The First Doctor 1-5 Vocabulary

Alright, Isti — here’s a longer and more detailed English version of the Isaac Newton text, still written at a level that’s accessible for Grade 4 students, but rich enough in information to meet PISA literacy expectations and EF A2-level vocabulary. I’ve kept sentences short, clear, and with explanations for new concepts so it’s easier for young learners to follow, while still including both famous facts and lesser-known stories. ⸻ Isaac Newton: The Man Who Changed the Way We See the World A Boy from a Small Village Isaac Newton was born on January 4, 1643, in Woolsthorpe, a small village in England. His life was not easy. His father died before he was born. When he was just a few months old, his mother remarried and left him to live with his grandmother. Isaac missed his parents, but he kept himself busy by making things and exploring the world around him. As a child, Isaac liked to build models and machines. He made a small windmill that could turn with the wind. He built a water clock that told the time by dripping water into a container. He even made a sundial — a clock that tells the time by using the shadow of the sun. 💡 Did you know? The sundial marks that Isaac carved as a boy can still be seen today on the wall of his old house. ⸻ School and Curiosity When Newton first went to school, he was not the top student. At first, he did not pay much attention in class. But one day, another boy teased him for not being smart. Newton decided to study hard to prove him wrong. Soon, he became the best in his class. Isaac loved asking questions. He wanted to know how and why things happened. He enjoyed watching the stars at night and thinking about how the world worked. ⸻ The Falling Apple and Gravity One of the most famous stories about Newton is the falling apple. One afternoon, Isaac sat in his mother’s garden and saw an apple drop from a tree. This made him think: “Why does the apple fall straight down? Why doesn’t it fly up into the sky?” From this question, Newton began to think about gravity — an invisible force that pulls objects toward each other. Gravity is what keeps our feet on the ground. It’s also what keeps the Moon moving around the Earth and the planets moving around the Sun. 💡 Fun fact: The apple did not hit Newton’s head. That’s just a story people made up later to make the tale more exciting. ⸻ Newton’s Three Laws of Motion Newton studied movement and wrote three important rules: 1. Objects stay still or keep moving unless something makes them change. • Example: A ball will not roll unless you push it. 2. The bigger the push, the bigger the movement. • Example: If you kick a ball harder, it will go faster and farther. 3. Every action has an equal and opposite reaction. • Example: When you jump off a boat, the boat moves backward as you move forward. These three laws are still used today to understand how cars, rockets, and even roller coasters work. ⸻ Discoveries in Light and Color Newton also studied light. He found that white light is not just one color — it is made of many colors. He used a glass prism to split sunlight into a rainbow. This helped scientists understand how colors work. ⸻ Inventions and New Ideas Newton made a special telescope that used mirrors instead of lenses. This type of telescope made images of planets and stars much clearer. It is still called the Newtonian telescope today. He also worked in mathematics and helped create a new type of math called calculus, which is used to study changes and movement. ⸻ Strange Experiments Newton was so curious that he sometimes tested ideas on himself. Once, he put a thin needle, called a bodkin, beside his eye to see how it would change his vision. It was very dangerous, but luckily he did not go blind. 💡 Did you know? Newton also studied alchemy — an old kind of science where people tried to turn metal into gold. He never succeeded, but it showed how wide his interests were. ⸻ Later Life and Work At the age of 27, Newton became a professor at Cambridge University. He later worked for the Royal Mint, making sure coins were made safely and stopping people from making fake money. He was very strict, and some criminals were sent to prison because of his work. Newton never married. He spent most of his life reading, writing, and doing experiments. ⸻ The End of His Life Isaac Newton died in 1727 at the age of 84. He was buried in Westminster Abbey, a famous place in London where great people of Britain are honored. His work changed the world forever. Even today, scientists, engineers, and students still use Newton’s laws and ideas. 