Renal Drug Elimination
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Questions and Answers

A patient with impaired renal function is prescribed a drug primarily eliminated through the kidneys. Which adjustment to the drug regimen would be LEAST appropriate to prevent drug accumulation and adverse effects?

  • Increasing the frequency of drug administration. (correct)
  • Increasing the time interval between doses.
  • Decreasing the dose of the drug.
  • Monitoring drug levels in the blood to guide dosage adjustments.
  • Competition between two drugs for the same anionic transporter in the proximal tubules of the kidney would most likely result in what outcome?

  • Selective decrease in the renal clearance of the drug with lower affinity for the transporter. (correct)
  • Selective increase in the renal clearance of the drug with higher affinity for the transporter.
  • Increased renal clearance of both drugs due to enhanced transporter activity.
  • Decreased renal clearance of both drugs, potentially leading to increased plasma concentrations.
  • A drug is metabolized into more polar compounds via phase I and phase II reactions, what is the primary purpose of this biotransformation regarding renal excretion?

  • To facilitate distal tubular reabsorption of the drug.
  • To increase the drug's affinity for P-glycoprotein (P-gp) efflux pumps.
  • To decrease the drug's volume of distribution.
  • To minimize the reabsorption of the drug in the distal convoluted tubule. (correct)
  • A drug is primarily cleared through both the kidney and the bile. If a patient experiences complete renal failure, what compensatory change in the body is most likely to occur to maintain drug clearance?

    <p>Upregulation of hepatic transporters to increase biliary excretion of the drug. (D)</p> Signup and view all the answers

    Premature infants and neonates have an incompletely developed tubular secretory mechanism. How does this physiological immaturity affect drug clearance and drug half-life in this population?

    <p>Decreased drug clearance, leading to a prolonged drug half-life. (C)</p> Signup and view all the answers

    Why is rectal administration advantageous when a drug induces vomiting upon oral administration?

    <p>It bypasses the emetic response triggered by oral ingestion, allowing the drug to be absorbed. (D)</p> Signup and view all the answers

    A patient requires immediate and localized treatment for cryptococcal meningitis. Which route of administration is MOST suitable?

    <p>Intrathecal/Intraventricular (D)</p> Signup and view all the answers

    What is the PRIMARY reason that a significant portion of drugs administered rectally bypasses first-pass metabolism?

    <p>The drug is absorbed into capillaries that drain directly into the inferior vena cava. (D)</p> Signup and view all the answers

    Why might transdermal drug delivery be considered advantageous over other routes for certain medications?

    <p>It can deliver a sustained release of the drug, improving patient compliance. (D)</p> Signup and view all the answers

    A patient with severe asthma is prescribed both albuterol and fluticasone via oral inhalation. What is the MOST LIKELY reason for prescribing these two drugs in combination?

    <p>Albuterol provides immediate bronchodilation, while fluticasone offers long-term control of inflammation. (C)</p> Signup and view all the answers

    A researcher is developing a new topical cream containing a novel anti-inflammatory drug. What is the PRIMARY advantage of using topical administration for this drug?

    <p>It allows for higher drug concentrations at the application site while minimizing systemic exposure. (D)</p> Signup and view all the answers

    A patient is prescribed nitroglycerin via a transdermal patch. What is the MOST important consideration regarding the application site to ensure optimal drug absorption?

    <p>The application site should be hairless, clean, and dry to minimize variability in absorption. (B)</p> Signup and view all the answers

    Why might nasal inhalation be preferred over oral administration for certain drugs targeting the respiratory system?

    <p>Nasal inhalation delivers the drug directly to the respiratory tract, maximizing local effects and minimizing systemic exposure. (C)</p> Signup and view all the answers

    A drug's elimination half-life is significantly shorter than the desired duration of action. Which extended-release formulation strategy would least effectively maintain therapeutic drug levels?

    <p>Administering the drug via a sublingual route to bypass first-pass metabolism and achieve rapid absorption. (D)</p> Signup and view all the answers

    A patient with dysphagia requires medication that is usually administered orally. Which route of administration would be least appropriate, considering the patient's condition?

    <p>Enteral (C)</p> Signup and view all the answers

    A new drug is developed that is highly susceptible to inactivation in the acidic environment of the stomach. Which formulation strategy would be most effective in ensuring its absorption?

