Page 1
The M ed ical Letter
HAD-3018
Medical Book Card
HANDBOOK
ADVERSE
DRUG
INTERACTIONS
User’s Guide
OF
Page 2
Quick Reference Guide
T o Start Using a Book Card
1. Install the book card in a slot in the
back of the Medical Book System
platform.
2. Turn the platform on.
3. If needed, press
use the
CARD
and then
or to highlight its
icon.
4. Press
ENTER
to select it.
T o Find All Other Drug Interactions
1.
2. Highlight a drug by typing its name
3. If needed, select more drugs by
4. Press
5. Highlight an interaction, if any, and
CLEAR
Press
or pressing
ENTER
.
or and then press
to select it.
highlighting them and pressing
ENTER
.
MORE
.
ENTER
press
to view it.
18
T o Find Drug Interactions
1.
2. Highlight a drug by typing its name
3. Select more drugs by highlighting
4. Press
5. Highlight an interaction, if any, and
CLEAR
Press
or pressing
ENTER
.
or and then press
to select it.
them and pressing
SEARCH
.
ENTER
press
to view it.
ENTER
.
To Find a Glossary Entry
1.
2. Highlight a drug by typing its name
3. Press
4. Use , DN, or
5. Press
CLEAR
Press
or pressing
SPEC
BACK
.
or .
.
SPACE
to scroll.
to go back.
Page 3
License Agreement
READ THIS LICENSE AGREEMENT BEFORE USING THE MEDICAL BOOK
SYSTEM.
YOUR USE OF THE MEDICAL BOOK SYSTEM DEEMS THAT YOU ACCEPT
THE TERMS OF THIS LICENSE. IF YOU DO NOT AGREE WITH THESE
TERMS, YOU MAY RETURN THIS PACKAGE WITH PURCHASE RECEIPT TO
THE DEALER FROM WHICH YOU PURCHASED THE MEDICAL BOOK SYSTEM AND YOUR PURCHASE PRICE WILL BE REFUNDED. The MEDICAL
BOOK SYSTEM means the software product, hardware, and documentation found in
this package and FRANKLIN means Franklin Electronic Publishers, Inc.
LIMITED USE LICENSE
All rights in the MEDICAL BOOK SYSTEM remain the property of FRANKLIN.
Through your purchase, FRANKLIN grants you a personal and nonexclusive license to
use the MEDICAL BOOK SYSTEM. You may not make any copies of the MEDICAL
BOOK SYSTEM or of the preprogrammed data stored therein, whether in electronic or
print format. Such copying would be in violation of applicable copyright laws. Further,
you may not modify, adapt, disassemble, decompile, translate, create derivative works
of, or in any way reverse engineer the MEDICAL BOOK SYSTEM. You may not export or re-export, directly or indirectly, the MEDICAL BOOK SYSTEM without compliance with appropriate governmental regulations. The MEDICAL BOOK SYSTEM
contains Franklin’s confidential and proprietary information which you agree to take
adequate steps to protect from unauthorized disclosure or use. This license is effective
until terminated. This license terminates immediately without notice from FRANKLIN
if you fail to comply with any provision of this license.
1
Page 4
Contents
Contents ....................................... 2
Introduction to the HADI.............. 3
Key Guide.....................................4
Installing Book Cards .................. 5
Selecting a Book .......................... 6
Changing the Settings ................. 6
Viewing a Demonstration ............ 7
Finding Drug Interactions ........... 7
Using the Interactions Menu ..... 10
Using the Glossary .................... 11
Highlighting Search Words ....... 11
Reading Special Markers........... 12
Looking Up Words
in Other Books ........................... 13
Resetting the Medical Book
System........................................ 13
Book Card Care.......................... 14
Specifications and Patents ....... 14
Limited Warranty (U.S. only) ..... 15
Index ........................................... 16
➤
About Book Card Compatibility
IMPORT ANT This book card can be
used only with the Medical Book Sys-
™
platform and will not function in any
tem
other Franklin BOOKMAN
®
platform.
The Medical Book System platform
can use Franklin BOOKMAN book
cards as well as Medical Book System
book cards. However, Franklin BOOKMAN platforms cannot use Medical
Book System book cards.
➤
For More Information
To learn more about the Medical Book
System or other products from Franklin Electronic Publishers, call 800-6655450 or visit the Franklin Web site at
www.franklin.com.
