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NURS 3303 > Neurological Agents and Chemotherapy > Flashcards

Neurological Agents and Chemotherapy Flashcards

1
Q

fluoxetine (Prozac) MOA

A

blocks reuptake of serotonin to produce CNS excitation

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2
Q

fluoxetine (Prozac) class

A

SSRI

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3
Q

fluoxetine (Prozac) indications

A
  • major depression
  • bipolar disorder
  • panic disorder
  • OCD

4 weeks to reach steady state

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4
Q

fluoxetine (Prozac) AEs

A
  • weight gain
  • nausea
  • suicidal thoughts
  • sexual dysfunction
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5
Q

fluoxetine (Prozac) nursing considerations

A
  • serotonin syndrome (begins within 2-72 hrs); concurrent use with MAOIs increase risk
  • confusion, agitation, disorientations, anxiety, AMS
  • spontaneous resolution when med stopped
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6
Q

venlafaxine (Effexor XR) MOA

A

blocks reuptake of serotonin and norepinephrine

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7
Q

venlafaxine (Effexor XR) class

A

SNRI

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8
Q

venlafaxine (Effexor XR) indications

A
  • GAD
  • major depression
  • social anxiety disorder
  • panic disorders
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9
Q

venlafaxine (Effexor XR) AEs

A
  • N/V
  • HA
  • nervousness
  • anorexia
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10
Q

venlafaxine (Effexor XR) nursing considerations

A
  • taper over two weeks to avoid withdrawal
  • serotonin syndrome
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11
Q

imipramine (Tofranil) MOA

A

block reuptake of serotonin and norepinephrine

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12
Q

imipramine (Tofranil) indications

A
  • depression
  • bipolar disorder
  • fibromyalgia syndrome
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13
Q

imipramine (Tofranil) AEs

A
  • sedation
  • orthostatic HOTN
  • anticholinergic effects
  • cardiac toxicity
  • sudden death
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14
Q

imipramine (Tofranil) nursing considerations

A
  • lethal dose = 8x therapeutic dose
  • treatment for OD = gastric lavage, activated charcoal
  • give suicidal pts 1-week supply = min. OD
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15
Q

imipramine (Tofranil) class

A

tricyclic antidepressant

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16
Q

phenelzine (Nardil) MOA

A

block monoamine oxidase, inc. NE, dopamine, serotonin, and tyramine

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17
Q

phenelzine (Nardil) class

A

monoamine oxidase inhibitors (MAOIs)

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18
Q

phenelzine (Nardil) indications

A
  • depression
  • bulimia nervosa
  • panic disorder
  • PTSD
  • OCD
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19
Q

phenelzine (Nardil) AEs

A
  • orthostatic HOTN
  • many drug interactions
  • HTN crisis when tyramine-rich foods consumed
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20
Q

bupropion (Wellbutrin) MOA

A

blocks dopamine and/or NE reuptake (effects seen in 1-3 weeks)

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21
Q

bupropion (Wellbutrin) class

A

atypical antidepressants

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22
Q

bupropion (Wellbutrin) indications

A
  • major depression
  • prevention of SAD
  • unlabeled ADHD
  • smoking cessation?
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23
Q

bupropion (Wellbutrin) AEs

A
  • agitation, HA, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, seizures
  • no sexual dysfunction
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24
Q

alprazolam (Xanax) MOA

A

inc inhibitory effects of GABA

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25
Q

alprazolam (Xanax) class

A

anxiolytics

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26
Q

alprazolam (Xanax) indications

A
  • GAD
  • panic disorder
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27
Q

alprazolam (Xanax) AEs

A
  • sedation
  • lightheadedness
  • ataxia
  • decreased cognitive function
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28
Q

alprazolam (Xanax) nursing considerations

A
  • increase CNS depression with other CNS depressants
  • retrograde amnesia
  • short-term use only - can lead to dependence
  • contraindicated w/ OSA
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29
Q