    <p>Creating an enteric-coated capsule that dissolves only in the small intestine. (D)</p> Signup and view all the answers

    A drug is known to undergo significant first-pass metabolism, resulting in very low bioavailability when administered orally. Which alternative route of administration would be the least effective in improving the drug's bioavailability?

    <p>Oral administration with a large bolus (A)</p> Signup and view all the answers

    A patient requires a medication that needs to reach the systemic circulation as rapidly as possible. Considering the typical absorption rates associated with different routes, which route would be the least suitable?

    <p>Oral administration. (C)</p> Signup and view all the answers

    Which statement regarding the impact of the route of administration on drug bioavailability is least accurate?

    <p>Intramuscular injections invariably result in higher bioavailability than subcutaneous injections. (B)</p> Signup and view all the answers

    A drug is being developed that must precisely target intracellular receptors within the central nervous system to exert its therapeutic effect. Which factor related to pharmacokinetics is least crucial for the drug's success?

    <p>The drug's volume of distribution in peripheral tissues. (B)</p> Signup and view all the answers

    Which factor most significantly contributes to the extended duration of action seen with extended-release (ER) oral medications?

    <p>A specialized coating that facilitates slower drug dissolution and absorption in the gastrointestinal tract. (C)</p> Signup and view all the answers

    A patient requires immediate and complete drug bioavailability. Which route of administration is most suitable to achieve this?

    <p>Intravenous (IV) bolus injection. (D)</p> Signup and view all the answers

    Why are some drugs administered via inhalation for rapid delivery?

    <p>To provide rapid access to the systemic circulation via the large surface area and high vascularity of the lungs. (B)</p> Signup and view all the answers

    Which characteristic of intravenous (IV) administration makes it particularly useful for drugs like rocuronium?

    <p>IV administration bypasses the need for drug absorption, which is crucial for drugs that are poorly absorbed orally. (B)</p> Signup and view all the answers

    For a drug that causes significant gastric irritation, which formulation strategy would be most appropriate?

    <p>Encapsulating the drug in an enteric-coated capsule that dissolves in the less acidic environment of the intestine. (A)</p> Signup and view all the answers

    Why are depot preparations, such as haloperidol decanoate, administered intramuscularly?

    <p>To provide a sustained release of the drug over an extended period, improving patient compliance. (D)</p> Signup and view all the answers

    A patient requires long-term treatment with a drug, but has poor adherence to oral medications. Which route of administration might be most suitable to improve compliance?

    <p>Intramuscular (IM) injections of a depot preparation administered every few weeks or months. (A)</p> Signup and view all the answers

    Why is subcutaneous (SC) administration preferred over intravenous (IV) administration for certain drugs like heparin?

    <p>SC administration minimizes the risk of hemolysis or thrombosis associated with IV injections. (B)</p> Signup and view all the answers

    A patient with poorly controlled diabetes develops a non-healing ulcer on their foot. Applying a topical antibiotic ointment to the ulcer would result in what regarding drug absorption, assuming the medication is typically administered topically for local effect?

    <p>Increased systemic absorption of the antibiotic due to compromised skin barrier. (B)</p> Signup and view all the answers

    A new drug is developed that is intended to act locally within the synovial fluid of the knee joint to treat arthritis. Considering the routes of administration, which route would be MOST appropriate to achieve the desired therapeutic effect?

    <p>Intra-articular injection directly into the knee joint. (D)</p> Signup and view all the answers

    A medication is administered via inhalation for the treatment of asthma. What BEST describes the intended primary site of action for this drug?

    <p>The lungs, for local bronchodilation and anti-inflammatory effects. (D)</p> Signup and view all the answers

    A patient is prescribed nitroglycerin to be administered sublingually during an angina attack. What is the MOST important reason for choosing this route of administration compared to swallowing a nitroglycerin tablet?

    <p>Sublingual administration bypasses first-pass metabolism, leading to a more rapid onset of action. (C)</p> Signup and view all the answers

    Consider varying routes of drug administration. What BEST explains why intravenous administration does NOT require absorption?

    <p>Intravenous administration delivers the drug directly into the bloodstream, thus bypassing the absorption process. (B)</p> Signup and view all the answers

    A drug molecule has a very high molecular weight. What is the MOST likely impact of this characteristic on its ability to cross cell membranes?

