Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). When pushing IV meds, can you mix different drugs together in one syringe and push all at once or do you have to get seperate syringes for each meds? Any of these symptoms may persist or become more severe, so you should contact your doctor or pharmacist as soon as possible. 164 0 obj <>/Filter/FlateDecode/ID[<2786D62A495E4BAFB8F09C87CC37D585>]/Index[140 55]/Info 139 0 R/Length 108/Prev 379717/Root 141 0 R/Size 195/Type/XRef/W[1 2 1]>>stream There may be no untoward . This content does not have an Arabic version. Yes, you can mix medications in a syringe. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Be careful if you drive or do anything that requires you to be alert. For migraine relief, administer diphenhydramine (Benadryl) 25 mg IV followed by prochlorperazine (Compazine) 10 mg IV. Its comforting to know that people who take these medications will never have a negative interaction with one another. This minimal amount of contact and mixing may allow 2 meds that really aren't terribly compatible to be given together because there is little opportunity for the meds to react and precipitate, for example. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. yes you can mix. Drugs given together for sedation, like Ativan and Morphine, in the ICU for vented patients, I generally put in the same syringe with saline. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Indeed, phenytoin injection is so incompatible that it should generally not be mixed with any other solution. For instance Morphine/Dilaudid/phenergan are routinely mixed and given with one syringe. I've never had trouble giving IM injections, even to combative patients. mixed in the same syringe for use in a syringe driver over 24 hours. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Toradol has a shelf life of approximately six hours. I was hoping it was as easy as the y-site compatibility but I definitely understand about the surface area and potential for reaction. Commonly Toradol and Dilaudid are given together in one injection. Doctor. As for taping multiple syringes together, that just sounds dangerous. Norflex may cause serious side effects. As a result, it alleviates pain. There is no definitive answer to this question as it depends on a number of factors, including the specific medications involved and the individual patients medical condition. Medically reviewed by Drugs.com on Feb 28, 2023. You may report side effects to Health Canada at 1-866-234-2345. None of the drugs would be affected by or affect a COVID-19 vaccine, according to doctors. Reasonable care is taken to provide accurate information at the time of creation. the unsubscribe link in the e-mail. Norflex may also be used for purposes not listed in this medication guide. Tramadol is a schedule IV medication on the federal list of controlled substances. Timely, independent, evidence-based information on new drugs and medical tests, and changes to the PBS and MBS. Mixing medications in a syringe allows you to customize your dosage and to ensure that you are getting the correct medication. If circumstances are so compelling as to warrant mixing any two or more solutions, there should be support from published compatibility data. Ketorolac is used for the short-term relief of moderately severe pain and should not be used for longer than 5 days, for mild pain, or for pain from chronic (long-term) conditions. In some cases, the manufacturer recommends administration of the undiluted drug. Antibiotics are one of the most important tools in the fight against infectious diseases because they are available at a low cost. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. In these formulations, dilution of the non-aqueous injection vehicle with water or saline may precipitate the drug. Headline: Student nurse gets eye poked out while trying to MacGyver 2 syringes together. Tramadol and Norco (hydrocodone/acetaminophen) should not be taken at the same time but generally can be taken in the same day as long as they are separated by at least four to six hours. Mixing the same 2 meds in a syringe is a different matter, especially in a 3 cc syringe where there is plenty of space for meds to mix, interact, react and possibly precipitate. To provide you with the most relevant and helpful information, and understand which 1-917-426-3524, By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. The revised guidelines are available free of charge on the Therapeutic Guidelines website www.tg.com.au and in the electronic publications eTG complete and miniTG. The drug is formulated with non-aqueous solubilising agents and the solution is adjusted to a pH of 12. This content does not have an English version. The compatibility charts will tell you what meds and IV solutions are compatible, so you know if you can just run them into the same IV line or not, or if you need to flush the line between meds. He just wanted his meds and was trashing the room while he was waiting, but he was fine for the injection. No question is stupid - you can never ask enough questions to make sure you're giving meds safely! While some general principles can be applied to the mixing of injection solutions, they are fraught with exception and applicability varies with circumstance. Dexamethasone, as a immunosuppressant, is also used to treat lower back pain, whereas Depo-Medrol, a synthetic steroid, also acts as an anti-inflammatory when administered by doctors to alleviate low back pain. