If AB is a square matrix then BA

is non conformable / does not exist

class activity on matrix

The LMS has been an essential tool in curriculum design and development and in organizing factors that motivate student learning, especially in online distance learning. However, an LMS can be used in blended, hybrid, and in-class delivery modes. It is a software application designed to help in the administration of courses for both students and instructors. Such systems have been designed for use in learning and teaching activities (Chung et al., 2012). They also provide a variety of interaction methods between instructors and learners to facilitate the learning process better, You must remember well-designed LMS could also help improve student skills, such as effective online learning and self-direction (Norouzi, 2014). Students could use the system to enhance performance (perceived usefulness), and they could use such systems with little effort (perceived ease of use) (Venkatesh & Davis, 2000). A majority of higher education institutions have incorporated LMS systems; they have been used in university systems by schools, faculty members, and instructors (Klobas & McGill,. 2010), Because so much of higher education has been focused on course delivery Chapter3 INSTRUCTIONAL DELIVERY SYSTEMS AND EDUCATIONAL TECHNOLOGY i 71 in a physical classroom, the implementation of an LYS has a;ded institutons in transitioning to new online universe of curriculum de!ivery (Georgou!i, & Guerre. 2NS). Repositories, central databases, and online meeting 'oations are all characteristcs of a management system. As a concept, a 'earning management system is a broad idea and an example of technology's inabifity to be specific in terms of a definition. Several requirements a generat overview of what constitutes a leaming management system, such as those listed above Finally, end-user access is also a part of a learning management system with various levels being set up by security. For example, students have read-onty access, faculty members have read and write access, and technical staff has complete access for support and administrative duties (Graf & Chien, 2009). At its core, a learning management system contains internal or Web-based support and management for numerous aspects of learning and teaching (Hiary & Abu-Shawar, 2009). This allows access from numerous locales, usually on a 24-hour basis. When looking at a university or college, this concept begins to grow greatly depending on the organization's size and scope; department, and degree program. Leaming management systems also go by other names such as course management systems, and their use goes beyond higher education institutions to include businesses and individual instructors. Meis)ar-Tal, Kurtz, and Pieterse (2012) mentioned three primary purposes of an CMS. They include the following: 1. to provide students with digital learning materials; 2. to employ interactive learning activities with students in the forums; and 3. to manage the course and the learners. Faculty members who use an LMS to make available lecture notes and other classroom resources for their face-to-face class create a web-enhanced classroom experience. Regardless of its usage, requirements for classification as a learning management system include several key concepts like the availability of assets over networks, providing hosting, administration. and support. With the requirements set, utilization becomes the focal point. A fully utilized learning management system looks at use at the student level, faculty level, and administration level. proper utilization of learning management systems should mirror traditional higher education goals, enhancing students' experiences. For learninä management systems, this creates a central hub for a class activity. For some classes, all activities work in the learning management system, while others only use its resources for select activities.

Here’s your **edited version** of the activity, now focused on **Shirley Jackson’s *“The Lottery”*** and **past and present participles**, while keeping the fun “Great Grammar Magician” game theme: --- ### 🎩 THE GREAT GRAMMAR MAGICIAN: “THE LOTTERY SPELL!” 🍀 It seems like you already know how **past and present participles** can transform simple verbs into more descriptive and expressive words. Now, it’s time to show your magical grammar powers and help the Great Grammar Magician complete her enchanting performance inspired by *“The Lottery”* by Shirley Jackson! --- ### 🌼 **THE LOTTERY SPELL!** **Directions:** The class will be divided into two groups, and each group will work together to help the Great Grammar Magician finish her magical act! Each group will receive **three magic flags** that can be used as advantages during the game: 🟩 **Green Flag** – Use for a clue about the question. 🟨 **Yellow Flag** – Use to look at the question first and decide whether to answer it or choose another one. 🟦 **Blue Flag** – Use to get another chance to answer the same question. The goal is to earn the **highest points** as a group. The first representative to raise their hand gets to choose a question to answer. There will be **six questions**, representing the **six stones** drawn during the “lottery.” Each stone contains a **Magic Spell Card** with a question your group must answer correctly to earn a point. --- ### 🪄 **MAGIC SPELL QUESTIONS** **1. Remembering** **Question:** Who is the author of *“The Lottery”?* **Expected Answer:** Shirley Jackson. --- **2. Understanding** **Question:** What is *“The Lottery”* mainly about? **Expected Answer:** It’s about a small town that follows a cruel tradition of holding a lottery where one person is chosen to be sacrificed. --- **3. Applying** **Question:** Identify a **past or present participle** used in *“The Lottery.”* Explain its function in the sentence. **Expected Answer:** Example: *“The children assembled first, of course.”* — “assembled” is a **past participle** used to describe what the children did before the lottery began. --- **4. Analyzing** **Question:** How does Shirley Jackson use participles to create suspense or describe actions in the story? **Expected Answer:** Participles like “gathered,” “watching,” or “whispered” make the actions more vivid and help build tension in the story. --- **5. Evaluating** **Question:** Do you think the townspeople’s calm behavior (described with participles like “smiling,” “talking,” “laughing”) makes the story more shocking? Why or why not? **Expected Answer:** (Open-ended) Yes, because the ordinary actions make the violent ending more disturbing / No, because it just shows how normal the ritual is to them. --- **6. Creating** **Question:** Write your own short two-line description using **past or present participles** to show tension or fear in a situation like the one in *“The Lottery.”* **Expected Answer:** (Open-ended) Example: *Shaking hands held the paper tight.* *The crowd waited, holding their breath.* --- ### 🪶 **Tie-Breaker Question** **Question:** If you were in *“The Lottery,”* what would you be doing as the black box was brought out? Use at least one participle in your answer. **Expected Answer:** (Open-ended; checks creativity and grammar) Example: *Standing in silence, I would watch the slips being drawn, my heart pounding.* --- Would you like me to make this version **visually formatted for a classroom printout** (e.g., with bold headers, emojis, and clear section boxes)?

