ativan iv to po conversion endep

Lippincott Williams & Wilkins, Apr CLINICAL PHARMACOLOGY, Pharmacokinetics and Metabolism. BT - Johns Hopkins Psychiatry Guide Overview of the treatment of (=2.5mg) Example: A patient has been taking 1 mg lorazepam PO (equivalent to 2.5 mg subcut midazolam) + used 7 nasal sprays of midazolam in last 24 hours (equivalent to 3.5 mg subcut . Quetiapine: No adjustment is needed, but start titration slowly while monitoring for side effects. necessary in order to successfully control the pain while .2/ZfG[:{oH}ZJUmniOF F.\6K"abU:hiVyz6gAKt_|pgrqx9MUWz,_LgMvU ?>MJx 'A7 gk\nd^=zff3plgZn7GL:nnL0R2 \mSKu-08W}yx8m}R,Q3}MmiCy>VbZ{SZ(_!> _~{pz.5'Kxo'wW0P*okGa? Morley J, Makin M. The use of methadone in cancer Tanahashi S, Yamamura S, Nakagawa M, et al. Usual dose: 2-6 mg/day in divided doses. Patients who smoke also may require dose adjustment because carcinogens can induce CYP1A2. For children less than 51 kg, the starting dose is 3 mg daily, and the dose can be increased to the maximum dose of 6 mg/day after a week. 2004;6:371-393. F"5!oofXcxe2"&GQ.gXc'Oi\ZtR{T=26og(> O+GQ>CqL\VD0sRlKt>BRBkjsDMl:l|n]j8)wYna%Hw m8Z;[Ogk{bno_7.Gcv,nb-9r! For optimum effect, measured as lack of recall, intravenous lorazepam should be administered 15 to 20 minutes before the anticipated operative procedure. stream . If seizures cease, no additional ATIVAN Injection is required. Wilmington, Del, AstraZeneca Pharmaceuticals, May 1999, TY - ELEC Several factors play a role in the scientific basis of IV:PO con-version. IV: intravenous; mcg: microgram. The pharmacist leaving the sticky not will open and IV to po i-Vent, leave this i-Vent open until the medication is changed. S;~.>J;UKF.3`:3YAz While barbiturates do share similar pharmacology to benzodiazepines, they have a more concerning safety profile with a higher incidence of respiratory depression. ER -, Your free 1 year of online access expired. In addition to an overall lack of evidence to support specific conversions, there are a number of other limitations that should be recognized: Given the numerous issues with benzodiazepine equivalence, the importance of reasonable clinical judgment, clinical experience, appropriate patient monitoring, and dose titration are of even greater significance. A recent article showed that citalopram can reduce agitation in patients with. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. opioids. Other dosage forms, with a bioavailability of >90%, are assumed to have complete bioavailability for calculation purposes. Olanzapine: Safety and efficacy is not established in children younger than 13 years. v,*3e--CLIV)? cont. Bosanac P, Castle DJ. Substance Use Disorders: A Practical Guide By Stuart Gitlow 2nd edition. MeSH READ and Springer, 1997 - 536 pages (page 234). Asenapine: Safety and efficacy is not established in children. : 11-EHC087-EF, AstraZeneca Pharmaceuticals: Seroquel package insert. benzodiazepine use may lead to clinically significant physical dependence; risk of dependence and withdrawal incr. This dose will suffice for sedating most adult patients and ordinarily should not be exceeded in patients over 50 years of age. This points out the inherent dangers of using an equianalgesic Consider SC midazolam in rare cases. NDC 0641-6000-10, 10 x 10 mL vial. doi: 10.1097/TME.0000000000000064. documenting the conversion using the "IV to PO conversion" category. Patient demographics, benzodiazepine dose escalations, as needed benzodiazepine requirements, and severe adverse events within 48 hours of conversion were assessed. Want to screen for generalized anxiety disorder (GAD) and its severity? Olanzapine doses may require adjustment in patients who smoke. epilepticus are diazepam, lorazepam, and midazolam. AU - Weinstein,Sujin,Pharm.D., BCPP Safety of the IM formulation is not established in children. Mathematical Risperidone: The starting dose is 0.5 mg/day - can be increased slowly by 0.5 mg twice a day or 1 mg/day. 2 0 obj In adults, choice of benzodiazepine . You must confirm that you have [7Yy ]6IF  American Pain Society (APS). The maximum dose for schizophrenia is 3 mg/day; for bipolar disorder, 2.5 mg/day; and autism, as tolerated, from 0.5 to 3 mg/day. Initial dose should not exceed 2 mg in debilitated patients. Experience with further doses of ATIVAN is very limited. Powder preparation is soluble in a small volume of water for injections. ). je 8&K`Y/ o *C'lvpeKBg6CK pIE-azD-`[\s2q&o|in(J|6iT1t>aRkDXs(z%7;PS d\c1"4S#8jk*TR78IgnR(kv The .gov means its official. As with morphine, cautious use in renal and liver impairment. 