Review: Tone Words

News Opinion Sport Culture Lifestyle Show more Books Music TV & radio Art & design Film Games Classical Stage ‘Hollywood doesn’t do very much of that business, they have the nice sign, and everything’s good, but they don’t do very much,’ said Trump. View image in fullscreen ‘Hollywood doesn’t do very much of that business, they have the nice sign, and everything’s good, but they don’t do very much,’ said Trump. Photograph: Lucy Nicholson/Reuters Film ‘I’m not trying to hurt the industry’: Trump softens tone on movie tariffs California governor Gavin Newsom announces a $7.5bn tax incentive scheme as Trump’s announcement of 100% tariffs on films ‘produced in foreign lands’ is mocked by Jimmy Kimmel and Fallon Andrew Pulver Tue 6 May 2025 11.24 BST Share Donald Trump appears to be softening his tone after widespread dismay in Hollywood and further afield at his bombshell announcement of 100% tariffs on films “produced in foreign lands”, saying he was “not looking to hurt the industry”. In remarks reported by CNBC, Trump said he was planning to discuss the plan with film industry leaders. “I’m not looking to hurt the industry, I want to help the industry.” He added: “So we’re going to meet with the industry. I want to make sure they’re happy with it because we’re all about jobs.” Trump also took aim again at California state governor Gavin Newsom, saying the film industry “has been decimated by other countries taking them out, and also by incompetence, like in Los Angeles, the governor [Gavin Newsom] is a grossly incompetent man, he’s just allowed it to be taken away from”. Trump added: “Hollywood doesn’t do very much of that business, they have the nice sign, and everything’s good, but they don’t do very much.” Trump’s talk of film tariffs makes no sense, but it’s already doing damage – to Hollywood Peter Bradshaw Peter Bradshaw Read more Newsom responded with a statement saying: “Governor Newsom continues to champion California’s iconic film and television industry – recognising it as a cornerstone of the state’s economy, one that sustains hundreds of thousands of good-paying jobs across every sector around the state.” “His plan to more than double the state’s film and television tax credit reflects a commitment to keeping production here at home, supporting workers and maintaining California’s global leadership in entertainment. If the President announces a proposal with more details, we will review it.” Newsom had earlier responded to Trump’s announcement by proposing a $7.5bn federal tax incentive scheme, saying in a statement to Variety: “Building on our successful state program, we’re eager to partner with the Trump administration to further strengthen domestic production.” Tax incentive schemes in the US currently operate on a state-by-state basis, and Newsom had announced a plan in April to boost California’s to $750m. California senator Adam Schiff also condemned Trump’s tariff proposal while backing calls for a federal tax credit scheme, saying in a statement: “Blanket tariffs on all films would have unintended and potentially damaging impacts, [but] we have an opportunity to work together to pass a major federal film tax credit to re-shore American jobs in the industry.” Late night TV hosts Jimmy Kimmel and Jimmy Fallon also joined the chorus of dismay and bafflement at Trump’s plan. Commenting that Trump was “now aiming his wrecking ball at Hollywood”, Kimmel questioned whether foreign-made movies were a “national security threat” as Trump claimed. “I don’t care where they’re made. I really don’t. I guess it’s what the late, great Hannibal Lecter would’ve wanted. Sonic, the illegal immigrant hedgehog, is a national security threat and he must be stopped!” Kimmel also mocked actor Jon Voight’s role in Trump’s thinking, saying: “This is where he reportedly got the tariff movies idea – from Angelina Jolie’s 86-year-old father she won’t talk to. What a great idea. Next year, The White Lotus is gonna be set at a Hampton Inn.” Fallon also took aim at Trump’s implication that foreign locations were somehow taboo, saying: “Gonna be fun seeing the next Lord of the Rings filmed in Bayonne, New Jersey,” adding: “If you don’t like that, you can also watch Emily in Des Moines [instead of Emily in Paris]. It’s just as charming.” Explore more on these topics Film Film industry Donald Trump Trump tariffs Gavin Newsom Jimmy Kimmel Jimmy Fallon news Share Reuse this content Most viewed Live German parliament votes again on Merz’s bid to be chancellor after humiliating first round – Europe live Trump and Carney to meet at White House in closely watched encounter Mushroom lunch’s sole surviving guest details deadly meal and its aftermath as trial of Erin Patterson continues ‘It’s the misogyny slop ecosystem!’ How Candace Owens and the American right declared war on Blake Lively Wisconsin woman missing for more than 60 years found ‘alive and well’

*MCQ Quiz: Understanding Good Practices in Writing AI Prompts** 1. **Q:** What is the first step in crafting an effective AI prompt? - a) Define the objective - b) Select the AI tool - c) Provide examples - d) Choose the target audience 2. **Q:** Why is it important to specify the target audience in a prompt? - a) It helps in choosing the right AI tool. - b) It ensures the output is tailored to the right level. - c) It determines the length of the prompt. - d) It makes the prompt more creative. 3. **Q:** Which of the following is a good practice when writing a prompt? - a) Keep the prompt vague to allow AI flexibility. - b) Include clear and specific instructions. - c) Write a very long and detailed prompt. - d) Start with examples before stating the objective. 4. **Q:** What is the role of examples in a well-structured prompt? - a) To confuse the AI with multiple possibilities. - b) To provide context and clarify expectations. - c) To make the prompt longer. - d) To show off knowledge of the subject. 5. **Q:** When should you select the AI tool in the prompt-writing process? - a) After defining the objective and specifying the audience. - b) Before defining the objective. - c) At the very end. - d) Before writing anything else. 6. **Q:** What is a common mistake to avoid when writing prompts? - a) Being too specific in instructions. - b) Including irrelevant information. - c) Mentioning the target audience. - d) Defining the objective clearly. 7. **Q:** How should the tone of a prompt be set? - a) It should be casual and open-ended. - b) It should be formal and precise. - c) It should change depending on the day. - d) It should be vague to encourage creativity. 8. **Q:** What is the final step in crafting a well-structured prompt? - a) Review and refine the prompt. - b) Select the target audience. - c) Provide examples. - d) Choose the AI tool. https://www.revisely.com/quiz/oEkao

Chapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic DrugAlpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic DrugsAlpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitorsaka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion  less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers(ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect  Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTNTreatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)

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