglandins play a critical role in maintaining renal blood flow, especially in states where renal perfusion may be compromised, such as when patients are on diuretics. Diuretics can reduce blood volume and, consequently, renal perfusion. When NSAIDs are added to this scenario, the inhibition of prostaglandin synthesis leads to further vasoconstriction of the afferent arterioles in the kidney, decreasing glomerular filtration rate (GFR). This combined effect can precipitate acute renal failure in susceptible individuals, especially those who are elderly or have underlying kidney issues. While hypotension, gastrointestinal bleeding, and electrolyte imbalance can also be concerns related to the use of NSAIDs or diuretics, their primary association in this context specifically ties back to the acute renal impairment that can arise from the combination of medication effects on renal physiology.