/*! For license information please see main.dd02f678.js.LICENSE.txt */
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e}},{key:"numChunksLoaded",get:function(){return this._loadedChunks.size}},{key:"isDataLoaded",get:function(){return this.numChunksLoaded===this.numChunks}},{key:"onReceiveData",value:function(e,t){var i=this.chunkSize;if(e%i!==0)throw new Error("Bad begin offset: ".concat(e));var a=e+t.byteLength;if(a%i!==0&&a!==this.bytes.length)throw new Error("Bad end offset: ".concat(a));this.bytes.set(new Uint8Array(t),e);for(var n=Math.floor(e/i),r=Math.floor((a-1)/i)+1,o=n;o<r;++o)this._loadedChunks.add(o)}},{key:"onReceiveProgressiveData",value:function(e){var t=this.progressiveDataLength,i=Math.floor(t/this.chunkSize);this.bytes.set(new Uint8Array(e),t),t+=e.byteLength,this.progressiveDataLength=t;for(var a=t>=this.end?this.numChunks:Math.floor(t/this.chunkSize),n=i;n<a;++n)this._loadedChunks.add(n)}},{key:"ensureByte",value:function(e){if(!(e<this.progressiveDataLength)){var t=Math.floor(e/this.chunkSize);if(!(t>this.numChunks)&&t!==this.lastSuccessfulEnsureByteChunk){if(!this._loadedChunks.has(t))throw new a.MissingDataException(e,e+1);this.lastSuccessfulEnsureByteChunk=t}}}},{key:"ensureRange",value:function(e,t){if(!(e>=t)&&!(t<=this.progressiveDataLength)){var i=Math.floor(e/this.chunkSize);if(!(i>this.numChunks))for(var n=Math.min(Math.floor((t-1)/this.chunkSize)+1,this.numChunks),r=i;r<n;++r)if(!this._loadedChunks.has(r))throw new a.MissingDataException(e,t)}}},{key:"nextEmptyChunk",value:function(e){for(var t=this.numChunks,i=0;i<t;++i){var a=(e+i)%t;if(!this._loadedChunks.has(a))return a}return null}},{key:"hasChunk",value:function(e){return this._loadedChunks.has(e)}},{key:"getByte",value:function(){var e=this.pos;return e>=this.end?-1:(e>=this.progressiveDataLength&&this.ensureByte(e),this.bytes[this.pos++])}},{key:"getBytes",value:function(e){var t=this.bytes,i=this.pos,a=this.end;if(!e)return a>this.progressiveDataLength&&this.ensureRange(i,a),t.subarray(i,a);var n=i+e;return n>a&&(n=a),n>this.progressiveDataLength&&this.ensureRange(i,n),this.pos=n,t.subarray(i,n)}},{key:"getByteRange",value:function(e,t){return e<0&&(e=0),t>this.end&&(t=this.end),t>this.progressiveDataLength&&this.ensureRange(e,t),this.bytes.subarray(e,t)}},{key:"makeSubStream",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null;function a(){}t?e+t>this.progressiveDataLength&&this.ensureRange(e,e+t):e>=this.progressiveDataLength&&this.ensureByte(e),a.prototype=Object.create(this),a.prototype.getMissingChunks=function(){for(var e=this.chunkSize,t=Math.floor(this.start/e),i=Math.floor((this.end-1)/e)+1,a=[],n=t;n<i;++n)this._loadedChunks.has(n)||a.push(n);return a},Object.defineProperty(a.prototype,"isDataLoaded",{get:function(){return this.numChunksLoaded===this.numChunks||0===this.getMissingChunks().length},configurable:!0});var n=new a;return n.pos=n.start=e,n.end=e+t||this.end,n.dict=i,n}},{key:"getBaseStreams",value:function(){return[this]}}]),i}(i(141).Stream);t.ChunkedStream=r;var o=function(){function e(t,i){b(this,e),this.length=i.length,this.chunkSize=i.rangeChunkSize,this.stream=new r(this.length,this.chunkSize,this),this.pdfNetworkStream=t,this.disableAutoFetch=i.disableAutoFetch,this.msgHandler=i.msgHandler,this.currRequestId=0,this._chunksNeededByRequest=new Map,this._requestsByChunk=new Map,this._promisesByRequest=new Map,this.progressiveDataLength=0,this.aborted=!1,this._loadedStreamCapability=(0,n.createPromiseCapability)()}return g(e,[{key:"sendRequest",value:function(e,t){var i=this,n=this.pdfNetworkStream.getRangeReader(e,t);n.isStreamingSupported||(n.onProgress=this.onProgress.bind(this));var r=[],o=0;return new Promise((function(e,t){n.read().then((function s(l){var c=l.value,d=l.done;try{if(d){var u=(0,a.arrayBuffersToBytes)(r);return r=null,void e(u)}o+=c.byteLength,n.isStreamingSupported&&i.onProgress({loaded:o}),r.push(c),n.read().then(s,t)}catch(p){t(p)}}),t)})).then((function(t){i.aborted||i.onReceiveData({chunk:t,begin:e})}))}},{key:"requestAllChunks",value:function(){if(!(arguments.length>0&&void 0!==arguments[0]&&arguments[0])){var e=this.stream.getMissingChunks();this._requestChunks(e)}return this._loadedStreamCapability.promise}},{key:"_requestChunks",value:function(e){var t=this,i=this.currRequestId++,a=new Set;this._chunksNeededByRequest.set(i,a);var r,o=h(e);try{for(o.s();!(r=o.n()).done;){var s=r.value;this.stream.hasChunk(s)||a.add(s)}}catch(A){o.e(A)}finally{o.f()}if(0===a.size)return Promise.resolve();var l=(0,n.createPromiseCapability)();this._promisesByRequest.set(i,l);var c,d=[],u=h(a);try{for(u.s();!(c=u.n()).done;){var p=c.value,m=this._requestsByChunk.get(p);m||(m=[],this._requestsByChunk.set(p,m),d.push(p)),m.push(i)}}catch(A){u.e(A)}finally{u.f()}if(d.length>0){var f,y=this.groupChunks(d),b=h(y);try{for(b.s();!(f=b.n()).done;){var g=f.value,v=g.beginChunk*this.chunkSize,_=Math.min(g.endChunk*this.chunkSize,this.length);this.sendRequest(v,_).catch(l.reject)}}catch(A){b.e(A)}finally{b.f()}}return l.promise.catch((function(e){if(!t.aborted)throw e}))}},{key:"getStream",value:function(){return this.stream}},{key:"requestRange",value:function(e,t){t=Math.min(t,this.length);for(var i=this.getBeginChunk(e),a=this.getEndChunk(t),n=[],r=i;r<a;++r)n.push(r);return this._requestChunks(n)}},{key:"requestRanges",value:function(){var e,t=[],i=h(arguments.length>0&&void 0!==arguments[0]?arguments[0]:[]);try{for(i.s();!(e=i.n()).done;)for(var a=e.value,n=this.getBeginChunk(a.begin),r=this.getEndChunk(a.end),o=n;o<r;++o)t.includes(o)||t.push(o)}catch(s){i.e(s)}finally{i.f()}return t.sort((function(e,t){return e-t})),this._requestChunks(t)}},{key:"groupChunks",value:function(e){for(var t=[],i=-1,a=-1,n=0,r=e.length;n<r;++n){var o=e[n];i<0&&(i=o),a>=0&&a+1!==o&&(t.push({beginChunk:i,endChunk:a+1}),i=o),n+1===e.length&&t.push({beginChunk:i,endChunk:o+1}),a=o}return t}},{key:"onProgress",value:function(e){this.msgHandler.send("DocProgress",{loaded:this.stream.numChunksLoaded*this.chunkSize+e.loaded,total:this.length})}},{key:"onReceiveData",value:function(e){var t=e.chunk,i=void 0===e.begin,a=i?this.progressiveDataLength:e.begin,n=a+t.byteLength,r=Math.floor(a/this.chunkSize),o=n<this.length?Math.floor(n/this.chunkSize):Math.ceil(n/this.chunkSize);i?(this.stream.onReceiveProgressiveData(t),this.progressiveDataLength=n):this.stream.onReceiveData(a,t),this.stream.isDataLoaded&&this._loadedStreamCapability.resolve(this.stream);for(var s=[],l=r;l<o;++l){var c=this._requestsByChunk.get(l);if(c){this._requestsByChunk.delete(l);var d,u=h(c);try{for(u.s();!(d=u.n()).done;){var p=d.value,m=this._chunksNeededByRequest.get(p);m.has(l)&&m.delete(l),m.size>0||s.push(p)}}catch(A){u.e(A)}finally{u.f()}}}if(!this.disableAutoFetch&&0===this._requestsByChunk.size){var f;if(1===this.stream.numChunksLoaded){var y=this.stream.numChunks-1;this.stream.hasChunk(y)||(f=y)}else f=this.stream.nextEmptyChunk(o);Number.isInteger(f)&&this._requestChunks([f])}for(var b=0,g=s;b<g.length;b++){var v=g[b],_=this._promisesByRequest.get(v);this._promisesByRequest.delete(v),_.resolve()}this.msgHandler.send("DocProgress",{loaded:this.stream.numChunksLoaded*this.chunkSize,total:this.length})}},{key:"onError",value:function(e){this._loadedStreamCapability.reject(e)}},{key:"getBeginChunk",value:function(e){return Math.floor(e/this.chunkSize)}},{key:"getEndChunk",value:function(e){return Math.floor((e-1)/this.chunkSize)+1}},{key:"abort",value:function(e){this.aborted=!0,this.pdfNetworkStream&&this.pdfNetworkStream.cancelAllRequests(e);var t,i=h(this._promisesByRequest.values());try{for(i.s();!