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2.

Generic name:
Epinephrine

1.
Classification:

Generic name:
Autonomic
nervous
2%
Lidocaine
system agent; alpha and
beta adrenergic agonist;
Classification:
bronchodilator
Antiarrhythmic,
Anesthetic (local and
Dosage
general) 1mL
1:1000mL
Dosage
5mL (100mg/5mL)

Indication/
Contraindication
Indications:
Indication/
o Temporary relief of
Contraindication
bronchospasm, acute
Indications:
attack,
o asthmatic
Pulseless ventricular
mucosal
congestion,
fibrillation
or
hypersensitivity
ventricular
and
tachycardia
anaphylactic
o reactions,
Sympathetic
nerve
syncope
block
due
to heart block or
carotid sinus
Contraindication:
o hypersensitivity,
Hypovolemia and
restore
cardiac
o to
Heart
block
or other
rhythm
in
cardiac
conduction
arrest.
distrubances

Mechanism of Action
Naturally occurring
catecholamine obtained
Mechanism
of Action
from
animal adrenal
glands; also prepared
is an amide type
local
synthetically.
Acts
anaesthetic.
It
stabilises
directly on both alpha
the neuronal
membrane
and
beta receptors;
the
and
inhibits
sodium
most potent activatorion
of
movements,
which are
alpha
receptors.
necessary formyocardial
Strengthens
conduction of
impulses.
contraction;
increases
In
the
heart,
lidocaine
systolic but may
reduces phase
4 blood
decrease
diastolic
depolarisation
and
pressure; increases
automaticity.
Duration
cardiac rate and cardiac
of action potential and
output.
effective refractory
period are also reduced

o Ophthalmic
preparation is used
in management of
simple (open-angle)
glaucoma, generally
as an adjunct to
topical miotics and
oral carbonic
anhydrase inhibitors;
also used as
ophthalmic
decongestant.

Drug

o Relaxes
myometrium and
inhibits uterine
contractions;
Indication/
prolongs
action and
Contraindication
delays systemic
absorption of local
and intraspinal

Side effect/Adverse
effect
Special Senses:
Nasal burning or
Side effect/Adverse
stinging,
dryness of
effectsneezing,
nasal mucosa,
Adversecongestion.
drug reaction:
rebound
Transient stinging or
oburning
Dizziness,
of eyes,
olacrimation,
Paraesthesia,
browache,
oheadache,
Drowsiness,
rebound
hyperemia,
oconjunctival
Confusion,
iritis; with
oallergy,
Respiratory
prolonged
use: melanindepression
deposits on lids,
olikeConvulsions.
conjunctiva, and cornea;
corneal
edema;
loss of
Potentially
fatal:
lashes
(reversible);
o Hypotension and
maculopathy
with
bradycardia
leading
central
scotoma
in
to cardiac arrest
patients
oaphakic
Anaphylaxis
(reversible).
Body as a Whole:
Nervousness,
restlessness,
sleeplessness, fear,
anxiety, tremors, severe
headache,
cerebrovascular
accident, weakness,
dizziness, syncope,
pallor, sweating,
dyspnea.
Digestive:
Nausea, vomiting.

Mechanism of Action

Cardiovascular:
Side effect/Adverse
Precordial
pain,
effect
palpitations,
hypertension, MI,
tachyarrhythmias
including ventricular

Nursing considerations
Monitor BP, pulse, respirations,
and urinary output and observe
Nursing considerations
patient closely following IV
administration. Epinephrine may
Special precaution:
widen pulse pressure. If
disturbances in cardiac rhythm
o Hepatic
or renal epinephrine
impairment and
occur, withhold
o CHF
and
following
cardiac
notify physician immediately.
o surgery
Keep physician informed of any
o Bradycardia
changes in intake-output ratio.
oo Respiratory
Use cardiac depression
monitor with patients
o Porphyria
receiving epinephrine IV. Have
full crash
immediately
o Elderly
or cart
debilitated
patients
available.
o Pregnancy
o
Check
BP repeatedly when
Drug
interactions
is administered
O epinephrine
Additive cardiac
effects withIV
IV
during
first
5
min,
then
q35min
phenytoin
until
stabilized.
O Effects
antagonized by
o Advise
patient caused
to report
hypokalaemia
byto
physician
if symptoms
are not
acetazolamide,
loop diuretics
relieved
in
20
min
or
if
they
and thiazides.
worse following
O become
Dose requirements
may be
inhalation.
increased with long-term use of
o Advise
patient
to report
bronchial
phenytoin
and other
enzymeirritation,
nervousness,
or
inducers.
sleeplessness. Dosage should be
reduced.Fatal:
Potentially
o
blood
& HbA1c
O Monitor
Cimetidine
andglucose
propranolol
for
loss
of
glycemic
control
if
increase plasma concentration
diabetic.
and toxicity.
O Increased risk of myocardial
depression with beta blockers
and other antiarrhythmics
o