The advantage of direct method is that the teacher can control the class and fit in a lot of activity into a short class period. This leaves plenty of opportunities for the students to hone their skills, especially new ones. On the other hand, because the class is centered around the teacher, some students may not receive proper feedback, and creativity is limited. Also, the lesser talented athletes often tend to get lost in the shuffle while the great athletes shine. However, there are now a multitude of various teaching strategies that can be employed in addition to that method. Ex: Announcements, Module/Unit introductions, Descriptions/modeling of assignments and learning activities, Written or video lectures, Demonstration videos, Presentations, Discussions moderated by instructors, Interactive tutorials. Indirect Method The Indirect Teaching Style allows students to be involved in their own learning through experience and other peer’s knowledge. Students can use critical thinking to expand their learning capabilities by seeing what others may be doing correct and adjusting this to their own knowledge. The Indirect approach is the opposite of what the direct style suggests, but they are both strictly related, meaning you can’t have one without the other. Direct teaching: The instructor stands in front of the class or group and lectures or advises. Indirect teaching: The instructor assumes a more passive role and guides the student interactions. Movement exploration: Incorporates the use of equipment that involves movement. Movement Exploration The movement exploration class is founded on developing a strong, positive association to physical activity. Classes are aimed at developing movement skills and foundational strength through fun and engaging activities. The activities are age appropriate and include games, challenges, and exploration that positively challenge children’s competency while improving their physical capabilities. Skills such as the ability to climb, hold animal shapes, gymnastic style activities, and the introduction to athletic motor skill competencies are the foundations to youth training. This class provides the introduction to strength training to give children the opportunity to learn the skills required to safely and confidently engage in resistance training. Cooperative Skills Cooperative activities teach students to work together for their group's common good. By participating in these activities, students can learn the skills of listening, discussing, thinking as a group, group decision making, and sacrificing individual wants for the common good. There are two primary objectives guiding the teaching of cooperative activities. First, cooperative activities allow students to apply a variety of fundamental motor skills in a unique setting. Students are typically asked to perform motor skills in a specific way, such as “skip in general space” or “balance on one foot and one elbow.” Cooperative activities ask students to perform different activities such as skip with their hands on the shoulders of someone in front of them, walk with big steps while placing their feet on small spots, or walk across an area blindfolded while someone directs their moves. Due to the uniqueness of such experiences, students often find cooperative activities exciting and motivating. Second, cooperative activities are a wonderful medium for teaching social and emotional learning (SEL). SEL offers students an opportunity to understand and manage their emotions. In addition, such activities offer an opportunity to show empathy for others and develop positive relationships. Cooperative activities demand that all students play a role in completing the task or solving the movement problem. Every student, regardless of ability level, is important and contributes to group goals. 9 traits a PE teacher often needs Here are nine essential traits of an effective PE teacher: 1. Athletic ability Athletic ability is an essential trait for a PE teacher because they're often showing kids how to perform exercises. To demonstrate proper form and encourage the kids to continue their fitness education, it's important they can perform the exercises themselves. Having experience with fitness training can enhance a PE teacher's lesson planning because they're familiar with how each exercise affects a person's body. Athletic ability can also refer to an aptitude for sports and games. PE teachers can instruct students on how to play these games or lead after-school activities involving them, like soccer or basketball. An aptitude for sports and games can help a PE teacher encourage students to participate in the activities during class. If the PE teacher enjoys physical activity, they may make the lessons more enjoyable for the student. 2. Teaching ability A PE teacher is a member of a school faculty, so it's essential they have the teaching ability that allows them to communicate lessons to students. There are various skills involved in teaching, including the technical capabilities associated with each professional's particular field. Learning these skills can help PE teacher plan their lessons effectively and connect with their students, meaning they can encourage students to practice fitness skills in optimal ways for their health. Here are some important teaching skills for PE teachers: Having an engaging classroom presence  Real-world learning  Project building  Lesson planning  Technology 3. Interpersonal skills PE coaches are part of faculty teams, so working alongside other teachers is an essential part of their job. They often collaborate with a student's general education teacher to address any behavioral issues that arise. They can also team up with other classes to plan activities for students, like field days and special field trips. Communicating with peers can ensure these interactions remain productive and create opportunities for more fulfilling lessons. Teachers can also model emotional skills for their students by displaying positive social interactions. Interpersonal skills can also help PE teachers interact with students and their families. If a student can make a student feel comfortable expressing their needs and preferences, they can often perform physical exercises or play games to the best of their individual capacities. Understanding how to soothe nerves and support students' emotional needs are important examples of interpersonal skills. When interacting with family members, you may use some of these same techniques to communicate effectively and best uplift students. 4. Written and verbal communication Both verbal and written communication is important for PE teachers because they often communicate with students, families and various personnel on a day-to-day basis. For example, a PE teacher uses their communication skills in a lesson plan to describe any student assignments or expectations accurately. They may also write instructions in a document, then explain them in a classroom lecture. They also use communication skills to share their lesson plans with other PE teachers during conferences or classroom development exercises. Many teachers continue to learn their trade even after working as a teacher for many years. They may share tips with each other or special lessons they've developed if they feel another teacher may benefit from it. Creating a community can help PE teachers continue to expand their teaching methodology and receive feedback on their lessons. 5. Patience and adaptability Working with children can require patience and adaptability because they're encountering many new concepts at the same time and learning how to regulate their emotions. As a result, it's important to treat them with patience and care while they're in your class so they can feel comfortable and feel motivated to complete assignments. As children become teenagers, they may require patience and adaptability to account for their changing bodies and attention spans. Like any job where you perform tasks in real-time, certain circumstances may occur that require you to adapt lesson plans. For example, if the weather turns from sunshine to rain on a day you planned for students to run a mile outside, you may need to adapt the lesson plan so they can practice endurance sports inside a gymnasium instead. 6. Organization PE teachers can use organization skills to improve their lesson planning sessions. For example, they can keep their plans in one place, and determine which parts of a semester or quarter to introduce new concepts. Throughout the year, these objectives may change because of unforeseen setbacks, but organizational skills can help PE teachers control the trajectory of their class curriculum. PE teachers can also use organizational skills to maintain their classroom space. Physical education frequently requires balls, equipment and tools to play games that may be on a lesson plan. They also organize equipment and decide where to store it within their classroom or storage space. 7. Creativity Creativity can help a PE teacher develop fun ways to introduce new material to their students or reinforce previous lessons. They can teach new games or devise interesting ideas to change the rules of a game to help keep students engaged. To find inspiration for their lesson plans, they can turn to personal hobbies or media aspects they enjoy, like movie scenes, songs or dances. A varied lesson plan can foster more engagement among students who prefer action- based learning activities, rather than lectures. 8. Focus Focus is an essential trait of a PE teacher because students often require their full attention during class, especially if they're learning a complicated physical task. You can focus your lesson plans around specific elements of physical education you believe are essential for students of a certain age group or skill level. If students require mentorship, you can also focus on each student's needs to supply them with a steady support system. Focusing on your students can help guide your career purpose. It can give you a core value system that informs your lesson plans and mentorship activities. This passion for your student's well-being can also help you become an advocate for each student in your class. You can also help organize funding for different field trips or establish after-school activities to support their interests. 9. Enthusiasm for teaching sports and fitness Enthusiasm is essential for a PE teacher. Many physical education activities require high energy and may suit someone who enjoys teaching them to others. Being an effective PE teacher also requires an enthusiasm for working with kids and making a positive impact on their lives.

