CLS Non-Statin Lipid-Lowering Pharmacotherapy

Question 1

What is the primary mechanism of action of ezetimibe?

Accepted Answer

Blocks cholesterol absorption at the Niemann-Pick C1-Like 1 (NPC1L1) transporter in the small intestine

Answer

Ezetimibe selectively inhibits cholesterol absorption at the brush border of the small intestine by blocking the NPC1L1 transporter, reducing cholesterol delivery to the liver.

Question 2

Which bile acid sequestrant is FDA-approved for both hypercholesterolemia and as an adjunct treatment for type 2 diabetes?

Accepted Answer

Colesevelam

Answer

Colesevelam (Welchol) is the only bile acid sequestrant with dual FDA approval for LDL-C lowering and improving glycemic control in adults with type 2 diabetes mellitus.

Question 3

What is the expected LDL-C reduction with ezetimibe monotherapy?

Accepted Answer

15–25%

Answer

Ezetimibe monotherapy typically reduces LDL-C by approximately 15–25%, making it useful as adjunctive therapy rather than a standalone alternative to statins.

Question 4

Bile acid sequestrants are contraindicated in patients with triglyceride levels exceeding which threshold?

Accepted Answer

400 mg/dL

Answer

Bile acid sequestrants can markedly increase triglyceride levels and are contraindicated when fasting triglycerides exceed 400 mg/dL due to the risk of acute pancreatitis.

Question 5

The IMPROVE-IT trial studied ezetimibe added to simvastatin in patients with recent acute coronary syndrome. What was the primary finding?

Accepted Answer

A significant reduction in major adverse cardiovascular events

Answer

IMPROVE-IT demonstrated that simvastatin plus ezetimibe significantly reduced the composite primary endpoint of major adverse cardiovascular events compared to simvastatin alone, validating the 'lower is better' hypothesis for LDL-C.

(CLS) Clinical Lipid Specialist Certification Practice Test

(CLS) Clinical Lipid Specialist Certification Practice Test

CLS Non-Statin Lipid-Lowering Pharmacotherapy