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Medication Search - Riva-Alendronate
Common Name:
How does Riva-Alendronate work? What will it do for me?
Alendronate belongs to a family of medications known as bisphosphonates. It is used to treat and prevent osteoporosis for postmenopausal women. It is also used to treat osteoporosis for men.
Alendronate may also be used to treat and prevent steroid-induced osteoporosis for men and women (osteoporosis caused by taking corticosteroids such as prednisone for long periods of time). It may also be used to treat Paget's disease of the bone for both men and women.
Alendronate increases the thickness of bone (bone mineral density) by slowing down the cells that usually break down bone (osteoclasts). This allows the cells that build bone (osteoblasts) to work more efficiently. By making bones stronger, alendronate can help to reduce the incidence of osteoporosis-related fractures.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does Riva-Alendronate come in?
Each white-to-off-white arc triangle tablet embossed "AN" over "40" on one side and ">" on the other contains 91.36 mg of alendronate monosodium salt equivalent to 70 mg of alendronate. Nonmedicinal ingredients: croscarmellose sodium, microcrystalline cellulose, lactose monohydrate, and magnesium stearate.
How should I use Riva-Alendronate?
When used for postmenopausal women, the recommended dose of alendronate to treat osteoporosis is one 10 mg tablet daily or 70 mg once weekly. To prevent osteoporosis, the recommended dose is 5 mg once a day.
To treat osteoporosis for men, the recommended dose of alendronate is one 10 mg tablet daily or 70 mg once weekly.
To treat and prevent steroid-induced osteoporosis for men and women, the recommended dose is 5 mg daily, except for postmenopausal women not taking estrogen. For those women, the recommended dose is 10 mg once a day.
When used to treat Paget's disease of the bone for men and women, the recommended dose is 40 mg once a day for 6 months.
The tablet should be taken upon rising for the day, at least 30 minutes before the first food, beverage, or medication of the day. To reduce the risk of irritating the throat or esophagus, take the tablet with a full glass (250 mL) of plain water only.
After swallowing, do not lie down until at least 30 minutes have passed and you have eaten your first food of the day. Swallow the tablets whole. Do not chew or suck on the tablets.
Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose when taking this medication once a day, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
If you miss a dose when taking this medication once weekly, take the missed dose the morning after you remember. Then return to your weekly dose on the original day of the week. Do not take 2 doses on the same day. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take Riva-Alendronate?
Do not take alendronate if you:
- are allergic to alendronate or any ingredients of the medication
- cannot stand or sit upright for at least 30 minutes
- have an abnormality of the esophagus (passage leading from throat to stomach) that delays the emptying of the esophagus into the stomach
- have low blood calcium
- have severely reduced kidney function
What side effects are possible with Riva-Alendronate?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- abdominal pain
- bloating
- changed sense of taste
- constipation
- diarrhea
- dizziness
- gas
- hair loss
- headache
- heartburn
- mild skin rash or redness
- nausea
- pain in bones, muscles, or joints
- rash that is made worse by sunlight
- spinning sensation
- vomiting
Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- persistent ear pain
- severe joint, bone, or muscle pain
- symptoms of low calcium levels such as muscle spasms, and prickling or tingling sensations around the mouth or in the hands or feet
- vision changes or eye pain
Stop taking the medication and seek immediate medical attention if any of the following occur:
- delayed healing and infection of mouth and jaw (usually after tooth extraction)
- new or unusual pain in the hip or thigh
- signs of a serious allergic reaction (e.g., swelling of face or throat, hives, or difficulty breathing)
- signs of a severe skin reaction (e.g., high fever; rash; sores; painful blisters on the skin, mouth, or eyes; or skin peeling off)
- signs of damage to the esophagus (e.g., pain in the esophagus [throat area] or behind the breastbone, chest pain, difficulty swallowing, pain when swallowing, or new or worsening heartburn)
- symptoms of a stomach or intestinal ulcer (e.g., nausea, vomiting, abdominal pain, loss of weight or appetite, black or bloody stools, or vomiting blood)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for Riva-Alendronate?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Atypical femur fracture: There is evidence that long term use of this class of medication may contribute to a type of rare fracture of the long bone in the thigh (femur) without any form of trauma.