lithium (Lithobid) MOA

A

unknown - may block serotonin receptor binding, alter glutamate uptake/release

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30
Q

lithium (Lithobid) class

A

mood stabilizer

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31
Q

lithium (Lithobid) indications

A
  • DOC for manic episodes
  • prophylaxis for mania/depression
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32
Q

lithium (Lithobid) AEs

A
  • GI upset
  • muscle weakness
  • fine hand tremors
  • polyuria
  • lethargy
  • slurred speech
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33
Q

lithium (Lithobid) nursing considerations

A
  • keep levels < 1.5mEq/L
  • therapeutic range = 0.8-1mEq/L
  • draw levels in AM 12 hrs after evening dose
  • initiation = levels q2-3 days
  • established dosing = levels q3-6 months
  • hemodialysis for levels > 2.5mEq/L
  • monitor kidney, thyroid, and sodium levels
  • improvement in 5-7 days, full benefits in 2-3 wks
  • adequate hydration
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34
Q

phenytoin (Dilantin) MOA

A

decreases sodium into cell

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35
Q

phenytoin (Dilantin) class

A

antiepileptic drugs (AEDs)

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36
Q

phenytoin (Dilantin) indications

A
  • partial and tonic-clonic seizures
  • post-neuro sx
  • off-label = antiarrythmic and severe preeclampsia
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37
Q

phenytoin (Dilantin) AEs

A
  • nystagmus, ataxia, dysarthria, slurred speech, mental confusion, tremor, HA, insomnia, hirsutism, gingival hyperplasia, increase glucose level, teratogenic effects, purple glover syndrome
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38
Q

phenytoin (Dilantin) nursing considerations

A
  • therapeutic range = 10-20mcg/mL (toxicity > 20)
  • dose adjustments: levels q5-7 days, taper off discontinuation
  • take with food
  • vesicant
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39
Q

oxcarbazapine (Oxtellar XR, Trileptal) MOA

A

decrease sodium into cell

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40
Q

oxcarbazapine (Oxtellar XR, Trileptal) class

A

AEDs

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41
Q

oxcarbazapine (Oxtellar XR, Trileptal) indications

A

partial seizures

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42
Q

oxcarbazapine (Oxtellar XR, Trileptal) AEs

A
  • dizziness, drowsiness, double vision, nystagmus, HA, ataxia, hyponatremia, hypothyroidism, SJS, hypersensitivity
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43
Q

oxcarbazapine (Oxtellar XR, Trileptal) nursing considerations

A
  • take w/o regard to food
  • XR tabs = swallow whole
  • decreased effectiveness of OCs
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44
Q

baclofen (Lioresal) MOA

A

mimics GABA, no direct effect on muscle strength

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45
Q

baclofen (Lioresal) indications

A
  • MS
  • spinal cord injuries
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46
Q

baclofen (Lioresal) AEs

A
  • drowsiness, dizziness, weakness, fatigue
  • abrupt withdrawal = visual hallucinations, paranoid ideations, seizures (TAPER OFF SLOWLY)
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47
Q

baclofen (Lioresal) nursing considerations

A
  • monitor neuro status, UOP
  • OD = taper off slowly
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48
Q

dantrolene (Dantrium) MOA

A

decreased calcium release to decrease muscle contractions

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49
Q

dantrolene (Dantrium) indications

A
  • MS
  • cerebral palsy
  • spinal cord injuries
  • malignant hyperthermia
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50
Q

dantrolene (Dantrium) nursing considerations

A
  • monitor LFTs for heptatotoxicity
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51
Q

cyclobenzaprine (Flexeril/Amrix) MOA

A

structurally like TCAs, acts on brainstem to reduce tonic somatic muscle activity

