Gallstone-dissolving agents: Nursing pharmacology

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. Next, be sure to explain how the medication dissolves their gallstones, and remind them that it can take several months for them to partially or completely dissolve.

Advise your client that chenodiol has a bitter taste, so the medication should be taken with food. Also, let them know that they will need to follow up with their healthcare provider; this is important for periodic monitoring of their hepatic function and lipid profile, as well as a cholecystogram or gallbladder ultrasound every 6 to 9 months to assess the effectiveness of the medication.

Then, prompt them to notify their healthcare provider if they experience any signs of hepatotoxicity, including nausea, vomiting, loss of appetite, dark-colored urine, or yellowing of the skin or eyes.

Also, be sure to caution your female clients to use a reliable form of birth control while taking this medication, and to let their healthcare provider know right away if they become pregnant.

Lastly, emphasize the lifestyle modifications that can help prevent the formation of additional gallstones, including weight loss and following a diet that’s high in fiber, and low in fat and cholesterol.

Finally, be sure to monitor your client for side effects, assist them in scheduling their follow-up appointments, and evaluate for the therapeutic response of gallstone dissolution and decreased abdominal pain.

Alright, as a quick recap. Gallstone-dissolving agents are medications used to treat gallstones.

Common side effects include abdominal pain, dyspepsia, nausea, vomiting, and diarrhea. Nursing considerations include performing a focused gastrointestinal assessment, reviewing relevant laboratory test results and diagnostic tests, such as cholecystogram and gallbladder ultrasound results, as well as evaluating the therapeutic response to medication.

Client teaching is focused on recognizing side effects that must be reported to the healthcare provider, reviewing lifestyle modifications, and scheduling follow-up monitoring.