Why are oral presentations important in business management?

They help communicate ideas clearly to stakeholders

They are a form of entertainment

They reduce the need for written reports

They are only useful for marketing purposes

What is one major benefit of networking in business management?

Building professional relationships that can lead to new opportunities

It replaces the need for technical skills

It ensures financial success immediately

It guarantees promotion within a company

How can effective networking impact career growth in business management?

By providing access to mentors and job opportunities

By eliminating the need for education

By guaranteeing raises every year

What is a key component of a successful oral presentation in business?

Speaking as quickly as possible

What is an important outcome of networking beyond job opportunities?

Knowledge sharing and gaining insights from others

Guaranteed success in every endeavor

What role do visuals play in oral presentations?

They help to clarify and enhance the message

They replace the speaker's role

They are unnecessary and may confuse

Why is feedback important after an oral presentation?

It helps improve future presentations

What is one effective way to network during business events?

Initiating conversations with new contacts

Staying in the corner and observing

Only talking to people you already know

What is a common mistake to avoid during an oral presentation?

Overloading slides with too much text

Using appropriate body language

Making eye contact with the audience

The Importance of Oral Presentations & Networking in Business Management Warm-Ups 9/17-18/25

Quiz on different modes of communication: What are the four main types of communication modes? Define non-verbal communication and give two examples. How does written communication differ from oral communication? What is the significance of listening in effective communication? Explain how technological advancements have impacted interpersonal communication. Describe one advantage and one disadvantage of electronic communication. In what ways can cultural differences affect communication? What role does body language play in face-to-face communications? How has social media changed the way organizations communicate with stakeholders? Discuss the importance of feedback in the process of communication.

