A 25 -year-old male presented to the emergency department with head trauma due to a road traffic accident. In the hospital, the patient developed seizures, and an emergency CT scan revealed widespread cerebral edema. Which of the following is the diuretic of choice for cerebral edema in this patient?
Q2
A person was taking an antihypertensive drug and continued taking it despite developing constipation, dry mouth, and dizziness. He was taking it regularly but forgot to take it during a trip abroad and has now developed a hypertensive emergency. Which antihypertensive was he likely taking?
Q3
A patient presents with hypertension and has a history of renal stones, along with several episodes of renal colic. Which diuretic is the most appropriate to use?
Q4
Which of the following cardioselective betablockers has been shown to decrease mortality in patients with congestive heart failure?
Q5
A hypertensive patient wants to conceive. Which of the following medications needs to be stopped before pregnancy?
Q6
A patient with hypertension, peripheral edema, and chronic kidney disease (CKD) presents for management. Which of the following medications would be the best choice?
Q7
A 38-year-old male presents to his primary care doctor with 8 months of uncontrollable anxiety. He states that he experiences overwhelming anxiety and worry in performing just ordinary tasks of daily living. He is started on venlafaxine for treatment of generalized anxiety disorder. Which of the following is a potential side effect of this medication?
Q8
A 61-year-old woman presents to her primary care provider with complaints of fatigue, weight gain of 5.5 kg (12.1 lb) and intermittent nausea over the past 4 months. She denies any changes to her diet. She has had type 2 diabetes mellitus for the past 27 years complicated by diabetic neuropathy. Vital signs include: temperature 37.0°C (98.6°F), blood pressure 167/98 mm Hg and pulse 80/min. Physical examination reveals bilateral pitting lower-extremity edema. Fundoscopic examination reveals bilateral micro-aneurysms and cotton wool patches. Her serum creatinine is 2.6 mg/dL. Which of the following is the best initial therapy for this patient?
Q9
A 63-year-old woman presents to her physician with hip pain. She has had pain in both hips for almost 5 years, and it has progressed over time. She notes that it gets worse as the day goes on, making it difficult for her to walk her small dog in the evening. She has a little morning stiffness which subsides quickly after she starts to walk. In the last week, her pain became worse. The past medical history includes hypertension, hyperlipidemia, and mild hypothyroidism. She takes captopril, atorvastatin, and levothyroxine. She has also been taking acetaminophen almost every day with a dose increase up to 4,000 mg, but there is no significant decrease in pain. Both of her parents died in their 80's. The blood pressure is 135/85 mm Hg, heart rate is 74/min, respiratory rate is 12/min, and the temperature is 37.0°C (98.6°F). The BMI is 35 kg/m2. On physical examination, the leg strength is normal bilaterally. The neurological exam of both upper and lower extremities is normal. Her gait is difficult to assess due to pain. A radiograph of her left hip joint is shown in the image below. Which of the following is the most appropriate treatment for the patient’s condition?
Q10
A 56-year-old woman presents to the physician for a routine health maintenance examination. She has no history of a serious illness and takes no medications. She exercises every day and follows a healthy diet. She does not smoke and consumes alcohol moderately. There is no family history of chronic disease. Her blood pressure is 145/92 mm Hg, which is confirmed on a repeat measurement. Her BMI is 23 kg/m2. The physical examination shows no abnormal findings. The laboratory test results show:
Serum
Total cholesterol 193 mg/dL
Low-density lipoprotein (LDL-C) 124 mg/dL
High-density lipoprotein (HDL-C) 40 mg/dL
Triglycerides 148 mg/dL
Her 10-year risk of CVD is 3.6%. Antihypertensive medication is initiated for her elevated blood pressure. Which of the following is the most appropriate additional pharmacotherapy at this time?
Antihypertensives US Medical PG Practice Questions and MCQs
Question 1: A 25 -year-old male presented to the emergency department with head trauma due to a road traffic accident. In the hospital, the patient developed seizures, and an emergency CT scan revealed widespread cerebral edema. Which of the following is the diuretic of choice for cerebral edema in this patient?
A. A. Mannitol (Correct Answer)
B. B. Spironolactone
C. C. Furosemide
D. D. Hydrochlorothiazide
E. E. Acetazolamide
Explanation: ***Mannitol***
- **Mannitol** is an osmotic diuretic that creates an osmotic gradient, drawing water from the brain parenchyma into the intravascular space, thereby reducing **cerebral edema**.
