21.3 Bile Acid Sequestrants, Fibrates, and Niacin

Lowering cholesterol isn't just about statins. Bile acid sequestrants, fibrates, and niacin are powerful allies in the fight against high lipids. These meds work in different ways to tackle LDL, triglycerides, and boost good HDL.

Each drug has its quirks. Bile acid sequestrants can cause tummy troubles and mess with other meds. Fibrates might make muscles ache. Niacin can make you flush like crazy. But with the right know-how, these side effects can be managed for better heart health.

Bile Acid Sequestrants, Fibrates, and Niacin

Bile acid sequestrants, fibrates, niacin lipid-lowering agents

• Bile acid sequestrants bind to bile acids in intestine preventing reabsorption primarily lowering LDL cholesterol (cholestyramine, colestipol, colesevelam)
• Fibrates activate peroxisome proliferator-activated receptor alpha (PPAR-α) primarily lowering triglycerides increasing HDL cholesterol (gemfibrozil, fenofibrate)
• Niacin (vitamin B3, nicotinic acid) inhibits synthesis and release of VLDL from liver lowering LDL cholesterol, triglycerides, increasing HDL cholesterol

Bile acid sequestrants, fibrates, niacin reduce lipid levels

• Bile acid sequestrants bind bile acids in intestine forming insoluble complex excreted in feces reducing bile acid reabsorption causing liver to use more cholesterol to produce new bile acids lowering blood cholesterol levels
• Fibrates activate PPAR-α nuclear receptor regulating lipid metabolism increasing lipoprotein lipase activity enhancing breakdown of triglyceride-rich lipoproteins reducing VLDL production increasing LDL removal from bloodstream
• Niacin inhibits enzyme synthesizing triglycerides and VLDL in liver decreasing VLDL release reducing LDL formation, increases lipoprotein lipase activity enhancing triglyceride-rich lipoprotein breakdown, reduces HDL catabolism increasing HDL levels

Side effects drug interactions lipid-lowering medications

• Bile acid sequestrants cause constipation, bloating, nausea, flatulence, abdominal discomfort and decrease absorption of other medications (warfarin, thyroid hormones, digoxin)
• Fibrates cause gastrointestinal disturbances, rash, myalgia, fatigue, headache and increase risk of myopathy when combined with statins potentiating anticoagulant effects
• Niacin causes flushing, pruritus, gastrointestinal disturbances, hyperglycemia, hyperuricemia and potentiates effects of antihypertensives increasing risk of myopathy with statins

Nursing considerations administering bile acid sequestrants, fibrates, niacin

• Bile acid sequestrants administer with plenty of fluids to minimize gastrointestinal side effects, separate administration from other medications by at least 2 hours, monitor for constipation recommending high-fiber diet and hydration
• Fibrates assess for signs of myopathy especially when combined with statins, monitor liver function tests periodically, educate patients about importance of reporting muscle pain or weakness
• Niacin administer with food to reduce flushing and gastrointestinal side effects, gradually increase dose to minimize side effects, monitor glucose and uric acid levels especially in patients with diabetes or gout, educate patients about management of flushing (taking aspirin before administration)

Patient education plan lipid-lowering drugs

• Bile acid sequestrants explain mechanism of action and importance of lowering LDL cholesterol, provide strategies to manage constipation (high-fiber diet, adequate hydration), emphasize need to separate administration of other medications
• Fibrates discuss benefits of lowering triglycerides and increasing HDL cholesterol, advise patients to report any muscle pain, weakness, or dark urine, encourage regular follow-up visits for monitoring liver function and lipid levels
• Niacin explain multiple lipid-lowering effects, provide strategies to manage flushing (taking aspirin, gradual dose titration), advise patients to report any persistent side effects or worsening of preexisting conditions, emphasize importance of regular glucose and uric acid monitoring