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NOTE-TAKING 1
Quiz by Veraly Morales
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âWhat may this symbol mean?
after
next
tomorrow
the end
âWhat may this symbol mean?
ear/hear
hear/here
again/repeat/return
What may this symbol mean?
What may this symbol mean?
What may this symbol mean?
Este sĂmbolo significa manzana?
What may these notes mean?
Este sĂbolo puede significar cerrado?
Este sĂmbolo puede significar final?
What could this symbol mean
What could this symbol mean?
Does this mean knowing?
Organize the possible meaning of these notes
Este sĂmbolo significa progreso o avance
Note Taking Week 10 Phobias VocabularyRevolutionising Education: Unleash AI to Spark Joy in the Classroom. What is Artificial Intelligence (AI)? ⢠Definition: AI involves creating computer systems that can perform tasks typically requiring human intelligence. These include learning, reasoning, problem-solving, perception, and language understanding. ⢠Examples in Everyday Life: From personal assistants like Siri and Alexa to more complex applications like predictive analytics in healthcare and autonomous driving. Two Types Artificial Intelligence (AI) ⢠Generative AI: refers to a type of artificial intelligence technology that can generate new content, such as text, images, music, and videos. It leverages advanced algorithms to understand and replicate patterns from existing data, allowing it to create original outputs that mimic human-like creativity. Examples include models that can write like a human, generate realistic images from textual descriptions, or compose music. ⢠Large Language Models: are a subset of Generative AI specifically designed to understand and generate human language. These models are trained on vast amounts of text data, which enable them to perform a variety of language-based tasks such as translation, summarization, answering questions, and even engaging in conversation. Notable examples include OpenAI's ChatGPT, Google Bard, and Microsoft Bing. AI in Education? ⢠Enhancing Learning: AI can personalise learning based on individual student needs by adapting materials and pacing. ⢠Automating Tasks: AI can automate administrative tasks like lesson planning and scheduling, allowing educators more time to focus on teaching and building relationships. Ethical Considerations? ⢠Privacy and Security: Ensuring student data is protected and not misused. ⢠Bias and Fairness: Developing AI systems that provide equal opportunities for all students and do not inherit or amplify biases. ⢠Transparency and Accountability: Making AI decisions in education understandable and subject to checks and balances. Our Top 10 AI For Educators ⢠Classroom conductor â ChatGPT - A versatile AI that assists teachers with emails, lesson plans, generating quiz questions, and example student pieces. ⢠Digital Design Dynamo â Canva - With its AI Magic Media app, Canva helps create engaging visuals and videos, making digital design accessible. ⢠Maetstro of Music â Suno - Instantly generates songs on any lesson topic or converts your lyrics into music, enhancing learning with tunes. ⢠Teacherâs AI Ally â School AI - Focused on educator needs, it features tools for creating interactive exit tickets and engaging chat bots. ⢠Differentiator â Diffit - Transforms PDFs and YouTube videos into differentiated worksheets and activities across languages and reading levels. ⢠Quiz Master â Quizalize - Turns any content into quizzes or games, engaging students with interactive challenges based on lesson material. ⢠Presentation Pro â Gamma - Helps create stunning presentations quickly, ideal for classroom use or professional meetings. ⢠Interactive Lesson Launcher â Cruipod - Quickly generates interactive presentations for classroom use, integrating activities seamlessly into lessons. ⢠Note-Taking Ninja â LLava - Produces study notes and quiz questions from any photo or image, simplifying study material generation. ⢠Creative Story Spinner â StroyWizard - Enables teachers to create custom stories incorporating elements from their own classrooms, linking imagination with academic achievement.Long Call Option Trading Strategy: Learn the Basics LONG CALL SUMMARY Purchasing a call option is a bullish strategy that gives the buyer the right, but not the obligation, to buy 100 shares of the underlying asset at a specified strike price on or before the expiration date. This strategy is typically employed when an investor believes that the price of the underlying asset will increase in the future. The value of a call option is influenced by several factors, including the underlying asset's price, the strike price, the time to expiration, and implied volatility. As the price of the underlying asset increases and approaches or breaches the long call's strike price, the option's value will appreciate. This is because the option holder has the right to buy the underlying asset at a lower price than the current market price, resulting in a potential profit. Out-of-the-money (OTM) calls have a strike price that is higher than the current market price of the underlying asset. These options are typically cheaper than in-the-money (ITM) calls, which have a strike price lower than the current market price. ITM calls have intrinsic value, which is the difference between the strike