Teaching English Introduction to the course: Language learning and teaching A 2 Characteristics of the language learners: Studying a system that aligns with international standards. A3 Cognitive factors in language learning: Addressing questions and obtaining necessary information regarding phenomena such as transfer, interference, and generalization; A4 Inductive and deductive language learning: ability and intelligence; and the phenomenon of systematic forgetting A5 Language learning methods and strategies: Familiarizing with foreign language learning methods, strategies for learning foreign languages, and communication strategies A6 International Assessment System of language skills in CEFR, IELTS, TOEFL: effective methods and strategies used to improve language skills (listening, reading, writing, speaking) A7 Psychological factors in language learning: Exploring various psychological factors such as self-esteem, shyness, risk-taking, anxiety, attitude, and motivation A8 The effectiveness of authentic materials during the learning process: The role of tasks and games in teaching foreign languages A9 Errors in language learning: Discussing types of errors, identifying and describing errors, causes of errors, and fossilized errors A10 Error correction or error analysis approaches: developing students' ability to apply their knowledge in practicing error correction A11 Age-related factors in language learning: Exploring types of comparisonand contrast, focusing on topics such as the age hypothesis and bilingualism, and providing a detailed explanation of these concepts A12 Teaching grammar: Studying grammar teaching methods; deductive and inductive approaches in grammar teaching; A13 Teaching grammar through context: linguistic intuition; language phenomena; using grammatical dictionaries; analyzing grammatical tasks; and designing exercises, tasks, and tests through completing grammarbased activities. A14 Teaching vocabulary. Seeking answers to questions such as 'What is a word?' and 'What does it mean to learn a word?' A15 Teaching vocabulary in context: teaching lexical units/phrases/collocations; introducing new vocabulary; using corpus data for pedagogical purposes; developing students' vocabulary learning strategies A16 Assessing vocabulary tasks: designing vocabulary tasks, exercises, and tests. In international assessment systems such as CEFR, IELTS, and TOEFL, grammar accuracy and lexical resource A 17 Teaching pronunciation: Understanding the importance of pronunciation for successful communication; teaching stress; teaching intonation A18 Modern technologies in teaching pronunciation A19 Error correction methods: watching to various experiences in this area and analyzing video lessons from international experts in the field A20 Analysis of skill integration in language learning: Understanding the stages of developing skill integration; integration of the four language skills; task-based integration; and project-based integration. A21 Teaching listening comprehension A22 Modern technologies in teaching listening comprehension A23 Teaching Speaking A24 Modern technologies in teaching Speaking A25 Teaching Reading A26 Modern technologies in teaching Reading A27 Teaching Writing A28 Modern technologies in teaching Writing A29 The role and importance of translation in teaching a foreign language A30 Module 2. International standards for teaching and assessment Classroom Language: The teacher's actions; the teacher's voice; the teacher's intonation; using the foreign language in the classroom A31 Foreign language environment: asking questions in the foreign language, giving instructions in the foreign language, providing oral explanations in the foreign language, and issues related to the use of the native language in the foreign language class. A 32 Designing curriculum: Studying, analyzing, and working with curricula designed for schools, lyceums, and colleges. A33 Planning lessons and the structure of lesson plans: determining thesequence of lessons, objectives, tasks, and expected outcomes; choosing the lesson structure for planning A34 Designing tasks for different stages of the lesson: Starting the lesson; concluding the lesson; connecting tasks within the lesson A35 Time management: allocating appropriate time for tasks during the lesson; and providing homework assignments A36 Educational materials and resources: Effective use of existing educational materials and resources; anticipating and addressing potential issues Planning and adapting materials: to the situation during teaching and working on lesson planning for groups of students with different abilities. A37 Classroom research: Stages of classroom research, data collection, analysis, and planning; creating/preparing the materials needed for data collection; distinguishing between the positive and negative aspects of the research A38 Data analysis: creating/preparing the materials needed for data collection; distinguishing between the positive and negative aspects of the research. A39 Peer lesson observation: Observing lessons; conducting interviews; questionnaires for teachers and students; maintaining a daily record; discussing problematic situations/events; notes and other aspects; the process of lesson observation: stages of observation; presenting observation results both orally and in writing. A40 Educational materials and national values: important tool for implementing and promoting educational standards, as well as national values. A41 Differences between methods of teaching foreign languages: practical application of modern methods in language teaching; foreign experiences in language teaching: the grammar-translation method; the method of conducting lessons entirely in the foreign language; the audio-linguistic method; and communicative methods. A42 Methods used in the local environment and their analysis: Discussion of the positive and negative aspects of various methods; language and culture; teaching/learning processes; the role of the native language in learning a foreign language; and the psychological foundations of foreign language teaching. A43 Teaching a foreign language through computer technologies A44 Types of independent work and its implementation A45 Principles of Assessment in foreign language teaching А46 Issues in Language Assessment А47 Alternatives in Assessment А48 Test methods. Methods and criteria for assessing language aspects: written expression, reading, listening comprehension, speaking, А49 integrating language skills: vocabulary; grammar; alternative forms of assessment; planning assessment; critical analysis; principles for designingtest tasks: scientific rigor, consistency, conciseness, clarity, informality, logical sequence, and systematic approach. А50 Foreign language for ESP. Studying and analyzing needs; setting objectives for teaching a foreign language in a specific field or professional area; defining teaching approaches in curriculum development; and discussing topics related to these areas. А51 Selecting textbooks, materials and resources А52 Content-based Instruction (CBI) А53 Strategies-based Instruction А54 Lifelong Learning: Teacher development, PreSETT, InSETT А55 The Role of Teaching Practice A56 Organization and implementation of compulsory and non-compulsory course process in foreign language teaching A57 Organization in and outclass activities A58 Defining the goals and content of foreign language teaching at various levels of the education system in the Republic of Uzbekistan: evaluating educational materials; adapting educational materials; creating educational materials; and discussing the role of the foreign language teacher in specialized fields to gain relevant information. A59 The role of independent study skills: foreign language focused on reading, research and study skills; make revision questions. incclude mcq question. answer the question. true false

