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► Med Misc 03 > Pharmaco3 > Flashcards

Pharmaco3 Flashcards

1
Q 
The major natural glucocorticoid is:
• triamcinolone
• cortisol
• dexamethasone
• prednisone
• prednisolone
A

cortisol - Glucocorticoids are most often used as anti-inflammatory and immunosuppressive agents
The synthetic glucocorticoids include hydrocortisone, cortisone, prednisone, prednisolone, dexamethasone, triamcinolone, methylyprednisolone, and betamethasone

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2
Q

Mineralocorticoids regulate ? in the collecting tubules of the kidney. The major natural mineralocorticoid in humans is ?. Other mineralocorticoids include deoxycorticosterone and fludrocortisone. Mineralocorticoids are used in replacement therapy in hypoadrenocorticism or ? disease

A
  • sodium and potassium reabsorption
  • aldosterone
  • Addison’s disease
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3
Q

Contraindications to corticosteroid use include ? — these drugs themselves may cause peptic ulcers

A

latent TB or fungal infection, AIDS, herpes infections and patients with peptic ulcer disease (specifically, gastric ulcers)

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4
Q

Corticosteroids ? cure any disease. In patients with Addison’s disease, corticosteroids serve as a replacement for the lack of steroid hormones being produced by the patient

A

do not

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5
Q

All of the following are pharmacologic effects of glucocorticoids EXCEPT one. Which one is the EXCEPTION?
• stimulate protein breakdown, which results in increased plasma amino acid levels
• stimulate gluconeogenesis in the liver and inhibit peripheral glucose use
• impaired wound healing
• reduce the immune response
• decreased lipolysis
• inhibit local edema, capillary dilation, migration and activation of white blood cells, and phagocytosis by macrophages
• increase hemoglobin concentration and increase the numbers of circulating red blood cells and platelets

A

decreased lipolysis

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6
Q

The pharmacologic effects of high mineralocorticoids include ?

A

an increase in sodium retention and an increase in potassium depletion which can lead to edema and hypertension

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7
Q

The pharmacologic effects of low mineralocorticoids may lead to ?

A

dehydration and hypotension

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8
Q 
The major natural mineralocorticoid in humans is:
• dexamethasone
• aldosterone
• cortisol
• prednisone
• triamcinolone
A

aldosterone - others are all glucocorticoids

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9
Q

Aldosterone is secreted by cells located in the ? of the adrenal cortex

A

zona glomerulosa

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10
Q

The secretion of aldosterone is regulated by ? and ? and is very important in the regulation of blood volume and pressure.

A
  • ACTH

* the renin-angiotensin system

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11
Q

Aldosterone promotes ? into the blood from the glomerular filtrate. ? is lost in the urine because of the electronegativity that is created by the reabsorption of sodium in the kidney tubules

A

• reabsorption of sodium
• Potassium
(Increased blood aldosterone levels will result in high sodium and low potassium levels in the plasma)

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12
Q

Addison’s disease is caused by ?

A

the hyposecretion of aldosterone and cortisol

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13
Q

ADH (Vasopressin) decreases the production of urine by ?

At high concentrations, ADH causes ? (increases blood pressure).

A
  • increasing the reabsorption of water by the renal tubules

* arterioles to constrict

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14
Q 
Which corticosteroid is administered by inhalation to treat asthma?
• hydrocortisone
• prednisone
• cortisone
• fluticasone (Flonase)
• methylprednisolone (Medrol)
A

fluticasone (Flonase) (also Beclomethasone and triamcinolone are popular inhalers)

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15
Q 
Which of the following drugs are classified as corticosteroids (steroids). Select all that apply.
• hydrocortisone
• methylprednisolone
• prednisone
• compazine
• fluoxetine
• triamcinolone
• dexamethasone
A
  • hydrocortisone
  • methylprednisolone
  • prednisone
  • triamcinolone
  • dexamethasone
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16
Q 
All of the following drugs are direct vasodilators EXCEPT one. Which one is the EXCEPTION?
• hydralazine (Apresoline)
• diazoxide (Proglycem)
• captopril (Capoten)
• sodium nitroprusside (Nipride)
• nitroglycerin (Nitrostat)
A

captopril (Capoten)

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17
Q

Calcium channel blockers are effective ? and have been applied to the management of hypertension

