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Pharmacology > pharmacology 1st quiz TS > Flashcards

pharmacology 1st quiz TS Flashcards

0
Q

which antimicrobial drugs interfere with bacterial cell wall synthesis?

A

beta lactams
bacitracin
vancomycin
cycloserine

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1
Q

which antimicrobial drugs act on bacterial cell membrane?

A

polymyxin b

colistin

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2
Q

which antimicrobial drugs interfere protein synthesis at 30s subunit?

A

tetracyclines

aminoglycosides

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3
Q

which antimicrobial drugs act on 50s subunit?

A

chloramphenicol
macrolides
lincosamides

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4
Q

which antimicrobials interfere with nucleic acid synthesis?

A

fluoroquinones
rifampin
metronidazole

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5
Q

which antimicrobials interfere with folic acid synthesis?

A

sulfonamides

diaminopyrimidines

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6
Q

which antimicrobials are narrow spectrum?

A

beta lactams
aminoglycosides
polymyxin b and colistin

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7
Q

which antimicrobials are bacteriostatic?

A

sulfonamides
tetracyclines
chloramphenicol
macrolides and lincosamides

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8
Q

what are the 3 efficacy predictors of antimicrobials?

A

type 1 - conc dependent
type. 2 time dependent
type 3 time dependent with pae (persistant suppression of bacteria)

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9
Q

what combo of antimicrobials produces additive effect?

A

bacteriostatic

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10
Q

what combo of drugs produces synergistic effect?

A

bactericidal drugs

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11
Q

what combo of drugs produces antagonistic effect?

A

bactericidal with bacteriostatic

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12
Q

what is transduction (antibiotic resistance)?

A

bacteria virus transfers genes

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13
Q

how do bacteria get antibiotic resistant from uptake of genes in environment?

A

transformation

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14
Q

what ways can bacteria decrease accumulation of drugs inside them?

A

decrease permeability thru cell membrane of gram negatives

energy dependent active efflux of drug

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15
Q

what is the prerequisite of folic acid in bacteria?

A

PABA

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16
Q

what are the 5 enteric sulfonamides?

A 
succinylsulfathiazole
sulfasalazine
sulfquinoxaline
sulfaguanidine
phthalylsulfathiazole
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17
Q

what does a triple sulfa bolus consist of?

A

sulfinilamide, sulfathiazole, sulfamethazine

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18
Q

which sulfonamide is hydrolzyed in the bowl?

A

phthalylsulfqthiazole

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19
Q

which sulfonamide is split into 2 parts in intestine and treats dog coilitis?

A

sulfasalazine

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20
Q

ehat are the 2 moa of sulfonamides?

A

structural analog of PABA, gets substituted

act as antimetabolites and interfere with rna and dna

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21
Q

which. 2 sulfonamides can be used topically?

A

silver sulfadiazine

mafenide

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22
Q

which sulfonamide should be used for opthalmic apps because of neutral ph?

A

sulfacetamide

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23
Q

how are sulfonamides metabolized?

A

acetylation in liver

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24
Q

what effect does alkaline urine have on the excretion of sulfonamides?

A

increases fraction of dose eliminated in urine

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25
Q

what are the 2 immunological based toxicities of sulfonamides?

A

kcs ( dry eye)

hepatic necrosis

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26
Q

what is the non immunological effects of sulfonamide toxicity on kidney?

A

crystalluria
hematuria
renal tubular blockage

because of dehydration, keep well hydrated and aciduria protects

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27
Q

does a combination of sulpha drugs increase or decrease their solubility?

A

increase ( law of independent solubility)

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28
Q

which sulpha drug causes hypoprothrombinemia in dogs and chickens?

A

sulfaquinoxaline

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29
Q

what sulfa drug can cause aplastic anemia?

A

trimethoprim sulfadiazine ( potentiated sulfa)

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30
Q

which species can have hypoglycemia from taking sulfa drugs?

A

ducks and dogs

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31
Q

which breed of dog can get polyarthritis and hepatitis from sulfa drugs?

A

doberman pinschers

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32
Q

what gland may sulfonamides interfere with but is reversible?

A

thyroid gland

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33
Q

What group is sulfonamides in efficacy predictors?

A

type 2 antimicrobials, therefore ideal dosing maximizes duration of exposure

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34
Q

What type of molecule are diaminopyramidines?

