Friday, October 18, 2019

Question of the Week – PEBC Evaluating Exam

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Evolocumab is a monoclonal antibody used along with diet and maximally tolerated statin therapy in adults with heterozygous familial hypercholesterolemia who need additional lowering of LDL cholesterol.  Which of the following statements best describes the mechanism of evolocumab?

     A. Inhibits subtilisin/kexin a protein that targets LDL receptors for degradation and thereby reduces the liver's ability to remove LDL-cholesterol from the blood
     B. Inhibits HMG-CoA reductase, an enzyme found in liver tissue that plays a key role in the production of cholesterol in the body
     C. Inhibits lipolysis and decrease subsequent hepatic fatty acid uptake as well as inhibit hepatic secretion of VLDL
     D. Inhibits the absorption of cholesterol binding to a critical mediator the Niemann-Pick C1-Like 1 (NPC1L1) protein on the gastrointestinal tract epithelial cells
     E. Acts by trapping bile acids leading to decreased enterohepatic recirculation of bile acids, increased synthesis of new bile acids by the liver from cholesterol and subsequent reduction of blood cholesterol levels

Answer: A
B is the mechanism of statins such as atorvastatin; C is the mechanism of fibrates such as gemfibrozil; D is the mechanism of cholesterol absorption inhibitors such as ezetimibe; E is the mechanism of bile acids sequestrants such as colestipol



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