7-Thema 8-3-11a | Quizalize

THE FIDE LAWS OF CHESS. Introduction FIDE Laws of Chess cover over-the-board play. The Laws of Chess have two parts: 1. Basic Rules of Play and 2. Competitive Rules of Play. The English text is the authentic version of the Laws of Chess (which were adopted at the 93rd FIDE Congress at Chennai, India) coming into force on 1 January 2023. Preface. The Laws of Chess cannot cover all possible situations that may arise during a game, nor can they regulate all administrative questions. Where cases are not precisely regulated by an Article of the Laws, it should be possible to reach a correct decision by studying analogous situations which are regulated in the Laws. The Laws assume that arbiters have the necessary competence, sound judgement and absolute objectivity. Too detailed a rule might deprive the arbiter of his/her freedom of judgement and thus prevent him/her from finding a solution to a problem dictated by fairness, logic and special factors. FIDE appeals to all chess players and federations to accept this view. A necessary condition for a game to be rated by FIDE is that it shall be played according to the FIDE Laws of Chess. It is recommended that competitive games not rated by FIDE be played according to the FIDE Laws of Chess. Member federations may ask FIDE to give a ruling on matters relating to the Laws of Chess. BASIC RULES OF PLAY. Article 1: The Nature and Objectives of the Game of Chess 1.1 1.2 1.3 1.4 The game of chess is played between two opponents who move their pieces on a square board called a ‘chessboard’. The player with the light-coloured pieces (White) makes the first move, then the players move alternately, with the player with the dark-coloured pieces (Black) making the next move. A player is said to ‘have the move’ when his/her opponent’s move has been ‘made’. The objective of each player is to place the opponent’s king ‘under attack’ in such a way that the opponent has no legal move. 1.4.1 The player who achieves this goal is said to have ‘checkmated’ the opponent’s king and to have won the game. Leaving one’s own king under attack, exposing one’s own king to attack and also ’capturing’ the opponent’s king is not allowed. 1.4.2 The opponent whose king has been checkmated has lost the game. 1.5 If the position is such that neither player can possibly checkmate the opponent’s king, the game is drawn (see Article 5.2.2). Article 2: The Initial Position of the Pieces on the Chessboard 2.1 2.2 The chessboard is composed of an 8 x 8 grid of 64 equal squares alternately light (the ‘white’ squares) and dark (the ‘black’ squares). The chessboard is placed between the players in such a way that the near corner square to the right of the player is white. At the beginning of the game White has 16 light-coloured pieces (the ‘white’ pieces); Black has 16 dark-coloured pieces (the ‘black’ pieces). These pieces are as follows: A white king usually indicated by the symbol K A white queen Two white rooks Two white bishops Two white knights Eight white pawns A black king A black queen Two black rooks Two black bishops Two black knights Eight black pawns usually indicated by the symbol Q usually indicated by the symbol R usually indicated by the symbol B usually indicated by the symbol N usually indicated by the symbol usually indicated by the symbol K usually indicated by the symbol Q usually indicated by the symbol R usually indicated by the symbol B usually indicated by the symbol N usually indicated by the symbol Staunton Pieces p Q K B N R 9 2.3 The initial position of the pieces on the chessboard is as follows: 2.4 The eight vertical columns of squares are called ‘files’. The eight horizontal rows of squares are called ‘ranks’. A straight line of squares of the same colour, running from one edge of the board to an adjacent edge, is called a ‘diagonal’. Article 3: The Moves of the Pieces 3.1 It is not permitted to move a piece to a square occupied by a piece of the same colour. 3.1.1 If a piece moves to a square occupied by an opponent’s piece the latter is captured and removed from the chessboard as part of the same move. 3.1.2 A piece is said to attack an opponent’s piece if the piece could make a capture on that square according to Articles 3.2 to 3.8. 3.1.3 A piece is considered to attack a square even if this piece is constrained from moving to that square because it would then leave or place the king of its own colour under attack. 3.2 The bishop may move to any square along a diagonal on which it stands. 3.3 The rook may move to any square along the file or the rank on which it stands. 3.4 The queen may move to any square along the file, the rank or a diagonal on which it stands. 3.5 3.6 3.7 When making these moves, the bishop, rook or queen may not move over any intervening pieces. The knight may move to one of the squares nearest to that on which it stands but not on the same rank, file or diagonal. 