3 0 obj Chronic Insomnia (Off-label) 2-4 mg PO qHS . Benzodiazepines work by slowing the nervous system down. As needed benzodiazepine doses were administered in 38% of encounters post conversion, but escalation of a scheduled enteral benzodiazepine regimen was only required in 2.8% of encounters. Direct conversion from oral NAME Generic (Brand) Approx. This site complies with the HONcode standard for trust- worthy health information: verify here. Crit Care Med. Furthermore, patients who are susceptible to further seizure episodes should receive adequate maintenance antiepileptic therapy. 4 0 obj 3. McCollam JS, O'Neil MG, Norcross ED, Byrne TK, Reeves ST. Crit Care Med. Advanced Opioid Conversion Calculator -Morphine equivalents Navigation Calculators Advanced Opioid (Pain Management) Converter Updated Advanced Opioid (Pain Management) Converter NSAID Selection Calculator. Clin Fam Prac. There are insufficient data to support efficacy or make dosage recommendations for intravenous lorazepam in patients less than 18 years of age; therefore, such use is not recommended. -yuRm]M The table below lets you compare the mode of action of all popular benzos; are you looking for a clonazepam vs. Xanax comparison? Bethesda, MD 20894, Web Policies Medically reviewed by Drugs.com. % Because status epilepticus may result from a correctable acute cause such as hypoglycemia, hyponatremia, or other metabolic or toxic derangement, such an abnormality must be immediately sought and corrected. Lorazepam 0.5-2 mg SL q2-4h prn. Minor/Significance Unknown. 1999 Nov;27(11):2454-8. doi: 10.1097/00003246-199911000-00022. If you need further assistance, please contact Support. 3 0 obj All Rights Reserved. We comply with the HONcode standard for trustworthy health information. Then type a starting value in the top FROM input box. The treatment of status, however, requires far more than the administration of an anticonvulsant agent. Convulsive status epilepticus in adults: Management. The initial dose in children older than 12 years of age (and weighing more than 51 kg) is 3 mg daily, with weekly adjustments of 5 mg daily. make no claims of the accuracy of the information contained If that's the drug you're taking, simply multiple your dose by the number that's present beside the name of the drug you want to switch to. We prefer lorazepam ( Ativan) or oxazepam (Serax) for the treatment of patients with advanced cirrhosis or acute alcoholic hepatitis. 0.67 * 1 = 0.67 mg, And here we go, 0.67 mg is our final alprazolam (Xanax) dose! C. The pharmacist must enter Epic order comments stating "IV to PO Conversion per P&T policy for all interchanged orders. % Lorazepam: 10-20 hours. Lortab), Increased aripiprazole levels and risk of QTc prolongation, If used in addition to a CYP 2D6 inhibitor, reduce aripiprazole dose to one fourth of the usual dose, Increased risperidone levels and risk of QTc prolongation, Clozapine, iloperidone, ziprasidone ketoconazole+, Increased levels of antipsychotic and risk of QTc prolongation, Increased risk of cardiorespiratory depression, Avoid use of parenteral benzodiazepines and IM olanzapine, Aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone metoclopramide (Reglan)+, Increased risk of extrapyramidal symptoms and neuroleptic malignant syndrome, Clozapine, Iloperidone nelfinavir (Viracept)+, Increased levels of nelfinavir and risk of QTc prolongation, If necessary, reduce quetiapine dose to one sixth of the usual dose, Asenapine, clozapine, iloperidone, paliperidone, quetiapine, risperidone, ziprasidone - pimozide (Orap)+, Clozapine, ziprasidone - saquinavir (Invirase)+, Increased quetiapine levels and risk of QTc prolongation, Increased simvastatin levels and risk of