Iker said: I know it's a bit high but in Science 4, the 80% of the mark comes from a summative assessment. I am new in the department and it is something that was already set.

I think we should think about it for the next year…

Leire said: I don’t deduct points for spelling or grammar mistakes because I think that is not a way to learn. But when the spelling mistake __________________________ I ask students to copy the words in their notebooks

changes the meaning of the word

Forum summary - 5.3 & 5.4 - ASSESSMENT

LESSON 4. Cellular Respiration • Define cellular respiration • Identify the stages of clan respiration You have just learned how the energy from the sun is captured, processed, and stored in the form of glucose. Cellular respiration, another important life process, is the means by which cells release the stored energy in glucose to make adenosine triphosphate (ATP). The primary goal of this life process is to convert stored energy into usable form, such as ATP, for the cells to carry out their functions. Cellular respiration involves several chemical reactions. The reactions can be summed up in the following equation: C6 H12 O6 + 602 ----- 6 CO₂ +6H₂O + ATP Glucose oxygen carbon dioxide water energy Aerobic respiration reactions, or cellular respiration that takes place in the presence of oxygen, can be grouped into three stages glycolysis, Krebs cycle, and electron transport chain (ETC). Stage 1: Glycolysis Glycolysis is the process that breaks down one molecule of 6-C glucose into 3-C pyruvates or pyruvic acids. It also releases four molecules of ATP. This process occurs in the cytoplasm of the cell. The following is the step-by-step process of glycolysis. Take note that several enzymes are involved in this process. 1. The first step of glycolysis requires energy. It can only proceed when the two ATP molecules donate energy to the glucose by transferring a phosphate group with the help of an enzyme, producing glucose 6-phosphate 2. Then, a specific enzyme promotes the rearrangement of the atoms, producing the fructose 6-phosphate. 3. The action of the enzyme in step 2 promotes the transfer of a phosphate group from another ATP molecule, forming fructose 1,6-bisphosphate. 4. The resulting fructose 1,6-bisphosphate molecules, with the help of another enzyme, splits into two molecules, each with three carbon backbones. These two sugars are dihydroxyacetone phosphate and glyceraldehyde 3-phosphate. 5. Another important enzyme then rapidly interconverts the molecules of dihydro-xyacetone phosphate and glyceraldehyde 3-phosphate. This produces two molecules of glyceraldehyde 3-phosphate or 3-phosphoglyceraldehyde (PGAL) 6. The succeeding step involves another enzyme-mediated action. The hydrogen (H) from PGAL is transferred to the oxidizing agent, nicotinamide adenine dinucleotide (NAD), which forms NADH. A phosphate (P) is also added from the cytosol of the cell to oxidize the two molecules of PGAL, forming two 1.3-bisphosphoglycerate. 7. A phosphate (P) from 1,3-biphosphoglycerate is transferred to ADP to form ATP. This happens for each of the two 1,3-bisphosphoglycerate. resulting to a yield of two ATP and two 3-phosphoglycerate molecules. 8. A phosphate is transferred from 3-phosphoglycerate molecules from the third carbon to the second carbon, forming 2-phosphoglycerate molecules A hydrogen atom and a hydroxyl ((OH) group is released, which then combines to form water (H2O). The removal of H2O from 2-phosphoglycerate results in the formation of 2- phosphoglycerate molecules. 9. A hydrogen atom and a hydroxyl ((OH) group is released, which then combines to form water (H2O). The removal of H2O from 2-phosphoglycerate results in the formation of two phosphoenolpyruvic acid (PEP) 10. Phosphate (P) from PEP is transferred to ADP (and forms ATP) and the final product, pyruvic acid. This reaction yields two molecules of pyruvic acid and two ATP molecules In summary, a single glucose molecule that undergoes the process of glycolysis produces two molecules of pyruvic acid, four molecules of ATP, two molecules of NADEL and two molecules of H.O. However, only two molecules of ATP are counted as net products since two molecules of ATP are spent throughout the process. Stage II: Krebs Cycle The Krebs cycle, named after its proponent Sir Hans Adolf Krebs, is a cyclical series of enzyme-controlled reactions. This stage of cellular respiration occurs in the matrix of the mitochondria. It is sometimes. called the citric acid cycle (CAC) since it produces citric acid. Citric acid contains three carboxyl (COOH) groups; hence, it is also called the tricarboxylic acid cycle (TCA). This requires the pyruvic acids produced during glycolysis. The main function of this cycle is to produce high-energy-yielding molecules, namely, NADH and flavin adenine dinucleotide (FADH) that will later on be used in the electron transport chain reaction. Figure 6-7. Summary of glycolysis and corresponding products in each reaction presented (See Appendix F on page 285 for an enlarged and complete version of the image.) An initial process is needed for the Krebs cycle to begin. As a pyruvate molecule from glycolysis enters the mitochondrion, it undergoes an important preliminary ate to form acetyl-CoA reaction. Coenzyme-A (COA) combines with pyruvate help of an enzymatic complex. This conversion also produces CO, and NADH. The Krebs cycle is summarized as follows. Take note that several enzymes are involved in this process. 1. The Krebs cycle technically begins when the acetyl-CoA combines with oxaloacetic acid (OAA), a 4-C molecule, to produce citric acid, a 6-C molecule. 