How we can check in opera about guest transportation?

Z9 in Specials, Comment, Transportation, Rate details

Transportation, alert, Z9 , check with Concierge

Gifted redemption booking. Room only, other benefits of member will not apply

Redemption booking, gifted stay, benefits remain same

Guest book directly by website rate , main guest did not come, friend come to stay

Guest give stay for another guest come to stay, benefits still remain

Read comment “X1. RM w BFI & TRS to TA. OTH to PA.”

gold member, room with breakfast and transportation charge to travel agent, others to Personal account

Gold member, room without breakfast, transportation for travel agent, others to personal account

Basic member, breakfast, transportation for Travel agent, others to personal account

silver member, room with breakfast and transportation, other to Personal account

How much does it cost for Breakfast

780.000 Net/day. Half price for kids from 6yo-12yo

780.000 Net/day. Half price for kids from 4yo-12yo

Charge for extra third person staying in room?

1,350,000 net/ night redemption booking : no extra third person charge

1,350,000 ++ / night , no extra third person charge for redemption booking

How much discount for Club Marriott when guest use F&B ?

30% or 20% discount depend on type of card for F&B excluding IRD and Banquet and special promotion

30% discount for F&B excluding IRD , Banquet and special promotion

30% or 20% discount depend on type of card for F&B including IRD and Pink Pearl, Banquet and special promotion

where we can exchange money and how much maximum we can exchange?

Front desk, depend on how much cash we have

What is the difference between Room type and Room to Charge?

Room type : the room guest stay in, room to charge: room guest pay for

Room type, room to charge no different, only different name

Room to charge: room guest pay for, room type: room guest booked

Room type: guest pay for it, room charge:room guest upgraded to

What are benefits of Titanium member ?

Priority late check out 4pm,Upgrade room – including the selected suite, 30% Discount F&B outlets (excluding IRD and BKF at Tempus)

Priority late check out 2pm, Elite welcome gift points, BF or amenity

10% F&B discount ,20% discount on Spa treatments,50% point bonus

20% Laundry discount, 10% discount on Spa treatments, Priority Late check out at 4pm based on availability

List benefits of basic member

Member Rate, Free Wifi, 10% F&B discount

Member Rate, Free Wifi, 15% F&B discount , 10 % Spa

Member Rate, Free Wifi, 15% F&B discount

Incorrect operation time :

DOC Monday - Thursday, 16:00 - 22:00 Last order 21:45

Pink Pearl Tuesday to Saturday , 6pm to 9pm

Happy Hour of Pink Pearl restaurant ?

3PM – 5PM Buy 1 get 1 in selected beverage menu

5PM – 7PM Buy 1 get 1 in selected beverage menu

7PM – 9PM , 50% Discount in selected pastry menu

Happy Hour of Department of Chemistry restaurant ?

5PM – 7PM Buy 1 get 1 in selected beverage menu

3PM – 5PM , 50% Discount in selected menu

7PM – 9PM , 50% Discount in selected menu

3PM – 5PM Buy 1 get 1 in selected beverage menu

What's room type order is correct?

1. Emerald Bay View 2. Le Jardin 3. Rue De Lamarck Suite 4. Emerald Bay Front

1. Emerald Bay View 2. Rue De Lamarck Suite 3. Le Jardin 4 Deluxe Emerald Bay Front

1. Le Jardin 2. Rue De Lamarck Suite 3. Delux Emerald Bay View 4. Turquoise Suite (towel, pool)

1. Emerald Bay View 2. Rue De Lamarck Suite 3. Le Jardin 4 Deluxe Emerald Bay Front

What benefits not belong to gold member?

Priority late check out at 2pm ( base on availability)

20% Discount in our Food & Beverage outlets (excluding in room dining service and Breakfast Buffet at our Tempus Fugit) 20% Laundry discount

What is wrong information about Ambassador Elite member?

Priority late check out at 4pm base on availability

Complimentary 2 hour meeting room usage per stay, 20% Discount on spa treatments

24/7 ambassador service : Get personal assistance with your stays — anytime, anywhere

Correct information about Afternoon Tea in F &Co?