Grade -3 Subject Mathematics Concept: Patterns Chapter/ Topic: Patterns Sub Topic: Identifies simple symmetrical shapes and patterns Objective: Students will be able to identify simple symmetrical shapes and patterns using the universal design of learning, CPA approach, and engaging activities. Materials: Whiteboard and markers Symmetrical shapes and patterns flashcards Pattern blocks Construction paper Scissors Glue Procedure Introduction (5Minutes) Introduce the concept of simple symmetrical shapes and patterns to the students. Explain the concept of symmetry and how it can be found in various shapes and patterns. Show examples of symmetrical shapes and patterns using flashcards and discuss with the students. Activity-1 (10 minutes) Hand out pattern blocks to each student. Instruct students to create symmetrical shapes using the pattern blocks. Once they have created their shapes, have them identify the line of symmetry in each shape. Discuss as a class which shapes are symmetrical and why Activity-2 (10 minutes) Provide students with construction paper, scissors, and glue. Instruct students to create a symmetrical pattern art piece by cutting out shapes and arranging them in a symmetrical pattern. Encourage students to be creative with their designs. Have students share their symmetrical pattern art with the class. Assessment (5 minutes): To assess student understanding, ask students to identify the line of symmetry in various shapes and patterns shown on the whiteboard. Provide feedback to students on their responses to ensure they understand the concept of symmetry.

