"Ve\u0161ker\u00E1 upozorn\u011Bn\u00ED t\u00FDkaj\u00EDc\u00ED se ka\u017Ed\u00E9 jednotliv\u00E9 slo\u017Eky, jak se uv\u00E1d\u011Bj\u00ED n\u00ED\u017Ee, by m\u011Bla rovn\u011B\u017E platit pro pevnou kombinaci p\u0159\u00EDpravku Perindopril/Amlodipin Krka.\nV souvislosti s perindoprilem\nZvl\u00E1\u0161tn\u00ED upozorn\u011Bn\u00ED\nHypersenzitivita/angioed\u00E9m:\nAngioed\u00E9m obli\u010Deje, kon\u010Detin, rt\u016F, sliznic, jazyka, hlasivkov\u00E9 \u0161t\u011Brbiny a/nebo hrtanu byl vz\u00E1cn\u011B hl\u00E1\u0161en u pacient\u016F l\u00E9\u010Den\u00FDch inhibitory ACE v\u010Detn\u011B perindoprilu (viz bod 4.8). M\u016F\u017Ee nastat kdykoli b\u011Bhem l\u00E9\u010Dby. V\u00A0takov\u00FDch p\u0159\u00EDpadech je t\u0159eba pod\u00E1v\u00E1n\u00ED p\u0159\u00EDpravku Perindopril/Amlodipin Krka ihned p\u0159eru\u0161it a zah\u00E1jit p\u0159\u00EDslu\u0161n\u00E9 monitorov\u00E1n\u00ED do \u00FApln\u00E9ho odezn\u011Bn\u00ED p\u0159\u00EDznak\u016F. V p\u0159\u00EDpadech, ve kter\u00FDch se otok omezil na obli\u010Dej a rty, by tento stav m\u011Bl obecn\u011B ustoupit bez l\u00E9\u010Dby, i kdy\u017E antihistaminika pomohla zm\u00EDrnit p\u0159\u00EDznaky.\nAngioed\u00E9m souvisej\u00EDc\u00ED s otokem hrtanu m\u016F\u017Ee b\u00FDt smrteln\u00FD. Pokud je pravd\u011Bpodobnost, \u017Ee posti\u017Een\u00ED jazyka, hlasivkov\u00E9 \u0161t\u011Brbiny nebo hrtanu zp\u016Fsob\u00ED obstrukci d\u00FDchac\u00EDch cest, je t\u0159eba ihned zav\u00E9st nal\u00E9havou l\u00E9\u010Dbu. Ta m\u016F\u017Ee zahrnovat pod\u00E1n\u00ED adrenalinu a/nebo udr\u017Eov\u00E1n\u00ED pr\u016Fchodn\u00FDch d\u00FDchac\u00EDch cest. Pacient by m\u011Bl b\u00FDt pod bezprost\u0159edn\u00EDm l\u00E9ka\u0159sk\u00FDm dohledem do dosa\u017Een\u00ED \u00FApln\u00E9ho a trval\u00E9ho \u00FAstupu symptom\u016F.\nPacienti s anamn\u00E9zou angioed\u00E9mu bez souvislosti s l\u00E9\u010Dbou inhibitory ACE mohou m\u00EDt p\u0159i pod\u00E1v\u00E1n\u00ED n\u011Bkter\u00E9ho inhibitoru ACE zv\u00FD\u0161en\u00E9 riziko angioed\u00E9mu (viz bod 4.3).\nU pacient\u016F l\u00E9\u010Den\u00FDch inhibitory ACE byl vz\u00E1cn\u011B hl\u00E1\u0161en intestin\u00E1ln\u00ED angioed\u00E9m. Tito pacienti vykazovali bolest b\u0159icha (s nevolnost\u00ED \u010Di zvracen\u00EDm nebo bez nich); v n\u011Bkter\u00FDch p\u0159\u00EDpadech nedo\u0161lo k\u00A0p\u0159edchoz\u00EDmu angioed\u00E9mu obli\u010Deje a hladiny C-1 ester\u00E1z byly norm\u00E1ln\u00ED. Angioed\u00E9m byl prok\u00E1z\u00E1n diagnostick\u00FDmi postupy v\u010Detn\u011B CT, ultrazvuku b\u0159icha nebo p\u0159i chirurgick\u00E9m z\u00E1kroku a symptomy ustoupily po vysazen\u00ED inhibitoru ACE.