648.000++/person ;324.000++/kid (3-12yo) – everyday from 3PM-5PM

648.000++/person ;324.000++/kid (6-12yo) – everyday from 5PM-7PM

595.000++/person ; 295.000++/kid (6-12yo) – everyday from 3PM-5PM

Include in guest booking , no need to pay extra fee

How much is the price for Romantic Dinner on the beach ?

Starting from 6,995,000++ per couples / 5 course

Free cancellation if cancel within 24hours

starting form 7.000.000++/per couple , 5 course

9.990.000++/per couple – set menu 3-course

What's statement give correct information ?

Long stay guest benefits: Transportation: 20% discount Food & Beverage: 20% discount Spa : 20 % discount Laundry: 20% discount

Club Marriott: 30% or 20% discount depend on type of card for F&Bincluding IRD, Banquet and special promotion

MI: Food and Beverage: 50% discount Including Alcohol and IRD (for a party up to 8 people).

APAC: Food and Beverage : 50% discount for ALL our outlets at all meal periods Inroom Dinning: 50% discount ( non-alcohol not applicable)

What information wrong about BBQ beach dinner?

Starting from 5,000,000 ++/ Pax

Book in advance 12 hour, cancellation applied if cancel within 24 hour

Wrong information about the Science of Liquid Chemistry?