    <p>It will have difficulty crossing the membrane unless transported by specific mechanisms. (D)</p> Signup and view all the answers

    A weak acid drug is administered orally. Where in the body is this drug MOST likely to be absorbed?

    <p>Small intestine (B)</p> Signup and view all the answers

    A research team is developing a new topical medication designed to deliver a drug for systemic absorption and effect. Which characteristic of the drug would be MOST favorable for effective absorption through the skin?

    <p>High lipid solubility to readily dissolve in membrane phospholipids. (B)</p> Signup and view all the answers

    A drug administered intravenously exhibits a significantly shorter duration of action compared to the same drug administered orally. Which of the following factors would MOST likely explain this difference, assuming both routes achieve similar peak plasma concentrations?

    <p>Increased hepatic uptake and metabolism due to the drug bypassing the portal circulation after intravenous administration. (D)</p> Signup and view all the answers

    A novel drug is found to be a substrate for P-glycoprotein. If a patient is also taking a P-glycoprotein inhibitor, what is the MOST likely effect on the novel drug's oral bioavailability and tissue distribution?

    <p>Increased oral bioavailability and increased tissue distribution. (D)</p> Signup and view all the answers

    A patient with severe diarrhea is prescribed an oral medication. How will this condition MOST likely affect the drug's absorption, and what physiological mechanism is primarily responsible?

    <p>Decreased absorption due to reduced contact time in the gastrointestinal tract. (D)</p> Signup and view all the answers

    A weak acid drug with a pKa of 4.5 is administered orally. Where in the gastrointestinal tract will the drug be MOST readily absorbed, and what physicochemical property dictates this?

    <p>Stomach, due to the acidic pH promoting the non-ionized form. (B)</p> Signup and view all the answers

    A drug that is a weak base is administered intravenously to a patient experiencing hyperventilation. How is the distribution of the drug likely to be affected, and what is the underlying mechanism?

    <p>Decreased distribution to tissues due to increased ionization in the blood. (A)</p> Signup and view all the answers

    During the development of a new tablet formulation, it is observed that increasing the compression force during manufacturing significantly slows down the drug's dissolution rate. What is the MOST probable reason for this?

    <p>Reduced surface area of the drug particles exposed to the dissolution medium. (D)</p> Signup and view all the answers

    A drug is known to be absorbed via carrier-mediated transport in the small intestine. If an overdose of a structurally similar compound is ingested, what is the MOST likely effect on the absorption of the drug, and why?

    <p>Decreased absorption due to competitive inhibition of the carrier protein. (A)</p> Signup and view all the answers

    A research team is developing a new drug that needs to cross the blood-brain barrier (BBB). Considering the properties that facilitate drug entry into the brain, which of the following characteristics would be MOST favorable for this drug?

    <p>Low molecular weight and high lipophilicity. (B)</p> Signup and view all the answers

    Flashcards

    Pharmacokinetics

    Quantitative measurement of drug processes: absorption, distribution, metabolism, and elimination.

    Absorption

    Entry of the drug into plasma from the administration site.

    Distribution

    Reversible movement of a drug from the bloodstream to tissues.

    Metabolism

    Biotransformation of the drug by liver or other tissues.

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    Elimination/Excretion

    Removal of the drug and its metabolites from the body.

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    Enteral Administration

    Drug delivery through the gastrointestinal tract, commonly oral.

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    Sublingual Administration

    Drug placed under the tongue for rapid absorption into circulation.

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    Enteric-coated Preparations

    Drugs protected from stomach acid, delivered into the intestines.

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    Transdermal Administration

    Application of drugs to the skin for systemic effects, often using patches.

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    Intrathecal Administration

    Direct introduction of drugs into the cerebrospinal fluid for rapid local effects.

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    Rectal Administration

    Drug delivery via the rectum, minimizing liver biotransformation.

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    Oral Inhalations

    Medications inhaled through the mouth, such as Albuterol and corticosteroids.

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    Nasal Inhalations

    Medications delivered into the nasal passages, like oxymetazoline.

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    Pulmonary Epithelium

    The thin layer of cells that line the respiratory tract where drugs can act quickly.

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    Erratic Rectal Absorption

    Inconsistent drug uptake through the rectal route due to mucosa irritation.

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    Topical Administration

    Local application of drugs aiming to minimize systemic toxicity; some can provide systemic effects.

