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Pharm II unit 2
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172
Nursing
Undergraduate 1
09/10/2011

Additional Nursing Flashcards

 


 

Cards

Term
Drugs affecting hematopoiesis involves medications that _____ cell growth.
Definition
stimulate 
Term
Hematopoiesis is the production and differentiation of What? 
Definition
blood cells such as red blood cells, white blood cells and platelets
Term
Production and maturation of blood cells  occurs in the _____  and is stimulated by ______ growth factors.
Definition
bone marrow, hematopoietic 
Term
What are the hematopoietic growth factors that stimulate RBC?
Definition
Epoetin Alfa, brand name Epogen or Procrit
Term
What are the hematopoietic growth factors that stimulate WBC
Definition
Filgrastim, brand name Neupogen
Term
What are the hematopoietic growth factors that stimulate platelets
Definition
oprelvekin or interleukin-1, brand name Neumega
Term
which cells are composed of hemoglobin, that carries oxygen to the cells in the body?
Definition
RBC
Term
What is the main peptide hormone that stimulates the production of red blood cells?
Definition
erythropoietin 
Term

What is Erythopoiesis?

 

Definition
the act of stimulating the production of red blood cells by erythropoietin.
Term
____________ is produced by the kidneys when tissues become hypoxic.  
Definition
Erythropoietin 
Term

_______ are involved in blood coagulation.

 

Definition
platelets
Term
Platelet production is naturally stimulated by 
Definition
interleukin-6 and a peptide called thrombopoietin
Term
Thrombopoietin is produced in the____ and is released when platelet counts are ____.
Definition
 liver, low
Term
White blood cells differentiate into What three main cells.  
Definition
granulocytes, monocytes or lymphocytes
Term
Granulocytes are further divided into what three cell types? 
Definition
neutrophils, bosophils or eosinophils
Term
What is the most abundant Granulocyte?
Definition
neutrophils
Term

What is the formation of granulocytes called?

 

Definition
myelopoiesis
Term

What is myelopoiesis stimulated by?

 

Definition
cytokines
Term

What cells are produced in response to infection, inflammation, and tissue damage or necrosis.

Definition
White blood cells 
Term
What are the physical barrier defense mechanisms to protect it from the invasion of pathogenic microorganisms?
Definition
intact skin and mucous membranes and acidity.    
Term
Should pathogens overcome one of the physical defense barriers to injure cells, the body responds by:
Definition
activating the nonspecific inflammatory reaction
Term

The activating the nonspecific inflammatory reaction includes activation of:

 

Definition

granulocytes and macrophages


to destroy foreign antigens and repair tissue damage

Term
____________ are the first line of defense against pathogenic organisms.
Definition
Neutrophils 
Term
When an acute bacterial infection is present in the body the number of __________  rises dramatically
Definition

neutrophils 

 


This rise in neutrophils includes both mature and immature (bands)

 

 

 

 

Term
When a significant number of immature neutrophils exists what is it called?
Definition
“shift to the left,”
Term
What does a “shift to the left,” indicate?
Definition
and usually indicates the patient has a bacterial infection
Term
What is it called, when the neutrophil count is low?
Definition
neutropenia 
Term

What is neutropenia an indication of?

 

Definition

the patient is at greater risk for infection.

Term
Should a pathogenic microorganism get past the physical barriers and nonspecific immune system How will the body protect itslef?
Definition

a specific immune response involving T and B lymphocytes is initiated.

Term

What is hematopoietic failure?

 

Definition

the inadequate production of cells to meet the body’s need for oxygen transportation, blood coagulation, and/or prevention of infection.

Term
What is first pathophysiologic consequence of hematopoietic failure?
Definition
anemia
Term
What is Anemia?
Definition
a condition that involves a reduced number or circulating red blood cells.  
Term

What can Anemia be caused by?

 

Definition

lack of folic acid, iron, erythopoietin or bone marrow suppression.  Or, anemia can be the result of red blood cell hemolysis or through the loss of blood volume.  

Term

Anemia caused by the lack of

erythropoietin can be treated with: 

Definition

exogenous erythropoietin or epoetin alfa.

Term

What is the 2nd pathophysiologic consequence of hematopoietic failure?