- Its rapid onset of action and ability to cross an intact blood-brain barrier sparingly makes it the drug of choice for acute management of elevated intracranial pressure due to **cerebral edema**.
*Spironolactone*
- **Spironolactone** is a potassium-sparing diuretic that primarily acts on the distal tubules to inhibit aldosterone, leading to sodium and water excretion.
- It is unsuitable for acute cerebral edema as its diuretic effect is too slow and it does not create the necessary osmotic gradient.
*Furosemide*
- **Furosemide** is a loop diuretic that inhibits sodium-potassium-chloride co-transporter in the loop of Henle, leading to significant diuresis.
- While it can remove fluid, it does not create the same osmotic gradient as mannitol and is less effective at rapidly reducing **intracranial pressure** directly related to cerebral edema.
*Hydrochlorothiazide*
- **Hydrochlorothiazide** is a thiazide diuretic that primarily acts on the distal convoluted tubule to inhibit sodium reabsorption.
- Its diuretic action is too slow and relatively mild for the acute management of severe conditions like **cerebral edema**.
*Acetazolamide*
- **Acetazolamide** is a carbonic anhydrase inhibitor that reduces CSF production and has a role in chronic management of idiopathic intracranial hypertension.
- However, it is not suitable for acute cerebral edema following trauma as its onset is too slow and its diuretic effect is relatively weak compared to osmotic diuretics.
Question 2: A person was taking an antihypertensive drug and continued taking it despite developing constipation, dry mouth, and dizziness. He was taking it regularly but forgot to take it during a trip abroad and has now developed a hypertensive emergency. Which antihypertensive was he likely taking?
A. Amlodipine
B. Clonidine (Correct Answer)
C. Lisinopril
D. Telmisartan
E. Metoprolol
Explanation: **Clonidine**
- The described symptoms of **constipation, dry mouth, and dizziness** are common side effects of **clonidine**, an alpha-2 adrenergic agonist.
- The development of a **hypertensive emergency** upon abrupt cessation of the drug strongly suggests clonidine, as it is known for causing **rebound hypertension** due to a sudden increase in sympathetic outflow.
*Amlodipine*
- **Amlodipine**, a dihydropyridine calcium channel blocker, primarily causes **peripheral edema, headache, and flushing**, not typically constipation or rebound hypertension upon withdrawal.
- While it can cause dizziness, the combination of side effects and withdrawal symptoms does not fit amlodipine.
*Lisinopril*
- **Lisinopril**, an ACE inhibitor, is known for causing **cough and angioedema**.
- It does not typically cause constipation, dry mouth, or rebound hypertension upon discontinuation.
*Telmisartan*
- **Telmisartan**, an angiotensin receptor blocker (ARB), generally has a **favorable side effect profile** and does not commonly cause constipation or dry mouth.
- Withdrawal of ARBs does not typically lead to a **hypertensive emergency** in the way clonidine does.
*Metoprolol*
- **Metoprolol**, a beta-blocker, can cause **fatigue and bradycardia** but does not typically cause the anticholinergic effects (dry mouth, constipation) seen with clonidine.
- While abrupt withdrawal of beta-blockers can lead to rebound tachycardia and hypertension, the severity and acute nature of the hypertensive emergency described is more characteristic of clonidine withdrawal.
Question 3: A patient presents with hypertension and has a history of renal stones, along with several episodes of renal colic. Which diuretic is the most appropriate to use?
A. Furosemide
B. Hydrochlorothiazide (Correct Answer)
C. Ethacrynic acid
D. Spironolactone
E. Indapamide
Explanation: **Hydrochlorothiazide**
- **Thiazide diuretics** like hydrochlorothiazide reduce urinary calcium excretion, which is beneficial in patients with a history of **calcium renal stones**.
- This effect helps prevent the recurrence of renal stones while also treating hypertension.
- Among thiazide and thiazide-like diuretics, hydrochlorothiazide has the **most established evidence** for preventing calcium stone recurrence.
*Furosemide*
- Furosemide is a **loop diuretic** that increases urinary calcium excretion, which would exacerbate the risk of renal stone formation.
- While effective for hypertension, its effect on calcium makes it unsuitable for this patient.
*Ethacrynic acid*
- Ethacrynic acid is also a **loop diuretic** with similar effects to furosemide, including increasing urinary calcium excretion.