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    Parenteral administration

    Delivery of drugs directly into systemic circulation, bypassing the GI tract.

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    Intravenous (IV)

    Route where drugs are injected directly into veins, providing immediate circulation.

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    Intramuscular (IM)

    Injection into muscle tissue, allowing for slower absorption through the bloodstream.

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    Subcutaneous (SC)

    Injection into the tissue layer between the skin and muscle for slow, sustained release.

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    Extended release (ER/XR)

    Formulation designed for gradual release of medication over time.

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    High bioavailability

    When a drug reaches systemic circulation at its full strength without first-pass metabolism.

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    Inhalation

    Method delivering drugs via the respiratory tract for rapid effect.

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    P-glycoprotein (P-gp)

    A type of efflux pump that helps in drug absorption and excretion.

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    Drug Clearance by the Kidney

    The process of removing drugs from the body through renal excretion, requiring polarity.

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    Proximal Tubules

    Site of drug secretion and active transport for drugs in the kidney.

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    Distal Tubular Reabsorption

    Process where drug concentration increases before reaching excretion in urine.

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    Renal Dysfunction Risks

    Patients with kidney issues may accumulate drugs leading to toxicity.

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    Carrier-Mediated Transport

    Transport mechanism that involves carriers recognizing specific molecules for absorption.

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    Saturable Transport

    Transport process that can reach a maximum rate when all carriers are occupied.

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    Effect of pH on Drug Absorption

    The pH influences whether a drug is charged or uncharged, affecting its permeability through membranes.

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    Endocytosis

    Process where a cell engulfs a drug by forming a vesicle around it.

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    Exocytosis

    The reverse of endocytosis; process where substances are expelled from a cell.

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    Blood Flow to Absorption Site

    Higher blood flow to certain organs like intestines increases drug absorption efficiency.

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    Total Surface Area for Absorption

    The greater surface area in the intestines enhances drug absorption compared to the stomach.

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    Contact Time at Absorption Surface

    Duration a drug spends in the GI tract affects how well it is absorbed; rapid transit reduces absorption.

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    Extravascular Administration

    Administration of drugs outside the blood vessels leading to absorption into circulation.

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    Local Effects

    Drugs applied directly to the target area for localized benefits without systemic absorption.

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    Systemic Effects

    Drugs designed to have effects throughout the body after entering systemic circulation.

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    Transdermal Absorption

    The process of drug absorption through the skin layers to reach systemic circulation.

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    Factors Affecting Absorption

    Multiple factors like wounds and drug amount can influence how well drugs are absorbed.

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    Lipid Solubility and Absorption

    Drugs with high lipid solubility pass easily through cellular membranes into circulation.

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    Types of Drug Administration

    Includes oral, topical, inhaled, and rectal methods, with varying absorption pathways.

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    Absorption Process in Extravascular Administration

    Movement of a drug from the site of administration into the bloodstream after being applied externally.

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    Study Notes

    Pharmacokinetics

    • Pharmacokinetics is the quantitative measurement of drug action
    • Absorption: Drug entry into plasma, either directly or indirectly
    • Distribution: Drug reversibly leaves the bloodstream and distributes into interstitial and intracellular fluids
    • Metabolism: Biotransformation of drugs by the liver or other tissues
    • Elimination/Excretion: Drug and metabolites are eliminated from the body (urine, bile, or feces)
    • It includes the rate processes for drug movement into, within, and out of the body
    • Pharmacodynamics: Describes the effects the drug has on the human body, including adverse effects

    Route of Drug Administration

    • Determined by the therapeutic objective (rapid onset, long-term treatment, local site)
    • Major routes are enteral, parenteral, and topical

    A. Enteral

    • Oral administration (safest, most common, and economical)
    • Oral drugs can be overcome with activated charcoal
    • Enteric-coated preparations protect the drug from stomach acid, delivering it to the less acidic intestine
    • Useful for acid-unstable drugs (Omeprazole) and stomach-irritating drugs (aspirin)
    • Extended-release preparations (ER or XR): Slower absorption and prolonged duration of action

    2. Sublingual/Buccal

    • Buccal similar to sublingual
    • Advantages include ease of administration, rapid absorption, and bypassing the harsh GI environment.
    • Useful for drug rapid absorption