2
Page 5
Introduction to the HADI
This handbook offers a quick guide to possible adverse effects of drug interactions,
with brief recommendations for precautionary measures. Pairs of interacting drugs are
listed alphabetically, followed by the adverse interaction, its mechanism (in parentheses), references and recommendations
for clinical management. These listings are
usually based on clinical reports. Interactions listed for groups of drugs (such as
“cephalosporins” or “antidepressants, tricyclic”) may not have been reported for every
drug in the group; known exceptions to the
interaction are noted.
It is not possible to determine the frequency of
most interactions. When an interaction is documented by one or two case reports rather than
clinical studies or reports in many patients, the
year of each report is given as some indication
of frequency.
Reports of interactions between more than two
drugs have begun to appear in the medical literature. Where these have been documented,
they are noted as comments under interacting
pairs of drugs.
UNDOCUMENTED INTERACTIONS ––
New adverse interactions are continually being
reported; the absence of a listing in this book
does not necessarily mean that drugs will not
interact when given concurrently. Interactions
extrapolated from animal studies or interactions reported with related drugs, frequently
mentioned in other sources, such as the
manufacturer’s package insert may not be included here.
Interactions between general anesthetics and
drugs likely to be administered during surgery ,
such as autonomic drugs and local anesthetics,
are not included. Interactions useful in therapy,
such as increased plasma concentration of
penicillin with concurrent use of probenecid,
are also not listed. Drug combinations should
be looked up under their components.
Common additive effects, such as occur with
use of two antihypertensive agents or two central nervous system depressants, are generally
not listed. Effects expected from the mechanism
of a drug’s action, such as that of potassium on
digitalis glycosides or calcium on calcium-entry
blockers, and useful antagonist effects, such as
that between a poison and an antidote, are also
not included. Most interactions of drugs with
foods, beverages, or other nutrients are not
listed, but foods interacting with monoamine
oxidase inhibitors are included.
3
Page 6
Introduction to the HADI
Key Guide
MECHANISMS OF INTERACTIONS —
Genetic differences can affect drug metabolism
and interactions. Some drugs can interact by
changing the metabolism of other drugs, either
through inhibition or induction of any of several hepatic enzyme activities or through alterations in hepatic blood flow. Many drugs are
metabolized by cytochrome P450 isozymes.
These isozymes are named according to a standard system, e.g., CYP3A4 or P4503A4.
Drugs that are substrates or inhibitors for the
same isozyme in vitro are likely to interact, but
no interaction may be detectable, or it may not
be clinically significant. Other drugs alter the
binding of another drug to plasma proteins or
tissue receptors, alter the distribution of drugs
to active receptor sites, delay or enhance excretion, or cause additive or synergistic effects.
RECOMMENDATIONS — Monitoring is
most important when one of the interacting
drugs is stopped or started. Some experienced
clinicians may prefer to monitor the patient’s
clinical status rather than follow serum concentrations of drugs. Concurrent use of drugs from
the same group, e.g., aspirin and other
NSAIDs, should be avoided.
Color Keys
MORE
(red) Displays interactions between
selected drug(s) and all other drugs
in this book.
SPEC
(green) Displays a glossary entry.
(yellow) Searches for interactions
SEARCH
among the selected drugs.
LIST
(blue) Lists the items currently selected from the main drug list.
Function Keys
BACK
Erases typed letters, or backs up to
the previous screen.
CAP
Shifts keys to type capitals or punctuation.
CARD
Exits the currently selected book.
CLEAR
Clears your search and returns to
the main drug list.
ENTER
Enters a word, selects a menu item,
or starts the highlight in text.
HELP
Displays help messages.
MENU
Displays the main menus.
ON/OFF
Turns the platform on or off.
SPACE
At menus and text, pages down. At
entry screens, types a space.
✻
At menus, displays the title of a high-
?
lighted item. At text, displays the current
entry title. With
4
(✽) to stand for letters in a word.
CAP
, types an asterisk
Page 7
Key Guide
Installing Book Cards
Direction Keys
DN
UP
Pages up or down.
Moves the cursor, text, or highlight.
Key Combinations*
CARD
✩
+
Transfers a highlighted word
between installed book cards.
