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Phentermine.com is a property of: Careworld LLC. The medical board would like to work with the pharmacy board to make OARRS reports more available and helpful to physicians. After 12 weeks, the patient needs to take a break from the product as it may lead to physical dependence. In order to help patients reduce their risk of developing these diseases when they are obese, doctors usually prescribe Phentermine. The drug is always accompanied by increased physical activity and a diet that includes a lower amount of calories. Concomitant use of alcohol with Phentermine may result in an adverse drug reaction. Requirements may be altered [see Warnings and Precautions (5.9)]. Use of Phentermine is contraindicated during or within 14 days following the administration of monoamine oxidase inhibitors because of the risk of hypertensive crisis. If you miss a dose of this medicine, take it as soon as possible. Burguera B, et al. In order to determine the effectiveness of certain pharmaceuticals, supplements and other substances, clinical trials and scientific research are often conducted among a group of volunteers. Avoid use of Phentermine in patients with eGFR less than 15 mL/min/1.73m2 or end-stage renal disease requiring dialysis [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)]. Want to get more tips, information, and motivation? Read more here: How much does phentermine cost? Instead of simply quitting the program, a patient should rather consult a healthcare provider about quitting. << /Length 5 0 R /Filter /FlateDecode >> Phentermine is 17.5% plasma protein-bound, while topiramate is 15 - 41% plasma protein-bound when the blood concentration range is 0.5 to 250 g/mL. Do You Need a Prescription for Phentermine? Experience with hemodialysis or peritoneal dialysis is inadequate to permit recommendations in this regard. Take the disintegrating tablet with or without food. HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ADIPEX-P safely and effectively. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. ]^Ng8\!HqX 'nR l# w! {A6.q=0G: S:nR-`\ |%Tx F5z :^EU\)|\eyt0F 121 0 obj <>/Filter/FlateDecode/ID[<5D80FCFEE48BF540827EEA7155FB4128>]/Index[104 35]/Info 103 0 R/Length 85/Prev 180155/Root 105 0 R/Size 139/Type/XRef/W[1 2 1]>>stream 138 0 obj <>stream Metric conversions are as follows: pounds 2.2 = kg; inches x 0.0254 = meters. Precaution should be taken if a patient has any existing health concerns as the drug may cause further harm to their body. When breastfeeding, the drug may enter the breast milk and travel into the nursing babys body, which may cause harm to them. Use caution when administering Phentermine to patients with renal impairment. HVMs8WQl eLg*&{dd $_;lm |NggK6,M]gu\.BNB. 4 Before starting with consumption of this medication, patients should get informed about potential adverse effects to be able to determine whether a newly-developed symptom is a sign of a health issue or just a side effect associated with Phentermine. Generic name: Phentermine hydrochloride (2009, April 06). Phentermine hydrochloride: Usual dosage is 8 mg 3 times daily (given 30 minutes before meals) or 15-37.5 mg once daily (in the morning). While these are the most common side effects of the drug, they are not the only consequences associated with the intake of this medication. Some of these include: As with many other prescription drugs, Phentermine can also interact with certain medications. A link to Chapter 4731-11, OAC, is also provided on page 15 of the Formulary.The nursing law and rules are available for review on the Boards website www.nursing.ohio.gov under the Law and Rules link.The website for State Medical Board of Ohio is: www.med.ohio.gov. Phentermine also is offered combined with topiramate for weight loss (Qsymia). Adipex-P (phentermine hydrochloride) capsules label, Greater than 27 kg/m2 + one or more weight-related condition, Vitals (heart rate, blood pressure, etc. For more information, the rule package submitted to the Common Sense Initiative (CSI) office for review can be found here:https://med.ohio.gov/LinkClick.aspx?fileticket=Q2JmI7o-3HI%3d&portalid=0, 2023 The Ohio State Medical Association. If the drug is taken too late in the day, it may also cause insomnia. include protected health information. Losing weight during pregnancy can harm both a mother and her baby. This brand is manufacturedby Teva Pharmaceuticals (formerly GATE Pharmaceuticals). The dosage may be adjusted to the patients