2. With the aid of an enzyme, the citric acid now goes through a series of reactions that releases energy. Water molecule is removed from the citric acid and is returned in a different location. The-OH group is repositioned, forming the molecule isocitrate. 3. Isocitrate is then oxidized, forming the a-ketoglutarate, a 5-C molecule. The byproducts of this reaction are NADH and CO, 4 The a-ketoglutarate loses its CO, and a coenzyme-A is added in its place. The decarboxylation occurs with the help of NAD, which then becomes NADH. The resulting molecule is called succinyl-CoA. 5. Succinyl-CoA is converted into succinate. Also in this reaction, a molecule of guanosine triphosphate (GTP) is synthesized. The GTP molecule has similar structure and energy properties to that of ATP and is used by cells the same way. The free phosphate group attacks the succinyl-CoA molecule, which detaches the COA. Then, phosphate is attached to GDP to come up with GTP, similar to the process that occur in ATP synthesis (from ADP to ATP). 6. Two hydrogens are removed from succinate, A molecule of flavin adenine dinucleotide (FAD), a coenzyme similar to NAD, is reduced to FADH, as it takes the hydrogens from the succinate. This reaction produces the fumarate. 7. Fumarate is then converted into malate as the addition of a water molecule is catalyzed. The final reaction is the regeneration of oxaloacetate. The resulting byproduct of this regeneration is NADH Recall that two pyruvate molecules were produced during glycolysis, causing the Krebs cycle to turn twice. Each tuts produces three molecules of NADH, single ATH one FADIH, and the by-product CO, which is exhaled. Stage III: Electron Transport Chain The electron transport chain (ETC) is a series of photon pumps on the inner membrane of the mitochondrion. Electron transport is the last stage of the cellular respiration. In this stage, the energy from NADH and FADH, from the Krebs cycle is transferred to ADP to produce ATP. This process is generally known as oxidative phosphorylation. This energy coupling mechanism in the cell was revealed by the work of Peter stored energy in the form of proton (1) gradient to phosphorylate (add phosphate) ADP and produce ATP. The pumping of hydrogen sons across the inner membrane creates higher concentration ions in the inner membrane than on the outside of the membrane. This chemiosmotic gradient causes the ions to flow back across the membrane where the concentration of ions is lower. ATP synthase lined in the matrix serve as a channel protein, helping the ions to move across the membrane. The chemiosmotic gradient powers the phosphorylation of ADP to ATP, which also occurs in the ATP synthase. After passing through the ETC, the oxygen, being the final hydrogen acceptor, combines with two electrons and two protons, forming a water molecule. Water is a by-product of cellular respiration and is excreted. MINI TEST 6-3 1. Which energy-releasing pathway yields the most ATF in each glucose molecule? 2. Briefly describe the two stages of aerobic respiration that follow glycolysis: (a) Krebs cycle (b) Electron transport chain Anaerobic Respiration Most cells carry out arrobic respiration when oxygen is present. Aerobic respiration is an efficient process that yields a lot of ATP. However, many organisms thrive in mud, marshes, animal gut, canned goods, sewage treatment pond, and deep oceans where oxygen is scarce. Organisms that can live without oxygen are called anaerobes. Cellular respiration that proceeds without the presence of oxygen is called anaerobic respiration. In the event that the oxygen supply becomes low, aerobic cells also perform fermentation and lactic acid fermentation anaerobic pathways. There are two common anaerobic pathways in these cells, alcoholic fermentation and lactic acid fermentation. In alcoholic fermentation, ethyl alcohol and carbon dioxide are produced by some cells using the pyruvate from glycolysis. Each pyruvate molecule is rearranged into acetaldehyde and carbon dioxide, which is eventually released. NADII gives up electrons to acetaldehyde to form ethanol Fermentation is widely used in the industry. Yeast, a fungus used in making bread. can undergo anaerobic respiration. Bakers aux sugar, flour, water, and yeast to form the bread dough. The dough rises due to the carbon dioxide and alcohol released by the yeast cells trapped in air bubbles. Beer and wine manufacturers, we yeast to ferment the sugars in wheat and grape juice, forming alcoholic beverages such as beer and wine. In some cells, glycolysis produces two pyruvates, two NADH molecules, and two ATP molecules. Pyruvate itself becomes the final acceptor of the electrons from the NADH that produces the final product: lactate. Oftentimes, this product is called lactic acid. Human skeletal muscles can carry out fermentation when the blood cannot supply the cells with adequate oxygen during strenuous activities. When lactic acid builds up in the muscles, fatigue, burning sensation, and cramps result. Lactic acid will continue to build up until there is adequate supply of oxygen. Lactic acid is then converted back into pyruvate in the liver. Muscles also restore normal functions. Have you ever wondered why milk or cream turns sour after some time? Bacterial cells that undergo fermentation are responsible in producing lactate that turns the milk sour. These bacteria are used in manufacturing yogurt and sour milk products. Fermentation pathways do not breakdown and utilize the glucose completely. ATP is no longer produced beyond the process of glycolysis. Thus, energy produced is just enough for some single-celled organisms, or the energy can only be used by multicellular organisms for a short period.