If you experience new or unusual pain in the groin, hip, or thigh area, contact your doctor as soon as possible.
Bone, joint, and muscle problems: Rarely, people taking this medication experience severe bone, joint, or muscle pain. This is usually reversed when the medication is stopped.
Calcium and vitamin D: Calcium and vitamin D are important contributors to bone growth and strength. It may be necessary to take calcium or vitamin D supplements to get the best effect from alendronate if you are not getting enough from your diet. Your doctor may test you for low calcium levels or vitamin D deficiency before you start taking alendronate.
Effects on the esophagus: Alendronate may irritate the lining of the esophagus (the passage from the throat to the stomach). Esophagitis, ulcers, and erosions have been reported by people who take alendronate. In some cases, these effects have been severe and have required hospitalization. Contact your doctor at once if you suddenly experience problems swallowing, find it painful to swallow, develop pain behind the sternum (breastbone), or have new or worsening heartburn.
To ease the passage of the medication to the stomach and thus reduce the potential for irritation of the esophagus, swallow alendronate with a full glass of plain water upon arising for the day. Do not lie down until 30 minutes have passed and you have eaten your first food of the day. Do not chew or suck on the tablet, as this may lead to ulcers in the mouth or throat. Do not take alendronate at bedtime or before getting up for the day.
Effects on the stomach and intestines: Rarely, people taking this medication have developed ulcers of the stomach or intestines. If you suffer from stomach problems, such as ulcers and severe indigestion, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Get immediate medical attention if you have symptoms of a stomach or intestinal ulcer, such as nausea, vomiting, abdominal pain, loss of weight or appetite, black or bloody stools, or vomiting blood.
Inflammation of the eye: Conditions of eye inflammation have been reported by people using alendronate. If you experience changes to your vision, red eyes, or eye pain, contact your doctor as soon as possible.
Jaw problems: Rarely, alendronate may cause severe jaw problems associated with delayed healing and infection, especially in people with cancer or after tooth extractions. If you experience any pain in the jaw, especially after having a tooth removed, contact your doctor immediately.
Kidney function: Alendronate is removed from the body by the kidneys. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if alendronate passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: The safety and effectiveness of using this medication have not been established for children under 18 years of age.
What other drugs could interact with Riva-Alendronate?
There may be an interaction between alendronate and any of the following:
- aminoglycoside antibiotics (e.g., amikacin, gentamicin, tobramycin)
- antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
- ASA and ASA-containing products (when alendronate is taken in doses greater than 10 mg daily) – note that this does not apply to the 70 mg weekly dose
- calcium supplements (wait at least 30 minutes after taking alendronate to take calcium supplements)
- deferasirox
- H2 antagonists (e.g., famotidine, ranitidine)
- non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
- proton pump inhibitors (e.g., lansoprazole, omeprazole)
- systemic angiogenesis inhibitors (e.g., axitinib, bevacizumab, lenalidomide, pazopanib, regorafenib, vandetanib)
- supplements containing minerals such as aluminum, calcium, iron, magnesium and phosphate
- other medications given by mouth (wait at least 30 minutes after taking alendronate to take any other medication by mouth)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Riva-Alendronate


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Mortgage Pre-Approval
If you are looking for a new home, be sure you are pre-approved. With a mortgage pre-approval, a licensed mortgage professional can do a more complete verification prior to sending you shopping for a home, and with that done, the dollar figure you are going shopping with is actually what you can spend.
The mortgage professional that you work with to get pre-approved will let you know for certain what you can afford based on lender and insurer criteria, and what your payments on a specific mortgage will be.
Dominion Lending Centres mortgage professionals can lock-in an interest rate for you for anywhere from 60 – 120 days while you shop for your perfect home. By locking in an interest rate, you are guaranteed to get a mortgage for at least that rate or better. If interest rates drop, your locked-in rate will drop as well. However, if the interest rates go up, your locked-in interest rate will not, ensuring you get the best rate throughout the mortgage pre-approval process.
