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Multiple choice test on If-then statement, converse, inverse and contrapositive
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Create me a multiple choice test questions with 4 options on the following topic:Consumer Education for Different Audience 1. Children and Youth: - Focus: Building foundational knowledge about basic consumer concepts, making safe choices, understanding money and value, and recognizing scams and unsafe situations. 2. Teens and Young Adults: - Focus: Building financial literacy, responsible debt management, understanding contracts and agreements, responsible technology use, online safety, and consumer rights. 3. Working Adults and Families: - Focus: Managing budgets, making informed purchasing decisions, understanding credit and debt, finding consumer protection resources, and navigating complex financial products (mortgages, insurance, investments). 4. Seniors: - Focus: Protecting themselves from scams and fraud, understanding common consumer issues like telemarketing, identity theft, and online scams, managing medications and healthcare costs, and accessing community resources. 5. Special Populations: - Focus: Adapting consumer education programs to the specific needs of people with disabilities, immigrants, refugees, and other marginalized communities. 6. Business and Industry:- Focus: Understanding ethical marketing practices, complying with consumer protection laws, and providing clear and accurate information to consumers. 7. Policymakers and Regulators: - Focus: Understanding consumer needs, developing effective consumer protection laws, enforcing regulations, and ensuring a fair and competitive marketplace. Adapting consumer education programs for children, teens, and seniors requires tailoring content and delivery methods to their unique needs and learning styles. Children (Ages 5-12): - Understanding the concept of money: Teaching children about saving, spending, and the value of money. - Developing basic budgeting skills: Helping children learn to make choices about how to spend their allowance or pocket money. EFFECTIVE STRATEGIES •Focus on basic concepts: Introduce core concepts like saving, spending, and budgeting in a fun and engaging way. Use simple language and relatable examples. •Real-life scenarios: Use age-appropriate scenarios to illustrate financial concepts, like buying toys or snacks. •Parental involvement: Encourage parent participation and provide resources to help them reinforce lessons at home. Teens (Ages 13-18): - Building budgeting and financial planning skills: Teaching teens how to manage their money, set financial goals, and plan for the future. - Navigating the digital marketplace: Equipping teens with the knowledge and skills to make safe and informed online purchases, understand digital marketing, and protect themselves from scams. EFFECTIVE STRATEGIES • Practical skills: Focus on skills relevant to teens, like managing money for social activities, saving for college, and understanding credit cards. • Digital literacy: Address the growing influence of online shopping, social media advertising, and financial scams. • Real-world applications: Connect financial concepts to real-life decisions teens make, like choosing a part-time job or making purchases online. Seniors (Ages 65+) - Managing retirement savings and healthcare costs: Providing information and resources on retirement planning, Medicare and Medicaid, and other healthcare options. - Navigating the digital world: Offering technology training and resources to help seniors access online services and information safely and securely. EFFECTIVE STRATEGIES • Addressing specific concerns: Focus on topics relevant to senior citizens, like retirement planning, managing healthcare expenses, and avoiding scams. • Clear and concise communication: Use simple language and visual aids to ensure easy understanding. • Social interaction: Create opportunities for seniors to share experiences and learn from each other. Teaching Financial Literacy in school and Communities In Schools: Curriculum Integration: Financial literacy concepts can be seamlessly integrated into existing subjects, making learning more relevant and engaging. - Math: Budgeting exercises, calculating interest rates, analyzing financial data, and understanding compound interest are all natural applications of math skills. - Social Studies: Exploring the history of money, financial institutions, economic systems, and the impact of financial decisions on society provide valuable context. - Economics: Discussions about supply and demand, inflation, investment, and the role of consumers in the economy enhance financial literacy. Dedicated Courses: Offering elective courses or workshops specifically focused on personal finance provides deeper dives into crucial topics. - Personal Finance: Cover budgeting, saving, investing, credit, debt management, and insurance. - Entrepreneurship: Introduce concepts like business planning, marketing, financial forecasting, and managing cash flow. In Communities: Community Centers and Libraries: Workshops, seminars, and classes tailored to adults and families provide accessible learning opportunities. - Financial Planning: Cover budgeting, retirement planning, debt management, and estate planning. - Homeownership: Provide guidance