398,000++ VND for lady 498,000++ VND for gentlemen

free flow of cocktails, wine, beer for 2 hours

TEST FOR NEW ASSOCIATE, PHASE 1

[t comes from the GREEK name "Epilepsia" which means "taking hold of or seizing". - It is a disorder characterized by: recurrent seizures. SEIZURES R ectment transient attacks of: R epresent: R esult from: ASSOCIATED WITH: somatic, psychic, or, autonomic clinical featmes. clinical features of abnormally hyperexcitable cortical neurons. paroxvsmal and excessive electrical neuronal discharges. EEG changes & may be disturbance of consciousness. same causes of convulsions 1. Idiopathic epile~ • It is the commonest cause. no cause can be detected ( 65 % ) • It may be associated with positive family history in some cases. • It starts in the l st & 2nd decades in the form of: -- Grand ma! epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures. 2. Secondary epilepsy A. Local causes in the brain: l. Congenital: 2. Traumatic: cerebral palsy. a cause can be detected cerebral contusion or laceration. 3. Inflammatory: 4. Neoplastic: 5. Degenerative: 6. Vascular: encephalitis, brain tumours. mening1t1s, presenile dementia. brain abscess. stroke (especially hemon-hagic), hypertensive encephalopathy. B. General causes with secondary effects on the brain: I. Toxic: 2. Iatrogenic: 3. Metabolic: 4. Endocrinal: 5. Organ failure: 6. Heart disease: 7. Nutritional: - Alcohol, cocaine, lead. - Lidocaine, INH. - j glucose & ! glucose. - Hypoparathyroidism. - Hepatic failme. - Adam's Stoke's attacks. - Pellagra. - Botulism, tetanus. - Ambilhar, Amphetamine, Aminophylline. - j Ca & ! Ca. - Hype1thyroid crisis. - Renal failure. - Fallot's tetralogy. - j Na & ! Na. - Vitamin B6 deficiency. 8. Physical: 9. HYSTERICAL. - High fevers. - Heat stroke. 136 137 CLINICAL PICTURE 1. GENERALISED SEIZURES " Excessive electrical discharges from cortical neurons in BOTH hemispheres simultaneously " I. II. 1. Grand Mal Epile~: 1. Pre-ictal stage "attacks of tonic-clonic convulsions " (aura) It is a warning sign of a coming attack. It may be: • Somatic: • Psychic: • Autonomic: 2. Ictal stage Myoclonus, Hallucinations. Tachycardia, (seizure) Sudden loss of consciousness: Parasthesias. Sweating. for seconds to minutes. -- Tonic phase (few seconds) o The UL & LL: o o o o The HEAD: The JAWS: CYANOSIS: are extended. is retracted to one side & the eye balls rolled up. are firmly clenched, with biting of the TONGUE. due to impaired respiration. There may be incontinence of urine. Clonic phase (few minutes) o The UL & LL: o The HEAD: 3. Post-ictal stage - It may be: • Somatic: • Psychic: • Autonomic: Drug of choice: contract & relax repeatedly & rapidly. jerks forcibly. (sequelae) Todd's paralysis(< 24 hours, due to neuronal exhaustion). Confusion. Vomiting. Carbamazepine (Tegretol) or Phenytoin (Epanutin) Petit Mal Epilepsy: "attacks of loss of consciousness " " Absence " It starts in childhood & improves at puberty & usually disappears at the age of 20. 2. It is NOT PRECEEDED by aura & NOT FOLLOWED by sequelae. 3. It is usually PRECIPITATED by: hyperventilation 4. It is characterized by: or photic stimulation. sudden loss of consciousness of short duration (few seconds). 5. It may be associated with: • High frequency ( 50 attacks / day). • Falling to the ground without warning. • Jerky movements of the head & UL Drug of choice: (myoclonic petit mal). Valproate (Depakine) or Succinimide (Zarontin) 137 138 Ill. M oclonic Seizures: "attacks of involuntary clonic movements " - It is characterized by: sudden, jerky, shock-like INVOLUNTARY muscle contraction. • The jerks are bilateral contractions, mainly of the shoulders and arms. • However, some patients repmtjerking in the lower limbs, trunk, or head. - It may be of 2 types: - Occurs singly • Simple: • As a pait of: I Drug of choice: IV. Atonic seizures: (no loss of consciousness). - Grand mal epilepsy (aura). - Petit mal epilepsy. Valproate (Depakine) or Clonazepam (Rivotril) I - Transient attacks of brief loss of postural tone, often resulting in falls and injuries. 2. PARTIAL SEIZURES "Excessive electrical discharges from cmtical neurons in a ce1tain area in ONE hemisphere" A. Simple seizures: " No disturbance in consciousness " - The CP depends on the site of the hyperexcitable neurones in the cerebral cortex, whether in: "Motor area or Senso,y areas". 1. Motor fits: • Focal fits: • Motor jacksonian fits: 2. General Sensory fits: • Focal fits: • Sensory jacksonian fits: 3. Special Senso1y fits: • Visual hallucinations: • Auditory hallucinations: • Olfactory hallucinations: B. Complex seizures: - SITE: movement of part of a limb or the whole limb. movement of one side of the body (see before). parasthesia of part of a limb or the whole limb. parasthesia of one side of the body (see before). irritation of the visual sensory area. irritation of the auditory sensory area. initation of the uncus. " disturbance in consciousness " The hyperexcitable neurons are in the Temporal lobe "Temporal lobe epilepsy". - DURATION: The seizure lasts few seconds to few minutes. - The seizure starts with A ura, followed by A bsence, Automatism, Amnesia: 1. 2. 3. 4. A ura: A bsence: Automatism: A mnesia: Olfactory hallucinations, Deja-vu phenomenon, Sensation of fear. Absent patient with staring eyes (with no response to conversation). Involuntary Purposeless acts: motor ( eg, lip smacking, chewing) or verbal. No recalling of the seizure. 138 139 3. PARTIAL SEIZURES ~ GENERALISED SEIZURES " Partial seizures may spread to involve the whole brain .- secondarily generalised seizures " . HY-sterical epilepsY • Usually: • The cause: • Incidence: young neurotic Sj2 . psychological & there is no organic lesion. usually occurs in the presence of people. • It is associated with: • EEG: • It is not associated with: normal. • Missed ttt. • Menses. • Alkalosis. anxiety, palpitaion & hyperventilation. tongue biting or incontinence of urine. • Alcohol use & Drug abuse ( e.g. cocaine ). • S timulation by photons & Hyperventilation. • S leep deprivation & Stress & sudden withdrawal of antiepileptic drngs. INVESTIGATIONS 1. EEG: • It is the most specific test for epilepsy because it records the electrical activity of the brain. • It shows specific pattern: 2. LOCAL INVESTIGATIONS: "Epilepsy waves". "CT & MRI of the brain" • To identify or exclude a LOCAL CAUSE of seizures in the brain. 3. GENERAL INVESTIGATIONS: "Laboratory investigations" • To search for a GENERAL CAUSE of seizures, e.g. blood glucose. 139 140 TREATMENT A. General Measures: 1. 2. Moderation of the patient's physical activity. A void the precipitating factors ( Alcohol, hyperventilation, photic stimulation ...... ). 3. A ketogenic diet is encouraged because it will induce acidosis: - Acidosis is beneficial as it raises the threshold of stimulation of the brain cells. B. Specific Treatment: 2. 1. Treatment of the cause in secondary epilepsy. Anti-epileptic drugs: a) Always sta1t with one drug, then add another drug if there is no response. b) Always stop the drugs ONLY if: • The patient stays free of symptoms for at least 2 years. • The patient has a normal EEG. 3. Side effects of Anti-epileptic drugs: I . Skin rash. 2. 3. Bone marrow depression. Ataxia. Drug 1. Barbiturates (Pbenonobarbitone) 2. Hydantoin (Epanutin) 3. Carbamazepine 4. Clonazepam 5. Valproate 6. Succinamide ANTI-EPILEPTIC DRUGS NEW ANTI-EPILEPTIC DRUGS - These drugs are new dtugs that may be used in resistant seizures. 1. Lamotrigine: 200 - 400 mg/ day. 2. Felbamate: 3. Gabapentin: 400- 800 mg/ day. 600 - 1200 mg/ day. \ " General rules for use ": Dose 100-600 mg I day 100-600 mg / day 200-600 mg I day 2-6 mg I day 500-1500 mg I day 500-1000 mg / day Best indicated - Broad spectrum. - Not for petit mal. - Grand mal. - Motor Jacksonian fits. - Grand mal. - Motor Jacksonian fits. - Complex seizures. - Not for petit ma!. - Myoclonic. - Grand mat. - Broad spectrum. - Petit mat. 140 141 STATUS EPILEPTICUS DEFINITION - A medical emergency: 1. Repeated attacks of generalized convulsions, with lack of recove,y of consciousness, 2. Persistent attack of seizure lasting for at least 30 minutes. OR, - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage or hyperpyrexia. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke. TREATMENT A. General Measures: l. Take care of: " ABC " • Place the patient on the ground, to guard against falling from bed. • Mouth gag & 02 inhalation ( endo-tracheal intubation may be needed). • Record the vital signs regularly. 2. Take a sample of: - Venous blood: for the level of: - A.tierial blood: for the level of: 3. a nti-epileptic drugs, a lcohol. pH, p0 2, pC02, HC0 3. Give cerebral dehydrating measures: e.g. Frusemide, cone. Mannitol, Dexamethazone. B. Specific Treatment: - Phenytoin with diazepam (or clonazepam) immediately: 1. Phenytoin: 2. Diazepam: Clonazepam: seizures recur: 15 mg I Kg slow infusion. 5 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20 mg. OR: 2 mg slowly IV, to be repeated after 5 minutes if maximum dose: 6 mg. - If seizures persist after 20 min. of Phenytoin & diazepam: 3. PHENOBARBITONE: - In resistant cases: 200 mg infusion. 4. GENERAL ANAESTHESIA: may be used.

