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Bile Acid Resins

Bile-Nile Acidic-Lemon Raisins
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Bile acid resins are a group of drug that prevent reabsorption of bile and lead to a decrease in cholesterol, specifically LDL. These drugs are indicated for treating hyperlipidemia (abnormally high values of lipids or lipoproteins in the blood), but have other uses as well. The mechanism of this drug is binding to bile acids and preventing their reabsorption in the gastrointestinal system, leaving them to be excreted. Circulating cholesterol is then utilized to replace the lost bile, decreasing blood levels of cholesterol. Commonly prescribed bile acid resins include colestipol, cholestyramine, which can be used for diarrhea treatment and toxin absorption, and colesevelam. Side effects of these drugs include patient complaints, due to the bad taste and GI disturbances that accompany their use. These medications lead to decreased absorption of fat-soluble vitamins and cholesterol gallstones as well.
9 KEY FACTS
INDICATIONS
Hyperlipidemia
Hiker-lips

This drug is indicated for hyperlipidemia, which refers to abnormally high levels of lipids or lipoproteins in the blood. Bile acid resins are also indicated for familial hyperlipidemia type IIa, an inherited disease where patients display xanthelasmas, arcus senilis, and tendon xanthomas.

MECHANISM OF ACTION
Bile Acid Reabsorption Prevented
Acidic-lemon Prevented before Sponge

This drug is a bile acid sequesterant, which binds to bile acids in the gastrointestinal tract. These form insoluble complexes which are excreted in the feces. 

Decrease LDL
Down-arrow Ladybug-devil

As bile is sequestered and excreted, the liver has to use cholesterol to make more bile. Intracellular cholesterol depletion leads to upregulate expression of HMG-CoA reductase and LDL reductase. This results in increased uptake of LDL particles by hepatocytes and subsequent reduction in plasma LDL.

DRUGS
Colestipol (Colestid)
Coal-stapler

Colestipol is a bile acid resin, which is commonly used. It has been known to bind to other medications and decrease their absorption/mechanism of action, such as digoxin, furosemide, and tetracycline.

Cholestyramine (Questran)
Coal-star-man

Cholestyramine is a commonly used bile acid resin, which is also used in other diseases. This drug can be used in Crohn's patients who have undergone ileal resection to prevent diarrhea. Furthermore, cholestyramine can be used to absorb toxins during a C. difficile infection.

Colesevelam (Welchol)
Coal-servant

Colesevelam is another commonly used bile acid resin, which also has been used to improve glycemic control in type 2 diabetics.

SIDE EFFECTS
GI Distress
GI with Flare-gun

These drugs tend to cause GI upset in many patients, which include symptoms such as constipation, bloating, indigestion, and nausea.

Cholesterol Gallstones
Cholesterol-burgers with Gold-stones

Very rarely, bile acid sequesterants can lead to cholesterol gallstones. This is because treatment yields higher cholesterol concentrations in the bile.

Decreased Absorption of Fat-soluble Vitamins
Down-arrow Bacon Viking-ship

Use of these medications lead to decreased absorption of fat-soluble vitamins: Vitamins A, D, E, and K.

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