on buying, selling, and maintaining a home. - Consumer Protection: Educate individuals about their rights and how to avoid scams. Partnerships with Financial Institutions: Collaborations with banks, credit unions, and financial advisors offer valuable resources, workshops, and financial literacy programs. Consumer Education for Low-Income and Vulnerable Populations Low-income refers to individuals or households with limited financial resources, typically below a certain threshold. Low-income individuals may face challenges like: 1. Limited education and job opportunities 2. Poor living conditions and housing 3. Food insecurity and malnutrition Causes of low income: 1. Unemployment or underemployment 2. Low-paying jobs or minimum wage 3. Limited education or skills 4. Single parenthood or large family size Vulnerable population'' is a term that is used to describe a group of people who possess some sort of disadvantage. elderly people, people with low incomes, homeless people, people in prison, migrant workers, pregnant women, Family Consumer Education: Managing Household Finances and Resources Financial literacy is the ability to understand and manage personal finances effectively. 1. Debt Debt is money you spend that isn’t yours. If you borrow money from the bank, use a credit card, or take out a short-term loan, or a payday loan, you are accumulating debt. Good debt is considered money borrowed for things that are absolutely necessary for making a life e.g. a house and for advancing your money-making potential e.g. an education. Bad debt is considered borrowing money or using a credit card to pay for things you don’t need, such as expensive clothes, hi-tech electronics, eating out at restaurants, going on holidays, etc. 2. Saving Saving is an essential part of financial wellness, a secure present, and a happy future. 3. Budgeting Budgeting is the life skill of planning and managing your money. By understanding exactly where your money goes every month, you are empowered to create an actionable plan by which you can spend less, by curtailing those unnecessary expenses and saving more for the things you need and want. 4. Investing Investing is all about creating and growing the wealth you need to enjoy a financially secure and happy future. It’s about putting your money into something that will make you a profit over time, such as property, retirement funds, and unit trusts Integrating Consumer Education into the Home Economics Curriculum. Integrating consumer education into the home economics curriculum can provide students with essential skills for making informed choices about their personal finances, food, clothing, and overall well-being. Here are some strategies and ideas for effectively incorporating consumer education: Financial Literacy Budgeting: Teach students how to create and manage a personal budget, including setting financial goals, tracking expenses, and understanding savings. Saving and Investment: Cover the basics of saving, including different saving accounts, and introduce concepts related to investing. Food and Nutrition Food Label Literacy: Engage students in learning how to read and interpret food labels, including nutrition facts and ingredient lists. Grocery Shopping Skills: Teach students how to compare product costs, understand unit pricing, and make healthy, budget-friendly choices while shopping. Clothing and Textile Education Consumer Choices in Clothing:Discuss factors influencing clothing purchases, such as quality, price, and sustainability. Fashion and Trends: Analyze the impact of marketing and advertising on consumer behavior regarding clothing. Sustainable Purchasing Eco-Friendly Choices: Raise awareness about environmentally friendly products and the importance of sustainability in consumer choices. Project-Based Learning - Assign real-life projects where students must apply their knowledge, such as creating a meal plan within a budget, planning a shopping list based on nutrient needs, or evaluating the cost-effectiveness of different products. Technology Integration - Use technology to teach students about online shopping, price comparison websites, and apps that aid budgeting and financial planning. Collaborative Learning Opportunities - Organize team projects where students work together to solve consumer-related problems, emphasizing teamwork and communication skills. Assessment and Reflection - Incorporate assessments that allow students to reflect on what they have learned about consumer education and how they can apply these skills in their daily lives. Create multiple choice questions using the following information: In November, Mrs. Baker has Holling read The Tempest. Despite his preconceptions, Holling is captivated by all the "good stuff" in the play, especially the cussing, which he decides to learn by heart. He figures that Mrs. Baker could not have read the play herself; if she had, she certainly would not have let him have it. Holling is amazed when he discovers that his teacher not only has read the play, but she knows the bad parts as well. Mrs. Baker gives Holling a one-hundred-and-fifty question test on The Tempest, and assigns him to read the play again, telling him "there is a lot more to (it) than a list of colorful curses." The deadline set by Holling's classmates for him to bring them cream puffs arrives, but although