To the Lakota, and other indigenous people on North America's Great Plains, the bison was an essential part of their culture ( expressed in the quote on the previous page). The bison provided meat for nutrition, a hide for clothing and shelter, bones for tools, and fat for soap. The bison was also central to their religious beliefs. So, when European settlers hunted the bison nearly to extinction, Lakota culture suffered. Culture is central to a society and the identity of its people, as well as its continued existence. Therefore, geographers study culture as a way to understand similarities and differences among societies across the world, and in some cases, to help preserve these societies. Analyzing Culture All of a group's learned behaviors, actions, beliefs, and objects are a part of culture. It is a visible force seen in a group's actions, possessions, and influence on the landscape. For example, in a large city you can see people working in offices, factories, and stores, and living in high-rise apartments or suburban homes. You might observe them attending movies, concerts, or sporting events. Culture is also an invisible force guiding people through shared belief systems, customs, and traditions. Culture is learned, in that it develops through experiences, and not merely transmitted through genetics. For example, many people in the United States have developed a strong sense of competitiveness in school and business, and believe that hard work is a key to success. These types of elements, visible and invisible, are cultural traits. A series of interrelated traits make up a cultural complex, such as the process of steps and acceptable behaviors related to greeting a person in different cultures. A single cultural artifact, such as an automobile, may represent many different values, beliefs, behaviors and traditions and be representative of a cultural complex. Since culture is learned there are many ways that one generation passes its culture to the next. Children and adults learn traits three ways: • imitation, as when learning a language by repeating sounds or behaviors from a person or television • informal instruction, as when a parent reminds a child to say "please" • formal instruction, as when students learn history in school 132 HUMAN GEOGRAPHY: AP" EDITION CULTURAL COMPLEX OF THE AUTOMOBILE The automobile provides much more than just transportation, as it reflects many values that are central to American culture. Origins of Culture The area in which a unique culture or a specific trait develops is a culture hearth. Classical Greece was a culture hearth for democracy more than 2,000 years ago. New York City was a culture hearth for rap music in the 1970s. Geographers study how cultures develop in hearths and diffuse-or spread-to other places. Geographers also study taboos, behaviors heavily discouraged by a culture. For example, many cultures have taboos against eating certain foods, such as pork or insects. What is considered taboo changes over time. In the United States, marriages between Protestants and Catholics were once taboo, but they are not widely opposed now. Traditional, Folk, and Indigenous Cultures With the beginning of the Industrial Revolution in the late 18th century, modern transportation and communication connected people as never before and led to extensive cultural mixing, especially as cities have grown. The world prior to this time was very different; however, remnants of the past are still evident in our modern cultures. Traditional, folk, and indigenous cultures share some important characteristics and are often grouped together, but they do have some subtle differences. Traditional Culture Recently, the meanings of traditional, folk, and indigenous culture have begun to merge, causing geographers to debate when each should be used. Increasingly, the term traditional culture is used to encompass all three cultural designations. All three types share the function of passing down long-held beliefs, values, and practices and are generally resistant to rapid changes in their culture. Folk Culture The beliefs and practices of small, homogenous groups of people, often living in rural areas that are relatively isolated and slow to change, are known as folk cultures. Like all cultures, they demonstrate the diverse ways that people have adapted to a physical environment. For example, people around the world learned to make shelters out of available resources, whether 3.1: INTRODUCTION TO CULTURE 133 it was snow or mud bricks or wood. However, people used similar resources such as wood differently. In Scandinavia, people used trees to build cabins. In the American Midwest, people processed trees into boards, built a frame, and attached the boards to it. Many traits of folk culture continue today. Corn was first grown in Mexico around 10,000 years ago, and it is still grown there today. While many elements of folk culture exist side by side with modern culture, there are people whose societies have changed little, if at all, from long ago. These people practice traditional cultures, those which have not been affected by modern technology or influences. They often live in remote regions, such as some small tribes in the Amazon rainforest, and have scant knowledge of the outside world. As the lines continue blurring between cultural designations, the Amish of Pennsylvania are often referenced as both folk and traditional culture. Indigenous Culture When members of an ethnic group reside in their ancestral lands, and typically possess unique cultural traits, such as speaking their own exclusive language, they are considered an indigenous culture. Some indigenous peoples have been displaced from their native lands, but still practice their indigenous culture. Native Americans in the United States, such as the Navajo, have kept indigenous cultural practices. First Nations of Canada, such as the Inuit, have also retained their indigenous culture. Globalization and Popular Culture As a result of the Industrial Revolution, improvements in transportation and communication have shortened the time required for movement, trade, or other forms of interaction between two places. This development, known as space-time compression (see Topics 1.4 and 3.6), has accelerated culture change around the world. In 1817, a freight shipment from Cincinnati needed 52 days to reach New York City. By 1850, because of canals and railroads, it took half that long. And by 1852, it took only 7 days. Today, an airplane flight takes only a few hours, and digital information takes seconds or less. Similar change has occurred on the global scale. People travel freely across the world in a matter of hours, and communication has advanced to a point where people share information instantaneously across the globe. The increased global interaction has had a profound impact on cultures, from spreading English across the world to instant sharing of news, events and music. Globalization specifically refers to the increased integration of the world economy since the 1970s. The process of intensified interaction among peoples, governments, and companies of different