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52
Q

cyclobenzaprine (Flexeril/Amrix) indications

A

localized muscle spasms/pain

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53
Q

cyclobenzaprine (Flexeril/Amrix) AEs

A
  • drowsiness, dizziness, fatigue, dry mouth, blurred vision, photophobia, urinary retention, constipation, dysrhythmias
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54
Q

cyclobenzaprine (Flexeril/Amrix) nursing considerations

A
  • drowsiness and dizziness most prevalent during early treatment
  • caution against operating heavy machinery
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55
Q

granulocyte colony stimulating factors (G-CSF) MOA

A

stimulate bone marrow growth of neutrophils

56
Q

granulocyte colony stimulating factors (G-CSF) indications

A

neutropenia prophylaxis for myelosuppressive therapy

57
Q

granulocyte colony stimulating factors (G-CSF) AEs

A
  • bone pain
  • pyrexia
  • pain, cough, dyspnea
58
Q

granulocyte colony stimulating factors (G-CSF) nursing considerations

A
  • do not admin within 24hr of chemotherapy
  • short acting = Filgrastim (Neupogen) daily SQ admin 3-5 days
  • long acting = Peg-filgrastim (Neulasta) injector or on-body injector
59
Q

cyclophosphamide (Cytoxan) MOA

A

nitrogen mustard, inhibit DNA/RNA synthesis

60
Q

cyclophosphamide (Cytoxan) class

A

alkylating agents

61
Q

cyclophosphamide (Cytoxan) indications

A

lymphomas, HR-breast cancers

62
Q

cyclophosphamide (Cytoxan) AEs

A
  • alopecia
  • CINV (severe)
  • myelosuppression
  • mucositis
  • hemorrhagic cysts
63
Q

cyclophosphamide (Cytoxan) nursing considerations

A
  • PO = give in AM w/ food
  • increase PO fluids, IV hydration/Mesna as ordered
  • monitor labs
  • supportive care as ordered - growth factors
  • I/O
64
Q

cisplatin (Platinol) MOA

A

alkylating agent, inhibits DNA/RNA synthesis

65
Q

cisplatin (Platinol) class

A

platinum compounds

66
Q

cisplatin (Platinol) indications

A
  • head, neck, testicular, lung, breat, GYN cancers
67
Q

cisplatin (Platinol) AEs

A
  • CINV
  • myelosuppression
  • nephrotoxicity
  • ototoxicity
68
Q

cisplatin (Platinol) nursing considerations

A
  • nephrotoxicity = increase PO fluids, IV hydration as ordered (10-20 days after tx, dose-related)
  • ototoxicity = baseline hearing test, monitor for changes (Cranial nerve VIII assessment)
  • monitor labs
  • I/O
  • supportive care as ordered - growth factors
69
Q

doxorubicin (Adriamycin) MOA

A

blocks enzyme topoisomerase 2 - breaks DNA strands

70
Q

doxorubicin (Adriamycin) class

A

antitumor abx

71
Q

doxorubicin (Adriamycin) indications

A

breast, ovarian, testicular, lymphomas, sarcomas of the soft tissue and bone, Hodgkin and non-Hodgkin lymphomas

72
Q

doxorubicin (Adriamycin) AEs

A
  • CINV
  • myelosuppression
  • alopecia
  • bright red discoloration of bodily fluids
73
Q

doxorubicin (Adriamycin) nursing considerations

A
  • cardiotoxicity acute/delayed = ECHO q3months (lifetime dose limits)
  • vesicant = treat with dexrazoxane (Zinecard) - pt IV or central line
74
Q

methotrexate MOA

A

inhibits folic acid conversion for synthesis of DNA (S-phase specific)

75
Q

methotrexate indications

A
  • rheumatoid arthritis
  • psoriasis
  • Crohn’s disease
  • many cancers
76
Q

methotrexate AEs

A
  • mucositis
  • gastric ulcers
  • GI perforation
77
Q

methotrexate nursing considerations

A
  • monitor labs
  • fluid intake 2-3 L/day
  • avoid salicylates, NSAIDs, penicillin, tetracyclines
  • monitor levels 24hrs post treatment
  • Leucovorin resuce
78
Q

vincristine (Oncovin) MOA

A

blocks mitosis during M-phase - disrupts microtubule assembly

79
Q

vincristine (Oncovin) indications

A
  • NHL
  • HL
  • ALL
  • Wilms’ tumor
  • breast CA
  • rhabdomyosarcoma
80
Q

