3A/B/C/D/E_Prime Time 2

Art 125: Raccolta rifiuti (R.E)—>> non meno di 0,18mq per ogni abitante . virtuale —>> non meno di 5 mq —>> altezza minima 2,4m (R.I: 2 m) —>> deve avere un punto di allacciamento d’acqua Regolamento d’igiene —>> dimensione tale da poter contenere 4,5l Di rifiuti per abitante.( in ogni caso > di 2mq) —>> scarichi sifonati dall’acqua di lavaggio —>> accorgimenti che assicurino un’adeguata Difesa antimurina e antinsetti Norma UNI 10750: superficie commerciale (ciò che compriamo) , cioè la somma delle superfici coperte—>> 100% delle superfici calpestatili —>>100% delle superfici su cui poggiano . Le pareti divisorie interne non portanti —>> 50% delle pareti portanti interne perimetrali —>> 25% delle aree non abitabili Superfici scoperte—>> 25% dei balconi e delle terrazze scoperte —>> 35% dei balconi e dei terrazzi coperti (3 lati) —>> 35% dei pati e dei porticati —>> 60% delle verande —>> 15% dei giardini di appartamento —>> 10% dei giardini di ville e villini (Se un muro è al confine con un altro appartamento lo considero dalla mezzeria, se confina con uno spazio comune idem, lo considero tutto invece se da sull’esterno ) Regolamento d’igiene (su esso prevale il Re) : norme che discipilinano degli aspetti della vita quotidiana al fine di tutelare la salute dei fruitori Si occupa di : Rumori , odori , fumi, vapori. Scarichi nel sottosuolo Pulizia e decoro Malattie infettive Igenicità degli ambienti Pareti trasparenti (tenendo conto di telai e infissi)—>> deve avere un area pari a 1\8 (nazionale), 1\10 (Milano ) della superficie di pavimento Profondità di pavimento—>> non deve superare i 2,5m dalla finestra Bagno cieco solo se la superficie lorda di pavimento è inferiore ai 70mq e se è presente una sola camera da letto , oppure se è un secondo bagno (altrimenti finestra > 0,5 apribile). Superficie illuminante—>> superficie totale dell’apertura meno - superficie finale non utile (C): 60 cm - superficie superiore non utile (A) A= va considerato per intero se non ci sono aggetti o se questi sono inferiori a 150 cm. Al contrario ne considero solo un terzo. Es: con aggetto, b+ 1\3a . Se il rapporto illuminante è rispettato la profondità del locale non può essere più di 2,5 volte l’altezza del voltino . Se non è rispettato (inferiore a 1\8) allora deve essere 3,5 volte