💬 Newton once said: “If I have seen further, it is by standing on the shoulders of giants.” This means we can make new discoveries by learning from the work of others who came before us. give 10 questions to each passage with PISA literacy standard for kid 10 years, 1. Nikola Tesla: The Man Who Dreamed of Lightning Born: July 10, 1856 Died: January 7, 1943 When Nikola Tesla was a boy in Croatia, he saw a flash of lightning and asked his mother, “Can we catch the light?” That question never left him. As he grew older, Tesla became a brilliant inventor, especially fascinated by electricity. He believed in a future where energy could be sent wirelessly through the air—like music through the radio! Tesla invented the alternating current (AC) system, which became the foundation of modern electricity. At the time, Thomas Edison promoted direct current (DC), and the two men had a fierce competition. Many laughed at Tesla's bold ideas, but he never gave up. He dreamed of wireless communication, flying machines, and even free energy for everyone. Though he died alone and poor, today the world honors his vision. Think About It: Why do you think people didn’t believe Tesla at first? What can we learn from Tesla’s courage to dream big? 2. Charles Darwin: The Man Who Studied the World’s Weirdest Creatures Born: February 12, 1809 Died: April 19, 1882 When young Charles Darwin got on a ship called HMS Beagle, he didn’t know he would change science forever. He sailed around the world for five years, collecting plants, animals, and fossils. On the Galápagos Islands, he noticed something curious: finches had different beaks depending on their island. Why? Darwin’s observations led him to write the theory of evolution by natural selection. It explained how animals adapt and survive. But his ideas shocked many people because they seemed to challenge religious beliefs. Despite the controversy, Darwin continued his work. His book On the Origin of Species changed how we see life on Earth. Think About It: Should scientists share their ideas even if they go against what others believe? How did traveling help Darwin make new discoveries? 3. Marie Curie: The Woman Who Glowed in the Dark Born: November 7, 1867 Died: July 4, 1934 Marie Curie was born in Poland at a time when girls were not allowed to study science. But that didn’t stop her. She moved to France, worked day and night, and discovered radioactivity, a powerful energy hidden inside atoms. She and her husband, Pierre Curie, found two new elements: polonium and radium. She became the first woman to win a Nobel Prize, and the only person to win in two different sciences: physics and chemistry. Even when Pierre died in an accident, Marie continued their work. Her discoveries helped doctors treat cancer—but working with radioactive materials also harmed her health. She died from radiation exposure, but her legacy lives on. Think About It: What challenges did Marie Curie face as a woman in science? Why is it important to balance discovery with safety? 4. Galileo Galilei: The Star Watcher Who Defied the Church Born: February 15, 1564 Died: January 8, 1642 Galileo loved looking at the stars. He built one of the first powerful telescopes and made stunning discoveries: mountains on the Moon, moons around Jupiter, and that the Earth orbits the Sun—not the other way around. This idea, called heliocentrism, went against the teachings of the Church. He was put on trial and forced to say he was wrong. But he wasn’t. He spent his last years under house arrest, quietly writing. Today, Galileo is called the father of modern science for daring to question what others blindly believed. Think About It: Why do you think Galileo was punished for telling the truth? Should science always follow evidence, even if it goes against powerful beliefs? 5. Isaac Newton: The Man Who Asked “Why?” When an Apple Fell Born: January 4, 1643 Died: March 31, 1727 One day, an apple fell from a tree, and Isaac Newton began to wonder: Why did it fall down, not sideways or up? This simple question led to his theory of gravity. Newton also invented calculus, described the laws of motion, and changed physics forever. But Newton wasn’t just a genius—he was curious, quiet, and often worked alone. He believed everything in nature followed rules, and it was our job to discover them. Thanks to him, we understand how planets move, how rockets launch, and why you fall when you trip. Think About It: How did Newton’s curiosity lead to great discoveries? Do you think working alone helped or hurt Newton? 