(t=i.n()).done;)t.value.reject(e)}catch(a){i.e(a)}finally{i.f()}}}]),e}();t.ChunkedStreamManager=o},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.StringStream=t.Stream=t.NullStream=void 0;var a=i(138),n=i(2),r=function(e){d(i,e);var t=u(i);function i(e,a,n,r){var o;return b(this,i),(o=t.call(this)).bytes=e instanceof Uint8Array?e:new Uint8Array(e),o.start=a||0,o.pos=o.start,o.end=a+n||o.bytes.length,o.dict=r,o}return g(i,[{key:"length",get:function(){return this.end-this.start}},{key:"isEmpty",get:function(){return 0===this.length}},{key:"getByte",value:function(){return this.pos>=this.end?-1:this.bytes[this.pos++]}},{key:"getBytes",value:function(e){var t=this.bytes,i=this.pos,a=this.end;if(!e)return t.subarray(i,a);var n=i+e;return n>a&&(n=a),this.pos=n,t.subarray(i,n)}},{key:"getByteRange",value:function(e,t){return e<0&&(e=0),t>this.end&&(t=this.end),this.bytes.subarray(e,t)}},{key:"reset",value:function(){this.pos=this.start}},{key:"moveStart",value:function(){this.start=this.pos}},{key:"makeSubStream",value:function(e,t){var a=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null;return new i(this.bytes.buffer,e,t,a)}}]),i}(a.BaseStream);t.Stream=r;var o=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,(0,n.stringToBytes)(e))}return g(i)}(r);t.StringStream=o;var s=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.call(this,new Uint8Array(0))}return g(i)}(r);t.NullStream=s},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Page=t.PDFDocument=void 0;var a=i(143),n=i(2),r=i(136),o=i(137),l=i(182),m=i(138),v=i(198),_=i(200),A=i(202),x=i(231),w=i(148),S=i(141),C=i(206),k=i(193),D=i(146),R=i(150),I=i(205),M=i(196),T=i(207),P=i(232),z=[0,0,612,792],B=function(){function e(t){b(this,e);var i=t.pdfManager,a=t.xref,n=t.pageIndex,r=t.pageDict,o=t.ref,s=t.globalIdFactory,l=t.fontCache,c=t.builtInCMapCache,p=t.standardFontDataCache,m=t.globalImageCache,h=t.nonBlendModesSet,f=t.xfaFactory;this.pdfManager=i,this.pageIndex=n,this.pageDict=r,this.xref=a,this.ref=o,this.fontCache=l,this.builtInCMapCache=c,this.standardFontDataCache=p,this.globalImageCache=m,this.nonBlendModesSet=h,this.evaluatorOptions=i.evaluatorOptions,this.resourcesPromise=null,this.xfaFactory=f;var y={obj:0};this._localIdFactory=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.apply(this,arguments)}return g(i,null,[{key:"createObjId",value:function(){return"p".concat(n,"_").concat(++y.obj)}},{key:"getPageObjId",value:function(){return"page".concat(o.toString())}}]),i}(s)}return g(e,[{key:"_getInheritableProperty",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],i=(0,r.getInheritableProperty)({dict:this.pageDict,key:e,getArray:t,stopWhenFound:!1});return Array.isArray(i)?1!==i.length&&i[0]instanceof o.Dict?o.Dict.merge({xref:this.xref,dictArray:i}):i[0]:i}},{key:"content",get:function(){return this.pageDict.getArray("Contents")}},{key:"resources",get:function(){var e=this._getInheritableProperty("Resources");return(0,n.shadow)(this,"resources",e instanceof o.Dict?e:o.Dict.empty)}},{key:"_getBoundingBox",value:function(e){if(this.xfaData)return this.xfaData.bbox;var t=this._getInheritableProperty(e,!0);if(Array.isArray(t)&&4===t.length){if((t=n.Util.normalizeRect(t))[2]-t[0]>0&&t[3]-t[1]>0)return t;(0,n.warn)("Empty, or invalid, /".concat(e," entry."))}return null}},{key:"mediaBox",get:function(){return(0,n.shadow)(this,"mediaBox",this._getBoundingBox("MediaBox")||z)}},{key:"cropBox",get:function(){return(0,n.shadow)(this,"cropBox",this._getBoundingBox("CropBox")||this.mediaBox)}},{key:"userUnit",get:function(){var e=this.pageDict.get("UserUnit");return("number"!==typeof e||e<=0)&&(e=1),(0,n.shadow)(this,"userUnit",e)}},{key:"view",get:function(){var e=this.cropBox,t=this.mediaBox;if(e!==t&&!(0,n.isArrayEqual)(e,t)){var i=n.Util.intersect(e,t);if(i&&i[2]-i[0]>0&&i[3]-i[1]>0)return(0,n.shadow)(this,"view",i);(0,n.warn)("Empty /CropBox and /MediaBox intersection.")}return(0,n.shadow)(this,"view",t)}},{key:"rotate",get:function(){var e=this._getInheritableProperty("Rotate")||0;return e%90!==0?e=0:e>=360?e%=360:e<0&&(e=(e%360+360)%360),(0,n.shadow)(this,"rotate",e)}},{key:"_onSubStreamError",value:function(e,t,i){if(this.evaluatorOptions.ignoreErrors)return e.send("UnsupportedFeature",{featureId:n.UNSUPPORTED_FEATURES.errorContentSubStream}),void(0,n.warn)("getContentStream - ignoring sub-stream (".concat(i,'): "').concat(t,'".'));throw t}},{key:"getContentStream",value:function(e){var t=this;return this.pdfManager.ensure(this,"content").then((function(i){return i instanceof m.BaseStream?i:Array.isArray(i)?new R.StreamsSequenceStream(i,t._onSubStreamError.bind(t,e)):new S.NullStream}))}},{key:"xfaData",get:function(){return(0,n.shadow)(this,"xfaData",this.xfaFactory?{bbox:this.xfaFactory.getBoundingBox(this.pageIndex)}:null)}},{key:"saveNewAnnotations",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,d,u,m,f,y,b,g;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.xfaFactory){e.next=2;break}throw new Error("XFA: Cannot save new annotations.");case 2:return r=new D.PartialEvaluator({xref:this.xref,handler:t,pageIndex:this.pageIndex,idFactory:this._localIdFactory,fontCache:this.fontCache,builtInCMapCache:this.builtInCMapCache,standardFontDataCache:this.standardFontDataCache,globalImageCache:this.globalImageCache,options:this.evaluatorOptions}),o=this.pageDict,s=this.annotations.slice(),e.next=7,a.AnnotationFactory.saveNewAnnotations(r,i,n);case 7:l=e.sent,d=h(l.annotations);try{for(d.s();!(u=d.n()).done;)m=u.value.ref,s.push(m)}catch(p){d.e(p)}finally{d.f()}return f=o.get("Annots"),o.set("Annots",s),y=[],b=null,this.xref.encrypt&&(b=this.xref.encrypt.createCipherTransform(this.ref.num,this.ref.gen)),(0,M.writeObject)(this.ref,o,y,b),f&&o.set("Annots",f),(g=l.dependencies).push.apply(g,[{ref:this.ref,data:y.join("")}].concat(c(l.annotations))),e.abrupt("return",g);case 20:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"save",value:function(e,t,i){var a=new D.PartialEvaluator({xref:this.xref,handler:e,pageIndex:this.pageIndex,idFactory:this._localIdFactory,fontCache:this.fontCache,builtInCMapCache:this.builtInCMapCache,standardFontDataCache:this.standardFontDataCache,globalImageCache:this.globalImageCache,options:this.evaluatorOptions});return this._parsedAnnotations.then((function(e){var r,o=[],s=h(e);try{for(s.s();!(r=s.n()).done;){var l=r.value;l.mustBePrinted(i)&&o.push(l.save(a,t,i).catch((function(e){return(0,n.warn)("save - ignoring annotation data during "+'"'.concat(t.name,'" task: "').concat(e,'".')),null})))}}catch(c){s.e(c)}finally{s.f()}return Promise.all(o).then((function(e){return e.filter((function(e){return!!e}))}))}))}},{key:"loadResources",value:function(e){var t=this;return this.resourcesPromise||(this.resourcesPromise=this.pdfManager.ensure(this,"resources")),this.resourcesPromise.then((function(){return new C.ObjectLoader(t.resources,e,t.xref).load()}))}},{key:"getOperatorList",value:function(e){var t=this,i=e.handler,o=e.sink,s=e.task,l=e.intent,c=e.cacheKey,d=e.annotationStorage,u=void 0===d?null:d,p=this.getContentStream(i),m=this.loadResources(["ColorSpace","ExtGState","Font","Pattern","Properties","Shading","XObject"]),y=new D.PartialEvaluator({xref:this.xref,handler:i,pageIndex:this.pageIndex,idFactory:this._localIdFactory,fontCache:this.fontCache,builtInCMapCache:this.builtInCMapCache,standardFontDataCache:this.standardFontDataCache,globalImageCache:this.globalImageCache,options:this.evaluatorOptions}),b=this.xfaFactory?null:(0,r.getNewAnnotationsMap)(u),g=Promise.resolve(null);if(b){var v=b.get(this.pageIndex);v&&(g=a.AnnotationFactory.printNewAnnotations(y,s,v))}var _=Promise.all([p,m]).then((function(e){var a=f(e,1)[0],n=new k.OperatorList(l,o);return i.send("StartRenderPage",{transparency:y.hasBlendModes(t.resources,t.nonBlendModesSet),pageIndex:t.pageIndex,cacheKey:c}),y.getOperatorList({stream:a,task:s,resources:t.resources,operatorList:n}).then((function(){return n}))}));return Promise.all([_,this._parsedAnnotations,g]).then((function(e){var t=f(e,3),i=t[0],a=t[1],r=t[2];if(r&&(a=a.concat(r)),0===a.length||l&n.RenderingIntentFlag.ANNOTATIONS_DISABLE)return i.flush(!0),{length:i.totalLength};var o,c=!!