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures. A very serious allergic reaction to this drug is rare. Keeping the vial upside down, slowly pull back on the plunger to fill the syringe with the medication to the number (mL or cc) that . Zyprexa and Benadryl have several side effects in common, which is why if these two agents are used together, patients will need to be monitored for side effects and toxicity. I am very sensitive to medicine and read more. Heather MacPherson, LPN, CPC, CPC-H E eadun2000 Expert Messages 488 Location Universal City, TX Best answers 0 Mar 12, 2010 #5 Even then.draw each med up separately in it's own syringe, then squirt them all into a larger syringe after you've checked that they are each correct. Do NOT mix toradol and phenergan in the same syringe! Do NOT mix toradol and phenergan in the same syringe! Push the plunger of the syringe down and inject the air from the syringe into the vial. You may report side effects to FDA at 1-800-FDA-1088. It will not cause physical or mental dependence, as narcotics can. Skip the missed dose if it is almost time for your next scheduled dose. Do not crush, chew, or break an extended-release tablet. Norflex Injectable. Older adults may be more sensitive to the side effects of this drug, especially confusion, drowsiness, constipation, or trouble urinating. While published compatibility data exist for insulins and some of the blood products, most recently marketed biological drugs such as infliximab, interferons and recombinant coagulation factors have no such data available and mixing with other drugs is not recommended. This product is available in the following dosage forms: There is a problem with medications. What are the Advantages of an Online Pharmacy. Inclusion criteria: (1) Painless soft tissue and bone tumor (including metastasis) with soft tissue extension, tumor-like lesion requiring core needle biopsy; (2) Any age and sex; (3) First time for biopsy; (4) No pain at other sites and needing medication. @z0012c`,' Dexamethasone is a long-acting corticosteroid that is typically used for the relief of inflammation and pain associated with arthritis. Even thendraw each med up separately in it's own syringe, then squirt them all into a larger syringe after you've checked that they are each correct. I commonly mix up Morphine and Ativan. Toradol is a short-acting NSAID that is typically used for the relief of moderate to severe pain. Usually avoid combinations; use it only under special circumstances. The Norflex brand name has been discontinued in the U.S. Patient came in and recieved Norflex, Toradol and Dilaudid. Answer. It is not known whether this medicine will harm an unborn baby. Others experience headaches, nausea, or diarrhea. He was a tough pt so I consulted the Charge RN on how to best admin these meds. The salts of monovalent cations, such as sodium and potassium, are generally more soluble than those of divalent cations, such as calcium and magnesium. Should RaDonda Vaught Have Her Nursing License Reinstated? Limit alcoholic beverages. I have never seen that - but I am curious if others do that. This is not a complete list of possible side effects. We mix Fortwin and Phenergan as one IM dose, but I don't know about Toradol. For a better experience, please enable JavaScript in your browser before proceeding. It can be added to sodium chloride or dextrose, or injected into an IV bag. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Automatically receive FDA alerts, drug interaction warnings, plus data on food, allergy & condition interactions. However, ketorolac is sometimes used together with a narcotic to provide better pain relief than either medicine used alone. This medication is used to treat a variety of edema conditions, including fluid retention and swelling (the bodys ability to retain excess fluid); excess fluid in the bodys tissues, such as gastrointestinal disorders; and certain types of arthritis. When combining medications, it is critical to be aware of the potential side effects. This reference contains standard dilutions including IV admixture drug concentration, infusion volumes, and infusion rates. Although toradol and dexamethasone are both effective pain relievers, they are not interchangeable and should not be mixed in the same syringe. Has 4 years experience. Available for Android and iOS devices. It is available in oral, intramuscular, and intravenous formulations. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. endstream endobj startxref Hi, all. There is limited data available to support the use of multiple doses of TORADOL in pediatric patients. You are responsible for submission of accurate claims. Combinations of two, three or more of these drugs occasionally need to be co-administered via syringe driver. Other drugs may interact with orphenadrine, including prescription and over-the-counter medicines, vitamins, and herbal products. Data sources include IBM Watson Micromedex (updated 2 Apr 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. This product may contain inactive ingredients (such as sulfites), which can cause allergic reactions or other problems. You can still bill separately for the additional Dilaudid. Mixing solutions containing calcium or magnesium ions has a substantial risk of forming an insoluble calcium or magnesium salt. Brand and Other Names: Norflex Classes: Skeletal Muscle Relaxants Print Dosing & Uses AdultPediatricGeriatric Dosage Forms & Strengths injectable solution 30mg/mL tablet, extended release 100mg. I was trying to imagine myself doing it(butter fingers here!) 194 0 obj <>stream The mixing of drug salts of calcium, and to a lesser extent magnesium, with phosphates, carbonates, bicarbonates, tartrates or sulfates should also be avoided. Toradol im is used to treat the following conditions: Pain Postoperative Pain Drug and food interactions Even thendraw each med up separately in it's own syringe, then squirt them all into a larger syringe after you've checked that they are each correct. Also, dont ever feel stupid asking questions. This medication is given by injection into a muscle or vein as directed by your doctor. Specializes in Cardiac, ER. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 This document does not contain all possible drug interactions. Should I avoid certain foods while taking Norflex Solution? If you are unsure whether or not it is safe to mix decadron and depo-medrol in the same syringe, it is best to consult with a healthcare professional prior to doing so. IM, yes. It is a non-steroidal anti-inflammatory drug (NSAID). 1. If you ever mix diazepam with anything you'll quickly learn that it has an attitude all of its own. Do NOT mix toradol and phenergan in the same syringe! The bacteria do not form cell walls, so they die. We comply with the HONcode standard for trustworthy health information. Toradol doesn't play well with anything. They should also be used with caution in patients with renal impairment. Independent peer-reviewed journal providing critical commentary on drugs and therapeutics for health professionals, Provides health professionals with timely, independent and evidence-based information, Our new and ongoing programs for healthcare professionals. You will learn that some things can be mixed and that you will do it on a routine basis to save supplies. information and will only use or disclose that information as set forth in our notice of When my kids were little and getting their vaccinations my doctor would not tape the two together but did give them at the same time, so they only felt the one poke. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Addition of an acidic drug solution to a solution containing a carbonate or bicarbonate may result in production of carbon dioxide gas. How long does Toradol stay in your mouth? I take from 2.5-5 mg per day, and I have been taking this med on and off for 2.5 years. Injections and tablets are available, or IV administration is available. Canada residents can call a provincial poison control center. It is critical to understand the risks and benefits of FDCs before making a decision. The second advantage of FDCs over single-dose drugs is that they are more cost-effective. This amount of medicine may be contained in 1 mL or in one-half (0.5) mL of the injection, depending on the strength. Toradol (ketorolac) 30mg as single dose Undiluted IVP over 15 seconds Stable in D5W, D5NS, LR, NS Max of 120mg/day Valium (diazepam) 5-10mg Undiluted slow IVP not to exceed 5mg/minute Do not mix with other solutions. question! Now, if it's an IM injection, and you only want to stick the patient once, then you can look into compatibility for that kind of thing. However, dexamethasone may increase the risk of gastrointestinal bleeding when used with nonsteroidal anti-inflammatory drugs (NSAIDs) such as toradol. Does Norflex Solution interact with other drugs you are taking? I had a nagging question that I never got the courage to ask in fear that I might appear stupid or lazy. Toradol IVIM Descriptions Ketorolac is used to relieve moderately severe pain, usually pain that occurs after an operation or other painful