Holling's father's company has won the Baker's Sporting Emporium contract, he refuses to extend an advance on his son's allowance. Desperate, Holling goes to Goldman's Best Bakery, offering to work for the money he lacks to buy the cream puffs. Coincidentally, Mr. Goldman, who is active in Long Island's Shakespeare Company, needs a boy to perform in their upcoming Extravaganza, and because of his work with Mrs. Baker, Holling fits the bill. Mr. Goldman gives Holling the required number of cream puffs in exchange, but sadly, while the students are at recess, Caliban and Sycorax, the escaped rats who inhabit the classroom walls and ceiling, come out and decimate the treats. Somehow, the disaster is blamed on Holling; he must clean up the mess, and his classmates decree that he still owes them cream puffs. The next Wednesday, Holling brings five cream puffs to school, which is all he can afford. In addition to facing his classmates' ire, he has to deal with the fact that, in the Shakespeare Company Holiday Extravaganza, he must play the part of Ariel, who is a fairy, and wear yellow tights with white feathers on an unmentionable part of his anatomy; "not a good thing for a boy from Camillo Junior High." To Holling's surprise, just when things are at their darkest, Mrs. Baker comes through for him, bringing cream puffs for the students on his behalf. That afternoon, Mrs. Baker and Holling discuss The Tempest, and whether or not Caliban, the "monster," deserves a happy ending. Holling argues that, as the antagonist, he does not, but Mrs. Baker muses whether Shakespeare might have shown, even in a monster, the capacity of humankind to use defeat to grow. Mrs. Bigio stumbles into the classroom at this point, emitting sounds of indescribable sadness; she has just learned that her husband has been killed in a futile reconnaissance mission in Vietnam. Two nights after his funeral, the Catholic Relief Agency, which houses Vietnamese refugees, including Holling's classmate Mai Thi, is the target of a hate crime. Holling reflects that Shakespeare, with his happy endings for nearly everyone in The Tempest, is wrong. He says, "sometimes, there isn't a Prospero to make everything fine...and...the quality of mercy is strained." In December, Camillo Junior High is awash in "signs of the season." Mrs. Baker, however, does not share the holiday spirit, but Holling is too absorbed with his problems with the Shakespeare Holiday Extravaganza to wonder why. As always, Holling seeks help from his family, but to no avail; his mother comments insipidly that his embarrassing costume is cute, his father tells him to wear it to please Mr. Goldman, who might one day need an architect, and his sister warns him that if news of his role gets to the high school, no one better find out they are related. The only thing that prevents December from being a total disaster is Mrs. Baker's announcement that Mickey Mantle will be signing autographs at the Baker Sporting Emporium. Unfortunately, Mrs. Baker also tells the class about Holling and the Shakespeare Extravaganza, and encourages the students to attend both events. Holling's classmates are intensely curious about his role as Ariel, whom he euphemistically describes as "a warrior." Mr. Goldman tells Mrs. Baker that Holling needs "some practice on interpretation", and she practices with him, playing the part of Prospero. Mrs. Baker is a terrific reader, and when she and Holling rehearse the part where Prospero releases Ariel from bondage, Holling is inspired, realizing what it means to be free "to create his own happy ending." On the night of the performance, Mrs. Baker, Mrs. Bigio, Danny Hupfer and his parents, Meryl Lee, and Mai Thi are in the audience to support Holling, unlike his own parents, who do not want to miss the Bing Crosby Christmas Special on television. Holling executes his part with such passion that his classmates are moved to tears, and do not even notice what he is wearing. When the show is over, Holling, finding the dressing room locked, rushes outside, still in costume, where his father is supposed to be waiting to take him to Baker's Sporting Emporium to see Mickey Mantle. Typically, his father is not there, and Holling, frantic, flags down a bus and begs the driver to take him to the Emporium. The driver takes pity on him and complies, getting him to the Emporium just in time, but when Holling approaches Mickey Mantle for an autograph, the famous player looks derisively at his costume and snaps rudely, "I don't sign baseballs for kids in yellow tights." Danny Hupfer witnesses this snub, and loyally returns his own autographed baseball to Mickey Mantle, saying, "I guess I don't need this after all." Holling and Danny leave together in silence, smarting because "when gods die, they die hard." During the days remaining until holiday break, Mrs. Bigio is especially cantankerous; her cafeteria cooking is unappetizing at best, and her comments to the students are impatient and unkind. Holling, remembering Mrs. Bigio's sadness when she received the news of her husband's death, does not complain, but he is bewildered at the sheer desolation he witnesses when Mrs. Bigio bitterly tells Mai Thi that she "shouldn't even be here...a queen in a refugee home while American boys are sitting in swamps on Christmas Day." After school on the last day before