For an older adult with renal insufficiency, hypertension, and osteoarthritis, which medication should be avoided?

In the case of an older adult with renal insufficiency, hypertension, and osteoarthritis, nonsteroidal anti-inflammatory drugs (NSAIDs) should generally be avoided. This stems from the fact that NSAIDs can significantly impact renal function, particularly in individuals who already have pre-existing renal insufficiency. The mechanism involves NSAIDs inhibiting the production of prostaglandins, which are crucial for maintaining renal blood flow, especially in states of low perfusion. This can lead to an increased risk of acute kidney injury or exacerbate chronic kidney disease.

Additionally, NSAIDs can also contribute to hypertension by promoting fluid retention and sodium retention, which can complicate the management of high blood pressure in susceptible populations, such as older adults. Therefore, in this context, the use of NSAIDs poses a greater risk compared to the other options available. Acetaminophen, while providing pain relief, is generally considered safer for renal function when used within recommended doses. Opioids may be an option when pain is not managed adequately with safer alternatives, and certain antidepressants can be beneficial in managing chronic pain or comorbid depression, provided they are used with caution.