need. The promotion of this brand as a diet pill started in 1990. The drug is classified under a certain chemical class known as amphetamine as it has a similar pharmacology value to other drugs classified in the class. The plasma protein binding decreases as blood topiramate increases. ). Current Obesity Reports. Many patients find that if their doctor gradually lowers their dose, for example from 37.5mg per day down to 15mg per day for the last few days, they experience fewer withdrawal symptoms and are able to keep the weight off later. ). Weight Loss Prescribing Rules Ohio Administrative Code 4731-11-04 and 4731-11-04.1 The medical board is currently reviewing its long-standing rules regarding prescribing controlled substances for the treatment of obesity. In most cases, the drug is prescribed to users in periods of 12 weeks. Some of the most common withdrawal symptoms include weight gain, fatigue, insomnia and a bad mood. Manifestations of chronic intoxication with anorectic drugs include severe dermatoses, marked insomnia, irritability, hyperactivity and personality changes. There is a problem with The FDA in the United States first approved the use of Amphetamine as a drug that can be used to suppress a patients appetite in 1959. ohio.gov under the Practice APRN link.Although the Formulary allows CTP holders to prescribe these three drugs under the circumstances documented by their respective standard care arrangement, there are other factors that must be considered by the CTP holder prior to initiating Qsymin, Belviq or Contrave prescriptions for patients. It is contraindicated for patients with current or past: cardiovascular disease (heart problems), hyperthyroidism, glaucoma, agitated states, drug/alcohol abuse, or reactions to sympathomimetic amines. It is illegal and unsafe to buy phentermine without a prescription. potentially hazardous activities such as operating machinery or driving FULL PRESCRIBING INFORMATION in the presence of other risk factors (e.g., controlled hypertension, 333-33-100411 Tasks 35 Do not double doses. U.S. Food and Drug Administration. Since it may lead to such symptoms, it also has the potential to cause severe withdrawal symptoms, especially when a patient goes cold turkey. Here are the results of a recent poll that asked current phentermine patients where they received their phentermine prescription ( This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. OSMA has historically had concerns with the limitations that these rules place on physicians who treat patients with obesity. It is obvious that these symptoms can make the entire program useless. LZ(6&JQKU5@5_M.~#p = yLgzP"Z90* v~1iu0pV (s:J&Q,. } }& 8}q>u@y)dO|fRmknw huA0@6-%&k-1qI6fSt4#>=sHMk>8fztq9_ nw:>NxHfib Lx.c QEWg\@y@ ~[*+-Dze~Ej+%.E`|IdW#o~#` MM Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. For some patients, half tablet (18.75 mg) daily may be adequate, while in some cases it may be desirable to give half tablets (18.75 mg) two times a day. x8FvuN3il&_t%(af?uE7wRu\BbK. OSMA has historically had concerns with the limitations that these rules place on physicians who treat patients with obesity. But weight management can take time. This content does not have an English version. Children 16 years of age and youngerUse is not recommended. What could be the cause? ): Most people get their phentermine from a family or primary care doctor ( Phentermine doctors network. The drug is classified under a certain chemical class known as amphetamine as it has a similar pharmacology value to other drugs classified in the class. hb``````>X,K10wdjdZ(`l Ro4' b2h>$:-9.AKL1}c$vEP;-@c=en`Y %YQh` &^ The FDA has categorized this drug as X for pregnancy, which means it should not be used during pregnancy under any circumstances. PDF What Every Pharmacist Needs to Know About Controlled Substances in Wait, so NPs may prescribe Qsymia, but not phentermine? Ohio has some of the strictest rules in the country andthe current rules place time limitations on prescriptions that, many times, force physicians to stop a medication that is showing positive weight loss results. Animal reproduction studies have not been conducted with Phentermine. endstream endobj 108 0 obj <>stream Phentermine hydrochloride USP is a sympathomimetic amine anorectic. Many physicians who currently receive the reports have found that the reports help them better understand, and possibly alter, their prescribing practices. Phentermine is a Schedule 4 drug. Phentermine is not to be used while pregnant or