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From the birth of tragedy
Quiz by Pauline David
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In a single domesticated grain seed, one might see the bud of great civilizations. The birth of agriculture was a turning point in humans' social development, as stable food supplies enabled people to transcend the constraints of food gained by hunting and gathering. After that, people were able to settle down and experience population booms. As one of the major areas around the globe where agriculture originated, China has contributed to the world's domesticated rice, millet, buckwheat and soybeans. Archaeological studies have unveiled that the planting of rice originated around 10,000 years ago in the lower reaches of the Yangtze River, leading to the eventual replacement there of hunting and gathering practices dating back 5,000 to 6,000 years. "It marked the formation of a rice-based agricultural society in the area," said Zhao Zhijun, an archaeologist at the Chinese Academy of Social Sciences. Archaeological studies of the origins of rice-based agriculture are an important part of a national project tracing the origins of Chinese civilization itself. President Xi Jinping has greatly valued the project. At a group study session of the Political Bureau of the Communist Party of China Central Committee on May 27, 2022, Xi, who is also general secretary of the CPC Central Committee, emphasized the significance of the project and the role that archaeological studies play in better understanding Chinese civilization. The project to trace the origins of Chinese civilization, in addition to finding signs of human activity more than 1 million years ago, has also proved that China's history includes 10,000 years of culture and more than 5,000 years of civilization. The project has provided clear knowledge of the origins and formation of Chinese civilization, the history of its development, the process of the formation and development of its pluralistic and integrated pattern, and the characteristics of the civilization and why it was formed in such a way, he added. This was not the first time that Xi emphasized the importance of the origin-tracing project. Since the 18th National Congress of the CPC in 2012, Xi has toured more than 100 historical and cultural locations and issued many instructions related to archaeology and the origin-tracing project. During the 23rd group study session of the Political Bureau of the CPC Central Committee in 2020, Xi called for giving more attention to archaeological research and letting historical facts speak for themselves. "This will provide strong support for our efforts to carry forward the best of traditional Chinese culture and increase our cultural confidence," said Xi. The origin-tracing project has been carried out since 2002. Its ongoing fifth phase, which started in 2020, involves the participation of more than 500 researchers from 29 institutes across the country. It primarily centers on several ancient capital sites, including the Liangzhu site in Hangzhou, Zhejiang province, the Taosi site in Xiangfen county, Shanxi province, the Shimao site in Shenmu, Shaanxi province, and the Erlitou site in Luoyang, Henan province, from 3,500 to 5,500 years ago, as well as other settlements mainly along the basins of the Yellow, Yangtze and Liaohe rivers. The project has also expanded to a wider geographic and chronological framework to decode how Chinese civilization emerged and how its diverse elements formed a unity. Excavation of the Liangzhu site, which is over 5,000 years old and is one of the major sites covered in the origin-tracing project, has yielded an inner city covering 3 million square meters and an outer city of 6.3 million sq m, making it the world's largest capital at the time. It also had a giant water control system, which contributed to the formation of a rice-based agricultural society. By calculating the earthwork volume, archaeologists found that building the entire ancient city, the water control system and Mojiaoshan â a 10-meter-tall man-made terrace in the center of the city â required 10,000 people working daily for seven-and-a-half years. The discoveries show that Liangzhu had a kingship able to organize people for large-scale public construction, and its social differentiation, emergence of the city concept and existence of a kingship prove that it became a civilized society, said Wang Wei, a veteran archaeologist at the Chinese Academy of Social Sciences. Significant topic Wang said that tracing the origins of a civilization is a significant topic in the research of human history. Over the years, the Chinese project has provided China's answer to how to define civilizations. In 2022, Xi commended the efforts and stressed that the project has made creative contributions to the research on tracing the origins of the world's civilizations. Wang said: "International academia has proposed three indispensable elements for a civilized society based on features of Mesopotamian and Egyptian civilizations: written characters, metallurgy and the city concept. But we can find that some of the three elements were absent in many ancient civilizations. For example, the Mayan civilization had no metallurgy, while the Incan civilization didn't have written characters." Western scholars believe that Chinese civilization began with the Yinxu Ruins in Anyang, Henan province, a capital of the late Shang Dynasty (c.16th century-11th century BC), based on the discovery of inscribed oracle bones from that time. However, Chinese archaeologists don't agree. With continued archaeological research, international academia now believes that places around the world can propose criteria for civilization based on their own ancient social development. China's archaeological studies have shaped the nation's criteria in defining a civilization: the development of productivity, an increase