Question

complete one for a patient diagnosed procedure   with cholelithiasis.   also select one medication that can be used to treat this condition and provide education for your patient on this medication.  

Answer 1

Cholelithiasis

It involves the presence of gallstones (see the image below), which are concretions that form in the biliary tract, usually in the gallbladder

Medical history, a physical exam, and lab and imaging tests are obtained from patient to diagnose gallstones.

You are asked  about your symptoms.

Lab tests

A health care professional may take a blood sample from you and send the sample to a lab to test. The blood test can show signs of infection or inflammation of the bile ducts, gallbladder, pancreas, or liver.

Imaging tests

Health care professionals use imaging tests to find gallstones. A technician performs these tests in your doctor’s office, an outpatient center, or a hospital. A radiologist reads and reports on the images. You usually don’t need anesthesia NIH external link or a medicine to keep you calm for most of these tests. However, a doctor may give you anesthesia or a medicine to keep you calm for endoscopic retrograde cholangiopancreatography (ERCP).

Ultrasound. Ultrasound is the best imaging test for finding gallstones. Ultrasound uses a device called a transducer, which bounces safe, painless sound waves off your organs to create an image or picture of their structure. If you have gallstones, they will be seen in the image. Sometimes, health care professionals find silent gallstones when you don’t have any symptoms.

Computed tomography (CT) scan. CT scans use a combination of x-rays and computer technology to create images of your pancreas, gallbladder, and bile ducts. CT scans can show gallstones, or complications such as infection and blockage of the gallbladder or bile ducts. However, CT scans also can miss gallstones that you may have.

Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed images of your organs and soft tissues without x-rays. MRIs can show gallstones in the ducts of the biliary tract.

Cholescintigraphy. Cholescintigraphy—also called a hydroxyl iminodiacetic acid scan, HIDA scan, or hepatobiliary scan—uses a safe radioactive material to produce pictures of your biliary tract. You’ll lie on a table while a health care professional injects a small amount of the radioactive material into a vein in your arm. The health care professional may also inject a substance that causes your gallbladder to squeeze. A special camera takes pictures of the radioactive material as it moves through your biliary tract. Doctors use cholescintigraphy to diagnose abnormal contractions of your gallbladder or a blockage in the bile ducts.

Endoscopic retrograde cholangiopancreatography (ERCP). ERCP combines upper gastroendoscopy and x-rays to treat problems of your bile and pancreatic ducts. ERCP helps the health care professional locate the affected bile duct and the gallstones. This test is more invasive—or involves more instruments inside your body—than other tests. Doctors use it selectively, usually to remove a gallstone that is stuck in the common bile duct.

Medication

Trade name :Actigall

GENERIC NAME(S): Ursodiol

Uses

Ursodiol is used to dissolve certain types of gallstones, to prevent gallstones from forming in obese patients who are losing weight rapidly, and to treat a certain type of liver disease (primary biliary cirrhosis). Ursodiol is a bile acid.

How to use Actigall

Take this medication exactly as directed by your doctor.

Dosage is based on your medical condition and response to therapy.

Do not increase your dose or take this medication more often without your doctor's approval. Your condition will not improve any faster, and the risk of serious side effects may be increased.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

Side Effects

Stomach upset, nausea, diarrhea, dizziness, back pain, hair loss, or cough may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: weakness, swelling of the ankles/feet, increased thirst/urination, signs of infection (e.g., fever, persistent sore throat), easy bleeding/bruising.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking ursodiol, tell your doctor or pharmacist if you are allergic to it; or to other bile acids; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: certain gallbladder/bile duct problems (e.g., acute cholecystitis, cholangitis, biliary obstruction, gallstone pancreatitis, biliary-gastrointestinal fistula).

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease (e.g., ascites, variceal bleeding, hepatic encephalopathy).

This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: aluminum-containing antacids, birth control pills, cholesterol medications (e.g., cholestyramine, clofibrate, colestipol), estrogen.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe diarrhea.

Notes

Do not share this medication with others.

Laboratory and/or medical tests (e.g., liver function tests, bilirubin level) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Storage

Store at room temperature away from light and moisture. Different brands/strengths of this medication may have different storage requirements. Read the package labeling or ask your pharmacist for the storage requirements for the product you are using. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.Information last revised October 2018. Copyright(c) 2018 First Databank, Inc.

Actigall 300 Mg Capsule

Color

pink,white

Shape

oblong

Imprint

ACTIGALL, 300 MG

Patient education taking Actigali

General

Take this medicine with or immediately after food.

Try to avoid eating foods that are high in calories or cholesterol.