A

vasodilators (indirect) such as Diltiazem and Nifedipine

***associated with causing gingival hyperplasia

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18
Q

? are peripheral vasodilators

A

Hydralazine and minoxidil

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19
Q 
All of the following drugs are used to prevent or to provide relief of angina pectoris EXCEPT one. Which one is the EXCEPTION?
• nitroglycerin (Nitrostat)
• isoflurophate
• nifedipine (Procardia)
• diftiazem (Cardizem)
• propranolol (Inderal)
• isosorbide (lsordil)
A

isoflurophate

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20
Q

Propranolol (Inderal) and Atenolol (Tenormin) are representative of ? used to prevent angina attacks.

A

the beta-blockers

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21
Q

Amyl nitrite is used in the emergency treatment of cyanide poisoning because it:
• oxidizes hemoglobin
• irreversibly binds cyanide
• competes with cyanide for binding of cytochromes
• inhibits tubular reabsorption of cyanide

A

oxidizes hemoglobin - to methemoglobin which binds cyanide tightly, keeping it in the peripheral circulation and preventing its access to tissues - administered by inhalation only. It is the most rapidly acting of the antianginal drugs, producing effects within 10 seconds, This drug is rarely prescribed and is abused to produce euphoria and as a sexual stimulant

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22
Q

The positive inotropic effect of Digoxin (Lanoxin):
• is dependent upon a normal cardiac rhythm
• directly increases the force of myocardial contractions
• is antagonized by beta-blockers
• all of the above

A

directly increases the force of myocardial contractions - cardiac glycosides (such as Digoxin) help the heart beat more strongly (positive inotropic effect), more slowly (bradycardia) and more efficiently - used to treat most supraventricular arrhythmias, cardiogenic shock and chronic heart failure.

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23
Q

These drugs are used to treat hypertension and congestive heart failure ?

A

angiotensin-converting enzyme (ACE) inhibitors - interfere with the conversion of angiotensin I (a weak vasoconstrictor) to angiotensin II (a highly effective constrictor) which is a stimulus for aldosterone release

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24
Q

Amiodarone (Cordarone) is the most potent and “broad-spectrum” anti-arrhythmic compound currently available.
Procainamide is an antihypertensive drug used to treat high blood pressure.
• both statements are true
• both statements are false
• The first statement is true, the second is false
• The first statement is false, the second is true

A

The first statement is true, the second is false - Procainamide is an antiarrhythmic agent that is used in the treatment of several cardiac arrhythmias

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25
Q 
Verapamil is useful for the treatment of:
• angina
• hypertension
• supraventricular tachyarrhythmias
• all of the above
A

all of the above (is a calcium channel blocker)

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26
Q

? are used to treat acute symptomatic deep vein thrombosis

A

heparin

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27
Q

heparin is administered ? since they are unable to be absorbed from the GI tract

A

subcutaneously

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28
Q

heparins have a small effect on partial thromboplastin time but strongly inhibit ?

A

factor Xa (NOT IIa)

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29
Q

The antidote for heparin is ?; the antidote for warfarin is ?

A
  • protamine

* vitamin K

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30
Q

Glycoprotein IIb/IIIa inhibitors are reversible anti-platelet agents used to prevent ? complications and used in patients with ?. They are administered intravenously.
These agents block the platelet glycoprotein IIb/llIa receptor, the binding site for ?

A
  • acute cardiac ischemic
  • acute coronary syndrome
  • fibrinogen and von Willebrand factor
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31
Q

For a patient who is taking anticoagulants, what is the most valuable test used in evaluating the patient as a surgical risk?
• PTT (Partial Thromboplastin Time)
• PT (Prothrombin Time)
• platelet count

A

PT (Prothrombin Time) - This test is a one-stage test for detecting certain plasma coagulation defects owing to a deficiency of factors V, VII, or X

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32
Q

A prolonged PT therefore indicates deficiency in ?