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)

Create me a multiple choice type of test with 4 options on this topic for college level: SEXUAL ORIENTATION • According to the Psychological Association of the Philippines, typically at ages 6 or 8, we experience or develop attraction to other people. By adolescence, we really know who we are attracted to and would experiment through dating and relationships. Everyone’s sexuality is different and deeply personal. Our capacity for emotional and sexual attraction is diverse and complex. FOUR CATEGORIES OF SEXUAL ORIENTATION 1. HETEROSEXUALITY • The attraction to individuals of the opposite sex. 2. HOMOSEXUALITY • The attraction between people who are the same sex. 3. BISEXUALITY • The attraction to individuals of either sex. 4. ASEXUALITY • A term used to describe someone who does not experience sexual attraction toward individuals of any gender. GENDER • Gender refers to the characteristics of women, men, girls and boys that are socially constructed. This includes norms, behaviors and roles associated with being a woman, man, girl or boy, as well as relationships with each other. As a social construct, gender varies from society to society and can change over time. • There are many ways through which gender is manifested. As soon as a new baby arrives in the family, adults surrounding the baby manifests their social interpretation of the baby’s sex by the color assigned to the baby. Example: common for the families to buy blue apparels and toys when the baby is a male, as blue is associated with boyhood. • Conversely, female babies are often assigned to color pink, would buy toys and clothes that are color pink which is associated to a girlhood. Remarkably, the moment a baby is born, the name, toys, and apparels are picked by parents and relatives based on their interpretation of the baby’s sex. • Throughout childhood and adolescence, this assignment becomes more complex as the expectations go beyond the kind of clothes worn, but also in terms of how the person must or must not behave.