Analysis is a method of organizing, sorting, and scrutinizing data in such a way that a research question can be answered or meaningful inferences can be drawn. 4 2. Bibliography is a list of all the sources used in the process of researching. 3. Concept refers to a mental idea of a phenomenon. These are words or terms that symbolize some aspects of reality. e. g. love, pain. 4. Conclusion provides a summary of the research. 5. Data is an information that can be words or numbers. 6. Data Gathering Tools refer to the devices/ instruments used to collect data such as questionnaire or computer- assisted interviewing system. 7. Data Presentation involves the use of a variety of different graphical techniques. 8. Descriptive study is a research design that describes “what is”( e.g. a survey). 9. In-Text Citation is the brief form of the reference included in the body of one’s work. 10. Limitations are restrictions in a study that may decrease the credibility and generalizability of the research findings. 11. Literature review is a critical summary or research on a topic of interest, generally prepared to put a research problem in context or to identify gaps and weaknesses in prior studies so as to justify a new investigation. 12. Plagiarism is the unethical practice of using words or ideas of another author/researcher without proper acknowledgement. 13. Quantitative Research is the process of collecting and analyzing numerical data. 14. Questionnaire is a set of questions used to gather information in a survey. 15. Research Topic is a subject or issue that a researcher is interested in when conducting a research. 16. Respondents are those persons who have been invited to participate in a particular study and have actually taken part in the study. 17. Research Question is the question around which a researcher centers his/ her research. 18. Sample is a part or subset of population selected to participate in the research study. 19. Socio Demographic Profile includes age, sex, education, migration, background and ethnicity, religious affiliation, marital status, household, employment, and income. 20.Variables are attributes or characteristics that can have more than one value, such as height or weight. These are qualities or quantities, properties or characteristics of people, things, or situations that change or vary