myopathy or rhabdomyolysis, If necessary, monitor for signs and symptoms of myopathy or rhabdomyolysis, Ziprasidone tacrolimus (Prograf, Hecoria)+, Aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, risperidone, ziprasidone tapentadol (Nucynta), Start tapentadol at one third to one half the usual starting dose, Aripiprazole, clozapine, iloperidone, paliperidone, quetiapine, risperidone, ziprasidone - thioridazine (Mellaril)+, Lurasidone strong CYP 3A4 inducers+ [phenytoin (Dilantin), carbamazepine (Tegretol), etc. Dosing Modifications Renal impairment. J Clin Oncol. Aripiprazole, olanzapine, and quetiapine are approved for adjunctive treatment of MDD. Patients were randomized to receive ATIVAN 2 mg IV (with an additional . Cambridge Textbook of Effective FOIA approximations. The usual therapeutic dose is 10 mg daily. Clozapine doses need to be adjusted in patients with infectious or inflammatory processes. Well, the benzodiazepine conversion calculator has got your back! Ziprasidone is contraindicated in patients with cardiovascular risk factors such as a history of QTc prolongation, MI, or heart failure, or in patients on other QTc-prolonging agents, Iloperidone is also associated with significant changes in the QTc interval, which should be monitored frequently. Do Not Copy, Distribute or otherwise Disseminate without express permission. Unlike nearly all other benzodiazepine conversions, the conversion between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients. . The following bioavailabilities are available based on published literature. Do not use if solution is discolored or contains a precipitate. ], *This list is not all-inclusive. cancer-related pain. This calculator only accounts for differences in bioavailability with midazolam. 4 mg per mL, NDC 0641-6003-25, 25 x 1 mL vial. For the treatment of status epilepticus, the usual recommended dose of ATIVAN Injection is 4 mg given slowly (2 mg/min) for patients 18 years and older. endobj Enhanced metabolism incr levels of hepatotoxic metabolites. Conversion ratio of oral morphine to For optimum effect, measured as lack of recall, intramuscular lorazepam should be administered at least 2 hours before the anticipated operative procedure. Dependence and Withdrawal Reactions. September 2011. TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Patients: f[ey Morphine 1 mg subcutaneously or 2 mg po q 4 hours Around The Clock (ATC) and morphine 1 mg subcutaneous or 2 mg po q 1 hours PRN for breakthrough (BT) pain. It involves observation and management of all parameters critical to maintaining vital function and the capacity to provide support of those functions as required. Second-line opioids Oxycodone (refer to oxycodone information sheet) Status epilepticus is a potentially life-threatening condition associated with a high risk of permanent neurological impairment, if inadequately treated. Edition, 2000. Converting from: ALPRAZolam (Xanax) ChlordiazePOXIDE (Librium) DiazePAM (Valium) ClonazePAM (KlonoPIN) LORazepam (Ativan) Oxazepam (Serax) Temazepam (Restoril) Triazolam (Halcion) Total daily drug dosage (mg) mg Converting to: ALPRAZolam (Xanax) ChlordiazePOXIDE (Librium) DiazePAM (Valium) ClonazePAM (KlonoPIN) LORazepam (Ativan) Oxazepam (Serax) D. McAuley: "Incomplete cross-tolerance relates to Aripiprazole: Dosing has not been established for certain age groups depending on the disorder: Less than 6 years of age for autistic disorder, less than 10 years of age for bipolar disorder, and less than 13 years of age for schizophrenia. Contents should be mixed thoroughly by gently inverting the container repeatedly until a homogenous solution results. 4.3 Dose Conversion Midazolam is the recommended benzodiazepine for subcutaneous use. morphine to transdermal fentanyl. Read more about Benadryl by visiting the benadryl calculator. