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76 Cards in this Set
- Front
- Back
Define analgesic
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drugs that relieve pain without causing loss of consciousness
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Define opioid
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any drug, natural or synthetic, that has actions similar to those of morphine
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Define the term opiate.
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more specific & only applies to compounds present in opium (morphine, codeine)
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List a few various interpretations of the term narcotic.
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- Analgesic, a CNS depressant & any drug capable of causing physical dependence
- In a legal context to despignate not only the opioids but also such diverse drugs as cocaine, marijuana, LSD |
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Name three families of endogenous opioid peptides.
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- Enkephalins, endorphins, dynorphins
- Serve as neurotransmitters, nuerohormones & nueromodulators |
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Name 4 responses to activation of Mu opioid receptors.
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Analgesia, respiratory depression, euphoria & sedation
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Identify the three major groups of drugs that bind to opioid receptors.
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o Pure opioid agonists
o Agonist-antagonist opioids o Pure opioid antagonists |
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Because the pure opioid agonists activate mu receptors and kappa receptors, what 6 effects can be produced?
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Produce analgesia, euphoria, sedation, respiratory depression, physical dependence, constipation & other effects
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When given alone, what effect do agonist-antagonist opioids, such as pentazocine or butorphanol have?
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Analgesia
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When given to a patient taking a pure opioid agonist, what effect do agonist-antagonist opioids, such as pentazocine have?
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Can antagonize analgesia caused by the pure agonist
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What is the principal use of pure opioid antagonists?
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Reversal of other effects caused by opioid agonists
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Name 6 pharmacologic effects of morphine.
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Analgesia, sedation, euphoria, respiratory depression, cough suppression & suppression of bowel motility
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Name the 3 medicinal compounds contained in opium. Where does opium come from?
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- Morphine, codeine & papaverine
- Opium comes from the seedpod of a the poppy plant, the dried juice of the poppy seedpod |
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In addition to relieving pain, name 4 pharmacologic actions of morphine
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Causes drowsiness, mental clouding ,anxiety reduction, and a sense of well-being
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Through actions on the CNS and periphery, name eight adverse effects that morphine can cause?
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Respiratory depression, constipation, urinary retention, orthostatic hypotension, emesis, miosis, cough suppression & biliary colic
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What is the principal indication for morphine?
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Relief of moderate to severe pain
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Name 4 effects that morphine is able to cause that contribute to the relief pain
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Relieve postoperative pain, chronic pain of cancer, labor & delivery pain, relive pain of MI and dyspnea associated w/ left ventricular failure
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How soon might respiratory depressant effects occur after an opioid …
IV? IM? Subcutaneous injection? |
IV injection? 7 minutes
IM injection? 30 minutes Subcutaneous injection? 90 minutes |
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With all three routes how long may respiratory depression persist?
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4 - 5 hours
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During opioid administration what action should be taken if the respiratory rate falls below 12 breaths per minute?
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Opioid should be withheld and the prescriber notified
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Name 4 ways that opioids promote constipation.
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Suppress propulsive intestinal contractions, intensify nonpropulsive contractions, increase the tone of the anal sphincter & inhibit secretion of fluids into the intestinal lumen
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Name 2 nonpharmacologic measures that can reduce opioid-induced constipation.
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Physical activity & increased intake of fiber & fluids
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Because of their effect on the intestine, what can opioids effectively treat?
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diarrhea
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What effect do opioids have on BP …
when standing? |
When standing up? Lowers BP, person becomes dizzy or lightheaded
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How does morphine cause urinary hesitation and urinary retention? How else can morphine interfere with voiding?
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- By increasing tone in the urinary sphincter, increasing tone in the detrusoer muscle, the drug can elevate pressure w/in the bladder causing urinary urgency
- Interfere w/ voiding by suppressing awareness of bladder stimuli - Also can decrease urine production by partly promoting release of antidiuretic hormone |
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How is the patient assessed for urinary retention? How often?
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Palpating the lower abdomen every 4 – 6 hours for bladder distention, intake & output
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Because opioids suppress the cough reflex, what adverse respiratory effects may result?
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Accumulation of secretions in the airway
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Compare the incidence of nausea and vomiting in the patient receiving morphine who is lying still or ambulating.
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Uncommon in the recumbent patient but occur in 15% to 40% of ambulatory patients
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Euphoria
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exaggerated sense of well-being
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Disphoria
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a sense of anxiety & unease
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How does morphine and other opioids impair vision?
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Cause papillary constriction (miosis), may constrict to “pinpoint” size
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Name 6 different routes used to administer morphine.
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Oral, IM, IV, subQ, epidural, intrathecal
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Due to much of the drug being inactivated during the first pass through the liver, how are oral doses affected?
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Oral doses need to be larger than parenteral doses to produce equivalent analgesic effect
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tolerance
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a state in which a larger dose is required to produce the same response that could formerly be elicited by a smaller dose.
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physical dependence
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state in which an abstinence syndrome will occur if drug use is abruptly stopped.
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Describe four early symptoms of opioid abstinence syndrome occurring about 10 hours after the last dose.
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Yawning, rhinorrhea, sweating
Followed by: anorexia, irritability, tremor & “gooseflesh” |
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At the peak of abstinence syndrome, what symptoms may occur?
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Violent sneezing, weakness, nausea, vomiting, diarrhea, abdominal cramps, bone & muscle pain, muscle spasm & kicking movements
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How likely is physical dependence when opioids are taken acutely to treat pain?
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rarely
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According to the Controlled Substance Act how are morphine and other strong opioids classified? What does this mean?