\nIntestin\u00E1ln\u00ED angioed\u00E9m by m\u011Bl b\u00FDt zahrnut do diferenci\u00E1ln\u00ED diagnostiky u pacient\u016F u\u017E\u00EDvaj\u00EDc\u00EDch inhibitory ACE a vykazuj\u00EDc\u00EDch bolest b\u0159icha (viz bod 4.8).\nAnafylaktoidn\u00ED reakce b\u011Bhem afer\u00E9zy lipoprotein\u016F o n\u00EDzk\u00E9 hustot\u011B (LDL):\nPacienti u\u017E\u00EDvaj\u00EDc\u00ED inhibitory ACE b\u011Bhem afer\u00E9zy lipoprotein\u016F o n\u00EDzk\u00E9 hustot\u011B (LDL) dextran-sulf\u00E1tem utrp\u011Bli vz\u00E1cn\u011B anafylaktoidn\u00ED reakce ohro\u017Euj\u00EDc\u00ED \u017Eivot. T\u011Bmto reakc\u00EDm se p\u0159ede\u0161lo do\u010Dasn\u00FDm vysazen\u00EDm terapie inhibitorem ACE p\u0159ed ka\u017Edou afer\u00E9zou.\nAnafylaktoidn\u00ED reakce b\u011Bhem desenzibilizace:\nU pacient\u016F u\u017E\u00EDvaj\u00EDc\u00EDch inhibitory ACE b\u011Bhem desenzibilizace (nap\u0159\u00EDklad jedem blanok\u0159\u00EDdl\u00FDch) byl zaznamenan\u00FD v\u00FDskyt anafylaktoidn\u00ED reakce. U t\u011Bchto pacient\u016F se t\u011Bmto reakc\u00EDm p\u0159ede\u0161lo do\u010Dasn\u00FDm vysazen\u00EDm inhibitor\u016F ACE, av\u0161ak znovu se objevily p\u0159i opakovan\u00E9 expozici alergenu z neopatrnosti.\nNeutropenie/Agranulocyt\u00F3za/Trombocytopenie/An\u00E9mie:\nNeutropenie/agranulocyt\u00F3za, trombocytopenie a an\u00E9mie byly hl\u00E1\u0161eny u pacient\u016F u\u017E\u00EDvaj\u00EDc\u00EDch inhibitory ACE. U pacient\u016F s norm\u00E1ln\u00ED ren\u00E1ln\u00ED funkc\u00ED a bez dal\u0161\u00EDch komplikuj\u00EDc\u00EDch faktor\u016F se neutropenie vyskytuje vz\u00E1cn\u011B. Perindopril by se m\u011Bl u\u017E\u00EDvat s mimo\u0159\u00E1dnou opatrnost\u00ED u pacient\u016F s kolagenovou vaskul\u00E1rn\u00ED chorobou, u osob l\u00E9\u010Den\u00FDch imunosupresivy, alopurinolem nebo prokainamidem nebo p\u0159i kombinaci t\u011Bchto komplikuj\u00EDc\u00EDch faktor\u016F, zvl\u00E1\u0161t\u011B p\u0159i ji\u017E existuj\u00EDc\u00ED zhor\u0161en\u00E9 funkci ledvin. U n\u011Bkter\u00FDch z t\u011Bchto pacient\u016F se vyvinuly z\u00E1va\u017En\u00E9 infekce, kter\u00E9 v mal\u00E9m mno\u017Estv\u00ED p\u0159\u00EDpad\u016F nereagovaly na intenzivn\u00ED terapii antibiotiky. Pokud je perindopril pod\u00E1van\u00FD takov\u00FDmto pacient\u016Fm, doporu\u010Duje se periodick\u00E9 sledov\u00E1n\u00ED b\u00EDl\u00FDch krvinek a pacienti by m\u011Bli b\u00FDt pou\u010Deni o nutnosti hl\u00E1sit ka\u017Edou zn\u00E1mku infekce (nap\u0159. bolest v\u00A0krku, hore\u010Dka).