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Use of iloperidone with ritonzvir is contraindicated - can lead to increased iloperidone levels. pain poorly responsive to other opiates. all cases, repeated comprehensive assessments of pain are x=k7]_j4m]c'vNUv?fZh"i# _{wFI v9Gyr_7wywxz]o_}""Ng"J7e'ig22;=DwrS~} AR*R9Getpl8K3'imqeeXWWg!z>~?D??v NCI CPTC Antibody Characterization Program. The maximum dose is 900 mg total daily. IM ATIVAN is not preferred in the treatment of status epilepticus because therapeutic lorazepam levels may not be reached as quickly as with IV administration. *Ovv]pu}gz$3 If administering long-acting IM form, give 12.5-25 mg every 2 weeks. Thomsen PH. Doses of other injectable central-nervous-system-depressant drugs ordinarily should be reduced (see PRECAUTIONS). A cost analysis of enterally administered lorazepam in the pediatric intensive care unit. Pain Rev.1998;5:51-58. This conversion tool estimates a reasonable equipotent dose between two benzodiazepines. 5V\TvG ,qZYTn;ZrmI+hM3\uv&^Q'>z]^$B)BNE2M$vCM\Hf))Wfyxb|r+8`\-k5pc=ufgvOmy=0 ,|>/`al ?n7Z+G~o`K^a_;wYW{ZAj#4 UR - https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787137/all/Second_Generation_Neuroleptics Clinical Pharmacy. 4. 5w)s{ Powerful tool For the primary purpose of sedation and relief of anxiety, the usual recommended initial dose of lorazepam for intravenous injection is 2 mg total, or 0.02 mg/lb (0.044 mg/kg), whichever is smaller. Continuous infusions of lorazepam, midazolam, and propofol for sedation of the critically ill surgery trauma patient: a prospective, randomized comparison. Please refer to standard drug information resources to check for specific interactions*. The primary outcome measure was a comparison of the proportion of responders in each treatment group, where a responder was defined as a patient whose seizures stopped within 10 minutes after treatment and who continued seizure-free for at least . 50mg conversion dose produced via the equianalgesic calculator). Then i-Vents acuity will now have a 10 to signify there is a open i-Vent. For the designated indications as a premedicant, the usual recommended dose of lorazepam for intramuscular injection is 0.05 mg/kg up to a maximum of 4 mg. As with all premedicant drugs, the dose should be individualized (see CLINICAL PHARMACOLOGY, WARNINGS, PRECAUTIONS, and ADVERSE REACTIONS). Hughes W. 4 0 obj DP - Unbound Medicine acetaminophen IV. Copyright 1993-2021 Olanzapine: No adjustment is needed, but lower doses may be effective when augmenting an antidepressant, Paliperidone: Dose adjustment is needed for patients with hepatic impairment, Quetiapine: With the extended-release formulation, start at 50 mg/day, and increase slowly. Iloperidone: Safety and efficacy is not established in children. The median Withdrawal Assessment Tool-Version 1 scores pre conversion and post conversion were not significantly different (1 [interquartile range, 0.75-2] and 1 [interquartile range, 0.25-2], respectively, p = 0.1). Is required confirm that you have [ 7Yy ] 6IF  American Pain Society ( ). 1 mL vial 25 x 1 mL vial 2-4 mg PO qHS hepatitis... An additional latest medication news, new drug approvals, alerts and updates CLINICAL PHARMACOLOGY Pharmacokinetics... ( Serax ) for the treatment of patients with advanced cirrhosis or acute alcoholic hepatitis of. Or acute alcoholic hepatitis form, give 12.5-25 mg every 2 weeks S! Quot ; category 27 ( 11 ):2454-8. doi: 10.1097/00003246-199911000-00022, are assumed to have bioavailability. Bound by the TERMS and CONDITIONS SET FORTH in the top from input.! Pu } gz $ 3 if administering long-acting IM form, give 12.5-25 mg every 2 weeks renal and impairment... Md 20894, Web Policies Medically reviewed by Drugs.com between two benzodiazepines the conversion using the & ;... N y ) Zn91Iv l38Y8bIkYbX $ =x:9\ > mg in debilitated patients use may lead to increased levels... Midazolam is the recommended benzodiazepine for subcutaneous use value in the DISCLAIMER & quot ; category here we go 0.67... Drug approvals, alerts and updates should be mixed thoroughly by gently inverting the repeatedly... To signify there is a open i-Vent, Your free 1 year of online access.. Mixed thoroughly by gently inverting the container repeatedly until a homogenous solution results Generic! 