In order to get pre-approved for a mortgage, a mortgage professional requires a short list of information that will allow them to determine your buying power. A mortgage professional will explain to you the benefits of shorter or longer mortgage terms, the latest programs available, which mortgage products they believe will most likely meet your needs the best, plus they will review all of the other costs involved with purchasing a home.
Getting pre-approved for a mortgage is something every potential home buyer should do before going shopping for a new home. A pre-approval will give you the confidence of knowing that financing is available, and it can put you in a very positive negotiation position against other home buyers who aren't pre-approved.

subset: commoncrawl


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Horatio Nelson had a problem. The British admiral's fleet was outnumbered at Trafalgar by an armada of French and Spanish ships that Napoleon had ordered to disrupt Britain's commerce and prepare for a cross-channel invasion. The prevailing tactics in 1805 were for the two opposing fleets to stay in line, firing broadsides at each other. But Nelson had a strategic insight into how to deal with being outnumbered. He broke the British fleet into two columns and drove them at the Franco-Spanish fleet, hitting its line perpendicularly. The lead British ships took a great risk, but Nelson judged that the less-trained Franco-Spanish gunners would not be able to compensate for the heavy swell that day and that the enemy fleet, with its coherence lost, would be no match for the more experienced British captains and gunners in the ensuing melee. He was proved right: the French and Spanish lost 22 ships, two-thirds of their fleet. The British lost none.1
Nelson's victory is a classic example of good strategy, which almost always looks this simple and obvious in retrospect. It does not pop out of some strategic-management tool, matrix, triangle, or fill-in-the-blanks scheme. Instead, a talented leader has identified the one or two critical issues in a situation—the pivot points that can multiply the effectiveness of effort—and then focused and concentrated action and resources on them. A good strategy does more than urge us forward toward a goal or vision; it honestly acknowledges the challenges we face and provides an approach to overcoming them.
Too many organizational leaders say they have a strategy when they do not. Instead, they espouse what I call "bad strategy." Bad strategy ignores the power of choice and focus, trying instead to accommodate a multitude of conflicting demands and interests. Like a quarterback whose only advice to his teammates is "let's win," bad strategy covers up its failure to guide by embracing the language of broad goals, ambition, vision, and values. Each of these elements is, of course, an important part of human life. But, by themselves, they are not substitutes for the hard work of strategy.
In this article, I try to lay out the attributes of bad strategy and explain why it is so prevalent. Make no mistake: the creeping spread of bad strategy affects us all. Heavy with goals and slogans, governments have become less and less able to solve problems. Corporate boards sign off on strategic plans that are little more than wishful thinking. The US education system is rich with targets and standards but poor at comprehending and countering the sources of underperformance. The only remedy is for us to demand more from those who lead. More than charisma and vision, we must demand good strategy.
The hallmarks of bad strategy
I coined the term bad strategy in 2007 at a Washington, DC, seminar on national-security strategy. My role was to provide a business and corporate-strategy perspective. The participants expected, I think, that my remarks would detail the seriousness and growing competence with which business strategy was created. Using words and slides, I told the group that many businesses did have powerful, effective strategies. But in my personal experiences with corporate practice, I saw a growing profusion of bad strategy.
In the years since that seminar, I have had the opportunity to discuss the bad-strategy concept with a number of senior executives. In the process, I have condensed my list of its key hallmarks to four points: the failure to face the challenge, mistaking goals for strategy, bad strategic objectives, and fluff.
Failure to face the problem
A strategy is a way through a difficulty, an approach to overcoming an obstacle, a response to a challenge. If the challenge is not defined, it is difficult or impossible to assess the quality of the strategy. And, if you cannot assess that, you cannot reject a bad strategy or improve a good one.
International Harvester learned about this element of bad strategy the hard way. In July 1979, the company's strategic and financial planners produced a thick sheaf of paper titled "Corporate Strategic Plan: International Harvester." It was an amalgam of five separate strategic plans, each created by one of the operating divisions.