vincristine (Oncovin) AEs

A
  • peripheral neuropathy
  • alopecia
  • constipation
81
Q

vincristine (Oncovin) nursing considerations

A
  • vesicant
  • always in a mini bag, NO IV push (this is fatal!)
82
Q

tamoxifen (Saltimox/Nolvadex) MOA

A

block estrogen receptors on cells

83
Q

tamoxifen (Saltimox/Nolvadex) indications

A

breast cancer

84
Q

tamoxifen (Saltimox/Nolvadex) AEs

A
  • hot flashes
  • fluid retention
  • N/V
  • menstrual irregularities
85
Q

tamoxifen (Saltimox/Nolvadex) nursing considerations

A
  • treatment and prophylaxis
  • small inc in DVT and endometrial CA incidence
  • pre and post-menopausal
86
Q

anastrozole (Arimidex) MOA

A

inhibits aromatase; dec production of estrogen

87
Q

anastrozole (Arimidex) indications

A

breast cancer

88
Q

anastrozole (Arimidex) AEs

A
  • hot flashes
  • menopausal symptoms
  • musculoskeletal pain
  • HA
  • vaginal dryness
  • N/V
89
Q

anastrozole (Arimidex) nursing considerations

A
  • post-menopausal
90
Q

leuprolide (Eligard) MOA

A

suppresses testicular androgen production (testosterone); goal is chemical castration

91
Q

leuprolide (Eligard) indications

A
  • prostate CA
  • endometriosis
92
Q

leuprolide (Eligard) AEs

A
  • hot flashes
  • erectile dysfunction
  • gynecomastia
  • DM
  • MI, stroke, early bone pain
93
Q

leuprolide (Eligard) nursing considerations

A
  • increased incidence of osteoporosis (dec w/ concurrent use of bisphosphonates)
94
Q

degarelix (Firmagon) MOA

A

dec release of LH and FSH in pituitary

95
Q

degarelix (Firmagon) indications

A

prostate CA

96
Q

degarelix (Firmagon) AEs

A
  • hot flashes
  • erectile dysfunction
  • gynecomastia
97
Q

degarelix (Firmagon) nursing considerations

A
  • inc incidence of osteoporosis (dec w/ concurrent use of bisphosphates)
98
Q

trastuzumab (Herceptin) MOA

A

binds to HER2 receptor

99
Q

trastuzumab (Herceptin) indications

A
  • HER2+ breast CA
  • HER2+ gastric CA
100
Q

trastuzumab (Herceptin) AEs

A
  • flu-like symptoms (fever, chills, pain)
  • hypersensitvity rxns
  • cardiotoxicity (LV dysfunction, CHF)
101
Q

trastuzumab (Herceptin) nursing considerations

A
  • neoadjuvant and adjuvant tx - total of 1 year
102
Q

cetuximab (Erbitux) MOA

A

blocks EGFR on cell membrane

103
Q

cetuximab (Erbitux) indications

A
  • colorectal CA
  • head and neck CA
104
Q

cetuximab (Erbitux) AEs

A
  • acneiform rash
  • decreased magnesium
  • diarrhea
  • stomatitis
  • inc LFTs
105
Q

cetuximab (Erbitux) nursing considerations

A
  • rash is NOT acne (limit sun exposure)
  • infusion rxn = airway obstruction, LOC, MI, shock, CP arrest
106
Q

rituximab (Rituxan) MOA

A

recruits immune response through binding of CD20 antigen on surface of B cells

107
Q

rituximab (Rituxan) indications

A

B-cell NHL, B-cell CLL, rheumatoid arthritis

108
Q

rituximab (Rituxan) AEs

A
  • mucocutaneous reactions
  • flu-like symptoms
109
Q

rituximab (Rituxan) nursing considerations

A
  • infusion rxns
  • Tumor Lysis Syndrome ONCOLOGIC EMERGENCY! (12-24 hrs post infusion, may require dialysis)
110
Q

bevacizumab (Avastin) MOA

A

binds to VEGF in extracellular space, inhibits cell membrane binding on vascular endothelial cells