price and the current market price, and extrinsic value, which is the additional premium paid for the option's time value. Extrinsic value decays over time as the option approaches expiration, and this can cause the option to lose value, especially if the underlying asset does not move towards the strike price. LONG CALL OPTION Purchasing a call option grants you the privilege, but not the responsibility, to buy 100 shares of the underlying asset at the specified strike price on or before the expiration date. This option grants you the flexibility to capitalize on potential price increases of the underlying asset. The value of a call option is positively correlated with the price of the underlying asset. As the price of the stock or ETF rises and approaches your strike price, the value of your call option increases. This is because the difference between the market price and the strike price widens, giving you a greater potential profit. This characteristic makes call options suitable for bullish strategies where investors anticipate price increases. Conversely, the value of a call option diminishes when the price of the underlying asset drops or remains constant. Time decay, which refers to the gradual loss of an option's value as its expiration date approaches, also contributes to the depreciation of call options. Over time, the intrinsic value of the option, which represents the difference between the strike price and the underlying asset's market price, decreases as the option nears expiration. Additionally, if the price of the underlying asset remains below the strike price, the option may expire worthless, resulting in a total loss of the premium paid. Understanding these dynamics is crucial when trading call options. It allows you to make informed decisions about when to enter and exit positions, taking into account factors such as the underlying asset's price movements, time decay, and market sentiment. Buying call options can provide an alternative strategy to gain long exposure to a stock's price movement without the need for purchasing shares directly. This approach, known as a long call position, offers the potential advantage of lower capital outlay compared to buying shares outright. However, it's crucial to understand the concept of time decay, which significantly impacts the value of long call options. Time decay refers to the gradual decrease in the value of an option as time passes. This phenomenon occurs due to two primary factors: theta and vega. Theta measures the rate at which an option's value decays over time, while vega measures the sensitivity of an option's price to changes in implied volatility. As the expiration date of the call option approaches, both theta and vega work together to erode the option's value. Consequently, to offset the impact of time decay, the underlying stock price must rise at a greater velocity towards the call option's strike price. This is because the intrinsic value of a call option, which represents the difference between the strike price and the underlying stock's current market price, increases as the stock price moves higher. Another important consideration when evaluating call options is the distinction between out-of-the-money (OTM) and in-the-money (ITM) calls. OTM calls have a strike price higher than the current market price of the underlying stock, while ITM calls have a strike price lower than the current market price. OTM calls are typically less expensive than ITM calls because their value is composed entirely of extrinsic value. Extrinsic value refers to the portion of an option's price that is not attributable to its intrinsic value. ITM calls, on the other hand, have both intrinsic and extrinsic value, resulting in a higher cost per contract. As time relentlessly marches forward, the value of call options undergoes a transformation. The extrinsic value, which represents the premium paid for the potential of future price movements, steadily diminishes as expiration approaches. This decay is universal, affecting all call options regardless of their initial strike price or distance from the underlying asset's current price. However, amidst this gradual erosion of extrinsic value, ITM (in-the-money) call options stand as an exception. These options retain their intrinsic value at expiration, which is the difference between the strike price and the underlying asset's price. This characteristic sets ITM call options apart from their OTM (out-of-the-money) counterparts, whose extrinsic value decays entirely to zero near or at expiration. The distinction between ITM and OTM call options underscores the significance of carefully considering both the time frame and strike price when making investment decisions. Traders seeking to maximize their potential gains through call options must be mindful of the impending decay of extrinsic value as expiration draws near. For long ITM call options, the ideal scenario is for the underlying asset to exhibit a significant upward movement. Such a price increase would enhance the intrinsic value of the option, making it worth more at expiration than the initial purchase price. This scenario holds true for OTM call options as well, as they require the underlying asset to move ITM at expiration to possess any value. Prior to expiration, both OTM and ITM call options have