6. Ada Lovelace: The First Computer Programmer Before Computers Existed Born: December 10, 1815 Died: November 27, 1852 Ada Lovelace was the daughter of the famous poet Lord Byron, but she didn’t love poetry—she loved numbers! At a time when girls were expected to sew, Ada studied mathematics. She met Charles Babbage, who designed an early computer called the Analytical Engine. Ada imagined the machine could do more than just math—it could create music, art, and even write! She wrote what is now considered the first computer program, long before real computers were built. Think About It: How did Ada imagine something that didn’t exist yet? Why do we call her a pioneer in technology? 7. Albert Einstein: The Man Who Brought Time and Space Together Born: March 14, 1879 Died: April 18, 1955 Albert Einstein wasn’t always a good student. In fact, his teachers thought he was slow. But Einstein thought deeply. He asked big questions like, “What if you could ride a beam of light?” His theories of relativity changed how we see space, time, and gravity. He also warned the world about the dangers of nuclear weapons, even though his ideas helped create them. Einstein believed science should help people, not harm them. With his messy hair, kind smile, and brilliant mind, he remains a symbol of genius. Think About It: Can someone be bad in school but still be brilliant? Should scientists be responsible for how their inventions are used? 8. Pythagoras: The Musician Who Loved Math Born: Around 570 BC Died: Around 495 BC Long ago in ancient Greece, Pythagoras believed the universe followed numbers. He discovered the Pythagorean Theorem, a rule about triangles that helps us build houses, design computers, and navigate space. He also believed that music had math inside it—that certain notes made perfect harmony because of mathematical ratios. Pythagoras started a secret school and taught his students to search for truth through numbers, shapes, and sound. Think About It: Why do you think Pythagoras saw math in everything? How does music relate to math? 9. Rosalind Franklin: The Woman Behind the DNA Discovery Born: July 25, 1920 Died: April 16, 1958 Rosalind Franklin loved looking closely at things. She used a special machine called X-ray crystallography to photograph molecules. One of her greatest photos, called Photo 51, showed the shape of DNA, the molecule that carries life’s instructions. But her work was taken without credit. Two men, Watson and Crick, used her photo to build their famous model of DNA and won the Nobel Prize. Rosalind died young and never knew how important her work became. Think About It: Why is it important to give credit in science? What can we learn from Rosalind’s quiet strength? 10. Carl Linnaeus: The Man Who Gave Names to Everything Born: May 23, 1707 Died: January 10, 1778 Have you ever wondered why a tiger is called Panthera tigris? That’s thanks to Carl Linnaeus, a Swedish scientist who created a way to name and organize every living thing. His system is still used today in biology. Linnaeus loved nature and spent his life collecting plants, animals, and even rocks. He believed that by organizing life, we could better understand it. Thanks to him, we now have a global “dictionary of nature.” Think About It: Why is it important to name and organize living things? How does order help us understand the world?

1. Flammable materials, like alcohol, should never be dispensed or used near A. an open door. B. an open flame. C. another student. D. a sink. 2. If a laboratory fire erupts, immediately A. notify your instructor. B. run for the fire extinguisher. C. throw water on the fire. D. open the windows. 3. Approved eye protection devices (such as goggles) are worn in the laboratory A. to avoid eye strain. B. to improve your vision. C. only if you don’t have corrective glasses. D. any time chemicals, heat or glassware are used. 4. If you wear contact lenses in the school laboratory, A. take them out before starting the lab. B. you do not have to wear protective goggles. C. advise your science instructor that you wear contact lenses. D. keep the information to yourself. 5. If you do not understand a direction or part of a lab procedure, you should A. figure it out as you do the lab. B. try several methods until something works. C. ask the instructor before proceeding. D. skip it and go on to the next part. 6. After completing an experiment, all chemical wastes should be A. left at your lab station for the next class. B. disposed of according to your instructor’s directions. C. dumped in the sink. D. taken home. 7. If a lab experiment is not completed, you should A. discuss the issue with your instructor. B. sneak in after school and work alone. C. come in during lunch and finish while eating lunch. D. make up some results. 