(l&n.RenderingIntentFlag.ANNOTATIONS_FORMS),d=!!(l&n.RenderingIntentFlag.ANY),p=!!(l&n.RenderingIntentFlag.DISPLAY),m=!!(l&n.RenderingIntentFlag.PRINT),b=[],g=h(a);try{for(g.s();!(o=g.n()).done;){var v=o.value;(d||p&&v.mustBeViewed(u)||m&&v.mustBePrinted(u))&&b.push(v.getOperatorList(y,s,l,c,u).catch((function(e){return(0,n.warn)("getOperatorList - ignoring annotation data during "+'"'.concat(s.name,'" task: "').concat(e,'".')),{opList:null,separateForm:!1,separateCanvas:!1}})))}}catch(_){g.e(_)}finally{g.f()}return Promise.all(b).then((function(e){var t,a=!1,n=!1,r=h(e);try{for(r.s();!(t=r.n()).done;){var o=t.value,s=o.opList,l=o.separateForm,c=o.separateCanvas;i.addOpList(s),l&&(a=l),c&&(n=c)}}catch(_){r.e(_)}finally{r.f()}return i.flush(!0,{form:a,canvas:n}),{length:i.totalLength}}))}))}},{key:"extractTextContent",value:function(e){var t=this,i=e.handler,a=e.task,n=e.includeMarkedContent,r=e.sink,o=e.combineTextItems,s=this.getContentStream(i),l=this.loadResources(["ExtGState","Font","Properties","XObject"]);return Promise.all([s,l]).then((function(e){var s=f(e,1)[0];return new D.PartialEvaluator({xref:t.xref,handler:i,pageIndex:t.pageIndex,idFactory:t._localIdFactory,fontCache:t.fontCache,builtInCMapCache:t.builtInCMapCache,standardFontDataCache:t.standardFontDataCache,globalImageCache:t.globalImageCache,options:t.evaluatorOptions}).getTextContent({stream:s,task:a,resources:t.resources,includeMarkedContent:n,combineTextItems:o,sink:r,viewBox:t.view})}))}},{key:"getStructTree",value:function(){var e=y(p().mark((function e(){var t,i;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this.pdfManager.ensureCatalog("structTreeRoot");case 2:if(t=e.sent){e.next=5;break}return e.abrupt("return",null);case 5:return e.next=7,this.pdfManager.ensure(this,"_parseStructTree",[t]);case 7:return i=e.sent,e.abrupt("return",i.serializable);case 9:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"_parseStructTree",value:function(e){var t=new I.StructTreePage(e,this.pageDict);return t.parse(),t}},{key:"getAnnotationsData",value:function(){var e=y(p().mark((function e(t,i,a){var r,o,s,l,c,d,u,m,f,y,b;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this._parsedAnnotations;case 2:if(0!==(r=e.sent).length){e.next=5;break}return e.abrupt("return",[]);case 5:o=[],s=[],c=!!(a&n.RenderingIntentFlag.ANY),d=!!(a&n.RenderingIntentFlag.DISPLAY),u=!!(a&n.RenderingIntentFlag.PRINT),m=h(r);try{for(m.s();!(f=m.n()).done;)y=f.value,((b=c||d&&y.viewable)||u&&y.printable)&&s.push(y.data),y.hasTextContent&&b&&(l||(l=new D.PartialEvaluator({xref:this.xref,handler:t,pageIndex:this.pageIndex,idFactory:this._localIdFactory,fontCache:this.fontCache,builtInCMapCache:this.builtInCMapCache,standardFontDataCache:this.standardFontDataCache,globalImageCache:this.globalImageCache,options:this.evaluatorOptions})),o.push(y.extractTextContent(l,i,this.view).catch((function(e){(0,n.warn)('getAnnotationsData - ignoring textContent during "'.concat(i.name,'" task: "').concat(e,'".'))}))))}catch(p){m.e(p)}finally{m.f()}return e.next=12,Promise.all(o);case 12:return e.abrupt("return",s);case 13:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"annotations",get:function(){var e=this._getInheritableProperty("Annots");return(0,n.shadow)(this,"annotations",Array.isArray(e)?e:[])}},{key:"_parsedAnnotations",get:function(){var e=this,t=this.pdfManager.ensure(this,"annotations").then((function(){var t,i=[],r=h(e.annotations);try{for(r.s();!(t=r.n()).done;){var o=t.value;i.push(a.AnnotationFactory.create(e.xref,o,e.pdfManager,e._localIdFactory,!1).catch((function(e){return(0,n.warn)('_parsedAnnotations: "'.concat(e,'".')),null})))}}catch(s){r.e(s)}finally{r.f()}return Promise.all(i).then((function(e){if(0===e.length)return e;var t,i,n=[],r=h(e);try{for(r.s();!(i=r.n()).done;){var o=i.value;o&&(o instanceof a.PopupAnnotation?(t||(t=[]),t.push(o)):n.push(o))}}catch(s){r.e(s)}finally{r.f()}return t&&n.push.apply(n,c(t)),n}))}));return(0,n.shadow)(this,"_parsedAnnotations",t)}},{key:"jsActions",get:function(){var e=(0,r.collectActions)(this.xref,this.pageDict,n.PageActionEventType);return(0,n.shadow)(this,"jsActions",e)}}]),e}();t.Page=B;var F=new Uint8Array([37,80,68,70,45]),E=new Uint8Array([115,116,97,114,116,120,114,101,102]),N=new Uint8Array([101,110,100,111,98,106]),O="\0\0\0\0\0\0\0\0\0\0\0\0\0\0\0\0";function G(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:1024,a=arguments.length>3&&void 0!==arguments[3]&&arguments[3],n=t.length,r=e.peekBytes(i),o=r.length-n;if(o<=0)return!1;if(a)for(var s=n-1,l=r.length-1;l>=s;){for(var c=0;c<n&&r[l-c]===t[s-c];)c++;if(c>=n)return e.pos+=l-s,!0;l--}else for(var d=0;d<=o;){for(var u=0;u<n&&r[d+u]===t[u];)u++;if(u>=n)return e.pos+=d,!0;d++}return!1}var L=function(){function e(t,i){if(b(this,e),i.length<=0)throw new n.InvalidPDFException("The PDF file is empty, i.e. its size is zero bytes.");this.pdfManager=t,this.stream=i,this.xref=new P.XRef(i,t),this._pagePromises=new Map,this._version=null;var a={font:0};this._globalIdFactory=function(){function e(){b(this,e)}return g(e,null,[{key:"getDocId",value:function(){return"g_".concat(t.docId)}},{key:"createFontId",value:function(){return"f".concat(++a.font)}},{key:"createObjId",value:function(){(0,n.unreachable)("Abstract method `createObjId` called.")}},{key:"getPageObjId",value:function(){(0,n.unreachable)("Abstract method `getPageObjId` called.")}}]),e}()}return g(e,[{key:"parse",value:function(e){this.xref.parse(e),this.catalog=new _.Catalog(this.pdfManager,this.xref)}},{key:"linearization",get:function(){var e=null;try{e=w.Linearization.create(this.stream)}catch(t){if(t instanceof r.MissingDataException)throw t;(0,n.info)(t)}return(0,n.shadow)(this,"linearization",e)}},{key:"startXRef",get:function(){var e=this.stream,t=0;if(this.linearization)e.reset(),G(e,N)&&(t=e.pos+6-e.start);else{for(var i=E.length,a=!1,o=e.end;!a&&o>0;)(o-=1024-i)<0&&(o=0),e.pos=o,a=G(e,E,1024,!0);if(a){var s;e.skip(9);do{s=e.getByte()}while((0,r.isWhiteSpace)(s));for(var l="";s>=32&&s<=57;)l+=String.fromCharCode(s),s=e.getByte();t=parseInt(l,10),isNaN(t)&&(t=0)}}return(0,n.shadow)(this,"startXRef",t)}},{key:"checkHeader",value:function(){var e=this.stream;if(e.reset(),G(e,F)){e.moveStart(),e.skip(F.length);for(var t,i="";(t=e.getByte())>32&&i.length<7;)i+=String.fromCharCode(t);r.PDF_VERSION_REGEXP.test(i)?this._version=i:(0,n.warn)("Invalid PDF header version: ".concat(i))}}},{key:"parseStartXRef",value:function(){this.xref.setStartXRef(this.startXRef)}},{key:"numPages",get:function(){var e=0;return e=this.catalog.hasActualNumPages?this.catalog.numPages:this.xfaFactory?this.xfaFactory.getNumPages():this.linearization?this.linearization.numPages:this.catalog.numPages,(0,n.shadow)(this,"numPages",e)}},{key:"_hasOnlyDocumentSignatures",value:function(e){var t=this,i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:0;return!!Array.isArray(e)&&e.every((function(e){if(!((e=t.xref.fetchIfRef(e))instanceof o.Dict))return!1;if(e.has("Kids"))return++i>10?