the potential to gain a combination of extrinsic and intrinsic value if the stock exhibits a rapid upward trajectory. This dynamic underscores the importance of monitoring market conditions and adjusting investment strategies accordingly. Understanding the Interplay of Time, Strike Price, and Option Value in Call Option Trading: In the realm of call option trading, comprehending the intricate interplay between time, strike price, and option value is paramount to success. These three factors collectively shape the dynamics of call option contracts, allowing traders to make informed decisions and capitalize on market opportunities. Time (Days to Expiration): Time, measured in days until expiration, is a crucial element in call option trading. As expiration approaches, the value of a call option is directly influenced by the time premium. The closer an option gets to expiration, the less time value it holds. This time decay accelerates in the final days leading up to expiration. Therefore, traders must carefully consider the time factor when selecting their expiration dates. Strike Price: The strike price represents the predetermined price at which the underlying asset can be bought (in the case of a call option) or sold (in the case of a put option). When choosing a strike price, traders must assess the current market price of the underlying asset and make an educated guess about its future direction. ITM (In-the-Money) call options are those with a strike price below the current market price, while OTM (Out-of-the-Money) call options have a strike price above the current market price. Option Value: Option value refers to the premium paid by the buyer of an option contract to the seller. This premium comprises two components: intrinsic value and time value. Intrinsic value is the difference between the strike price and the underlying asset's current market price. Time value, as mentioned earlier, is the premium paid for the remaining time until expiration. Auto-Exercise and Expiration Scenarios: Auto-Exercise: Long call options that expire ITM by $0.01 or more will be automatically exercised. This means that the buyer of the call option has the right to purchase the underlying asset at the strike price. If the investor holds only a long call, this will result in 100 long shares per contract purchased at the call option's strike price. On the other hand, investors holding the corresponding short shares will cover or buy shares at the call option's strike price. Expiration Worthless: Any long call options that expire OTM will expire worthless. In this scenario, the investor loses the entire premium paid for the contract, resulting in a maximum loss. Understanding these concepts is instrumental in developing effective call option trading strategies. By carefully considering the interplay between time, strike price, and option value, traders can position themselves to make profitable trades and minimize potential losses. PROFIT & LOSS DIAGRAM OF A LONG OTM CALL A long OTM call option can be profitable if the current market value of the option exceeds the price paid to purchase it. This can occur in two main scenarios: Stock Price Surpasses Strike Price: If the underlying asset's price rises above the strike price of the call option by more than the premium paid for the option, the call option becomes profitable. This is because the intrinsic value of the call option (the difference between the strike price and the underlying asset's price) becomes positive, and the call option can be exercised to purchase the underlying asset at a price below the market price. OTM Call Moves Closer to Underlying Asset Price: Even if the underlying asset's price does not reach the strike price, a long OTM call can still be profitable if the option's price increases. This can happen when there is a quick rally in the underlying asset's price, causing the call option's price to increase as well, even if the strike price is not reached. This is because the time value of the call option increases as the expiration date approaches, and the call option becomes more likely to be in the money. However, it's important to note that long OTM call options can also result in losses if the underlying asset's price does not surpass the breakeven point. The breakeven point is the price at which the call option's intrinsic value becomes equal to the purchase price of the option. If the underlying asset's price remains below the breakeven point until expiration, the call option will expire worthless, and the investor will lose the entire amount paid for the option. The maximum profit potential of a long OTM call option indeed has no theoretical limit, as a stock's price can theoretically rise indefinitely. This means that if the underlying stock price increases significantly, the call option holder can potentially reap substantial profits by exercising the option and buying the stock at the predetermined strike price. On the downside, the maximum loss on a long call option is limited to the premium paid for the option. This premium represents the total amount invested in the option contract and acts as a protective barrier against further losses. If the stock price declines or stays below the strike price at expiration, the option will expire worthless, and the investor will lose the entire premium