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History of Africa
QuizĀ by Christine Simerly
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History of Africa PostTestHistory of Africa Vocabulary History of south africaYouGov found 44 per cent were proud of Britain's history of colonialism, with 21 per cent regretting it happened and 23 per cent holding neither view. The same poll also found 43 per cent believed the British Empire was a good thing, 19 per cent said it was bad and 25 per cent said it was "neither". At its height in 1922, the British empire governed a fifth of the world's population and a quarter of the world's total land area. Although the proponents of Empire say it brought various economic developments to parts of the world it controlled, critics point to massacres, famines and the use of concentration camps by the British Empire. 1. Boer concentration camps During the Second Boer War (1899-1902), the British rounded up around a sixth of the Boer population - mainly women and children - and detained them in camps, which were overcrowded and prone to outbreaks of disease, with scant food rations. Of the 107,000 people interned in the camps, 27,927 Boers died, along with an unknown number of black Africans. 2. Amritsar massacre When peaceful protesters defied a government order and demonstrated against British colonial rule in Amritsar, India, on 13 April 1919, they were blocked inside the walled Jallianwala Gardens and fired upon by Gurkha soldiers. The soldiers, under the orders of Brigadier Reginald Dyer, kept firing until they ran out of ammunition, killing between 379 and 1,000 protesters and injuring another 1,100 within 10 minutes. Brigadier Dyer was later lauded a hero by the British public, who raised Ā£26,000 for him as a thank you. 3. Partitioning of India In 1947, Cyril Radcliffe was tasked with drawing the border between India and the newly created state of Pakistan over the course of a single lunch. After Cyril Radcliffe split the subcontinent along religious lines, uprooting over 10 million people, Hindus in Pakistan and Muslims in India were forced to escape their homes as Some estimates suggest up to one million people lost their lives in sectarian killings. 4. Mau Mau Uprising Thousands of elderly Kenyans, who claim British colonial forces mistreated, raped and tortured them during the Mau Mau Uprising (1951-1960), have launched a Ā£200m damages claim against the UK Government. Members of the Kikuyu tribe were detained in camps, since described as "Britain's gulags" or concentration camps, where they allege they were systematically tortured and suffered serious sexual assault. Estimates of the deaths vary widely: historian David Anderson estimates there were 20,000, whereas Caroline Elkins believes up to 100,000 could have died. 5. Famines in India Between 12 and 29 million Indians died of starvation while it was under the control of the British Empire, as millions of tons of wheat were exported to Britain as famine raged in India. In 1943, up to four million Bengalis starved to death when Winston Churchill diverted food to British soldiers and countries such as Greece while a deadly famine swept through Bengal. Talking about the Bengal famine in 1943, Churchill said: āI hate Indians. They are a beastly people with a beastly religion. The famine was their own fault for breeding like rabbits.ā A church is a place where Christians worship God. The European missionaries were the first to establish churches in Nigeria. The history of the establishment of churches began in the 16th century and continued in the 19th century. Churches in Nigeria can be categorized as Orthodox, Pentecostal and Spiritual Churches. SOME IMPORTANT HISTORICAL CHURCHES IN NIGERIA. The following are some of the important historical churches in Nigeria: 1. The Cathedral Church of St. Peters: It was established by the Anglican Mission at Ake, Abeokuta in 1898. 2. Holy Aruosa Cathedral: It was established in 1538 by the Portuguese missionaries in Benin Kingdom. 3. The Duke Town Cathedral: It was built by Presbyterian missionaries in 1895 in Calabar. 4. ECWA (Evangelical Church of West Africa): It began its activities in Nigeria in 1893 in Lagos and later moved to Northern Nigeria such as Bida, Zaria, Jos and Ilorin. The headquarters of ECWA is in Jos, Plateau State.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 wonāt talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined Ī± and Ī² receptor blockers (peripheral) A2. Peripherally Acting Adrenergic Drug Alpha1 Blockers (weāve 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 Ī±1 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 ā lowers peripheral resistance āĀ Results in decreased BP So ā¦.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 Ī²1 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 Ī²1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both Ī²1 and Ī²2 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 Ī²1 and Ī²2 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 Ī±1 and Ī² 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 Ī±1 and Ī² 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 doesnāt 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 ļØ 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 patientās 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-lifeļØ 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-areĀ contraindicated during the second and third trimesters of pregnancyĀ 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 ļ 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 theĀ RASĀ 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, hyperkalemiaā¦ 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)6th Grade: History of N. Africa, SW Asia, and Central AsiaJuneteenth is an important holiday in American history. It honors the day in 1865 when enslaved people in Texas found out they were free. This day marked a major milestone on the path to ending slavery throughout the U.S. On June 19, 1865, Major General Gordon Granger of the Union army arrived in Galveston, Texas. He informed the enslaved people of Texas about the Emancipation Proclamation. The Emancipation Proclamation was a speech made by President Abraham Lincoln two years earlier, on January 1, 1863. It stated that enslaved people in many of the southern states were now free. President Lincoln gave this speech during the height of the Civil War. But by the time the Union soldiers made it to Texas, the Civil War had ended. It took over two years for this message to reach the people still enslaved in Texas! More than 250,000 people celebrated their newfound freedom on June 19. Soon after, many of these freed people decided to migrate to northern states to start a new life. But they continued to celebrate Juneteenth year after year and to share this holiday with their community. In 1872, a group of formerly enslaved people raised money to buy 10 acres of land near Houston, Texas. They named this land āEmancipation Parkā. To this day, many Americans celebrate Juneteenth in this park to remember their history. Texas also holds a special parade to celebrate this day. Thousands of people participate and enjoy learning and celebrating African American culture and history. They fly the Juneteenth flag. The Juneteenth flag has a white star that symbolizes freedom and new hope for African Americans. Juneteenth is a day to remember the triumphs and struggles of African Americans. Even though enslaved people in Texas learned of their freedom on Juneteenth, they still faced violence, discrimination and inequality. That is why Juneteenth celebrations are so important to many Americans. Juneteenth recognizes the hardships of gaining freedom and the importance of remembering Black history in the United States.