Question

You are working at a bariatric center and a patient comes to you for pre-operative exercise counseling. Your role is to assess and counsel/ prescribe patients on exercise prior and post-surgery. With this, each patient must participate in at least 8 weeks of an exercise program prior to surgery. (10 points)

Patient Profile: the patient is 48 years old, weight is 345 pounds; BMI= 57 kg/m2. She had a recent oral glucose tolerance test result of 285 mg/dl, TC= 290 mg/dl; TG= 560 mg/dl; HDL = 19 mg/dl. She also has sleep apnea and is developing arthritis in both knees. She takes 120 units of Lantus (basal insulin); 25 units Humalog (rapid insulin) per 3 meals; 80 mg of Zocor; 100mg Atenolol; 1500 mg Niaspan and Valsartan 160 mg twice daily.

Her goal with the laparoscopic adjustable gastric banding surgery is to lose 200 pounds and discontinue all her medications. She is getting the surgery so she does not have to try another diet and fail. She also hates to exercise so having this surgery will help her avoid exercising to lose weight. However, she realizes that she has to comply with your 8 week program to get the surgery.

The doctor never explained why she is taking the meds that she is. She asks you what her meds are for (what condition), why she needs her medications and what specifically they do to help her. Explain all the med’s mechanism of action.

Answer 1

Drugs	Condition	Why she requires	Specific action
Lantus insulin	diabetes mellitus	her GTT is very much raised, uncontrolled diadetes	long acting man made insulin act by peripheral uptake of glucose into skeletal muscle
humalog insulin	diabetes mellitus	her sugar levels are high	Manmade insulin, fast acting insulin, this reduces blood sugar level which happens immediately after a meal
Zocor (Somavastatin)	hypertriglycermia	her lipid profile is deranged with increased level of total cholesterol, triglyceride and low high density lipoprotein	HMGCoA Reductase enzyme ihibitor
Atenlol	Hypertension	this normalises the blood pressure, also normalise the heart rate
Niaspan	increase metabolism	to lower low density lipoprotein, it converts food into energy	it decrease lipolysis and inhibits apolipoprotein B, helping in increasing blood level of HDL and lowers LDL and Triglyceride
Valsartan	hypertension	cardio protective anti hypertensive	-Angiotensin receptor blocker, -decreses peripheral resistance leading to relaxation of blood vessel leading to normalising BP