paid. The flattened red loss zone in the diagram illustrates this limited loss potential. This zone represents the range of stock prices below the strike price at expiration where the option holder will lose money. The loss amount decreases as the stock price approaches the strike price and becomes zero when the stock price equals the strike price. Beyond the strike price, the option holder starts to make a profit. It's important to note that while the maximum profit potential is theoretically unlimited, it is highly unlikely for a stock price to rise dramatically within the short timeframe of an OTM option's expiration period. Therefore, while the potential rewards can be significant, the probability of achieving them is relatively low. PROFIT & LOSS DIAGRAM OF A LONG ITM CALL ITM (In-the-Money) options have a unique characteristic where the price of their intrinsic value directly correlates with the underlying asset's price. This means that for every one point movement in the underlying asset's price, the ITM option's intrinsic value moves by the same amount. While purchasing an ITM option provides immediate intrinsic value, it does not guarantee profitability upon execution. Similar to buying an OTM (Out-of-the-Money) call option, the purchase price of an ITM call must increase for it to be profitable. This requires the stock price to move further above the call strike price. This relationship is visually represented in the diagram, where the red and green zones converge on the x-axis. The maximum potential loss on a long call option is limited to the debit paid for the option, which is represented by the flattened red area in the diagram. This means that the most an investor can lose on a long call is the premium paid for the option, regardless of how far the underlying asset's price moves below the strike price. Understanding the price dynamics and potential risks associated with ITM options is crucial for traders and investors. While ITM options offer immediate intrinsic value, careful analysis and consideration of market conditions are necessary to determine their potential profitability. EXAMPLE OF A LONG OTM CALL OPTION XYZ currently trading @ $45 Buy to Open +1 XYZ 50-strike call @ $4 debit Cost: $4 debit ($400 total, ($4 x 100 shares)) Time Decay Affect Works against the optionâs value Max Profit Theoretically unlimited Max Loss Debit paid per contract ($400) Breakeven Price (at expiration) Strike price + debit paid ($54) Account Type Required Cash, Margin, and IRA EXAMPLE OF A LONG ITM CALL OPTION XYZ currently trading @ $45 Buy to Open +1 XYZ 40-strike call @ $7 debit ($5 intrinsic value + $2 extrinsic value) Cost: $7 debit ($700 total) Time Decay Affect Works against the optionâs value Max Profit Theoretically unlimited Max Loss Debit paid per contract ($700) Breakeven Price (at expiration) Strike price + debit paid ($47) Account Type Required Cash, Margin, and IRAIn our classroom, we believe in teamwork and responsibility. That's why we have different classroom jobs that students can take on to help make our learning environment run smoothly. Each job comes with specific tasks and responsibilities, and it is important for the students to understand the requirements and expectations for each role. Let's take a closer look at the different classroom jobs available to our sixth-grade students: 1. Teacher's Assistant: The Teacher's Assistant plays a crucial role in our classroom. Their main responsibility is to remind the teacher of important tasks that need to be done throughout the day. This includes taking attendance, passing out papers to go home, and any other "do not forget" tasks that the teacher might need help with. The Teacher's Assistant needs to be organized, responsible, and reliable. 2. Supplies Monitor: The Supplies Monitor is responsible for ensuring that all classroom supplies are put away neatly. This includes making sure that pencils, pens, markers, and other materials are returned to their designated places after each use. The Supplies Monitor needs to be attentive to detail and have good organizational skills. 3. Technology Assistant: With our use of technology in the classroom, the Technology Assistant plays a vital role. They help students and guest teachers who might not be tech-savvy with chromebooks and other devices. The Technology Assistant should be comfortable with technology, patient, and willing to help others. 4. Room Monitor: The Room Monitor is in charge of checking desks and floors before lunch dismissal. They make sure that everything is clean and organized before we leave the classroom. The Room Monitor needs to be responsible, observant, and take pride in maintaining a tidy learning environment. 5. Line Leader: The Line Leader has the important task of leading the class and setting the pace when we transition from one place to another. They need to walk in a straight line, follow instructions, and be a positive role model for their peers. The Line Leader should be reliable, responsible, and demonstrate good leadership skills. 6. Messenger: The Messenger is responsible for taking things to the office or picking up items that the teacher needs. They need to be trustworthy, reliable, and able to follow instructions. The Messenger should also have good time management skills to ensure tasks are completed promptly. 