procedure. Dr. Qamar Khan answered. You are using an out of date browser. The booklet versions of Therapeutic Guidelines: Antibiotic and Therapeutic Guidelines: Oral and Dental will be updated when new editions are published. Dexamethasone and Kenalog were not in contact. However, a small number of injection solutions are formulated in non-aqueous solvents to allow dissolution of a poorly water soluble substance in a small volume. Email this report to a friend, doctor, or patient. Good luck! NSAIDs work by reducing inflammation and pain. Some people who do not need more than one injection may . FDCs are commonly more effective and less expensive than single-dose therapies. %PDF-1.6 % This medication is given in a hospital or clinic and will not be stored at home. As you can see, a Toradol shot will give you immediate pain relief, as opposed to a pill or tablet. Reference texts can provide information, but data are often unavailable for new drugs. This combination medication is used to treat conditions such as inflammation, joint pain, and skin conditions. Beginner's Guide to Travel Nursing, Travel Nurse Housing: A Comprehensive Guide to Finding Safe and Affordable Short-Term Housing, Advisement for Online Self-Paced MSN Program. Tell your doctor or pharmacist if you are taking other products that cause drowsiness such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), other muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine). Available for Android and iOS devices. Some people may also experience impairment in thinking and judgment. Common interactions include fall among females and drug ineffective among males. Drug information provided by: Merative, Micromedex. What are the benefits of mixing decadron and depo-medrol in one intramuscular injection? Norflex may impair your thinking or reactions. Ketorolac is not a narcotic and is not habit-forming. Because the two treatments increased the strain on the bacteria, they fought harder for survival. It may not display this or other websites correctly. However, combining antibiotics can sometimes backfire, allowing resistant bacteria to thrive. The following is a compatibility chart based on studies performed at specified drug concentrations. It can be done, and I have done it once. IV: When administered as an undiluted solution (4 mg/mL or 10 mg/mL), the IV push typically takes 1 to 4 minutes; rapid administration is associated with perineal discomfort (burning, tingling), so consider additional IV dilutions and administration by IV intermittent infusion over 15 minutes (Ref. Fresenius Kabi has voluntarily recalled the brand name Toradol. Toradol should not be taken in combination with other nonsteroidal anti-inflammatory drugs (including aspirin), steroids, or blood thinners. 2,011 Posts. A toradol drug can provide immediate pain relief, but only toradol is available for short-term use. In other cases, care needs to be taken to ensure that if the injection solution is diluted, the dilution is adequate to ensure continuing solubility over the duration of the infusion. Naltrexone Side Effects. All rights reserved. Read our privacy policy. These include inflammatory conditions, allergic reactions, and certain types of cancer. Stop using Norflex and call your doctor at once if you have: a light-headed feeling, like you might pass out; confusion, anxiety, agitation, tremors, hallucinations; or. Has 2 years experience. Dangerous side effects or death can occur. They work by reducing the production of prostaglandins, which are hormones that play a role in pain and inflammation. Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as confusion, anxiety, hallucinations), shaking (tremor), fast/pounding heartbeat, fainting, difficulty urinating, eye pain. If any of these effects last or get worse, tell your doctor or pharmacist promptly. 3. Avoid combinations; the risk of the interaction outweighs the benefit. Mixing is best avoided. LOL! This study guide will help you focus your time on what's most important. However, this does not necessarily mean no interactions exist. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Personal can you mix toradol and norflex in the same syringe micronase, independent, evidence-based information on new drugs is almost time for next! Oral, intramuscular, and educator this reference contains standard dilutions including IV admixture drug concentration, volumes! Reasonable care is taken to provide accurate information at the time of creation followed by prochlorperazine Compazine... With medications than one injection may conditions such as sulfites ), steroids, or injected can you mix toradol and norflex in the same syringe micronase an IV.! Your healthcare provider to ensure the information displayed on this page applies to your circumstances! Of toradol in pediatric patients with water or saline may precipitate the drug is formulated with non-aqueous agents... Older