Nursing considerations

Generic name:
Diazepam
Classification:
Benzodiazepine ,
Anxiolytic
Dosage
10mg/2ml

Indications:
o Anxiety disorders
o For the treatment of
agitation, tremors,
delirium, seizures,
and hallucinations
resulting from
alcohol withdrawal
o Treatment of
seizures and relief of
muscle spasms in
some neurological
diseases.
Contraindication:
o Pregnancy
o Nursing mothers
o Hypersensitivity
o Myasthenia gravis,
o Preexisting CNS
depression or coma
o respiratory
depression;
o acute pulmonary
insufficiency
o sleep apnoea
syndrome;
o severe hepatic
impairment;
o acute narrow angle
glaucoma;
o children <6 mth
(oral)

a long-acting
benzodiazepine with
anticonvulsant,
anxiolytic, sedative,
muscle relaxant and
amnestic properties. It
increases neuronal
membrane permeability
to chloride ions by
binding to
stereospecific
benzodiazepine
receptors on the
postsynaptic GABA
neuron within the CNS
and enhancing the
GABA inhibitory
effects resulting in
hyperpolarisation and
stabilization. GABA is
a neurotransmitter (a
chemical that nerve
cells use to
communicate with each
other) that inhibits
activity in the brain. It
is believed that
excessive activity in the
brain may lead to
anxiety or other
psychiatric disorders.

Most common:
o Drowsiness
o Fatigue
o ataxia (loss of
balance).
Rare
O Muscle spasm
O Confusion
O Depression
O Speech problems
O Double vision

o Can lead to addiction


(dependency), especially when
higher dosages are used over
prolonged periods of time.
o Diazepam is excreted in breast
milk and can affect nursing
infants. Therefore, diazepam
should not be used by women
who are nursing.
o Alcohol or medications that
cause sedation may add to the
sedative effects of diazepam.
Patients taking benzodiazepines
should avoid such combinations.
o The following drugs may
prolong the effects of diazepam
by inhibiting liver enzymes that
break down diazepam. Dosages
may need to be decreased when
these drugs are used with
diazepam.
Cimetidine (Tagamet)
Ketoconazole (Nizoral),
Omeprazole (Prilosec,
Rapinex),
Fluvoxamine (Luvox), and
Fluoxetine (Prozac)

Drug Name

Dosage & Route

Action

Indication

Adverse Effects

Contraindication

Nursing Responsibility

3.

ATROPINE

SULFATE
(a'troe-peen)

Atropair , Atropisol,
Isopto Atropine

Classifications:
AUTONOMIC NERVOUS
SYSTEM AGENT;
ANTICHOLINERGIC
(PARASYMPATHOLYTIC);
ANTIMUSCARINIC

Preanesthesia
Adult: IV/IM/SC
0.21 mg 3060
min before
surgery
Child: IV/IM/SC
<5 kg, 0.02
mg/kg; >5 kg,
0.010.02 mg/kg
3060 min before
surgery
Arrhythmias
Adult: IV/IM 0.5
1 mg q12h prn
(max: 2 mg)
Child: IV/IM 0.01
0.03 mg/kg for 1
2 doses
Organophospha
te Antidote
Adult: IV/IM 12
mg q560min
until muscarinic
signs and
symptoms
subside (may
need up to 50
mg)
Child: IV/IM 0.05
mg/kg q1030
min until
muscarinic signs
and symptoms
subside
COPD
Adult: Inhalation
0.025 mg/kg
diluted with 35
mL saline, via
nebulizer 34
times daily (max:
2.5 mg/d)
Child: Inhalation
0.030.05 mg/kg
diluted with 35

Acts by selectively
blocking all
muscarinic responses
to acetylcholine (ACh),
whether excitatory or
inhibitory. Selective
depression of CNS
relieves rigidity and
tremor of Parkinson's
syndrome.
Antisecretory action
(vagolytic effect)
suppresses sweating,
lacrimation,
salivation, and
secretions from nose,
mouth, pharynx, and
bronchi. Blocks vagal
impulses to heart with
resulting decrease in
AV conduction time,
increase in heart rate
and cardiac output,
and shortened PR
interval.