A

one of the factors, as in liver disease, vitamin K deficiency, or anticoagulation therapy

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33
Q 
All of the following conditions are managed by using anticoagulants and anti-platelet agents EXCEPT one. Which one is the EXCEPTION?
• coronary artery disease (CAD)
• angina pectoris (Unstable Angina)
• myocardial infarction (Heart Attack)
• stroke
• hypertension
A

hypertension

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34
Q

The “statin” drugs (atorvastatin and lovastatin) have the capability to increase the breakdown of ? thereby releasing muscle protein. If the protein overloads the kidneys, ? could result. ? drugs enhance the capabilities of the “statins” to cause this effect. It is advisable for patients medicated with a “statin” drug not to be given erythromycin products

A
  • skeletal muscle
  • renal failure
  • The erythromycin
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35
Q

Antihypertensive agents lower blood pressure by reducing total peripheral resistance and by reducing cardiac output through a variety of mechanisms.
ACE inhibitors inhibit the conversion of inactive angiotensin I to the angiotensin II, a vasoconstrictor.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true

A

both statements are true

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36
Q 
Which of the drugs below can prolong the QT interval of cardiac electrical conduction and thus can increase the risk of cardiac arrhythrnias?
• erythromycin
• ibuprofen
• hydrocodone
• penicillin VK
• azithromycin (Z-Pak)
A

erythromycin - Azithromycin, another member of the erythromycin family of antibiotics is not associated with prolonging the QT interval

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37
Q

Antimetabolites are cell cycle-specific drugs acting primarily in the:
• G0 phase or resting phase of the cell cycle
• S phase of the cell cycle
• G1 phase of the cell cycle
• G2 phase of the cell cycle

A

S phase of the cell cycle (DNA synthesis)

by interfering with the biosynthesis of the purine and pyrimidine bases

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38
Q

The most important toxic effect of potassium-sparing diuretics is ?

A

hyperkalemia

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39
Q 
All of the following are effects of insulin EXCEPT one. Which one is the EXCEPTION?
• decreased gluconeogenesis
• increased triglyceride storage
• decreased protein synthesis
• increased glycogen synthesis
A

decreased protein synthesis - This is false; insulin increases protein synthesis

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40
Q 
Which of the following is a heteropolysaccharide that inactivates thrombin and other coagulation factors and thus prevents blood clotting?
• prothrombin
• fibrin
• heparin
• plasmin
A

heparin

41
Q 
Heparin ?
• neutralizes tissue thromboplastin, 
• blocks thromboplastin generation
• both of them
• none of them
A

both of them

42
Q

Do not administer Triazolam (Halcion), a pre-operative sedative in dentistry to patients taking ?

A

any of antifungal agents because they can significantly elevate the serum levels of triazolam resulting in toxicity

43
Q

Levodopa is used in the treatment of Parkinson’s disease to replenish the brain’s supply of serotonin, the neurotransmitter that is deficient in this dis-order.
Administering carbidopa in combination with levodopa reduces the required dose of levodopa by about 75%.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true

A

the first statement is false, the second is true - to replenish the brain’s supply of dopamine, the neurotransmitter that is deficient in this disorder

44
Q 
Which antiarrhythmic agent is effective only on the ventricle and is often administered IV to treat life-threatening ventricular arrhythmias?
• quinidine (Quinidex)
• lidocaine (Xylocaine)
• flecainide (Tambocor)
• propafenone (Rythmol)
• none of the above
A

lidocaine (Xylocaine)

45
Q 
Which of the following gastrointestinal drugs reduce the formation of stomach acid by inhibiting the proton pump of the stomach parietal cells?
Select all that apply.
• ranitidine (Zantac)
• omeprazole (Prilosec)
• cimetidine (Tagamet)
• famotidine (Pepcid)
• lansoprazole (Prevacid)
A
  • lansoprazole (Prevacid)

* omeprazole (Prilosec)

46
Q 
Which of the following drugs inhibit blood clotting by affecting the coagulation pathway to prevent fibrin formation? Select all that apply.
• heparin
• vitamin K
• aspirin
• clopidogrel (Plavix)
• warfarin (Coumadin)
A

• heparin
• warfarin (Coumadin)
(Aspirin inhibits blood clotting by inhibiting platelet aggregation in an irreversible manner and does not affect the coagulation pathway)

47
Q

the bisphosphonate class of drugs used to treat and manage ?. Bisphoshonate therapy has been associated with ?; this has been observed mostly in ?, but also in patients with ?