A

lipid soluble organic bases

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35
Q

Are diaminopyramidines bacteriocidal or bacteriostatic?

A

bacteriostatic

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36
Q

How do diaminopyramidines block bacterial folate synthesis?

A

reversibly binds and inhibits dihydrofolate reductase

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37
Q

Which diaminopyramidine inhibits folate synthesis in protozoa?

A

pyrimethamine

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38
Q

Which diaminopyramidine can be given orally to ruminants?

A

ormetoprim

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39
Q

What are the 3 different diaminopyramidines?

A

Pyrimethamine, trimethoprim, and ormetoprim

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40
Q

Are potentiated sulfonamides bacteriostatic or bacteriocidal?

A

bacteriocidal (each one alone is bacteriostatic)

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41
Q

How do beta lactam antibiotics exert bactericidal activity?

A

interfere with transpeptidase enzyme that is responsible for formation of cross links (penicillin binding proteins - PBP)

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42
Q

What type of bacterial cell wall can beta lactams NOT penetrate?

A

gram negative

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43
Q

What 2 beta lactam drugs are “natural penicillins”?

A

Penicillin G

Penicillin V

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44
Q

Which natural penicilllin can be given orally?

A

Penicillin V

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45
Q

What are the 2 log acting formulations of Penicillin G?

A

Benzathine

Procaine

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46
Q

What bacteria are resistant to natural penicillins?

A

Pseudomonas, enterobacteriaceae and penicillinase producing staph

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47
Q

What are the 3 groups of semi synthetic penicillins?

A 
Penicillinase resistant penicillins
Broad spectrum (aminopenicillins)
extended spectrum (carboxypenicillins)
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48
Q

What 3 penicillinase-resistant penicillins have good oral absorption?

A

Cloxacillin
Oxacillin
Dicloxacillin

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49
Q

What are penicillinase-resistant penicillins used to treat mostly?

A

staph infections

-bovine staph mastitis

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50
Q

What penicillinase-resistant penicillin can be formulated as an opthalmic ointment and treat staph and bacillus infections?

A

cloxacillin

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51
Q

What are the two drugs in the broad spectrum penicillins?

A

Amoxicillin

ampicillin

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52
Q

What are some related esters of ampicillin? (prodrugs)

A

bacampicillin
hetacillin
pivampicillin
talampicillin

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53
Q

What 5 penicillins are in the extended spectrum group?

A

ticarcillin, carbenicillin, piperacillin, mezlocillin, azlocillin

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54
Q

Why can’t procaine penicillin G be administered IV?

A

affects cardiac conduction system

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55
Q

What can be used to competitively inhibit penicillin excretion?

A

another organic acid, such as probenecid

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56
Q

Which penicillin is not excreted in urine?

A

Nafcillin (bile)

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57
Q

What can sodium benzylpenicillin produce in dogs and cats?

A

ataxia and convulsions (inhibits GABA)

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58
Q

What drug can produce anaphylaxis and CNS disorders in small mammals and reptiles?

A

procaine

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59
Q

What can procaine and postassium penicillin salts administered IV as a rapid bolus induce?

A

acute cardiac toxicities

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60
Q

What salt form should you use when administering penicillins IV?

A

sodium salt

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61
Q

What are the 3 first generation cephalosporins that can be given orally?

A

cefadroxil
cephalexin
cephradine

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62
Q

What are the 3 first gen cephalosporins that can be given parenteral?

A

cefazolin
cephalothin
cephapirin

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63
Q

Which first gen cephalosporin has greatest gram negative activity?

A

cefazolin

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64
Q

What bacteria are 2nd gen cephalosporins better at killing than 1st gen?

A

gram negative because increased resistance to lactamases

also anaerobes

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65
Q

Which drug is a “new generation” of cephalosporins?

A

ceftiofur (broader gram + activity)

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66
Q

How does ceftiofur compare to other 3rd gen cephalosporins?

A

better at strept

less activity against pseudomonas

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67
Q

What cephalosporin is 4th gen?

A

cefepime

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68
Q

Which 2 cephalosporins have the best oral absorption?

A

cephalexin

cefaclor

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69
Q

What is the only 2nd gen cephalosporin that can penetrate cerebrospinal fluid?

A

cefuroxime

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70
Q

What 3rd generation cephalosprins can attain high concentration in cerebrospinal fluid when meninges are inflammed?