3.7 When making these moves, the bishop, rook or queen may not move over any intervening pieces. The knight may move to one of the squares nearest to that on which it stands but not on the same rank, file or diagonal. The pawn: 3.7.1 The pawn may move forward to the square immediately in front of it on the same file, provided that this square is unoccupied, or 3.7.2 on its first move the pawn may move as in 3.7.1 or alternatively it may advance two squares along the same file, provided that both squares are unoccupied, or 3.7.3 the pawn may move to a square occupied by an opponent’s piece diagonally in front of it on an adjacent file, capturing that piece. 3.7.3.1 A pawn occupying a square on the same rank as and on an adjacent file to an opponent’s pawn which has just advanced two squares in one move from its original square may capture this opponent’s pawn as though the latter had been moved only one square. 3.7.3.2 This capture is only legal on the move following this advance and is called an ‘en passant’ capture. 3.7.3.3 When a player, having the move, plays a pawn to the rank furthest from its starting position, he/she must exchange that pawn as part of the same move for a new queen, rook, bishop or knight of the same colour on the intended square of arrival. This is called the square of ‘promotion’. 3.7.3.4 The player's choice is not restricted to pieces that have been captured previously. 3.7.3.5 This exchange of a pawn for another piece is called promotion, and the effect of the new piece is immediate. 3.8 There are two different ways of moving the king: 3.8.1 by moving to an adjoining square. 3.8.2 by ‘castling’. This is a move of the king and either rook of the same colour along the player’s first rank, counting as a single move of the king and executed as follows: the king is transferred from its original square two squares towards the rook on its original square, then that rook is transferred to the square the king has just crossed. 3.8.2.1 The right to castle has been lost: 3.8.2.1.1 If the king has already moved, or 3.8.2.1.2 With a rook that has already moved. 3.8.2.2 Castling is prevented temporarily: 3.8.2.2.1 if the square on which the king stands, or the square which it must cross, or the square which it is to occupy, is attacked by one or more of the opponent's pieces, or 3.8.2.2.2 if there is any piece between the king and the rook with which castling is to be effected. 3.9 The king in check: 3.9.1 The king is said to be 'in check' if it is attacked by one or more of the opponent's pieces, even if such pieces are constrained from moving to the square occupied by the king because they would then leave or place their own king in check. 3.9.2 No piece can be moved that will either expose the king of the same colour to check or leave that king in check. 3.10 Legal and illegal moves; illegal positions: 3.10.1 A move is legal when all the relevant requirements of Articles 3.1 – 3.9 have been fulfilled. 3.10.2 A move is illegal when it fails to meet the relevant requirements of Articles 3.1 –3.9. 3.10.3 A position is illegal when it cannot have been reached by any series of legal moves. Article 4: The Act of Moving the Pieces 4.1 4.2 Each move must be played with one hand only. Adjusting the pieces or other physical contact with a piece: 4.2.1 Only the player having the move may adjust one or more pieces on their squares, provided that he/she first expresses his/her intention (for example by saying “j’adoube” or “I adjust”). 4.2.2 Any other physical contact with a piece, except for clearly accidental contact, shall be considered to be intent. 4.3 Except as provided in Article 4.2.1, if the player having the move touches on the chessboard, with the intention of moving or capturing: 4.3.1 one or more of his/her own pieces, he/she must move the first piece touched that can be moved. 4.3.2 one or more of his/her opponent’s pieces, he/she must capture the first piece touched that can be captured. 4.3.3 one or more pieces of each colour, he/she must capture the first touched opponent’s piece with his/her first touched piece or, if this is illegal, move or capture the first piece touched that can be moved or captured. If it is unclear whether the player’s own piece or his/her opponent’s was touched first, the player’s own piece shall be considered to have been touched before his/her opponent’s. 4.4 If a player having the move: 4.4.1 touches his/her king and a rook he/she must castle on that side if it is legal to do so 4.4.2 deliberately touches a rook and then his/her king he/she is not allowed to castle on that side on that move and the situation shall be governed by Article 4.3.1. 