A
  • Paget’s disease, osteoporosis and to prevent hypercalcemia of malignancy
  • osteonecrosis, primarily of the jaw
  • cancer patients
  • postmenopausal osteoporosis
48
Q 
Which substance is an enzyme formed in the kidney and released into the bloodstream where it has an important role in the formation of angiotensin?
• plasmin
• lysozyme
• renin
• heparin
A

renin - fnally stimulating aldosterone release

49
Q 
Disulfiram (Antabuse) is used in the management of:
• nicotine abuse
• ethanol abuse
• opioid abuse
• NSAID abuse
A

ethanol abuse

50
Q

Antacids do not prevent the overproduction of acid.
Antacids do neutralize the acid once it is in the stomach.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true

A

both statements are true

51
Q 
Inhaled ammonia is the drug of choice for acting against:
• anaphylaxis
• heart attack
• syncope
• urticaria
A

syncope - irritates trigeminal nerve sensory endings, with a resulting reflex stimulation of medullary respiratory and vasomotor centers. An aromatic ammonia vaporole is crushed between the fingers and held near the patient’s nose

52
Q 
All of the following are catecholamines EXCEPT one. Which one is the EXCEPTION?
• epinephrine
• norepinephrine
• chlorpromazine
• isoproterenol
• dopamine
• dobutamine
A

chlorpromazine - is a dopamine antagonist and antipsychotic agent
Catecholamines are any one of a group of sympathomimetic compounds

53
Q 
Of the following drugs, which ones are skeletal muscle relaxants? Select all that apply.
• methocarbamol (Robaxin)
• cyclobenzaprine (Flexeril)
• baclofen (Lioresal)
• succinylcholine (Anectine)
• carisoprodol (Soma)
• omeprazole (Prilosec)
A
  • methocarbamol (Robaxin)
  • cyclobenzaprine (Flexeril)
  • baclofen (Lioresal)
  • carisoprodol (Soma)
54
Q

? is the prototype depolarizing neuromuscular blocking drug

A

Succinylcholine

55
Q

skeletal muscle relaxants (spasmolytic drugs) are agents that relieve muscle spasms without paralysis. They act in ? rather than at the neuromuscular end plate

A

the CNS or in the skeletal muscle cell

56
Q

? is used in the treatment of muscle spasms and pain associated with acute temporomandibular joint pain

A

Carisoprodol (Soma)

57
Q

? is widely used for the effective relief of nocturnal leg cramps

A

Quinine

58
Q 
All of the following drugs are used in the treatment of Parkinson's disease EXCEPT one. Which one is the EXCEPTION?
• levodopa (Dopar)
• bromocriptine (Parlodel)
• pergolide (Permax)
• haloperidol (Haldol)
• selegiline (Eldepryl)
• amantadine (Symmetrel)
A

haloperidol (Haldol) - Haloperidol is used to treat psychotic syndromes

59
Q

In Parkinson’s disease, nerve cells in the basal ganglia degenerate, resulting in lower production of ?

A

dopamine

60
Q

Anti-Parkinson’s agents (mainly levodopa, the direct dopamine agonists) have been associated with ? in dentistry

A
  • orthostatic hypotension

* Dyskinesia (abnormal muscle movements)

61
Q 
All of the following are CNS stimulants EXCEPT one. Which one is the EXCEPTION?
• caffeine
• doxapram (Dopram)
• phenobarbital
• methylphenidate
• phendimetrazine
• strychnine
A

phenobarbital - Phenobarbital is a barbiturate (sedative-hypnotic)

62
Q

? is a term that refers to a CNS stimulant which has the ability to overcome drug-induced respiratory depression and hypnosis

A

Analeptic

63
Q

? include caffeine, theophylline and theobromine

A

Xanthines - Caffeine is the only approved OTC stimulant

64
Q

? is the only xanthine important in the treatment of asthma. It stimulates the respiratory centers of the medulla and is able to cause bronchial dilation in patients with asthma

A

Theophylline

65
Q

Sympathomimetic amines include the amphetamines and other related agents (i.e., methylphenidate, phendimetrazine, etc.). They are ?. They are used to treat ?

