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87 Cards in this Set
- Front
- Back
meds that can cuase secondary htn?
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corticosteroids, alcohol, amphetamines, appetite suppressants, caffeine, cyclosporine, estrogens, nsaids, oral decongestants, thyroid (if too much), venlafaxine, chemo (bevacizumab and sorafenib..bio agents)
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what is normal BP?
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under 120/80
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pre htn?
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120-140/80-90
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htn 1?
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140-160/90-100
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htn 2
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over 160/100
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drug for DM type 1 w/ htn and albunuria
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ACE
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DM 2 and htn adn microalb
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ace or arb
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DM 2 with htn, macroalbin, and renal insuff
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ARB
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HF and HTN meds
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ACEi, diuretics
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MI and HTN?
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BB (non ISA) and ACE
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isolated systolic HTN (usually elderly)
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long acting DHP CCP
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Followup for BP monitoring once med is initiated? after stable? Other things to make sure of (3)
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monthly, 3-6 months, smoking cessation/manage comorbidities and complications, lipid panel
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what are the 6 lifestyle things to stop for HTN?
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weight reduction (5-20 drop SBP), DASH eating (8-14), Na reduction (2-8), physical activity (4-9), moderate consumption of alcohol (2-4), stop smoking
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waht are the CI to thiazide diuretics?
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pregnancy, persistant anuria, sulfa allergy
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4 cautions with thiazide diuretics
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gout, ClCr under 30, DM, dyslipidemia
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what are the lab value SE that thiazide diuretics will cuase?
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hypokalemia, hypERcalcemia, hypOnatremia, hypOmag, hypERuricemia (gout), hyperGlycemia (caution in DM), hyperchol (caution in dyslipid), hypertriglycer (caution in dyslipid), photosensitive
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Inxs of thiazeds?
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blood sugar addition with BB, digoxin toxicity with the electrolytes (hypokalemia, hypomagn), additive gout risk with cyclosporine, may increase lithium levels, nsaids/bile acid resins/decongestants can decresae effect
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brand name of hctz?
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microzide, oretic
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brand of chlorthalidone
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thalitone
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MOA of thiazides?
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inh Na reabsorption
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what is the special use remark on metolazone?
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use with a loop diuretic
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name 3 K sparing diuretics
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spironolactone, amiloride, triamterene
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spironolactone brand
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aldactone
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MOA of K sparing diuretics
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ald rec antag, works in distal rrenal tubules, Na excretion increased while holding onto K
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Ci of the ald antag (K sparing)
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anuria, pregnancy, hyperkalemai, chronic renal insuff
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general SE considerations of the ald antag (K sparing)
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increased K, decreased Na
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spironolactone specific SE
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gynecomastia, hair loss, menstrual irregu, impotence
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specific K level where the ald antag (K sparing) are contraindicated?
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5.5
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Loop diuretics MOA
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inh Na and Cl reabsorption in loop of henle and distal renal
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furosemide and bumetanide brand
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lasix, bumex
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oral dose equivalence among loops for furosemide, bumetanide, torsemide?
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40=1=10
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CI to loop diuretics?
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sulfa allergy, anuria, pts with hepatic coma
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Genergal SE of loops
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hypOkalemia, otheelectroly, gout etc, OTOTOxicity, ortho hypotension
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what other meds will have additive ototoxicity?
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AG, vanco, salicylates, cisplatin
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loop inxns?
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additive hypo effects, dig toxicity (hypokalemia), increased lithium levels, MONITOR dehydration
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what is a sign of hypokalemia?
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muscle cramps
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what time in day should you take diuretics? K sparing?
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mornign, after meals
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what are the most effective thiazides for pts with impaired renal fxn?
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metolazone, indapamide
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brand of benazepril? enalapril? lisinopril? ramipril?
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lotensin (benz), vasotec (enal) prinivil, zestril (lisin), altace (rami)
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CI to ACEi
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pregnancy, angioedema, bilateral renal artery stenosis
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SE of ACE...CAPTOPRIL
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Cough, angioedema, proteinuria, tast changes, ortho hypo, preg cat D, rash/renal failure, increase in K, Lithium increase
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when given electrolyte substitutes waht should you take note of ?
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KCL rather than NaCl
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3 monitoring parameters for ACE
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serum K, fluid staus, renal fxn
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what ethnic may not benefit as much?
