Pharmacology, part 22.3: Cardiovascular Medications - Bile Acid Sequestrants

Hi. I'm Cathy with Level Up RN. In this video, I will be discussing bile acid sequestrants. And at the end of the video, I'm going to give you guys a little quiz to test your understanding of some of the key facts I'll be going over, so be sure to stay for that.

Bile acid sequestrants are a drug class used to treat high cholesterol or hypercholesterolemia. Medications that fall within this drug class include colesevelam, which is brand name Welchol, and cholestyramine. So our cool chicken hint to help you remember these medications is to look at the beginning part of the drug names. If it starts with col, either C-H-O-L-E or C-O-L-E, then that is a strong indicator that that medication is used to lower cholesterol levels. Bile acid sequestrants work by binding to bile acids in the intestines, forming complexes that are excreted in the feces. The liver then has to make new bile acids to replace the lost ones, and it does this by converting cholesterol into bile acids, which in turn leads to lower levels of cholesterol in the bloodstream. Key side effects of bile acid sequestrants include constipation as well as other GI symptoms such as bloating and stomach pain. Because constipation is such a common side effect with this drug class, you want to advise your patient to increase their intake of fluids and fiber to help counteract this effect. Bile acid sequestrants are available both as a powder that you mix with a full glass of water and as a tablet. Either way, you need to advise your patient to take this medication with food. This is because this medication works by binding to bile acids, which are secreted during digestion of food.

Another important thing to note is that bile acid sequestrants can interfere with the absorption of fat-soluble vitamins, which includes vitamins A, D, E, and K. In some cases, supplementation may be necessary. And it's important that the patient take their supplement several hours before they take their bile acid sequestrant. Bile acid sequestrants also interfere with many other medications. So in general, other medications should be taken one hour before or four hours after taking a bile acid sequestrant. However, for colesevelam specifically, some medications, including oral contraceptives, will need to be taken four hours before taking colesevelam.

All right. It's quiz time. Who's excited? I've got three questions for you.

Question number one. Bile acid sequestrants should be taken on an empty stomach. True or false?

The answer is...false. They should be taken with food.

Question number two. Bile acid sequestrants interfere with the absorption of which vitamins?

The answer is...fat-soluble vitamins, which include vitamins A, D, E, and K.

Question number three. Why should an individual taking a bile acid sequestrant increase their fiber intake?

The answer is... to prevent constipation, which is a common side effect with this drug class.

All right. That's it for this video. I hope it was helpful. Take care, and thank you so much for watching.