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C class K (3d.1 - 3c 14) pages31,32.
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endangered species
είδος υπό εξαφάνιση
καταστροφή
habitat loss
καταστροφή του φυσικού περιβάλλοντος ενός ζώου
παράνομο κυνήγι
endangered species
habitat loss
illegal hunting
climate change
pollution
ilegal pet trade
fur
under threat
in the wild
animal shelter
solve
Pick up sb
train
deforestation
in danger
at risk
Can you create an evaluation using this information PHONETICS VS. PHONOLOGY Whereas phonetics is the study of sounds that occur in language, phonology is the study of how these sounds are organized and how they function in language. It uses the classifications of sounds derived from phonetics to describe and analyze how sounds occur in speech. STRUCTURALIST PHONEMICS STRUCTURALIST PHONEMICS As linguists began to study sounds in fine detail, they recognized increasingly complex aspects of phonetic organization. For example, the sound /p/ appears in different varieties in English. STRUCTURALIST PHONEMICS One of the varieties of /p/ is indicated by [ph]. This sound is produced with an accompanying puff of air called aspiration, as in the words “pill,” and “peace.” Another sound, indicated by [p•], is produced when there is little or no aspiration; this sound occurs in a word like “spill.” A third major variety for the /p/ sound is the unreleased [p– ], which may occur at the end of a word like “stop.” To deal with these variations for the /p/ sound, the structuralists suggested the existence of an abstract unit which they termed a phoneme. STRUCTURALIST PHONEMICS A phoneme was defined by the structuralists as an abstract phonological unit that represents a class of real sounds, termed the allophones of a phoneme. The phoneme /p/ in English, then, is represented by the allophones [ph], [p•], and [p– ]. STRUCTURALISTS: MINIMAL PAIRS How do we know what these abstract units of sound called phonemes are? In order to find the phonemes of a language, the structuralists developed the concept of the minimal pair, defined as any two words that: a) Contain the same number of segments b) Differ in meaning c) Exhibit only one phonetic difference. STRUCTURALISTS: MINIMAL PAIRS In practical terms, phonemes distinguish meanings; and a phoneme can also be defined as the smallest meaning-distinguishing unit of sound. For instance, the words “pin” /pɪn/ and “bin” /bɪn/ mean different things, and the only one difference in these words occurs in the initial sounds. STRUCTURALISTS: MINIMAL PAIRS By using the concept of a minimal pair, we can determine that the three variations of the /p/ sound do not represent three phonemes. Certainly, it is possible to pronounce the word cap with either an aspirated [ph ] or unreleased [p– ]; however, the two forms [kæph ] and [kæp– ] are not a minimal pair, even though they involve different sounds, because they are identical in meaning. STRUCTURALISTS: FREE VARIATION The two forms [kæph ] and [kæp– ] are, therefore, said to exhibit free variation: that is, the pronunciation may vary without signifying a change in meaning. In other words, we may conclude that the unreleased [p– ] and the aspirated [ph ] are not representations of different phonemes in English; they are, in fact, allophones of one phoneme, /p/. STRUCTURALISTS: COMPLEMENTARY DISTRIBUTION When phonemes have more than one allophone in a language, the allophones are said to be in complementary distribution. Complementary distribution means that the allophones of a phoneme occur in different phonetic environments (that is, with different sounds surrounding them). TRANSFORMATIONAL- GENERATIVE PHONOLOGY TRANSFORMATIONAL-GENERATIVE PHONOLOGY Transformational-generative phonology is a relatively recent development in linguistic theory. Chomsky launched Transformational-Generative Grammar in 1957, but the earliest studies within this framework were largely concerned with syntax. A decade later, the first comprehensive transformational-generative treatment of English phonology appeared: Chomsky and Halle’s The Sound Pattern of English (1968). TRANSFORMATIONAL-GENERATIVE PHONOLOGY Transformational-generative phonologists strongly oppose the structuralists’ phonemic level. They replace this level by a series of rules that directly relate underlying representations to observed phonetic representations. The central mechanisms in transformational-generative phonology, then, are underlying representations and phonological rules. PHONOLOGICAL RULES A rule is an operational statement in which some linguistic entity is modified, resulting in a new linguistic entity. Rules may add elements, remove elements, or change elements. By using