((0,n.warn)("_hasOnlyDocumentSignatures: maximum recursion depth reached"),!1):t._hasOnlyDocumentSignatures(e.get("Kids"),i);var a=(0,o.isName)(e.get("FT"),"Sig"),r=e.get("Rect"),s=Array.isArray(r)&&r.every((function(e){return 0===e}));return a&&s}))}},{key:"_xfaStreams",get:function(){var e=this.catalog.acroForm;if(!e)return null;var t=e.get("XFA"),i={"xdp:xdp":"",template:"",datasets:"",config:"",connectionSet:"",localeSet:"",stylesheet:"","/xdp:xdp":""};if(t instanceof m.BaseStream&&!t.isEmpty)return i["xdp:xdp"]=t,i;if(!Array.isArray(t)||0===t.length)return null;for(var a=0,n=t.length;a<n;a+=2){var r=void 0;if(r=0===a?"xdp:xdp":a===n-2?"/xdp:xdp":t[a],i.hasOwnProperty(r)){var o=this.xref.fetchIfRef(t[a+1]);o instanceof m.BaseStream&&!o.isEmpty&&(i[r]=o)}}return i}},{key:"xfaDatasets",get:function(){var e=this._xfaStreams;if(!e)return(0,n.shadow)(this,"xfaDatasets",null);for(var t=0,i=["datasets","xdp:xdp"];t<i.length;t++){var a=i[t],r=e[a];if(r)try{var o=(0,n.stringToUTF8String)(r.getString()),l=s({},a,o);return(0,n.shadow)(this,"xfaDatasets",new x.DatasetReader(l))}catch(c){(0,n.warn)("XFA - Invalid utf-8 string.");break}}return(0,n.shadow)(this,"xfaDatasets",null)}},{key:"xfaData",get:function(){var e=this._xfaStreams;if(!e)return null;for(var t=Object.create(null),i=0,a=Object.entries(e);i<a.length;i++){var r=f(a[i],2),o=r[0],s=r[1];if(s)try{t[o]=(0,n.stringToUTF8String)(s.getString())}catch(l){return(0,n.warn)("XFA - Invalid utf-8 string."),null}}return t}},{key:"xfaFactory",get:function(){var e;return this.pdfManager.enableXfa&&this.catalog.needsRendering&&this.formInfo.hasXfa&&!this.formInfo.hasAcroForm&&(e=this.xfaData),(0,n.shadow)(this,"xfaFactory",e?new T.XFAFactory(e):null)}},{key:"isPureXfa",get:function(){return!!this.xfaFactory&&this.xfaFactory.isValid()}},{key:"htmlForXfa",get:function(){return this.xfaFactory?this.xfaFactory.getPages():null}},{key:"loadXfaImages",value:function(){var e=y(p().mark((function e(){var t,i,a,n,r,o,s,l;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this.pdfManager.ensureCatalog("xfaImages");case 2:if(t=e.sent){e.next=5;break}return e.abrupt("return");case 5:return i=t.getKeys(),a=new C.ObjectLoader(t,i,this.xref),e.next=9,a.load();case 9:n=new Map,r=h(i);try{for(r.s();!(o=r.n()).done;)s=o.value,(l=t.get(s))instanceof m.BaseStream&&n.set(s,l.getBytes())}catch(c){r.e(c)}finally{r.f()}this.xfaFactory.setImages(n);case 13:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"loadXfaFonts",value:function(){var e=y(p().mark((function e(t,i){var a,s,c,d,u,m,y,b,g,v,_,A,x,w,S,R,I,M,T,P,z,B,F,E,N,O,G,L,j,q,H,U,Y,X;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this.pdfManager.ensureCatalog("acroForm");case 2:if(a=e.sent){e.next=5;break}return e.abrupt("return");case 5:return e.next=7,a.getAsync("DR");case 7:if((s=e.sent)instanceof o.Dict){e.next=10;break}return e.abrupt("return");case 10:return c=new C.ObjectLoader(s,["Font"],this.xref),e.next=13,c.load();case 13:if((d=s.get("Font"))instanceof o.Dict){e.next=16;break}return e.abrupt("return");case 16:(u=Object.assign(Object.create(null),this.pdfManager.evaluatorOptions)).useSystemFonts=!1,m=new D.PartialEvaluator({xref:this.xref,handler:t,pageIndex:-1,idFactory:this._globalIdFactory,fontCache:this.catalog.fontCache,builtInCMapCache:this.catalog.builtInCMapCache,standardFontDataCache:this.catalog.standardFontDataCache,options:u}),y=new k.OperatorList,b=[],e.t0=function(){return this},g={get font(){return b.at(-1)},set font(e){b.push(e)},clone:e.t0},v=new Map,d.forEach((function(e,t){v.set(e,t)})),_=[],A=h(v),e.prev=27,A.s();case 29:if((x=A.n()).done){e.next=44;break}if(w=f(x.value,2),S=w[0],R=w[1],(I=R.get("FontDescriptor"))instanceof o.Dict){e.next=34;break}return e.abrupt("continue",42);case 34:if(M=(M=I.get("FontFamily")).replace(/[ ]+(\d)/g,"$1"),T=I.get("FontWeight"),P=-I.get("ItalicAngle"),z={fontFamily:M,fontWeight:T,italicAngle:P},(0,r.validateCSSFont)(z)){e.next=41;break}return e.abrupt("continue",42);case 41:_.push(m.handleSetFont(s,[o.Name.get(S),1],null,y,i,g,null,z).catch((function(e){return(0,n.warn)('loadXfaFonts: "'.concat(e,'".')),null})));case 42:e.next=29;break;case 44:e.next=49;break;case 46:e.prev=46,e.t1=e.catch(27),A.e(e.t1);case 49:return e.prev=49,A.f(),e.finish(49);case 52:return e.next=54,Promise.all(_);case 54:if(B=this.xfaFactory.setFonts(b)){e.next=57;break}return e.abrupt("return");case 57:u.ignoreErrors=!0,_.length=0,b.length=0,F=new Set,E=h(B);try{for(E.s();!(N=E.n()).done;)O=N.value,(0,l.getXfaFontName)("".concat(O,"-Regular"))||F.add(O)}catch(p){E.e(p)}finally{E.f()}F.size&&B.push("PdfJS-Fallback"),G=h(B),e.prev=65,G.s();case 67:if((L=G.n()).done){e.next=74;break}if(j=L.value,!F.has(j)){e.next=71;break}return e.abrupt("continue",72);case 71:for(q=0,H=[{name:"Regular",fontWeight:400,italicAngle:0},{name:"Bold",fontWeight:700,italicAngle:0},{name:"Italic",fontWeight:400,italicAngle:12},{name:"BoldItalic",fontWeight:700,italicAngle:12}];q<H.length;q++)U=H[q],Y="".concat(j,"-").concat(U.name),X=(0,l.getXfaFontDict)(Y),_.push(m.handleSetFont(s,[o.Name.get(Y),1],null,y,i,g,X,{fontFamily:j,fontWeight:U.fontWeight,italicAngle:U.italicAngle}).catch((function(e){return(0,n.warn)('loadXfaFonts: "'.concat(e,'".')),null})));case 72:e.next=67;break;case 74:e.next=79;break;case 76:e.prev=76,e.t2=e.catch(65),G.e(e.t2);case 79:return e.prev=79,G.f(),e.finish(79);case 82:return e.next=84,Promise.all(_);case 84:this.xfaFactory.appendFonts(b,F);case 85:case"end":return e.stop()}}),e,this,[[27,46,49,52],[65,76,79,82]])})));return function(t,i){return e.apply(this,arguments)}}()},{key:"serializeXfaData",value:function(){var e=y(p().mark((function e(t){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.abrupt("return",this.xfaFactory?this.xfaFactory.serializeData(t):null);case 1:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"version",get:function(){return this.catalog.version||this._version}},{key:"formInfo",get:function(){var e={hasFields:!1,hasAcroForm:!1,hasXfa:!1,hasSignatures:!1},t=this.catalog.acroForm;if(!t)return(0,n.shadow)(this,"formInfo",e);try{var i=t.get("Fields"),a=Array.isArray(i)&&i.length>0;e.hasFields=a;var o=t.get("XFA");e.hasXfa=Array.isArray(o)&&o.length>0||o instanceof m.BaseStream&&!o.isEmpty;var s=!!(1&t.get("SigFlags")),l=s&&this._hasOnlyDocumentSignatures(i);e.hasAcroForm=a&&!l,e.hasSignatures=s}catch(c){if(c instanceof r.MissingDataException)throw c;(0,n.warn)('Cannot fetch form information: "'.concat(c,'".'))}return(0,n.shadow)(this,"formInfo",e)}},{key:"documentInfo",get:function(){var e,t={PDFFormatVersion:this.version,Language:this.catalog.lang,EncryptFilterName:this.xref.encrypt?this.xref.encrypt.filterName:null,IsLinearized:!!this.linearization,IsAcroFormPresent:this.formInfo.hasAcroForm,IsXFAPresent:this.formInfo.hasXfa,IsCollectionPresent:!!this.catalog.collection,IsSignaturesPresent:this.formInfo.hasSignatures};try{e=this.xref.trailer.get("Info")}catch(d){if(d instanceof r.MissingDataException)throw d;(0,n.info)("The document information dictionary is invalid.")}if(!(e instanceof o.Dict))return(0,n.shadow)(this,"documentInfo",t);var i,a=h(e.getKeys());try{for(a.s();!(i=a.n()).done;){var s=i.value,l=e.get(s);switch(s){case"Title":case"Author":case"Subject":case"Keywords":case"Creator":case"Producer":case"CreationDate":case"ModDate":if("string"===typeof l){t[s]=(0,n.stringToPDFString)(l);continue}break;case"Trapped":if(l instanceof o.Name){t[s]=l;continue}break;default:var c=void 0;switch(typeof l){case"string":c=(0,n.stringToPDFString)(l);break;case"number":case"boolean":c=l;break;default:l instanceof o.Name&&(c=l)}if(void 0===c){(0,n.warn)('Bad value, for custom key "'.concat(s,'", in Info: ').concat(l,"."));continue}t.Custom||(t.Custom=Object.create(null)),t.Custom[s]=c;continue}(0,n.warn)('Bad value, for key "'.concat(s,'", in Info: ').concat(l,"."))}}catch(d){a.e(d)}finally{a.f()}return(0,n.shadow)(this,"documentInfo",t)}},{key:"fingerprints",get:function(){function e(e){return"string"===typeof e&&e.length>0&&e!