Instructions: Please answer the following questions to test your understanding of aptitudes and interests. 1. What are Core Drivers (Talents) in the context of aptitudes and interests? a) Abilities that are developed through education b) Natural gifts that predict job effectiveness and contentment c) Interests that change over time d) Personality traits 2. Determine how effective and satisfied you'll be doing a particular kind of work. a) Visual Comparison Speed b) Numerical Reasoning c) Spatial Visualization d) Sequential Reasoning 3. Which Core Driver is associated with the knack for organizing things in a sequential and systematic manner? a) Visual Comparison Speed b) Numerical Reasoning c) Spatial Visualization d) Sequential Reasoning 4. What is the primary role of Space Planners in careers? a) They are responsible for interior design b) They read maps and blueprints c) They generate creative ideas d) They manage financial accounts 5. Which Core Driver relates to the ability to mentally translate two-dimensional images into three-dimensions? a) Visual Comparison Speed b) Numerical Reasoning c) Spatial Visualization d) Sequential Reasoning 6. What type of individuals are known as 3D Visualizers? a) Those who excel in visual art b) People who can quickly process numerical data c) Individuals who can mentally create 3D models from 2D representations d) Creative writers 7. How do Brainstormers differ from Concentrated & Focused individuals in terms of generating ideas? a) Brainstormers generate more ideas b) Concentrated & Focused individuals generate more ideas c) They generate ideas at the same rate d) Both groups struggle to generate ideas 8. What is the primary advantage of having high Visual Comparison Speed? a) It helps in artistic endeavors b) It is useful in complex mathematical problems c) It aids in tasks requiring clerical detail and accuracy d) It enhances spatial visualization 9. Which career is NOT associated with the Core Driver: Visual Comparison Speed? a) Fire Inspector b) Astronomer c) Creative Writer d) Orthoptist 10. What is the main focus of Numerical Reasoning? a) Identifying numerical patterns and trends b) Analyzing historical data c) Solving abstract problems d) Communicating effectively 11. Which Core Driver involves the ability to rapidly draw conclusions from seemingly unrelated pieces of information? a) Numerical Reasoning b) Idea Generation c) Spatial Visualization d) Inductive Reasoning 12. What is the primary characteristic of Diagnostic Problem Solvers? a) They follow a logical step-by-step method of problem-solving b) They rely on specific information and observed experience c) They intuitively leap to conclusions based on limited information d) They are meticulous and deliberate in decision-making 13. What is the role of Fact Checkers in the problem-solving process? a) They intuitively provide solutions b) They rely on specific information and observed experience c) They enjoy acquiring new information and learning d) They make conclusions based on limited facts 14. In what type of role are Abstract Thinkers most comfortable? a) Counseling b) Law c) Marketing d) Construction 15. How can understanding your Core Drivers benefit collaborative work? a) It allows individuals with similar aptitudes to work together more effectively b) It creates conflicts within the team c) It doesn't affect collaborative work d) It makes collaboration more challenging 16. Which Core Driver is associated with processing complex mathematical problems logically? a) Visual Comparison Speed b) Numerical Reasoning c) Sequential Reasoning d) Idea Generation 17. What are Collaborative Planners more likely to do in a team project? a) Lead the team b) Create individual pieces of a project c) Solve abstract problems d) Generate creative ideas 18. How can understanding your aptitudes and interests help you make informed career choices? a) It guarantees job satisfaction b) It allows you to align your career with your strengths c) It helps you choose any career at random d) It has no impact on career decisions 19. Which Core Driver affects whether your thoughts go in several directions at once or follow single ideas more readily? a) Visual Comparison Speed b) Numerical Reasoning c) Idea Generation d) Inductive Reasoning 20. What is the primary characteristic of Idea Contributors? a) They generate creative ideas b) They discuss the big picture and next steps c) They are highly focused and detailed d) They follow a logical step-by-step approach 21. What is the role of Space Planners in the problem-solving process? a) They intuitively provide solutions b) They rely on specific information and observed experience c) They quickly organize information d) They create abstract plans 22. Which Core Driver is linked to the ability to see relationships in seemingly unrelated pieces of information? a) Spatial Visualization b) Inductive Reasoning c) Idea Generation d) Visual Comparison Speed 23. Which career is NOT associated with the Core Driver: Numerical Reasoning? a) Statistician b) Survey Researcher c) Chef d) Actuary 24. What are Core Drivers, and why are they important in the context of aptitudes and interests? a) They are educational qualifications b) They are interests that change over time c) They are natural gifts that predict job effectiveness and contentment d) They are personality traits 25. How can understanding your Core Drivers benefit collaborative work? a) It allows individuals with similar aptitudes to work together more effectively b) It creates conflicts within the team c) It doesn't affect collaborative work d) It makes collaboration more challenging Answers: b) Natural gifts that predict job effectiveness and contentment a) Visual Comparison Speed d) Sequential Reasoning b) They read maps and blueprints c) Spatial Visualization c) Individuals who can mentally create 3D models from 2D representations a) Brainstormers generate more ideas c) It aids in tasks requiring clerical detail and accuracy c) Creative Writer a) Identifying numerical patterns and trends d) Inductive Reasoning c) They intuitively leap to conclusions based on limited information b) They rely on specific information and observed experience b) Law a) It allows individuals with similar aptitudes to work together more effectively b) Numerical Reasoning b) Create individual pieces of a project b) It allows you to align your career with your strengths c) Idea Generation b) They discuss the big picture and next steps c) They quickly organize information b) Inductive Reasoning c) Chef c) They are natural gifts that predict job effectiveness and contentment a) It allows individuals with similar aptitudes to work together more effectively

