Pharmacology · Lipid-Lowering
Two weapons. One battle. Your job is to know how they fight and why they work better together.
The board will ask: what happens to his lipids? Why take both? When should he take the statin?
↓ Begin
Trace It
Tap each step to watch the mevalonate pathway get dismantled.
Think of your liver as a cholesterol factory. It runs 24 hours a day, and the whole operation depends on one critical machine at step 3. Statins walk in and wreck that machine. Here is how the line runs:
Tap each step to unlock it
Trace It
It never enters the bloodstream. It works entirely in your gut.
Normally, your liver makes bile acids out of cholesterol. These bile acids get released into the gut to help digest fat. Then, crucially, about 95% of them get reabsorbed at the terminal ileum and recycled back to the liver.
Cholestyramine is a giant resin molecule that grabs bile acids in the gut and refuses to let them go.💡Cholestyramine = Cholesterol's thief: traps bile acids so the liver must steal LDL from blood to make more. They get excreted in the stool. The liver, now short on bile acids, has to make more. And the only way it knows how is to pull cholesterol from the blood.
Gut Diagram · Click to add cholestyramine
Interactive
Toggle each drug on or off. Watch how the numbers move.
No drugs active. Baseline lipid panel.
Game
One question. Classic board setup. What is the right answer?
Your patient is on both atorvastatin and cholestyramine. The pharmacist calls you: "What time should the patient take the statin relative to the cholestyramine?"
This is not about the drug. This is about cholestyramine's binding problem.
Game
Tap a drug on the left, then tap the side effect on the right to match them.
Each side effect belongs to one (or both) drugs. Match them all to win.
| Side Effect | Statin | Cholestyramine | Notes |
|---|---|---|---|
| Myopathy / Rhabdo | YES | No | Check CPK; risk with fibrates + niacin |
| Hepatotoxicity | YES | No | LFT > 3x → stop statin |
| Constipation / GI | No | YES | Major reason for non-compliance |
| Fat-soluble vitamin malabsorption | No | YES | Vitamins A, D, E, K |
| Raises TG | No | YES | Avoid if TG > 500 |
Context
Statins are first line. Know what comes after.
Know Your Drugs
Each drug is hiding something. Tap to flip and expose the side effects and board pearls.
Algorithm
From LDL goal to drug selection. Follow the branches.
Visual Context
Xanthomas, labs, and the lipid pathway made visible.
Scroll horizontally to see all images. Tap to expand.
Game
One patient. Four drug options. Clues appear one at a time. Tap the drug that gets ruled out by each clue. On the final clue, the pattern flips: tap the drug you would choose.
A patient with high LDL needs a new lipid-lowering drug. Each clue rules one drug out. Keep eliminating until only the right choice is left.
Algorithm
Primary lipid abnormality drives drug selection. Follow the branches.
Prove It
5 patients. All of them on lipid drugs. Let's see if you paid attention.
Original clinical vignettes. Shuffled, never-repeat, full explanations for every choice.