- This makes it an inappropriate choice for a patient with a history of renal stones.
*Spironolactone*
- Spironolactone is a **potassium-sparing diuretic** that works by antagonizing aldosterone, primarily affecting sodium and potassium excretion.
- It does not significantly impact urinary calcium excretion in a way that would prevent calcium renal stones, nor is it a first-line agent for hypertension with co-existing renal stones.
*Indapamide*
- Indapamide is a **thiazide-like diuretic** with some calcium-retaining properties, but it is less effective than hydrochlorothiazide in reducing calcium excretion.
- While it can be used for hypertension, **hydrochlorothiazide is preferred** specifically for preventing calcium stone recurrence due to stronger evidence and greater effect on reducing urinary calcium.
Question 4: Which of the following cardioselective betablockers has been shown to decrease mortality in patients with congestive heart failure?
A. Propranolol
B. Bisoprolol (Correct Answer)
C. Labetalol
D. Pindolol
E. Atenolol
Explanation: ***Bisoprolol***
- **Bisoprolol** is a highly cardioselective beta-1 blocker that has been extensively studied and proven to reduce mortality and morbidity in patients with **systolic congestive heart failure**.
- It is one of the **"big three" beta-blockers** (along with **carvedilol** and **metoprolol succinate**) recommended for chronic heart failure management by major cardiology guidelines, supported by the **CIBIS-II trial**.
*Atenolol*
- **Atenolol** is a cardioselective beta-1 blocker commonly used for hypertension and angina.
- Despite being cardioselective, it has **not been shown to reduce mortality** in patients with chronic heart failure and is generally **not recommended** for this indication due to lack of supportive clinical trial evidence.
*Propranolol*
- **Propranolol** is a non-selective beta-blocker that blocks both beta-1 and beta-2 receptors.
- While effective for conditions like angina and arrhythmias, it is generally **not recommended** for chronic heart failure due to its non-selectivity and lack of evidence for mortality reduction in this specific patient population.
*Labetalol*
- **Labetalol** is an alpha- and beta-adrenergic blocker, often used in hypertensive emergencies and for managing hypertension in pregnancy.
- It is **not indicated** for mortality reduction in chronic heart failure due to its different pharmacological profile and lack of clinical trial evidence supporting its use for this purpose.
*Pindolol*
- **Pindolol** is a non-selective beta-blocker with **intrinsic sympathomimetic activity (ISA)**, meaning it partially stimulates beta-receptors while blocking the effects of norepinephrine and epinephrine.
- Beta-blockers with ISA are generally **contraindicated** in heart failure because their partial agonist activity can potentially worsen myocardial function, and they have not shown any mortality benefit.
Question 5: A hypertensive patient wants to conceive. Which of the following medications needs to be stopped before pregnancy?
A. ACE inhibitors (Correct Answer)
B. Alpha Methyl dopa
C. Calcium Channel Blockers
D. Labetalol
E. Hydralazine
Explanation: ***ACE inhibitors***
- **ACE inhibitors** are **teratogenic** and can cause **fetal kidney damage**, **oligohydramnios**, and **fetal death** if used during pregnancy.
- They should be discontinued before conception or immediately upon pregnancy confirmation, and an alternative safe antihypertensive should be initiated.
*Alpha Methyl dopa*
- **Alpha-methyldopa** is considered one of the **first-line agents** for managing **hypertension in pregnancy** due to its established safety profile.
- It reduces peripheral resistance without significantly affecting renal or uteroplacental blood flow.
*Calcium Channel Blockers*
- **Calcium channel blockers (CCBs)** like nifedipine and amlodipine are **generally considered safe** for use during pregnancy, especially dihydropyridines.
- They are often used as **second-line treatments** for managing hypertension in pregnant women.
*Labetalol*
- **Labetalol** is a **beta-blocker** that is widely used and considered **safe** for treating **hypertension in pregnancy**.
- It effectively lowers blood pressure without significant adverse effects on the fetus.
*Hydralazine*
- **Hydralazine** is a direct vasodilator that is **safe** for use in pregnancy and is commonly used for **acute management** of severe hypertension in pregnant women.
- It has a long history of safe use during pregnancy without teratogenic effects.
Question 6: A patient with hypertension, peripheral edema, and chronic kidney disease (CKD) presents for management. Which of the following medications would be the best choice?