Economy of Southeast Asia Even prior to the penetration of European interests, Southeast Asia was a critical part of the world trading system. A wide range of commodities originated in the region, but especially important were such spices as pepper, ginger, cloves, and nutmeg. The spice trade initially was developed by Indian and Arab merchants, but it also brought Europeans to the region. First the Portuguese, then the Dutch, and finally the British and French became involved in this enterprise in various countries. The penetration of European commercial interests gradually evolved into annexation of territories, as traders lobbied for an extension of control to protect and expand their activities. As a result, the Dutch moved into Indonesia, the British into Malaya, and the French into Indochina. Europe’s interest and activity in the region was further enhanced by the opening of the Suez Canal, the development of telegraphic communications, the adoption of steam shipping, and the prospects for trade with China. In the case of Malaya, the gradual diffusion of British administration provided systems of law and order and of taxation and allowed for the gradual development of infrastructure, principally reliable transport systems. This environment attracted Chinese immigrants, and the growth of the tin mining industry soon followed. Later rubber plantations were established, which brought about still further immigration. Similar developments took place in Burma (Myanmar), Vietnam, and Indonesia. In Siam (Thailand) during the second half of the 19th century, a rapid expansion of Western enterprise occurred, though not by colonization. Both British and American firms began trading in the region. The impact of the Western activity was essentially to remove trade from what had been a Chinese monopoly and to emphasize the export of a single commodity, rice. Established indigenous textile and sugar-processing industries were replaced by imports, and the economy slowly became dependent on rice exports. The Philippines gradually developed a plantation farming system under Spanish and later American influence, although rice, sugar, and tobacco continued to be produced by small-scale growers and processed by Chinese enterprises until the mid-19th century. The incorporation of Southeast Asia into the world economy had a major impact on the distribution of the region’s economic development, and it created more uneven patterns of population growth and economic activity. It also brought about a stronger sense of class distinction and resulted in a larger discrepancy between the wealthy and poor. The worldwide economic depression of the 1930s severely affected the commercialized areas most dependent on the world economy. Unemployment rose, and the period produced the seeds of political change and activism that culminated in the independence of most of the region’s countries after World War II. Since the 1950s the economic development strategies of virtually all the capitalist Southeast Asian states have emphasized urban industrialization, while agricultural development generally has been viewed as subsidiary to industrial growth. These strategies have met with mixed success. Indeed, the trading pattern of the region by and large has continued to be one of producing and exporting raw materials and importing manufactured goods. Only Singapore has reached an advanced level of industrialization, in the process becoming one of the world’s great centers of industry and commerce. There is great disparity in development rates within the region, especially between the member and nonmember countries of the Association of Southeast Asian Nations (ASEAN). Those belonging to this grouping—Brunei, Indonesia, Malaysia, the Philippines, Singapore, and Thailand—generally have experienced significant economic development since the mid-1960s; the exception has been the Philippines, the economy of which has grown at a much slower rate. Development has been extremely slow or nonexistent in the non-ASEAN countries of Cambodia, Laos, Myanmar, and Vietnam, and these are among the poorest nations in the world.