countries around the globe has had profound impacts on culture. The culture of the United States is intertwined with globalization. Through the influence of its corporations, Hollywood movies, and government, the United States exerts widespread influence in other countries. But other countries also shape American culture. For example, in 2019, the National Basketball Association included players from 38 countries or territories. When cultural traits- such as clothing, music, movies, and types of 134 HUMAN GEOGRAPHY: AP. EDITION businesses-spread quickly over a large area and are adopted by various groups, they become part of popular culture. Elements of popular culture often begin in urban areas and diffuse quickly through globalization processes such as the media and Internet. These elements can quickly be adopted worldwide, making them part of global culture. People around the world follow European soccer, Indian Bollywood movies, and Japanese animation known as anime. With people in many nations wearing similar clothes, listening to similar music, and eating similar food, popular cultural traits often promote uniformity in beliefs, values, and the cultural landscape across many places The cultural landscape, also known as the built environment (see Topic 3.2), is the modification of the environment by a group and is a visible reflection of that group's cultural beliefs and values. Traditional Culture to Popular Culture Popular culture emphasizes trying what is new rather than preserving what is traditional. Many people, especially older generations or those who follow a folk culture, openly resist the adoption of popular cultural traits. They do this by preserving traditional languages, religions, values, and foods. While older generations often resist the adoption of popular culture, they seldom are successful in keeping their traditional cultures from changing, especially among the young people of their society. One clash between popular and traditional culture is occurring in Brazil. As the population expands to the interior of the rain forest, many indigenous cultures, like the Yanamamo tribe, have more contact with outside groups. Remaining isolated by the forest is becoming increasingly difficult as many young people from the indigenous cultures become exposed to popular culture and begin to integrate into the larger Brazilian society. As the young people leave their communities, they are more likely to accept popular culture at the expense of their indigenous cultural heritage, which threatens the very existence of their folk culture. Traditional culture typically exhibits horizontal diversity, meaning each traditional culture has its own customs and language that makes it distinct from other culture groups. Yet, people people within each group are usually homogeneous, or very similar to each other. By contrast, popular culture typically exhibits vertical diversity, meaning that modern urban societies are usually heterogeneous, or exhibiting differences, within the society and usually contain numerous multiethnic neighborhoods. However, on a global scale popular cultures are relatively similar with the same type of malls, shops, fast food, and clothing. Urban global culture centers are not identical, yet, global cities often do not have as much horizontal diversity across space as folk cultures. 3.1: INTRODUCTION TO CULTURE 135 COMPARING TRADITIONAL AND POPULAR CULTURE Trait Traditional Culture Popular or Global Culture Society • Rural and isolated location • Urban and connected location • Homogeneous and • Diverse and multiethnic indigenous population population • Most people speak an • Many people speak a global indigenous or ethnic local language such as English or language Arabic • Horizontal diversity • Vertical diversity Social • Emphasis on community and • Emphasis on individualism and Structure conformity making choices • Families live close to each • Dispersed families other • Weakly defined gender roles • Well-defined gender roles Diffusion • Relatively slow and limited • Relatively rapid and extensive • Primarily through relocation • Often hierarchical • Oral traditions and stories • Social media and mass media Buildings and • Materials produced locally, • Materials produced in distant Housing such as stone or grass factories, such as steel or glass • Built by community or owner • Built by a business • Similar style for community • Variety of architectural styles • Different between cultures • Similar between cities • Traditional architecture • Postmodern / contemporary architecture Food • Locally produced • Often imported • Choices limited by tradition • Wide range of choice • Prepared by the family or • Purchased in restaurants community Spatial Focus • Local and regional • National and global Artifacts, Mentifacts, and Sociofacts Whether a cultural attribute is considered traditional, folk, indigenous, or popular in nature, it is valuable to differentiate between elements of culture that can be seen and those that can not. There are artifacts that comprise the material culture, which consists of tangible things, or those that can be experienced by the senses. Art, clothing, food, music, sports, and housing types are all tangible elements of culture. Another element of the study of artifacts is understanding the techniques to use or build a specific artifact. Artifacts can be unique to a particular culture, or can be shared. For example, people of all cultures need to communicate through language, yet there are many groups that possess languages unique to their culture. The ability to read, write and understand the English language is an artifact of importance for much of popular global culture. 136 HUMAN GEOGRAPHY: AP" EDITION Mentifacts comprise a group's nonmaterial culture and consist ofintangible concepts, or those not having a physical presence. Beliefs, values, practices, and aesthetics (pleasing in appearance) determine what a cultural group views as acceptable and desirable. Mentifacts can also be unique or shared. People of many cultures possess an belief in one or many deities, and often the deities are unique to that culture. The belief in a god is a mentifact-the religious building or symbols are artifacts. Cultural groups also possess sociofacts, which are the ways people organize their society and relate to one another. Taken altogether, people tend to see the whole of their culture as greater than the sum of its individual parts. Sociofacts are embodied through families, governments, sports teams, religious organizations, education systems, and other social constructs. As with artifacts and mentifacts, sociofacts may also be unique or similar to other societies. Families are the foundations of most societies, yet what constitutes the structure of a family may vary widely between cultural groups. For example, Western cultures tend to view the nuclear family, consisting of the parents and their children as the basic family unit. By contrast, in many Western African cultures the norm is the extended family, consisting of several generations and other family members such as cousins living under one roof.