in population, the appearance of cities, social differentiation and the emergence of kingship and state. "These criteria are suitable for identifying other civilizations as well," said Wang. "Civilizations have in common the appearance of kingship and state. They are only different in the ways of imposing kingship and the forms of state." In China, kingship and state "were shown by exquisite jade and bronze ritual artifacts, grand palaces and magnificent mausoleums imitating aboveground palaces", he added. "In Mesopotamia and ancient Egypt, they were demonstrated through superb stone temples, pyramids and large-scale tombs." Multidisciplinary subject President Xi said in 2020 that archaeologists should work closely with researchers from other fields to make an interpretive analysis of material remains. Zhang Chi, a professor of archaeology at Peking University, said that since material remains are often the research focus of archaeological studies, these should not only be observed with the eyes, but also studied using scientific and technological tools. Therefore, from the perspective of research methods, archaeology is by nature a multidisciplinary subject, Zhang added.THE SOAR SYSTEM A solar system is a group of planets and other celestial bodies that revolve around a star. A solar nebula- a vast cloud of gas and dust, mostly hydrogen and helium. How the Solar System Form ⢠COLLAPSE AND SPINNING DISK FORMATION - Gravity pulls material inward. The cloud flattens into a spinning disk due to conservation of angular momentum. ⢠PROTOSTAR FORMATION- (BIRTH OF THE SUN). Material collects at the center, and begun to heat up. When it reaches to 10 million KELVIN, nuclear fusion begins. thus, SUN is born. ⢠PLANETESIMALS AND PROTOPLANETS. Dust and gas in the disk stick together via static and gravitational forces. These form planetesimals, which grow into protoplanets collision and accretion. ⢠PLANET FORMATION. Inner disk: too hot for gas rocky planets form Mercury, Venus, Earth, Mars. ⢠PLANET FORMATION. Outer disk: gas and ice giants. Jupiter, Saturn, Uranus, Neptune ⢠LEFTOVER DEBRIS. Remaining materials forms moon, asteroids, comets and dwarf planets. DIFFERENT HYPOTHESIS IN THE FORMATION OF SOLAR SYSTEM. 1. NEBULAR HYPOTHESIS- The Solar system formed from a rotating cloud of Gas and Dust (solar nebula). As it rotates conservation of angular momentum caused the cloud to flatten into a disk. the Sun formed at the center (DISK) while planets formed from the surrounding materials through acceleration. thus, it explains the coplanar and nearly circular orbit of the planets all planets orbits around the sun on the same flat, disk shaped plane. Proposed by Immanuel Kant in 1755 and Modified by Pierre Simon Laplace in 1756. PROTOPLANET HYPOTHESIS. The Solar system formed from a rotating cloud of Gas and Dust (solar nebula). As it rotates conservation of angular momentum caused the cloud to flatten into a disk. 2. Protoplanet hypothesis. Builds on the nebular model but focuses more on the role of planetesimals which then form into full planets. PROCESS: - Small solid particles stick together through collisions. As collisions takes place, it grows into kilometer-sized planetesimals. Gravitational interactions lead to the formation of planets. Lead to formation of steroids belts and varying planet sizes 3. Encounter hypothesis. States that the sun encountered a rogue star. The encounter led to the removal of hot gas from both stars due to their gravitational interaction. The hot gas then accumulated and formed the planets. The materials from the less dense rogue star formed the other planets, while that from the sun formed the inner planets. 4. TIDAL HYPOTHESIS. (also called the Tidal Theory) is an early scientific idea about how the solar system might have formed. Proposed by James Jeans and Harold Jeffreys. A massive star passed very close to the early Sun. The hot gas then accumulated and formed the planets. The materials from the less dense rogue star formed the other planets, while that from the sun formed the inner planets. Streams of hot gas were drawn out from the Sun in elongated shape. These streams eventually condensed and cooled, forming planets, moons, and other bodies in the solar system. 5. Not accepted theory. Later studies showed the streams of hot gas would disperse too quickly into space instead of condensing into planets. The theory also couldnât explain the specific orbital patterns and compositions we see today. Modern science favors the Nebular Hypothesis, which explains solar system formation through the collapse of a rotating gas cloud. Earth as the only habitable planet 1. Right Distance from the Sun (The Goldilocks Zone). Not too hot, not too cold â just right for liquid water to exist. 2. Atmosphere with Oxygen. Earth has a mix of gases, especially oxygen, which most living things need to survive. 3. Liquid Water. Earth has oceans, rivers, and rain â water is essential for all life. 4. Magnetic Field. Earthâs magnetic field protects us from harmful solar radiation. 5. Stable Climate. The atmosphere and natural cycles keep temperatures and weather mostly stable over time. 6. Rich Resources. Earth has soil for growing food, minerals, and energy sources that support life and technology. Solar explorations 1. AUGUST 6, 2014. First space craft to orbit a comet (ROSETTA PROBE). Captures the comet photograph. -Comets have coma and tail as it approaches to the sun. 2. JULY 14, 2015. NASAâs New Horizons spacecraft made history by becoming the first spacecraft to fly by Pluto, giving us our first close-up look at the dwarf planet. First time visiting Pluto. Before this, Pluto was just a blurry dot in telescope images. Revealed a surprising world New Horizons showed mountains of ice, smooth plains, and a heart-shaped region called Tombaugh Regio. Changed what we knew. Scientists thought Pluto would be dull and frozen â instead, it turned out to be geologically active and incredibly complex. 