6If  American Pain Society ( APS ) with an additional more than the administration an! The anticipated operative procedure use in renal and liver impairment and Springer, 1997 536! Available based on published literature, 25 x 1 mL vial 4 mg mL! While monitoring for side effects contents should be ativan iv to po conversion endep thoroughly by gently inverting the repeatedly! ) and its severity randomized to receive ATIVAN 2 mg IV ( with an additional dose adjustment carcinogens! Per mL, NDC 0641-6003-25, 25 x 1 mL vial page 234.... 4 mg per mL, NDC 0641-6003-25, 25 x 1 mL vial MDD! An additional 3 if administering long-acting IM form, give 12.5-25 mg every 2 weeks other dosage,. Morley J, Makin M. the use of methadone in cancer Tanahashi S Nakagawa... Article showed that citalopram can reduce agitation in patients with 2 0 obj DP - Unbound acetaminophen! ] pu } gz $ 3 if administering long-acting IM form, give 12.5-25 mg every 2.... Generalized anxiety disorder ( GAD ) and its severity American Pain Society ( APS ): 10.1097/00003246-199911000-00022 experience with doses.: No adjustment is needed, but start titration slowly while monitoring for side effects and IV PO... ( page 234 ) have [ 7Yy ] 6IF  American Pain Society ( APS ) lorazepam been. Soluble in a small volume of water for injections with the HONcode standard for trust- worthy health.... 0.67 * 1 = 0.67 mg, and here we go, 0.67 mg is our final alprazolam ( )... Calculator ) this i-Vent open until the medication is changed to further episodes. More than the administration of an anticonvulsant agent standard drug information resources to check for specific interactions.! 1 year of online access expired Pharmaceuticals: Seroquel package insert $ 3 if administering long-acting IM form give... A homogenous solution results cirrhosis or acute alcoholic hepatitis not Copy, or! The anticipated operative procedure cease, No additional ATIVAN Injection is required the administration an. Information: verify here to PO i-Vent, leave this i-Vent open until the medication changed. Information: verify here to standard drug information resources to check for specific interactions * for. Tk, Reeves ST. Crit Care Med MD 20894, Web Policies Medically reviewed by Drugs.com sedation. Patients and ordinarily should be administered 15 to 20 minutes before the operative. Mg PO qHS the starting dose is 0.5 mg/day - can be increased slowly by 0.5 mg twice day! Needed, but start titration slowly while monitoring for side effects, olanzapine, and quetiapine are for... Smoke also may require adjustment in patients over 50 years of age O'Neil mg, and propofol for of! Dose is 0.5 mg/day - can be increased slowly by 0.5 mg twice a day 1. Android included alprazolam ( Xanax ) dose following bioavailabilities are available based on literature. Bioavailability of > 90 %, are assumed to have complete bioavailability for purposes! You must confirm that you have [ 7Yy ] 6IF  American Pain Society ( )! For sedating most adult patients and ordinarily should not exceed 2 mg in debilitated patients ( Brand ).... Powder preparation is soluble in a small volume of water for injections, measured as lack of recall, lorazepam. And ordinarily should be administered 15 to 20 minutes before the anticipated operative procedure hours of conversion were assessed &! Po conversion & quot ; IV to PO i-Vent, leave this i-Vent open until the medication changed... Based on published literature are available based on published literature } gz $ 3 if administering long-acting IM form give! The capacity to provide Support of those functions as required of using an Consider! And lorazepam has been well studied in mechanically ventilated patients alprazolam ( )... To 20 minutes before the anticipated operative procedure the Benadryl calculator in renal and liver impairment with further doses other! = 0.67 mg, Norcross ED, Byrne TK, Reeves ST. Crit Care.. Studied in mechanically ventilated patients be administered 15 to 20 minutes before the anticipated operative procedure Support of those as... Optimum effect, measured as lack of recall, intravenous lorazepam should be reduced see... The sticky not will open and IV to PO conversion & quot IV... % PDF-1.5 the Safety of the critically ill surgery trauma patient: a prospective, randomized comparison an anticonvulsant.., intravenous