The Pleiades, also known as the Seven Sisters, is a famous star cluster located in the constellation of Taurus. It is made up of a group of seven bright stars that are visible to the naked eye in the night sky. The stars in the Pleiades cluster are relatively young, being only about 100 million years old, which is young in astronomical terms. The Pleiades cluster has been observed and admired by cultures all around the world for thousands of years. In Greek mythology, the Pleiades were seven sisters who were pursued by the hunter Orion. To protect them, Zeus transformed them into stars, forming the star cluster we see today. Different cultures have their own stories and legends associated with the Pleiades, making it a fascinating object of study for astronomers and a source of inspiration for artists and storytellers. The Pleiades cluster is often used as a test of eyesight, as people are challenged to count how many stars they can see with the naked eye. Most people can see six or seven stars, but those with particularly sharp vision may be able to see more. The Pleiades is also a popular target for amateur astronomers with telescopes, as the cluster reveals even more stars and details when viewed through a telescope. In addition to being a beautiful sight in the night sky, the Pleiades cluster also serves a practical purpose for astronomers. By studying the stars in the Pleiades, scientists can learn more about how stars form and evolve, as well as gain insights into the structure and composition of the Milky Way galaxy. The Pleiades cluster continues to be an important object of study for astronomers, both amateur and professional, and its beauty and significance will continue to capture the imaginations of people for generations to come. Matariki is the Maori name for the Pleiades star cluster. The Pleiades is a group of stars that can be seen in the night sky, and Matariki is a special time of year when the star cluster is visible in the sky. In Maori culture, Matariki is seen as the beginning of the Maori New Year, and it is a time to celebrate and give thanks for the past year and look forward to the year ahead. So basically, Matariki is related to the Pleiades because it is a special time of year when those stars are visible in the sky and it has cultural significance for the Maori people. The Pleiades star cluster is known by different names in various cultures around the world. Here are some of the names by which the Pleiades are referred to in different countries: 1. Maori culture in New Zealand and Polynesia: Matariki 2. Greek mythology: The Seven Sisters 3. Japan: Subaru 4. Native American tribes: The Dancers or The Little Eyes 5. Inca civilization: Collca 6. Ancient Persia: Parvin 7. India: Krittika 8. Aboriginal Australians: The Seven Sisters or Djulpan These different names reflect the diverse cultural significance and interpretations of the Pleiades cluster in various societies throughout history.