7. Host/Hostess: When visitors come to our classroom and need assistance while the teacher is busy, the Host/Hostess is there to help. They greet visitors, provide directions, and offer any necessary support. The Host/Hostess should have good communication skills, be friendly, and approachable. 8. Guest Teacher Guide: In the event of a guest teacher, this student will help them take attendance and assist the teacher with anything they need help with. The Guest Teacher Guide needs to be responsible, reliable, and have good communication skills. They should also be respectful and supportive of the guest teacher. 9. Researcher: During whole-class discussions, if there is a question or topic that needs further exploration, the Researcher steps in. They use the internet to look up information and provide additional insights. The Researcher should have good research skills, be able to navigate online resources, and share accurate information with the class. 10. Secretary: The Secretary takes down notes when directed in the class notebook and collects any papers for absent students, placing them in their designated file. They need to be organized, attentive, and have good handwriting. It is important to note that all of these roles come with certain requirements. To be considered for any of these jobs, you must be punctual and have good attendance. This means arriving to school and class on time every day. Additionally, honesty and reliability are crucial traits for anyone taking on these responsibilities. By working together and taking on these classroom jobs, we can create an environment that is conducive to learning, organized, and supportive. Each of these roles plays a vital part in our classroom community, and we appreciate the efforts of all students who take on these responsibilities. Let's make our classroom a place where everyone feels valued and can thrive!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 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)Good day this is Chris today we will be doing a quick walkthrough on ISO 14001 2015 Environmental Management System and its main clauses let's get started ISO 14001 2015 Environmental Management System is a globally recognized standard for environment Management systems or EMS an EMS is a framework that organizations use to manage their environmental impact comply with regulations and improve their environmental performance the standard outlines are requirements for an EMS including the development of an environmental policy the identification of environmental aspects and impacts the establishment of objectives and targets the implementation of operational control monitoring and measurement systems and the ongoing review and Improvement of the system ISO 14001 is a flexible standard that can be used by organizations of any size or type regardless of their environment impact or level of environment performance it provides a practical framework for organizations to manage their environmental impact reduce environment risks and demonstrate their commitment on sustainability to their stakeholders here is the standard that provides a structured approach to develop an EMS which includes several key steps one organizations must develop an environmental policy that outlines their commitment to environmental sustainability this policy should be communicated to all employees and stakeholders two organizations must identify their environmental aspects and impacts this involves identifying the activities products and services that have an impact on the environment as well as the potential environmental consequences of those impacts three once the environmental aspects and the impacts have been identified organizations must establish environmental objectives and targets these objectives and targets should be specific measurable achievable relevant and time-bound 4. after setting objectives and targets organizations must Implement operational controls and establish monitoring and measurement systems to ensure that they are meeting their objectives and targets finally organizations must review and continually improve their EMS this involves conducting regular audits reviewing the EMS to ensure that it remains relevant and effective and making any necessary changes or improvements the main Clause of iso 14001 2015 apart from its scope normative references and terms and conditions that the main Clauses of iso 14001 2015 can be listed as context of the organization leadership planning support operation performance evaluation and Improvement Clause 4.0 context of the organization is about understanding the organization and its context understanding the needs and expectations of the interested parties determining the scope of the Environmental Management System EMS and Environmental Management System itself Clause 5.0 talks about leadership and commitment Environmental Policy organizational roles responsibility and authorities Clause 6.0 planning focuses on actions to address risk and opportunities as well as environmental objectives and planning to achieve them Clause 7.0 support are detailed requirements on resources competence awareness communication that includes external and internal communication documented information that involves creating updating in control of documented information Clause 8.0 operation talks about