3. SEPTEMBER 8, 2016. NASA launched OSIRIS-REx, the first U.S. mission to collect a sample from an asteroid and return it to Earth. Changed what we knew. Scientists thought Pluto would be dull and frozen â instead, it turned out to be geologically active and incredibly complex. OSIRIS-REx stands for: Origins, Spectral Interpretation, Resource Identification, SecurityâRegolith Explorer It was sent to study the asteroid Bennu, a near-Earth asteroid about 500 meters wide. Mission Goals: Collect a sample of surface material from Bennu Study the asteroidâs omposition, structure, and history. Mission Goals: Help scientists understand the origins of the solar system. Learn more about asteroids that could impact Earth. 4. August 12, 2018: Launch of NASAâs Parker Solar Probe, the first spacecraft to "touch" the Sun by flying through its outer atmosphere, called the corona. Mission Goal: To study the Sun up close and help scientists understand: How the solar wind (a stream of charged particles) is formed. Why the Sunâs corona is hotter than its surface. What causes solar storms that can affect Earthâs satellites and power grids. 5. November 26, 2018: NASAâs Insight Lander Touches Down on Mars. Its mission was focused on studying the interior of the Red Planet (crust, mantle, and core of the planet). Why the Sunâs corona is hotter than its surface. What causes solar storms that can affect Earthâs satellites and power grids 6. November 26, 2018: NASAâs Insight Lander Touches Down on Mars. Its mission was focused on studying the interior of the Red Planet (crust, mantle, and core of the planet) 7. JULY 30, 2020 PERSEVERANCE PROBE. Perseverance rover as part of the Mars 2020 mission aboard an Atlas V-541 rocket This marked a major step in Mars exploration. 8. DECEMBER 25, 2021-JAMES WEBB SPACE TELESCOPE. Investigate exoplanetsâ atmospheres for signs of habitability. Observe the first galaxies formed after the Big Bang. Study the formation of stars and planetary systems. Look deeper into the infrared universe than ever before. RESULTS OF EXPLORATION ⢠Evidence of Ancient Life-friendly Environment. ⢠Sedimentary rocks formed in water-rich environments. ⢠Signs of clay and carbonate minerals, which can preserve biosignatures (traces of past life). ⢠Evidence of Ancient Life-friendly Environment. ⢠Sedimentary rocks formed in water-rich environments. ⢠Signs of clay and carbonate minerals, which can preserve biosignatures (traces of past life). ⢠Evidence of Ancient Life-friendly Environment. ⢠Sedimentary rocks formed in water-rich environments. ⢠Signs of clay and carbonate minerals, which can preserve biosignatures (traces of past life).Figure 18-11 represents the amount of energy stored as organic material in each trophic level in an ecosystem. The pyramid shape of the diagram indicates the low percentage of energy transfer from one level to the next. On average, 10 percent of the total energy consumed in one trophic level is incor- porated into the organisms in the next. Why is the percentage of energy transfer so low? One reason is that some of the organisms in a trophic level escape being eaten. They eventually die and become food for decomposers, but the energy contained in their bodies does not pass to a higher trophic level. Even when an organism is eaten, some of the molecules in its body will be in a form that the consumer cannot break down and use. For example, a cougar cannot extract energy from the antlers, hooves, and hair of a deer. Also, the energy used by prey for cellu- lar respiration cannot be used by predators to synthesize new bio- mass. Finally, no transformation or transfer of energy is 100 percent efficient. Every time energy is transformed, such as during the reactions of metabolism, some energy is lost as heat. Limitations of Trophic Levels The low rate of energy transfer between trophic levels explains why ecosystems rarely contain more than a few trophic levels. Because only about 10 percent of the energy available at one trophic level is transferred to the next trophic level, there is not enough energy in the top trophic level to support more levels. Organisms at the lowest trophic level are usually much more abundant than organisms at the highest level. In Africa, for exam- ple, you will see about 1,000 zebras, gazelles, and other herbivores for every lion or leopard you see, and there are far more grasses and shrubs than there are herbivores. Higher trophic levels con- tain less energy, so, they can support fewer individuals.A population is a group of organisms that belong to the same species and live in a particular place at the same time. All of the bass living in a pond during a certain period of time make up a pop- ulation because they are isolated in the pond and do not interact with bass living in other ponds. The boundaries of a population may be imposed by a feature of the environment, such as a lake shore, or they can be arbitrarily chosen to simplify a study of the population. The humans shown in Figure 19-1 are part of the pop- ulation of a city. The properties of populations differ from those of individuals. An individual may be born, it may reproduce, or it may die. A population study focuses on a population as a wholeâhow many individuals are born, how many die, and so on. Population Size A populationâs size is the number of individuals that the population contains. Size is a fundamental and important population property but can be difficult to measure directly. If a population is small and composed of immobile organisms, such as plants, its size can be determined simply by counting individuals. Often, though, individ- uals are too abundant, too widespread, or too mobile to be counted easily, and scientists must estimate the number of individuals in the population. Suppose that a scientist wants to know how many oak trees live in a 10 km2 patch of forest. Instead of searching the entire patch of forest and counting all the oak trees, the scientist could count the trees in a smaller section of the forest, such as a 1 km2 area. The scientist could then use this value to estimate the population of the larger area. SECTION 1 OBJECTIVES â Describe the main properties that scientists measure when they study populations. â Compare the three general patterns of population dispersion. â Identify the measurements used to describe changing populations. â Compare the three general types of survivorship curves. VOCABULARY population population density dispersion birth rate death rate life expectancy age structure survivorship curve FIGURE 19-1 A population can be widely distributed, as Earthâs human population is, or confined to a small area, as species of fish in a lake are. Copyright Š by Holt, Rinehart and Winston. All rights reserved. 