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CSEMS Protocols
Medications
121
Health Care
Undergraduate 1
09/25/2011

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Term
ALBUTEROL GENERIC NAME/TRADE NAME
Definition
GENERIC: Albuterol
TRADE: Airet, Proventil, Repetabs,Respirol, Ventolin, Volmax, Combivent (with Ipratroprium)
Term
ALBUTEROL CHEMICAL/THERAPEUTIC CLASS
Definition
Sympathomimetic amine; Beta 2 adrenergic agonist.
Antiasthmatic, bronchodilator
Term
ALBUTEROL ACTION
Definition
Selective Beta 2 adrenergic agonist with minimal number of side effects. Prompt bronchodilation, duration of +/- 5 hours.
Term
ALBUTEROL PHARMACOKINETICS
Definition
Onset 5-15 minutes.
Peak 1 - 1 1/2 hours.
Duration 4-6 hours.
T 1/2 = 2 1/2 - 4 hours
Term
ALBUTEROL INDICATIONS
Definition
1. Bronchial asthma.
2. Reversible bronchospasm associated with chronic bronchitis and emphysema.
3. Anaphylactic respiratory distress.
Term
ALBUTEROL CONTRAINDICATIONS
Definition
1. Hypertension - SBP > 180
2. Tachycardia - HR > 140 adult; >180 peds
3. Severe cardiac disease (chest pain that could be MI
4. Hypersensitivity
Term
ALBUTEROL PRECAUTIONS
Definition
1. Hyperthyroidism
2. Diabetes mellitus
3. Convulsive disorders
Term
ALBUTEROL SIDE EFFECTS
Definition
CNS - dizziness, headache stimulation, tremors
CV - chest pain, dysrhythmias, hypertension, palpitations, tachycardia
GI - nausea, vomiting
Term
ALBUTEROL ADMINISTRATION
Definition
Small volume nebulizer with O2 6-10lpm.
Adult - 2.5mg 3.0mL in 0.083% solution by mouthpiece or face mask Q10 min x 4 max
Peds - same by mask or blow-by
Term
ALBUTEROL SUPPLY
Definition
Unit dose vials containing 2.5ml in 3mL
Term
ALBUTEROL NOTES
Definition
1. Possibility of side effects increases with other sympathetic agonists.
2. Beta blockers may blunt the effect of albuterol
3. Albuterol also comes in metered-dose inhalers delivering 90mcg per inhalation
4. Overdose can cause bronchial constriction and possibly death.
Term
ASPIRIN GENERIC/TRADE NAME
Definition
Aspirin
Bayer, Bufferin, Ecotrin
Term
ASPIRIN CHEMICAL/THERAPEUTIC CLASS
Definition
Salicylate deriviative
Antiplatelet agent
Term
ASPIRIN ACTIONS
Definition
Aspirin blocks the formation of the substance thromoboxane Alpha2, which causes platelets to aggregate and ateries to constrict. Reduces mortality associated with MI. Reduces rate on nonfatal reinfarction and nonfatal stroke.
Term
ASPIRIN INDICATIONS
Definition
Chest pain suggestive of acute MI.
Term
ASPIRIN CONTRAINDICATIONS
Definition
1. Hypersensitivity to aspirin, NSAIDS and tartrazine (FDC yellow dye #5)
2. Bleeding disorders including GI hemorrhage and hemophilia
3. Hemorrhagic states.
Term
ASPIRIN PRECAUTIONS/PREGNANCY CATEGORY
Definition
Children or teenagers with flu-like symptoms, which may be associated with development of Reye's Syndrome.
Pregnancy category C.
Term
ASPIRIN SIDE EFFECTS
Definition
GI - GI bleeding heartburn, nausea
HEME - prolonged bleeding time
Term
ASPIRIN INTERACTIONS
Definition
When administered together, aspirin and anti-inflammatory agents may cause increased incidence of side effects and increased blood levels of both drugs.
Administration with antacids may reduce drug level from decreased absorption.
Term
ASPIRIN ADMINISTRATION/SUPPLY/NOTES
Definition
Give four 81mg chewable tablets (324mg total dose) PO asap after onset of chest pain.
81mg low dose chewable tablets
Must complete CSEMS local protocols to be authorized to administer
Term
DEXTROSE GENERIC/TRADE NAME
Definition
Dextrose.
