Cardiovascular drugs: bempedoic acid: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Cardiovascular drugs: bempedoic acid

Sample item

A patient with coronary disease cannot tolerate statins because of myalgia, and LDL remains high on ezetimibe. Which oral drug inhibits an enzyme upstream of HMG-CoA reductase in the liver but is not activated in muscle?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Bempedoic acid

Bempedoic acid is a prodrug activated only in the liver, where it inhibits ATP citrate lyase, an enzyme upstream of HMG-CoA reductase in cholesterol synthesis. Muscle lacks the activating enzyme, so myopathy is less common.

Option by option

  • A. Niacin

    Niacin lowers VLDL production and does not inhibit cholesterol synthesis.

  • B. Bempedoic acid (correct)

    Correct. It inhibits ATP citrate lyase and is activated only in the liver.

  • C. Fenofibrate

    Fenofibrate acts through PPAR-alpha to lower triglycerides.

  • D. Colestipol

    Colestipol binds bile acids in the gut and acts by a different mechanism.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Bempedoic acid. Bempedoic acid is a prodrug activated only in the liver, where it inhibits ATP citrate lyase, an enzyme upstream of HMG-CoA reductase in cholesterol synthesis.

Why is "Niacin" not the answer?

Niacin lowers VLDL production and does not inhibit cholesterol synthesis.

Why is "Fenofibrate" not the answer?

Fenofibrate acts through PPAR-alpha to lower triglycerides.

Why is "Colestipol" not the answer?

Colestipol binds bile acids in the gut and acts by a different mechanism.

What concept does this question test?

It tests Cardiovascular drugs: bempedoic acid in Pharmacology. Muscle lacks the activating enzyme, so myopathy is less common.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular drugs: bempedoic acid?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.