 

Definition
neutropenia
Term
What is neutropenia?
Definition
a condition that involves a significant reduction in circulating neutrophils
Term
what is neutropenia typically caused by? 
Definition

decreased bone marrow activity and

reduces neutrophil survival.  

Term
When neutropenia is related to decreased bone marrow activity, it is usually caused by: 
Definition

drug therapy such as antineoplastic agents.

Term

What is the final pathophysiologic consequence

of hematopoietic failure?

Definition
thrombocytopenia
Term
What is thrombocytopenia?
Definition

a condition that involves a low platelet count


a result of decreased production, shortened survival, or loss of platelets

Term
_________ stimulants are hematopoietic growth factors that replace endogenous growth factors
Definition
Erythropoiesis 
Term
When are Erythropoiesis stimulants used?
Definition
when the body is unable to produce sufficient blood cells to meet the body’s demand because of a lack of growth factor.  
Term
The prototype drug used to stimulate the production of red blood cells is: 
Definition
epoetin alfa
Term
Epoetin alfa, also known as: 
Definition
erythropoetin or EPO
Term

What is Epoetin alfa commonly used to treat?

 

Definition
anemia secondary to chronic renal failure
Term
The use of epoetin alfa decreases the need for ____ _______, as it elevates or maintains the red blood cell count to adequate levels.
Definition
blood transfusions
Term
Epoetin alfa is also used to treat anemia related to: _
Definition

zidovudine theripy

(Zidovudine is an antiviral medication that prevents human immunodeficiency virus (HIV) cells from multiplying in your body.)

 

chemotherapy induced anemia in cancer

 and patients who are high risk for substantial surgical blood loss.

 

Term
How is Epoetin alfa administered?
Definition
either intravenously or subcutaneously
Term

How is Epoetin alfa Eliminated?

 

Definition
through the kidneys, but is not affected by dialysis
Term

Epoetin alfa has the same effect on the body as endogenous erythropoietin.


True or Fales?

Definition
True
Term
In patients with chronic renal failure,What is  the first sign that epoetin alfa is effective? 
Definition
an increase in reticulocyte count or immature red blood cells.  
Term
What are other important factors that effect the rate and extent of epoetin alfa effectiveness?
Definition
availability of iron stores, baseline hematocrit and any concurrent illnesses
Term

What type of pts should not use epoetin alfa?

 

Definition

uncontrolled hypertension

patients with hypersensitivity to mammalian cell-derived products or human albumin


patients with chronic renal 

Term
Why should the use of epoetin alfa  be avoided in patients with uncontrolled hypertension?
Definition
blood pressure may rise during therapy, especially during the early phase of treatment.
Term

Why should the use of epoetin alfa  be avoided in

patients with chronic renal failure?  

 

Definition
The risk of thrombotic events such as myocardial infarction, transient ischemic attacks, or cerebral vascular accidents can occur in patients with chronic renal failure who are receiving epoetin alfa treatment
Term
Before starting a pt on Epoetin alfa the nurse should  verify that the anemia is not secondary to: 
Definition

to iron or folate deficiency, hemolysis, or bleeding.


As these anemias are treated differently.

Term
It is important for the nurse to assess whether the patient has pre-existing vascular disease, as epoetin alfa may increase the patient’s risk for: 
Definition
developing adverse thrombolic events
Term

Why should a nurse determine the patient’s iron status before starting epoetin?

 

Definition

iron is needed to support erythropoiesis.

Term

To maximize therapeutic effect and maintain the biologic activity of epoetin alfa, it is important that the nurse knows this about epoetin alfa?

 

Definition
not to shake the drug after reconstituting the medication
Term

Vigorous _____ of epoetin alfa can denature the glycoprotein, which makes it biologically inactive.

Definition

shaking

Term
Single-dose 1 ml vials of epoetin alfa do not contain ______. 
Definition

preservatives 

so it is important to discard any unused portion.

Term
What shoul the nurse assess the patient for throughout epoetin alfa therapy?
Definition

hematocrit


blood pressure for hypertension 

Term
What should the nurse educate the pt about epoetin alfa?
Definition

purpose of the drug 

the need for follow-up hematocrits


increase iron intake to aid in the effectiveness of the drug 

iron is best absorbed with ascorbic acid

iron should not be taken with phosphate binders.