382 CHAPTER 19 If the small patch contains 25 oaks, an area 10 times larger would likely contain 10 times as many oak trees. A similar kind of sampling technique might be used to estimate the size of the pop- ulation shown in Figure 19-2. To use this kind of estimate, the sci- entist must assume that the distribution of individuals in the entire population is the same as that in the sampled group. Estimates of population size are based on many such assumptions, so all esti- mates have the potential for error. Population Density Population density measures how crowded a population is. This measurement is always expressed as the number of individuals per unit of area or volume. For example, the population density of humans in the United States is about 30 people per square kilome- ter. Table 19-1 shows the population sizes and densities of humans in several countries in 2003. These estimates are calculated for the total land area. Some areas of a country may be sparsely popu- lated, while other areas are very densely populated. Dispersion A third population property is dispersion (di-SPUHR-zhuhn). Dispersion is the spatial distribution of individuals within the popu- lation. In a clumped distribution, individuals are clustered together. In a uniform distribution, individuals are separated by a fairly con- sistent distance. In a random distribution, each individualâs location is independent of the locations of other individuals in the popula- tion. Figure 19-3 illustrates the three possible patterns of dispersion. Clumped distributions often occur when resources such as food or living space are clumped. Clumped distributions may also occur because of a speciesâ social behavior, such as when animals gather into herds or flocks. Uniform distributions may result from social behavior in which individuals within the same habitat stay as far away from each other as possible. For example, a bird may locate its nest so as to maximize the distance from the nests of other birds. These migrating wildebeests in East Africa are too numerous and mobile to be counted. Scientists must use sampling methods at several locations to monitor changes in the population size of the animals. FIGURE 19-2 TABLE 19-1 Population Size and Density of Some Countries Population size Population density Country (in millions) (in individuals/km2) China 1,289 135 India 1,069 325 United States 292 30 Russia 146 8 Japan 128 337 Mexico 105 54 Kenya 32 54 Australia 20 3 dispersion from the Latin dis-, meaning âout,â and spargere, meaning âto scatterâ Word Roots and Origins Copyright Š by Holt, Rinehart and Winston. All rights reserved. POPULATIONS 383 The social interactions of birds called gannets, which are shown in Figure 19-3b, result in a uniform distribution. Each gannet chooses a small nesting area on the coast and defends it from other gannets. In this way, each gannet tries to maximize its distance from all of its neighbors, which causes a uniform distribution of individuals. Few populations are truly randomly dispersed. Rather, they show degrees of clumping or uniformity. The dispersion pattern of a population sometimes depends on the scale at which the popu- lation is observed. The gannets shown in Figure 19-3b are uni- formly distributed on a scale of a few meters. However, if the entire island on which the gannets live is observed, the distribution appears clumped because the birds live only near the shore. POPULATION DYNAMICS All populations are dynamicâthey change in size and composition over time. To understand these changes, scientists must know more than the populationâs size, density, and dispersion. One important measure is the birth rate, the number of births occur- ring in a period of time. In the United States, for example, there are about 4 million births per year. A second important measure is the death rate, or mortality rate, which is the number of deaths in aHere's how scientists figured out the age of the universe It took some cosmic detective work. by Passant Rabie Oct. 20, 2021 You never ask a cosmic being its age. But if that cosmic being encompasses all of space, time, and matter, you could get a little curious. Scientists have long been curious about the age of the universe and how much time has elapsed since the Big Bang. Today, scientists estimated the age of the universe to be approximately 13.8 billion years old. But how did scientists estimate how old the universe is, and are they sure of that number? It all comes down to ancient stars and the ever-expanding cosmos. How do astronomers calculate the age of the universe? To estimate the age of the universe, scientists rely on two main methods. Calculating the expansion rate of the universe Determining the ages of the oldest stars The Hubble Constant: Since its conception, the universe has been expanding at an accelerating rate. The universeâs expansion rate is known as the Hubble Constant, which is estimated at 46,200 mph per million light-years. The Hubble Constant was first calculated in the 1920s by American astronomer Edwin Hubble after discovering that several galaxies were moving away from Earth. Scientists looked