Q1. A teacher designs a lesson where students compute real-life percentages such as discounts and savings. 👉 A student calculates 15% of 200 to determine savings in a purchase. What is the correct result? A. 20 B. 25 C. 30 D. 35 Q2. In a classroom activity, learners compare numbers to find the highest common factor for grouping materials evenly. 👉 What is the GCF of 24 and 36? A. 6 B. 8 C. 12 D. 18 📘 FRACTIONS, DECIMALS, AND POWERS Q3. A learner converts fractions into percentages for data interpretation. 👉 What is 3/4 expressed as a percentage? A. 50% B. 60% C. 75% D. 80% Q4. A student models exponential growth using repeated multiplication. 👉 What is the value of 252^525? A. 25 B. 30 C. 32 D. 64 📘 ALGEBRA (EQUATIONS AND EXPRESSIONS) Q5. A teacher guides students to solve equations that represent real-life situations. 👉 Solve: 2x+8=202x + 8 = 202x+8=20 A. x = 4 B. x = 6 C. x = 8 D. x = 10 Q6. Students simplify expressions to understand relationships between quantities. 👉 Simplify: 3(x+4)−2x3(x + 4) - 2x3(x+4)−2x A. x + 12 B. x + 4 C. 5x + 4 D. 5x + 12 📘 FUNCTIONS AND GRAPHING Q7. A student analyzes a linear equation to determine its rate of change. 👉 What is the slope of y=3x−5y = 3x - 5y=3x−5? A. -5 B. -3 C. 3 D. 5 Q8. A learner evaluates functions to predict outcomes. 👉 If f(x)=2x+3f(x) = 2x + 3f(x)=2x+3, what is f(4)f(4)f(4)? A. 7 B. 9 C. 11 D. 14 📘 GEOMETRY Q9. Students explore geometric shapes and their properties through visual models. 👉 What is the sum of interior angles of a triangle? A. 90° B. 180° C. 270° D. 360° Q10. A student calculates the area of a classroom table with dimensions 8 cm by 5 cm. 👉 What is the area? A. 26 sq cm B. 30 sq cm C. 40 sq cm D. 48 sq cm 📘 MEASUREMENT AND FIGURES Q11. A learner determines the volume of a cube used in a science experiment. 👉 What is the volume of a cube with side 4 cm? A. 16 cubic cm B. 32 cubic cm C. 48 cubic cm D. 64 cubic cm Q12. Students identify shapes used in design projects. 👉 How many sides does a hexagon have? A. 5 B. 6 C. 7 D. 8 📘 STATISTICS AND PROBABILITY Q13. A teacher helps students interpret data sets using measures of central tendency. 👉 What is the mean of 4, 6, 8, 10, 12? A. 6 B. 8 C. 10 D. 12 Q14. A class experiment involves flipping a fair coin. 👉 What is the probability of getting heads? A. 1/4 B. 1/3 C. 1/2 D. 2/3 📘 WORD PROBLEMS (APPLICATION) Q15. A car travels 180 km in 3 hours during a learning task on speed. 👉 What is its average speed? A. 45 km/h B. 60 km/h C. 75 km/h D. 90 km/h Q16. Students analyze work efficiency in a project. 👉 If 5 workers complete a task in 12 days, how long will 10 workers take? A. 3 days B. 6 days C. 8 days D. 12 days Q17. A student solves a problem involving ratios in a classroom population. 👉 If the ratio of boys to girls is 3:2 and there are 30 students, how many boys are there? A. 12 B. 15 C. 18 D. 20 Q18. A learner determines the duration of a scheduled trip. 👉 A journey starts at 8:30 AM and ends at 11:15 AM. How long is the trip? A. 2 hrs 15 mins B. 2 hrs 30 mins C. 2 hrs 45 mins D. 3 hrs 15 mins Q19. A student computes simple interest for financial literacy. 👉 What is the simple interest on ₱1000 at 5% for 2 years? A. ₱50 B. ₱75 C. ₱100 D. ₱150 Q20. A learner solves a perimeter problem involving a rectangle. 👉 A rectangle has a length of 12 cm and perimeter of 34 cm. What is the width? A. 5 cm B. 7 cm C. 10 cm D. 11 cm ✅ ANSWER KEY (BASED ON YOUR REVIEWER) (All verified from your uploaded file) [ilide.info...002acd4e5a | PDF] QAnswer1C2C3C4C5B6A7C8C9B10C11D12B13B14C15B16B17C18C19C20A

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)

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 - back

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