break, Mrs. Baker gives Holling, Danny Hupfer, and Doug Swieteck each a new baseball and mitt, and sends them to the gym, where, to their delight, they meet Joe Pepitone and Horace Clark in their Yankee uniforms, and receive tickets to Opening Day at the Stadium. Mrs. Baker's family knows what happened with Mickey Mantle, and wants to make it up to the boys. The next day, President Johnson declares a Christmas ceasefire in Vietnam, and the holiday season begins in earnest.Can you make a multiple choice of test questions regarding this information given which is Curriculum from Different Points of View There are many definitions of curriculum. Because of this, the concept of curriculum is sometimes characterized as fragmentary, elusive and confusing. However, the numerous definitions indicate dynamism that connotes diverse interpretations of what curriculum is all about. The definitions are influenced by models of thought, pedagogies, political as well as cultural experiences. Let us study some of these definitions. 1. Traditional Points of View of Curriculum In early years of the 20th century, the traditional concepts held of the “curriculum is that it is a body of subjects or subject matter prepaid by the teachers for the student’s to learn”. It was synonymous to the “course of study” and “syllabus” Robert M. Hutchins views curriculum as “permanent studies” where the rules of grammar, reading, rhetoric and logic and mathematics for basic education are emphasized. Basic education should emphasize the 3 Rs and college education should be grounded on liberal education. On the other, Arthur Bestor as an essentialist, believes that the mission of the school should be intellectual training, hence curriculum should focus on the fundamental intellectual disciplines of grammar, literature and writing. It should also include mathematics, science, history and foreign language. The definition leads us to the view of Joseph Schwab that discipline is the sole source of curriculum. Thus in our education system, curriculum is divided into chunks of knowledge we call subject areas in basic education such as English, Mathematics, Science, Social Studies and others. In college, discipline may include humanities, sciences, language and many more. To Phoenix, curriculum should consist entirely of knowledge which comes from various disciplines. Academic discipline became the view of what curriculum is after the cold war and the race to space. Joseph Schwab, a leading curriculum theorist coined the term discipline as a ruling doctrine for curriculum development. Curriculum should consist only of knowledge which comes from disciplines which is the sole source. Thus curriculum can be viewed as a field of study. It is made up of its foundations (philosophical, historical, psychological and social foundations); domains of knowledge as well as its research theories and principles. Curriculum is taken as scholarly and theoretical. It is concerned with broad historical, philosophical and social issues and academics. Most of the traditional ideas view curriculum as written documents or a plan of action in accomplishing goals. 2. Progressive Points of View of Curriculum On the other hand, to a progressivist, a listing of school subjects, syllabi, course of study, and a list of courses or specific discipline do not make a curriculum. These can only be called curriculum if the written materials are actualized by the learner. Broadly speaking, curriculum is defined as the total learning experiences of the individual. This definition is anchored on John Dewey’s definition of experience and education. He believed that reflective thinking is a means that unifies curricular elements. Thought is not derived from action but tested by application. Caswell and Campbell viewed curriculum as “all experiences children have under the guidance of teachers”. This definition is shared by Smith, Stanley and Shores when they defined “curriculum as a sequence of potential experiences set up in the schools for the purpose of disciplining children and youth in group ways of thinking and acting”. Marsh and Willis on the other hand view curriculum as all the “experiences in the classroom which are planned and enacted by the teacher, and also learned by the students”. Points of View on Curriculum Development From the various definitions and concepts presented, it is clear that curriculum is a dynamic process. Development connotes changes which are systematic. A change for the better means any alteration, modification or improvement of existing condition. To produce positive changes, development should be purposeful, planned and progressive. This is how curriculum evolves. Let us look at the two models of curriculum development and concepts of Ralph Tyler and Hilda Taba. Ralph Tyler Model: Four Basic Principles. This is also popularly known as Tyler’s Rationale. He posited four fundamental questions or principles in examining any curriculum in schools. These four fundamental principles are as follows: 1. What educational purposes should the school seek to attain? 2. What educational experiences can be provided that are likely to attain these purposes? 3. How can these educational experiences be effectively organized? 