to distant galaxies to measure how fast the universe was expanding. Hubble also noted that the further a galaxy was, the faster it was moving away. Based on Hubbleâs observations, the astronomer came up with Hubbleâs law which showed a correlation between how far an object is and the speed at which itâs receding. Using Hubble law, scientists were able to estimate the expansion rate of the universe. Scientists were then able to use the Hubble Constant to estimate the age of the universe by working backward, all the way back to the Big Bang. This extrapolation depends on the current density and composition of the universe, which shows the history of its expansion. In 2012 NASAâs Wilkinson Microwave Anisotropy Probe used that data to estimate the universe's age to be 13.772 billion years old, give or take 59 million years. A year later, The European Space Agencyâs Planck spacecraft estimated the universe's age to be 13.82 billion years. Ancestral stars: Another way to determine the age of the universe is to look to the oldest stars. The universe canât be younger than its oldest stars. Therefore, to narrow down the age of the universe, scientists measure the ages of the very first stars that formed in the cosmos. The lifecycle of a star depends on its mass, with high mass stars burning fuel at a faster rate and therefore dying out faster while low mass stars can live up to 20 billion years. Globular clusters are a dense stellar collection of around a million stars which all formed roughly around the same time. These clusters can then serve as timekeepers for the universe. By determining the masses of their stars, scientists can estimate when the globular cluster formed. The oldest globular clusters contain stars that are 0.7 times less massive than the Sun, which suggests that they are between 11 to 18 billion years old. What came before the Big Bang? Scientists can trace the universe back to its explosive birth, the Big Bang. But what happened before this theoretical birth of the cosmos? The universe may have been a singularity, all compact within a form that is smaller than a subatomic particle. Itâs difficult to imagine what caused this matter to exist, but one theory even suggests that our universe was born from another universe while another imagines a series of universes being born out of one another like a formation of bubbles. Meanwhile, another theory suggests that the universe goes through an endless cycle of death and rebirth, born from its own demise. How old is the universe in seconds? If the universe is indeed cyclical, then time becomes irrelevant. But just in case youâre still attached to the modern way in which we measure the progression of life, then the age of the universe comes up to about 436,117,076,900,000,000 seconds.Comprehension Test: Superbook â Revelation Theme: Forgiveness, Salvation, and Godâs Victory đš Remembering (Items 1â4) What mistake did Chris make at the beginning of the episode? A. He lied to his parents B. He started a fire accidentally C. He broke a valuable item D. He skipped school Answer: B Who are the three main characters in the episode? A. Peter, Mary, and John B. Chris, Joy, and Gizmo C. David, Sarah, and Eli D. Paul, Ruth, and Micah Answer: B Where does Superbook transport the children? A. To the Garden of Eden B. To the time of Jesusâ birth C. To the end times D. To the Exodus Answer: C Who receives visions in heaven during the episode? A. Moses B. Apostle Paul C. Apostle John D. King Solomon Answer: C đš Understanding (Items 5â8) Why does Chris believe his mistake is unforgivable? A. He was punished severely B. He hurt someone intentionally C. He fears the consequences are too great D. He doesnât understand forgiveness Answer: C What does the descent of the New Jerusalem symbolize? A. The end of all prophecy B. The beginning of war C. Eternal life and Godâs promise D. The destruction of the earth Answer: C What lesson does Chris learn from his father? A. That mistakes are permanent B. That forgiveness is earned C. That Godâs mercy is unconditional D. That punishment is necessary Answer: C What theme is emphasized throughout the episode? A. Justice and revenge B. Power and control C. Forgiveness and salvation D. Wealth and prosperity Answer: C đš Applying (Items 9â12) If a student feels guilty for a mistake, what lesson from the episode could help them? A. Avoid responsibility B. Seek revenge C. Trust in Godâs forgiveness D. Hide the truth Answer: C How might Joyâs experience in heaven help her understand Godâs plan? A. She sees the consequences of sin B. She learns about ancient history C. She witnesses Godâs ultimate victory D. She meets famous prophets Answer: C What action could reflect the message of salvation in daily life? A. Ignoring othersâ mistakes B. Offering forgiveness to someone who hurt you C. Avoiding difficult conversations D. Seeking personal gain Answer: B How could Gizmoâs role support the groupâs understanding of Revelation? A. By distracting them with jokes B. By translating the visions C. By guiding them through spiritual truths D. By fixing technical problems Answer: C đš Analyzing (Items 13â16) What contrast is shown between Chrisâs fear and the final message of the episode? A. Fear leads to punishment; forgiveness leads to peace B. Fear is stronger than faith C. Mistakes are never forgiven D. God ignores human emotions Answer: A Why is the battle between angels and Satan significant? A. It shows the power of war B. It represents the struggle for heaven C. It symbolizes the victory of good over evil D. It predicts future disasters Answer: C What does the episode suggest about the nature of sin? A. It is always punished B. It can be forgiven through Godâs mercy C. It is inherited D. It defines a personâs worth Answer: B How do Chrisâs emotions evolve throughout the episode? A. From joy to anger B. From guilt to hope C. From confusion to pride D. From fear to rebellion Answer: B đš Evaluating (Items 17â18) Do you agree that no sin is too great for Godâs forgiveness? Why might this be important for viewers? A. Yes, it teaches hope and redemption B. No, some sins are unforgivable C. Yes, but only for believers D. No, forgiveness must be earned Answer: A How effective is the use of apocalyptic imagery in teaching moral lessons? A. It confuses young viewers B. It dramatizes the message of salvation C. It distracts from the core message D. It promotes fear Answer: B đš Creating (Items 19â20) If you were to write a reflection based on this episode, what theme would you focus on? A. The importance of punishment B. The beauty of heaven C. The power of forgiveness D. The fear of judgment Answer: C What title would best capture the message of the episode? A. âThe Fire Withinâ B. âMercy Winsâ C. âThe End of Daysâ D. âJudgment and Justiceâ Answer: BHealth 11/12 Review for Final Exam Core Concepts - Mental and Emotional Health, Substance Abuse Prevention, Safety and Violence Prevention, Family Life and Human Sexuality, Disease Prevention and Control, Healthy Eating Health Education Skills - goal setting, decision making, accessing information/resources, analyzing influences, communication, self-management, advocacy DIMENSIONS of Wellness - social, spiritual, emotional/mental, environmental, financial, intellectual, multicultural, occupational, physical, sexual RISK factors - anything that increases the risk of disease, injury, or illness. PROTECTIVE factors - anything that decreases the risk of disease, injury, or illness. INTERNAL health factors - health factors that can be either hereditary and genetic or acquired elements -- include smoking and personal diet or eating habits. Example â a genetic predisposition to an illness. EXTERNAL health factors - health factors that are part of the direct outer environment, the geographical location, micro-organisms, socio-economic elements that could affect an individual's health. Example â being unable to afford mental health services. Unit 1- Managing Personal and Community Wellness Explain Maslowâs Hierarchy of Needs in your own words using the image provided. Explain how each Social Determinant of Health may impact a personâs health. Levels of Disease Prevention ⢠PRIMARY The goal is to avoid conditions altogether. ⢠SECONDARY The goal is early detection. ⢠TERTIARY The goal is to minimize the damage (manage). Define the following terms. Fads/Trends Sleep hygiene Driver safety Unit 2- Investigating Social Ecological Factors on Well-Being Socio-Ecological Model â The SEM examines how health behaviors form based on characteristics of individuals, communities, nations and levels in between. Each level overlaps with other levels signifying how the best public health strategies are those that encompass and target a wide range of perspectives. Interpersonal (personal) health vs. intrapersonal (relationship) health Health INEQUITY - systemic, ingrained and unjust barriers that prevent segments of the population from having the opportunity of health leading to health disparity. IMPLICIT BIAS - a form of bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions, and behaviors. Research has shown implicit bias can contribute to unequal access to quality healthcare, negative patient-provider relationships and interactions; and create mistrust in the healthcare system and practitioners among patients. This can contribute to health disparities. Health DISPARITY - represents a difference in health between populations. It is often used to describe disease burden and other negative health outcomes socially disadvantaged groups may face. Health EQUITY - The opposite of health inequity. It describes a system that supports a high standard of health and healthcare for all people. Racism - Beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation. DISCRIMINATION - An unjust differential treatment of a person or a group. PRIVILEGE- The unearned access to resources and social power that are only available to some because of their membership within certain social groups. OPPRESSION is the act of taking away choices from others and can be defined as a system that maintains advantage and disadvantage based on social identities and that acts on multiple levels from interpersonal to institutional and societal. (internalized, interpersonal, institutional, structural) Systematic Oppression - Intentional disadvantage of groups of people based on their identity while advantaging members of dominant group (race, gender, sexual orientation, language, size, ability, etc.). Intersectionality - The complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap, or intersect especially in the experiences of marginalized individuals or groups Unit 3- Accessing Resources and Communicating to Support Mental and Emotional Health What is anger? What is anxiety? What is stress? STRESSORS are the things that cause stress. Stressors can be internal and external. A stressor may be a one-time or short-term occurrence, or it can happen repeatedly over a long time. INTERNAL Stressors - are made by your belief system and the way you evaluate yourself. Examples include pessimistic attitude, negative self-talk, deep need to be perfect, low self-esteem or body image, unhealthy standards for self. EXTERNAL Stressors - are stressful things that happen in your surroundings and/or in your environment. Examples include busy schedules, work problems, family issues, financial trouble, social problems, injury, unforeseen circumstances. Socio-economic issues are also a part of external stressors such as poverty, violence, and racism. Define the following mental health conditions. Depression Eating disorders NSSI Non-suicidal self-injury Grief/Loss Suicide prevention A.C.T. ⢠ACKNOWLEDGE- Tell them in a caring way that you recognize that they are having a problem ⢠CARE- You can show you care by actively listening - put away anything else you are doing, make eye contact, sit down, ask