phonological rules, linguists attempt to demonstrate that there is order in linguistic phenomena and that linguistic patterns are systematic. PHONOLOGICAL DERIVATION A phonological derivation is an operation that begins with an underlying representation and, through the application of a set of specific rules, yields the actual sound the speaker produces. The representation of a phonological rule has the following general appearance. /A/ → [B] / C “A” changes to “B” under condition “C” PHONOLOGICAL RULE – EXAMPLE In most Southern dialects, the word ten is pronounced like the word tin. This is not an isolated fact, for den is pronounced like din and Ben is pronounced like bin, and so on. This very general fact can be represented by the phonological rule: /ɛ/ → [I] / ___ [n] den /dɛn/ → /dIn/ Ben /bɛn/ → /bIn/ ten /tɛn/ → /tIn/ /ɛ/ → [I] / ___ [n] - high - low - tense + front + high - tense + front + sonorant + anterior + coronal - continuant NOTATIONAL DEVICES IN PHONOLOGICAL RULES The statement of phonological rules can be complex, and linguists have developed several notational devices for writing them. Often, the following symbols will be necessary for stating the conditions under which rules apply: # indicates a word boundary + indicates an intraword boundary $ indicates a syllable boundary UNDERLYING REPRESENTATIONS AND RELATED ISSUES The transformational-generative description of phonology relates underlying representations to phonetic representations by rules. This can be represented in a simple example: In English, there are certain pairs of words like sign / signature, and malign / malignant that exhibit a regular alternation in their phonetic representations: [g] is present in the second member of the pairs but absent in the first member. UNDERLYING REPRESENTATIONS AND RELATED ISSUES To explain the relatedness of words such as sign / signature, we could claim that the underlying representation of the segment in all such pairs is /g/ and that a rule operates to delete /g/ before syllable-final nasals. Thus, the rule “/g/ is deleted before syllable-final nasal” would appear formally as: + voice - anterior →∅ ____ [+ nasal] $ - coronal UNDERLYING REPRESENTATIONS AND RELATED ISSUES On the left-hand side of the arrow, we place the features needed to uniquely specify /g/ among the consonants; that is, no other consonant has the features [+ voice], [- anterior], and [- coronal]. The symbols → mean that the sound /g/ changes to nothing or more properly “/g/ is deleted.” The horizontal line following the slash mark refers to the position of /g/ - namely, before a segment that is [+nasal]. Finally, this [+nasal] segment occurs before a syllable boundary, as indicated by $. A less formal way of writing this rule would be: /g/ → / _ [+nasal] $ Notice that this rule also helps describe such alternations as phlegm/phlegmatic and paradigm/paradigmatic. Application Activity: Think of other words in which this rule can be applied. Write the sound segments to prove /g/ is deleted. Another example is the process through which the prefix meaning “not” is added to words. This prefix alternates among the forms /Im/, /In/, and /Iŋ/, depending on the point of articulation of the initial segment of the following word. -If the segment begins in the extreme front part of the mouth (labials), the form is /Im/, as in improper. -If the segment begins in the extreme back part of the mouth (velars), the form is /Iŋ/, as in incomplete. -If the segment begins in the mid-region of the mouth (all other sounds), the form is /In/, as in indecent. *Exceptions:Words beginning with /r/ or /l/. Analyze the Word “in + complete,” for example. /n/ → [ŋ] / __ [k] - continuant - continuant - continuant + sonorant → + sonorant - sonorant + anterior - anterior - strident + coronal - coronal - coronal + tense THE VELAR SOFTENING RULE Still another example of alternation in English is found in pairs of words like “electric / electricity,” in which the segments /k/ and /s/ alternate. /k/ changes to [s] only before non- low, front vowels. THE VELAR SOFTENING RULE /k/ → [s] / __ - continuant + continuant - strident → - sonorant V - anterior + anterior - low - coronal + coronal - backChapter 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 Drug Alpha1 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 Drugs Alpha 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 Inhibitors aka 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 HTN Treatment 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)C CLASS: "TECH3" L.30-Part1. CHOOSEC CLASS: "TECH3" LESSON 27-Part1C' Class dictation 11th May C class 3rd term reviewC'class / Vocabulary / Unit 2C CLASS: "TECH3" LESSON 28-Part1. CHOOSE