 

Term
______ is a granulocyte colony-stimulating factor (G-CSF) and the prototype drug that stimulates the production of white blood cells.  
Definition

Filgrastim or (Neupogen)

 

Term
What are Colony-stimulating factors?
Definition
glycoproteins that initiates the proliferation and differentiation of blood cells.
Term
What is Filgrastim or Neupogen used for
Definition

cancer patients to increase their neutrophil counts

patients with non-myeloid malignancies and who are receiving meylosuppressive chemotherapy

Term
Filgrastim is used to increase ______ counts and reduce the patients risk of ______  associated with neutropenia.
Definition
neutrophil , infection
Term
How isFilgrastim administered? 
Definition

as a single daily subcutaneous injection,

short intravenous infusion (over 15-30 minutes) or

by continuous subcutaneous or intravenous infusion.

Term
What is the only contraindication to filgastrim?
Definition
hypersensitivity to the drug
Term

What is the only consistently reported adverse  

side effect of filgastrim?

Definition
medullary bone pain
Term

To maximize the therapeutic effects of filgastrim it is important for the nurse to keep the medication atroom temperature  and allow the drug to reach refrigerated temperature before administration. 

True or Fales?

Definition

Fales.

 

To maximize the therapeutic effects of filgastrim it is important for the nurse to keep the medication refrigerated and allow the drug to reach room temperature before administration. 

Term
It is important for the nurse to dilute filgastrim in what and why? 
Definition

5% dextrose with albumin to prevent absorption by plastic materials.


Absorption into plastic materials such as IV container and tubing. 

Term
 It is imperative not to dilute filgastrim in normal saline, Why?
Definition
 as this will cause the drug to precipitate causing a physical inconpatibility.
Term
Should the nurse shake filgastrim why or why not?
Definition
the nurse should not shake the drug, as this will damage the glycoprotein
Term
filgrastim should be administered with the ___ cycle of  _________ for those patients at risk for febrile neutropenia or low neutrophil counts.
Definition
first, chemotherapy
Term

Filgastrim is preservative free and requires that the nurse discard any vial that has been at room temperature for more than 24 hours.


True or Fales? 

Definition
True.
Term

filgastrim is a multi-dose vial and that unused medication should be refrigerated.  


True of Fales?

Definition

Fales

 

filgastrim is a single-dose vial and that unused medication should be discarded.

 

Term

filgastrim

patient and family education :

Definition

Neutropenic patients are at extreme risk for infection

importance of frequent handwashing, avoiding crowds and avoiding people with illnesses.

Term
What is important for the nurse to closely monitor the patients for throughout treatment with filgastrim?
Definition

temperature- may indicate an infection


white blood cell count - to evaluate relative risk of infection and effectiveness of treatment.


Term
Oprelvekin stimulates the production of what? 
Definition

platelet

and is the prototype for interleukins

Term
What is Oprelvekin or Neumega used to treat ?
Definition
severe thrombocytopenia or low platelet counts 
Term
What is Oprelvekin or Neumega  useful in reducing the need for? 
Definition

platelet transfusions (FFP)

 

 

Term
what type of pt is Oprelvekin or Neumega  used?
Definition

for patients with

myelosuppressive chemotherapy 

nonmyeloid malignancie

Term
how is Oprelvekin or Neumega given?
Definition
once daily subcutaneously 
Term
What is Oprelvekin’s primary hematopoietic function?
Definition

to stimulate the production of megakaryocytes and thrombopoietin, both of which stimulate the production of platelets.

Term
What is only contraindication to oprelvekin? 
Definition

hypersensitivity to the drug or any of its components.

Term
What are most commonly reported and serious adverse effect of oprelvekin? 
Definition

fluid retention -weight gain, peripheral edema, dyspnea, hemodilution, and an increased incidence of pleural effusion


Fluid overload- can lead to cardiovascular complications such as tachycardia, palpitations, syncope, and atrial dysrythmias.

Term
What should the nurse to assess the patient for before starting a pt on oprelvekin?
Definition
congestive heart failure, pleural or pericardial effusion, as these are potential complications due to fluid retention 
Term

What should the nurse to assess the patient for during oprelvekin theripy?

Definition

cardiac status

(atrial fibrillation and flutter )

Term

True or Fales?