    B. Parenteral

    • Introduces drug directly into the systemic circulation
    • Used for drugs poorly absorbed in the GI tract (e.g., Heparin)
    • Useful for drugs unstable in the GI tract (e.g. Insulin), for unconscious patients or when rapid action is needed

    1. Intravenous (IV)

    • Most common parenteral route
    • Useful for drugs not absorbed orally, such as neuromuscular blockers (e.g., rocuronium)
    • Administered as a bolus (full amount of drug delivered immediately) or infusion (infused over a longer period)
    • Lower peak plasma concentrations and increased duration of circulating drug levels

    2. Intramuscular (IM)

    • Can be in aqueous solutions or specialized depot preparations
    • Depot preparations absorb slowly

    3. Subcutaneous (SC)

    • Minimizes hemolysis and thrombosis risks
    • Provide constant, slow, and sustained effects
    • Should not be used with drugs causing tissue irritation

    C. Others

    • Inhalations: Rapid delivery across the respiratory tract and pulmonary epithelium.
    • Intrathecal/Intraventricular: Direct introduction into the cerebrospinal fluid (e.g., intrathecal amphotericin B)
    • Topical: Used for local effects (e.g., creams for fungal infections)
    • Transdermal: Achieves systemic effects through skin application (e.g., patches)
    • Rectal: Minimizes liver biotransformation, useful for vomiting patients or unconscious patients.

    5. Rectal

    • 50% of rectal drainage bypasses the portal circulation, minimizing liver biotransformation.
    • Useful when drug causes vomiting, or if the patient is unconscious.

    Extravascular Administration

    • Drugs administered extravascularly can be divided into two categories: local and systemic effects
    • Local effects: often applied topically (e.g., eye drops, dermal preparations)
    • Systemic effects: Facilitates absorption into the circulatory system (e.g., tablets)

    Absorption

    • Intravascular administration directly enters the bloodstream
    • Extravascular administration: drug moves from the site of administration to the systemic circulation
    • Mechanisms: Passive diffusion (most common), facilitated diffusion, active transport, endocytosis

    Factors Affecting Absorption

    • pH: Affects absorption of weak acids and bases
    • Solubility: Lipophilic drugs absorb better than highly hydrophilic drugs.
    • Surface area: Larger surface area facilitates greater absorption (e.g., intestine).
    • Contact time: Longer contact time at the absorption site facilitates greater absorption
    • Blood flow: Higher blood flow to the absorption site (e.g., intestine) increases absorption.
    • Chemical instability: Some drugs, such as penicillin G, are unstable in the pH of the gastric contents, and some are degraded by the enzymes in the tract

    Bioavailability

    • The extent to which a drug is absorbed into the systemic circulation.
    • It is calculated using the area under the plasma concentration-time curve (AUC).
    • Poorly soluble drugs have a lower bioavailability

    Factors Affecting Bioavailability

    • First-pass metabolism: some drugs are metabolized by the liver when swallowed (before entering systemic circulation)
    • Solubility of the drug
    • Chemical instability

    Distribution

    • Movement of drugs from the systemic circulation to various tissues and organs
    • Factors: Blood flow, capillary permeability, drug's binding to plasma proteins, and relative lipophilicity of the drug
    • Compartments: Plasma, extracellular fluid (interstitial and intracellular), and total body water

    Clearance

    • Removal of drugs from the body.
    • Important organs: kidneys, liver (bile), gut (feces), lungs, and skin.

    Renal Elimination

    • Glomerular filtration: Drugs enter the kidney to form a glomerular capillary plexus.
    • Proximal tubular secretion: Drugs leave the glomerular filtrate (that were not transferred) and are secreted through the efferent arterioles which form a capillary plexus surrounding the tubular lumen.
    • Factors to consider: Anions (weak acids) move in one transport system, and cations (weak bases) move in another.

    Altered Metabolism

    • Enzyme induction: Speeds up drug metabolism resulting in decreased drug concentration, half-life, and increased clearance
    • Enzyme inhibition: slows down drug metabolism resulting in increased drug concentration, half-life, and decreased clearance.
    • Factors like barbiturates, alcohol, some herbal substances and some foods inhibit/induce metabolic enzymes.

    Zero and First Order Kinetics

    • First-order kinetics: Constant percentage of drug removed per unit time, and rate of elimination is proportional to the drug concentration
    • Zero-order kinetics: Constant amount of drug removed per unit time, and higher concentration decreases the elimination rate.

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