\nT\u011Bhotenstv\u00ED:\nPod\u00E1v\u00E1n\u00ED ACE inhibitor\u016F by nem\u011Blo b\u00FDt zah\u00E1jeno b\u011Bhem t\u011Bhotenstv\u00ED. S\u00A0v\u00FDjimkou pacientek, pro kter\u00E9 je dlouhodob\u00E1 l\u00E9\u010Dba ACE inhibitory nezbytn\u00E1, by v\u0161echny ostatn\u00ED pacientky m\u011Bly b\u00FDt v\u00A0p\u0159\u00EDpad\u011B pl\u00E1novan\u00E9ho t\u011Bhotenstv\u00ED p\u0159evedeny na jinou antihypertenzn\u00ED l\u00E9\u010Dbu s\u00A0l\u00E9pe ov\u011B\u0159enou bezpe\u010Dnost\u00ED pro t\u011Bhotenstv\u00ED a plod. Pokud do\u0161lo k\u00A0ot\u011Bhotn\u011Bn\u00ED, je t\u0159eba ihned ukon\u010Dit pod\u00E1v\u00E1n\u00ED ACE inhibitor\u016F a v\u00A0p\u0159\u00EDpad\u011B nutnosti dal\u0161\u00ED l\u00E9\u010Dby zah\u00E1jit jinou l\u00E9\u010Dbu (viz bod 4.3, 4.6).\nOpat\u0159en\u00ED pro pou\u017Eit\u00ED\nHypotenze:\nInhibitory ACE mohou zp\u016Fsobit pokles krevn\u00EDho tlaku. U nekomplikovan\u00FDch hypertenzn\u00EDch pacient\u016F byla symptomatick\u00E1 hypotenze pozorov\u00E1na vz\u00E1cn\u011B a jej\u00ED v\u00FDskyt je pravd\u011Bpodobn\u011Bj\u0161\u00ED u pacient\u016F s\u00A0poklesem objemu t\u011Bln\u00EDch tekutin, nap\u0159. vlivem diuretick\u00E9 terapie, dietn\u00EDm omezen\u00EDm soli, dial\u00FDzou, pr\u016Fjmem nebo zvracen\u00EDm, nebo u pacient\u016F, kte\u0159\u00ED trp\u00ED z\u00E1va\u017Enou renin-dependentn\u00ED hypertenz\u00ED (viz body 4.5 a 4.8). U pacient\u016F s vysok\u00FDm rizikem symptomatick\u00E9 hypotenze je t\u0159eba b\u011Bhem l\u00E9\u010Dby p\u0159\u00EDpravkem Perindopril/Amlodipin Krka pe\u010Dliv\u011B sledovat krevn\u00ED tlak, ren\u00E1ln\u00ED funkci a drasl\u00EDk v krevn\u00EDm s\u00E9ru.\nPodobn\u00E9 \u00FAvahy plat\u00ED pro pacienty s ischemickou chorobou srde\u010Dn\u00ED nebo cerebrovaskul\u00E1rn\u00EDmi chorobami, u\u00A0kter\u00FDch by mohl nadm\u011Brn\u00FD pokles krevn\u00EDho tlaku zp\u016Fsobit infarkt myokardu nebo cerebrovaskul\u00E1rn\u00ED po\u0161kozen\u00ED.\nPokud dojde k hypotenzi, m\u011Bl by b\u00FDt pacient um\u00EDst\u011Bn do polohy vle\u017Ee na z\u00E1dech, a je-li t\u0159eba, m\u011Bl by dostat intraven\u00F3zn\u00ED infuzi roztoku chloridu sodn\u00E9ho 9 mg/ml (0,9 %). N\u00E1hl\u00E1 hypotenzn\u00ED odpov\u011B\u010F nen\u00ED kontraindikac\u00ED pro pod\u00E1n\u00ED dal\u0161\u00EDch d\u00E1vek, kter\u00E9 mohou pacienti obvykle u\u017E\u00EDvat bez obt\u00ED\u017E\u00ED, jakmile jim po dopln\u011Bn\u00ED objemu stoupne krevn\u00ED tlak.\nSten\u00F3za srde\u010Dn\u00ED a mitr\u00E1ln\u00ED chlopn\u011B/hypertrofick\u00E1 kardiomyopatie:\nPodobn\u011B jako u jin\u00FDch inhibitor\u016F ACE, by se m\u011Bl perindopril pod\u00E1vat s opatrnost\u00ED u pacient\u016F se sten\u00F3zou mitr\u00E1ln\u00ED chlopn\u011B a obstrukc\u00ED v oblasti v\u00FDtokov\u00E9ho traktu lev\u00E9 komory, jako je tomu v\u00A0p\u0159\u00EDpadech aort\u00E1ln\u00ED sten\u00F3zy nebo hypertrofick\u00E9 kardiomyopatie.