Questions – Lipid Control

00:01 Okay, let's move on to a question.

00:04 The following will be effective in homozygous familial hypercholesterolemia except: Colesevelam, Mipomersen, Ezetimibe, or a heart healthy only diet.

00:17 You chose D.

00:18 Good for you.

00:20 Lifestyle changes alone will not lower cholesterol enough in familial hypercholesterolemia, which always requires control by a specific medications.

00:29 So, let's move on to the second question.

00:32 What is the mechanism of action of Ezetimibe? Is it A, a blockage of the enzyme that produces intracellular cholesterol? Is it B, increased synthesis of PCSK9? Is it C, increased uptake of luminal cholesterol into the bloodstream? Is it D, inhibition of intestinal cholesterol transport proteins? Or is it E, reduction of the calcium slow current? Good, you chose D.

01:05 So D, inhibition of intestinal cholesterol transport proteins reduces the level of LDL in the blood.

01:14 A is incorrect, because blockage of an enzyme that produces intracellular cholesterol that's a statin.

01:20 B. Increased synthesis of PCSK9 that's actually no drug.

01:25 The PCSK9 inhibitors act as immune modulators, or immune globulins that attached to PCSK9 and prevented from doing its job.

01:36 C is wrong.

01:37 Increased uptake of luminal cholesterol into the bloodstream.

01:40 That almost doesn't even make any sense.

01:42 And E, reduction of the inward calcium slow current is wrong.

01:48 They will do that to you because sometimes they'll get you confused with a cardiac drug that sounds similar.

01:55 So pay attention to the drugs that you're using.

01:58 Okay, let's go on to a question again.

02:01 A 55-year-old male has elevated LDL cholesterol.

02:05 He was started on rosuvastatin 10 mg daily.

02:09 His current medications include perindopril for hypertension, aspirin, and fenofibrate for severe hypertriglyceridemia.

02:18 What do you think the most appropriate strategy is going forward? So what should we do? Should we stop the finofibrate as there is a very high likelihood of a fatal drug interaction.

02:30 Should we reduce the finofibrate dosage as there is a potential for a fatal drug reaction? Should we continue finofibrate but monitor liver enzymes and continue and follow closely? Or use a higher dose of rosuvastatin and continue the finofibrate? I think that's reasonable, continue finofibrate but monitor liver enzymes, and follow closely.

02:53 Remember that a combination of finofibrate and rosuvastatin has a very low risk of that really horrible fatal interaction possibly in the 1 in 1 million range.

03:03 So to stop the medication of the severe hypertriglyceridemia in order to start a statin is not a rational choice.

03:11 It might be what your patient wants to do.

03:14 But it's not rational because there's not a real tangible risk other than that theoretical risk going forward.

03:20 Monitoring and being careful is the best way to do this.

03:26 Okay, that's it.

03:26 I hope you enjoyed the lecture, and good luck on your exams.