Adjunct in
symptomatic
treatment of GI
disorders (e.g., peptic
ulcer, pylorospasm, GI
hypermotility, irritable
bowel syndrome) and
spastic disorders of
biliary tract. Relaxes
upper GI tract and
colon during hypotonic
radiography.
Ophthalmic Use: To
produce mydriasis and
cycloplegia before
refraction and for
treatment of anterior
uveitis and iritis.
Preoperative Use: To
suppress salivation,
perspiration, and
respiratory tract
secretions; to reduce
incidence of
laryngospasm, reflex
bradycardia
arrhythmia, and
hypotension during
general anesthesia.
Cardiac Uses: For
sinus bradycardia or
asystole during CPR or
that is induced by
drugs or toxic
substances (e.g.,
pilocarpine, betaadrenergic blockers,
organophosphate
pesticides, and
Amanita mushroom
poisoning); for
management of
selected patients with
symptomatic sinus
bradycardia and
associated
hypotension and

CNS: Headache,
ataxia, dizziness,
excitement, irritability,
convulsions,
drowsiness, fatigue,
weakness; mental
depression, confusion,
disorientation,
hallucinations. CV:
Hypertension or
hypotension,
ventricular
tachycardia,
palpitation,
paradoxical
bradycardia, AV
dissociation, atrial or
ventricular fibrillation.
GI: Dry mouth with
thirst, dysphagia, loss
of taste; nausea,
vomiting,
constipation, delayed
gastric emptying,
antral stasis, paralytic
ileus. Urogenital:
Urinary hesitancy and
retention, dysuria,
impotence. Skin:
Flushed, dry skin;
anhidrosis, rash,
urticaria, contact
dermatitis, allergic
conjunctivitis, fixeddrug eruption.
Special Senses:
Mydriasis, blurred
vision, photophobia,
increased intraocular
pressure, cycloplegia,
eye dryness, local
redness.

Assessment & Drug


Hypersensitivity to
Effects
belladonna alkaloids;
synechiae; angle
Monitor vital signs. HR is a
closure glaucoma;
sensitive indicator of
parotitis; obstructive
patient's response to
uropathy, e.g., bladder
atropine. Be alert to
neck obstruction
changes in quality, rate,
caused by prostatic
and rhythm of HR and
hypertrophy; intestinal
respiration and to changes
atony, paralytic ileus,
in BP and temperature.
obstructive diseases of
GI tract, severe

Initial paradoxical
ulcerative colitis, toxic
bradycardia following IV
megacolon;
atropine usually lasts only
tachycardia secondary
12 min; it most likely
occurs when IV is
to cardiac insufficiency
administered slowly (more
or thyrotoxicosis;
than 1 min) or when small
acute hemorrhage;
doses (less than 0.5 mg)
myasthenia gravis.
are used. Postural
Safety during
hypotension occurs when
pregnancy (category
patient ambulates too
soon after parenteral
C) or lactation is not
administration.
established.

Note: Frequent and


continued use of eye
preparations, as well as
overdosage, can have
systemic effects. Some
atropine deaths have
resulted from systemic
absorption following
ocular administration in
infants and children.
Monitor I&O, especially in
older adults and patients
who have had surgery
(drug may contribute to
urinary retention). Palpate
lower abdomen for
distention. Have patient
void before giving
atropine.

mL saline, via
nebulizer 34
times daily
Uveitis
Adult/Child:
Ophthalmic 12
drops of solution
or small amount
of ointment in
eye up to t.i.d.

ventricular irritability;
for diagnosis of sinus
node dysfunction and
in evaluation of
coronary artery
disease during atrial
pacing

