Cholestyramine

INTRODUCTION

Indications

Management of primary hypercholesterolemia. Pruritus associated with elevated levels of bile acids. Unlabeled Use: Diarrhea associated with excess bile acids.

Action

Bind bile acids in the GI tract, forming an insoluble complex. Result is increased clearance of cholesterol. Therapeutic Effects: Decreased plasma cholesterol and low-density lipoproteins (LDLs). Decreased pruritus.

Adverse Reactions/Side Effects

EENT: irritation of the tongue. GI: abdominal discomfort, constipation, nausea, fecal impaction, flatulence, hemorrhoids, perianal irritation, steatorrhea, vomiting. Derm: irritation, rashes. F and E: hyperchloremic acidosis. Metab: vitamin A, D, and K deficiency.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hyperchloremic acidosis, including headache, lethargy, stupor, seizures, vision disturbances, increased respiration, cardiac arrhythmias, weakness, and GI symptoms (nausea, vomiting, abdominal pain). Notify physician immediately if these signs occur.

• Monitor signs of vitamin deficiencies, including deficiencies of vitamin A (vision disturbances, poor night vision), vitamin D (bone pain, muscle weakness, hypertension), and vitamin K (bleeding gums, nosebleeds, bruising). Notify physician if these signs persist.

Interventions

• Design and implement aerobic exercise and endurance training programs to improve cardiovascular function and help reduce the risk of coronary heart disease.

Patient/Client-Related Instruction

• Remind patients to take medication as directed to control hyperlipidemia even though they are asymptomatic.

• Counsel patients about additional interventions to help control lipid disorders and improve cardiovascular health, including dietary modification, regular exercise, moderation of alcohol consumption, and smoking cessation.

• Advise patient about the likelihood of GI problems including nausea, constipation, abdominal pain, flatulence, oily/foul smelling stools, hemorrhoids, and fecal impaction. Instruct patient to report severe or prolonged GI problems.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged tongue irritation or skin reactions (rash, irritation).

Pharmacokinetics

Absorption: Action takes place in the GI tract. No absorption occurs.

Distribution: No distribution.

Metabolism and Excretion: After binding bile acids, insoluble complex is eliminated in the feces.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Complete biliary obstruction; Some products contain aspartame and should be avoided in patients with phenylketonuria.

Use Cautiously in: History of constipation. Exercise Extreme Caution in: Children (may cause intestinal obstruction; deaths have occurred).

Interactions

Drug-Drug: May ↓ absorption/effects of orally administered ...