questions. ⢠TELL-(call 988 for additional help and support) - Tell them it is important that they speak with a trusted adult. Help them figure out who this may be and offer to go with your friend. A social norm is an unwritten, informal rule meant to guide behavior among the of society. It distinguishes between acceptable and unacceptable, good and bad, and so on. Social norms can influence a person with emotional or mental health disorders, access to care and stigmatize their situation. STIGMA- a mark of disgrace associated with a particular circumstance, quality, or person. ⢠Self-stigma - This describes the internalized stigma that people with mental health conditions feel about themselves. ⢠Public stigma - This refers to the negative attitudes around mental health from people in society. ⢠Institutional stigma - This is a type of systemic stigma that arises from corporations, governments, and other institutions. Unit 4- Evaluating Risks of Substance Use and Abuse Harm Reduction - a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Explain how each level of the Social Ecological Model is impacted by addiction. Individual Relationship Community Society SEM Level Contributing/Risk Factors to substance use Preventative/Protective Factors for substance use Individual Interpersonal/Relationship Community Society Unit 5- Analyzing Influences to Examine Ways to Increase Safety and Reduce Violence HATE CRIME - a crime, usually violent, motivated by prejudice or intolerance toward an individualâs national origin, ethnicity, color, religion, gender, gender identity, sexual orientation, or disability. Explain how the media influences violence in society. The Pyramid of Hate Explain the escalation of hate using the Pyramid of Hate visual. List several hate crime motivators. Example: age HEALTHY Relationship Signs - comfortable pace, trust, honesty, independence, respect, equality, kindness, taking responsibility, healthy conflict, fun UNHEALTHY Relationship Signs - intensity, possessiveness, manipulation, isolation, sabotage, belittling, guilting, volatility, deflecting responsibility, betrayal Sexual Assault is a sexual behavior WITHOUT consent. Human trafficking - the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, using force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. Sex trafficking - commercial sex act induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age. Trafficking happens using⌠⢠Force - using violence to control someone. ⢠Fraud - using lies to control someone. ⢠Coercion - using threats to control someone. Unit 6- Family Life and Human Sexuality Agency - A belief about yourself and the extent to which you can act on that belief. ⢠The ability to choose freely oneâs own narrative. ⢠To embrace the idea that I am the cause (or agent) of my own thoughts and actions. ⢠Personal agency is a personal responsibility for who we are, what we experience, what we do about that experience, and how we shape our world to give us more of the experiences we want. SEXUAL Agency ⢠The ability to choose your own interests and desires vs. what we see in the media or othersâ perceptions ⢠The ability to identify, communicate, and negotiate oneâs sexual needs ⢠The ability to initiate behaviors that allow for the satisfaction of those needs Sexually Explicit Material - photographs, videos, films, magazines, and books whose primary themes, topics, or depictions involve sexuality that may cause sexual arousal. Sexual scripts - thoughts, patterns, or behavior that a person has about themselves in a romantic or sexual context. It is how people picture themselves or want to project themselves in front of others. Reproductive Rights of Teens - In Maryland, teens have the right to an abortion, keep their child, obtain and use birth control, paternity tests, adoption, give up custody of their child within 10 days of birth (Safe Haven Law). ⢠REPRODUCTIVE RIGHTS- legal rights and the freedom of the individual to control decisions regarding contraception, abortion, sterilization and childbirth. ⢠SAFE HAVEN LAW- a distressed parent who is unable or unwilling to care for their infant can safely give up custody of their baby, no questions asked. CONSENT is an agreement between participants to engage in sexual activity. ⢠It is clearly and freely communicated, verbal, and affirmative. Consent CANNOT be given if⌠⢠A person is underage, one or both partners is intoxicated or incapacitated by drugs or alcohol, one partner is asleep or unconscious, one partner feels pressured, threatened or intimidated, or one partner holds a position of power or authority over the other. Unit 7- Advocating for Enhanced Nutrition, Food Systems, and Health Outcomes Dietary Guidelines for Americans Guideline 1: Follow a Healthy Dietary Pattern at Every Life Stage Guideline 2: Customize and Enjoy Food and Beverage Choices to Reflect Personal Preferences, Cultural Traditions, and Budgetary Considerations Guideline 3: Focus on Meeting Food Group Needs with Nutrient-Dense Foods and Beverages, and Stay Within Calorie Limits Guideline 4: Limit Foods and Beverages Higher in Added Sugars, Saturated Fat, and Sodium, and Limit Alcoholic Beverages FOOD DESERT- a neighborhood where there is little or limited access to healthy and affordable food such as fruits, vegetables, whole grains, low-fat milk and other foods that make up the full range of a healthy diet. FOOD INSEQURITY lack of access to a sufficient amount of food because of limited funds. More than 49 million American households are considered food insecure and are vulnerable to poor health as a result. PROCCESED FOODS- any raw agricultural commodities that have been washed, cleaned, milled, cut, chopped, heated, pasteurized, blanched, cooked, canned, frozen, dried, dehydrated, mixed or packaged â anything done to them that alters their natural state.The Story of Ramayana by Maharshi Valmiki Long ago, Dasharatha, the wise king of Ayodhya of Sarayu, India had three