The strategic plan did not lack for texture and detail. Looking, for example, within the agricultural-equipment group—International Harvester's core, dating back to the McCormick reaper, which was a foundation of the company—there is information and discussion about each segment. The overall intent was to strengthen the dealer/distributor network and to reduce manufacturing costs. Market share in agricultural equipment was also projected to increase, from 16 percent to 20 percent.
That was typical of the overall strategy, which was to increase the company's share in each market, cut costs in each business, and thereby ramp up revenue and profit. A summary graph, showing past and forecast profit, forms an almost perfect hockey stick, with an immediate recovery from decline followed by a steady rise.
The problem with all this was that the plan didn't even mention Harvester's grossly inefficient production facilities, especially in its agricultural-equipment business, or the fact that Harvester had the worst labor relations in US industry. As a result, the company's profit margin had been about one-half of its competitors' for a long time. As a corporation, International Harvester's main problem was its inefficient work organization—a problem that would not be solved by investing in new equipment or pressing managers to increase market share.
By cutting administrative overhead, Harvester boosted reported profits for a year or two. But following a disastrous six-month strike, the company quickly began to collapse. It sold off various businesses—including its agricultural-equipment business, to Tenneco. The truck division, renamed Navistar, is today a leading maker of heavy trucks and engines.
To summarize: if you fail to identify and analyze the obstacles, you don't have a strategy. Instead, you have a stretch goal or a budget or a list of things you wish would happen.
Mistaking goals for strategy
A few years ago, a CEO I'll call Chad Logan asked me to work with the management team of his graphic-arts company on "strategic thinking." Logan explained that his overall goal was simple—he called it the "20/20 plan." Revenues were to grow at 20 percent a year, and the profit margin was to be 20 percent or higher.
"This 20/20 plan is a very aggressive financial goal," I said. "What has to happen for it to be realized?" Logan tapped the plan with a blunt forefinger. "The thing I learned as a football player is that winning requires strength and skill, but more than anything it requires the will to win—the drive to succeed. . . . Sure, 20/20 is a stretch, but the secret of success is setting your sights high. We are going to keep pushing until we get there."
I tried again: "Chad, when a company makes the kind of jump in performance your plan envisions, there is usually a key strength you are building on or a change in the industry that opens up new opportunities. Can you clarify what the point of leverage might be here, in your company?"
Logan frowned and pressed his lips together, expressing frustration that I didn't understand him. He pulled a sheet of paper out of his briefcase and ran a finger under the highlighted text. "This is what Jack Welch says," he told me. The text read: "We have found that by reaching for what appears to be the impossible, we often actually do the impossible." (Logan's reading of Welch was, of course, highly selective. Yes, Welch believed in stretch goals. But he also said, "If you don't have a competitive advantage, don't compete.")
The reference to "pushing until we get there" triggered in my mind an association with the great pushes of 1915–17 during World War I, which led to the deaths of a generation of European youths. Maybe that's why motivational speakers are not the staple on the European management-lecture circuit that they are in the United States. For the slaughtered troops did not suffer from a lack of motivation. They suffered from a lack of competent strategic leadership. A leader may justly ask for "one last push," but the leader's job is more than that. The job of the leader—the strategist—is also to create the conditions that will make the push effective, to have a strategy worthy of the effort called upon.
Bad strategic objectives
Another sign of bad strategy is fuzzy strategic objectives. One form this problem can take is a scrambled mess of things to accomplish—a dog's dinner of goals. A long list of things to do, often mislabeled as strategies or objectives, is not a strategy. It is just a list of things to do. Such lists usually grow out of planning meetings in which a wide variety of stakeholders suggest things they would like to see accomplished. Rather than focus on a few important items, the group sweeps the whole day's collection into the strategic plan. Then, in recognition that it is a dog's dinner, the label "long term" is added, implying that none of these things need be done today. As a vivid example, I recently had the chance to discuss strategy with the mayor of a small city in the Pacific Northwest. His planning committee's strategic plan contained 47 strategies and 178 action items. Action item number 122 was "create a strategic plan."