Glucose, Glutose, Insta-Glucose
Term
DEXTROSE CHEMICAL/THERAPEUTIC CLASS
Definition
Carbohydrate.
Nutrient, caloric.
Term
DEXTROSE ACTIONS
Definition
Supplies supplemental glucose in cases of hypoglycemia and restores blood sugar to normal (70-110mg/dL)
Term
DEXTROSE INDICATIONS
Definition
1. ALOC of unknown etiology (GCS 2. Hypoglycemia (<60mg/dL) by glucometer or clinical judgment
3. Status epilecticus
4. Oral hypoglycemic agent overdose
5. Neonatal resuscitation not responsive to ventilation and chest compressions.
Term
DEXTROSE CONTRAINDICATIONS
Definition
None for a patient with suspected hypoglycemia.
Term
DEXTROSE PRECAUTIONS
Definition
1. Use with caution in pts with increased intracranial pressure because may worsen cerebral edema
2. Localize venous irritaion may occur in smaller veins
3. Infiltration may cause tissue necrosis
4. Dextrose is only administered IV/IO
Term
DEXTROSE SIDE EFFECTS
Definition
Tissue necrosis and phlebitis at the injection site.
Term
DEXTROSE ADMINISTRATION
Definition
Pt > 2 YO - Dextrose 50% 1g/kg up to 25g IV. Repeat once in 2 min if ALOC persists
Pt < 2 YO - Dextrose 25% 1g/kg up to 25g IV. Repeat once in 2 min if ALOC persists.
Neonate <28 days old - Dextrose 12.5% 1g/kg IV (8mL/kg)
Term
DEXTROSE SUPPLY
Definition
Prefilled syringe containing 25 grams in 50mL (50% solution)
Term
DEXTROSE NOTES
Definition
1. Establish free flowing IV of normal saline in large vein. Aspirate blood before and during administration of dextrose to ensure patency.
Term
DEXTROSE SUPPLY
Definition
Prefilled syringe containing 25 grams in 50mL (50% solution)
Term
DEXTROSE NOTES 2
Definition
Hypoglycemic states require immediate intervention. Prolonged can result in brain damage.
Term
DEXTROSE NOTES 3
Definition
To make Dextrose 25%, dispel 25mL of solution from the pre-filled syringe and draw 25mL of normal saline back into the syringe. Dextrose 25% will contain 12.5g in 50ml.
Term
DIPHENHYDRAMINE GENERIC/TRADE
Definition
Diphenhydramine
Benadryl
Term
DIPHENHYDRAMINE CHEMICAL/THERAPEUTIC CLASS
Definition
Ethanolamine derivative
Antihistamine, antianaphylactic agent
Term
DIPHENHYDRAMINE ACTIONS
Definition
Antihistamin with anticholinergic and sedative side effects. Decreases the allergic response by blocking histamine and H1 receptor sites.
Term
DIPHENHYDRAMINE PHARMACOKINETICS
Definition
PO Peak 2 - 4 hours
T1/2 2 - 8 hours
IV = NA
Term
DIPHENHYDRAMINE INDICATIONS
Definition
1. Anaphylaxis, as adjunct to epinephrine
2. Severe vomiting & motion sickness
3. Treat extrapyramidal reactions caused by phenothiazines
4. Adjunct to haloperidol for combative patients secondary to acute psychotic episodes or alcohol intoxication
Term
DIPHENHYDRAMINE CONTRAINDICATIONS
Definition
1. Bronchial asthma
2. Nursing mothers
3. Children < 10kg.
4. Glaucoma
5. Hypersensitivity to drug or other antihistamines
Term
DIPHENHYDRAMINE PRECAUTIONS/PREGNANCY CLASS
Definition
Use with caution in patients with a history of hyperthyroidism, cardiovascular disease and hypertension.
Pregnancy class B.