A
  • potent CNS stimulants

* narcolepsy (نظم خواب بهم میریزه), obesity and attention deficit disorder

66
Q 
The symptoms of chronic caffeine consumption can include all of the following EXCEPT one. Which one is the EXCEPTION?
• feelings of anxiety and nervousness
• sleep disruption
• coughing
• irritability
• diuresis
• stomach complaints
• palpitations and arrhythmias
A

coughing

67
Q

Caffeine stimulates the CNS unequally, with the cortex being ? affected and the spinal cord being ? affected

A
  • the most

* the least

68
Q

Al of the following drugs are used to treat what condition?
dexmethylphenidate (Focalin)
extended-release methylphenidate (Concerto)
mixed amphetamine salts (Adder 4)
atemoxetine (Strattera)
controlled-delivery methylphenidate (Metadate CR)
lisdexamfetamine (Vyvanse)
• insomnia in adults
• tourette’s syndrome in children
• attention deficit hyperactivity disorder (ADHD)
• insomnia in children

A

attention deficit hyperactivity disorder (ADHD)

69
Q 
Which drug belongs to the opioid family and reduces GI motility ?
• loperamide (Imodium)
• lorazepam (Ativan)
• prochlorperazine (Compazine)
• propranolol (Inderal)
A

loperamide (Imodium) - is an antidiarrheal which acts on intestinal muscles to inhibit peristalsis - no evidence of drug abuse or dependence

70
Q 
All of the following are prominent toxic effects of mercury EXCEPT one. Which one is the EXCEPTION?
• irritability
• xerostomia
• loosened teeth
• gum disorders
• slurred speech
• tremors
A

xerostomia - Excessive saliva is a prominent toxic effect of mercury not xerostomia

71
Q

For carbon monoxide poisoning the treatment is 100% ?

A

oxygen therapy (involves breathing oxygen through a tight-fitting mask).

72
Q

Cyanide poisoning can be treated with rapid oxygen administration and the antidotes ?

A

sodium nitrite and sodium thiosulfate

73
Q 
Of the amino acid neurotransmitters listed below which one is an excitatory neurotransmitter?
• glycine
• glutamate
• GABA (g -aminobutyric acid)
• none of the above
A

glutamate - GABA and glycine are inhibitory neurotransmitters

74
Q 
Oral contraceptives block ovulation by inhibiting which anterior pituitary hormones below?
Select all that apply.
• follicle stimulating hormone (FSH)
• growth hormone (GH)
• thyroid stimulating hormone (TSH)
• luteinizing hormone (LH)
• adrenocorticotrophic hormone (ACTH)
A
  • follicle stimulating hormone (FSH)

* luteinizing hormone (LH)

75
Q
  • ? is the most abundant and potent natural estrogen in humans
  • ? is the most abundant and potent progestin in humans
A
  • Estradiol

* Progesterone

76
Q

Warnings/Precautions with Oral Contraceptives

A
  • The risk of cardiovascular side effects increases in women who smoke cigarettes
  • May increase the risk of thromboembolism. Women with hypertension should be encouraged to use a non-hormonal form of contraception
77
Q

Advise patients to use additional method of birth control when taking ? and oral contraceptives concurrently

A

antibiotics (potential to diminish the effectiveness of oral contraceptives)

78
Q

Drugs travel through the blood stream by binding to albumin plasma protein.
However, only a small number of drugs travel through the blood stream by this mechanism.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is fats, the second is true

A

the first statement is true, the second is false

79
Q 
What are four criteria to consider when selecting an analgesic agent for a patient?
• type of pain
• location of pain
• age of patient
• sex of patient
• patient's weight
• concurrent medication
• pregnancy
A
  • type of pain
  • age of patient
  • concurrent medication
  • pregnancy
80
Q 
Which if the following competitively blocks vitamin K-binding sites and inhibits the synthesis of vitamin K-dependent coagulation factors VII, IX, X, and (prothrombin) and anticoagulant proteins C and S?
• heparin
• warfarin (Coumadin)
• aspirin
• anagrelide
A

warfarin (Coumadin)

81
Q

If patient is on anticoagulants, his/her physician should have documentation of INR values to assess anticoagulant effects. INR stands for ? and essentially is the ratio of ?

A
  • International Normalized Ratio
  • the prothrombin time measured in the patient divided by a standard prothrombin time value, and multiplied by a constant.
82
Q

An INR value of 1 means normal prothrombin times of approximately 12 seconds; normal blood clotting would be present. Many patients taking anticoagulants have INR values of ?