8. You are heating a substance in a test tube. Always point the open end of the tube A. toward yourself. B. toward your lab partner. C. toward another classmate. D. away from all people. Science Laboratory Safety teSt 9. You are heating a piece of glass and now want to pick it up. You should A. use a rag or paper towels. B. pick up the end that looks cooler. C. use tongs. D. pour cold water on it. 10. You have been injured in the laboratory (cut, burn, etc.). First you should A. visit the school nurse after class. B. see a doctor after school. C. tell the science instructor at once. D. apply first aid yourself. 11. When gathering glassware and equipment for an experiment, you should A. read all directions carefully to know what equipment is necessary. B. examine all glassware to check for chips or cracks. C. clean any glassware that appears dirty. D. All of the above. 12. You want to place a piece of glass tubing into a rubber stopper after the tubing has been fire polished and cooled. This is best done by A. lubricating the tubing with water or glycerin. B. using a towel or cotton gloves for protection. C. twisting the tubing and stopper carefully. D. all of the above. 13. Personal eyeglasses provide as much protection as A. a face shield. B. safety glasses. C. splashproof chemical goggles. D. none of the above. 14. Long hair in the laboratory must be A. cut short. B. held away from the experiment with one hand. C. always neatly groomed. D. tied back or kept entirely out of the way with a hair band, hairpins, or other confining device. 15. In a laboratory, the following should not be worn. A. loose clothing. B. dangling jewelry. C. sandals. D. all of the above. 16. The following footwear is best in the laboratory. A. sandals B. open-toed shoes C. closed-toed shoes D. shoes appropriate for the weather3 © 2017 Flinn Scientific, Inc. All Rights Reserved. 17. Horseplay or practical jokes in the laboratory are A. always against the rules. B. okay. C. not dangerous. D. okay if you are working alone. 18. If a piece of equipment is not working properly, stop, turn it off, and tell A. the custodian. B. your lab partner. C. your best friend in the class. D. the science instructor. 19. If an acid is splashed on your skin, wash at once with A. soap. B. oil. C. weak base. D. plenty of water. 20. When you finish working with chemicals, biological specimens, and other lab substances, always A. treat your hands with skin lotion. B. wash your hands thoroughly with soap and water. C. wipe your hands on a towel. D. wipe your hands on your clothes. True—False T F 22. ■ ■ Hot glass looks the same as cold glass. 23. ■ ■ All chemicals in the lab are to be considered dangerous. 24. ■ ■ Return all unused chemicals to their original containers. 25. ■ ■ Work areas should be kept clean and tidy. 26. ■ ■ Pipets are used to measure and dispense small amounts of liquids. You should draw the liquid into the pipet using your mouth. 27. ■ ■ Laboratory work can be started immediately upon entering the laboratory even if the instructor is not yet present. 28. ■ ■ Never remove chemicals or other equipment from the laboratory. T F 29. ■ ■ Chipped or cracked glassware is okay to use. 30. ■ ■ Read all procedures thoroughly before entering the laboratory. 31. ■ ■ All unauthorized experiments are prohibited. 32. ■ ■ You are allowed to enter the chemical preparation/storage area any time you need to get an item. 33. ■ ■ Laboratory aprons should be worn during all lab activities. 34. ■ ■ It’s okay to pick up broken glass with your bare hands as long as the glass is placed in the trash. 35. ■ ■ Never leave a lit burner unattended. 21. Draw a diagram of your science room and label the locations of the following: ■ Fire Blanket ■ Fire Extinguisher(s) ■ Exits ■ Eyewash Station ■ Emergency Shower ■ Closest Fire Alarm Station ■ Waste Disposal Container(s)4 © 2017 Flinn Scientific, Inc. All Rights Reserved. Name: ________________________________________________ Date: ______________________________________________ 1. Flammable materials, like alcohol, should never be dispensed or used near A. an open door. B. an open flame. C. another student. D. a sink. 2. If a laboratory fire erupts, immediately A. notify your instructor. B. run for the fire extinguisher. C. throw water on the fire. D. open the windows. 3. Approved eye protection devices (such as goggles) are worn in the laboratory A. to avoid eye strain. B. to improve your vision. C. only if you don’t have corrective glasses. D. any time chemicals, heat or glassware are used. 4. If you wear contact lenses in the school laboratory, A. take them out before starting the lab. B. you do not have to wear protective goggles. C. advise your science instructor that you wear contact lenses. D. keep the information to yourself. 