DRUG

4. Dobutamine
Hydrochloride

Generic Name

ACTION

Stimulates

heats beta1
receptors to
increase
myocardial
contractility
and stroke
volume. At
therapeutic
dosages, drug
increases
cardiac output
by decreasing
peripheral
vascular
resistance,
reducing
ventricular
filling
pressure, and
facilitating AV
node
conduction

Prescribed and

INDICATION

Increase cardiac

output in shorttern treatment of


cardiac
decompensation
cause by
depressed
contractility, such
as during
refractory heart
failure; adjunctive
therapy in cardiac
surgery

Mechanism of

CONTRAINDICATIO
N

ADVERSE
REACTION

Contraindicated

CNS:
headache
CV:
hypertension,
increased
heart rate

in patients
hypersensitive
to drug or its
components and
in those w/
idiopathic
hypertrophic
subaortic
stenosis

Indication

NURSING
RESPONSIBILTIES

PATIENT
TEACHING

Before

Tell patient

starting
therapy, give a
plasma
volume to
correct
hypovolemia
an a cardiac
glycoside
Continuously
monitor ECG,
blood
pressure,
pulmonary
artery wedge
pressure,
cardiac output
and urine
output

to report
adverse
reactions
promptly,
especially
labored
breathing
and druginduced
headache
Instruct
pati8ent to
report
discomfort
at I.V.
insertion
site

Contraindication

Adverse Reaction

Nursing

Recommended
Brand Name
Classifications

Dosage,
Frequency, and

Action

Responsibl

route of
Administration

5. Sodium
Bicarbonate

Arm & Hammer


Baking Soda, Neut,
Soda Mint

Acidifiers and
alkalinizing

; tab OD, oral

Restores buffering
capacity of the body
and utilizes excess
acid.

>cardiac arrest
>metabolic acidosis
>systemic or urinary
alkalinization
>antacid

>Contraindicated to
pts w/ metabolic or
respiratory alkalosis &
in those with
hypocalcaemia in w/c
alkalosis may
produce tetany,
hypertension,
seizures or heart
failure
>Also contraindicated
in pts losing chlorides
bec. of vomiting or
continuous GI suction
& receiving diuretics
that produce
hypochloremic
alkalosis

CNS: tetany

>Monitor pt clo
for toxicity and
affectiveness

CV: edema

GI: gastric
distention, flatulence

Metabolic:
hypokalemia,
hyponatremia

>Avoid using
NaHCO3 and e
coated drugs
together.

GENERIC NAME

6. Naloxone
hydrocholoride
BRAND NAME
Narcan
DOSAGE
Adult : 0.4 -2 mg IV
q2 to 3 mins.
p.r.n.

INDICATION

ACTION

Displaces
Known suspected
previously
narcotic induced
administered
respiratory
narcotic
depression
analgesics from
including that cause their receptors.
by pentazocine and Has no
propaxyphene
pharmacologic
activity of its
own

Classification: Antispasmodic

CONTRAINDICATION

Patient known to be
hypersensitive to
naloxone hydrochloride

SIDE EFFECTS/
ADVERSE REACTION

Tachycardia
Hypertension
Nausea
Vomiting
Tremors

NURSING CONSIDERATION

Safest drug to use when


cause respiratory depression
is uncertain.
Monitor respiratory depth and
rate. Be prepared to provide
O2, ventilation and
resuscitative measures.
Also been shown to improve
circulation in refractory shock

7. Generic Name
Tranexamic Acid
Brand Names
Lysteda
Cyklokapron
Classification
Therapeutic: hemostatic agents
Pharmacologic: fibrinolysis inhibitors
Indications and Usage

Patients with hemophilia for short-term use (two to eight days)

To reduce or prevent hemorrhage during and following tooth extraction.