Do not take antacid preparations at the same time as this medicine. Some indigestion remedies stop ursodiol from working properly

About ursodiol

Type of medicine	A bile acid
Used for	Preventing or dissolving gallstones A type of liver disease known as primary biliary cirrhosis
Also called	Actigall®; Urso® 250; Urso® Forte
Available as	Capsules, tablets

Gallstones cause problems such as pain, yellowing of your skin and the whites of your eyes (jaundice), inflammation of your pancreas (pancreatitis), and gallbladder inflammation. They occur when bile, which is normally fluid, forms stones. Gallstones commonly contain lumps of fatty (cholesterol-like) material that has solidified and hardened. They may also contain bile pigments and calcium deposits. These stones can block the bile duct, causing pain.

Surgery is the usual treatment for gallstones that are causing symptoms, but treatment with ursodiol (also known as ursodeoxycholic acid) may dissolve smaller stones which are made mainly of cholesterol. Ursodiol is a bile acid which is produced naturally by the body. It works by reducing the amount of cholesterol released by your liver and by slowly dispersing the cholesterol in bile. This breaks up the stones or stops them developing.

Some ursodiol preparations are used to prevent gallstones developing in people who are undergoing rapid weight loss.

Some ursodiol preparations can also help to treat primary biliary cirrhosis. This is a condition that slowly damages the bile ducts in the liver, and as the disease progresses, it can damage the liver.

Before taking ursodiol

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking ursodiol it is important that your physician or pharmacist knows:

• If you have problems with the way your liver works.
• If you have a problem with your gallbladder other than gallstones.
• If you have a condition which affects your intestines (such as Crohn's disease or ulcerative colitis), or if you have had surgery on your bowel.
• If you are pregnant, trying for a baby or breastfeeding.
• If you are taking other medicines, including those available to buy without a prescription, herbal or complementary medicines. In particular, let your physician know if you are taking the oral contraceptive pill or hormone replacement therapy.
• If you have ever had an allergic reaction to a medicine.

How to take ursodiol

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about the specific brand of ursodiol you have been given, and a full list of side-effects which you may experience from taking it.
• Take ursodiol exactly as your physician tells you to. How much you need to take will depend upon what you are being treated for. Your physician will tell you exactly how much to take and when, and the dosage directions will be on the label of the pack to remind you.
• To dissolve gallstones, it is usually taken two or three times a day. If you are taking ursodiol for primary biliary cirrhosis, it is likely that you will be asked to take 2-4 doses daily. To prevent gallstones whilst you are losing weight the dose is usually twice daily. In all cases try to take your last dose at bedtime.
• Try to take ursodiol at the same times each day as this will help you to remember to take it. Take each of your doses with a snack or just after eating a meal.
• If you forget to take a dose, take one as soon as you remember unless it is nearly time for your next dose, in which case skip the missed dose. Do not take two doses at the same time to make up.

Getting the most from your treatment

• Try to keep your regular appointments with your physician. This is so your physician can check on your progress. You will need to have blood tests, scans or X-rays from time to time.
• It is important that you follow any dietary advice that you have been given by your physician. Try to avoid foods that are high in calories or cholesterol.
• You may need to take ursodiol for up to two years for the treatment of gallstones. Once the gallstones have dissolved, your physician may continue your treatment for three to four months to ensure that they have completely cleared up. Treatment for primary biliary cirrhosis is usually long-term unless you experience an adverse effect.
• If you buy any medicines, check with a pharmacist that they are suitable to take with this medicine. This is particularly important if you are buying indigestion remedies. Some antacid preparations contain aluminium salts which can interfere with the way ursodiol works.
• If you are using oral combined hormonal contraception ('birth control pill'), please ask your physician for advice. A method of contraception that contains less estrogen may be more suitable for you.

Can ursodiol cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with ursodiol. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your physician or pharmacist if any of the following continue or become troublesome.

Common ursodiol side-effects - these affect less than 1 in 10 people who take this medicine	What can I do if I experience this?
Diarrhea	Drink plenty of water to replace lost fluids. If this becomes troublesome, speak with your physician
Other possible but less common side-effects	What can I do if I experience this?
Itchy skin rash, nausea	If either of these becomes troublesome, speak with your physician

If you experience any other symptoms which you think may be due to this medicine, speak with your physician or pharmacist.

How to store ursodiol

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the emergency room of your local hospital. Take the container with you, even if it is empty. This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. Do not keep out-of-date or unwanted medicines. Ask your pharmacist about ways to dispose of medicines safely in your local area. If you have any questions about this medicine ask your pharmacist.

THANK YOU.....