Term
DIPHENHYDRAMINE SIDE EFFECTS
Definition
CNS: dizziness, drowsiness, sedation, sleeplessness
CV: headache, palpitations
GI: dryness of mouth, nose and throat
RESP: thickening of bronchial secretions, wheezing
Term
DIPHENHYDRAMINE INTERACTIONS
Definition
1. Has additive effects with alcohol and other CNS depressants
2. MAO inhibitors prolong and intensify anticholinergic (drying) effects of antihistamines.
Term
DIPHENHYDRAMINE ADMINISTRATION/SUPPLY
Definition
Adult - give 1mg/kg up to 50mg IM or slow IV push (25mg/min)
Pediatric - give 1mg/kg up to 50mg IM or slow IV push (25 mg/min)
Vial containing 50mg in 1ml.
Term
DIPHENHYDRAMINE NOTES
Definition
The IV route is preferred for the patient in severe shock. If an IV cannot be readily established give via IM route, deep into large muscle mass.
Term
DIPHENHYDRAMINE NOTES
Definition
The IV route is preferred for the patient in severe shock. If an IV cannot be readily established give via IM route, deep into large muscle mass.
Term
EPINEPHRINE 1:1000 GENERIC/TRADE NAMES
Definition
Epinephrine 1:1000
Adrenalin
Term
EPINEPHRINE 1:1000 CHEMICAL/THERAPEUTIC CLASS
Definition
Catecholamine
Bronchodilator, vasopressor
Term
EPINEPHRINE 1:1000 ACTIONS 1
Definition
Naturally occurring catacholamine. Acts directly on alpha and beta andrenergic receptors. It's effect is more profound on beta than alpha receptors. Effects on B1 andrenergic receptors include a positive chronotropic (increased HR) and positive inotropic (contractile force) effect.
Term
EPINEPHRINE 1:1000 ACTIONS 2
Definition
The effects of epinephrine on the alpha andrenergic receptor sites include increased systemic vascular resistance. The effects on B and A receptors causes an increased BP. Also causes bronchodilation due to effects on B2 adrenergic receptors.
Term
EPINEPHRINE 1:1000 PHARMACOKINETICS
Definition
SC - onset 3-5 minutes
Term
EPINEPHRINE 1:1000 INDICATIONS
Definition
1. Anaphylaxis
2. Bronchial asthma
3. Respiratory distress due to epiglottitis or croup.
Term
EPINEPHRINE 1:1000 CONTRAINDICATIONS
Definition
Epinephrine should be avoided in the following pts unless signs and symptoms are severe:
1. Hypertension SBP> 180
2. Tachycardia HR >140 adult, 180 child
3. Cardiovascular disease
4. Elderly age >55
5. Angle closure glaucoma
Term
EPINEPHRINE 1:1000 PRECAUTIONS/PREGNANCY CATEGORY
Definition
Precautions:
1. Hyperthyroidism
2. Diabetes mellitus
Term
EPINEPHRINE 1:1000 SIDE EFFECTS
Definition
CNS - anxiety, dizziness, restlessness, tremulousness, headache
CV - anginal pain, dysrhythmias, hypertension, palpitations
GI - nausea, vomiting
SKIN - pallor
Term
EPINEPHRINE 1:1000 INTERACTIONS
Definition
Cyclic antidepressants and antihistamines may potentiate the effects of epinephrine.
Term
EPINEPHRINE 1:1000 ADMINISTRATION
Definition
Adult - give 0.3mg IM. Repeat in ten minutes if needed
Peds - give 0.01mg/kg up to 0.3mg IM. Repeat in ten minutes PRN.
Term
EPINEPHRINE 1:1000 SUPPLY/NOTES
Definition
Ampule containing 1mg in 1ml.
The IM route is preferred for the patient in severe shock.
Term
GLUCAGON GENERIC/TRADE NAMES
Definition
Glucagon
GlucaGen
Term
GLUCAGON CHEMICAL/THERAPEUTIC CLASS
Definition
Polypeptide hormone
Antihypoglycemic
Term
GLUCAGON ACTIONS 1
Definition
Protein secreted by alpha cells of the pancreas. When released, it causes the breakdown of glycogen stored in the liver to glucose. Inhibits synthesis of glycogen from glucose. Both cause in increase in circulating blood glucose.
Term
GLUCAGON ACTIONS 2
Definition
A return to consciousness following the administration of glucagon take 5-20 minutes. Only effective if there are sufficient stores of glycogen in the liver.
Term
GLUCAGON PHARMACOKINETICS
Definition
Onset withing 15 minutes.