A. Aliskiren
B. Beta blocker
C. Prazosin
D. Chlorthalidone (Correct Answer)
E. Furosemide
Explanation: ***Chlorthalidone***
- **Chlorthalidone** is a **thiazide-type diuretic** that is effective in managing hypertension and associated edema, even in patients with moderate CKD (eGFR >30 mL/min/1.73m²).
- Its long duration of action and proven cardiovascular benefits make it a good choice for hypertension control in this clinical context.
- **Superior to loop diuretics for blood pressure control** and has better evidence for reducing cardiovascular events.
*Aliskiren*
- **Aliskiren** is a **direct renin inhibitor** that blocks the renin-angiotensin-aldosterone system (RAAS).
- However, in patients with CKD, particularly those with existing hypertension and peripheral edema, it is generally **not preferred due to potential risks** of hyperkalemia, renal impairment, and hypotension, especially when combined with ACE inhibitors or ARBs.
*Beta blocker*
- While **beta-blockers** can treat hypertension, they are **not the first-line choice** for patients with both hypertension and significant peripheral edema.
- They also have potential side effects like bradycardia, fatigue, and bronchospasm, and may mask symptoms of hypoglycemia in diabetic patients.
*Prazosin*
- **Prazosin** is an **alpha-1 adrenergic blocker** that can reduce blood pressure but is primarily used for **hypertension with benign prostatic hyperplasia (BPH)** due to its dilating effect on the bladder neck.
- It's **not typically a first-line agent** for essential hypertension with peripheral edema and carries a risk of **first-dose syncope**.
*Furosemide*
- **Furosemide** is a **loop diuretic** that is more effective than thiazides for managing edema, especially in severe CKD (eGFR <30).
- However, for **blood pressure control** in patients with moderate CKD and edema, **thiazide-type diuretics like chlorthalidone are preferred** due to their superior antihypertensive efficacy and cardiovascular benefits.
- Loop diuretics have a shorter duration of action and are less effective for chronic hypertension management.
Question 7: A 38-year-old male presents to his primary care doctor with 8 months of uncontrollable anxiety. He states that he experiences overwhelming anxiety and worry in performing just ordinary tasks of daily living. He is started on venlafaxine for treatment of generalized anxiety disorder. Which of the following is a potential side effect of this medication?
A. Hypertension (Correct Answer)
B. Priapism
C. Increased urination
D. Weight gain
E. Seizures
Explanation: ***Hypertension***
- **Venlafaxine** is a serotonin-norepinephrine reuptake inhibitor (SNRI) that can increase **blood pressure**, particularly at higher doses, due to its effect on norepinephrine reuptake.
- Patients initiating venlafaxine should have their **blood pressure monitored** regularly.
*Priapism*
- **Priapism** (a prolonged erection) is a rare but severe side effect more commonly associated with certain atypical antipsychotics (e.g., trazodone) or alpha-blockers, not typically venlafaxine.
- While various antidepressant classes can affect sexual function, priapism is not a characteristic side effect of SNRIs like venlafaxine.
*Increased urination*
- **Increased urination** is not a common or significant side effect of venlafaxine.
- Antidepressants can sometimes cause urinary retention or hesitancy due to anticholinergic effects, but venlafaxine has relatively weak anticholinergic properties.
*Weight gain*
- While some antidepressants, particularly some tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), are associated with **weight gain**, venlafaxine is often considered weight-neutral or may even cause **modest weight loss** in some individuals.
- Significant weight gain is not a primary side effect to anticipate with venlafaxine.
*Seizures*
- Although any antidepressant can lower the **seizure threshold** to some extent, venlafaxine's risk is generally low and comparable to other antidepressants, especially at therapeutic doses.
- A history of seizures often warrants careful consideration when prescribing antidepressants, but seizures are not a common or dose-limiting side effect for most patients taking venlafaxine.
Question 8: A 61-year-old woman presents to her primary care provider with complaints of fatigue, weight gain of 5.5 kg (12.1 lb) and intermittent nausea over the past 4 months. She denies any changes to her diet. She has had type 2 diabetes mellitus for the past 27 years complicated by diabetic neuropathy. Vital signs include: temperature 37.0°C (98.6°F), blood pressure 167/98 mm Hg and pulse 80/min. Physical examination reveals bilateral pitting lower-extremity edema. Fundoscopic examination reveals bilateral micro-aneurysms and cotton wool patches. Her serum creatinine is 2.6 mg/dL. Which of the following is the best initial therapy for this patient?
