Cardio: Cholestyramine, Ezetimibe

Question 1

Cholestyramine is a _____________.

Answer 1

bile-acid-binding resin

Question 2

Explain the bile circuit.

Answer 2

Bile is synthesized in the liver from cholesterol and sent down the hepatic duct into the intestine. It gets reabsorbed by the distal ileum.

Question 3

What is an undesirable effect that cholestyramine has on serum values?

Answer 3

It also ramps up triglyceride synthesis. (Think of the men with pitchforks being chased off the liver dock by the cho-lobster-amine lobster.)

Question 4

Because it ramps up cholesterol synthesis, cholestyramine can cause _____________.

Answer 4

gallstones

Question 5

In the GI tract, cholestyramine can cause two worrisome things: ____________.

Answer 5

constipation (represented by the lobster squeezing the pipes of the intestinal airship) and decreased absorption of drugs and fat-soluble vitamins (including statins, represented by the steampunk statin clashing with the lobster)

Question 6

Ezetimibe works by ________________.

Answer 6

blocking the dietary absorption of cholesterol, preventing loading into chylomicrons (just like the Z-shaped eel blocking the loading of gold onto the chylomicron hot air balloon)

Question 7

What is the mechanism of evolocumab?

Answer 7

It is a monoclonal antibody that blocks PCSK9, thus preventing LDL receptor degradation.

Question 8

The most common side effects of ezetimibe are ____________.

Answer 8

diarrhea and elevation of LFTs (represented by the LFT flag in the water and the diarrhea behind the ezetimibe eel)