5. If you do not understand a direction or part of a lab procedure, you should A. figure it out as you do the lab. B. try several methods until something works. C. ask the instructor before proceeding. D. skip it and go on to the next part. 6. After completing an experiment, all chemical wastes should be A. left at your lab station for the next class. B. disposed of according to your instructor’s directions. C. dumped in the sink. D. taken home. 7. If a lab experiment is not completed, you should A. discuss the issue with your instructor. B. sneak in after school and work alone. C. come in during lunch and finish while eating lunch. D. make up some results. 8. You are heating a substance in a test tube. Always point the open end of the tube A. toward yourself. B. toward your lab partner. C. toward another classmate. D. away from all people. Science Laboratory Safety teSt 9. You are heating a piece of glass and now want to pick it up. You should A. use a rag or paper towels. B. pick up the end that looks cooler. C. use tongs. D. pour cold water on it. 10. You have been injured in the laboratory (cut, burn, etc.). First you should A. visit the school nurse after class. B. see a doctor after school. C. tell the science instructor at once. D. apply first aid yourself. 11. When gathering glassware and equipment for an experiment, you should A. read all directions carefully to know what equipment is necessary. B. examine all glassware to check for chips or cracks. C. clean any glassware that appears dirty. D. All of the above. 12. You want to place a piece of glass tubing into a rubber stopper after the tubing has been fire polished and cooled. This is best done by A. lubricating the tubing with water or glycerin. B. using a towel or cotton gloves for protection. C. twisting the tubing and stopper carefully. D. all of the above. 13. Personal eyeglasses provide as much protection as A. a face shield. B. safety glasses. C. splashproof chemical goggles. D. none of the above. 14. Long hair in the laboratory must be A. cut short. B. held away from the experiment with one hand. C. always neatly groomed. D. tied back or kept entirely out of the way with a hair band, hairpins, or other confining device. 15. In a laboratory, the following should not be worn. A. loose clothing. B. dangling jewelry. C. sandals. D. all of the above. 16. The following footwear is best in the laboratory. A. sandals B. open-toed shoes C. closed-toed shoes D. shoes appropriate for the weather5 © 2017 Flinn Scientific, Inc. All Rights Reserved. 17. Horseplay or practical jokes in the laboratory are A. always against the rules. B. okay. C. not dangerous. D. okay if you are working alone. 18. If a piece of equipment is not working properly, stop, turn it off, and tell A. the custodian. B. your lab partner. C. your best friend in the class. D. the science instructor. 19. If an acid is splashed on your skin, wash at once with A. soap. B. oil. C. weak base. D. plenty of water. 20. When you finish working with chemicals, biological specimens, and other lab substances, always A. treat your hands with skin lotion. B. wash your hands thoroughly with soap and water. C. wipe your hands on a towel. D. wipe your hands on your clothes. 21. Draw a diagram of your science room and label the locations of the following: ■ Fire Blanket ■ Fire Extinguisher(s) ■ Exits ■ Eyewash Station ■ Emergency Shower ■ Closest Fire Alarm Station ■ Waste Disposal Container(s) True—False T F 22. ■ ■ Hot glass looks the same as cold glass. 23. ■ ■ All chemicals in the lab are to be considered dangerous. 24. ■ ■ Return all unused chemicals to their original containers. 25. ■ ■ Work areas should be kept clean and tidy. 26. ■ ■ Pipets are used to measure and dispense small amounts of liquids. You should draw the liquid into the pipet using your mouth. 27. ■ ■ Laboratory work can be started immediately upon entering the laboratory even if the instructor is not yet present. 28. ■ ■ Never remove chemicals or other equipment from the laboratory. T F 29. ■ ■ Chipped or cracked glassware is okay to use. 30. ■ ■ Read all procedures thoroughly before entering the laboratory. 31. ■ ■ All unauthorized experiments are prohibited. 32. ■ ■ You are allowed to enter the chemical preparation/storage area any time you need to get an item. 33. ■ ■ Laboratory aprons should be worn during all lab activities. 34. ■ ■ It’s okay to pick up broken glass with your bare hands as long as the glass is placed in the trash. 35. ■ ■ Never leave a lit burner unattended.