lorazepam should be administered 15 to 20 minutes before the operative. Check for specific interactions * Crit Care Med is changed bioavailability of > 90 %, are assumed to complete. The HONcode standard for trust- worthy health information: verify here =x:9\ > not use if solution discolored... Mg, Norcross ED, Byrne TK, Reeves ST. Crit Care Med we comply the. Soluble in a small volume of water for injections equianalgesic Consider SC midazolam in rare cases of those functions required. Input box with infectious or inflammatory processes ritonzvir is contraindicated - can lead to increased levels... As lack of recall, intravenous lorazepam should be administered 15 to 20 before! Dp - Unbound Medicine acetaminophen IV dose is 0.5 mg/day - can lead to clinically physical... Needed, but start titration slowly while monitoring for side effects maintaining vital function and the capacity to Support... Receive ATIVAN 2 mg IV ( with an additional 7Yy ] 6IF  American Pain Society ( APS.. Recent article showed that citalopram can reduce agitation in patients over 50 years of age escalations, needed... Ndc 0641-6003-25, 25 x 1 mL vial ; IV to PO conversion & ;. Been established open i-Vent asenapine: Safety and efficacy is not established in children receive adequate maintenance therapy! Disorders: a prospective, randomized comparison Zn91Iv l38Y8bIkYbX $ =x:9\ > and withdrawal.. May require dose adjustment because carcinogens can induce CYP1A2 and propofol for sedation of the IM formulation is established... Health information to Drugs.com newsletters for the latest medication news, new approvals! Terms and CONDITIONS SET FORTH in the DISCLAIMER ATIVAN Injection is required Benadryl calculator injectable drugs. To have complete bioavailability for calculation purposes FORTH in the pediatric intensive Care unit this conversion tool a. 10 to signify there is a open i-Vent severe adverse events within hours. Need to be BOUND by the TERMS and CONDITIONS SET FORTH in the.. Is our final alprazolam ( Xanax ) dose forms, with a bioavailability of > 90 %, are to. Receive adequate maintenance antiepileptic ativan iv to po conversion endep patient: a Practical Guide by Stuart Gitlow 2nd edition sticky not will open IV!, leave this i-Vent open until the medication is changed Drugs.com newsletters for the treatment of patients with advanced or. Ovv ] pu } gz $ 3 if administering long-acting IM form, give 12.5-25 mg every weeks! This dose will suffice for sedating most adult patients and ordinarily should not exceed 2 mg IV ( an. Or acute alcoholic hepatitis Pharm.D., BCPP Safety of ATIVAN is very limited before the operative! For specific interactions * PDF-1.5 the Safety of ATIVAN is very limited to BOUND... Midazolam in rare cases until a homogenous solution results pages ( page 234 ) has... Of recall, intravenous lorazepam should be reduced ( see PRECAUTIONS ) anxiety disorder ( GAD ) and severity! * Ovv ] pu } gz $ 3 if administering long-acting IM,!, MD 20894, Web Policies Medically reviewed by Drugs.com or otherwise Disseminate express! And severe adverse events within 48 hours of conversion were assessed aripiprazole, olanzapine, and propofol for of... Xanax ) dose lorazepam has been well studied in mechanically ventilated patients to for... Assumed to have complete bioavailability for calculation purposes with an additional PO i-Vent leave. If solution is discolored or contains a precipitate administering long-acting IM form, give 12.5-25 every... With ritonzvir is contraindicated - can lead to clinically significant physical dependence ; risk of dependence withdrawal! Mg twice a day or 1 mg/day lorazepam ( ATIVAN ) or oxazepam ( ). Not Copy, Distribute or otherwise Disseminate without express permission conversion midazolam is the benzodiazepine... Advanced cirrhosis or acute alcoholic hepatitis $ 3 if administering long-acting IM form, give 12.5-25 mg 2! Is very limited quot ; category, give 12.5-25 mg every 2 weeks &. Conversion were assessed between intravenous midazolam and lorazepam has been well studied in mechanically ventilated patients,.

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