ENTER
+
✩
At text, highlights special markers (e.g., bibliographic
references, MAO inhibitor information , etc.).
+Q-P Types numbers.
✩
DN
+
✩
UP
or
CAP
or
* Hold the first key while pressing the second.
➤
Understanding the Keys
At text, displays the next or
previous interaction or search
match.
+
Goes to the top or bottom of
a menu or text.
The functions of the keys may vary according to which book card is installed
and selected in the platform. T o learn
how to use a particular book card, read
its User’s Guide.
CAUTION Never install or remove a
book card when the platform is turned on.
If you do, information entered in any
installed book cards may be erased.
1. Turn the platform off.
2. Turn the platform over.
3. Align the book card tabs with the
notches in a card slot.
4. Press the book card until it snaps
into the slot.
➤
Removing Book Cards
CAUTION When you remove a book
card from a platform, information entered in that book card may be erased.
5
Page 8
Selecting a Book
Changing the Settings
If you have installed two book cards in
the platform, you can select which book
you want to read.
1. Turn the platform on.
CARD
2. Press
.
3. Use or to highlight the book
you want to use.
4. Press
➤
ENTER
to select it.
Resuming Where Y ou Left Off
You can turn off the platform at any
screen. When you turn it on again, the
last screen that you viewed appears.
Using the Setup menu, you can adjust the
type size, shutoff time, and screen contrast of
this book.
The type size sets how large the characters appear on screen. The shutoff time
sets how long your Medical Book System
stays on if you forget to turn it off.
1. Press
2. Highlight
3. Press
4. Use
MENU
.
Set Type Size, Set Shutoff
or
Set Contrast
ENTER
on the Setup menu.
.
or to change the setting.
Or press
BACK
to leave the setting
unchanged.
5. Press
ENTER
to select it.
6
,
Page 9
Viewing a Demonstration
Finding Drug Interactions
Before you start using this book, you may
want to see a brief demonstration.
MENU
Press
and then use the arrow keys to
highlight View Demo on the Setup menu.
ENTER
Press
onstration, press
to select it. To stop the dem-
CLEAR
.
➤ Help is Always at Hand
You can view a help message at virtu-
HELP
ally any screen by pressing
exit help, press
BACK
.
. To
T o read a tutorial about this book, select Tutorial from the Setup menu.
For more information about the Hand-
book of Adverse Drug Interactions, select Introduction from the Setup menu.
➤
Follow the Arrows
The flashing arrows at the right of the
screen show which arrow keys you can
press to move through menus or view
more text.
For a Single Drug
You can select a single drug from the
main drug list and quickly find drugs with
which it interacts.
1. Press
2. Type a drug name. For example,
3. When the drug is highlighted, press
4. Press
7
CLEAR
.
type
heparin
.
T o de-select a letter, press
BACK
You can also highlight a menu item by
using or .
T o type a number, hold ✩ and press a
numbered key.
T o see a full menu title, press
ENTER
to select it.
?
A check marks your selection.
T o deselect a drug, press
MORE
(red) to find all the in-
ENTER
again.
teractions for the selected drug
listed in this book.
.
✻
.
Page 10
Finding Drug Interactions
These are the interactions for heparin.
5. T ype an interaction title or use the
arrow keys to highlight an interaction. For example, highlight
arins & nitroglycerin
6. Press
7.
8. Press
➤
ENTER
to view it.
To go to the next or previous interac-
tion, if any, hold
CLEAR
✩
and use DN or UP.
when finished.
About the Main Drug List
hep-
.
The main drug list contains brand and generic drugs, foods, as well as drug and
food groups. Brand names are capitalized, but you do not need to type capitals.
Note: In this User’s Guide, “drug” refers to any item on the main drug list.
Finding Drug Interactions
Among Many Drugs
You can select up to 20 drugs at a time
and find their interactions.
1. Press
2. Select a drug from the main drug
3. Select other drugs, for example, select
4. T o see the drugs you have selected,
8
CLEAR
.
list. For example, select
quinine
A check marks your selection.
acetaminophen
To deselect a drug, press
and
antihistamines.
ENTER
again.
Y ou can add more drugs here if you wish.
LIST
press
(blue).
To see the glossary entry of a drug on
your query list, highlight it and press
SPEC
(green) or
ENTER
.
.