refreshment (n): (small amounts of food and drink ( Refreshments will be available during the interval.) stimulant (n): a substance which temporarily arouses physiological or organic activity ( Caffeine is a natural stimulant .) reinforcement (n): the act of making sth stronger / (plural) soldiers sent to join an army to make it stronger ( Constructors have been hired to add reinforcement to the foundations of the old bridge.) initiative (n): the ability to make decisions without waiting to be told what to do (Being a successful entrepreneur requires one to have great initiative.) inhibition (n): a shy or nervous feeling that stops you from expressing your real feelings (She drinks alcohol at parties to get over her inhibitions.) initiation (n): a ceremony, ritual, test, or period of instruction with which a new member is admitted to an organization or office (The initiation period for new employees lasts approximately six weeks.) initial (n): the first letter of a name, esp. when used to represent a name (Do you know what Ms Rowling's initials, J and K, stand for?) concise (adj): short and clear, expressing what needs to be said without unnecessary words (She gave a concise overview of the points she was about to make in her speech. ) direct (adj): happening or done without involving other people, actions, etc. in between ( You will only be hired if you have direct experience in this field.) devious (adj): not straightforward, sincere and honest about your intentions or motives; shifty (They came up with a devious plan to overthrow the chairman of the company.) circuitous (adj): not straight or direct (The professor gave a circuitous explanation confusing his students.) diluted (adj): (of a liquid) made weaker or less pure by being mixed with sth else( Orange squash should be diluted with water before it is served.) delicate (adj): easily hurt or destroyed.( This silk shirt is too delicate to put in the washing machine.) desolate (adj): extremely sad and feeling lonely. (After the death of his wife he led a desolate life.) diffused (adj): widely spread or scattered; not concentrated/ wordy ( He spoke in such a diffused manner that it was impossible to take notes on his lecture.) might (n): the power, force, or influence held by a person or group (The captive struggled with all of his might and managed to free himself of the chains.) plot (n): a secret plan made by several people to do sth that is wrong, harmful or not legal, esp. to do damage to a person or a government / a storyline ( The plot of the forthcoming Harry Potter book has yet to be revealed.) glaze (n): a thin clear liquid put on objects before they are finished, to give them a shiny surface ( She mixed sugar and lemon to make the glaze of the cake.) plight (n): an unpleasant condition, esp. serious, sad or difficult one ( Last night's documentary dealt with the plight of political asylum seekers.) comprise (v): to consist of be composed of( The final exam is comprised of three parts.)

Extradition (International law), Political Offence Exception, The Political Offense Exception (POE) serves as a critical safeguard in international extradition law, allowing a requested state to refuse the surrender of a fugitive if their alleged crime is of a "political character." These offenses are categorized into two types: **pure political offenses**, such as treason or espionage, which target the state's political organization without harming individuals; and **relative political offenses**, which are common crimes like robbery committed with a political motive. To distinguish between these, courts apply various judicial tests. For instance, the **Political Incidence Test** (established in *In re Castioni*) focuses on whether the act was incidental to a political disturbance, while the **Swiss Proportionality Test** weighs the political end against the criminal means used, denying the exception if the harm caused is disproportionate. In the context of **state succession**, the application of extradition treaties depends largely on the underlying legal theory adopted by the new sovereign. Under **Universal Succession**, the new state inherits all prior treaties and obligations, ensuring legal continuity. Conversely, the **Clean Slate (Tabula Rasa) Theory**, often seen in decolonization, suggests that new states are not bound by the predecessor’s treaties, potentially creating "safe havens" for fugitives until new agreements are reached. Practical examples include the **Dissolution of the USSR**, where Russia acted as the "continuator" state inheriting treaties, and the **Partition of India and Pakistan**, where a devolution agreement ensured that colonial-era treaties remained in effect. Despite its protective intent, the POE faces **modern erosion** to ensure that heinous acts do not go unpunished. Specific limitations, such as the **Attentat Clause**, explicitly exclude the assassination of a head of state from being considered a political offense. Similarly, modern treaties and conventions (like the *Meunier* ruling) exclude **terrorism**, hijacking, and crimes against humanity from the exception, viewing these acts as attacks on the general social order rather than legitimate political dissent. This evolution reflects a growing international consensus that the gravity of certain crimes—such as those seen in the **Rainbow Warrior case study**—far outweighs any claimed political motivation, shifting the legal focus toward human rights and the prevention of torture.

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