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First ACT Comma Quiz
Quiz by Emily Garris
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Create a quiz about the first act of Romeo and Julliet for 5th grade studentsHistory of policing Pre-confederation Mostly informal policing by community residents First police officers Quebec city, mid 17th century Upper Canada, early 19th century Mandate Police conflicts between ethinc groups and employes/labours Maintain moral standards (drunkenness, alcoholism) Apprehend criminals Provincal Police Force Response to disorder resulting form gold strikes in 19th century Replaced by RCMP during 20th century Currently, Ontario,Quebec and parts of Newfoundland have their own provincal police force History of RCMP North-Wesr Mounted Police Founded in 1873 Maintain law and order Ensure orderly settlement in prairies Many problems: desertion, resignation and improper conduct Replaced by Royal Canadain Mounted Police Police Today About 70,000 police officers across Canada 199 police officers per 100,000 population Lower than Scotland (337), England(244), U.S (238) NUmber increased over past decade NUmber of female officers increased 1 out of 5 officers is a women Contemporary Policing Structure of policing Four levels Federal, Provincial, municipal, and First nations Also public transportation police (railway, airport, and transit) Some municipalities have own forces E.g, Peel, Toronoto Others use provincial force detachments or RCMP detachments Royal Candanin Mounted Police Governed by Royal Canadian Mounted Pollcei Act (1985) Broad Range of policing activities, including federal policing and international peacekeppiong Contract Policing Provincial, territorial and municipal level Concerns about local oversight and accountability In but not of communities-difficult to ensure that RCMp detachments are responsive to communities Provincial Police Three forces Ontario Provincial Police Surete du Quebec (SQ) Royal Newfoundland Constabulary (RNC) Other provinces contractually use the RCMP Responsibilities Police rural areas and areas outside municipalities Enforce provincial laws and Criminal Code Regional Police Amalgamated Forces E.g Peel region police and Halton Regional Police Force Provide Police Services to over Half of Ontarians Advantages Cheaper, more servies Disadvantages To centralized, not in touch with community Municipal Police Responsibilites Enforce Criminal Code, Provincal Statues, municipal by laws, some federal statues (e.g drugs) Largest number of officers of any level My be contracted to RCMP or Provincal force Costs are paid by the municipality First Nations Type of policing is negotiated by First Nations Commnity Autonomous reserve based First Nations Officers from RCMP or OPP Responsibilites Enforce Criminal Code, federal and provicanl statues, band bylaws Accountability Reserve based police commission or band council Private Security Services Two main types 1. Private Security Firms 2. Company based, in house security officers No more legal authority than ordinary citizens But can arrest and detain people who commit crimes on private property In Canada, Private security officers outnumber police officer by four to one Parapolice Extension of activities Lack of systems of oversight like transitional police Police Work POlicing The activities of any indivual or organization acting legally on behalf of public or private organizations or persons to maintain security or social order Pluralization of Policing The sharing between public and private security Legislative Framework Carry out tasks within a number of legislative frameworks, define role, powers/responsibilites Canadian charter of rights and freedoms- most impactful on power/actvites of police Provincial and municipal legislation - Status such as motor vehicle administration acts, highway traffic acts, liquor acts and provincial/musincpal police acts Democracy Governance Categories of Policing Recruitment and Training of police officers Police recruitment Recruiting Visible Minorites and Aboriginal People Special initvates and programs for youth, women and visible minorities PEACE (Police Ethnic and Cultureal Exchange) OPPBound (particpate in variety of activate with officer) Toronto POlice recruitment of Somali Officers Edmonton police uniforms that include a hijab Police Training Residential/non-residential academies, centralized and decentralized Physical and academic instruction, socilization into the police occupation Operational field traiing Hands-on application of principles learned in the academy Mentoship form senior officer Working Personality of Police officers Challenges of Police Work Work Enviroment Long hours and shift work Exposure to stressors, especially in high demand environments PTSD and burnout Work Organiztion Harassment of female officers Cumbersome of system of internal redress Summary A number of misconceptions arounds police work, including th emotion that most police work involves crime control A variety of influences on the roles and activities of the police Four levels of policing: federal, provincial, mnicipal and First Nations, each with different responsibilities I got used to it / adapt with - მივეჩვიე
Bridesmaid - მეჯვარე [ბრაიდსმეიდ]
Awards - ჯილდო [oscars awards - ოსკარის დაჯილდოება]
Act - თამაში კინოში
Direct - გადაიღო ფილმი
They have things In common - საერთო აქვთ
determine - განსაზღვრა
pale - ფერმკრთალი
Recognition - აღიარება (რაღაცის გაკეთებისთვის, პატივისცემით) recognize her as, notice- შემჩვნევა, აღიარება
Admit - აღიარება დანაშაულის
As -ად I recognize her as the first actor.