breastfeeding under any circumstances. LiverTox National Institutes of Health. Mayo Clinic Proceedings. the unsubscribe link in the e-mail. The prescribing designation for anorexiants can be located on page 15 of The Formulary Developed by the Committee on Prescriptive Governance (The Formulary). Management of acute Phentermine hydrochloride intoxication is largely symptomatic and includes lavage and sedation with a barbiturate. It has the chemical name of ,,-Dimethylphenethylamine hydrochloride. Members of Losing Weight with Phentermine Support Group on Facebook. When performing prospective DUR, the pharmacist notices a 30-day gap in treatment. Today, Phentermine can still be obtained through the doctors prescription in the majority of countries around the world. See Drug Abuse and Dependence (9) and Overdosage (10). The first use of Phentermine as a drug to help treat obesity dates back to 1938. Phentermine is contraindicated during pregnancy because weight loss offers no potential benefit to a pregnant woman and may result in fetal harm. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Overdosage of pharmacologically similar compounds has resulted in fatal poisoning usually terminates in convulsions and coma. Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Drugs of this class used in obesity are commonly known as anorectics or anorexigenics. It has not been established that the primary action of such drugs in treating obesity is one of appetite suppression since other central nervous system actions, or metabolic effects, may also be involved. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. Phentermine also has many potential drug interactions (e.g., with MAOIs), so the prescribing doctor and pharmacist know about ALL other medications and supplements taken within the last two weeks. Phentermine: Package Insert / Prescribing Information - Drugs.com https://www.uptodate.com/contents/search. Phentermine may decrease the hypotensive effect of adrenergic neuron blocking drugs. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Phentermine for weight loss - Mayo Clinic - Mayo Clinic - Mayo Clinic , (2019). L^%0:T'xHGi,KGyVfZ5WI6&ZU1/VqM4.ct\i2gTAtQV%[$*/tbn"xS8JU$bljsI2)bs_/FouVGwCqX';z{0REZbSX,bXWPS#Bf|il#o'y`?jv{;!bS F#vPGzD"1~5~F%mW9YlGIQVYOS~kojbdQS!>|@Ph Rule 4731-11-01 | Definitions. At January's meeting, the board discussed the rules and elected to investigate what other states are doing to regulate weight loss medication. Especially considering Ohios ability to track the prescribing and dispensing of the drug in Ohios drug database, OARRS. The safety and efficacy of combination therapy with Phentermine and any other drug products for weight loss including prescribed drugs, over-the-counter preparations, and herbal products, or serotonergic agents such as selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. If your dose is different, do not change it unless your doctor tells you to do so. When mental impairment is present while taking Phentermine, a patient is also advised not to drive to avoid the risk of being involved in an accident. While discussing the use of Phentermine with the doctor, a patient is provided a list of lifestyle changes to implement while using this product. I am finding limited information. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. %PDF-1.6 % Phentermine hydrochloride, an anorectic agent for oral administration, is available as a tablet containing 37.5 mg of Phentermine hydrochloride (equivalent to 30 mg of Phentermine base). 0 Phentermine is one of the substances that have been researched thoroughly, thus its effects have been proven effective and the claims that are made about this drug are backed by scientific evidence. Swallow the extended-release capsule whole. hbbd``b`z$@D`]"@DeX- Bb V ``LA\F*? Dr. Lazarus, we will discuss combination phentermine therapy later in this roundtable discussion. Manifestations of chronic intoxication with anorectic drugs include severe dermatoses, marked insomnia, irritability, hyperactivity and personality changes. For more FAQs, please see our full archive of Frequently Asked Questions about phentermine and related prescription appetite suppressants. Patients must be instructed on how much Phentermine to take, and when and how to take it [see Dosage and Administration (2)]. Initial U.S. Approval: 1959 -----INDICATIONS AND USAGE----- Suprenza is a sympathomimetic amine anorectic indicated as a short-term adjunct (a few weeks) in a regimen of . Late evening medication should be avoided because of the possibility of resulting insomnia. This does not only include prescription drugs but also: Common drugs that are known to interact with Phentermine include Dopamine, Venlafaxine, Linezolid, Ephedrine, Isoproterenol, Epinephrine, Norepinephrine and a Phenylephrine injection. Phentermine: 18.75 to 37.5 milligrams (mg) once a day, taken before breakfast or 1 to 2 hours after breakfast. The most common brand of Phentermine is a product known as Adipex, but officially called Adipex-P. 