Skip to content

Gallstone-dissolving agents: Nursing Pharmacology

Notes

Notes

GALLSTONE-DISSOLVING AGENTS
DRUG NAME
ursodiol / ursodeoxycholic acid / UDCA (Urso, Actigall), 
chenodiol / chenodeoxycholic acid (Chenodal)
CLASS
Gallstone-dissolving agents
MECHANISM OF ACTION
Decrease intestinal absorption of cholesterol, and reduce liver secretion of cholesterol into bile → change bile composition → facilitate bile flow, and dissolve gallstones
INDICATIONS
Prevention or treatment of cholelithiasis
ROUTE(S) OF ADMINISTRATION
PO
SIDE EFFECTS
  • Gastrointestinal: abdominal pain, dyspepsia, nausea, vomiting, diarrhea
  • General: headaches, dizziness, weakness, tachycardia, back pain, alopecia, skin rash, pruritus
  • Respiratory: infection, cough
  • Urinary: frequent urge to urinate, difficult, burning, or painful urination, bloody or cloudy urine
  • Boxed warning (chenodiol): hepatotoxicity
CONTRAINDICATIONS AND CAUTIONS
  • Calcified, radiopaque, or radiolucent gallstones
  • Complete biliary obstruction
  • Unremitting acute cholecystitis
  • Cholangitis
  • Gallstone pancreatitis
  • Pregnancy (chenodiol)
NURSING CONSIDERATIONS: GALLSTONE-DISSOLVING AGENTS
ASSESSMENT AND MONITORING
  • Vital signs
  • Gastrointestinal status
  • Laboratory results
    • Hepatic function
    • Lipid panel
  • Recent cholecystogram and gallbladder ultrasound
  • Monitor for side effects
  • Scheduling their follow-up appointments
  • Evaluate therapeutic response of gallstone dissolution and decreased abdominal pain
CLIENT EDUCATION
  • Purpose of medication: dissolves gallstone
    • Therapy can take several months
  • Take medication with food
    • Bitter taste
  • Report: signs of hepatotoxicity; e.g., nausea, vomiting, loss of appetite, dark-colored urine, or yellowing of the skin or eyes
  • Lifestyle modifications: weight loss. high fiber, low fat and cholesterol diet
  • Biologically female clients: use reliable form of birth control; notify healthcare provider for pregnancy
  • Follow-up monitoring of labs, cholecystogram or gallbladder ultrasound
Transcript

Gallstone-dissolving agents are medications used to treat cholelithiasis, more commonly known as gallstones, as an alternative for clients who can’t or prefer not to undergo surgery to remove them, as well as for treatment of clients with primary biliary cirrhosis, and to prevent gallstones in obese clients who are rapidly losing weight, such as after bariatric surgery.

Gallstone-dissolving agents include ursodiol, also known as ursodeoxycholic acid, or UDCA for short, as well as chenodiol, also known as chenodeoxycholic acid, which are bile acids that can be taken orally.

Now, once gallstone-dissolving agents are administered, their mechanism of action is not totally clear, but they primarily seem to act on the intestines by reducing cholesterol absorption, as well as on the liver by reducing the secretion of cholesterol into bile.

As a result, gallstone-dissolving agents help change the composition of bile, which facilitates bile flow, and ultimately dissolves gallstones.

Unfortunately, the decreased intestinal absorption of cholesterol can cause gastrointestinal side effects, such as abdominal pain, dyspepsia, nausea, vomiting, and diarrhea.

In addition, clients taking gallstone-dissolving agents may experience headaches, dizziness, weakness, tachycardia, back pain, and may develop alopecia, a skin rash, or pruritus.

Some clients may present with respiratory side effects like infection or cough; as well as urinary side effects, such as a frequent urge to urinate, as well as difficult, burning, or painful urination, and even bloody or cloudy urine. Finally, chenodiol has a boxed warning for hepatotoxicity, so it requires monitoring for liver function.

As far as contraindications go, gallstone-dissolving agents should not be given to clients with calcified, radiopaque, or radiolucent gallstones, as well as in clients with complete biliary obstruction, unremitting acute cholecystitis, cholangitis, or gallstone pancreatitis. Finally, chenodiol is contraindicated during pregnancy.

Okay, if your client with cholelithiasis is prescribed chenodiol, first perform a focused assessment of your client’s vital signs and gastrointestinal status, including symptoms like abdominal pain, dyspepsia, nausea, vomiting, and diarrhea.

Then, review their laboratory test results, specifically hepatic function tests and lipid profile; and be sure to confirm a negative pregnancy test. Finally, review their most recent diagnostic test results, including cholecystogram and gallbladder ultrasound.

Sources
  1. "Gold Standard Drug Database" Elsevier (2021)
  2. "Lehne's Pharmacology for Nursing Care" Saunders (2018)
  3. "LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]" NIH (2012)
  4. "Ursodiol" Healthwise (2013)
  5. "Ursodiol" MedlinePlus (2019)
  6. "Ursodeoxycholic Acid Ursoiol Drug Information" UpToDate ()