operational planning and control as well as emergency preparedness and response overall the design of iso 14001 2015 provides guidelines to form a system that is structured to cater the requirements of stakeholder needs and expectations to drive life cycle perspective and Energy Efficiency as pictured here Clause 9.0 performance evaluation provides guidelines to monitoring measurement analysis and evaluation evaluation compliance and management review an additional note here is that ISO 19011 2018 guidelines for auditing Management Systems which is an audit process that will determine the scope to establish the audit criteria by collecting evidence evaluating the evidence and then draw a conclusion based on the findings as pictured here [Music] finally Clause 10.0 Improvement talks about how Improvement is an integral factor to an effective Environmental Management system through General non-conformity and corrective action and continual Improvement talking about Improvement it is always continual in putting efforts towards the betterment of the existing system here is a snapshot of the main Clauses of iso 14001 2015 [Music] I hope you find this video useful we are industry experts specialized in management system consultancy and Industry relevant corporate training give us a call and let us help you drive your business excellence and upskill your employees to elevate workplace efficiency [Music] CREATE 10 MCQ AND 2 SAQ QUESTIONS BASED ON THE ABOVE PARAGRAPHâThereâs No Such Thing as Sound Scienceâ by By Christie Aschwanden was a lead science writer for FiveThirtyEight. FiveThirtyEight, Science, Dec. 6, 2017 Science is being turned against itself. For decades, its twin ideals of transparency and rigor have been weaponized by those who disagree with results produced by the scientific method. Under the Trump administration, that fight has ramped up again. In a move ostensibly meant to reduce conflicts of interest, Environmental Protection Agency Administrator Scott Pruitt has removed a number of scientists from advisory panels and replaced some of them with representatives from industries that the agency regulates. Like many in the Trump administration, Pruitt has also cast doubt on the reliability of climate science. For instance, in an interview with CNBC, Pruitt said that âmeasuring with precision human activity on the climate is something very challenging to do.â Similarly, Trumpâs pick to head NASA, an agency that oversees a large portion the nationâs climate research, has insisted that research into human influence on climate lacks certainty, and he falsely claimed that âglobal temperatures stopped rising 10 years ago.â Kathleen Hartnett White, Trumpâs nominee to head the White House Council on Environmental Quality, said in a Senate hearing last month that she thinks we âneed to have more precise explanations of the human role and the natural roleâ in climate change. The same entreaties crop up again and again: We need to root out conflicts. We need more precise evidence. What makes these arguments so powerful is that they sound quite similar to the points raised by proponents of a very different call for change thatâs coming from within science. This other movement strives to produce more robust, reproducible findings. Despite having dissimilar goals, the two forces espouse principles that look surprisingly alike: Science needs to be transparent. Results and methods should be openly shared so that outside researchers can independently reproduce and validate them. The methods used to collect and analyze data should be rigorous and clear, and conclusions must be supported by evidence. These are the arguments underlying an âopen scienceâ reform movement that was created, in part, as a response to a âreproducibility crisisâ that has struck some fields of science.1 But theyâre also used as talking points by politicians who are working to make it more difficult for the EPA and other federal agencies to use science in their regulatory decision-making, under the guise of basing policy on âsound science.â Scienceâs virtues are being wielded against it. What distinguishes the two calls for transparency is intent: Whereas the âopen scienceâ movement aims to make science more reliable, reproducible and robust, proponents of âsound scienceâ have historically worked to amplify uncertainty, create doubt and undermine scientific discoveries that threaten their interests. âOur criticisms are founded in a confidence in science,â said Steven Goodman, co-director of the Meta-Research Innovation Center at Stanford and a proponent of open science. âThatâs a fundamental difference â weâre critiquing science to make it better. Others are critiquing it to devalue the approach itself.â Calls to base public policy on âsound scienceâ seem unassailable if you donât know the termâs history. The phrase was adopted by the tobacco industry in the 1990s to counteract mounting evidence linking secondhand smoke to cancer. A 1992 Environmental Protection Agency report identified secondhand smoke as a human carcinogen, and Philip Morris responded by launching an initiative to promote what it called âsound science.