Negotiate about [ nigoshieit] - მოლაპარაკება
I have not recognized it yet. -მე ჯერ არ შემიმჩნევია.
I didn’t really like - დიდად არ მომეწონა
Me neither - არც მე
I liked it though - თუმცა მომეწონა
musicians [miusishnz] - მუსიკოსი
how about you? - შენ რას მეტყვი?
Do you think so? - შენც ასე ფიქრობ?
Separation of Church and State: The distance in the relationship between organized religious and the nation state. Due process: The government must act fairly and in accord with established rules in all that it does. Free Speech: Speech that is protected by the First Amendment to the United States Constitution Right of Assembly: The freedom of meeting together in groups protected by the first amendment. Constitutional Guarantee: The idea that the Constitution guarantees certain rights to all people. Civil Liberties: The guarantees of the safety of persons, opinions, and property from the arbitrary acts of government including freedom of religion. Civil Rights: A term used for those positive acts of government that seek to make constitutional guarantees a reality for all people, prohibitions of discrimination. Equal Protection: a guarantee under the 14th Amendment to the United States Constitution that a state must treat an individual or class of individuals the same as it treats other individuals or classes in like circumstances Racial Discrimination: Prejudiced or prejudicial outlook, action, or treatment based on race. Religious Liberty: Religious freedom based on the establishment and free-exercises clauses of the first amendment.There are two numbers you need to know about climate change. The first is 51 billion. The other is zero. Fifty-one billion is how many tons of greenhouse gases the world typically adds to the atmosphere every year. This is where we are today. Zero is what we need to aim for. To stop the warming and avoid the worst effects of climate change, humans need to stop adding greenhouse gases to the atmosphere. This sounds difficult, because it will be. Every country will need to change its ways. Virtually every activity in modern life – growing things, making things, getting around from place to place – involves releasing greenhouse gases, and as time goes on, more people will be living this modern lifestyle. That’s good, because it means their lives are getting better. Yet if nothing else changes, the world will keep producing greenhouse gases, climate change will keep getting worse, and the impact on humans will be catastrophic. But “if nothing else changes” is a big If. I believe that things can change. We already have some of the tools we need, and as for those we don’t yet have, we can not only invent, but also deploy them, and, if we act fast enough, avoid a climate catastrophe. Two decades ago, I would never have predicted that one day I would be talking in public about climate change. My background is in software, not climate science. Things changed for me when I met with two former Microsoft colleagues who were starting non-profits focused on energy and climate. They brought along two climate experts who were well versed in the issues, and the four of them showed me the data connecting greenhouse gas emissions to climate change. I kept learning everything I could about climate and energy, agriculture, oceans, sea levels, glaciers, power lines, and more. One thing that became clear to me was that our current sources of renewable energy – wind and solar, mostly – could make a big dent in the problem, but we weren’t doing enough to deploy them. It also became clear why, on their own, they aren’t enough to get us all the way to zero. The wind doesn’t always blow and the sun doesn’t always shine. Within a few years, I had become convinced of three things: 1. To avoid a climate disaster, we have to get to zero. 2. We need to deploy the tools we already have, like solar and wind, faster and smarter. 