A

2, 3 and even up through 6 - use acetaminophen (Tylenol) for pain control not Aspirin

83
Q 
Which drugs below act to induce gene transcription, inhibit cellular growth and alter the state of cell differentiation.
• immune globulins
• immunosuppressants
• keratinocyte growth factor
• interferons
A

interferons
(• immune globulins: passive immunity by increasing antibody titers
• immunosuppressants: prevent organ transplant rejection
• keratinocyte growth factor: promote cell proliferation )

84
Q

? represents a class of central nervous system stimulants used to improve wakefulness in patients with excessive daytime sleepiness associated with narcolepsy and shift work sleep disorder

A

Modatinil (Provigil)

85
Q

Which herbal supplement is known to be somewhat effective in treating mild forms of mental depression?

A

St Johns Wort

86
Q

Garlic is a herbal supplement used to ? resulting in a decrease in blood clotting.

A

lower cholesterol and to inhibit platelet aggregation

87
Q

St Johns Wort is a herbal supplement which can interact with some conventional medications to:
• increase the effectiveness of medications
• decrease the effectiveness of medications
• increase the toxicity of medications

A

decrease the effectiveness of medications

88
Q

Nicotine is rapidly absorbed across the pulmonary capillary membrane and is delivered to the brain in high concentration within seconds of inhalation.
The nasal spray has the fastest delivery of the NRTs (nicotine replacement therapy) and more closely resembles the onset of the nicotine effects of smoking.
• both statements are true
• both statements are false
• the first statement is true, the second is false
• the first statement is false, the second is true

A

both statements are true

89
Q 
Opioid drugs (narcotics) can be used as:  Select all that apply.
• analgesics
• anti-inflammatories
• antitussives
• antidiarrheals
• preanesthetic medications
A
  • analgesics
  • antitussives (suppress the cough reflex)
  • antidiarrheals
  • preanesthetic medications
90
Q 
Which drug is the standard to which all opiates (narcotics) are compared?
• codeine
• oxycodone
• hydrocodone
• meperidine
• morphine
• fentanyl
A

morphine

91
Q 
Which adverse effect is associated with opioid analgesics and not non-narcotic pain relievers?
• allergic response
• nausea
• vomiting
• respiratory depression
A

respiratory depression - Death secondary to opioid overdose is nearly always due to respiratory depression

92
Q 
Which drug is the prototype opioid antagonist?
• morphine
• naloxone
• propranolol
• ibuprofen
A

naloxone - will reverse the respiratory depressant effects - given intravenously, intramuscularly or subcutaneously

93
Q 
The central nervous system contains three types of endogenous opioids. Which one of the following is NOT one of them?
• beta-endorphins
• morphine
• enkephalins
• dynorphins
A

morphine

94
Q
  • Among the opiates available for use in dentistry, ? products are commonly the drugs of choice
  • Which narcotic is not used in dentistry?
A
  • hydrocodone

* morphine

95
Q 
Which of the following analgesics may interact with warfarin (Coumadin) to cause increased bleeding?
Select all that apply.
• acetaminophen
• ibuprofen
• hydrocodone with acetaminophen
• aspirin
• oxycodone with acetaminophen
A
  • ibuprofen

* aspirin

96
Q 
Your patient has a history of neuropathic pain. They are currently taking oxycodone (OxyContin), which is an opiate analgesic. Which of the following are adverse effects of oxycodone? Select all that apply.
• nausea
• peptic ulcers
• insomnia
• constipation
• xerostomia
• excessive perspiration
A

• nausea
• constipation
The most serious side effect of the narcotic analgesics is respiratory depression

97
Q 
Which drug is a synthetic opioid analgesic used as an intravenous sedative and is more potent than morphine?
• meperidine (Demerol)
• pentazocine (Talwin)
• propoxyphene (Darvon)
• fentanyl
A

fentanyl - 80-100 times more potent than morphine

98
Q 
All of the following analgesics can produce drug dependence and addiction EXCEPT one. Which one is the EXCEPTION?
• codeine
• morphine
• hydrocodone
• meperidine (Demerol)
• oxycodone
• voltaren
A

voltaren - is a NSAID which do not produce drug dependence and addiction

► Med Misc 03 (29 decks)

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