Page 11
Finding Drug Interactions
Finding Drug Interactions
5. Press
SEARCH
(yellow) to find inter-
actions among the selected drugs.
6. Highlight an interaction and press
ENTER
to view it.
7. To find all the other interactions
that include one of the selected
drugs, press
8. Highlight an interaction to read
and press
MORE
ENTER
(red).
to view it.
9. To go to the next or previous interaction, hold
10. Press
➤
If You Misspell a Drug Name
✩
and use DN or UP.
CLEAR
when finished.
When you type letters that do not
match a drug on the main drug list, the
spelling correction entry screen ap-
BACK
pears. You can press
repeatedly
to exit it. Or you can enter the misspelled drug name to view corrections.
Select a correction to add it to your
search, or press
to select Words
starting with... and view completions,
if any.
9
Page 12
Finding Drug Interactions
Using the Interactions Menu
➤
Searching for Parts of Words
If you want to find prefixes, suffixes,
or other parts of words, type an asterisk (✻) to stand for a series of letters.
To type an asterisk, hold
✻
press
.
?
For example, type poly
CAP
✻
at the main
drug list.
Then press
ENTER
to see its matches, or
type a correction.
Use to highlight a match and then
ENTER
press
to add it to your search.
and
All the drug interactions in the printed
book are listed in alphabetical order on
the Interactions menu.
1. Press
2.
MENU
.
T ype the name of a drug or use the ar-
row keys to highlight it. For example,
highlight
3. Press
4. Use , DN, or
5. Press
haloperidol & lithium
ENTER
.
SPACE
to scroll.
CLEAR
when finished.
10
.
Page 13
Using the Glossary
Highlighting Search Words
You can view a glossary entry for any
drug on the main drug list. A glossary entry can contain a drug’s generic or brand
name, any drug or food groups to which it
belongs, and MAO inhibitor information.
1. Press
CLEAR
.
2. Highlight a drug on the main drug
list. For example, highlight
ibuprofen
3. Press
.
SPEC
(green) to see its glos-
sary entry.
4. Use , DN, or
5. To go back to the main drug list,
press
BACK
SPACE
to scroll.
.
You can also find a glossary entry for a
drug by highlighting it in text. Note: You
can only search for drugs that are listed in
this book.
1. At the text, press
T o turn off the highlight, press
ENTER
.
BACK
2. Use the arrow keys to highlight a drug.
3. Press
4. To go back, press
5. Press
ENTER
to find its glossary entry.
BACK
.
CLEAR
when finished.
11
.
Page 14
Reading Special Markers
Throughout this book, you will find bibliographic references (indicated by
’s), and notes about foods that inter-
act with MAO inhibitors (indicated by
erences provide additional information.
found in glossary entries.
Note: The hand icon (
marker. It separates the interaction
description from any commentary on the
interaction.
1. When you see a , or
✩
and press
Notice the highlight. To undo the highlight, press
2. Press
’s). Bibliographic ref markers are usually
ENTER
BACK
.
ENTER
.
) is not a special
in the text, hold
.
Reading Special Markers
3. Press
➤
BACK
repeatedly to go back.
Reading Multiple Special Markers
Sometimes more than one special
marker appears on screen at one time.
To highlight the first special marker,
hold
✩
and press
ENTER
. To highlight
subsequent special markers, continue
holding
✩
and press
ENTER
When you have highlighted the special
marker that you want, press
read it. Then press
BACK
to return to
the highlighted item.
12
again.
ENTER
to
Page 15
Looking Up Words
in Other Books
Resetting the Medical
Book System
The Medical Book System platform enables
you to look up a word from one installed
book card in the other installed book card.
This book card can send words to and receive words from other book cards. Some
book cards are not able to transfer words. T o
learn if a book card can send or receive
words, read its User’s Guide.
1. Install two book cards in the
platform.
2. Select a book to read.
3. Highlight a word in that book.
You can highlight words in menus,
lists, entries, and other text. T o learn
how to highlight a word in this book,
read “Highlighting Search Words.”
4. Hold ✩ and press
5. Highlight the icon of the other
book card and then press
CARD
.
ENTER
.
The word that you highlighted appears
in the other book.
6. Press
ENTER
search for the word in the other
book.
again, if needed, to
If, due to electrostatic discharge or other
cause, the keyboard fails to respond or the
screen performs erratically, try the steps
below to reset the platform. Perform only
as many steps as required to restore normal operation.