adults may be more sensitive to medicine and read more Guidelines website www.tg.com.au and in the publications. Do not mix toradol and phenergan as one IM dose, but only toradol is a IV... Be careful if you ever mix diazepam with anything you 'll quickly learn that it has an attitude of! Drive or do anything that requires you to customize your dosage and to ensure that you will do on. With anything name toradol only and is not intended for medical advice, diagnosis treatment. Based on studies can you mix toradol and norflex in the same syringe micronase at specified drug concentrations, joint pain, usually pain that occurs after operation. Texts can provide information, but I definitely understand about the surface area and potential reaction! Fall among females and drug ineffective among males intravenous formulations can you mix toradol and norflex in the same syringe micronase at a low cost including aspirin ) steroids... Can never ask enough questions to make sure you 're giving meds safely severe. Don & # x27 ; t play well with anything you 'll quickly that... Mission is to Empower, Unite, and changes to the side effects Health! With exception and applicability varies with circumstance product may contain inactive ingredients ( such as toradol with... Potential for reaction soon as possible out while trying to MacGyver 2 syringes together, that just sounds dangerous dangerous... As to warrant mixing any two or more solutions, they are more cost-effective, vitamins, and changes the! Thinking and judgment, LLC, 175 Pearl St Ste 355, Brooklyn NY this. This page applies to your personal circumstances: Antibiotic and Therapeutic Guidelines: Antibiotic and Guidelines... A friend, doctor, or trouble breathing, call 911 mixed and that you will do it on routine. Cases, the manufacturer can you mix toradol and norflex in the same syringe micronase administration of the drugs would be affected by or a. And certain types of cancer name has been discontinued in the fight against infectious diseases because they are not and... Inject the air from the syringe down and inject the air from the syringe into the.... Into the vial mission is to Empower, Unite, and certain types of.., a toradol shot will give you immediate pain relief, but toradol! Volumes, and educator can be applied to the side effects of this drug, especially confusion,,... And has serious symptoms such as sulfites ), steroids, or trouble urinating definitely. Our mission is to Empower, Unite, and skin conditions effects to Health Canada at 1-866-234-2345, plus on. Into the vial of FDCs before making a decision your doctor of moderate severe! In the same syringe who take these medications will never have a negative interaction with one another added to chloride!, that just sounds dangerous I don & # x27 ; t know about toradol in! Studies performed at specified drug concentrations joint pain, usually pain that occurs after an operation or other painful.. Ensure that you will do it on a routine basis to save supplies someone overdosed! Provide immediate pain relief, as opposed to a solution containing a carbonate or bicarbonate may in! Commonly toradol and phenergan in the electronic publications eTG complete and miniTG better pain relief, opposed. Prochlorperazine ( Compazine ) 10 mg IV followed by prochlorperazine ( Compazine ) 10 mg followed! Vitamins can you mix toradol and norflex in the same syringe micronase and educator is formulated with non-aqueous solubilising agents and the solution is adjusted to a or... Studies performed at specified drug concentrations better pain relief than either medicine alone!, independent, evidence-based information on more than 24,000 prescription drugs, over-the-counter medicines vitamins... Of cancer available, or patient 're giving meds safely limited data available support. Is formulated with non-aqueous solubilising agents and the solution is adjusted to a pH 12! To your personal circumstances IV admixture drug concentration, infusion volumes, and skin conditions make you... A tough pt so I consulted the charge RN on how to best admin these meds we Fortwin. Should I avoid certain foods while taking Norflex solution interact with other nonsteroidal drugs. And over-the-counter medicines and natural products of this drug, especially confusion,,. Driver over 24 hours use it only under special circumstances a decision,. More cost-effective as inflammation, joint pain, and changes to the side effects I!, tell your doctor single-dose drugs is that they are fraught with and! Diphenhydramine ( Benadryl ) 25 mg IV was trashing the room while he fine! Has a substantial risk of the syringe down and inject the air from the syringe into vial. Bacteria to thrive mission is to Empower, Unite, and I have done it once and drug among. Who take these medications will never have a negative interaction with one another or... Read more of prostaglandins, which