A

ceftriaxone
cefotaxime
ceftazidime
ceftizoxime

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71
Q

What 2 cephalosporins can decrease platelet aggregation?

A

cephalothin

cefinetazole

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72
Q

How does clavulanic acid and sulbactam potentiate penicillin?

A

competitive inhibitor of beta lactamases of bacteria

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73
Q

What are the two kinds of Cabapenems?

A

Imipenems

Meropenems

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74
Q

What must imipenems be administered with?

A

cilastatin (renal enzyme inhibitor)

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75
Q

What bacteria does imipenems have activity on?

A

broad spectrum
gram negative aerobic
anaerobic

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76
Q

What is the adverse effect of imipenems?

A

seizures

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77
Q

How is meropenems different from imipenems?

A

more soluble

decreased seizures

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78
Q

What can be used against gram negative bacteria or pseudomonas if patient is allergic to penicillin?

A

monobactams

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79
Q

How do antimicrobials that inhibit protein synthesis target bacterial ribosomes instead of the host?

A

affinity for 70s size (eukaryotes is 80s)

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80
Q

What 2 parts of protein synthesis can antibiotics interfere with?

A

initiation

elongation of polypeptide chain

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81
Q

What 2 groups of antibiotics act on the 30 S subunit to inhibit protein synthesis?

A

aminoglycosides

tetracyclines

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82
Q

What 3 groups of antibiotics act on 50S subunit to inhibit protein synthesis?

A

macrolides
lincosamides
chloramphenicol and derivatives

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83
Q

Are aminoglycosides bacteriostatic or bacteriocidal?

A

bactericidal

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84
Q

What are the 6 aminoglycoside drugs?

A 
streptomycin
neomycin
kanamycin
gentamicin
amikacin
tobramycin
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85
Q

Why is one single dose of aminoglycosides q24 the same as many small ones?

A

post antibiotic effect (PAE)

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86
Q

What kind of bacteria do aminoglycosides act on?

A

aerobic gram negative bacteria

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87
Q

What aminoglycoside has the broadest spectrum?

A

amikacin

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88
Q

Which bacteria has natural permeability barrier to aminoglycosides?

A

streptococci

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89
Q

How are aminoglycosides administered?

A

parentally (never orally)

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90
Q

Where do aminoglycoside drugs concentrate in the body?

A

perilymph of the inner ear and in the renal cortex (attracted to phospholipids)

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91
Q

Why shouldn’t aminoglycosides and diuretic agents be used concurrently?

A

dehydration –> nephrotoxicity

92
Q

What can happen when aminoglycosides are in high plasma concentrations after bolus?

A

non depolarizing neuromuscular blockade

93
Q

What are 3 ways bacteria can be resistant to aminoglycosides?

A

enzymatic inactivation
ribosomal alterations
reduced permeability to drug

94
Q

What is the efficacy predictor of aminoglycosides?

A

Type 1 - concentration dependent killing kinetics

95
Q

How can renal uptake of gentamicin be inhibited?

A

alkalinizing the urine with sodium bicarbonate

96
Q

Which aminoglycoside is too toxic for systemic use and used in topical applications?

97
Q

Which aminoglycoside is effective against gram positive AND negative bacteria?

A

paromomycin

98
Q

What aminoglycoside is effective against Pseudomonas in dogs and cats?

A

Tobramycin

99
Q

What are the 3 natural tetracyclines?

A

chlortetracycline
tetracycline
oxytetracycline

100
Q

What are the 2 semi-synthetic tetracyclines?

A

minocycline

doxycycline

101
Q

Are tetracyclines bacteriostatic or bacteriocidal?

A

bacteriostatic

102
Q

What do tetracyclines bind to?

A

30s ribosomal subunit

103
Q

Which tetracycline is the treatment of choice for equine monocytic ehrlichiosis? (potomac horse fever)

A

oxytetracycline

104
Q

What tetracycline is effective against penicillinase resistant strains of staph aureus?

A

minocycline

105
Q

What microorganisms are resistant to tetracyclines?

A

Proteus vulgaris
Pseudomonas aeruginosa
Mycobacterium
some Mycoplasma

106
Q

Which tetracycline is given IM?

A

oxytetracycline

107
Q

Which tetracycline is more completely absorbed in GI tract?

A

doxycycline

108
Q

What are the 2 most lipid soluble tetracyclines?