==O}function t(e){var t,i=[],a=h(e);try{for(a.s();!(t=a.n()).done;){var n=t.value.toString(16);i.push(n.padStart(2,"0"))}}catch(r){a.e(r)}finally{a.f()}return i.join("")}var i,a,r=this.xref.trailer.get("ID");return Array.isArray(r)&&e(r[0])?(i=(0,n.stringToBytes)(r[0]),r[1]!==r[0]&&e(r[1])&&(a=(0,n.stringToBytes)(r[1]))):i=(0,v.calculateMD5)(this.stream.getByteRange(0,1024),0,1024),(0,n.shadow)(this,"fingerprints",[t(i),a?t(a):null])}},{key:"_getLinearizationPage",value:function(){var e=y(p().mark((function e(t){var i,a,r,s,l,c;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return i=this.catalog,a=this.linearization,r=this.xref,s=o.Ref.get(a.objectNumberFirst,0),e.prev=2,e.next=5,r.fetchAsync(s);case 5:if(!((l=e.sent)instanceof o.Dict)){e.next=16;break}if(!((c=l.getRaw("Type"))instanceof o.Ref)){e.next=12;break}return e.next=11,r.fetchAsync(c);case 11:c=e.sent;case 12:if(!(0,o.isName)(c,"Page")&&(l.has("Type")||l.has("Kids"))){e.next=16;break}return i.pageKidsCountCache.has(s)||i.pageKidsCountCache.put(s,1),i.pageIndexCache.has(s)||i.pageIndexCache.put(s,0),e.abrupt("return",[l,s]);case 16:throw new n.FormatError("The Linearization dictionary doesn't point to a valid Page dictionary.");case 19:return e.prev=19,e.t0=e.catch(2),(0,n.warn)('_getLinearizationPage: "'.concat(e.t0.message,'".')),e.abrupt("return",i.getPageDict(t));case 23:case"end":return e.stop()}}),e,this,[[2,19]])})));return function(t){return e.apply(this,arguments)}}()},{key:"getPage",value:function(e){var t=this,i=this._pagePromises.get(e);if(i)return i;var a,n=this.catalog,r=this.linearization,s=this.xfaFactory;return a=(a=s?Promise.resolve([o.Dict.empty,null]):r&&r.pageFirst===e?this._getLinearizationPage(e):n.getPageDict(e)).then((function(i){var a=f(i,2),r=a[0],o=a[1];return new B({pdfManager:t.pdfManager,xref:t.xref,pageIndex:e,pageDict:r,ref:o,globalIdFactory:t._globalIdFactory,fontCache:n.fontCache,builtInCMapCache:n.builtInCMapCache,standardFontDataCache:n.standardFontDataCache,globalImageCache:n.globalImageCache,nonBlendModesSet:n.nonBlendModesSet,xfaFactory:s})})),this._pagePromises.set(e,a),a}},{key:"checkFirstPage",value:function(){var e=y(p().mark((function e(){var t=arguments;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(t.length>0&&void 0!==t[0]&&t[0])){e.next=3;break}return e.abrupt("return");case 3:return e.prev=3,e.next=6,this.getPage(0);case 6:e.next=15;break;case 8:if(e.prev=8,e.t0=e.catch(3),!(e.t0 instanceof r.XRefEntryException)){e.next=15;break}return this._pagePromises.delete(0),e.next=14,this.cleanup();case 14:throw new r.XRefParseException;case 15:case"end":return e.stop()}}),e,this,[[3,8]])})));return function(){return e.apply(this,arguments)}}()},{key:"checkLastPage",value:function(){var e=y(p().mark((function e(){var t,i,a,o,s,l,c,d,u,m,y,b,g,v=arguments;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return t=v.length>0&&void 0!==v[0]&&v[0],i=this.catalog,a=this.pdfManager,i.setActualNumPages(),e.prev=3,e.next=6,Promise.all([a.ensureDoc("xfaFactory"),a.ensureDoc("linearization"),a.ensureCatalog("numPages")]);case 6:if(!this.xfaFactory){e.next=10;break}return e.abrupt("return");case 10:o=this.linearization?this.linearization.numPages:i.numPages;case 11:if(Number.isInteger(o)){e.next=15;break}throw new n.FormatError("Page count is not an integer.");case 15:if(!(o<=1)){e.next=17;break}return e.abrupt("return");case 17:return e.next=19,this.getPage(o-1);case 19:e.next=44;break;case 21:return e.prev=21,e.t0=e.catch(3),this._pagePromises.delete(o-1),e.next=26,this.cleanup();case 26:if(!(e.t0 instanceof r.XRefEntryException)||t){e.next=28;break}throw new r.XRefParseException;case 28:return(0,n.warn)("checkLastPage - invalid /Pages tree /Count: ".concat(o,".")),e.prev=29,e.next=32,i.getAllPageDicts(t);case 32:s=e.sent,e.next=41;break;case 35:if(e.prev=35,e.t1=e.catch(29),!(e.t1 instanceof r.XRefEntryException)||t){e.next=39;break}throw new r.XRefParseException;case 39:return i.setActualNumPages(1),e.abrupt("return");case 41:l=h(s);try{for(l.s();!(c=l.n()).done;)d=f(c.value,2),u=d[0],m=f(d[1],2),y=m[0],b=m[1],g=void 0,y instanceof Error?(g=Promise.reject(y)).catch((function(){})):g=Promise.resolve(new B({pdfManager:a,xref:this.xref,pageIndex:u,pageDict:y,ref:b,globalIdFactory:this._globalIdFactory,fontCache:i.fontCache,builtInCMapCache:i.builtInCMapCache,standardFontDataCache:i.standardFontDataCache,globalImageCache:i.globalImageCache,nonBlendModesSet:i.nonBlendModesSet,xfaFactory:null})),this._pagePromises.set(u,g)}catch(p){l.e(p)}finally{l.f()}i.setActualNumPages(s.size);case 44:case"end":return e.stop()}}),e,this,[[3,21],[29,35]])})));return function(){return e.apply(this,arguments)}}()},{key:"fontFallback",value:function(e,t){return this.catalog.fontFallback(e,t)}},{key:"cleanup",value:function(){var e=y(p().mark((function e(){var t,i=arguments;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return t=i.length>0&&void 0!==i[0]&&i[0],e.abrupt("return",this.catalog?this.catalog.cleanup(t):(0,A.clearGlobalCaches)());case 2:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"_collectFieldObjects",value:function(e,t,i){var r=this.xref.fetchIfRef(t);if(r.has("T")){var o=(0,n.stringToPDFString)(r.get("T"));e=""===e?o:"".concat(e,".").concat(o)}if(i.has(e)||i.set(e,[]),i.get(e).push(a.AnnotationFactory.create(this.xref,t,this.pdfManager,this._localIdFactory,!0).then((function(e){return e&&e.getFieldObject()})).catch((function(e){return(0,n.warn)('_collectFieldObjects: "'.concat(e,'".')),null}))),r.has("Kids")){var s,l=r.get("Kids"),c=h(l);try{for(c.s();!(s=c.n()).done;){var d=s.value;this._collectFieldObjects(e,d,i)}}catch(u){c.e(u)}finally{c.f()}}}},{key:"fieldObjects",get:function(){if(!this.formInfo.hasFields)return(0,n.shadow)(this,"fieldObjects",Promise.resolve(null));var e,t=Object.create(null),i=new Map,a=h(this.catalog.acroForm.get("Fields"));try{for(a.s();!(e=a.n()).done;){var r=e.value;this._collectFieldObjects("",r,i)}}catch(d){a.e(d)}finally{a.f()}var o,s=[],l=h(i);try{var c=function(){var e=f(o.value,2),i=e[0],a=e[1];s.push(Promise.all(a).then((function(e){(e=e.filter((function(e){return!!e}))).length>0&&(t[i]=e)})))};for(l.s();!(o=l.n()).done;)c()}catch(d){l.e(d)}finally{l.f()}return(0,n.shadow)(this,"fieldObjects",Promise.all(s).then((function(){return t})))}},{key:"hasJSActions",get:function(){var e=this.pdfManager.ensureDoc("_parseHasJSActions");return(0,n.shadow)(this,"hasJSActions",e)}},{key:"_parseHasJSActions",value:function(){var e=y(p().mark((function e(){var t,i,a,n;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,Promise.all([this.pdfManager.ensureCatalog("jsActions"),this.pdfManager.ensureDoc("fieldObjects")]);case 2:if(t=e.sent,i=f(t,2),a=i[0],n=i[1],!a){e.next=8;break}return e.abrupt("return",!0);case 8:if(!n){e.next=10;break}return e.abrupt("return",Object.values(n).some((function(e){return e.some((function(e){return null!==e.actions}))})));case 10:return e.abrupt("return",!1);case 11:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"calculationOrderIds",get:function(){var e=this.catalog.acroForm;if(!e||!e.has("CO"))return(0,n.shadow)(this,"calculationOrderIds",null);var t=e.get("CO");if(!Array.isArray(t)||0===t.length)return(0,n.shadow)(this,"calculationOrderIds",null);var i,a=[],r=h(t);try{for(r.s();!(i=r.n()).done;){var s=i.value;s instanceof o.Ref&&a.push(s.toString())}}catch(l){r.e(l)}finally{r.f()}return 0===a.length?