 

It is important for the nurse to keep

the powdered drug (oprelvekin) and diluent refrigerated.

Definition
True
Term

it is important to keep oprelvekin out of direct light


True or fales?

Definition
True
Term
What is Oprelvekin reconstituted with?
Definition

preservative free, sterile water for injection diluent

that is provided with the drug.  

Term

Why must the nurse not shake or

agitate the vial of Oprelvekin?

 

Definition
this can denature the protein and alter the effectiveness of the medication. 
Term
How should the nurse mix Oprelvekin?
Definition

.  The nurse should gently swirl the vial or slowly roll vial between hands.

Term

Why is it important for the nurse not to reenter or

reuse single dose oprelvekin?

Definition

because neither the drug nor the sterile water used to dilute the medication contains preservative

 

 

 

 

 

it will go bad 

 

 

Term

when must oprelvekin be administed by

after reconstitution?

Definition
within 3 hours of reconstitution
Term

What must the nurse to closely monitor through Oprelvekin

  treatment?

Definition

platelet count - until greater than or equal to 50,000 cells/mm3.


bleeding- include petichiae, echymosis and guiac positive stools

 

Term
Drugs affecting immune response involve biologic modulators, are also called what?
Definition
biologic modifiers
Term
What goup of drugs alter the body’s immunologic responses?
Definition
biologic modifiers
Term

How are Biologic modulators or modifiers classified?

 

Definition
by their specific biologic mechanism of activity and by whether they suppress or stimulate the immune system.  
Term
What are three kinds of drugs that alter biologic activity?
Definition
cytokines, antibodies and immune modulators
Term

What are Cytokines?

 

Definition
immunologic toxins produced by white blood cells in response to foreign antigens. 
Term

What is the prototype cytokine drug?

 

Definition
interferon alfa-2a, brand name Roferon-A, 
Term

What is interferon alfa-2a, brand name Roferon-A

used for?

Definition

used to treat certain leukemia and autoimmune disorders.

Term

What two type of Antibodies

  are there in drug theripy?

Definition
polyclonal or monoclonal
Term
What are Monoclonal antibodies used for? 
Definition
used and have been engineered to attach to tumor cells for diagnosis or treatment of malignancies or to target T lymphocytes to cause immunosuppresion.  
Term
What is the prototype monoclonal antibodie?
Definition

rituximab, brand name Rituxan.  

Term

 Immune modulators are a group of several

drugs that are used for what?

 

Definition
to alter T and B cell or lymphocyte activity.  
Term
what is the Immune modulator prototype drug?
Definition

cyclosporine

brand name: Sandimmune, Neoral and SangCya.

 

Term
What are the immunologically active tissue and cells, in the lymph system?
Definition

spleen, liver, lungs, gastrointestinal tract and brain

 

hemopoietic cells, such as lymphocytes, Leukocytes

Term
___________ or white blood cells are the main component to all immune responses.
Definition
Leukocytes
Term
A _____  immune response is initiated when foreign antigens, such as a virus, is able to get past the ______ barriers and overcome _______  immunity. 
Definition
specific, physical, nonspecific
Term
A specific immune response involves activation of what cells?
Definition
T and B lymphocytes, also called T and B cells
Term
T cells mature in the thymus to develop into what 3 types of cells?
Definition

 cytotoxic T cells

 

helper T cells

 

suppresor T cells

Term
Waht is the roll of the cytotoxic T cells (CD 8)
Definition
 attack foreign antigens using lymphokines
Term
What is the roll of the helper T cells ( CD 4)
Definition
T cells that stimulate more T lymphocyte production
Term
what is the roll of suppresor T cells?
Definition
slow down the T cell reaction
Term
T cell activity is referred to as what?
Definition
cellular immunity.
Term
B cells respond to a specific foreign antigen by producing what?
Definition
antibodies or immunoglobulins
Term
B cell activity is referred to as:
Definition
humoral immunity.
Term

B cells-

 When the antibodies react with the foreign antigen, an antigen-antibody complex is forms which enables the complement to do what?

Definition

further destroy the foreign antigen.  

 

****This reaction also induces chemotaxis, which makes the foreign antigen more attractive for phagocytosis.

Term
What chemicals are critical to a specific immune response and what they do?
Definition

interferons-prevent viral replication and suppress malignant cells and tumor growth

 

interleukins- activates more T and B cells.

