Lipid-lowering drugs: statin interactions: 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 · Lipid-lowering drugs: statin interactions

Sample item

A patient on simvastatin starts clarithromycin and soon develops severe myalgia with a markedly raised creatine kinase. What is the likely interaction?

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

The answer and the reasoning

A. CYP3A4 inhibition raises simvastatin exposure

Clarithromycin inhibits CYP3A4, the major metabolic pathway for simvastatin, increasing the risk of myopathy and rhabdomyolysis. Avoidance or an alternative statin/antibiotic is appropriate.

Option by option

  • A. CYP3A4 inhibition raises simvastatin exposure (correct)

    Correct. Increased simvastatin concentration drives muscle toxicity.

  • B. Vitamin K antagonism causes myopathy

    Vitamin K pathways do not explain statin myopathy.

  • C. P-glycoprotein induction lowers simvastatin exposure

    Induction would lower, not raise, drug concentration.

  • D. Chelation prevents simvastatin absorption

    Chelation is typical of tetracyclines or fluoroquinolones with cations.

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 A, CYP3A4 inhibition raises simvastatin exposure. Clarithromycin inhibits CYP3A4, the major metabolic pathway for simvastatin, increasing the risk of myopathy and rhabdomyolysis.

Why is "Vitamin K antagonism causes myopathy" not the answer?

Vitamin K pathways do not explain statin myopathy.

Why is "P-glycoprotein induction lowers simvastatin exposure" not the answer?

Induction would lower, not raise, drug concentration.

Why is "Chelation prevents simvastatin absorption" not the answer?

Chelation is typical of tetracyclines or fluoroquinolones with cations.

What concept does this question test?

It tests Lipid-lowering drugs: statin interactions in Pharmacology. Avoidance or an alternative statin/antibiotic is appropriate.

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 Lipid-lowering drugs: statin interactions?

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.