(0,n.shadow)(this,"calculationOrderIds",null):(0,n.shadow)(this,"calculationOrderIds",a)}}]),e}();t.PDFDocument=L},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.PopupAnnotation=t.MarkupAnnotation=t.AnnotationFactory=t.AnnotationBorderStyle=t.Annotation=void 0,t.getQuadPoints=P;var a=i(2),s=i(136),c=i(144),m=i(137),v=i(196),_=i(138),A=i(191),x=i(200),w=i(145),S=i(203),C=i(206),k=i(193),D=i(141),R=i(207),I=function(){function e(){b(this,e)}return g(e,null,[{key:"create",value:function(e,t,i,a,n){var r=this;return Promise.all([i.ensureCatalog("acroForm"),i.ensureCatalog("baseUrl"),i.ensureCatalog("attachments"),i.ensureDoc("xfaDatasets"),n?this._getPageIndex(e,t,i):-1]).then((function(o){var s=f(o,5),l=s[0],c=(s[1],s[2]),d=s[3],u=s[4];return i.ensure(r,"_create",[e,t,i,a,l,c,d,n,u])}))}},{key:"_create",value:function(e,t,i,n,r){var o=arguments.length>5&&void 0!==arguments[5]?arguments[5]:null,l=arguments.length>6?arguments[6]:void 0,c=arguments.length>7?arguments[7]:void 0,d=arguments.length>8&&void 0!==arguments[8]?arguments[8]:-1,u=e.fetchIfRef(t);if(u instanceof m.Dict){var p=t instanceof m.Ref?t.toString():"annot_".concat(n.createObjId()),h=u.get("Subtype");h=h instanceof m.Name?h.name:null;var f=r instanceof m.Dict?r:m.Dict.empty,y={xref:e,ref:t,dict:u,subtype:h,id:p,pdfManager:i,acroForm:f,attachments:o,xfaDatasets:l,collectFields:c,needAppearances:!c&&!0===f.get("NeedAppearances"),pageIndex:d,isOffscreenCanvasSupported:a.FeatureTest.isOffscreenCanvasSupported&&i.evaluatorOptions.isOffscreenCanvasSupported};switch(h){case"Link":return new H(y);case"Text":return new q(y);case"Widget":var b=(0,s.getInheritableProperty)({dict:u,key:"FT"});switch(b=b instanceof m.Name?b.name:null){case"Tx":return new O(y);case"Btn":return new G(y);case"Ch":return new L(y);case"Sig":return new j(y)}return(0,a.warn)('Unimplemented widget field type "'.concat(b,'", ')+"falling back to base field type."),new N(y);case"Popup":return new U(y);case"FreeText":return new Y(y);case"Line":return new X(y);case"Square":return new V(y);case"Circle":return new Q(y);case"PolyLine":return new W(y);case"Polygon":return new Z(y);case"Caret":return new J(y);case"Ink":return new K(y);case"Highlight":return new $(y);case"Underline":return new ee(y);case"Squiggly":return new te(y);case"StrikeOut":return new ie(y);case"Stamp":return new ae(y);case"FileAttachment":return new ne(y);default:return c||(h?(0,a.warn)('Unimplemented annotation type "'.concat(h,'", ')+"falling back to base annotation."):(0,a.warn)("Annotation is missing the required /Subtype.")),new B(y)}}}},{key:"_getPageIndex",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.prev=0,e.next=3,t.fetchIfRefAsync(i);case 3:if((r=e.sent)instanceof m.Dict){e.next=6;break}return e.abrupt("return",-1);case 6:if((o=r.getRaw("P"))instanceof m.Ref){e.next=9;break}return e.abrupt("return",-1);case 9:return e.next=11,n.ensureCatalog("getPageIndex",[o]);case 11:return s=e.sent,e.abrupt("return",s);case 15:return e.prev=15,e.t0=e.catch(0),(0,a.warn)('_getPageIndex: "'.concat(e.t0,'".')),e.abrupt("return",-1);case 19:case"end":return e.stop()}}),e,null,[[0,15]])})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"saveNewAnnotations",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c,d,u,f,y;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:r=t.xref,s=[],l=[],c=h(n),e.prev=4,c.s();case 6:if((d=c.n()).done){e.next=17;break}u=d.value,e.t0=u.annotationType,e.next=e.t0===a.AnnotationEditorType.FREETEXT?11:e.t0===a.AnnotationEditorType.INK?14:15;break;case 11:return o||((f=new m.Dict(r)).set("BaseFont",m.Name.get("Helvetica")),f.set("Type",m.Name.get("Font")),f.set("Subtype",m.Name.get("Type1")),f.set("Encoding",m.Name.get("WinAnsiEncoding")),y=[],o=r.getNewTemporaryRef(),(0,v.writeObject)(o,f,y,null),s.push({ref:o,data:y.join("")})),l.push(Y.createNewAnnotation(r,u,s,{evaluator:t,task:i,baseFontRef:o})),e.abrupt("break",15);case 14:l.push(K.createNewAnnotation(r,u,s));case 15:e.next=6;break;case 17:e.next=22;break;case 19:e.prev=19,e.t1=e.catch(4),c.e(e.t1);case 22:return e.prev=22,c.f(),e.finish(22);case 25:return e.next=27,Promise.all(l);case 27:return e.t2=e.sent,e.t3=s,e.abrupt("return",{annotations:e.t2,dependencies:e.t3});case 30:case"end":return e.stop()}}),e,null,[[4,19,22,25]])})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"printNewAnnotations",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c,d;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(n){e.next=2;break}return e.abrupt("return",null);case 2:r=t.xref,o=[],s=a.FeatureTest.isOffscreenCanvasSupported&&t.options.isOffscreenCanvasSupported,l=h(n),e.prev=6,l.s();case 8:if((c=l.n()).done){e.next=19;break}d=c.value,e.t0=d.annotationType,e.next=e.t0===a.AnnotationEditorType.FREETEXT?13:e.t0===a.AnnotationEditorType.INK?15:17;break;case 13:return o.push(Y.createNewPrintAnnotation(r,d,{evaluator:t,task:i,isOffscreenCanvasSupported:s})),e.abrupt("break",17);case 15:return o.push(K.createNewPrintAnnotation(r,d,{isOffscreenCanvasSupported:s})),e.abrupt("break",17);case 17:e.next=8;break;case 19:e.next=24;break;case 21:e.prev=21,e.t1=e.catch(6),l.e(e.t1);case 24:return e.prev=24,l.f(),e.finish(24);case 27:return e.abrupt("return",Promise.all(o));case 28:case"end":return e.stop()}}),e,null,[[6,21,24,27]])})));return function(t,i,a){return e.apply(this,arguments)}}()}]),e}();function M(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:new Uint8ClampedArray(3);if(!Array.isArray(e))return t;var i=t||new Uint8ClampedArray(3);switch(e.length){case 0:return null;case 1:return w.ColorSpace.singletons.gray.getRgbItem(e,0,i,0),i;case 3:return w.ColorSpace.singletons.rgb.getRgbItem(e,0,i,0),i;case 4:return w.ColorSpace.singletons.cmyk.getRgbItem(e,0,i,0),i;default:return t}}function T(e){return Array.from(e,(function(e){return e/255}))}function P(e,t){var i=e.getArray("QuadPoints");if(!Array.isArray(i)||0===i.length||i.length%8>0)return null;for(var a=[],n=0,r=i.length/8;n<r;n++){for(var o=1/0,s=-1/0,l=1/0,c=-1/0,d=8*n,u=8*n+8;d<u;d+=2){var p=i[d],m=i[d+1];o=Math.min(p,o),s=Math.max(p,s),l=Math.min(m,l),c=Math.max(m,c)}if(null!==t&&(o<t[0]||s>t[2]||l<t[1]||c>t[3]))return null;a.push([{x:o,y:c},{x:s,y:c},{x:o,y:l},{x:s,y:l}])}return a}function z(e,t,i){var n=a.Util.getAxialAlignedBoundingBox(t,i),r=f(n,4),o=r[0],s=r[1],l=r[2],c=r[3];if(o===l||s===c)return[1,0,0,1,e[0],e[1]];var d=(e[2]-e[0])/(l-o),u=(e[3]-e[1])/(c-s);return[d,0,0,u,e[0]-o*d,e[1]-s*u]}t.AnnotationFactory=I;var B=function(){function e(t){b(this,e);var i=t.dict,n=t.xref;this.setTitle(i.get("T")),this.setContents(i.get("Contents")),this.setModificationDate(i.get("M")),this.setFlags(i.get("F")),this.setRectangle(i.getArray("Rect")),this.setColor(i.getArray("C")),this.setBorderStyle(i),this.setAppearance(i),this.setOptionalContent(i);var r=i.get("MK");if(this.setBorderAndBackgroundColors(r),this.setRotation(r),this._streams=[],this.appearance&&this._streams.push(this.appearance),this.data={annotationFlags:this.flags,borderStyle:this.borderStyle,color:this.color,backgroundColor:this.backgroundColor,borderColor:this.borderColor,rotation:this.rotation,contentsObj:this._contents,hasAppearance:!!this.appearance,id:t.id,modificationDate:this.modificationDate,rect:this.rectangle,subtype:t.subtype,hasOwnCanvas:!1},t.collectFields){var o=i.get("Kids");if(Array.isArray(o)){var l,c=[],d=h(o);try{for(d.s();!(l=d.n()).done;){var u=l.value;u instanceof m.Ref&&c.push(u.toString())}}catch(p){d.e(p)}finally{d.f()}0!==c.length&&(this.data.kidIds=c)}this.data.actions=(0,s.collectActions)(n,i,a.AnnotationActionEventType),this.data.fieldName=this._constructFieldName(i),this.data.pageIndex=t.pageIndex}this._isOffscreenCanvasSupported=t.isOffscreenCanvasSupported,this._fallbackFontDict=null,this._needAppearances=!1}return g(e,[{key:"_hasFlag",value:function(e,t){return!!