â In an internal memo, Philip Morris vice president of corporate affairs Ellen Merlo wrote that the program was designed to âdiscredit the EPA report,â âprevent states and cities, as well as businesses from passing smoking bansâ and âproactivelyâ pass legislation to help their cause. The sound science tactic exploits a fundamental feature of the scientific process: Science does not produce absolute certainty. Contrary to how itâs sometimes represented to the public, science is not a magic wand that turns everything it touches to truth. Instead, itâs a process of uncertainty reduction, much like a game of 20 Questions. Any given study can rarely answer more than one question at a time, and each study usually raises a bunch of new questions in the process of answering old ones. âScience is a process rather than an answer,â said psychologist Alison Ledgerwood of the University of California, Davis. Every answer is provisional and subject to change in the face of new evidence. Itâs not entirely correct to say that âthis study proves this fact,â Ledgerwood said. âWe should be talking instead about how science increases or decreases our confidence in something.â The tobacco industryâs brilliant tactic was to turn this baked-in uncertainty against the scientific enterprise itself. While insisting that they merely wanted to ensure that public policy was based on sound science, tobacco companies defined the term in a way that ensured that no science could ever be sound enough. The only sound science was certain science, which is an impossible standard to achieve. âDoubt is our product,â wrote one employee of the Brown & Williamson tobacco company in a 1969 internal memo. The note went on to say that doubt âis the best means of competing with the âbody of factââ and âestablishing a controversy.â These strategies for undermining inconvenient science were so effective that theyâve served as a sort of playbook for industry interests ever since, said Stanford University science historian Robert Proctor. The sound science push is no longer just Philip Morris sowing doubt about the links between cigarettes and cancer. Itâs also a 1998 action plan by the American Petroleum Institute, Chevron and Exxon Mobil to âinstall uncertaintyâ about the link between greenhouse gas emissions and climate change. Itâs industry-funded groupsâ late-1990s effort to question the science the EPA was using to set fine-particle-pollution air-quality standards that the industry didnât want. And then there was the more recent effort by Dow Chemical to insist on more scientific certainty before banning a pesticide that the EPAâs scientists had deemed risky to children. Now comes a move by the Trump administrationâs EPA to repeal a 2015 rule on wetlands protection by disregarding particular studies. (To name just a few examples.) Doubt merchants arenât pushing for knowledge, theyâre practicing what Proctor has dubbed âagnogenesisâ â the intentional manufacture of ignorance. This ignorance isnât simply the absence of knowing something; itâs a lack of comprehension deliberately created by agents who donât want you to know, Proctor said.2 In the hands of doubt-makers, transparency becomes a rhetorical move. âItâs really difficult as a scientist or policy maker to make a stand against transparency and openness, because well, who would be against it?â said Karen Levy, researcher on information science at Cornell University. But at the same time, âyou can couch everything in the language of transparency and it becomes a powerful weapon.â For instance, when the EPA was preparing to set new limits on particulate pollution in the 1990s, industry groups pushed back against the research and demanded access to primary data (including records that researchers had promised participants would remain confidential) and a reanalysis of the evidence. Their calls succeeded and a new analysis was performed. The reanalysis essentially confirmed the original conclusions, but the process of conducting it delayed the implementation of regulations and cost researchers time and money. Delay is a time-tested strategy. âGridlock is the greatest friend a global warming skeptic has,â said Marc Morano, a prominent critic of global warming research and the executive director of ClimateDepot.com, in the documentary âMerchants of Doubtâ (based on the book by the same name). Moranoâs site is a project of the Committee for a Constructive Tomorrow, which has received funding from the oil and gas industry. âWeâre the negative force. Weâre just trying to stop stuff.â Some of these ploys are getting a fresh boost from Congress. The Data Quality Act (also known as the Information Quality Act) was reportedly written by an industry lobbyist and quietly passed as part of an appropriations bill in 2000. The rule mandates that federal agencies ensure the âquality, objectivity, utility, and integrity of informationâ that they disseminate, though it does little to define what these terms mean. The law also provides a mechanism for citizens and groups to challenge information that they deem inaccurate, including science that they disagree with. âIt was passed in this very quiet way with no explicit debate about it â that should tell you a lot about the real goals,â Levy said. But whatâs most telling about the Data Quality Act is how itâs been used, Levy said. A 2004 Washington Post analysis found that in the 20 months following its implementation, the act was repeatedly used by industry groups to push back against proposed regulations