A second type of weak strategic objective is one that is "blue sky"—typically a simple restatement of the desired state of affairs or of the challenge. It skips over the annoying fact that no one has a clue as to how to get there. A leader may successfully identify the key challenge and propose an overall approach to dealing with the challenge. But if the consequent strategic objectives are just as difficult to meet as the original challenge, the strategy has added little value.
Good strategy, in contrast, works by focusing energy and resources on one, or a very few, pivotal objectives whose accomplishment will lead to a cascade of favorable outcomes. It also builds a bridge between the critical challenge at the heart of the strategy and action—between desire and immediate objectives that lie within grasp. Thus, the objectives that a good strategy sets stand a good chance of being accomplished, given existing resources and competencies.
A final hallmark of mediocrity and bad strategy is superficial abstraction—a flurry of fluff—designed to mask the absence of thought. Fluff is a restatement of the obvious, combined with a generous sprinkling of buzzwords that masquerade as expertise. Here is a quote from a major retail bank's internal strategy memoranda: "Our fundamental strategy is one of customer-centric intermediation." Intermediation means that the company accepts deposits and then lends out the money. In other words, it is a bank. The buzzphrase "customer centric" could mean that the bank competes by offering better terms and service, but an examination of its policies does not reveal any distinction in this regard. The phrase "customer-centric intermediation" is pure fluff. Remove the fluff and you learn that the bank's fundamental strategy is being a bank.
Why so much bad strategy?
Bad strategy has many roots, but I'll focus on two here: the inability to choose and template-style planning—filling in the blanks with "vision, mission, values, strategies."
The inability to choose
Strategy involves focus and, therefore, choice. And choice means setting aside some goals in favor of others. When this hard work is not done, weak strategy is the result. In 1992, I sat in on a strategy discussion among senior executives at Digital Equipment Corporation (DEC). A leader of the minicomputer revolution of the 1960s and 1970s, DEC had been losing ground for several years to the newer 32-bit personal computers. There were serious doubts that the company could survive for long without dramatic changes.
To simplify matters, I will pretend that only three executives were present. "Alec" argued that DEC had always been a computer company and should continue integrating hardware and software into usable systems. "Beverly" felt that the only distinctive resource DEC had to build on was its customer relationships. Hence, she derided Alec's "Boxes" strategy and argued in favor of a "Solutions" strategy that solved customer problems. "Craig" held that the heart of the computer industry was semiconductor technology and that the company should focus its resources on designing and building better "Chips."
Choice was necessary: both the Chips and Solutions strategies represented dramatic transformations of the firm, and each would require wholly new skills and work practices. One wouldn't choose either risky alternative unless the status quo Boxes strategy was likely to fail. And one wouldn't choose to do both Chips and Solutions at the same time, because there was little common ground between them. It is not feasible to do two separate, deep transformations of a company's core at once.
With equally powerful executives arguing for each of the three conflicting strategies, the meeting was intense. DEC's chief executive, Ken Olsen, had made the mistake of asking the group to reach a consensus. It was unable to do that, because a majority preferred Solutions to Boxes, a majority preferred Boxes to Chips, and a majority also preferred Chips to Solutions. No matter which of the three paths was chosen, a majority preferred something else. This dilemma wasn't unique to the stand-off at DEC. The French philosopher Nicolas de Condorcet achieved immortality by first pointing out the possibility of such a paradox arising, and economist Kenneth Arrow won a Nobel Prize for showing that "Condorcet's paradox" cannot be resolved through cleverer voting schemes.
Not surprisingly, the group compromised on a statement: "DEC is committed to providing high-quality products and services and being a leader in data processing." This fluffy, amorphous statement was, of course, not a strategy. It was a political outcome reached by individuals who, forced to reach a consensus, could not agree on which interests and concepts to forego.
Ken Olsen was replaced, in June 1992, by Robert Palmer, who had headed the company's semiconductor engineering. Palmer made it clear that the strategy would be Chips. One point of view had finally won. But by then it was five years too late. Palmer stopped the losses for a while but could not stem the tide of ever more powerful personal computers that were overtaking the firm. In 1998, DEC was acquired by Compaq, which, in turn, was acquired by Hewlett-Packard three years later.