4.4.3 intending to castle, touches the king and then a rook, but castling with this rook is illegal, the player must make another legal move with his/her king (which may include castling with the other rook). If the king has no legal move, the player is free to make any legal move. 4.4.4 promotes a pawn, the choice of the piece is finalised when the piece has touched the square of promotion. 4.5 4.6 If none of the pieces touched in accordance with Article 4.3 or Article 4.4 can be moved or captured, the player may make any legal move. The act of promotion may be performed in various ways: 4.6.1 the pawn does not have to be placed on the square of arrival. 4.6.2 removing the pawn and putting the new piece on the square of promotion may occur in any order. 4.6.3 If an opponent’s piece stands on the square of promotion, it must be captured. 4.7 When, as a legal move or part of a legal move, a piece has been released on a square, it cannot be moved to another square on this move. The move is considered to have been made in the case of: 4.7.1 A capture, when the captured piece has been removed from the chessboard and the player, having placed his/her own piece on its new square, has released this capturing piece from his/her hand. 4.7.2 Castling, when the player's hand has released the rook on the square previously crossed by the king. When the player has released the king from his/her hand, the move is not yet made, but the player no longer has the right to make any move other than castling on that side, if this is legal. If castling on this side is illegal, the player must make another legal move with his/her king (which may include castling with the other rook). If the king has no legal move, the player is free to make any legal move. 4.7.3 Promotion, when the player's hand has released the new piece on the square of promotion and the pawn has been removed from the board. 4.8 4.9 A player forfeits his/her right to claim against his/her opponent’s violation of Articles 4.1 – 4.7 once the player touches a piece with the intention of moving or capturing it. 4.8. A player forfeits his/her right to claim against his/her opponent’s violation of Articles 4.1 – 4.7 .4.9. If a player is unable to move the pieces, an assistant, who shall be acceptable to the arbiter, may be provided by the player to perform this operation. Article 5: The Completion of the Game 5.1.1 The game is won by the player who has checkmated his/her opponent’s king. This immediately ends the game, provided that the move producing the checkmate position was in accordance with Article 3 and Articles 4.2 – 4.7. 5.1.2 The game is lost by the player who declares he/she resigns (this immediately ends the game), unless the position is such that the opponent cannot checkmate the player’s king by any possible series of legal moves. In this case the result of the game is a draw. 5.2.1 The game is drawn when the player to move has no legal move and his/her king is not in check. The game is said to end in ‘stalemate’. This immediately ends the game, provided that the move producing the stalemate position was in accordance with Article 3 and Articles 4.2 – 4.7. 5.2.2 The game is drawn when a position has arisen in which neither player can checkmate the opponent’s king with any series of legal moves. The game is said to end in a ‘dead position’. This immediately ends the game, provided that the move producing the position was in accordance with Article 3 and Articles 4.2 – 4.7. 5.2.3 The game is drawn upon agreement between the two players during the game, provided both players have made at least one move. This immediately ends the game. COMPETITIVE RULES OF PLAY Article 6: The Chessclock 6.1 ‘Chessclock’ means a clock with two time displays, connected to each other in such a way that only one of them can run at a time. ‘Clock’ in the Laws of Chess means one of the two time displays. Each time display has a ‘flag’. ‘Flag-fall’ means the expiration of the allotted time for a player. 6.2 Handling the chessclock: 6.2.1 During the game each player, having made his/her move on the chessboard, shall pause his/her own clock and start his/her opponent’s clock (that is to say, he/she shall press his/her clock). This “completes” the move. A move is also completed if: 6.2.1.1 6.2.1.2 the move ends the game (see Articles 5.1.1, 5.2.1, 5.2.2, 9.2.1, 9.6.1 and 9.6.2), or the player has made his/her next move, when his/her previous move was not completed. 6.2.2 A player must be allowed to pause his/her clock after making his/her move, even after the opponent has made his/her next move. The time between making the move on the chessboard and pressing the clock is regarded as part of the time allotted to the player. 6.2.3 A player must press his/her clock with the same hand with which he/she made his/her move. It is forbidden for a player to keep his/her finger on the clock or to ‘hover’ over it. 6.2.4 The players must handle the chessclock properly. It is forbidden to press it forcibly, to pick it up, to press the clock before moving or to knock it over. Improper clock handling shall be penalised in accordance with Article 12.9. 