A

Minocycline and doxycycline

109
Q

What two tetracyclines are metabolized in the body? How are they then removed?

A

mino (oxidation)

doxy (bile diffusion) - can be used in renal failure

110
Q

Why should IV (oxy?)tetracycline be given slowly?

A

chelates calcium in blood

111
Q

What can IV injections of doxy in horses do?

A

induces cardiac arrhythmia – sudden death

112
Q

How does oral tetracycline alter microflora in horses?

A

proliferation of clostridium perfringens or salmonella –> colitis

113
Q

What group of efficacy predictors does tetracycline belong to?

A

type 3 - time dependent killing and PAE

114
Q

What is the mode of action for chloramphenicol?

A

binds to 50s subunit

115
Q

What can happen in prolonged admin of chloramphenicol?

A

bone marrow suppression (esp in cats) mitochondrial ribosome similar to bacterial one

116
Q

What other antibiotic can chloramphenicol compete with and should not be administered with?

A

macrolides (erythromycin)

117
Q

Which 2 types of bacteria are resistant to chloramphenicol?

A

Pseudomonas aeruginosa

enterobacteriaceae (readily acquired)

118
Q

Which chloramphenicol drug is only available orally?

A

chloramphenicol base

119
Q

Which chloramphenicol is hydrolyzed in small intestine by esterases?

A

chloramphenicol palmitate

120
Q

Which chloramphenicol can be given IV/IM?

A

chloramphenicol succinate

121
Q

How is chloramphenicol metabolized and therefore which animal has a slower clearance time?

A

conjugated with glucoronic acid

cats

122
Q

Can you use chloramphenicol in food-producing animals?

123
Q

Which chloramphenicols do not induce bone marrow stem cell damage?

A

thiamphenicol

florfenicol

124
Q

What type of animals are most sensitive to chloramphenicol toxicity?

A

young animals
cats
impaired liver fxn

125
Q

What is the side effect in newborn humans that are treated with high doses of chloramphenicol?

A

Gray baby syndrome

126
Q

Which bacterial enzyme inactivates chloramphenicol and is acquired by plasmids?

A

acetyltransferase (florfenicol resistant to it)

127
Q

What semi-synthetic chloramphenicol derivative is more water soluble?

A

thiamphenicol

128
Q

Which chloramphenicol derivative is more potent and can be used in food producing animals?

A

florfenicol

129
Q

What efficacy predictor group is chloramphenicol?

A

type 2 - time dependent

130
Q

What are the 6 macrolide antibiotics?

A 
erythromycin
tilmicosin
tylosin
tiamulin
azithromycin
clarithromycin
131
Q

How do macrolides differ in their mode of action than chloramphenicols?

A

unable to cross mitochondrial membrane and do not effect bone marrow

132
Q

Are macrolides bacteriostatic or bacteriocidal?

A

bacteriostatic at therapeutic levels

bacteriocial slowly against strep

133
Q

How does pH effect the antimicrobial action of macrolides?

A

high pH - enhanced

low pH - suppressed

134
Q

Which macrolide is used to treat pink eye?

135
Q

What is the preferred route of admin of macrolides?

A

oral (injections painful)

136
Q

Which macrolide is metabolized by the liver?

A

erythromycin

137
Q

Which macrolide is fatal to horses?

138
Q

Which macrolide has a type 3 efficacy predictor?

A

azithromycin

139
Q

What 2 drugs are lincosamides?

A

lincomycin

clindamycin

140
Q

What bacteria are not effected by lincomycin?

A

gram negatives

141
Q

Which lincosamide is more lipid soluble and can cross BBB?

A

clindamycin

142
Q

How are lincosamides excreted?

143
Q

What animals should lincosamides not be used in?

A

chinchillas, guinea pigs, hamsters
horses, ponies
rabbits

144
Q

What efficacy predictor group is lincosamides?

145
Q

What 2 groups of antimicrobials inhibit DNA replication?

A

fluorquinolones

metronidazole

146
Q

What antimicrobial drug inhibits RNA synthesis?

147
Q

What are the 3 first generation fluorquinolones?

A

naildixic acid
oxolinic acid
cinoxacin

148
Q

What are the 4 third generation fluoroquinolones?

A

orbifloxacin
levofloxacin
sparfloxacin
grepafloxacin

149
Q

What are the 7 2nd generation fluorquinolones?