Treatment of severe localized bleeding secondary to hyperfibrinolysis, including epistaxis, hyphema, or hypermenorrhea
(menorrhagia) and hemorrhage following certain surgical procedures

Treatment of hereditary angioedema

Mode of Action
Tranexamic acid competitively inhibits activation of plasminogen thereby reducing conversion of plasminogen to plasmin (fibrinolysin),
an enzyme that degrades fibrin clots, fibrinogen, and other plasma proteins, including the procoagulant factors V and VIII.
In patients with hereditary angioedema, inhibition of the formation and activity of plasmin by tranexamic acid may prevent attacks of
angioedema by decreasing plasmin-induced activation of the first complement protein (C1).
Dosage and Administration

Prevention and treatment of oral hemorrhage, including hemorrhage following dental surgery, in hemophilic patients

PO: Presurgical: 25 mg per kg of body weight every six to eight hours, beginning one day before the dental procedure.
Postsurgical: 25 mg per kg of body weight every six to eight hours for two to eight days after surgery

IV: Presurgical: 10 mg per kg of body weight, administered immediately prior to surgery.Postsurgical (for patients unable to take
medication orally): 10 mg per kg of body weight every six to eight hours for seven to ten days

Hemorrhage, hyperfibrinolysis-inducedepistaxis

PO: 1 to 1.5 grams three or four times a day for 10 days


IV: 15 mg per kg of body weight or 1 gram every six to eight hours

Angioedema, hereditary

PO: 1 to 1.5 grams two or three times a day.


Tranexamic Acid Oral Solution
A 5% oral rinse is prepared by diluting 5 mL of 10% tranexamic acid injection with 5 mL of sterile water
Drug Interactions
Anti-inhibitor coagulant complex or Factor IX complex:
Concurrent use may increase the risk of thrombotic complications
Contraceptives, estrogen-containing, oral or Estrogens:
Concurrent use with tranexamic acid may increase the potential for thrombus formation
Thrombolytic agents:
The actions of tranexamic acid and of thrombolytic agents are mutually antagonistic; although controlled studies to demonstrate its
efficacy have not been done in humans, tranexamic acid may be useful in treating severe hemorrhage caused by a thrombolytic agent
Side Effects

Nausea

Vomiting

Diarrhea

Hypotension

Thromboembolic, e.g., arterial, venous, embolic;

Neurologic, e.g., visual impairment, convulsions, headache, mental status changes; myoclonus;

Rash

Contraindications
Tranexamic acid is contraindicated in patients with:

hypersensitivity to tranexamic acid or any of the ingredients

acquired defective color vision, since this prohibits measuring one endpoint that should be followed as a measure of toxicity

subarachnoid hemorrhage

active intravascular clotting

Precautions

Pregnancy

Tranexamic acid crosses the placenta.

Breast-feeding

Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the maternal plasma concentration

Nursing Responsibilities
Before:

Monitor blood pressure, pulse, and respiratory status as indicated by severity of bleeding.

Monitor for overt bleeding every 1530 min.

Monitor neurologic status (pupils, level of consciousness, motor activity) in patients with subarachnoid hemorrhage.

Assess for thromboembolic complications.(especially in patients with history). Notify physician of positive Homans sign, leg
pain hemorrhage, edema, hemoptysis, dyspnea, or chest pain.

Monitor platelet count and clotting factors prior to and periodically throughout therapy in patients with systemic fibrinolysis.

During:

After:

Stabilize IV catheter to minimize thrombophlebitis. Monitor site closely.

Instruct patient to notify the nurse immediately if bleeding recurs or if thromboembolic symptoms develop.

Caution patient to make position changes slowly to avoid orthostatic hypotension.

GENERIC/
BRAND NAME &
CLASSIFICATION

DOSE,
STRENGTH &
FORMULATIO
N

INDICATION/
MECHANISMS OF
DRUG ACTION

ADVERSE/ SIDE
EFFECTS
DRUG
INTERACTION

NURSING
RESPONSIBILITIE
S

RATIONALE

CLIENT
TEACHING

Check doctors
order.

- To prevent
medication error.

Let the patient


verbalize her
name.

- To correctly
identify the
patient so as to
prevent error.

1. Do not
perform activities
that require
mental alertness;
drug may cause
drowsiness and
impair mental or
physical
performance.
Alcohol may
intensify drug
effects.

8.
Generic:
tramadol
hydrochloride

Brand: Ultram

Classification:
CENTRAL
NERVOUS SYSTEM
(CNS) AGENT;
ANALGESIC;
NARCOTIC
(OPIATE) AGONIST

Ordered: 50
mg IVTT

Timing: every
6 hours

Duration:

Other forms:
tablets: 50 mg

Indications:
Management of
moderate to
moderately severe
pain.