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Schedule II – a moderate to high abuse liability
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Describe the classic triad of signs produced with opioid overdose.
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Coma (profound & pt can’t be aroused), respiratory depression (2-4 breathers/min) & pinpoint pupils ( may dilate as hypoxia sets in which can cause BP to fall)
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What should be determined before an opioid is administered?
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Respiratory rate, BP, & pulse rate
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Why are opioids sometimes administered on a "fixed schedule?"
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Medication is given before intense pain returns, pt is spared less discomfort
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When morphine is injected into IV tubing, how long should the nurse take to give it?
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Slowly over 4 -5 minutes
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When IV injections are made what two things should be available?
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Opioid antagonist and facilities for respiratory support should be available
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What is the duration of morphine administered by the epidural route?
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up to 24 hours
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What opioid with pharmacologic properties similar to morphine was considered a first line drug of choice in the past but has now declined in use?
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Meperidine
- Short half-life & dosing must be repeated at short time intervals - Interacts adversely w/ a number of drugs - With continuous use, there is a risk of harm owing to accumulation of a toxic metabolite |
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What is the usual dosage range for hydromorphone (Dilaudid) given IM or subcutaneous? How does this compare to the usual IM or subcutaneous dose of morphine?
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Dosages range from 1 – 4 mg every 4 – 6 hours
Morphine: 5 – 1 mg every 4 hours |
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What is the indication for codeine? How is it usually administered?
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o For mild to moderate pain
o Usually administered PO |
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Why is the degree of pain relief that can be achieved with codeine quite low?
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Because it is achieved safely
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What 2 non-opioid analgesics are frequently combined with codeine to produce greater pain relief than either agent alone?
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Aspirin or acetaminophen
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Besides pain, for what other action is codeine widely used?
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Cough suppressant
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What is a brand name for a combination of oxycodone and aspirin?
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Percodan
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What is unique about OxyContin?
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Long acting analgesic designed to relieve moderate to severe pain around the clock for an extended time.
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What may be done if a patient taking OxyContin has break through pain?
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Supplemental dosing w/ short-acting analgesic is indicated
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To prevent a potentially fatal dose of OxyContin, how should the extended release tablets be taken?
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Swallowed whole without breaking, crushing or chewing
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What are two brand names for propoxyphene?
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Darvon
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What additional drug is in Darvocet?
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Acetaminophen
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How do agonist-antagonists compare to pure opioid agonists related to abuse potential, side effects and pain relief?
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Have a low potential for abuse, produce less respiratory depression & have less powerful analgesic effects
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What are agonist-antagonists opioids such as pentazocine (Talwin) indicated for? How does pentazocine (Talwin) compare to morphine in the treatment of severe pain?
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o Mild to moderate pain
o It is much less effective than morphine against severe pain |
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If pentazocine (Talwin) is given to a patient who is physically dependent on a pure opioid what can happen?
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Can precipitate withdrawal
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Why are agonist-antagonists such as pentazocine (Talwin) and butorphanol (Stadol) contraindicated in patients with a myocardial infarction?
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It increases cardiac work, a pure agonist is preferred for relieving MI pain
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When should pain status be evaluated when a patient is being treated with opioids?
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Prior to opioid administration & about 1 hour after
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Ultimately what must pain assessment be based on?
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The patients description of his/her experience
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Name four characteristics of pain that should be part of pain assessment.
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Where pain is located, type of pain (dull, sharp), how the pain changes w/ time, what makes the pain better or worse
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Give three reasons a patient might under-report pain.
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Fear of addiction, fear of needles, and a need to be stoic & bear the pain
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Summarize the benefits of administering opioids on a fixed schedule rather than PRN.
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Each dose is given before pain returns, sparing the pt needless comfort
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How might a nurse's overconcern about the ability of opioids to cause physical dependence and addiction effect nursing decisions?
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Administer less of prescribed medication, unable to make a rational decision, supposed to be a patient advocate
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What is Patient-Controlled Analgesia?
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A method of drug delivery that permits the patient to self-administer parenteral opioids on an “as needed” basis
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For what patients has PCA been primarily used? Name five other patient conditions where PCA is used.
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Postoperative patients, pain caused by cancer, trauma, MI, vaso-occlusive sick cell crisis & labor
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What is an essential component of all PCA devices? What does it control?
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A timing control, it limits the total dose that can be administered each hour, minimizing the risk of overdose
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What opioid is used most extensively for PCA?
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morphine
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Prior to starting PCA what is the postoperative patient given?
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An opioid loading dose
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What are the principal uses for opioid antagonists?
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Opioid overdose, relief of opioid-induced constipation, reversal of postoperative opioid effects & management of opioid addiction
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Identify the pharmacologic effect of naloxone under the following circumstances…
1. When administered in the absence of opioids 2. If administered prior to an opioid 3. If given to a patient already receiving an opioid 4. If administered to a patient physically dependent on opioids |
1. No significant effects
2. Will block opioid actions 3. Reverse analgesia, sedation, euphoria & respiratory depression 4.Precipitate an immediate withdrawal reaction |
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After administration of naloxone how soon will effects begin?
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IV – begins immediately and persist an 1 hour
IM or Subcutaneous – 2 to 5 minutes and persist several hours |
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Following surgery how should naloxone be administered in order to reverse excessive respiratory and CNS depression without unmasking pain?
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Dosage should be titrated with care, the objective is to achieve adequate ventilation & alertness without reversing opioid actions to the point of unmasking pain
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