(e&t)}},{key:"_isViewable",value:function(e){return!this._hasFlag(e,a.AnnotationFlag.INVISIBLE)&&!this._hasFlag(e,a.AnnotationFlag.NOVIEW)}},{key:"_isPrintable",value:function(e){return this._hasFlag(e,a.AnnotationFlag.PRINT)&&!this._hasFlag(e,a.AnnotationFlag.INVISIBLE)}},{key:"mustBeViewed",value:function(e){var t=e&&e.get(this.data.id);return t&&void 0!==t.hidden?!t.hidden:this.viewable&&!this._hasFlag(this.flags,a.AnnotationFlag.HIDDEN)}},{key:"mustBePrinted",value:function(e){var t=e&&e.get(this.data.id);return t&&void 0!==t.print?t.print:this.printable}},{key:"viewable",get:function(){return null!==this.data.quadPoints&&(0===this.flags||this._isViewable(this.flags))}},{key:"printable",get:function(){return null!==this.data.quadPoints&&0!==this.flags&&this._isPrintable(this.flags)}},{key:"_parseStringHelper",value:function(e){var t="string"===typeof e?(0,a.stringToPDFString)(e):"";return{str:t,dir:t&&"rtl"===(0,A.bidi)(t).dir?"rtl":"ltr"}}},{key:"setDefaultAppearance",value:function(e){var t=(0,s.getInheritableProperty)({dict:e.dict,key:"DA"})||e.acroForm.get("DA");this._defaultAppearance="string"===typeof t?t:"",this.data.defaultAppearanceData=(0,c.parseDefaultAppearance)(this._defaultAppearance)}},{key:"setTitle",value:function(e){this._title=this._parseStringHelper(e)}},{key:"setContents",value:function(e){this._contents=this._parseStringHelper(e)}},{key:"setModificationDate",value:function(e){this.modificationDate="string"===typeof e?e:null}},{key:"setFlags",value:function(e){this.flags=Number.isInteger(e)&&e>0?e:0}},{key:"hasFlag",value:function(e){return this._hasFlag(this.flags,e)}},{key:"setRectangle",value:function(e){Array.isArray(e)&&4===e.length?this.rectangle=a.Util.normalizeRect(e):this.rectangle=[0,0,0,0]}},{key:"setColor",value:function(e){this.color=M(e)}},{key:"setLineEndings",value:function(e){if(this.lineEndings=["None","None"],Array.isArray(e)&&2===e.length)for(var t=0;t<2;t++){var i=e[t];if(i instanceof m.Name)switch(i.name){case"None":continue;case"Square":case"Circle":case"Diamond":case"OpenArrow":case"ClosedArrow":case"Butt":case"ROpenArrow":case"RClosedArrow":case"Slash":this.lineEndings[t]=i.name;continue}(0,a.warn)("Ignoring invalid lineEnding: ".concat(i))}}},{key:"setRotation",value:function(e){if(this.rotation=0,e instanceof m.Dict){var t=e.get("R")||0;Number.isInteger(t)&&0!==t&&((t%=360)<0&&(t+=360),t%90===0&&(this.rotation=t))}}},{key:"setBorderAndBackgroundColors",value:function(e){e instanceof m.Dict?(this.borderColor=M(e.getArray("BC"),null),this.backgroundColor=M(e.getArray("BG"),null)):this.borderColor=this.backgroundColor=null}},{key:"setBorderStyle",value:function(e){if(this.borderStyle=new F,e instanceof m.Dict)if(e.has("BS")){var t=e.get("BS"),i=t.get("Type");i&&!(0,m.isName)(i,"Border")||(this.borderStyle.setWidth(t.get("W"),this.rectangle),this.borderStyle.setStyle(t.get("S")),this.borderStyle.setDashArray(t.getArray("D")))}else if(e.has("Border")){var a=e.getArray("Border");Array.isArray(a)&&a.length>=3&&(this.borderStyle.setHorizontalCornerRadius(a[0]),this.borderStyle.setVerticalCornerRadius(a[1]),this.borderStyle.setWidth(a[2],this.rectangle),4===a.length&&this.borderStyle.setDashArray(a[3],!0))}else this.borderStyle.setWidth(0)}},{key:"setAppearance",value:function(e){this.appearance=null;var t=e.get("AP");if(t instanceof m.Dict){var i=t.get("N");if(i instanceof _.BaseStream)this.appearance=i;else if(i instanceof m.Dict){var a=e.get("AS");if(a instanceof m.Name&&i.has(a.name)){var n=i.get(a.name);n instanceof _.BaseStream&&(this.appearance=n)}}}}},{key:"setOptionalContent",value:function(e){this.oc=null;var t=e.get("OC");t instanceof m.Name?(0,a.warn)("setOptionalContent: Support for /Name-entry is not implemented."):t instanceof m.Dict&&(this.oc=t)}},{key:"loadResources",value:function(e,t){return t.dict.getAsync("Resources").then((function(t){if(t)return new C.ObjectLoader(t,e,t.xref).load().then((function(){return t}))}))}},{key:"getOperatorList",value:function(){var e=y(p().mark((function e(t,i,n,r,o){var s,l,c,d,u,h,f,y,b,g;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(s=this.data,l=this.appearance,c=!!(this.data.hasOwnCanvas&&n&a.RenderingIntentFlag.DISPLAY),l){e.next=8;break}if(c){e.next=6;break}return e.abrupt("return",{opList:new k.OperatorList,separateForm:!1,separateCanvas:!1});case 6:(l=new D.StringStream("")).dict=new m.Dict;case 8:return d=l.dict,e.next=11,this.loadResources(["ExtGState","ColorSpace","Pattern","Shading","XObject","Font"],l);case 11:if(u=e.sent,h=d.getArray("BBox")||[0,0,1,1],f=d.getArray("Matrix")||[1,0,0,1,0,0],y=z(s.rect,h,f),b=new k.OperatorList,!this.oc){e.next=20;break}return e.next=19,t.parseMarkedContentProps(this.oc,null);case 19:g=e.sent;case 20:return void 0!==g&&b.addOp(a.OPS.beginMarkedContentProps,["OC",g]),b.addOp(a.OPS.beginAnnotation,[s.id,s.rect,y,f,c]),e.next=24,t.getOperatorList({stream:l,task:i,resources:u,operatorList:b,fallbackFontDict:this._fallbackFontDict});case 24:return b.addOp(a.OPS.endAnnotation,[]),void 0!==g&&b.addOp(a.OPS.endMarkedContent,[]),this.reset(),e.abrupt("return",{opList:b,separateForm:!1,separateCanvas:c});case 28:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n,r){return e.apply(this,arguments)}}()},{key:"save",value:function(){var e=y(p().mark((function e(t,i,a){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.abrupt("return",null);case 1:case"end":return e.stop()}}),e)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"hasTextContent",get:function(){return!1}},{key:"extractTextContent",value:function(){var e=y(p().mark((function e(t,i,a){var n,r,o,s;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(this.appearance){e.next=2;break}return e.abrupt("return");case 2:return e.next=4,this.loadResources(["ExtGState","Font","Properties","XObject"],this.appearance);case 4:return n=e.sent,r=[],o=[],s={desiredSize:Math.Infinity,ready:!0,enqueue:function(e,t){var i,a=h(e.items);try{for(a.s();!(i=a.n()).done;){var n=i.value;o.push(n.str),n.hasEOL&&(r.push(o.join("")),o.length=0)}}catch(s){a.e(s)}finally{a.f()}}},e.next=10,t.getTextContent({stream:this.appearance,task:i,resources:n,includeMarkedContent:!0,combineTextItems:!0,sink:s,viewBox:a});case 10:this.reset(),o.length&&r.push(o.join("")),r.length>0&&(this.data.textContent=r);case 13:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"getFieldObject",value:function(){return this.data.kidIds?{id:this.data.id,actions:this.data.actions,name:this.data.fieldName,strokeColor:this.data.borderColor,fillColor:this.data.backgroundColor,type:"",kidIds:this.data.kidIds,page:this.data.pageIndex,rotation:this.rotation}:null}},{key:"reset",value:function(){var e,t=h(this._streams);try{for(t.s();!(e=t.n()).done;)e.value.reset()}catch(i){t.e(i)}finally{t.f()}}},{key:"_constructFieldName",value:function(e){if(!e.has("T")&&!e.has("Parent"))return(0,a.warn)("Unknown field name, falling back to empty field name."),"";if(!e.has("Parent"))return(0,a.stringToPDFString)(e.get("T"));var t=[];e.has("T")&&t.unshift((0,a.stringToPDFString)(e.get("T")));var i=e,n=new m.RefSet;for(e.objId&&n.put(e.objId);i.has("Parent")&&(i=i.get("Parent"))instanceof m.Dict&&(!i.objId||!n.has(i.objId));)if(i.objId&&n.put(i.objId),i.has("T")){var r=(0,a.stringToPDFString)(i.get("T"));r.startsWith("#")||t.unshift(r)}return t.join(".")