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)

THE STRATEGIC PLAN OF RICHARD BLAND COLLEGE OF WILLIAM & MARY 2020-2025 “The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew and act anew.” – Abraham Lincoln What is the role of a selective, two-year, residential, liberal arts transfer institution within the higher education landscape of the Commonwealth of Virginia? This is a key question that must be answered to ensure the success of Richard Bland College (RBC) and the constituency that the College serves. The 2020 RBC strategic plan’s primary objective is to answer that very question so that the College, the community and the Commonwealth can engage successfully within this identity and purpose to the benefit of all. RBC has long been identified as the hidden gem of higher education in Virginia. The hidden adjective is based both on its relative obscurity—few are aware of RBC outside the Tri-Cities region—and its rural setting featuring 750+ acres of wetlands, bucolic forest, and the state’s oldest and largest pecan grove. Additionally, on average, a student of Richard Bland College travels a mere 36 miles to campus. This keeps the knowledge of RBC in a tightly focused radius. The gem moniker refers both to the College’s reputation for excellence and the undeniable sensation that the campus often elicits in its students, visitors, faculty and staff, the feeling of a warm and palpable embrace of care, compassion and support. That sensation is where we start. According the State Council of Higher Education for Virginia (SCHEV), 99% of the 11.5 million new jobs created since the great recession require workers to have more than a high-school education. Students with a bachelor’s degree have an earning potential almost double that of people with only a high school education, and yet only 17% of residents in the Petersburg area have a bachelor’s degree, 15% below the national average. The obstacles in the way of education have been exhaustively researched and include financial challenges, academic under-preparedness, low self-esteem, slow college assimilation and immature levels of self-efficacy. To combat this growing problem, Richard Bland College initiated a pilot program to determine the viability of a data-driven approach to improve retention and graduation rates. The program ultimately effected a cultural, organizational and operational shift at RBC, resulting in a personalized model of student support, the Exceptional Student Experience (ESE@RBC). Originally many of the practices that RBC used as the basis of ESE@RBC were adapted from the four key principles found in the American Association of Community Colleges (AACC) Pathways Project: 1) map pathways to student end goals; 2) help students choose and enter a program pathway; 3) keep students on path; and 4) ensure that students are learning. Unfortunately, limited resources made it necessary to skip some primary elements of guided pathways and instead to focus on a specific, high-priority project that was immediately available for implementation, dedicated student support. This strategic framework reimagines the way that RBC serves students, faculty and staff within the context of our existing culture, the principles of guided pathways and a hybrid work-college experience. Rather than thinking of a two-year college as a pipeline to a four-year university, this vision describes a more expansive menu of well-defined pathways to high-demand fields, all radiating from a curriculum constructed around the development of soft skills that define the liberal arts experience: critical thinking, written communication, analytical reasoning, civic engagement and oral communication. Furthermore, the impact of meaningful work is a resonating theme, providing avenues to participate in career-focused internships and jobs that develop important life & work skills, confidence, and character. Richard Bland has tested its entrepreneurial mettle and its capacity for transformation in recent years. The College was among a select few Competency-Based Education sites established by the U.S. Department of Education. We were ahead of the curve using predictive analytics to improve student retention and success rates, and online enrollment now makes up nearly 20 percent of course offerings. It may be counter-intuitive, but these and other deep-level institutional changes still to come will ensure that Richard Bland College remains true to its original mission. We prepare our students for a lifetime of endless potential.

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