 
Term

Initially, B lymphocytes, also called B cells, produce antibodies to attack a specific foreign antigen.  After this initial response, the B cells produce memory B cells that are able to immediately produce antibodies whenever a foreign antigen is encountered.  

 

This is referred to as what?

Definition

active immunity

 

***and is the basis of immunizationing against various viral infections.

Term
Cytokines generally enhance an _______ response
Definition
inflammatory 
Term
many _________ have antiviral, antiproliferative and antineoplastic qualities.
Definition
Cytokines
Term
Both interferons and interleukins are _____  produces by a ________.
Definition
cytokines, activated lymphocytes
Term
What is Interferon Alfa 2A used to treat?
Definition

malignancies: Kaposi sarcoma, chronic myelogenous leukemia. 


viral infections: hepatitis C and cytomeglovirus. 

Term
How is Interferon Alfa 2A typically administered?
Definition

subcutaneously or intramuscularly,

although intravenous administration is indicated in some instances.

Term
How does Interferon Alfa 2A creat an action on the body?
Definition

by inhibiting the growth of tumor cells and by blocking the replication of a virus in the body.

Term
Interferon Alfa 2A should not be used when: 
Definition

a history of hypersensitivity to interferon or its components exists. 

 during pregnancy or lactation should be avoided.

Term

What is a common side effect of interferon alfa 2A?

 

Definition

hypothyroidism, as it may occur in up to 10% of cases.

Term
Why is it  important for the nurse to note other drugs that the patient is taking during treatment with interferon alfa-2A?
Definition

An increased incidence of theophylline toxicity occurs if the patient is taking interferon alfa 2A at the same time as theophylline.


**Theophylline is used to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases

Term

Interferon alfa-2A can cause toxicity when combined with drugs that are neurotoxic, hematotoxic and cardiotoxic.

what is this due to?

Definition
This toxicity is due to the inability of the body to clear similer drugs  through the liver
Term
Prior to administering interferon alfa-2A it is important for the nurse to assess the patient for what conditions? 
Definition

cardiovascular, pulmonary and neurological disorders,


as these conditions may exacerbate the adverse effects of this treatment. 

hypothyroidism (before and after)

 

 

 

Term

Why is it  important to assess the patient’s blood glucose before/ during/ after  administering interferon alfa-2A?

  

Definition
glucose intolerance is a common effect of interferon alfa-2A.  
Term
After administering interferon alfa-2A it is important for the nurse to assess the patient for what?
Definition

glucose intolerance 

hypothyroidism- T3 T4 TSH

bone marrow suppression- CBC

 liver damage-  liver function tests

Term

the nurse to obtain baseline blood counts and chemistries

prior to administering interferon alfa-2A


These include:

Definition
white blood cell counts, red blood cell counts and platelet counts.
Term

Why is isimportant for the nurse to ensure adequate sleep and proper nutrition for the pt on interferon alfa-2A?

 

Definition
to enhance the patient’s immunologic function.
Term

It is important for the nurse to follow treatment guidelines such as premedicating patients with drugs to reduce the adverse side effects of the drug. 


Premedication drugs include:

Definition

acetaminophen-Tylenol 

diphenhydramine- Benadryl


*to reduce flu-like effects of interferon alfa-2A.

Term
.  Why  is it prudent to administer interferon alfa-2A injections in the evening?
Definition
so that the patient can sleep through most of the adverse side effects of the drug
Term

T/F

 

During treatment (interferon alfa-2A ) the patient should observe infection precautions.

Definition
TRUE
Term
What areAntibodies used to suppress?
Definition
immune cell type or receptor site.  
Term
Monoclonal antibodies are used to react with what? 
Definition
a specific tumor receptor site to diagnose or treat a malignancy
Term
The prototype monoclonal antitumor antibody is call: 
Definition

rituximab

brand name Rituxan.

Term
What is Rituximab used to treat?
Definition

several different kinds of cancer and a variety of autoimmune disorders.

Term

How is rituximab administrered?

 

Definition
a slow intravenous infusion
Term
What is the only contraindication to rituximab?
Definition

hypersensitivity or anaphylaxis to the drug or any of its components


epecially murine proteins.