T1/2 = 3 to 6 minutes.
Term
GLUCAGON INDICATIONS
Definition
When unable to obtain IV access and give dextrose AND:
1. ALOC of unknown etiology (GCS 2. Hypoglycemia based on glucometer or clinical judgment.
3. Status epilepticus
4. Oral hypoglycemic agent overdose.
Term
GLUCAGON PRECAUTTIONS/PREGNANCY CATEGORY
Definition
Glucagon in only effective if there are sufficient stores of glycogen in the liver. IV dextrose is the agent of choice.
Pregnancy category C
Term
GLUCAGON SIDE EFFECTS
Definition
CNS - dizziness, headache
CV - hypotension
GI - nausea, vomiting
Term
GLUCAGON ADMINISTRATION
Definition
Adult - 1mg IM
Pediatric - 1mg IM
Term
GLUCAGON SUPPLY
Definition
Must be reconstituted before administration. Supplied in rubber stoppered vials containing 1mg powder and 1ml of diluting solution.
Term
GLUCAGON NOTES
Definition
Must complete local protocols class to use. May be given to reverse effects of beta blocker overdoses, usually 3 to 10 mg IV bolus followed by a 2 - 5 mg/h infusion.
Term
IPRATROPIUM GENTERIC/TRADE NAMES
Definition
Ipratropium
Atrovent
Term
IPRATROPIUM CHEMICAL/THERAPEUTIC CLASS
Definition
Quarternary ammonium compound.
Bronchodilator
Term
IPROATROPIUM ACTIONS
Definition
Anticholinergic bronchodilator related to atropine. Inhibits action of acetylcholine at receptor sites on bronchial smooth muscle, thus inhibiting parasympathetic stimulation and causing bronchodilation. Antisecretory properties locally.
Term
IPRATROPIUM PHARMACOKINETICS
Definition
Onset 5 to 15 minutes.
Peak 1 to 2 hours.
Duration 3 to 6 hours.
Term
IPRATROPIUM INDICATIONS
Definition
1. Bronnchoconstriction in COPD, including chronic bronchitis and emphysema as an adjunct to albuterol.
2. Bronchial asthma as an adjunct to albuterol.
Term
IPRATROPIUM CONTRAINDICATIONS
Definition
Hypersensitivity to the drug, or to atropine and its derivatives.
Term
IPRATROPIUM PRECAUTIONS/PREGNANCY CATEGORY
Definition
Use with caution in patients with narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction.
Pregnancy category B
Term
IPRATROPIUM SIDE EFFECTS
Definition
CNS - anxiety, dizziness, headache, nervousness
CV - palpitations GI - nausea, vomiting
EENT - blurred vision, dry mouth
RESP - bronchospasm, cough
Term
IPRATROOPIUM ADMINISTRATION
Definition
Using small volume nebulizer, O2 6-10L/min. Adults and children 500mcg in 2.5mL mouthpiece, face mask or blow by. Do not repeat.
Term
IPRATROPIUM SUPPLY/NOTES
Definition
Unit dose vials containing 500mcg in 2.5ml.
Give only one dose with the initial albuterol treatment. Do not use as stand alone drug. Not used for anaphylactic respiratory distress.
Term
NALOXONE GENERIC/TRADE NAME
Definition
Naloxone
Narcan
Term
NALOXONE CHEMICAL/THERAPEUTIC CLASS
Definition
Thebaine derivative
Antidote, opiate
Term
NALOXONE ACTIONS
Definition
Chemically similar to opiates, but only antagonistic properties. Competes for opiate receptors in the brain. Displaces narcotic molecules from opiate receptors. Reverses respiratory depression from narcotic overdose.
Term
NALOXONE PHARMACOKINETICS
Definition
IV - Onset 2 minutes
T1/2 4 minutes
Term
NALOXONE INDICATIONS/CONTRAINDICATIONS
Definition
1. Respiratory depression caused by narcotics.
2. Coma unknown etiology.
Contra - hypersensitivity.
Term
NALOXONE
Definition
Term
NALOXONE PRECAUTIONS
Definition
Administer cautiously to pts who are know or suspected to be physically dependent on narcotics. Abrupt reversal can cause withdrawal-type effects. This includes newborns of dependent mothers.