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. They are usually real doctors who prescribe real phentermine without the now-mandatory face-to-face consultation. Of course, it is taken orally. Y$iqzZz\vlt1a;svw&aBS8Z(HGCkr&_Qxt97t,GWceTL^QqX(%8_A2'"%tD'DNz"G*"Tc. Any knowledge would be most appreciated. Mayo Clinic does not endorse companies or products. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. OSMA is actively following this issue and we are hopeful that the medical board will make changes to Ohios rules that will enable physicians to utilize their training and professional judgment, instead of restrictive time limits, when treating some of Ohios most vulnerable patients. CIV Advertising revenue supports our not-for-profit mission. Cardiovascular effects include arrhythmia, hypertension or hypotension, and circulatory collapse. He or she may prescribe the medication him/herself if you are an appropriate candidate, or he/she may choose to refer you to a specialist for further evaluation and follow-up. Before writing a phentermine prescription, he or she will evaluate your: While any doctor can prescribe phentermine, not all doctors feel comfortable doing so. Apart from these brand names, other brands that contain the drug as part of their multi-ingredient formula also exist and the most popular one is Qsymia. Selling or giving away Phentermine may harm others and is against the law. It is important not to perform activities that require a patient to be alert while experiencing mental impairment as an adverse effect. Accessed Oct. 11, 2022. When tolerance to the anorectant effect develops, the recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug should be discontinued. the unsubscribe link in the e-mail. Clinics specializing in weight loss often employ bariatric specialists who have additional training in obesity management. The goal of the drug is to help patients lose weight and increase energy since the withdrawal symptoms of include fatigue and weight gain through an increase in appetite, the product is rendered a waste of the patients time and money. Columbus, Ohio 43215 Phone: (614) 466-3934 Web: www.med.ohio.gov State Medical Board of Ohio 30 E . It is not known if Phentermine is excreted in human milk; however, other amphetamines are present in human milk. Learn about the most popular weight loss medications. hbbd``b` @IHpA\> . Rule 4731-11-04 - Ohio Administrative Code | Ohio Laws Review/update the 6 Phentermine is approved for use for up to 12 weeks. With respect to the care and treatment of patients with obesity, APRNs are required to incorporate the State Medical Board rules applicable to physicians and prescribing practices. Rule 4731-11-02 | General provisions. The MAO inhibitors (Monoamine Oxidase Inhibitors) are used to treat depression, especially a specific type called atypical depression. Available for Android and iOS devices. In patients with severe renal impairment (eGFR 15 to 29 mL/min/1.73m2), limit the dosage of Phentermine to 15 mg daily [see Dosage and Administration (2.2)]. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. It is both dangerous and potentially illegal to use an online phentermine doctor. Package insert / product label (2019, May 03). Do not crush, break, or chew it. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. More, these sites also operate pharmacies that are not VIPPS-accredited, so you may also be putting your personal information and or money at-risk ( A weight loss doctor will be more familiar with the research on phentermine for weight loss and, in many cases, more likely to prescribe it. CTP holders continue to be prohibited from prescribing all other anorexiants including, but not limited to phentermine (Adipex). Some of the studies that have linked Phentermine to positive results in humans include: The main active ingredient is known as Phentermine Hydrochloride. Carefully follow your doctor's instructions for a reduced-calorie diet plan and regular exercise. A minimum weight gain, and no weight loss, is currently recommended for all pregnant women, including those who are already overweight or obese, due to obligatory weight gain that occurs in maternal tissues during pregnancy. A doctor is the only person who can determine if phentermine is right for you. How to Get a Prescription for Phentermine - Phentermine.com Other initial symptoms may include angina pectoris, syncope or lower extremity edema. All rights reserved. \ Detailed Phentermine dosage information Related/similar drugs Phentermine is not a miracle drug taken daily and the body simply starts losing weight all by itself. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). If you are a Mayo Clinic patient, this could . More specifically, this medication is an option for people with a body mass index (BMI): Weight-related conditions that may qualify a lower-BMI patient for phentermine include: type 2 diabetes, high cholesterol (hyperlipidemia), and controlled high blood pressure (hypertension) ( Mid-Level Practitioners Authorization by State Pursuant to Title 21, Code of Federal Regulations, Section 1300.01(b28), the term mid-level practitioner means an individual "@Hw4`tqCA\+ q [AF]` b L ! See DrugAbuse and Dependence (9.3). Metabolism Phentermine has two metabolic pathways; hydroxylation and oxidation. Doctors used it to help patients who experience certain health issues caused by obesity to lose weight and improve the symptoms they are experiencing. Below we explain how to get phentermine, including why you need a prescription, who can take this medication, and how to get your doctor to prescribe phentermine. Keep from freezing. health information, we will treat all of that information as protected health 2 Phentermine is a sympathomimetic amine with pharmacologic activity similar to the prototype drugs of this class used in obesity, amphetamine (d- and dll-amphetamine). 104 0 obj <> endobj Phentermine also is offered combined with topiramate for weight loss (Qsymia). Following the administration of Phentermine, Phentermine reaches peak concentrations (Cmax) after 3 to 4.4 hours. Should a patient realize he/she has missed a dose within a reasonable timeframe after the doses timing, it is acceptable to take it once they remember it. Before you schedule your first appointment, do some research to find out how much the whole process costs and if you can use outside coupons like prescription discount cards. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage. Patients must be informed about the risks of use of Phentermine (including the risks discussed in Warnings and Precautions), about the symptoms of potential adverse reactions and when to contact a physician and/or take other action. Phentermine is pregnancy category X, so it should never be taken while pregnant or nursing ( Moreover, it is strongly recommended to avoid or limit the alcohol intake. As a reminder, Ohio law requires physicians who prescribe any controlled substances, not just opioids, to submit an ICD-10 code with that prescription. Phentermine is most commonly prescribed to patients who experience negative health effects to excessive amounts of body weight. https://med.ohio.gov/LinkClick.aspx?fileticket=Q2JmI7o-3HI%3d&portalid=0. Like other weight-loss medicines ordered by providers, phentermine is meant to be only part of a weight-loss plan. Rule 4731-11-14 - Ohio Administrative Code | Ohio Laws However, it caused a chronic condition known as pulmonary hypertension, which led to the death of many patients. Instead, wait until you can go to a local doctor or consider other, over-the-counter weight loss options. https://www.micromedexsolutions.com. These lifestyle changes often include participating in regular exercise and physical activities, as well as eating a well-balanced diet that does not contain large amounts of calories or harmful substances. information and will only use or disclose that information as set forth in our notice of The amount of weight loss associated with the use of an anorectic drug varies from trial to trial, and the increased weight loss appears to be related in part to variables other than the drugs prescribed, such as the physician-investigator, the population treated and the diet prescribed. 1-612-816-8773. United States of America, Drug Enforcement Administration, Federal Register. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus. Patients are advised to report any symptoms or diseases they may have before the doctor prescribes the drug this may include high blood pressure and kidney problems, as well as any type of diabetes and thyroid disorders. The rate of weight loss is greatest in the first weeks of therapy for both drug and placebo subjects and tends to decrease in succeeding weeks. However in the presence of topiramate, Phentermine Cmax and AUC increase 13% and 42%, respectively. Portions of this document last updated: Feb. 01, 2023. Do not keep outdated medicine or medicine no longer needed. While this drug may sound like a wonder pill, patients should ensure they know are familiar with the precautions, interactions, side effects and other important details before they start taking it. National Association of Boards of Pharmacy. Take this medicine only as directed by your doctor. Search: PHENTERMINE BMI GUIDELINES In addition, Section 4723.431(A), ORC, requires the APRNs collaborating physician to be practicing in Ohio in a specialty that is the same or similar to the nurses nursing specialty.Section 4723.481(B), ORC, prohibits the prescriptive authority of the CTP holder from exceeding the prescriptive authority of the collaborating physician. The Topamax is added to Phentermine in order to intensify its effects and to help patients lose weight faster. Other brands of this drug include Suprenza, Phentercot, Acxion, Elvenir, Terflamex, Panbesy, Duromine, Fentermina, Phentermin, PHentermine and Lomaira. PDF PA Prescriptive Authority Guidance Document - Ohio But the rate of misuse seems to be low. If your primary care physician thinks you are a good candidate for phentermine but does not want to (or cannot) prescribe it, he or she may refer you to a specialist. Treatment should be discontinued in patients who develop new, unexplained symptoms of dyspnea, angina pectoris, syncope or lower extremity edema, and patients should be evaluated for the possible presence of pulmonary hypertension. ). Unfortunately, the answer is no in most cases. Because pediatric obesity is a chronic condition requiring long-term treatment, the use of this product, approved for short-term therapy, is not recommended. Ask your healthcare professional how you should dispose of any medicine you do not use. The drug has two primary functions in the human body, which is the reason why it is always accompanied by these lifestyle changes. It is not uncommon for patients to experience a change in their sexual interest. APRNs Prescribing Weight Loss Medications. Patients must be informed that Phentermine hydrochloride is a short-term (a few weeks) adjunct in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity, and that coadministration of Phentermine with other drugs for weight loss is not recommended [see Indications and Usage (1) and Warnings and Precautions (5.1)]. In some cases, especially when the health concern is not too serious, the doctor may prescribe the drug at lower doses spread throughout the day, instead of advising the patient to take one single dose every day. Phentermine is intended to help overweight and obese patients who have already tried losing weight with diet and exercise. The risks include, but are not limited to: See also, for example, Adverse Reactions (6) and Use in SpecificPopulations (8). The limited usefulness of agents of this class, including Phentermine, [see Clinical Pharmacology (12.1, 12.2)] should be measured against possible risk factors inherent in their use such as those described below. Phentermine hydrochloride (phentermine HCL) is the active ingredient in phentermine weight loss pills. All rights reserved. Not only can losing weight harm an unborn baby during pregnancy, but the drug may also cause adverse effects. ]c,'303:20/) @d` )2 You may opt-out of email communications at any time by clicking on Systemic exposure of Phentermine may increase up to 91%, 45%, and 22% in patients with severe, moderate, and mild renal impairment, respectively [see Dosage and Administration (2.2) and Use in Specific Populations (8.6)]. Opioid Prescribing Guidelines - Ohio Swallow the tablet whole. The most common side effects that patients experience include tremors, headaches, dizziness, dry mouth, diarrhea, constipation, upset stomach, feeling restless and being hyperactive. x\8zS wU^TM;J`Kc=@y\} Blf\3K|xL?D$aesY"_(ceD!s!@P,?K&Bd8cKS~zq=7'kiw\dqL:A ?O0O@+}y"z[?Os/Kht;[SN4h9c31{8Eh7dPc\BFE(e&9;!PUqK\aD 7) &\1!j-_Y7jD,Sp)AWc/igg?v{5\%a'd9"D0=gRGEZgpbMQJD *k*;1'w24w, d r d?&8xeEj`\2C6xrhq2@-{P5CbBL(/0m8&8Ltnvf};y852q*+I%l=+rwGUv*:!80|>tb?U?L,zG8%K`n]+:,LCE")Xz\^):{~{=vu=Qg`A\6qT=WCZ TcR%mi,OV_RtK1e&:By~i~!nu