Mechanism of
action:
A centrally acting
analgesic not related
chemically to
opiates. Precise
mechanism is not
known. Two
complimentary
mechanisms may be
applicable: It may
bind to muOpioid receptors and
inhibit reuptake or
norepinephrine and
serotonin. The
analgesic effect is
only partially
antagonized by the
antagonist naloxone.
Causes significantly
less respiratory
depression than

CNS: dizziness,
vertigo,
headache,
somnolence, CNS
stimulation,
anxiety,
confusion,
incoordination,
euphoria,
nervousness,
sleep disorders,
seizures,
paresthesia,
cognitive
dysfunction,
hallucinations,
tremor, amnesia,
concentration
difficulty,
abnormal gait,
migraine,
development of
drug
dependence,
speech disorders,
depression,
increased risk of
seizures.
GI: Nausea,
constipation,
vomiting,

Explain the
possible side
effects of the drug.

- So that the
patient will not
be knowledge
deficit about the
medication she is
taking.

- Keeping patient
well- hydrated
reduces risk of
nephrotoxicity.

Monitor any
changes in intake
and output of the
patient.

- To indicate
patients baseline
data and monitor
drugs

2. Report lack of
response. Review
list of side effects
(nausea,
dizziness,
constipation)
that one may
experience and
report if
persistent or
intolerable.
3. Advise patient
to avoid alcohol
while taking
tramadol.

morphine. In contrast
to morphine,
tramadol does not
cause release of
histamine. Produces
dependence of muopioid type (i.e., like
codeine or
dextropropoxyphene)
; however, there is
little evidence of
abuse. Tolerance
occurs but is
relatively mild; the
withdrawal syndrome
is not as severe as
with other opiates.
Rapidly absorbed
after PO
administration. Food
does not affect the
rate or extent of
absorption.

dyspepsia, dry
mouth, diarrhea,
abdominal pain,
anorexia,
flatulence, GI
bleeding,
hepatitis,
stomatitis,
dysgeusia, liver
failure.
CV: Vasodilation,
syncope,
orthostatic
hypotension,
hypertension,
tachycardia,
abnormal ECG,
myocardial
ischemia,
palpitations,
pulmonary
edema/
embolism.
Dermatologic:
pruritus,
sweating, rash,
urticaria,
vesicles, StevensJohnson
syndrome, toxic
epidermal
necrolysis.
Body as a
whole: asthenia,
malaise, allergic
reation,
accidental injury,
weight loss,
suicidal tendency.
GU: urinary
retention/

effectiveness.

Assess patients
infection before
therapy and
regularly
thereafter.

Be alert for signs


and drug
interactions like
fever and rashes,
notify physician
immendiately.

Assess patients
and familys
knowledge of drug
therapy.

Avoid giving
tramadol to
patients with acute
abdominal
conditions.

- To establish
proper
precationary
measures and
management for
possible adverse
effects of the
drug.

- To know
patients and
familys
knowledge about
the drug.

- It may mask
evidence and
disrupt
assessment of
the abdomen.

4. Urge
caregivers to
watch patient
closely for
evidence of
suicidal
tendencies,
especially when
therapy starts or
dosage changes
and to report
concerns at once
to prescriber.

frequency,
menopausal
symptoms,
dysuria,
menstrual
disorder.
Ophthalmic:
miosis, visual
disturbances,
cataracts.
Miscellaneous:
anaphylaxis,
deafness,
tinnitus,
hypertonia,
dyspnea,
serotonin
syndrome.

Drug
Interaction:
Alcohol/ increase
respiratory
depression.
Anesthetics,
general/ increase
respiratory
depression.
Carbamazepine/
decrease
tramadol effect
R/T increase
metabolism.
CNS depressants/
Additive CNS
depression.
Cyclobenzaprine/

increase risk of
seizures.
Digoxin/ increase
risk (rare) of
digoxin toxicity.
MAO Inhibitors/
increase risk of
seizures.
Naloxone/
increase risk of
seizures if
naloxone used for
tramadol
overdose.
Promethazine/
increase risk of
seizures.
Quinidine/
increase levels of
tramadol and
decrease levels
of M1 R/T
inhibition of
metabolism.
SSRIs/ increase
risk of seizures
and increase risk
of serotonin
syndrome.
Tricyclic
antidepressants/
increase risk of
seizures.
Warfarin/
increase PT and
INR.

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