Term
NALOXONE PREGNANCY CATEGORY
Definition
Category B.
Term
NALOXONE SIDE EFFECTS
Definition
CNS - seizures, tremulousness, withdrawal symptoms.
CV - hypertension, hypotension, tachycardia, ventricular dsyrhythmia
GI - nausea, vomiting
Term
NALOXONE ADMINISTRATION - ADULT/SUPPLY
Definition
Adult - 2mg IV at 0.4mg/min (5 in to push)
IM - give two 0.8mg injections (1.6mg) in different muscles.
If no response, contact medical control.
Vial containing 4mg in 10mL.
Term
NALOXONE PEDIATRIC
Definition
Pediatric - IV - five 0.1mg/kg up to 2mg IV at 0.4mg/min
IM - give 0.1mg/kg up to 1.6mg IM.
If no response, call medical control.
Term
NALOXONE NOTES
Definition
1. Unless necessary, avoid insertion of advanced airway prior to administration of naloxone. 2. Administer by slow IV push (0.4mg/min.) 3. Reversal effects may be temporary, titrate to respiratory rate. 4. Common narcotics include codeine, Darvon, Demerol, Dilaudid, fentanyl, heroin, morphine, Nubain, paregoric, Percodan, Stadol, Talwin.
Term
NITROGLYCERIN GENERIC/TRADE NAMES
Definition
Nitroglycerin.
Nitrolingual, Nitroquick Nitrostat, Nitr-bid, Nitrol
Term
NITROGLYCERIN CHEMICAL/THERAPEUTIC CLASS
Definition
Nitrate, organic.
Antianginal, vasodilator
Term
NITROGLYCERIN ACTIONS 1
Definition
Rapid smooth muscle relaxant that causes vasodilation and to a lesser degree dilates the coronary arteries. This results in increased coronary blood flow and improved perfusion of the ischemic myocardium.
Term
NITROGLYCERIN ACTIONS 2
Definition
Vasodilation decreases preload and leads to decreased cardiac work, helping to reverse the effects of angina pectoris.
Term
NITROGLYCERIN ACTIONS 3
Definition
Decreased preload results in decreased pulmonary capillary hydrostatic pressure and reduction of fluid passing into the pulmonary interstitium and alveoli cardiogenic pulmonary edema.
Term
NITROGLYCERIN PHARMACOKINETICS
Definition
SL - Onset 1 to 3 minutes. Peak 5 minutes. Duratin at least 25 min. T1/2 2-3 min.
TOP - Onset 15 to 60 min. Peak 30 to 120 min. Duration 2 to 12 hours.
Term
NITROGLYCERIN CONTRAINDICATIONS
Definition
1. Hypotension SBP < 100. 2. Bradycardia HR < 60. 3. Increased intracranial pressure (CVA, head injury). 4. Hypersensitivity. 5. Patient on Viagara or other anti-impotence agent.
Term
NITROGLYCERIN PRECAUTIONS 1
Definition
1. Administer with extreme caution if at all to pts. with suspects inferior wall MI with possible right ventricular involvement because these patients require adequate RV preload.
Term
NITROGLYCERIN PRECAUTIONS 2 AND 3
Definition
Pts taking routinely may develop tolerance and require an increased dose.
Postural syncope sometimes occurs following administration and should be anticipated. Keep pt. supine.
Term
NITROGLYCERIN PRECAUTIONS 4 AND PREGNANCY CATEGORY
Definition
Careful clinical or hemodynamic monitoring must be used because of the possibility of hypotension and tachycardia.
Pregnancy category C.
Term
NITROGLYCERIN SIDE EFFECTS
Definition
CNS: dizziness, headache, weakness
CV: dysrhythmias, palpitations, postural hypotension, tachycardia
GI: nausea, vomiting
SKIN: diaphoresis, flushing, pallor, rash
Term
NITROGLYCERIN INTERACTIONS 1 AND 2
Definition
1. Severe hypotension is possible in pts who have recently ingested alcohol.
2. Orthostatic hypotension is possible when used in conjunction with beta andrenergic antagonists.
Term
NITROGLYCERIN INTERACTIONS 3
Definition
Administration contraindicated in pts who are using anti-impotence agents such as sildenafil since they have been known to hypotensive effects of organic nitrates.