Term

What are the infusion related adverse effects of rituximab?

 

Definition

respiratory distress and hypotension


occur in up to 80% of all patients

Term

What patients are advised not to have of any type during treatment with rituximab?


Why?

Definition

 vaccines


because of potential drug interactions and risk for allergic and anaphylactic reactions.


Term

Before stating rituximab what is important for the nurse to assess for in the  patient?

Definition

pre-existing cardiac

 respiratory problems 


***This drug should be administered cautiously in patients with these types pre-existing conditions

Term
common adverse effects of rituximab include:
Definition

cardiac dysrythmias, angina, hypo and hypertension and worsening respiratory status.

Term
What is Rituximab is mixed in?
Definition
either normal saline or dextrose solutions in a plastic bag
Term

Why should mixing Rituximab

 in a glass container be avoided?

Definition

the antibodies adhere to glass and alters the amount of drug administered.

Term

All antibodies can produce allergic reactions.


True or fales

Definition
True
Term

As a reslute of all antibodies can produce allergic reactions,


What are the usual

administration guidelines for  Rituximab?

Definition

premedicating: acetaminophen and diphenhydramine,

 emergency resusitation equipment: corticosteroids, and adrenaline readily available. 

It is important for patients with cardiac and respiratory risk factors to have continuous cardiac monitoring and frequent assessment during infusion.

Term
What are Immune modulators?
Definition
drugs that act directly on the function of T and B lymphocytes by either suppressing or stimulating the immune response.  
Term

What is the prototype for Immune modulators?

 

Definition

cyclosporine (Sandimmune and Neoral)

 

Term
How does cyclosporine have an effect on the body?
Definition
suppress the immune system by  blocking  the normal function of the immune system in the body.  
Term
What types of pts need cyclosporine?
Definition

organ transplantation to prevent the body’s immune system from destroying the grafted foreign tissue, such as a transplanted kidney, and in

autoimmune disorders, in which the body attacks its own tissue.

Term
What drug is typically given in conjunction with Cyclosporine?
Definition
corticosteroids
Term
Cyclosporine is contraindicated in patients with: 
Definition

hypersensitivity to castor oil


Kidny disfunctions- there is a significant risk for nephrotoxicity

 

Term

What are the most common adverse side effects of cyclosporine?

 

Definition

renal damage, tremors, hirsutism, hypertension, and gingival or gum hyperplasia


risk for malignancies, especially that of skin cancer, is increased


Hirsutism is a condition where women have excess facial and body hair that is dark and coarse.  

Term
It is important for the nurse to assess what as a baseline and as therapy continues.  
Definition

hepatic and renal function

CBC and differential 

blood pressure 

tremors, seizures, mental status, visual disturbances

Term
If a pt on cyclosporine has newly reported tremors, seizures, mental status, visual disturbances what is it an indication of?
Definition
these are signs and symptoms of neurotoxicity, which is indicative of high blood levels of cyclosporine.
Term
What kind of diet increases the bioavailability of this drug and can lead to high blood levels of cyclosporine?
Definition

A high fat diet 


Therefore, it is important for the nurse to assess the patient’s fat intake.

Term

The nurse should monitor blood levels of cyclosporine to avoid toxicity.


True or Fales? 

Definition
True
Term
How is Cyclosporine administered?
Definition

intravenously,

however, the oral form should be used as soon as possible to achieve steady blood levels

Term

The nurse should never mix oral cyclosporine with  

any type of juice.


True or Fales?

Definition

Fales

 

The nurse should mix oral cyclosporine with a juice to increase the palatability

 

However, this medication should not be refrigerated or mixed with grapefruit juice

 

Term

It is important for the patient to not take cyclosporine with foods, especially foods high in fat.


True or Fales?

Definition
True
Term

Wah should the nurse do if the boold test of Cyclosporine

 comes bake high or there are sings of toxicity?

Definition
The drug should be held and the physician notified 
Term

After the adminastation of Cyclosporine what are the interventions the nurse should have in place?

 

Definition

protect the patient from exposure to infection

assess the patient for neurotoxicity and hypertension.

Term

Waht teaching should a nurse

give to a pt on Cyclosporine?

Definition
Teach patient to avoid sun exposure due to the increased risk of skin malignancies
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