\nPo\u0161kozen\u00ED ledvin:\nV p\u0159\u00EDpad\u011B po\u0161kozen\u00ED ledvin (clearance kreatininu < 60 ml/min) se doporu\u010Duje individu\u00E1ln\u00ED titrace d\u00E1vek s\u00A0jednotliv\u00FDmi slo\u017Ekami (viz bod 4.2).\nU pacient\u016F s ren\u00E1ln\u00EDm po\u0161kozen\u00EDm je rutinn\u00ED sledov\u00E1n\u00ED drasl\u00EDku a kreatininu sou\u010D\u00E1st\u00ED norm\u00E1ln\u00ED l\u00E9ka\u0159sk\u00E9 praxe (viz bod 4.8).\nU n\u011Bkter\u00FDch pacient\u016F s bilater\u00E1ln\u00ED sten\u00F3zou ren\u00E1ln\u00EDch arteri\u00ED nebo sten\u00F3zou arterie solit\u00E1rn\u00ED ledviny, kte\u0159\u00ED byli l\u00E9\u010Deni inhibitory ACE, bylo pozorov\u00E1no zv\u00FD\u0161en\u00ED s\u00E9rov\u00FDch koncentrac\u00ED urey a kreatininu, kter\u00E9 byly obvykle p\u0159i p\u0159eru\u0161en\u00ED terapie reverzibiln\u00ED. Jejich v\u00FDskyt je zvl\u00E1\u0161t\u011B pravd\u011Bpodobn\u00FD u pacient\u016F s ren\u00E1ln\u00ED insuficienc\u00ED. Pokud byla u pacienta sou\u010Dasn\u011B zji\u0161t\u011Bn\u00E1 renovaskul\u00E1rn\u00ED hypertenze, je riziko z\u00E1va\u017En\u00E9 hypotenze a ren\u00E1ln\u00ED insuficience zv\u00FD\u0161en\u00E9. U n\u011Bkter\u00FDch hypertonik\u016F bez zjevn\u00E9ho preexistuj\u00EDc\u00EDho renovaskul\u00E1rn\u00EDho onemocn\u011Bn\u00ED byly pozorov\u00E1ny vzestupy s\u00E9rov\u00FDch koncentrac\u00ED urey a kreatininu, obvykle m\u00EDrn\u00E9ho stupn\u011B a p\u0159echodn\u00E9, zejm\u00E9na pokud u\u017E\u00EDvali perindopril sou\u010Dasn\u011B s n\u011Bkter\u00FDm diuretikem. K uveden\u00FDm laboratorn\u00EDm zm\u011Bn\u00E1m doch\u00E1z\u00ED s v\u011Bt\u0161\u00ED pravd\u011Bpodobnost\u00ED u pacient\u016F s ji\u017E existuj\u00EDc\u00EDm po\u0161kozen\u00EDm ledvin.\nSelh\u00E1n\u00ED jater:\nPod\u00E1n\u00ED inhibitor\u016F ACE m\u011Blo vz\u00E1cn\u011B souvislost se syndromem po\u010D\u00EDnaj\u00EDc\u00EDm cholestatickou \u017Eloutenkou a progreduj\u00EDc\u00EDm a\u017E v n\u00E1hlou hepatickou nekr\u00F3zu a (n\u011Bkdy) \u00FAmrt\u00ED. Mechanismus tohoto syndromu nen\u00ED zn\u00E1m. Pacienti u\u017E\u00EDvaj\u00EDc\u00ED inhibitory ACE, u nich\u017E se rozvine \u017Eloutenka nebo v\u00FDrazn\u00E9 zv\u00FD\u0161en\u00ED jatern\u00EDch enzym\u016F, by m\u011Bli ukon\u010Dit l\u00E9\u010Dbu inhibitorem ACE a z\u016Fstat pod vhodn\u00FDm l\u00E9ka\u0159sk\u00FDm dohledem (viz bod 4.8).