Question

Your patient has the following conditions and takes the following meds. (10 points)

Obesity (BMI 56) (takes Saxenda)

HTN (takes atenolol)

Hyperlipidemia (takes Zocor)

(a) Based on these meds, tell me how you would monitor exercise intensity and why?

(b) Based on the conditions, tell me what considerations you would need for programming. HINT: think contraindications AND awareness/ sensitivity to the obese client.

*Please explain in most detail possible*

Answer 1

Answers :

(a) Based on these meds, tell me how you would monitor exercise intensity and why?

Atenolol :

There is no need to stop playing sports if you take atenolol. But do not push yourself too much. Regular exercise is good for you because it lowers blood pressure by keeping your heart and blood vessels in good condition.

Exercise vs statins :

Obesity/adiposity - decreased exercise- no change

Saxenda :

saxenda (liraglutide [rDNA origin] ) Injection is an analog of human GLP-1 and acts as a GLP-1 receptor agonist used for as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of 30 kg/m² or greater (obese), or 27 kg/m² or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia)

(b) Based on the conditions, tell me what considerations you would need for programming.

Contraindication of saxenda

Saxenda is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2. Counsel patients regarding the risk for MTC and inform them of symptoms of thyroid tumors (e.g., a mass in the neck, dysphagia, dyspnea, persistent hoarseness).

Contraindication of statins

Statins are contraindicated for use by patients with active hepatic disease or unexplained persistent elevations in aminotransferase levels. Statins are contraindicated during pregnancy and while breastfeeding because of the effects on the cholesterol pathway.

Contraindications / Precautions of atenolol

• · Abrupt discontinuation. ...
• · Hyperthyroidism, thyroid disease, thyrotoxicosis. ...
• · AV block, bradycardia, cardiogenic shock, heart failure, hypotension, pheochromocytoma, pulmonary edema, sick sinus syndrome, vasospastic angina, ventricular dysfunction. ...
• · Cerebrovascular disease. ...
• · Diabetes mellitus.

Sensitivity of atenolol on obese patient

We found no evidence that physicians differentiate drug use according to the severity of obesity, to visceral fat accumulation or to the presence of metabolic syndrome. There is an urgent need of further data to provide informed directions that could help practitioners in choosing the right therapy for hypertensive obese patients.

Sensitivity of zocor to the obese client.

Obesity is independently associated with enhanced coronary arteriole dilation in patients undergoing heart surgery. Moreover, we identified statins as another important, independent predictor of dilation of coronary resistance arteries. Whether or not the enhanced arteriole dilation in obese patients, with or without statin therapy correlates with short- and longer-term outcomes following surgery has yet to be elucidated.

Sensitivity of saxenda on the obese client.

Liraglutide is a glucagonlike peptide-1 (GLP-1) analog. GLP-1 is a physiological regulator of appetite and calorie intake, and the GLP-1 receptor is present in several areas of the brain involved in appetite regulation.

The dose for obesity differs from that of liraglutide (Victoza) that is used to treat diabetes. Saxenda is initiated at 0.6 mg SC once daily for 1 week, and is then increased by 0.6 mg/day in weekly intervals until a dose of 3 mg/day is achieved