A 
ciprofloxacin
enrofloxacin
marbofloxacin
danofloxacin
difloxacin
norfloxacin
enoxacin
150
Q

What bacterial enzyme is inhibited by fluoroquinolones?

A

DNA gyrase enzyme

151
Q

Which fluoroquinolone may have activity on anaerobes?

A

difloxacin

152
Q

What type of bacteria are more susceptible to fluoroquinolones in an alkaline environment?

A

Enterobacteriaceae and other gram negative aerobes

153
Q

What three conditions is pradofloxacin effective for against anaerobes, gram positives and gram negatives?

A

pradofloxacin

154
Q

What are the two “new” generation fluoroquinolones?

A

premafloxacin

pradofloxacin

155
Q

What are the 2 factors that affect the action of fluoroquinolones?

A

Cations decrease activity

low pH decreases activity

156
Q

Which fluoroquinolones can be given in water for poultry infections?

A

enrofloxacin

sarafloxacin

157
Q

Which fluoroquinolone is not widely distributed in tissues?

158
Q

Which 2 tissues do fluoroquinolones not achieve a high concentration?

159
Q

Which fluoroquinolone is well distributed in bone, prostate and skin and all horse tissues?

A

enrofloxacin

160
Q

What tissue does enrofloxacin, marbofloxacin and orbifloxacin achieve good levels?

161
Q

Which 2 fluoroquinolones are highly excreted in milk?

A

enrofloxacin

danofloxacin

162
Q

Which fluoroquinolones have active metabolites?

A

Difloxacin
Enrofloxacin
Pefloxacin

163
Q

Which fluoroquinolone exception is excreted through faeces instead of urine?

A

difloxacin

164
Q

What are some of the side effects of fluoroquinolones?

A 
Photosensitivity
CNS effects
Crystalluria
GI effects
Arthropathy/Joint Arthropathy
Ocular toxicities
165
Q

What fluoroquinolone causes abnormalities in horses tendon cultures?

A

enrofloxacin

166
Q

Why does fluoroquinolones given IV rapidly cause CNS effects?

A

inhibition of GABA

dont give to seizure patients

167
Q

What is the most important bacterial resistance mechanism for fluoroquinolones?

A

increased efflux (alterations in gyrase enzyme and decreased uptake also mechanisms)

168
Q

What efficacy group is fluoroquinolones?

A

Type 1 - max concentration

169
Q

What is the MOA for bacitracin?

A

inhibits peptidoglycan synthesis

170
Q

What are the indications for bacitracin?

A

topical tx of superficial infections in skin, mucosal surfaces, ear and eye

171
Q

What is the MOA for novobiocin?

A

inhibits cell wall synthesis, RNA, DNA, protein, respiration

172
Q

Do bacteria acquire resistance against novobiocin?

A

Yes, very quickly

173
Q

What spectrum of activity does thiostrepton have? how is it administered?

A

gram + and some -

topical therapy

174
Q

Which nitrofuran drug can have a carcinogec effect when administered chronically?

A

Furazolidone

175
Q

How are nitrofurans administered?

A

Topically/orally

need acid environment to go into cell membrane

176
Q

What is the MOA for virginiamycin and is it bacteriostatic or bacteriocidal?

A

Bacteriocidal

inhibits protein synthesis at 23s ribosomal subunit

177
Q

What is the clinical use of virginiamycin?

A

growth promotion in swine, turkeys and laying hens

178
Q

What clinical uses is carbadox used for?

A

growth promotant in swine

tx swine dysentery, bacterial enteritis

179
Q

What happens if there is a toxicity of carbadox?

A

hypoaldosteronism (>100 ppm)

180
Q

What is the MOA for vancomycin? Bacteriocidal or static?

A

inhibits peptidoglycan synthesis

bactericidal

181
Q

What should vancomycin be combined with to treat enterococcal infections?

A

aminoglycoside (amikacin/gentamicin)

182
Q

What are the 2 adverse effects of vancomycin?

A

nephrotoxicity

histamine release –> IV

183
Q

What group of antibiotics is vancomycin in that is banned from using in food animals?

A

glycopeptides

184
Q

Is methenamine bacteriostatic or bacteriocidal

A

depends on pH of urine

185
Q

What condition is methenamine used to treat?

A

UTI in small animals

186
Q

What other antibiotic should not be administered with methenamine?