Template-style strategy
The Jack Welch quote about "reaching for what appears to be the impossible" is fairly standard motivational fare, available from literally hundreds of motivational speakers, books, calendars, memo pads, and Web sites. This fascination with positive thinking has helped inspire ideas about charismatic leadership and the power of a shared vision, reducing them to something of a formula. The general outline goes like this: the transformational leader (1) develops or has a vision, (2) inspires people to sacrifice (change) for the good of the organization, and (3) empowers people to accomplish the vision.
By the early 2000s, the juxtaposition of vision-led leadership and strategy work had produced a template-style system of strategic planning. (Type "vision mission strategy" into a search engine and you'll find thousands of examples of this kind of template for sale and in use.) The template looks like this:
The Vision. Fill in your vision of what the school/business/nation will be like in the future. Currently popular visions are to be the best or the leading or the best known.
The Mission. Fill in a high-sounding, politically correct statement of the purpose of the school/business/nation. Innovation, human progress, and sustainable solutions are popular elements of a mission statement.
The Values. Fill in a statement that describes the company's values. Make sure they are noncontroversial. Key words include "integrity," "respect," and "excellence."
The Strategies. Fill in some aspirations/goals but call them strategies. For example, "to invest in a portfolio of performance businesses that create value for our shareholders and growth for our customers."
This template-style planning has been enthusiastically adopted by corporations, school boards, university presidents, and government agencies. Scan through such documents and you will find pious statements of the obvious presented as if they were decisive insights. The enormous problem all this creates is that someone who actually wishes to conceive and implement an effective strategy is surrounded by empty rhetoric and bad examples.
The kernel of good strategy
By now, I hope you are fully awake to the dramatic differences between good and bad strategy. Let me close by trying to give you a leg up in crafting good strategies, which have a basic underlying structure:
1. A diagnosis: an explanation of the nature of the challenge. A good diagnosis simplifies the often overwhelming complexity of reality by identifying certain aspects of the situation as being the critical ones.
2. A guiding policy: an overall approach chosen to cope with or overcome the obstacles identified in the diagnosis.
3. Coherent actions: steps that are coordinated with one another to support the accomplishment of the guiding policy.
I'll illustrate by describing Nvidia's journey from troubled start-up to market leader for 3-D graphics chips. Nvidia's first product, a PC add-in board for video, audio, and 3-D graphics, was a commercial failure. In 1995, rival start-up 3Dfx Interactive took the lead in serving the burgeoning demand of gamers for fast 3-D graphics chips. Furthermore, there were rumors that industry giant Intel was thinking about introducing its own 3-D graphics chip. The diagnosis: "We are losing the performance race."
Nvidia CEO Jen-Hsun Huang's key insight was that given the rapid state of advance in 3-D graphics, releasing a new chip every 6 months— instead of at the industry-standard rate of every 18 months—would make a critical difference. The guiding policy, in short, was to "release a faster, better chip three times faster than the industry norm."
To accomplish this fast-release cycle, the company emphasized several coherent actions: it formed three development teams, which worked on overlapping schedules; it invested in massive simulation and emulation facilities to avoid delays in the fabrication of chips and in the development of software drivers; and, over time, it regained control of driver development from the branded add-in board makers.
Over the next decade, the strategy worked brilliantly. Intel introduced its 3-D graphics chip in 1998 but did not keep up the pace, exiting the business of discrete 3-D graphics chips a year later. In 2000, creditors of 3Dfx initiated bankruptcy proceedings against the company, which was struggling to keep up with Nvidia. In 2007, Forbes named Nvidia "Company of the Year."2
Despite the roar of voices equating strategy with ambition, leadership, vision, or planning, strategy is none of these. Rather, it is coherent action backed by an argument. And the core of the strategist's work is always the same: discover the crucial factors in a situation and design a way to coordinate and focus actions to deal with them.


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Drug information provided by: Merative, Micromedex®
Perindopril is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. Lowering blood pressure can reduce the risk of strokes and heart attacks.