CAUTION Resetting the platform when
book cards are installed may erase settings and information entered in those
book cards. Remove all book cards before
resetting.
1. Hold
CLEAR
and press
ON/OFF
twice.
If nothing happens, try Step 2.
2. Use the end of an opened paper clip
to gently press the reset button on
the back of the platform.
The reset button is recessed in a pin-sized
hole located near the book card slots.
CAUTION Pressing the reset button
with more than light pressure may permanently disable it.
If nothing happens, try Step 3.
3. Remove and reinstall the batteries.
T o learn how, read the Medical Book
System platform’s User’ s Guide.
13
Page 16
Book Card Care
Specifications and Patents
• Do not touch the metal contacts on
the book cards.
CAUTION T ouching the electrical contacts with statically charged objects, including your fingers, could erase
information entered in a book card.
• Do not put excessive pressure on
the book cards.
LBS.
• Do not expose the book cards to
heat, cold, or liquids.
Model HAD-3018
• size: 5.9 x 4.2 x 0.6 cm
• weight: 0.4 oz
© 1999 Franklin Electronic Publishers,
Inc., Burlington, N.J. 08016-4907
U.S.A. All rights reserved.
© 1998 by The Medical Letter, Inc. All
rights reserved.
Medical Book System and BOOKMAN
are trademarks of Franklin Electronic Publishers, Inc.
FCC Notice: Complies with the limits for a Class
B computing device pursuant to Subpart B of part
15 of FCC Rules. Operation is subject to the following two conditions: (1) This device may not
cause harmful interference; and (2) This device
must accept any interference received, including
interference that may cause undesired operation.
U.S. Patents 4,490,811; 4,830,618;
5,113,340; 5,218,536; 5,321,609;
5,396,606; 5,627,726; 5,153,831.
Euro. Patent 0 136 379.
German Pats. M9409743.7, M9409744.5.
PATENTS PENDING.
ISBN 1-56712-492-5
14
Page 17
Limited Warranty (U.S. only)
Franklin Electronic Publishers, Inc. (“Franklin”) warrants to
the end user that this product will be free from defects in material and workmanship for a period of ONE YEAR from the
date of original retail purchase, as evidenced by sales receipt.
On discovery of a defect, the end user must return this product (transportation charges prepaid) either to the dealer from
whom it was purchased or directly to Franklin at the address
given below. Each product returned must include the user’s
name, address, and telephone number, as well as a brief description of the nature of the defect and a copy of the sales receipt as proof of the date of the original retail purchase.
Franklin will, at its sole option, repair or replace with an
equivalent product any product at no further charge to the end
user on determination by Franklin, in its sole discretion, that
the product was defective and that such defect arose within the
duration of this limited warranty.
Enclose $3.00 check or money order for shipping and handling to Franklin Electronic Publishers, Inc.
This warranty does not apply if, in the sole discretion of Franklin, the product has been tampered with, damaged by accident, abuse, misuse, or misapplication, or as a result of service
or modification by any party, including any dealer, other than
Franklin. FRANKLIN SHALL NOT BE RESPONSIBLE IN
ANY WAY FOR ANY SERVICE OR MODIFICATION TO
THIS PRODUCT BY ANY PARTY, INCLUDING ANY
DEALER, OTHER THAN FRANKLIN.
This warranty applies only to products manufactured by or for
Franklin. Batteries, corrosion of battery contacts and any damage caused by batteries are not covered by this warranty.
ALL IMPLIED WARRANTIES, INCLUDING ANY IMPLIED W ARRANTIES OF MERCHANT ABILITY OR FITNESS FOR A PARTICULAR PURPOSE, SHALL BE
STRICTLY LIMITED IN DURATION TO THAT OF THE
EXPRESS WARRANTY SET FORTH ABOVE, THAT IS,
ONE YEAR FROM THE DATE OF ORIGINAL RETAIL
PURCHASE.