and bog down the decision-making process. Instead of deploying transparency as a fundamental principle that applies to all science, these interests have used transparency as a weapon to attack very particular findings that they would like to eradicate. Now Congress is considering another way to legislate how science is used. The Honest Act, a bill sponsored by Rep. Lamar Smith of Texas,3 is another example of what Levy calls a âTrojan horseâ law that uses the language of transparency as a cover to achieve other political goals. Smithâs legislation would severely limit the kind of evidence the EPA could use for decision-making. Only studies whose raw data and computer codes were publicly available would be allowed for consideration. That might sound perfectly reasonable, and in many cases it is, Goodman said. But sometimes there are good reasons why researchers canât conform to these rules, like when the data contains confidential or sensitive medical information.4 Critics, which include more than a dozen scientific organizations, argue that, in practice, the rules would prevent many studies from being considered in EPA reviews.5 It might seem like an easy task to sort good science from bad, but in reality itâs not so simple. âThereâs a misplaced idea that we can definitively distinguish the good from the not-good science, but itâs all a matter of degree,â said Brian Nosek, executive director of the Center for Open Science. âThere is no perfect study.â Requiring regulators to wait until they have (nonexistent) perfect evidence is essentially âa way of saying, âWe donât want to use evidence for our decision-making,ââ Nosek said. Most scientific controversies arenât about science at all, and once the sides are drawn, more data is unlikely to bring opponents into agreement. Michael Carolan, who researches the sociology of technology and scientific knowledge at Colorado State University, wrote in a 2008 paper about why objective knowledge is not enough to resolve environmental controversies. âWhile these controversies may appear on the surface to rest on disputed questions of fact, beneath often reside differing positions of value; values that can give shape to differing understandings of what âthe factsâ are.â Whatâs needed in these cases isnât more or better science, but mechanisms to bring those hidden values to the forefront of the discussion so that they can be debated transparently. âAs long as we continue down this unabashedly naive road about what science is, and what it is capable of doing, we will continue to fail to reach any sort of meaningful consensus on these matters,â Carolan writes. The dispute over tobacco was never about the science of cigarettesâ link to cancer. It was about whether companies have the right to sell dangerous products and, if so, what obligations they have to the consumers who purchased them. Similarly, the debate over climate change isnât about whether our planet is heating, but about how much responsibility each country and person bears for stopping it. While researching her book âMerchants of Doubt,â science historian Naomi Oreskes found that some of the same people who were defending the tobacco industry as scientific experts were also receiving industry money to deny the role of human activity in global warming. What these issues had in common, she realized, was that they all involved the need for government action. âNone of this is about the science. All of this is a political debate about the role of government,â she said in the documentary. These controversies are really about values, not scientific facts, and acknowledging that would allow us to have more truthful and productive debates. What would that look like in practice? Instead of cherry-picking evidence to support a particular view (and insisting that the science points to a desired action), the various sides could lay out the values they are using to assess the evidence. For instance, in Europe, many decisions are guided by the precautionary principle â a system that values caution in the face of uncertainty and says that when the risks are unclear, it should be up to industries to show that their products and processes are not harmful, rather than requiring the government to prove that they are harmful before they can be regulated. By contrast, U.S. agencies tend to wait for strong evidence of harm before issuing regulations. Both approaches have critics, but the difference between them comes down to priorities: Is it better to exercise caution at the risk of burdening companies and perhaps the economy, or is it more important to avoid potential economic downsides even if it means that sometimes a harmful product or industrial process goes unregulated? In other words, under what circumstances do we agree to act on a risk? How certain do we need to be that the risk is real, and how many people would need to be at risk, and how costly is it to reduce that risk? Those are moral questions, not scientific ones, and openly discussing and identifying these kinds of judgment calls would lead to a more honest debate. Science matters, and we need to do it as rigorously as possible. But science canât tell us how risky is too risky to allow products like cigarettes or potentially harmful pesticides to be sold â those are value judgements that only humans can make.Note-taking