A. Perindopril (Correct Answer)
B. Diltiazem
C. Hydrochlorothiazide
D. Labetalol
E. Metoprolol
Explanation: ***Perindopril***
- This patient exhibits signs of **diabetic nephropathy**, including a history of long-standing diabetes, elevated blood pressure, peripheral edema, and a significantly increased serum creatinine. **ACE inhibitors** like perindopril are the preferred initial therapy for hypertension in diabetic patients with renal disease, as they **reduce proteinuria** and **slow the progression of kidney damage**.
- The presence of **retinopathy** (micro-aneurysms and cotton wool patches) further supports the diagnosis of microvascular complications of diabetes, for which ACE inhibitors offer protective benefits.
*Diltiazem*
- While **non-dihydropyridine calcium channel blockers** such as diltiazem can reduce proteinuria and are an option for blood pressure control in diabetic nephropathy, they are generally considered **second-line** after ACE inhibitors or ARBs.
- They do not offer the same extensive evidence for preventing the progression of renal disease as ACE inhibitors.
*Hydrochlorothiazide*
- **Thiazide diuretics** can be used as **antihypertensive agents**, but they are **less effective** in patients with a **creatinine clearance below 30 mL/min**, which is likely the case here with a creatinine of 2.6 mg/dL.
- They do not provide the specific renoprotective benefits, such as reducing proteinuria, that ACE inhibitors offer in diabetic nephropathy.
*Labetalol*
- **Labetalol is a beta-blocker/alpha-blocker** that can effectively lower blood pressure. However, it does not offer the specific renoprotective benefits, such as significant reduction in proteinuria or slowing the progression of kidney disease, that **ACE inhibitors** provide in diabetic nephropathy.
- While useful for blood pressure control, it's not the **best initial therapy** in this specific context.
*Metoprolol*
- **Metoprolol is a beta-1 selective beta-blocker** used for hypertension and other cardiac conditions. Similar to labetalol, while it can lower blood pressure, it **does not offer the specific renoprotective advantages** of ACE inhibitors in diabetic patients with nephropathy.
- Beta-blockers are generally not the first-line choice for hypertension in diabetic patients with proteinuria, especially when ACE inhibitors are indicated.
Question 9: A 63-year-old woman presents to her physician with hip pain. She has had pain in both hips for almost 5 years, and it has progressed over time. She notes that it gets worse as the day goes on, making it difficult for her to walk her small dog in the evening. She has a little morning stiffness which subsides quickly after she starts to walk. In the last week, her pain became worse. The past medical history includes hypertension, hyperlipidemia, and mild hypothyroidism. She takes captopril, atorvastatin, and levothyroxine. She has also been taking acetaminophen almost every day with a dose increase up to 4,000 mg, but there is no significant decrease in pain. Both of her parents died in their 80's. The blood pressure is 135/85 mm Hg, heart rate is 74/min, respiratory rate is 12/min, and the temperature is 37.0°C (98.6°F). The BMI is 35 kg/m2. On physical examination, the leg strength is normal bilaterally. The neurological exam of both upper and lower extremities is normal. Her gait is difficult to assess due to pain. A radiograph of her left hip joint is shown in the image below. Which of the following is the most appropriate treatment for the patient’s condition?
A. Addition of intra-articular hyaluronic acid injections
B. Switching acetaminophen to meloxicam (Correct Answer)
C. Switching acetaminophen to oral methylprednisolone
D. Increasing the dose of acetaminophen to 6000 mg per day
E. Addition of glucosamine supplementation
Explanation: ***Switching acetaminophen to meloxicam***
- The patient presents with classic symptoms of **osteoarthritis (OA)**, including progressive hip pain, worsening with activity, and minimal morning stiffness, along with radiographic evidence of severe OA (joint space narrowing, osteophytes, subchondral sclerosis, and cysts) in the left hip. As **acetaminophen (paracetamol)** at 4000 mg/day is no longer effective, a **non-steroidal anti-inflammatory drug (NSAID)** like meloxicam is the next appropriate step for pain management in OA, especially given her relatively healthy status for NSAID use.
- **Meloxicam** is a selective COX-2 inhibitor, which may have a slightly lower risk of gastrointestinal side effects compared to non-selective NSAIDs, making it a reasonable choice if tolerated.