\nEtnick\u00E9 rozd\u00EDly:\nInhibitory ACE zp\u016Fsobuj\u00ED vy\u0161\u0161\u00ED v\u00FDskyt angioed\u00E9mu u pacient\u016F s \u010Dernou barvou pleti ne\u017E u jin\u00FDch pacient\u016F. Stejn\u011B, jako u jin\u00FDch inhibitor\u016F ACE, m\u016F\u017Ee b\u00FDt i perindopril m\u00E9n\u011B \u00FA\u010Dinn\u00FD p\u0159i sni\u017Eov\u00E1n\u00ED krevn\u00EDho tlaku u \u010Dern\u00FDch osob ne\u017E u jin\u00FDch, pravd\u011Bpodobn\u011B vzhledem k vy\u0161\u0161\u00ED prevalenci stav\u016F s\u00A0n\u00EDzk\u00FDm reninem u populace \u010Dern\u00FDch hypertonik\u016F.\nKa\u0161el:\nP\u0159i u\u017E\u00EDv\u00E1n\u00ED inhibitor\u016F ACE byl hl\u00E1\u0161en ka\u0161el. Tento ka\u0161el je obvykle neproduktivn\u00ED, p\u0159etrv\u00E1vaj\u00EDc\u00ED a ustupuje po p\u0159eru\u0161en\u00ED l\u00E9\u010Dby. Ka\u0161el vyvolan\u00FD ACE inhibitorem je t\u0159eba pova\u017Eovat za sou\u010D\u00E1st diferenci\u00E1ln\u00ED diagn\u00F3zy ka\u0161le.\nChirurgie/anestezie:\nU pacient\u016F, kte\u0159\u00ED se podrobuj\u00ED velk\u00E9mu chirurgick\u00E9mu z\u00E1kroku nebo znecitliv\u011Bn\u00ED prost\u0159edky, kter\u00E9 zp\u016Fsobuj\u00ED hypotenzi, m\u016F\u017Ee p\u0159\u00EDpravek Perindopril/Amlodipin Krka blokovat tvorbu angiotensinu II sekund\u00E1rn\u011B po kompenza\u010Dn\u00EDm uvoln\u011Bn\u00ED reninu. L\u00E9\u010Dbu je t\u0159eba p\u0159eru\u0161it jeden den p\u0159ed t\u00EDmto chirurgick\u00FDm z\u00E1krokem. Pokud dojde k v\u00FDvoji hypotenze a uva\u017Euje se, \u017Ee je zp\u016Fsoben\u00E1 t\u00EDmto mechanismem, m\u016F\u017Ee se upravit dopln\u011Bn\u00EDm objemu.\nHyperkalemie:\nU n\u011Bkter\u00FDch pacient\u016F l\u00E9\u010Den\u00FDch inhibitory ACE v\u010Detn\u011B perindoprilu byly pozorov\u00E1ny vzestupy s\u00E9rov\u00FDch koncentrac\u00ED drasl\u00EDku. Rizikov\u00FDmi faktory pro rozvoj hyperkalemie jsou ren\u00E1ln\u00ED insuficience, zhor\u0161en\u00E9 ren\u00E1ln\u00ED funkce, v\u011Bk (> 70 let), diabetes mellitus, p\u0159idru\u017Een\u00E9 patologick\u00E9 stavy (zejm\u00E9na dehydratace), akutn\u00ED srde\u010Dn\u00ED nedostate\u010Dnost, metabolick\u00E1 acid\u00F3za a sou\u010Dasn\u00E9 u\u017E\u00EDv\u00E1n\u00ED diuretik \u0161et\u0159\u00EDc\u00EDch drasl\u00EDk (nap\u0159\u00EDklad spironolaktonu, eplerenonu, triamterenu nebo amiloridu), drasl\u00EDkov\u00FDch dopl\u0148k\u016F nebo n\u00E1hrad soli s obsahem drasl\u00EDku; nebo u\u017E\u00EDv\u00E1n\u00ED jin\u00FDch l\u00E9\u010Div\u00FDch p\u0159\u00EDpravk\u016F, kter\u00E9 mohou zp\u016Fsobovat vzestup s\u00E9rov\u00FDch koncentrac\u00ED drasl\u00EDku (nap\u0159\u00EDklad heparin). U\u017E\u00EDv\u00E1n\u00ED drasl\u00EDkov\u00FDch dopl\u0148k\u016F, diuretik \u0161et\u0159\u00EDc\u00EDch drasl\u00EDk nebo n\u00E1hrad sol\u00ED s obsahem drasl\u00EDku, zejm\u00E9na u pacient\u016F s po\u0161kozenou ren\u00E1ln\u00ED funkc\u00ED, m\u016F\u017Ee v\u00E9st k v\u00FDznamn\u00E9mu vzestupu drasl\u00EDku v krevn\u00EDm s\u00E9ru. Hyperkalemie m\u016F\u017Ee zp\u016Fsobit z\u00E1va\u017En\u00E9 a n\u011Bkdy fat\u00E1ln\u00ED arytmie. Pokud se pod\u00E1v\u00E1n\u00ED perindoprilu za kter\u00E9hokoli z v\u00FD\u0161e zm\u00EDn\u011Bn\u00FDch situac\u00ED pova\u017Euje za nutn\u00E9, m\u011Bl by b\u00FDt pod\u00E1van\u00FD s opatrnost\u00ED a za pravideln\u00E9 monitorace s\u00E9rov\u00FDch koncentrac\u00ED drasl\u00EDku (viz bod 4.5).\nDiabetici:\nU diabetik\u016F l\u00E9\u010Den\u00FDch peror\u00E1ln\u00EDmi antidiabetiky nebo insulinem je t\u0159eba pe\u010Dliv\u011B kontrolovat glykemii v\u00A0prvn\u00EDm m\u011Bs\u00EDci l\u00E9\u010Dby inhibitorem ACE (viz bod 4.5).\nV souvislosti s amlodipinem: \nOpat\u0159en\u00ED pro u\u017E\u00EDv\u00E1n\u00ED\nPacienti se zhor\u0161enou jatern\u00ED funkc\u00ED:\nStejn\u011B, jako je tomu u v\u0161ech blok\u00E1tor\u016F kalciov\u00FDch kan\u00E1l\u016F, plasmatick\u00FD polo\u010Das amlodipinu se u pacient\u016F se zhor\u0161enou funkc\u00ED jater prodlu\u017Euje. Proto by m\u011Bl b\u00FDt amlodipin u t\u011Bchto pacient\u016F pod\u00E1van\u00FD s opatrnost\u00ED a za pravideln\u00E9 monitorace jatern\u00EDch enzym\u016F.\nPacienti se srde\u010Dn\u00EDm selh\u00E1n\u00EDm:\nPacienti se srde\u010Dn\u00EDm selh\u00E1n\u00EDm by m\u011Bli b\u00FDt l\u00E9\u010Deni amlodipinem se zv\u00FD\u0161enou opatrnost\u00ED.\nP\u0159i dlouhodob\u00E9 placebem kontrolovan\u00E9 studii s amlodipinem u pacient\u016F se srde\u010Dn\u00EDm selh\u00E1n\u00EDm t\u0159\u00EDdy NYHA III a IV, bylo srde\u010Dn\u00ED selh\u00E1n\u00ED neischemick\u00E9 etiologie spojeno se zv\u00FD\u0161en\u00FDm v\u00FDskytem plicn\u00EDho ed\u00E9mu, i kdy\u017E nebyl v\u00FDznamn\u00FD rozd\u00EDl ve v\u00FDskytu zhor\u0161en\u00ED srde\u010Dn\u00EDho selh\u00E1n\u00ED ve srovn\u00E1n\u00ED s placebem (viz bod 5.1).\nV souvislosti s p\u0159\u00EDpravkem Perindopril/Amlodipin Krka\nOpat\u0159en\u00ED pro u\u017E\u00EDv\u00E1n\u00ED\nInterakce\nSou\u010Dasn\u00E9 u\u017E\u00EDv\u00E1n\u00ED p\u0159\u00EDpravku Perindopril/Amlodipin Krka s lithiem, diuretiky \u0161et\u0159\u00EDc\u00EDmi drasl\u00EDk nebo dopl\u0148ky drasl\u00EDku se nedoporu\u010Duje (viz bod 4.5).\n"@cs . . . . . . . . "4.4\tZvl\u00E1\u0161tn\u00ED upozorn\u011Bn\u00ED a opat\u0159en\u00ED pro pou\u017Eit\u00ED"@cs . . . . . . . . . . . . . . . . . . . . . . . . . "004.004" . . . . . . . . . .