THE WARRANTY AND REMEDY SET FORTH ABOVE
ARE THE EXCLUSIVE REMEDY OF THE RETAIL
BUYER AND END USER IN CONNECTION WITH THE
MANUFACTURE, SALE, OR USE OF THIS PRODUCT
AND ARE IN LIEU OF ANY AND ALL OTHER WARRANTIES OR REMEDIES, WRITTEN OR ORAL, EXPRESS OR IMPLIED. NO FRANKLIN DEALER, AGENT,
OR EMPLOYEE IS AUTHORIZED TO MAKE ANY ADDITIONAL WARRANTY IN THIS REGARD OR TO
MAKE ANY MODIFICATION OR EXTENSION OF THIS
EXPRESS WARRANTY.
FRANKLIN SHALL NOT BE RESPONSIBLE FOR SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES
RESULTING FROM THE BREACH OF ANY EXPRESS
OR IMPLIED WARRANTY OR IN CONNECTION WITH
THE MANUFACTURE, SALE, OR USE OF THIS PRODUCT UNDER ANY LEGAL THEOR Y, WHICH DAMAGES
SHALL INCLUDE, BUT NOT BE LIMITED TO, LOST
PROFITS, DAMAGES TO PROPERTY OR DAMAGES
FOR PERSONAL INJURY (BUT ONLY TO THE EXTENT
PERMITTED BY LAW). UNLESS OTHERWISE CONTRARY TO APPLICABLE LAW, FRANKLIN’S LIABILITY SHALL IN NO CASE EXCEED THE PRICE PAID
FOR THE PRODUCT CLAIMED TO BE DEFECTIVE.
This warranty shall not be applicable to the extent that the enforcement of any provision may be prohibited by applicable
law. This warranty gives you specific rights, and you may also
have other rights which vary from state to state. Some states
do not allow the exclusion or limitation of incidental or consequential damages or limitation on how long an implied warranty may last so the above limitation or exclusion may not
apply to you. Enclose $3.00 check or money order for shipping and handling to:
FRANKLIN ELECTRONIC PUBLISHERS, INC.
ATTENTION: SERVICE DEPARTMENT
ONE FRANKLIN PLAZA
BURLINGTON, NEW JERSEY 08016-4907
609-386-2500
15
Page 18
Limited Warranty (outside U.S.)
Index
This product, excluding batteries, is
guaranteed by Franklin for a period of
one year from the date of purchase. It will
be repaired or replaced with an equivalent
product (at Franklin’s option) free of
charge for any defect due to faulty workmanship or materials.
Products purchased outside the United
States that are returned under warranty
should be returned to the original vendor
with proof of purchase and description of
fault. Charges will be made for all repairs
unless valid proof of purchase is provided.
This warranty explicitly excludes defects
due to misuse, accidental damage, or
wear and tear. This guarantee does not
affect the consumer’s statutory rights.
This unit may change operating modes due to Electrostatic Discharge. Normal operation of this unit can be reestablished by pressing the reset key,
removing/replacing batteries.
ON/OFF
, or by
?* key 4, 10
Arrow keys 5, 7
Auto-resume feature 6
BIB marker 12
Blue (LIST) key 4, 8
Book cards
installing 5
platform compatibility 2
removing 5
selecting 6
Changing
screen contrast 6
shutoff time 6
type size 6
Color keys
key guide 4
understanding 4
Demonstration 7
Direction keys 5
Drugs
deselecting 7
highlighting 7
selecting 7
Function keys 4
Glossary entry 8, 11, 12
Green (SPEC) key 4, 8, 11
Hand icon 12
16
Page 19
Index
Help messages 7
Highlighting
bibliographic references 12
MAO Inhibitor Info markers 12
MAO inhibitor information 5
search words 11
words 11
Interactions menu 10
Introduction, reading 7
Key combinations 5
LIST (blue) key 4, 8
Main drug list, about 8
MAO Inhibitor Info marker 12
MAO inhibitor information
3, 5, 11, 12
Misspellings, correcting 9
MORE (red) key 4, 7
Numbers, typing 5
Parts of words, searching for 10
Red (MORE) key 4, 7
Reset button 13
Screen contrast 6
SEARCH (yellow) key 4
FRB-28507-00
P/N 7201576 Rev. A
Shutoff time 6
SPEC (green) key 4, 8, 11
Special markers, reading 12
Spelling correction entry screen
9, 10
Tutorial 7
Type size 6
Viewing
bibliographic references 12
cross-references 12
demonstration 7
help messages 7
Words, highlighting 11
Yellow (SEARCH) key 4
17
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