A

sulfonamides

187
Q

What 2 antibiotics interfere with the cell membrane?

A

polymyxin B

colistin (polymyxin E)

188
Q

Are polymyxins bacteriostatic or cidal?

A

bacteriocidal

189
Q

Why are polymyxins used for “bowel sterilization” before sx?

A

not absorbed from GIT when given orally

190
Q

What is polymyxin B effective against in gram negative bacteria infections?

A

endotoxins

191
Q

How are most polymyxins given?

A

topical use

192
Q

What can polymyxins be combined with to act synergistically against gram negative bacilli?

A

sulfonamides

193
Q

What is the MOA for metronidazole?

A

disrupts DNA structure

bacteriocidal

194
Q

What type of bacteria is metronidazole most effective against?

A

systemic and enteric obligate anaerobic bacterial infections

195
Q

What part of metronidazole can have a carcinogenic effect in rats?

A

a minor metabolite that evolved from splitting the metronidazole ring

196
Q

Can nitroimidazoles be used in food producing animals?

A

NO - may be carcinogenic

197
Q

What efficacy predictor group is metronidazole?

A

type 1 - concentration dependent

198
Q

How is rifampin metabolized?

A

de-acetylation –> active metabolite

induces Cytochrome p450

199
Q

How is rifampin excreted?

200
Q

What are some of the adverse effects of rifampin?

A

anemia/thrombocytopenia

hepatitis in dogs

201
Q

what are the 5 bacteiostatic type drug groups?

A 
sulfonamides
tetracyclines
chloramphenicol
macrolides
lincosamides
202
Q

Which antibiotic causes bowel sterilization?

203
Q

What is it called when 2 static antibiotics work together?

A

additive effect

204
Q

What group of antibiotics is effected by cations and pH?

A

fluoroquinolones

205
Q

What cephalosporin is the only 2nd gen that can go into CSF?

A

cefuroxime

206
Q

What antibiotic treats swine dysentery but has hypoaldosteronism toxicity?

207
Q

What are the antibiotics that are type 1 efficacy? (3)

A

aminoglycosides
fluoroquinolones
metronidazole

208
Q

What are the 5 bacteriostatic antibiotics?

A

sulfonamides
tetracyclines
chloramphenicol, macrolides, lincosamides (50S)

209
Q

Which beta lactam has low immunogenic profile?

A

monobactam (aztreonam)

210
Q

Which cephalosporins are excreted in bile?

A

ceftriaxone

cefoperazone

211
Q

Which bacteria are resistant to fluoroquinolones?

212
Q

What is the first choice antibiotic for C. jejuni?

A

Erythromycin

213
Q

What is the first choice drug for mycoplasma sp?

214
Q

What bacteria are susceptible to metronidazole?

A 
obligate anaerobes (clostridium, fusobacterium)
protozoa
215
Q

Which antibiotics are carcinogenic?

A

Metronidazole

Nitrofuran

216
Q

Which antibiotic has good effect on pseudomonas and proteus?

217
Q

Which drug group has arthropies and ocular toxicities?

A

fluoroquinolones

218
Q

What bacteria are resistant to lincomycin?

A

gram negatives

219
Q

What are the susceptible bacteria groups of each of the cephalosporin generations?

A

First - gram +
2nd - gram -
3rd - better gram -
Ceftiofur - more gram +

220
Q

Which drug group chelates calcium in teeth and bone?

A

tetracyclines

221
Q

What is the 4th generation cephalosporin?

222
Q

Which drug group causes fatal enterocolitis in hind gut fermenters?

A

lincosamides

223
Q

What are the 4 antibiotic groups banned in food animals?

A

Metronidazole
Vancomycin
Nitrofurans (Furazolidone)
Chloramphenicol

224
Q

Which antibiotics inhibit GABA?

A

Fluoroquinolones

Penicillin

225
Q

What drug is combined with tetracycline for synergism against kennel cough?

A

novobiocin

226
Q

Which antibiotics treat prostate infection?

A

Enrofloxacin
marbofloxacin
orbifloxacin
(fluoroquinolones)

227
Q

Which macrolide causes cardio toxicity?

A

tilmicosin

228
Q

How is bacterial resistance acquired against rifampin?

A

single step mutation –> happens quickly

use with other antimicrobials

Pharmacology (21 decks)

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