cholestyramine Nursing Considerations & Management

 Drug Name

Generic Name : cholestyramine

Brand Name: Cholestyramine Light, Prevalite, Questran, Questran Light

Classification: Antihyperlipidemic, Bile acid sequestrant

Pregnancy Category Not Established

Dosage & Route
Adults
  • Initially, 4 g one to two times per day PO. Individualize dose based on response. For maintenance, 8–16 g/day divided into two doses. Increase dose gradually with periodic assessment of lipid/lipoprotein levels at intervals of > 4 wk. Maximum dose 6 packets or scoopfuls. May be administered 1–6 doses/day. Dosage may be as high as 36 g every day.
    • Skin and skin structure infections: 500 mg PO q 12 hr. Larger doses may be needed in severe cases; do not exceed 4 g/day.
Pediatric Patients
  • Safety and efficacy not established.
Therapeutic actions
  • Binds bile acids in the intestine, allowing excretion in the feces; as a result, cholesterol is oxidized in the liver to replace the bile acids lost; serum cholesterol and LDL are lowered.
Indications
  • Adjunctive therapy: Reduction of elevated serum cholesterol in patients with primary hypercholesterolemia (elevated LDL)
  • Pruritus associated with partial biliary obstruction
  • Unlabeled uses: Antibiotic-induced pseudomembranous colitis; chlordecone (Kepone) pesticide poisoning to bind the poison in the intestine; treatment of thyroid hormone overdose, treatment of digitalis toxicity
Adverse effects
  • Constipation; fecal impaction; hemorrhoids; abdominal discomfort or pain; heartburn; flatulence; nausea; vomiting; diarrhea; increased bleeding tendency (chronic use); osteoporosis; stetorrhea (high doses); skin rashes; pruritus of the tongue, skin and perianal region; hyperchloremic acidosis.
Contraindications
  • Complete biliary obstruction; hypersensitivity.
Nursing considerations
Assessment
  • History: Allergy to bile acid sequestrants, tartrazine; complete biliary obstruction; abnormal intestinal function; lactation, pregnancy
  • Physical: Skin lesions, color, T; orientation, affect, reflexes; P, auscultation, baseline ECG, peripheral perfusion; liver evaluation, bowel sounds; lipid studies, LFTs, clotting profile
Interventions
  • Mix contents of one packet or one level scoop of powder with 2–6 fluid oz of beverage (water, milk, fruit juices, noncarbonates), highly fluid soup, pulpy fruits (applesauce, pineapple); do not give drug in dry form.
  • Administer drug before meals.
  • WARNING: Monitor intake of other oral drugs due to risk of binding in the intestine and delayed or decreased absorption, give oral medications 1 hr before or 4–6 hr after the cholestyramine.
  • Alert patient and concerned others about high cost of drug.
Teaching points
  • Take drug before meals; do not take the powder in the dry form; mix one packet or one scoop with 2–6 ounces of fluid—water, milk, juice, noncarbonated drinks, highly fluid soups, cereals, pulpy fruits such as applesauce or pineapple.
  • Take other medications 1 hour before or 4–6 hours after cholestyramine.
  • You may experience these side effects: Constipation (ask about measures that may help); nausea, heartburn, loss of appetite (eat frequent small meals); dizziness, drowsiness, vertigo, fainting (avoid driving and operating dangerous machinery); headache, muscle and joint aches and pains (may lessen with time).
  • Report unusual bleeding or bruising, severe constipation, severe GI upset, chest pain, difficulty breathing, rash, fever.