111
Q

bevacizumab (Avastin) indications

A
  • metastatic colorectal CA
  • nonsquamous NSCLC
  • metastatic renal cell CA
  • glioblastoma
  • GYN CA
112
Q

bevacizumab (Avastin) AEs

A
  • GI perforation
  • hemorrhage
  • proteinuria
  • dry skin
  • HA
113
Q

bevacizumab (Avastin) nursing considerations

A
  • HTN -> hypertensive crisis
  • delayed wound healing
114
Q

imatinib mesylate (Gleevec) MOA

A

inhibits BCR-ABL tyrosine kinase activity d/t presence of Philadelphia Chromosome

115
Q

imatinib mesylate (Gleevec) indications

A

chronic myeloid leukemia (CML)

116
Q

imatinib mesylate (Gleevec) AEs

A
  • GI upset
  • HA
  • fatigue
  • pyrexia
  • musculoskeletal pain
  • hepatotoxicity
  • neutropenia and thrombocytopenia
  • fluid retention
117
Q

vemurafenib (Zelboraf) MOA

A

inhibits kinase BRAF V600E activity

118
Q

vemurafenib (Zelboraf) indications

A

metastatic melanoma

119
Q

vemurafenib (Zelboraf) AEs

A
  • hepatotoxicity
  • SJS/TEN
  • QT prolongation
  • GI upset
  • arthralgia
  • alopecia
120
Q

vemurafenib (Zelboraf) nursing considerations

A
  • severe hypersensitivity rxns common
  • secondary malignancies common
121
Q

bortezomib (Velcade) MOA

A

inhibits activity of proteasomes producing buildup of waste proteins in the cell -> apoptosis

122
Q

bortezomib (Velcade) indications

A
  • multiple myeloma
  • mantle cell lymphoma
123
Q

bortezomib (Velcade) AEs

A
  • GI upset
  • weakness
  • anorexia
  • peripheral neuropathy
  • pyrexia
  • cytopenias
124
Q

bortezomib (Velcade) nursing considerations

A
  • monitor labs
  • avoid St. John’s wort
125
Q

nivolumab (Opdivo) MOA

A

programmed cell death receptor-1 (PD-1) blocking MoAB/checkpoint inhibitor

126
Q

nivolumab (Opdivo) indications

A
  • unresectable and metastatic melanoma
  • metastatic NSCLC
  • renal cell carcinoma
  • HL, head and neck, urothelial
127
Q

nivolumab (Opdivo) AEs

A
  • fatigue, malaise
  • peripheral neuropathy
  • GI toxicities
  • elevated LFTs
  • increased creatinine
  • electrolyte imbalances
  • pancytopenia
  • uppers RTIs
  • cough, febrile rxn
128
Q

nivolumab (Opdivo) nursing considerations

A

monitor for immune-related adverse effects (hepatitis, nephritis, colitis, pneumonitis, etc)

129
Q

denosumab (Xgeva, Prolia) MOA

A

RANK ligand inhibitor

130
Q

denosumab (Xgeva, Prolia) indications

A
  • prevention of skeletal events in pts with bone mets, MM, and osteoporosis
131
Q

denosumab (Xgeva, Prolia) AEs

A
  • fatigue, muscle weakness
  • nausea
  • hypophosphatemia
  • hypocalcemia
  • joint pain
  • HA, cough, SOB, diarrhea
132
Q

denosumab (Xgeva, Prolia) nursing considerations

A
  • osteonecrosis of the jaw
  • monitor labs
  • calcium supplementation daily
133
Q

zoledronate (Zometa) MOA

A

inhibits osteoclast function

134
Q

zoledronate (Zometa) indications

A

prevention of skeletal events, hypercalcemia of malignancy

135
Q

zoledronate (Zometa) AEs

A
  • fatigue, muscle weakness
  • nausea
  • hypophosphatemia
  • hypocalcemia
  • joint pain, HA, cough, SOB, diarrhea
136
Q

zoledronate (Zometa) nursing considerations

A
  • osteonecrosis of the jaw
  • monitor labs
  • calcium supplementation daily

NURS 3303 (10 decks)

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