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)

WHAT IS SCIENCE? - is a way in which answers related to NATURAL events are proposed. - a way in which people can learn and UNDERSTAND events in the NATURAL WORLD - based on OBSERVABLE EVENTS - a study of the NATURAL WORLD - a method of DISCOVERY and UNDERSTANDING by using a PROBLEM-SOLVING process called the?? - A systematic body of knowledge based on observation and experimentation. FOUR COMMON CHARACTERISTICS OF SCIENCE: 1. It focuses on the NATURAL WORLD. 2. Goes through experiment. 3. Relies on evidence. 4. Passes through the scientific community. WHAT IS TECHNOLOGY? Brian Arthur (2009) defined technology as: 1. a means to fulfill a human purpose 2. assemblage of practices and components 3. a collection of devices and engineering practices available to a culture. SOCIETY ST (Science Technology) would not exist without society. WHAT IS STS? Science and Technology and Society (STS) is the study of how society, politics and culture affect scientific research and technological innovation and how these, in turn affects society, politics and culture. EVENTS IN THE HISTORY OF SCIENCE AND TECHNOLOGY THAT TRANSFORMED THE SOCIETY (IN THE WORLD) ANCIENT PERIOD 3500 BC. - 500 AD EUROPE - use of fire by Homo Erectus CA 750,000 - Stone Headed Spears CA 45,000 - Wooden bow and arrow CA 20,000 - The Minoans build palaces in Crete CA 2,000 THE AMERICAS - The Folsom people living on eastern side of the Rocky Mountain developed sophisticated tools CA 8,000. - Pottery is made in South America CA 6,000 - Olmec sculpture carves figurines and giant human heads. CA 1200 ASIA AND OCEANA - Earliest known clay pots are made in Japan CA 11,000. - Bronze is first made in Thailand CA 4000 - A lunar calendar is developed in China CA 2950 - Chinese doctors begin using acupuncture CA 2500 - The Hindu calendar of 360 days was introduced in India CA 1000 AFRICA AND MIDDLE EAST - Homo erectus uses stone tools CA 1000000 - CA 15000 in Africa, bone harpoons are used for fishing. - Clay tokens are used for record keeping in Mesopotamia CA 7500 - Mesopotamian mathematicians discover the Pythagorean Theorem MEDIEVAL PERIOD CA 500 -1500 - Dark ages because few written records and evidences remained - Scholastic tradition was established by Charlemagne - Vertical windmills, spectacles, mechanical clock, water mills, gothic style were invented - Johannes Gutenberg invented the printing press RENAISSANCE PERIOD 14TH – 17TH CENTURY - Rebirth of revival - Printing with movable type allowed Bible, secular books made in large amount - Nicolas Copernicus presented a heliocentric theory - Galileo Galilei invented telescope INDUSTRIAL REVOLUTION 18TH CENTURY - Skilled workers were set aside because of the machines - Iron production, steam engine and textile flourished - Scottish James Watt improved steam engine Robert Fulton (steam boat) - The following were invented: Light bulb, telephone, first steam powered locomotive 19TH CENTURY - Age of machine and tools - Herman Helmholtz (law of conservation of energy) - James Clark Maxwell (light as electro-magnetic wave) - Henry Becquerel (radioactivity) - Marie and Pierre Curie (radium) - Hans Christian Oersted (electric current near the magnet) - Michael Faraday (magnet produces electricity) - Atomic Theory proposed by John Dalton - Electron discovered by JJ. Thomson - Telegraph developed by Samuel Morse 20TH CENTURY - Communication, transportation, military research were developed - Personal computer was created - Intel developed microprocessor - Apple was introduced by Steve Jobs and Steve Wozniak - Internet was created (ARPANET) - Henry Ford's mass production of cars - Artificial Intelligence was invented SCIENCE, TECHNOLOGY AND SOCIETY (PHILIPPINE HISTORY) Stone Age - Archeological findings show that modern man from Asian mainland first came over land on across narrow channels to live in Batangas and Palawan about 48,000 B.C. - Subsequently they formed settlement in Sulu, Davao, Zamboanga, Samar, Negros, Batangas, Laguna, Rizal, Bulacan and Cagayan. Inventions - They made simple tools and weapons of stone flakes and later developed method of sawing and polishing stones around 40,000 