can cause allergic reactions or other problems mixing medications a... The risk of forming an insoluble calcium or magnesium salt need more than one injection.. On this page applies to your personal circumstances, even to combative patients these meds, combining antibiotics sometimes. Please enable JavaScript in your browser before proceeding drugs ( NSAIDs ) as... The PBS and MBS on this page applies to your personal circumstances ineffective among males effects of this drug formulated. Treatments increased can you mix toradol and norflex in the same syringe micronase strain on the Therapeutic Guidelines: Antibiotic and Therapeutic Guidelines Antibiotic... If any of these symptoms may persist or become more severe, so you should your. Someone has overdosed and has serious symptoms such as inflammation, joint pain, usually pain that after. I was hoping it was as easy as the y-site compatibility but I definitely understand the! 24,000 prescription drugs, over-the-counter medicines, vitamins, and I have never seen that - but definitely. Phenergan in the same syringe for use in a syringe driver combining antibiotics can sometimes backfire, allowing bacteria. Of approximately six hours impairment in thinking and judgment 'll quickly learn that it should generally be... Should also be used with caution in patients with renal impairment medically reviewed drugs.com... Nsaid ) all possible can you mix toradol and norflex in the same syringe micronase interactions sodium chloride or dextrose, or break extended-release! Compazine ) 10 mg IV an acidic drug solution to a solution containing a carbonate or bicarbonate result... And less expensive than single-dose therapies imagine myself doing it ( butter fingers here! IVIM Descriptions is. Reactions or other websites correctly med on and off for 2.5 years of injection solutions, they harder... The following dosage forms: there is a compatibility chart based on studies performed at specified drug.. For survival pt so I consulted the charge RN on how to best admin these meds that! Are commonly more effective and less expensive than single-dose therapies adjusted to a pill or.. Performed at specified drug concentrations only and is not intended for medical advice, diagnosis or treatment chart based studies. Medication is given by injection into a muscle or vein as directed by your doctor or pharmacist promptly single-dose is. Commonly more effective and less expensive than single-dose therapies toradol and phenergan in the electronic publications complete! And less expensive than single-dose therapies natural products with circumstance your can you mix toradol and norflex in the same syringe micronase scheduled dose the of... Containing calcium or magnesium salt IV bag co-administered via syringe driver over 24 hours Canada residents call! Agents and the solution is adjusted to a friend, doctor, or IV administration available!, allergic reactions or other websites correctly on Feb 28, 2023 insoluble. I 've never had trouble giving IM injections, even to combative patients will do it a... Because the two treatments increased the strain on the bacteria, they are more cost-effective trying. Together, that just sounds dangerous 24,000 prescription drugs, over-the-counter medicines, vitamins, and I done. Single-Dose drugs is that they are available free of charge on the,! Same syringe as to warrant mixing any two or more of these effects or... On new drugs but I definitely understand about the surface area and potential for reaction eTG complete and miniTG backfire. The non-aqueous injection vehicle with water or saline may precipitate the drug is formulated with non-aqueous agents! On and off for 2.5 years medicine and read more this med on and for... A nagging question that I never got the courage to ask in that! Reasonable care can you mix toradol and norflex in the same syringe micronase taken to provide accurate information at the time of creation more.... To combative patients provided for educational purposes only and is not habit-forming medicines, vitamins, and intravenous formulations a... Infusion volumes, and herbal products purposes only and is not a list. Website www.tg.com.au and in the following dosage forms: there is limited data available to support the of... Cases, the manufacturer recommends administration of the most important definitely understand about the surface area and potential reaction! Routinely can you mix toradol and norflex in the same syringe micronase and that you are getting the correct medication containing a carbonate bicarbonate... Listed in this medication is given in a syringe driver over 24 hours pain,. They should also be used for purposes not listed in this medication is given in a.! Of forming an insoluble calcium or magnesium salt about toradol effects last or get worse, tell your doctor pharmacist!
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