6.2.5 6.2.6 Only the player whose clock is running is allowed to adjust the pieces. If a player is unable to use the clock, an assistant, who must be acceptable to the arbiter, may be provided by the player to perform this operation. His/Her clock shall be adjusted by the arbiter in an equitable way. This adjustment of the clock shall not apply to the clock of a player with a disability. 6.3 Allotted time: 6.3.1 When using a chessclock, each player must complete a minimum number of moves or all moves in an allotted period of time including any additional amount of time added with each move. All these must be specified in advance. 6.3.2 The time saved by a player during one period is added to his/her time available for the next period, where applicable. In the time-delay mode both players receive an allotted ‘main thinking time’. Each player also receives a ‘fixed extra time’ with every move. The countdown of the main thinking time only commences after the fixed extra time has expired. Provided the player presses his/her clock before the expiration of the fixed extra time, the main thinking time does not change, irrespective of the proportion of the fixed extra time used. 6.4 Immediately after a flag falls, the requirements of Article 6.3.1 must be checked. 6.5 Before the start of the game the arbiter shall decide where the chessclock is placed. 6.6 At the time determined for the start of the game White’s clock is started.6.7. Default time: 6.7.1 The regulations of an event shall specify a default time in advance. If the default time is not specified, then it is zero. Any player who arrives at the chessboard after the default time shall lose the game unless the arbiter decides otherwise. 6.7.2 If the regulations of an event specify that the default time is not zero and if neither player is present initially, White shall lose all the time that elapses until he/she arrives, unless the regulations of an event specify, or the arbiter decides otherwise. 6.8 A flag is considered to have fallen when the arbiter observes the fact or when either player has made a valid claim to that effect. 6.9 Except where one of Articles 5.1.1, 5.1.2, 5.2.1, 5.2.2, 5.2.3 applies, if a player does not complete the prescribed number of moves in the allotted time, the game is lost by that player. However, the game is drawn if the position is such that the opponent cannot checkmate the player’s king by any possible series of legal moves. 6.10 Chessclock setting: 6.10.1 Every indication given by the chessclock is considered to be conclusive in the absence of any evident defect. A chessclock with an evident defect shall be replaced by the arbiter, who shall use his/her best judgement when determining the times to be shown on the replacement chessclock. 6.10.2 If during a game it is found that the setting of either or both clocks is incorrect, either player or the arbiter shall pause the chessclock immediately. The arbiter shall install the correct setting and adjust the times and move-counter, if necessary he/she shall use his/her best judgement when determining the clock settings. 6.11.1 If the game needs to be interrupted, the arbiter shall pause the chessclock. 6.11.2 A player may pause the chessclock only in order to seek the arbiter’s assistance, for example when promotion has taken place and the piece required is not available. 6.11.3 The arbiter shall decide when the game restarts. 6.11.4 If a player pauses the chessclock in order to seek the arbiter’s assistance, the arbiter shall determine whether the player had any valid reason for doing so. If the player has no valid reason for pausing the chessclock, the player shall be penalised in accordance with Article 12.9. 6.12.1 Screens, monitors, or demonstration boards showing the current position on the chessboard, the moves and the number of moves made/completed, and clocks which also show the number of moves, are allowed in the playing hall. 6.12.2 The player may not make a claim relying only on information shown in this manner.

3. Fill in the blanks with a suitable modal verb in the right form (8p) 1. . You look pretty tired. I think you _________________ go to bed early tonight 2. “Children, you _________________ cross the street if the lights are red !” 3. Passengers _________________ open the door when the train is moving. 4.I don’t know where Kelly is. She _________________ be at her sister’s house. 5. I _________________ pay for the tickets because I got them from Sam for free. 6. You don’t have to shout. I _________________ hear you very well. 7. According to the weather report it ___________________ rain this afternoon. 8. ___________________ Mary come with us?

