Learning Cardiology

 Bempedoic Acid A novel nonstatin drug that inhibits cholesterol biosynthesis in liver. Prodrug → converted to active form in liver, not in muscles. # Mechanism of action → ATP-citrate lyase inhibitor. • No muscular side effects. • Does not worsen glycemic control • side effects → Hyperuricemia and gout  Slightly increased risk of tendon rupture ⇒ Major clinical trial - CLEAR wisdom and CLEAR Outcomes ⇒ Indications at present: 1. LDL not effectively reduced with statins -As additional therapy 2. Patients not tolerating stating due to side effects -As monotherapy

Cardiology MCQ Q. What is the mechanism of action of drug Bempedoic acid? A. ATP citrate lyase inhibitor B. HMG CoA reductase inhibitor C. Niemann–Pick C1-like 1 protein (NPC1L1) inhibitor D. PCSK9 inhibitor

Q. All of the following have shown mortality benefit in heart failure except? A. Eplerenone B. Enalapril C. Digoxin D. Metoprolol Answer: C. Digoxin Explanation: Drugs which have shown mortality benefit in patients with heart failure with reduced ejection fraction (HFrEF) are- 1. Beta blockers 2. ACE inhibitors 3. Angiotensin receptor blockers 4. Aldosterone antagonist Digoxin did not show any survival advantage in these patients. None of drugs till date have shown mortality benefit in patients with heart failure with preserved ejection fraction (HFpEF).

Q.  A patient with atrial fibrillation was prescribed  digoxin.  What does it bind to in order to generate its  mode of action? A. Calcium channel B. Potassium channel C.  Na-Ca transporter D. Na / K- ATPase   Answer: D.    Na / K- ATPase   Explanation:  Digoxin belongs to cardiac glycoside group of medications. It is obtained from foxglove plant. Half life is 36 hours . Mechanism of action: Inhibition of Na/K ATPase and ultimately increased intracellular calcium. Eliminated mainly by renal excretion through P-glycoproteins . Narrow therapeutic index. Can cause gynecomastia . Effective plasma level between 0.5 to 1.0 ng/ml .