DRUG THERAPY OF HYPERLIPIDEMIA   1. Inhibition of Cholesterol Synthesis HMG-CoA Reductase Inhibitors (Statins) Atorvastatin, Rosuvastatin, Simvastatin, Pravastatin, Lovastatin   Mechanism Inhibit HMG-CoA reductase → ↓ hepatic cholesterol synthesis ↑ LDL receptors → ↑ LDL uptake from blood ↓ LDL, ↓ VLDL, mild ↑ HDL Lipid effects ↓↓↓ LDL (20–60%) ↓ TG (10–30%) ↑ HDL (5–10%) Pleiotropic (non-lipid) benefits ↓ inflammation & ROS ↓ endothelial dysfunction ↓ platelet aggregation Stabilize atherosclerotic plaques Pharmacokinetics (high yield) Oral CYP3A4 metabolism: atorvastatin, simvastatin, lovastatin → many drug interactions Pravastatin/rosuvastatin → minimal CYP metabolism → safer interactions Biliary excretion (mostly) Dose adjustment in renal disease (except atorvastatin preferred in severe CKD) Uses All dyslipidemias (first-line) ASCVD prevention (CAD, stroke prevention) Combination therapy with ezetimibe or PCSK9 inhibitors Adverse effects Myopathy → myositis → rhabdomyolysis (↑ CK) Worse with: fibrates (esp. gemfibrozil), niacin, colchicine Hepatotoxicity (↑ LFTs) ↑ Risk of type 2 DM Contraindicated in active liver disease Avoid in pregnancy & breastfeeding   2. ↑ Lipoprotein Lipase (LPL) Activation — Fibrates Fenofibrate (preferred), Gemfibrozil   Mechanism Activate PPAR-α → ↑ LPL activity ↑ TG breakdown → ↓ VLDL Lipid effects ↓↓↓ TG (35–50%) ↓ LDL (5–15%) ↑ HDL (5–20%) Uses Severe hypertriglyceridemia (pancreatitis prevention) Mixed dyslipidemia with high TG Adverse effects GI upset Myopathy (↑ with statins, especially gemfibrozil) Gallstones (↑ biliary cholesterol) Hepatotoxicity Possible ↑ CV risk (gemfibrozil concern) Key interaction Gemfibrozil ↑ statin toxicity (CYP inhibition) Pregnancy Avoid unless severe TG (>1000 risk pancreatitis)   3. Inhibition of Cholesterol Absorption Ezetimibe   Mechanism Blocks NPC1L1 transporter in intestinal brush border ↓ cholesterol absorption → ↓ hepatic cholesterol → ↑ LDL receptors Lipid effects ↓ LDL (~15–20%) Mild ↓ TG Slight ↑ HDL Uses Add-on to statins (very common) Statin intolerance Adverse effects Diarrhea Mild ↑ LFTs Myalgia (rare, ↑ with statins) Contraindications Active liver disease Pregnancy (limited data)   4. PCSK9 Inhibitors (MOST POWERFUL LDL-Lowering Drugs) Alirocumab, Evolocumab   Mechanism Inhibit PCSK9 → prevent LDL receptor degradation ↑ LDL receptors → massive LDL clearance Lipid effects ↓↓↓↓↓ LDL (40–70%) ↓ TG ↑ HDL Uses Familial hypercholesterolemia ASCVD patients needing additional LDL lowering Statin-resistant hyperlipidemia Adverse effects Injection site reactions URTI, nasopharyngitis Rare hypersensitivity Route Subcutaneous every 2–4 weeks   5. Omega-3 Fatty Acids Icosapent ethyl (EPA-only) Omega-3 acid ethyl esters (EPA + DHA)   Mechanism ↓ hepatic VLDL synthesis ↑ fatty acid oxidation ↑ LPL activity Anti-inflammatory effects Lipid effects ↓↓↓ TG (25–45%) ↑ HDL Minimal LDL effect (EPA-only preferred) Uses Severe hypertriglyceridemia ASCVD risk reduction (especially EPA-only formulation) Adverse effects Fishy taste (compliance issue) GI upset ↑ bleeding time at high doses (platelet inhibition)   Question: A 58-year-old man with a history of coronary artery disease is started on a medication that inhibits HMG-CoA reductase. Three weeks later, he reports muscle pain and weakness. Laboratory testing shows: Creatine kinase (CK): 12,300 U/L (normal: 30–200 U/L) AST/ALT: mildly elevated The patient is also taking gemfibrozil for hypertriglyceridemia. Which of the following best explains this patient’s condition?

DRUG THERAPY OF ARRHYTHMIAS   Class III — K⁺ Channel Blockers Class IIIa — Non-selective K⁺ Blockers: Dofetilide, Ibutilide, Sotalol, Dronedarone Mechanism: Block K⁺ efflux → ↑ AP duration & ↑ ERP → Prolong QT Uses: AF, VT, VF, WPW Adverse Effects ⚠️ Torsades de pointes Dronedarone: CI in HF ↑ mortality in permanent AF   Amiodarone (Special) “Antiarrhythmic shotgun” Class I, II, III, IV actions Pharmacokinetics Very long half-life (25–60 days) CYP3A4 interactions Uses Life-threatening arrhythmias only Major Adverse Effects (HIGH-YIELD) Pulmonary fibrosis Hepatotoxicity Hypo-/hyperthyroidism Corneal deposits Blue-gray skin discoloration Neurotoxicity   Class IV — Ca²⁺ Channel Blockers: Verapamil, Diltiazem Mechanism: Block L-type Ca²⁺ channels Effects ↓ SA node automaticity ↓ AV conduction Uses SVT AF   Miscellaneous: Magnesium Sulfate (MgSO₄) Mechanism: ↓ Ca²⁺ influx/release Uses Torsades de pointes (first-line) VT/VF (esp. hypomagnesemia) Adverse Effects Hypotension Respiratory depression ↓ reflexes   Question: A 72-year-old woman is brought to the emergency department after a syncopal episode. ECG shows polymorphic ventricular tachycardia consistent with torsades de pointes. She has a prolonged QT interval on baseline ECG. Which of the following is the first-line treatment?

To test for possible understatement of sales, the most appropriate direction of testing would be from

Confirming accounts receivable balances with customers primarily provides evidence about which financial statement assertion

In which of the following situations would an auditor choose between a qualified and an adverse opinion?

Shell is a customer of Beach Co. and had an outstanding accounts receivable balance of $20,000 at December 31, 2025. You sent an A/R confirmation and Shell wrote back saying their balance as of 12/31/2025 was $1,000. You determine that on December 30, 2025, Shell mailed a check to Beach Co.  for $19,000.  Beach Co. received the check on January 2, 2026. What amount should be recorded in A/R on 12/31/2025 related to Shell Co’s balance?

On 2/13/2026, the audit firm completed their audit procedures and had obtained sufficient appropriate evidence to sign off on the audit report.  On 2/14/2026 an event came to the auditor’s attention that should be disclosed in the footnotes.  The event was properly disclosed by the client in footnote 18 and the financial statements were released on 2/15/2026. Which date option has less liability for the auditor?

The negative form of accounts receivable can be used when the risk of material misstatement is 

Gator Company had financial difficulties for the year ending 12/31/2024 and the auditor included language related to the client’s ability to continue as a going concern in the FY 2024 audit report. Gator Co. is doing much better financially in FY 2025 and there is no longer any substantial doubt about Gator Co’s ability to continue as a going concern as of 12/31/2025.  Two years of financial statements are presented when financial statements and the audit report are released.  What should occur related to auditor reporting?

The sample size of a test of controls moves in the opposite direction (i.e. inversely) with