B.C. - By around 3,000 B.C. they were producing adzes ornaments of seashells and pottery. Pottery flourished for the next 2,000 years until they imported Chinese porcelain. Soon they learned to produce copper, bronze, iron, and gold metal tools and ornaments. Iron Age - The Iron Age lasted from the third century B.C. to 11th century A.D. During this period Filipinos were engaged in extraction smelting and refining of iron from ores, until the importation of cast iron from Sarawak and later from China. INVENTIONS AND DISCOVERIES - They learn to weave cotton, make glass ornaments, and cultivate lowland rice and dike fields of terraced fields utilizing spring water in mountain regions. - They also learned to build boats for trading purposes. - Spanish chronicles noted refined plank built warships called caracoa suited for interisland trade raids 10TH CENTURY A.D. - Filipinos from the Butuan were trading with Champa (Vietnam) and those from Ma-I (Mindoro) with China as noted in Chinese records containing several references to the Philippines. These archaeological findings indicated that regular trade relations between the Philippines, China and Vietnam had been well established from the 10th century to the 15th century A.D. TRADING - The People of Ma-I and San-Hsu (Palawan) traded bee wax, cotton, pearls, coconut heart mats, tortoise shell and medicinal betel nuts, panie cloth for porcelain, leads fishnets sinker, colored glass beads, iron pots, iron needles and tin. SOME PRESPANISH FILIPINO SCIENCE AND TECHNOLOGY - Curative values of plants extract use as medicine - Alphabet (Alibata) - Counting Methods - Weights - Measuring system (isang gatang) - Calendar based on the periods of moon - Banaue Rice Terraces SPANISH REGIME  Religion the Catholic Church - The latter part of the 16th Century Development of schools: - Colegio de San Ildefonso-Cebu-1595 - Colegio de San Ignacio-Manila-1595 - Colegio De Nuestra Senora del Rosario-Manila 1597 - Colegio De San Jose-Manila-1601  Colegio De San Ildefonso De Cebu - In 1863 the colonial authorities issued a royal degree to reform the existing educational system. In 1871 the school of medicine and pharmacy were opened to UST, after 15 years it had granted the degree Of Licenciado En Medicina to 62 graduates.  Medicine - Development of hospitals San Juan Lazaro hospital the oldest in the far east was founded in 1578.  Roads and Bridges Among other Spanish contributions: - Arithmetic - Algebra - Geometry - Trigonometry - Physics - Hydrography - Meteorology - Navigation - Pilotage American Period and Post Commonwealth Era - BUREAU OF GOVERNMENT LABORATORIES (1901) - BUREAU OF SCIENCE (1905) - INSTITUTE OF SCIENCE (1946) RA 2067 OTHERWISE KNOWN AS THE “SCIENCE ACT OF 1958”. - This was enacted to integrate, coordinate, and intensify scientific and technological research and development and to foster invention including allocation of funds and other purposes. NATIONAL RESEARCH COUNCIL WAS ESTABLISHED ON DECEMBER 8, 1933. - Its Mandate (Nrcp) Promotes And Supports Fundamental Or Basic Research For The Continuing Total Improvement Of The Research Capability Of Individual Scientists Or Group Of Scientists; Provides Advice On Problems And Issues Of National Interest; Promotes Scientific And Technological Culture To All Sectors Of Society; And Fosters Linkages With Local And International Scientific Organizations For Enhanced Cooperation In The Development And Sharing Of Information NATIONAL RESEARCH COUNCIL WAS ESTABLISHED IN DECEMBER 8, 1933. - Its Mandate (NRCP) promotes and supports fundamental or basic research for the continuing total improvement of the research capability of individual scientists or group of scientists; provides advice on problems and issues of national interest; promotes scientific and technological culture to all sectors of society; and fosters linkages with local and international scientific organizations for enhanced cooperation in the development and sharing of information. It was during the American Period when Science was inclined towards: - Agriculture - Food Processing - Forestry - Medicine - Pharmacy - Nursing

The First Doctor 12-14

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