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Pharmacology · patient case question

Rosuvastatin lowers cholesterol by which mechanism?

Patient case: Polypharmacy — Cardiovascular & GI

demo: 68-year-old male

chief: “I need a crown on my lower left molar.”

history: Hypertension, gastroesophageal reflux disease, atrial fibrillation, hyperlipidemia, gout. Non-smoker.

meds: Lisinopril, omeprazole, verapamil, apixaban, rosuvastatin, allopurinol

findings: BP 132/84 mmHg. Generalized attrition. Tooth #19 with fractured MOD amalgam, no pulpal symptoms. No active periodontal disease.

  1. Inhibition of HMG-CoA reductase, reducing hepatic cholesterol production
  2. Inhibiting intestinal cholesterol absorption at NPC1L1
  3. Binding bile acids in the intestinal lumen
  4. Activating peroxisome proliferator-activated receptor alpha
Show answer and explanation

Correct answer: A. Inhibition of HMG-CoA reductase, reducing hepatic cholesterol production

  • A. Correct. Statins competitively inhibit HMG-CoA reductase, the rate-limiting enzyme of hepatic cholesterol synthesis.
  • B. NPC1L1 inhibition describes ezetimibe.
  • C. Bile acid sequestration describes cholestyramine.
  • D. PPAR-alpha activation describes fibrates such as gemfibrozil.

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