*Addition of intra-articular hyaluronic acid injections*
- **Intra-articular hyaluronic acid injections** (viscosupplementation) are sometimes used in knee osteoarthritis, but their effectiveness in **hip osteoarthritis** is less well-established and generally considered for patients who have failed oral therapies and are not yet candidates for surgery.
- Given the severe radiographic findings, this patient is likely beyond the stage where these injections would provide significant long-term relief, and oral NSAIDs should be tried first if acetaminophen failed.
*Switching acetaminophen to oral methylprednisolone*
- **Oral corticosteroids** like methylprednisolone are generally **not recommended** for the long-term management of osteoarthritis due to significant systemic side effects such as osteoporosis, hyperglycemia, and immunosuppression.
- While they can provide temporary pain relief due to their anti-inflammatory properties, their chronic use for OA is discouraged.
*Increasing the dose of acetaminophen to 6000 mg per day*
- The **maximum recommended daily dose of acetaminophen** for adults is generally 3000-4000 mg (3-4 grams) to avoid **hepatotoxicity**.
- Increasing the dose to 6000 mg (6 grams) per day would significantly increase the risk of **severe liver damage** and is therefore contraindicated.
*Addition of glucosamine supplementation*
- **Glucosamine supplementation** has shown **inconsistent efficacy** in clinical trials for osteoarthritis and is generally not recommended as a primary treatment.
- There is little evidence to support its ability to slow disease progression or significantly reduce pain in moderate to severe osteoarthritis, particularly when compared to proven pain management strategies like NSAIDs.
Question 10: A 56-year-old woman presents to the physician for a routine health maintenance examination. She has no history of a serious illness and takes no medications. She exercises every day and follows a healthy diet. She does not smoke and consumes alcohol moderately. There is no family history of chronic disease. Her blood pressure is 145/92 mm Hg, which is confirmed on a repeat measurement. Her BMI is 23 kg/m2. The physical examination shows no abnormal findings. The laboratory test results show:
Serum
Total cholesterol 193 mg/dL
Low-density lipoprotein (LDL-C) 124 mg/dL
High-density lipoprotein (HDL-C) 40 mg/dL
Triglycerides 148 mg/dL
Her 10-year risk of CVD is 3.6%. Antihypertensive medication is initiated for her elevated blood pressure. Which of the following is the most appropriate additional pharmacotherapy at this time?
A. No pharmacotherapy at this time
B. Evolocumab
C. Cholestyramine
D. Ezetimibe
E. Atorvastatin (Correct Answer)
Explanation: ***Atorvastatin***
- This patient meets the criteria for initiating a **moderate-intensity statin** due to her **elevated LDL-C (124 mg/dL)**, despite having a 10-year CVD risk below 7.5%.
- The patient has **hypertension (BP 145/92 mmHg)** and elevated LDL-C, which are major risk factors for **atherosclerotic cardiovascular disease (ASCVD)**. Current guidelines recommend statin therapy for primary prevention in individuals with LDL-C ≥ 70 mg/dL and multiple ASCVD risk factors.
*No pharmacotherapy at this time*
- This is incorrect because the patient has several risk factors (hypertension, elevated LDL-C for her age) that warrant intervention, specifically for **dyslipidemia**.
- While her 10-year CVD risk is low, individual risk factors such as **hypertension** and **elevated LDL-C** still need to be addressed to prevent future events.
*Evolocumab*
- **Evolocumab** is a PCSK9 inhibitor, typically reserved for patients with very high LDL-C who cannot achieve target levels with statins, or in cases of **familial hypercholesterolemia**.
- It is not a first-line agent for a patient with moderately elevated LDL-C and no history of cardiovascular events.
*Cholestyramine*
- **Cholestyramine** is a **bile acid sequestrant** used primarily to lower LDL-C, but it can sometimes *increase triglycerides*.
- Statins are generally preferred as a first-line therapy because they provide superior LDL-C reduction and have pleiotropic effects, including anti-inflammatory properties, making them more effective for global cardiovascular risk reduction.
*Ezetimibe*
- **Ezetimibe** works by inhibiting cholesterol absorption and is often used as add-on therapy for patients who cannot reach their LDL-C goals with statins alone, or for those who are **statin-intolerant**.
- It is not recommended as initial monotherapy in this patient given their moderate LDL-C elevation and the clear indication for a statin.