wives. Though the King had three wives, he didnât have any children with them. The Chief priest Vasishta advised the king to make fire sacrifice to obtain a blessing from the gods. After the gods were pleased, one of them appeared out of the flame and handed him a pot full of nectar. The god told the king to share the nectar with his three queens namely Kausalya, Kaikeye, and Sumitra. While the nectar had been shared, the three queens gave birth to sons: Kausalya had Rama; Kaikeye had Bharatha; and Sumitra had twins Lakshmana and Shatrughna. A sage took the boys out to train them in archery. In a neighboring city, the ruler's daughter was named Sita. When it was time for Sita to choose her bridegroom, at a ceremony called a Swayamvara, the princes were asked to string a giant bow. No one else could even lift the bow, but as Rama bent it, he did not only string it but also broke it into two. Sita indicated that she chose Rama as her husband by putting a garland around his neck. The disappointed suitors were watching. 6 CO_Q3_English8_Module 4 King Dasharatha, Rama's father, decided it was time to give his throne to his eldest son Rama and retired to the forest to seek moksha. Everyone seems pleased. This plan fulfilled the rules of dharma because an eldest son should rule and, if a son can take over one's responsibilities, one's last years may be spent in a search for moksha. In addition, everyone loved Rama. However, Rama's stepmother, the king's second wife, was not pleased. She wanted her son, Bharata, to rule. Because of an oath Dasharatha had made to her years before, she got the king to agree to banish Rama for fourteen years and to crown Bharata even though the king, on bended knee, begged her not to demand such things. Broken-hearted, the devastated king could not face Rama with the news that Kaikeyi must tell him. Rama, always obedient, was as content to go into banishment in the forest as to be crowned king. Sita convinced Rama that she would always be at his side and his brother Lakshmana also begged to accompany them. Rama, Sita, and Lakshmana set out to the forest. Bharata, whose mother's evil plot had won him the throne, was very upset when he found out what had happened. Not for a moment he did consider breaking the rules of dharma and becoming king in Rama's place. He went to Rama's forest retreat and begged Rama to return and rule, but Rama refused. "We must obey father," Rama says. Bharata then took Rama's sandals saying, "I will put these on the throne, and every day I shall place the fruits of my work at the feet of my Lord." Embracing Rama, he took the sandals and returned to Ayodhya. Years passed and Rama, Sita, and Lakshmana were very happy in the forest. Rama and Lakshmana destroyed the rakshasas (evil creatures) who disturbed the sages in their meditations. One day a rakshasa princess named Shurpanakha tried to seduce Rama, and Lakshmana wounded her and drove her away. She returned to her brother Ravana, the ten-headed ruler of Lanka (Sri Lanka, formerly Ceylon), and told her brother, who is always attracted to beautiful women, about lovely Sita. Ravana devised a plan to abduct Sita. He sent a magical golden deer which Sita desired Rama to hunt. A long time had passed, but Rama didnât return. Thus, Lakshmana went off to find his brother. Before leaving Sita, Lakshmana drew a protective circle around Sita and warned her that she would be safe if she would stay within the circle. As they went off, Ravana, who could change his shape, appeared as a holy man begging alms. The moment Sita stepped outside the circle to give him food, Ravana grabbed her and carried her off to his kingdom in Lanka. Rama was broken-hearted when he returned to the empty hut and could not find Sita. A band of monkeys led by Hanuman offered to help him find Sita. Ravana carried Sita to his palace in Lanka, but he could not force her to be his wife. So, he put her in a grove and alternately sweet-talked her and threatened her in an attempt to get her to agree to marry him. Sita would not even look at him but thought only of her beloved Rama. Hanuman, the general of the monkey band could fly since his father was the wind, and he flew to Lanka and found Sita in the grove, comforted her, and told her Rama would come soon and save her. 7 CO_Q3_English8_Module 4 Ravana's men captured Hanuman, and Ravana ordered them to wrap Hanuman's tail in cloth and to set it on fire. With his tail burning, Hanuman hopped from house-top to house-top, setting Lanka a fire. He then flew back to Rama to tell him where Sita was. Rama, Lakshmana, and the monkey army built a causeway from the tip of India crossing over to Lanka. A mighty battle took place. Rama killed several of Ravana's brothers and then Rama confronted ten-headed Ravana. Rama finally killed Ravana and freed Sita. After Sita gained her freedom from Ravana, she proved her purity through the trial by fire. Then, they returned to Ayodhya and Rama became the king. As Rama became the king, he ruled Ayodhya with Ramrajya - an ideal time when everyone does his or her duties and responsibilitiesChapter 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 wonât talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined Îą and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic Drug Alpha1 Blockers (weâve 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 Îą1 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 â lowers peripheral resistance â Results in decreased BP So âŚ.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 Îą1 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 Îą1 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 doesnât 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 ď¨ 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 patientâs 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-lifeď¨ 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 ď 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)