Perindopril works by blocking a substance in the body that causes the blood vessels to tighten. As a result, perindopril relaxes the blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart.
Perindopril is also used in patients with coronary artery disease to prevent heart attacks.
This medicine is available only with your doctor's prescription.
This product is available in the following dosage forms:
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of perindopril in the pediatric population. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of perindopril in the elderly.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.
Do not use this medicine together with sacubitril. Do not use this medicine and sacubitril/valsartan (Entresto®) within 36 hours of each other.
This medicine may cause serious types of allergic reactions, including anaphylaxis. This can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, mouth, or throat while you are using this medicine.
Call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of a condition called intestinal angioedema.
Dizziness, lightheadedness, or fainting may also occur, especially when you get up from a lying or sitting position or if you have been taking a diuretic (water pill). Do not drive or do anything else that could be dangerous until you know how this medicine affects you. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning.
Check with your doctor right away if you become sick while taking this medicine, especially with severe or continuing nausea, vomiting, or diarrhea. These conditions may cause you to lose too much water or salt and may lead to low blood pressure. You can also lose water by sweating, so drink plenty of water during exercise or in hot weather.
Check with your doctor right away if you have a fever, chills, or sore throat. These could be symptoms of an infection resulting from low white blood cells.
Check with your doctor right away if you have bloody urine, a decrease in frequency or amount of urine, an increase in blood pressure, increased thirst, loss of appetite, lower back or side pain, nausea, swelling of the face, fingers, or lower legs, troubled breathing, unusual tiredness or weakness, vomiting, or weight gain. These could be symptoms of a serious kidney problem.
Hyperkalemia (high potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you have the following symptoms: abdominal or stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea, vomiting, nervousness, numbness or tingling in the hands, feet, or lips, shortness of breath, or weakness or heaviness of the legs. Do not use salt substitutes containing potassium without first checking with your doctor.
Check with your doctor right away if you have upper stomach pain, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem. C
Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery.
Do not take other medicines unless they have been discussed with your doctor. This includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Portions of this document last updated: April 01, 2024
Original article: https://www.mayoclinic.org/es/drugs-supplements/perindopril-oral-route/description/drg-20069270


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Type in the modpack name (AdvvanceCraft) or paste the following url into the search box.
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Fireside in Queenstown Candle
- Description
- Shipping
- Returns
Smouldering Woods & Cinnamon
Intense as a flickering fire, this scent is as exhilarating as a day on the slopes. Notes of cinnamon, clove and sandalwood roar to life with wild orris and rich guiac wood, resulting in a deliciously warm fragrance that will conjure up moments of apres ski.
- Triple-scented with fine fragrance
- Handmade in Australia
- High quality, non-toxic soy blend wax
- Two natural lead-free cotton wicks
- Clean, even burn
- Glass jar with elegant lid and gold decal
- No parabens, no silicones, No PEGS
- Not tested on animals
- Airtight jars can be up-cycled
Hedgerow orders are sent via courier to ensure delivery direct to your door (unfortunately we do not ship to P.O Boxes). All packages are targeted for delivery between 2-10 working days of order confirmation.
Hedgerow offers free shipping on standard orders over $150 New Zealand wide.
For all orders over $150 the following shipping rates are incurred -
- Auckland delivery - $5 flat rate
- Rest of North Island and Rural delivery - $10 flat rate
- South Island - $15 flat rate
- South Island Rural delivery - $20 flat rate
Read our full shipping policy here
Full priced products can be returned or exchanged providing it's in a saleable condition. If you intend to return an item:
- Please ensure that all tags and packaging are still attached.
- Items must not have been worn, altered or washed. We will not accept returns for any non-faulty items that have been used.
- The original invoice must accompany the returning item(s)
You can make your return or refund request to firstname.lastname@example.com
Returns and exchanges will be accepted for items within 10 days of purchase.
Items must be returned to Hedgerow within 14 days of delivery. If the return exceeds our 14 day policy, we unfortunately will not be able to process your return and your order will be shipped back to you at an additional charge.