Term
NITROGLYCERIN ADMINISTRATION
Definition
An IV or INT must be established prior to administering unless the patient has taken before without complications.
Term
NITROGLYCERIN SUBLINGUAL ADMINISTRATION
Definition
Chest pain - give 0.4mg SL. Repeat q 5 min up to 3 doses. Pulmonary edema (SBP>180) give 2 tablets 0.4mg SL. Repeat 2 tablets q 3 min PRN. Pulmonary edema (SBP 100-180) five 1 tablets 0.4mg SL. Repeat 1 tablet q 5 min PRN.
Pediatric - not indicated.
Term
NITROGLYCERIN NOTES SL
Definition
1. Alternate the SL site when repeating dose.
2. May produce burning or tinging sensation when administered SL. This is not a reliable method to determine potency.
Term
NITROGLYCERIN TOPICAL DOSE
Definition
Chest pain - if pain persists after SL, apply 1 inch of paste. Pulmonary edema SBP > 180, apply 2 inches of paste. Pulmonary edema SBP 100-180 apply 1 inch of paste. Pediatric not indicated.
Term
NITROGLYCERIN TOPICAL NOTES
Definition
1. Apply paste to chest or upper arm.
2. Do not rub into skin.
3. If contraindications develop when paste is applied, remove the paste.
4. Wear gloves for application and removal of paste.
Term
NITROGLYCERIN SUPPLY AND NOTES
Definition
Tablet: Bottle containing 0.4mg (1/150 grain) tablets
Paste: Packets containing 1 gr (1 inch) or tubes containing 30 to 60 grams.
Keep in original container, tightly capped.
Term
ONDANSETRON GENERIC AND TRADE NAMES
Definition
Ondansetron
Zofran
Term
ONDANSETRON CHEMICAL AND THERAPEUTIC CLASS
Definition
Carbazole derivative
Antiemetic
Term
ONDANSETRON ACTIONS
Definition
Selective 5-HT3 antagonist which is an effective anti-nausea and anti-emetic with minimal side effects. Nausea and vomiting are strongly associated with serotonin receptors of the 5-HT3 type. Present peripherally on vagal nerve terminus and centrally in the chemoreceptor trigger zone of the area postrema.
Term
ONDANSETRON PHARMACOKINETICS/INDICATIONS
Definition
IV: peak immediate. IM: n/a
1. Severe vomiting or nausea
2. Vertigo
Term
ONDANSETRON CONTRAINDICATIONS/PRECAUTIONS/PREGNANCY CATEGORY
Definition
Contra: hypersensitivity. Pre: rarely, transient ECG changes including QT interval prolongation. Pregnancy cat B.
Term
NITROGLYCERIN SIDE EFFECTS
Definition
CNS: headache, lightheadedness, seizures
CV: angina, bradycardia, syncope, tachycardia. EENT: blurred vision. GI; constipation, diarrhea. RESP: bronchospasm. SKIN: rash
Term
NITROGLYCERIN ADMINISTRATION/SUPPLY
Definition
IV: give 0.1 mg/kg up to 4.0 over 2 to 5 min. May repeat once in 5 min if needed.
IM: give 0.1 mg/kg up to 4 mg IM. Do not repeat.
Vial containing 4mg in 2mL.
Term
ORAL GLUCOSE DRUG NAMES
Definition
Dextrose, Glutose, Insta-Glucose
Term
ORAL GLUCOSE NOTES
Definition
Used to treat pts. with history of diabetess with ALOC and ability to swallow. Can reverse hypoglycemic condition. Time makes a critical difference. Comes in a tube of gel.
Term
ORAL GLUCOSE INDICATIONS/CONTRAINDICATIONS
Definition
Pt. with ALOC ad known history of diabetes controlled with medication.
1. Unresponsive.
2. Unable to swallow.
Term
ORAL GLUCOSE SIDE EFFECTS AND SUPPLY
Definition
None when given properly. May be aspirated without a gag reflex.
Tube contains 15 grams.
Term
GLUCOSE ADMINISTRATION
Definition
1. Assure signs and symptoms of AL with known history.
2. Assure pt. is conscious and can swallow and protect airway.
3. Administer between cheek and gum. Place on tongue depressor between cheek and gum.
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