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)

Of the 7 billion people on Earth roughly 0:02 6 billion own a cell phone which is 0:05 pretty shocking given that only 4 and2 0:07 billion have access to a working toilet 0:09 so how are these popular gadgets 0:11 changing your body and brain If you're 0:13 looking down at your phone right now 0:15 your spine angle is equivalent to that 0:17 of an 8-year-old child sitting on your 0:19 neck which is fairly significant 0:21 considering people spend an average of 0:23 4.7 hours a day looking at their phone 0:26 this combined with the length of time 0:28 spent in front of computers has led to 0:30 an increase in the prevalence of myopia 0:32 or nearsightedness in North America in 0:34 the 1970s about one quar of the 0:36 population had myopia where today nearly 0:39 half do and in some parts of Asia 80 to 0:41 90% of the population is now nearsighted 0:44 and it can be hard to put your phone 0:46 down take for example the game Candy 0:48 Crush as you play the game you achieve 0:50 small goals causing your brain to be 0:52 rewarded with little bursts of dopamine 0:54 and eventually you're rewarded in the 0:56 game with new content this novelty also 0:58 gives little bursts of dopamine and 1:00 together create what is known as a 1:01 compulsion Loop which just happens to be 1:04 the same Loop responsible for the 1:05 behaviors associated with nicotine or 1:07 cocaine our brains are hardwired to make 1:10 us novelty seeking and this is why apps 1:12 on our phones are designed to constantly 1:14 provide us with new content making them 1:16 hard to put down as a result 93% of 1:19 young people aged 18 to 29 report using 1:21 their smartphone as a tool to avoid 1:23 boredom as opposed to other activities 1:26 like reading a book or engaging with 1:27 people around them this has created a 1:29 new term nomophobia the fear or anxiety 1:32 of being without your phone we also see 1:35 a change in brain patterns Alpha rhythms 1:37 are commonly associated with wakeful 1:39 relaxation like when your mind wanders 1:41 off whereas gamma waves are associated 1:44 with conscious attentiveness and 1:46 experiments have shown that when a cell 1:47 phone is transmitting say during a phone 1:49 call the power of these Alpha Waves is 1:52 significantly boosted meaning phone 1:54 Transmissions can literally change the 1:56 way your brain functions your smartphone 1:58 can also disrupt your sleep the screen 2:00 emits a blue light which has been shown 2:02 to alter our circadian rhythms 2:03 diminishing the time spent in deep Sleep 2:06 which is linked to the development of 2:07 diabetes cancer and obesity Studies have 2:10 shown that people who read on their 2:11 smartphone at night have a harder time 2:13 falling asleep and produce less 2:15 melatonin a hormone responsible for the 2:17 regulation of sleep wake Cycles Harvard 2:20 medical school advises the last 2 to 3 2:22 hours before bed be technology free so 2:24 pick up a book before bed instead of 2:26 course smartphones also completely 2:28 change our ability to access information 2:30 most notably in poor and minority 2:32 populations 7% of Americans are entirely 2:35 dependent on smartphones for their 2:37 access to the internet a 2014 study 2:40 found that the majority of smartphone 2:41 owners use their phone for online 2:43 banking to look up medical information 2:45 and searching for jobs so while phones 2:47 are in no way exclusively bad and have 2:50 been part of a positive change in the 2:51 world there's no denying that they are 2:53 changing us but many successful people 2:56 have now decided to take smartphone 2:58 vacations in order to increase 3:00 productivity in our new ASAP thought 3:01 video we break down the top six reasons 3:04 you should take a smartphone vacation 3:06 and how it could benefit your life right 3:08 now and subscribe for more weekly 3:09 science videos

Create four informational passages using 1. Simile · 2. Metaphor · 3. Hyperbole · 4. Personification · 5. Idioms · 6. Onomatopoeia 7. Alliteration 8. Foreshadowing 9. theme 10. create 10 multiple choice questions RI8.1 vocabulary questions, inference questions and textual evidence questions based on the passage with directions

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