Hedgerow does not refund any shipping costs. The cost of the shipping on a returned item will be your responsibility unless the item sent is deemed to be faulty or has been sent in error by Hedgerow.
Read our full returns policy here


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Abstract View
We ship all paintings world-wide, free of charge. We are partnered with major carriers like DHL, UPS, and FedEx.
Due to the hand-painting and drying process, all orders are processed within 10 business days. And the average shipping times range between 5 and 10 business days:
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AU, NZ: 10 business days
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Rest of the world: 10 business days
The total delivery time from the moment you place your order until the package is delivered to your door is normally between three to four weeks.
To make shipping worldwide possible, all paintings are shipped as a carefully rolled up canvas, placed in a protective tube. For any other questions please contact us on firstname.lastname@example.com
100% Satisfaction Guaranteed
Get a full refund or a painting re-do if you find that your art piece didn't meet your expectations, or you were anyhow dissatisfied with it.


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eTickets.ca takes pride in offering you a seamless way to witness the electrifying performance of your favorite team or player, Alaska Anchorage Seawolves Our platform is designed to make your ticket purchasing experience hassle-free and enjoyable, with a wide range of options to suit all your sport needs.
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If you are buying a home or refinancing, you have probably heard about "mortgage points." This form of pre-paid interest can save you thousands of dollars over the course of your loan but in many circumstances is not worth the upfront cost. How do you know whether to pay points or not? Here's a quick guide to help you figure it out.
What are Mortgage Points?
Mortgage points – also known as discount points - are essentially a way to pay some of the interest upfront on your home loan. One point is equal to 1% of your mortgage amount. For example, one point on a $100,000 loan would be $1,000 or $2,000 on a $200,000. Mortgage points are paid directly to the lender in exchange for a lower interest rate. This is known as "buying down the interest rate."
Paying mortgage points can reduce both your monthly payment and the amount of interest you pay over the entire course of the loan.
There is no standard scale for rate reductions and points. Each lender decides how much one point will reduce your interest rate and their fee schedule can change depending on the rate climate. For example, one lender might lower your interest rate by a quarter percent for 1 point, while another might give you the same discount for 1.125 points.
When Does It Make Sense to Pay Points?
Paying points is all about saving money on your mortgage. Paying these upfront fees can make sense if:
- You already have a 20% down payment and extra cash to spare.
- You are applying for a fixed-rate, rather than an adjustable rate mortgage.
- Mortgage interest rates are rising or historically high.
- You plan to stay in your home for a long time to be able to enjoy the savings.
- You have extra cash now, but need a lower, more affordable monthly payment for the future.
How Much Should I Pay?
If paying some points makes sense in your situation, you will need to figure out the "break even" period to know how many points to pay. This is calculated by dividing the total dollar amount of points you plan to pay by the monthly mortgage savings the lower interest rate generates. So say you pay one point equal to $2000 and that will save you $30 a month on your mortgage. Your break-even point would be roughly 67 months or five-and-a-half years. That means you would need to stay in that home at least 6 years to start seeing any true savings. No matter how much you pay, the longer you stay in your home the better for taking advantage of those savings.
When Should I Not Pay Points?
Paying points is not a good idea if:
- You do not have a full 20% down payment. In this case you will have to pay for private mortgage insurance and that may negate any interest rate savings.
- You do not plan to stay in your home long. If you plan to sell in just a few years, paying all those upfront fees will not save you money.
- You are requesting an adjustable rate mortgage (ARM). Paying points on these loans usually only buys you a discount on the initial fixed-rate period when the interest rate is already lower. Because it often takes many years to break even on points, you may not end up seeing any savings.
- Market interest rates are near historic lows.
Call us at today at 410-798-6611 if you have any questions for one of our mortgage professionals. All of us at Colonial Mortgage Group are dedicated to helping you understand and make the best mortgage financing decisions for you and your family.


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Flowers for the Wedding Party
No matter how big or small your wedding party is, we've got just the thing to help everyone look their best. See our selection of boutonnieres, corsages and more. We'll make sure every member of your wedding party looks impeccable. To arrange an appointment, call us or fill out our consultation form today!