Certainly, let's expand on each section in detail so you can learn more from the provided text: # Summary This text aims to explain various aspects related to technology, particularly focusing on a concept known as "Tech Disruption." It explores how technology affects different sectors, outlines the conditions for tech disruption, discusses the industrial revolutions, introduces the laws of disruption, and mentions factors influencing technology choices. ## Concept of Technology **Technology** encompasses a range of elements within organizations. It includes **expertise, equipment, and procedures** used to convert inputs, such as resources or raw materials, into outputs, which can be products or services. This involves various aspects, such as **product design, production techniques, quality assurance measures, human resource development, and management systems**. In essence, technology represents the tools and knowledge used to create and deliver goods or services effectively. ## What is Tech Disruption **Tech Disruption** refers to a phenomenon where smaller companies with limited resources successfully challenge well-established incumbent businesses. This disruption is primarily driven by **technology**, which acts as the catalyst, enabler, or even the sole reason behind the change. The significance of this concept lies in the fact that entrepreneurs must make careful and thoughtful decisions when it comes to adopting and investing in technology. **Why it's Important?** These decisions are crucial because they involve significant investments and will have a substantial impact on a company's ability to create, innovate, and operate its services in a sustainable and cost-effective manner. ## Four Main Impact **Tech Disruption** has four main impacts on businesses and industries: 1. **Shifting Customer Expectations**: As technology evolves, customer expectations change. Companies must adapt to meet these evolving demands to remain competitive. 2. **Enhanced Products Through Data**: Data-driven insights improve the productivity and efficiency of assets, leading to better products and services. 3. **New Partnerships and Collaboration**: Tech disruption encourages companies to form new partnerships and collaborations, recognizing the importance of working together to stay relevant. 4. **Transformation of Operating Models**: Traditional operating models are being transformed into digital models, where technology plays a central role in how businesses operate and deliver value. ## The 11 Macro Sources of Distribution The **11 Macro Sources of Distribution** represent various factors that influence the distribution of resources and opportunities in society. These factors include: 1. **Wealth Distribution**: How wealth is distributed among individuals and entities. 2. **Education**: The availability and quality of education opportunities. 3. **Infrastructure**: The state of infrastructure, such as transportation and communication networks. 4. **Government**: Government policies and regulations that impact resource distribution. 5. **Geopolitics**: Geopolitical factors, such as international relations and conflicts. 6. **Economy**: Economic conditions and trends, including markets and financial systems. 7. **Public Health**: The state of healthcare and public health systems. 8. **Demographics**: Characteristics of the population, such as age and gender. 9. **Environment**: Environmental factors and sustainability concerns. 10. **Media and Telecommunications**: The role of media and communication technologies. 11. **Technology**: Technological advancements and their impact on society. ## When Does Tech Disruption Happen? **Tech Disruption** occurs when specific conditions are met: ### Technology Is Mature Enough - **Technology Accessibility**: Technology must be accessible to a wide range of people and organizations. - **Critical Mass**: It should have reached a critical mass where it can create significant impact. - **Affordability**: Technology must be affordable for businesses to adopt. ### Sector Is Ready For Change - **Tech Infrastructure**: The sector should have the necessary technological infrastructure in place. - **Policy Framework**: A conducive policy framework is essential to support and regulate the use of technology. - **Lack of Disruption**: If the sector is stagnant or facing issues, it becomes ripe for tech disruption. ### Sector + Technology + Timing + Product - **Mature Technology with an Unready Sector**: If technology is mature but the sector is not ready, it can lead to building the wrong product based on incorrect assumptions. - **Unmatured Technology with a Ready Sector**: Conversely, if technology is not matured but the sector is ready, it may take longer to develop the product. ## Ready for Industri 5.0? This section briefly outlines the five industrial revolutions: 1. **Industri 1.0 (1784)**: Marked by mass production assembly lines using electrical power. 2. **Industri 2.0 (1870)**: Introduced mechanization, steam, and water power. 3. **Industri 3.0 (1969)**: Characterized by automated production, computers, IT systems, and robotics. 4. **Industri 4.0 (Present)**: Involves smart factories, autonomous systems, IoT (Internet of Things), and machine learning. 5. **Industri 5.0 (Future)**: Envisions mass customization and cyber-physical cognitive systems. ## Three Laws of Disruption These laws explain the nature of disruption: 1. **Disruption Comes to All**: Disruption is a universal phenomenon; it affects all industries and businesses sooner or later. 2. **Product-Market Fit**: Disruption occurs due to changes in Product-Market Fit, which means aligning a product with its target market effectively. 3. **Methods to Change Product-Market Fit**: To address disruption, a company can change the product, the target market, or influence people's preferences regarding the product. ## The 40% Rule This rule provides a framework for evaluating the fit between a product and its market: - **Value Proposition**: The product should solve customers' problems effectively. - **Channels**: The product should be able to reach customers cost-effectively. - **Monetization**: Customers should be willing to pay for the product. ## PMF Framework: 5 Steps to Product/Market Fit The **PMF (Product/Market Fit) Framework** consists of five steps: 1. **Business Modeling**: Developing a business model that aligns with the market. 2. **Market Validation**: Confirming that there is demand for the product in the market. 3. **Customer Interviews**: Gaining insights from potential customers. 4. **Product Development and Customer Acquisition**: Creating the product and acquiring customers. 5. **Product Analytics**: Using data to determine if the product has achieved Product/Market Fit. ## Factors Determining the Choice of Technology Several factors influence the choice of technology: 1. **Government Policy**: Government regulations and policies can encourage or restrict the adoption of specific technologies. 2. **Available Resources**: The resources, both financial and human, impact the adoption of technology. 3. **Technological Capability**: The organization's technological capabilities influence the choice of technology. 4. **Existing Technological Level**: The current technological state of the industry or organization plays a role. 5. **Institutional Arrangement**: Organizational structures and arrangements affect technology choices. ## Conclusion In conclusion, the text emphasizes the critical role of technology in driving change and disruption in various industries. It highlights the need for informed decision-making when it comes to technology investments, as well as the conditions necessary for tech disruption to occur. Understanding the historical context of industrial revolutions, the laws of disruption, and the factors influencing technology choices is essential in today's fast-paced and tech-driven business environment. Embracing technology disruption is crucial for transforming business models and adapting to evolving market dynamics.

