Cardiovascular drugs: bile acid sequestrants: 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: bile acid sequestrants

Sample item

A man with mixed dyslipidaemia, triglyceride 480 mg per dL, is started on cholestyramine for a high LDL and returns with a higher triglyceride level. What explains this?

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

The answer and the reasoning

D. Increased hepatic VLDL synthesis

Bile acid sequestrants deplete bile acids and increase hepatic bile acid synthesis, which also stimulates VLDL production. Triglycerides therefore rise, and the drugs are avoided when triglycerides are markedly elevated.

Option by option

  • A. Inhibition of lipoprotein lipase activity

    Cholestyramine does not inhibit lipoprotein lipase.

  • B. Impaired clearance of chylomicron remnants

    Chylomicron clearance is not slowed by resins and this would not explain the change.

  • C. Blocked intestinal cholesterol absorption

    Blocking cholesterol absorption is the action of ezetimibe and would not raise triglycerides.

  • D. Increased hepatic VLDL synthesis (correct)

    Correct. The resin increases hepatic VLDL production and raises triglycerides.

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 D, Increased hepatic VLDL synthesis. Bile acid sequestrants deplete bile acids and increase hepatic bile acid synthesis, which also stimulates VLDL production.

Why is "Inhibition of lipoprotein lipase activity" not the answer?

Cholestyramine does not inhibit lipoprotein lipase.

Why is "Impaired clearance of chylomicron remnants" not the answer?

Chylomicron clearance is not slowed by resins and this would not explain the change.

Why is "Blocked intestinal cholesterol absorption" not the answer?

Blocking cholesterol absorption is the action of ezetimibe and would not raise triglycerides.

What concept does this question test?

It tests Cardiovascular drugs: bile acid sequestrants in Pharmacology. Triglycerides therefore rise, and the drugs are avoided when triglycerides are markedly elevated.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: bile acid sequestrants?

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.