4. How can we determine whether these purposes are being attained or not? In summary, Tyler’s Model show that in curriculum development, the following considerations should be made: (1) Purpose of the school, (2) Educational experiences related to the purposes, (3) Organization of the experiences, and (4) Evaluation of the experiences. On the other hand, Hilda Taba improved on Tyler’s Rationale by making a linear model. She believed that teachers who teach or implement the curriculum should participate in developing it. Her advocacy was commonly called the grassroots approach. She presented seven major steps to her model where teachers could have a major input. These steps are as follows: 1. Diagnosis of learner’s needs and expectations of the larger society. 2. Formulation of learning objectives. 3. Selection of learning content. 4. Organization of learning content. 5. Selection of learning experiences. 6. Organization of learning activities. 7. Determination of what to evaluate and the means of doing it. Thus as you look into curriculum models, the three interacting processes in curriculum development are planning, implementing and evaluating. Types of Curriculum Operating in Schools From the various concepts given, Allan Glatthorn(2000) describes seven types of curriculum operating in the schools. These are (1) Recommended curriculum- proposed by scholars and professional organizations. (2) Written Curriculum- appears in school, district, division or country documents. (3) Taught Curriculum- what teacher’s implement or deliver in the classrooms and schools. (4) Supported Curriculum- resources-textbooks, computers, audio- visual materials which support and help in the implementation of the curriculum. (5) Assessed Curriculum- that which is tested and evaluated. (6) Learned Curriculum- which the students actually learn and what is measured and (7) Hidden Curriculum- the unintended curriculum. 1. Recommended Curriculum- Most of the school curricula are recommended. The curriculum may come from a national agency like the Department of Education, Commission on Higher Education (CHED), Department of Science and Technology (DOST) or any professional organization who has stake in education. For example the Philippine Association for Teacher Education (PAFTE) or the Biology Teacher Association (BIOTA) may recommend a curriculum to be implemented in the elementary or secondary education. 2. Written Curriculum- This includes documents, course of study or syllabi handed down to the schools, districts, division, departments or colleges for implementation. Most of the written curricula are made by curriculum experts with participation of teachers. These were pilot-tested or tried out in sample schools or population. Example of this is the Basic Education Curriculum (BEC). Another example is the written lesson plan of each classroom teacher made up of objectives and planned activities of the teacher. 3. Taught Curriculum- The different planned activities which are put into action in the classroom compose the taught curriculum. These are varied activities that are implemented in order to arrive at the objectives or purposes of the written curriculum. These are used by the learners with the guidance of teachers. Taught curriculum varies according to the learning styles of students and the teaching styles of teachers. 4. Supported Curriculum- In order to have a successful teaching, other than the teacher, there must be materials which should support or help in the implementation of a written curriculum. These refer to the support curriculum that includes material resources such as textbooks, computers, audio-visual materials, laboratory equipment, playgrounds, zoos and other facilities. Support curriculum should enable each learner to achieve real and lifelong learning. 5. Assessed Curriculum- This refers to a tested or evaluated curriculum. At the duration and end of the teaching episodes, series of evaluations are being done by the teachers to determine the extent of teaching or to tell if the students are progressing. This refers to the assessed curriculum. Assessment tools like pencil-and-paper tests, authentic instruments like portfolio are being utilized. 6. Learned Curriculum- This refers the learning outcomes achieved by the students. Learning outcomes are indicated by the results of the tests and changes in behavior which can either be cognitive, affective or psychomotor. 7. Hidden Curriculum- This is the unintended curriculum which is not deliberately planned but may modify behavior or influenced learning outcomes. There are lots of hidden curricula that transpire in the schools. Peer influence, school environment, physical condition, teacher-learner interaction, mood of the teachers and many other factors made up the hidden curriculum.Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic Drug Alpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic Drugs Alpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitors aka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers (ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTN Treatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)Multiple choice test on the vocabulary of science C1-C2Multiple choice test on Language for Specific PurposesMake a multiple choice test on the story of the hare and the tortoiseHots/solo based multiple choice test questions on these The Functions, Nature, and Process of Communication, and The Various Models of Communication