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blacks
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brand name of irbesartan
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avapro
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brand losartan
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coazzr
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valsartan brnad
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diovan
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brand olmesartan
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benicar
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CI to BB (5)
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2nd/3rd degree heart block, sinus brady, cardio shock, decomp HF, pulm edema, pregnancy
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how must BB discontinuing be handled?
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do not abruptly withdraw
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waht are the many SE of BB
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depression, sexual dys, hyperglyc, vivid dreams and hallucination, hyperlipid, brady, ortho hypo, CHF
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what is an additional warning when pt is DM?
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can mask hypoglycemic symptoms
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what is a combined alph and beta blocker?
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carv (coreg)
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what are the differences for nebivolol (bystolic?)
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also an increased NO release with Beta blocking....2d6 inxns
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name the 4 BB with isa activity
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carteolol, acebutolol, penbutolol, pindolol
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what ethinicity many BB not be as good in?
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black
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what hypo symtpom sdo BB not mask?
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hunger and sweating
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Beta1 selective BB?
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aten, meto, esomolo, bisoprolol, betaxolol, acebutolol
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name 3 alpha blockers?
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prazosin (minipress), terazosin (hytrin), doxazosin (cardura)
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alpha blocker caution
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if concurreet use of PDE-5 inh (sildenafil, tadalafil, vardenafil)...avoid concurrent use with tamsulosin, alfuzosin
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SE of alpha blockers (prazosin, terazosin, doxazosin)
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post hypo, first dose SYNCOPE, dizzy, vergtigo, HA, weakness, depression, edema, sexual dysfunction
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what meds when combined with alpha blockers may increase orthostaiss?
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TCA's and antipsychotics
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CI to nondihydros?
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2nd/3rd degree heart block, hypotension, Acute MI, pulm congestion, sick sinus rythm
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waht are the SE of Nondihydros that are more common with verapamil?
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constipation, gingival hyperplasia
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SE of nondihydros?
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Ha, flushing, dizzy, constipation, edema, gingival hyperplasia, fatigue, bradycardia, nausea
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Inxns important to the nondihydros
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Increase CCB levels: azoles, cimetidine, ciproflox, erythromycin, valproid acid, PI....decrease CCB: carbamazepine, bariturates, phenobarb, rifampin, rifabutin
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what meds can CCB increase the levels of?
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carbamazepine, cyclosporine, digoxin, statins, lithium
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what is the mech of the dihydros?
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purely afterload reducers, no AV node or HR effects
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name a few dihydros
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amlodipine, felodipine, nicardipine...IPINE
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which dihydros are reflex tachy seen?
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none with amlodipine...felodipine, nicardipine, nisoldipine, IR nifedipine
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SE of dihydros
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periph edema, HA, flushing, hypotension, dizzy, rash, gingival hyperplasia
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name some central acting Alph ag
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clinidine (catapres), guanfacine, methyldopa
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waht is the side effect profile of central actin alpha
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antichol (sedation, dry moth), sexual dysfunction, brady, reboutn htn, constipation, depression
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inxns of central acting alpha?
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watch for additived antihyper, CNS depr (antipsycho), methyldopa can increase lithium...methyldopa: LFT changes, hepatitis, hemolytic anemia, lupos like syndrome
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moa of peripheral adrenergic antags?
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decrease catecholamines and 5HT decreasing peripheral resistance and increasing plasma volume and decreasing CO
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what are the SE concerns with the periph adren agents reserpine (serpasil) and guanadresl
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induce depressoin, park state, nasal congestion, lethargy, brady
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name the 2 direct vasodilators
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hydralazine, minoxidil
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major SE of hydralazine?
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reflex tachy, lupus like syndrome, dizzy fluid retention
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major SE of minoxidil?
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fluid retention, tachy,
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name the direct renin inh?
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aliskiren (tekturna)
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CI to aliskiren?
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preg, bilateral renal art stenosis
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SE of aliskirne
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hyperkalemia, increased Scr, diarrhea, hypo, angioedema
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typically the direct renin inh and direct vaso are good for combo therapy
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k
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goal MAP reduction for hyper emergency?
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less than 25% reduction in 30-60 min, reach 160/100 within 2-6 hours, measure bp every 5-10 min until goal map achieved,
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htn emergency vs urgency
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PO vs IV
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hyp emergency/urgency meds
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pg 180
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pt counseling pg 181
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k
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