PHOTOSYNTHESIS LIGHT DEPENDENT REACTION 1. Photosystem II (PSII) – Light Absorption & Water Splitting • Light energy (photons) excites electrons in chlorophyll molecules. • These high-energy electrons leave PSII and are passed into the electron transport chain (ETC). • Meanwhile, water molecules are split (photolysis) into: o O₂ (released as a by-product into the atmosphere) o H⁺ ions (protons, which build up inside the thylakoid) o Electrons (e⁻), which replace the ones lost by PSII. 2. Electron Transport Chain (ETC) • Excited electrons move through protein carriers embedded in the thylakoid membrane. • As they move, their energy pumps H⁺ ions into the thylakoid space, creating a proton gradient (high H⁺ inside, low outside). 3. ATP Production (ATP Synthase) • The buildup of H⁺ ions acts like a “waterfall” of potential energy. • These protons flow back across the membrane through ATP synthase, a protein complex that acts like a turbine. • This flow drives the conversion of ADP + Pi → ATP, which provides energy for the Calvin cycle. 4. Photosystem I (PSI) • Electrons arriving from the ETC enter PSI. • Sunlight excites them again, boosting them to a higher energy level. 5. NADPH Production • The energized electrons are transferred to NADP⁺. • Along with a proton (H⁺), this forms NADPH, another energy carrier. • NADPH is then delivered to the Calvin cycle to help build glucose. End Products of Light-Dependent Reactions: • ATP (energy source for Calvin cycle) • NADPH (reducing power for glucose synthesis) • O₂ (released into the atmosphere as waste) Light-Independent Reactions (Calvin Cycle) • These reactions do not directly require sunlight. • They occur in the stroma of the chloroplast (the fluid-filled space surrounding the thylakoids). • The inputs are ATP and NADPH (from light-dependent reactions) and CO₂ (from the atmosphere). • The outputs are glucose (C₆H₁₂O₆) and other carbohydrates. Think of the Calvin cycle as a factory that uses the energy and “raw materials” made in Stage I (ATP & NADPH) to build sugars. The 3 Main Steps of the Calvin Cycle 1. Carbon Fixation • CO₂ from the atmosphere enters the chloroplast and diffuses into the stroma. • Each CO₂ molecule attaches to a 5-carbon sugar called RuBP (ribulose-1,5-bisphosphate). • This reaction is catalyzed by the enzyme RuBisCO (Ribulose-1,5-bisphosphate carboxylase/oxygenase — the most abundant enzyme on Earth!). • The result is a short-lived 6-carbon compound, which immediately splits into two 3-carbon molecules called 3-PGA (3-phosphoglycerate). Summary: CO₂ + RuBP → 2 × 3-PGA 2. Reduction Phase • The 3-PGA molecules are “energized” and converted into G3P (glyceraldehyde-3-phosphate), a more energy-rich 3-carbon sugar. • This transformation requires: o ATP (provides energy) o NADPH (provides high-energy electrons and hydrogen atoms). • Some of the G3P molecules will eventually be combined to form glucose and other sugars. Summary: 3-PGA + ATP + NADPH → G3P 3. Regeneration of RuBP • Not all G3P molecules leave the cycle. Most of them are used to regenerate RuBP so the cycle can continue. • This regeneration also requires ATP. • For every 3 turns of the cycle, 5 G3P molecules are recycled to regenerate 3 molecules of RuBP. Summary: G3P + ATP → RuBP The Full Cycle Balance • To make one G3P molecule that can exit the cycle (and later form glucose), the cycle must run 3 times, fixing 3 molecules of CO₂. • To make one glucose molecule (C₆H₁₂O₆), the cycle must run 6 times (since glucose needs 6 carbon atoms). Inputs (for 1 glucose): • 6 CO₂ • 18 ATP • 12 NADPH Outputs: • 1 glucose (C₆H₁₂O₆) • 18 ADP + 18 Pi • 12 NADP⁺ Day vs Night Clarification • The Calvin Cycle is called light-independent, but that doesn’t mean it only happens at night. • It usually happens during the day because it depends on ATP and NADPH, which are only produced in light-dependent reactions (when sunlight is available). Simplified Analogy • Carbon fixation = The factory brings in CO₂ as raw material. • Reduction = Workers use energy (ATP & NADPH) to shape the raw material into useful products (G3P). • Regeneration = Some products are recycled to keep the factory running (RuBP is re-formed). • Output = After enough cycles, the factory produces glucose, the “food” of the plant.

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)

History 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

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