What cholesterol lowering drug is used for pregnant patients and those with liver disease?

A. HMG CoA reductase inhibitor: atorvastatin: Statins like atorvastatin are contraindicated in pregnancy and in clients with active liver disease because they can cause teratogenic effects and hepatotoxicity. They work by inhibiting cholesterol synthesis in the liver, which places additional strain on hepatic function. B. Vitamin B3: nicotinic acid: While niacin can lower cholesterol, it is poorly tolerated due to side effects such as flushing, hepatotoxicity, and glucose intolerance. It is not recommended for pregnant patients or those with liver disease due to its potential to worsen liver function. C. Bile acid sequestrant: cholestyramine: Cholestyramine is not absorbed systemically and therefore does not affect the fetus or liver directly. It is considered safer for pregnant women and those with liver disease, as it works locally in the GI tract to bind bile acids and promote cholesterol excretion. D. Fenofibrate: gemfibrozil: Fibrates like gemfibrozil are used to reduce triglyceride levels but are associated with liver enzyme elevations and potential hepatotoxicity. They are not the first choice for pregnant patients or individuals with liver disease due to these risks.