A client is taking ezetimibe (Zetia). How does Zetia work?

• A. Forms insoluble complexes and reduces circulating cholesterol in blood.
• B. Binds with bile acids in the intestines to reduce LDL levels.
• C. Inhibits HMG-CoA reductase, which is necessary for cholesterol production in the liver.
• D. Inhibits absorption of dietary cholesterol in the intestines.

Answer: (D)

Zetia works by blocking the transporter in the lining of the small intestine that takes up cholesterol from the diet and biliary cholesterol (NPC1L1). With less cholesterol absorbed, the liver senses a drop in cholesterol and responds by increasing LDL receptors, which pulls more LDL cholesterol from the bloodstream, lowering total LDL levels. This mechanism is distinct from statins, which inhibit cholesterol synthesis in the liver, and from bile acid sequestrants, which trap bile acids in the gut to reduce cholesterol reabsorption. Zetia specifically targets intestinal cholesterol absorption and does not form insoluble complexes or bind bile acids.