3. We need to create breakthrough technologies that can take us the rest of the way.Powers granted to the national government by the United States Constitution which are spelled out (written) specifically in the Constitution are called ___________ powers. Denied Concurrent Federal Enumerated This was the first plan of government for the United States. It was meant to be a league of friendship between the states. It was too weak and failed. Magna Carta Mayflower Compact Petition of Right Articles of Confederation What gave Congress the power to regulate both foreign and interstate trade? Commerce Clause Kansas-Nebaska Act Supremacy Clause Santa Clause What is the structure of the national government? a) Unitary b) Federal c) Confederal d) Autocratic What is the relationship between the three branches of government, including separation of powers? a) They have no relationship b) They work independently of each other c) They share powers and work together d) They have overlapping powers 16. What is the relationship between the state governments and national government? a) State governments have more power than the national government b) State governments have no power compared to the national government c) State governments and the national government have equal power d) State governments and the national government have separate powers 17. What powers are denied by the state governments but given to the national government? a) Reserved powers b) Concurrent powers c) Denied powers d) Implied powers 18. What powers are shared by both the state governments and national government? a) Reserved powers b) Enumerated powers c) Concurrent powers d) Implied powers 19. States had no government at all when the United States was born. a) True b) False 20. The central government of the U.S. is known as the federal government. a) True b) Falserefreshment (n): (small amounts of food and drink ( Refreshments will be available during the interval.) stimulant (n): a substance which temporarily arouses physiological or organic activity ( Caffeine is a natural stimulant .) reinforcement (n): the act of making sth stronger / (plural) soldiers sent to join an army to make it stronger ( Constructors have been hired to add reinforcement to the foundations of the old bridge.) initiative (n): the ability to make decisions without waiting to be told what to do (Being a successful entrepreneur requires one to have great initiative.) inhibition (n): a shy or nervous feeling that stops you from expressing your real feelings (She drinks alcohol at parties to get over her inhibitions.) initiation (n): a ceremony, ritual, test, or period of instruction with which a new member is admitted to an organization or office (The initiation period for new employees lasts approximately six weeks.) initial (n): the first letter of a name, esp. when used to represent a name (Do you know what Ms Rowling's initials, J and K, stand for?) concise (adj): short and clear, expressing what needs to be said without unnecessary words (She gave a concise overview of the points she was about to make in her speech. ) direct (adj): happening or done without involving other people, actions, etc. in between ( You will only be hired if you have direct experience in this field.) devious (adj): not straightforward, sincere and honest about your intentions or motives; shifty (They came up with a devious plan to overthrow the chairman of the company.) circuitous (adj): not straight or direct (The professor gave a circuitous explanation confusing his students.) diluted (adj): (of a liquid) made weaker or less pure by being mixed with sth else( Orange squash should be diluted with water before it is served.) delicate (adj): easily hurt or destroyed.( This silk shirt is too delicate to put in the washing machine.) desolate (adj): extremely sad and feeling lonely. (After the death of his wife he led a desolate life.) diffused (adj): widely spread or scattered; not concentrated/ wordy ( He spoke in such a diffused manner that it was impossible to take notes on his lecture.) might (n): the power, force, or influence held by a person or group (The captive struggled with all of his might and managed to free himself of the chains.) plot (n): a secret plan made by several people to do sth that is wrong, harmful or not legal, esp. to do damage to a person or a government / a storyline ( The plot of the forthcoming Harry Potter book has yet to be revealed.) glaze (n): a thin clear liquid put on objects before they are finished, to give them a shiny surface ( She mixed sugar and lemon to make the glaze of the cake.) plight (n): an unpleasant condition, esp. serious, sad or difficult one ( Last night's documentary dealt with the plight of political asylum seekers.) comprise (v): to consist of be composed of( The final exam is comprised of three parts.)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 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)