Riferimenti normativi per il settore residenziale: Art 81: Accesso alla rete viaria—>> il cancello deve essere arretrato di almeno 4,5m dal filo esterno del marciapiede Art 82: Passo carrabile—>> larghezza non inferiore a 4,5m e non superiore a 6,5m Art 83:Pendenza Rampa —>> max 16% Art 97: Superficie minima degli ambienti - cucina —>> min 5mq - studio—>> min 7mq - soggiorno—>> min 14 mq - soggiorno spazi di cottura—>> 17 -camera (1posto letto)—>> 8mq - camera (2posti letto)—>> 12mq Superficie alloggio totale —>> non inferiore a 28 mq Art 95: Altezze minime- cucina, soggiorno, camera e studio—>> min 2,70m -locali accessori—>> min 2,40 m (bagno, lavanderie) - locali di servizio—>> min 2,10m (disimpegni, riposti.) - soppalchi—>> min 2,10m - parapetti—>> non inf. a 1,1m (10 cm cordolo) (92) Art 86: Distanze - negli edifici di nuova costruzione la distanza degli edifici dal confine con proprietà di terzi — nei NAF—>> non inf. a 3 m — altri ambiti —>> non inf. a 5m Art 89: Scale (R.E. ) —alzate—>> max 12 consecutive — a chiocciola—>> consentite solo all’interno di un’unità abit. — illuminazione—>> se collegano più di due piani devono . essere areati con lucernario. Dim: 0,3 mq . per ogni piano servito (R.I.: 0,4 mq x piano) — areazione —>> non ci può essere areazione verso i vani scala . ( Lo dice anche il regolamento d’igiene ) (R.I) —>> superficie non inferiore a 1mq per piano servi. — larghezza (R.I.) —>> deve garantire la possibilità di soccorso e . trasporto di persone Art 88: Locali sotterranei —>> non possono MAI essere adibiti ad abitazione Locali seminterrati—>> possono ma devono rispettare determinati . requisiti - l’altezza media deve essere > di 2,7m Art 91: Copertura—>> istallazione di apparati tecnici non deve essere visibile . dalle pubbliche vie Art 98: Bagni —>> ambiente contenente il vaso deve essere disimpegnato . dalla cucina (R.I: disimpegnato dai locali abitabili, esclusione Secondo bagno se è a servizio esclusivo di una camera) (R.I)—>> deve essere dotato di vaso, lavabo, bidet doccia o vasca —>> il lavabo può essere ubicato nell’antibagno Art 100: Areazione —>> riscontro d’aria deve essere garantito su aperture . perpendicolari o contrapposte.(non inf. a 1\10) —>> appartamenti inf. a 60mq possono essere . monoaffaccio ( ma non esposti a nord) Art 125: Raccolta rifiuti (R.E)—>> non meno di 0,18mq per ogni abitante . virtuale —>> non meno di 5 mq —>> altezza minima 2,4m (R.I: 2 m) —>> deve avere un punto di allacciamento d’acqua Regolamento d’igiene —>> dimensione tale da poter contenere 4,5l Di rifiuti per abitante.( in ogni caso > di 2mq) —>> scarichi sifonati dall’acqua di lavaggio —>> accorgimenti che assicurino un’adeguata Difesa antimurina e antinsetti Norma UNI 10750: superficie commerciale (ciò che compriamo) , cioè la somma delle superfici coperte—>> 100% delle superfici calpestatili —>>100% delle superfici su cui poggiano . Le pareti divisorie interne non portanti —>> 50% delle pareti portanti interne perimetrali —>> 25% delle aree non abitabili Superfici scoperte—>> 25% dei balconi e delle terrazze scoperte —>> 35% dei balconi e dei terrazzi coperti (3 lati) —>> 35% dei pati e dei porticati —>> 60% delle verande —>> 15% dei giardini di appartamento —>> 10% dei giardini di ville e villini (Se un muro è al confine con un altro appartamento lo considero dalla mezzeria, se confina con uno spazio comune idem, lo considero tutto invece se da sull’esterno ) Regolamento d’igiene (su esso prevale il Re) : norme che discipilinano degli aspetti della vita quotidiana al fine di tutelare la salute dei fruitori Si occupa di : Rumori , odori , fumi, vapori. Scarichi nel sottosuolo Pulizia e decoro Malattie infettive Igenicità degli ambienti Pareti trasparenti (tenendo conto di telai e infissi)—>> deve avere un area pari a 1\8 (nazionale), 1\10 (Milano ) della superficie di pavimento Profondità di pavimento—>> non deve superare i 2,5m dalla finestra Bagno cieco solo se la superficie lorda di pavimento è inferiore ai 70mq e se è presente una sola camera da letto , oppure se è un secondo bagno (altrimenti finestra > 0,5 apribile). Superficie illuminante—>> superficie totale dell’apertura meno - superficie finale non utile (C): 60 cm - superficie superiore non utile (A) A= va considerato per intero se non ci sono aggetti o se questi sono inferiori a 150 cm. Al contrario ne considero solo un terzo. Es: con aggetto, b+ 1\3a . Se il rapporto illuminante è rispettato la profondità del locale non può essere più di 2,5 volte l’altezza del voltino . Se non è rispettato (inferiore a 1\8) allora deve essere 3,5 volte Alloggi devono essere dotati— per 1\2 perone—>> 1 spazio cottura,1 servizio igienico , 1 ripostiglio — per 3\4 persone—>> 1 cucina indipendente, 1 servizio igienico , 1 ripostiglio — per 4\5 persone —>> 1 cucina indipendente, 2 servizi igienici, 1 ripostiglio (per il secondo servizio è richiesta una superficie minima di 2mq e un lato minimo di 1,2m) Dotazione dei servizi: Cucina—>> pavimenti e pareti con superficie Di materiale impermeabile, liscio, lavabile,resist. —>> soffitto materiale traspirante —>> cappa collegata a ogni punto di cottura (Vedi bagno su) Prevenzione incendi : definisce —dimensionamenti—accessi all’area (locali di intrattenimento e di pubblico Spettacolo —>> larghezza 3,5 —>> h libera 4m —>> raggio di svolta 13m —>> pendenza non sup al 10% —>> resist al carico almeno 20t —profondità locali —>> i locali al chiuso non possono Essere ubicati oltre il secondo piano Interrato (non oltre i 10m) . Questi se Sono tra i 7,5 e i 10 m devono essere Protetti da un’impianto sprinkler e Essere dotati di uscite sicure. — carichi d’incendio — comunicazione (locali di intrattenimento e di pubb. Spettacolo —>> locali possono comunicare con altre Attività purché dotate di filtri a prova di Fumo e di porte REI (ameno 30) (queste Non vanno cont nel comp. delle vie d’uscit) — compartimentazioni — autorimesse — comportamento al fuoco

Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic DrugAlpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic DrugsAlpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitorsaka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion  less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers(ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect  Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTNTreatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)

📄 Spanish Preterite Tense & Guatemalan Culture Quiz Grammar (1–15) Yo _____ (hablar) con mi abuela ayer. A. hablé B. hablaba C. habla D. habléste ¿Cuál es la forma correcta de comer en la 3ª persona plural en el pretérito? A. comían B. comieron C. comeron D. comaban Nosotros _____ (vivir) en México por dos años. A. vivimos B. vivíamos C. vivieron D. viviste Tú _____ (jugar) al fútbol el sábado, ¿verdad? A. jugabas B. juegas C. jugaste D. jugasteis ¿Cuál es la forma correcta de buscar en la primera persona singular del pretérito? A. buscé B. busqué C. busco D. buscaba Ellos _____ (almorzar) muy tarde. A. almorzaban B. almorzaron C. almorzaste D. almorzó Yo no _____ (pagar) mucho por este libro. A. pagé B. pagué C. pago D. pagaba ¿Qué forma es correcta para el verbo hacer con "ella" en el pretérito? A. hace B. hizo C. hacía D. hizo Mis amigos y yo _____ (dar) una fiesta el viernes. A. dimos B. daban C. dieron D. dábamos ¿Tú _____ (ver) la película anoche? A. veías B. viste C. vistes D. verás ¿Cuál es la forma correcta de ser en la primera persona del singular en el pretérito? A. soy B. fui C. era D. seré Nosotros _____ (ir) al museo el domingo pasado. A. íbamos B. fuimos C. vamos D. vamos a ir Ella _____ (escribir) una carta a su abuela. A. escribía B. escribió C. escribé D. escribó ¿Cuál es la forma correcta de leer con “ellos” en el pretérito? A. leyeron B. leían C. leyeran D. leíeron Tú no me _____ (dar) el número correcto. A. das B. diste C. dabas D. diste Culture (16–20) ¿Qué son los barriletes gigantes que se ven en Guatemala el 1 y 2 de noviembre? A. Instrumentos musicales tradicionales B. Comidas típicas del Día de Muertos C. Cometas artesanales usadas para honrar a los muertos D. Fuegos artificiales usados en bodas ¿Dónde se celebra principalmente el festival de barriletes gigantes? A. Antigua y Chichicastenango B. Santiago y Sumpango C. Ciudad de Guatemala y Tikal D. Quetzaltenango y Cobán ¿Cuándo ocurrió la Guerra Civil Guatemalteca? A. 1910–1925 B. 1944–1954 C. 1960–1996 D. 1980–2000 ¿Quién es Rigoberta Menchú? A. Una cantante famosa guatemalteca B. Una líder indígena y defensora de los derechos humanos C. Una política que fue presidenta D. Una artista de barriletes ¿Por qué recibió Rigoberta Menchú el Premio Nobel de la Paz? A. Por su música tradicional B. Por su arte textil C. Por su lucha por los derechos de los pueblos indígenas D. Por su carrera política en el congreso

3A/B/C/D_Prime Time 3

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