}}]),e}();t.Annotation=B;var F=function(){function e(){b(this,e),this.width=1,this.style=a.AnnotationBorderStyleType.SOLID,this.dashArray=[3],this.horizontalCornerRadius=0,this.verticalCornerRadius=0}return g(e,[{key:"setWidth",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:[0,0,0,0];if(e instanceof m.Name)this.width=0;else if("number"===typeof e){if(e>0){var i=(t[2]-t[0])/2,n=(t[3]-t[1])/2;i>0&&n>0&&(e>i||e>n)&&((0,a.warn)("AnnotationBorderStyle.setWidth - ignoring width: ".concat(e)),e=1)}this.width=e}}},{key:"setStyle",value:function(e){if(e instanceof m.Name)switch(e.name){case"S":this.style=a.AnnotationBorderStyleType.SOLID;break;case"D":this.style=a.AnnotationBorderStyleType.DASHED;break;case"B":this.style=a.AnnotationBorderStyleType.BEVELED;break;case"I":this.style=a.AnnotationBorderStyleType.INSET;break;case"U":this.style=a.AnnotationBorderStyleType.UNDERLINE}}},{key:"setDashArray",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];if(Array.isArray(e)&&e.length>0){var i,a=!0,n=!0,r=h(e);try{for(r.s();!(i=r.n()).done;){var o=i.value;if(!(+o>=0)){a=!1;break}o>0&&(n=!1)}}catch(s){r.e(s)}finally{r.f()}a&&!n?(this.dashArray=e,t&&this.setStyle(m.Name.get("D"))):this.width=0}else e&&(this.width=0)}},{key:"setHorizontalCornerRadius",value:function(e){Number.isInteger(e)&&(this.horizontalCornerRadius=e)}},{key:"setVerticalCornerRadius",value:function(e){Number.isInteger(e)&&(this.verticalCornerRadius=e)}}]),e}();t.AnnotationBorderStyle=F;var E=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict;if(r.has("IRT")){var o=r.getRaw("IRT");n.data.inReplyTo=o instanceof m.Ref?o.toString():null;var s=r.get("RT");n.data.replyType=s instanceof m.Name?s.name:a.AnnotationReplyType.REPLY}if(n.data.replyType===a.AnnotationReplyType.GROUP){var l=r.get("IRT");n.setTitle(l.get("T")),n.data.titleObj=n._title,n.setContents(l.get("Contents")),n.data.contentsObj=n._contents,l.has("CreationDate")?(n.setCreationDate(l.get("CreationDate")),n.data.creationDate=n.creationDate):n.data.creationDate=null,l.has("M")?(n.setModificationDate(l.get("M")),n.data.modificationDate=n.modificationDate):n.data.modificationDate=null,n.data.hasPopup=l.has("Popup"),l.has("C")?(n.setColor(l.getArray("C")),n.data.color=n.color):n.data.color=null}else n.data.titleObj=n._title,n.setCreationDate(r.get("CreationDate")),n.data.creationDate=n.creationDate,n.data.hasPopup=r.has("Popup"),r.has("C")||(n.data.color=null);return r.has("RC")&&(n.data.richText=R.XFAFactory.getRichTextAsHtml(r.get("RC"))),n}return g(i,[{key:"setCreationDate",value:function(e){this.creationDate="string"===typeof e?e:null}},{key:"_setDefaultAppearance",value:function(e){var t=e.xref,i=e.extra,a=e.strokeColor,n=e.fillColor,r=e.blendMode,o=e.strokeAlpha,s=e.fillAlpha,l=e.pointsCallback,c=Number.MAX_VALUE,d=Number.MAX_VALUE,u=Number.MIN_VALUE,p=Number.MIN_VALUE,y=["q"];i&&y.push(i),a&&y.push("".concat(a[0]," ").concat(a[1]," ").concat(a[2]," RG")),n&&y.push("".concat(n[0]," ").concat(n[1]," ").concat(n[2]," rg"));var b=this.data.quadPoints;b||(b=[[{x:this.rectangle[0],y:this.rectangle[3]},{x:this.rectangle[2],y:this.rectangle[3]},{x:this.rectangle[0],y:this.rectangle[1]},{x:this.rectangle[2],y:this.rectangle[1]}]]);var g,v=h(b);try{for(v.s();!(g=v.n()).done;){var _=l(y,g.value),A=f(_,4),x=A[0],w=A[1],S=A[2],C=A[3];c=Math.min(c,x),u=Math.max(u,w),d=Math.min(d,S),p=Math.max(p,C)}}catch(F){v.e(F)}finally{v.f()}y.push("Q");var k=new m.Dict(t),R=new m.Dict(t);R.set("Subtype",m.Name.get("Form"));var I=new D.StringStream(y.join(" "));I.dict=R,k.set("Fm0",I);var M=new m.Dict(t);r&&M.set("BM",m.Name.get(r)),"number"===typeof o&&M.set("CA",o),"number"===typeof s&&M.set("ca",s);var T=new m.Dict(t);T.set("GS0",M);var P=new m.Dict(t);P.set("ExtGState",T),P.set("XObject",k);var z=new m.Dict(t);z.set("Resources",P);var B=this.data.rect=[c,d,u,p];z.set("BBox",B),this.appearance=new D.StringStream("/GS0 gs /Fm0 Do"),this.appearance.dict=z,this._streams.push(this.appearance,I)}}],[{key:"createNewAnnotation",value:function(){var e=y(p().mark((function e(t,i,a,n){var r,o,s,l,c,d,u;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return r=t.getNewTemporaryRef(),e.next=3,this.createNewAppearanceStream(i,t,n);case 3:return o=e.sent,s=[],o?(c=t.getNewTemporaryRef(),l=this.createNewDict(i,t,{apRef:c}),d=t.encrypt?t.encrypt.createCipherTransform(c.num,c.gen):null,(0,v.writeObject)(c,o,s,d),a.push({ref:c,data:s.join("")})):l=this.createNewDict(i,t,{}),s.length=0,u=t.encrypt?t.encrypt.createCipherTransform(r.num,r.gen):null,(0,v.writeObject)(r,l,s,u),e.abrupt("return",{ref:r,data:s.join("")});case 10:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n){return e.apply(this,arguments)}}()},{key:"createNewPrintAnnotation",value:function(){var e=y(p().mark((function e(t,i,a){var n,r;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this.createNewAppearanceStream(i,t,a);case 2:return n=e.sent,r=this.createNewDict(i,t,{ap:n}),e.abrupt("return",new this.prototype.constructor({dict:r,xref:t,isOffscreenCanvasSupported:a.isOffscreenCanvasSupported}));case 5:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()}]),i}(B);t.MarkupAnnotation=E;var N=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=e.xref,l=n.data;n.ref=e.ref,n._needAppearances=e.needAppearances,l.annotationType=a.AnnotationType.WIDGET,void 0===l.fieldName&&(l.fieldName=n._constructFieldName(r)),void 0===l.actions&&(l.actions=(0,s.collectActions)(o,r,a.AnnotationActionEventType));var c=(0,s.getInheritableProperty)({dict:r,key:"V",getArray:!0});l.fieldValue=n._decodeFormValue(c);var d=(0,s.getInheritableProperty)({dict:r,key:"DV",getArray:!0});if(l.defaultFieldValue=n._decodeFormValue(d),void 0===c&&e.xfaDatasets){var u=n._title.str;u&&(n._hasValueFromXFA=!0,l.fieldValue=c=e.xfaDatasets.getValue(u))}void 0===c&&null!==l.defaultFieldValue&&(l.fieldValue=l.defaultFieldValue),l.alternativeText=(0,a.stringToPDFString)(r.get("TU")||""),n.setDefaultAppearance(e),l.hasAppearance=n._needAppearances&&void 0!==l.fieldValue&&null!==l.fieldValue||l.hasAppearance;var p=(0,s.getInheritableProperty)({dict:r,key:"FT"});l.fieldType=p instanceof m.Name?p.name:null;var h=(0,s.getInheritableProperty)({dict:r,key:"DR"}),f=e.acroForm.get("DR"),y=n.appearance&&n.appearance.dict.get("Resources");return n._fieldResources={localResources:h,acroFormResources:f,appearanceResources:y,mergedResources:m.Dict.merge({xref:o,dictArray:[h,y,f],mergeSubDicts:!0})},l.fieldFlags=(0,s.getInheritableProperty)({dict:r,key:"Ff"}),(!Number.isInteger(l.fieldFlags)||l.fieldFlags<0)&&(l.fieldFlags=0),l.readOnly=n.hasFieldFlag(a.AnnotationFieldFlag.READONLY),l.required=n.hasFieldFlag(a.AnnotationFieldFlag.REQUIRED),l.hidden=n._hasFlag(l.annotationFlags,a.AnnotationFlag.HIDDEN),n}return g(i,[{key:"_decodeFormValue",value:function(e){return Array.isArray(e)?e.filter((function(e){return"string"===typeof e})).map((function(e){return(0,a.stringToPDFString)(e)})):e instanceof m.Name?(0,a.stringToPDFString)(e.name):"string"===typeof e?(0,a.stringToPDFString)(e):null}},{key:"hasFieldFlag",value:function(e){return!!(this.data.fieldFlags&e)}},{key:"getRotationMatrix",value:function(e){var t=e?e.get(this.data.id):void 0,i=t&&t.rotation;if(void 0===i&&(i=this.rotation),0===i)return a.IDENTITY_MATRIX;var n=this.data.rect[2]-this.data.rect[0],r=this.data.rect[3]-this.data.rect[1];return(0,s.getRotationMatrix)(i,n,r)}},{key:"getBorderAndBackgroundAppearances",value:function(e){var t=e?e.get(this.data.id):void 0,i=t&&t.rotation;if(void 0===i&&(i=this.rotation),!this.backgroundColor&&!this.borderColor)return"";var a=this.data.rect[2]-this.data.rect[0],n=this.data.rect[3]-this.data.rect[1],r=0===i||180===i?"0 0 ".concat(a," ").concat(n," re"):"0 0 ".concat(n," ").concat(a," re"),o="";if(this.backgroundColor&&(o="".concat((0,c.getPdfColor)(this.backgroundColor,!0)," ").concat(r," f ")),this.borderColor){var s=this.borderStyle.width||1;o+="".concat(s," w ").concat((0,c.getPdfColor)(this.borderColor,!1)," ").concat(r," S ")}return o}},{key:"getOperatorList",value:function(){var e=y(p().mark((function e(t,n,s,l,c){var d,u,m,h,f,y,b;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!l||this instanceof j){e.next=2;break}return e.abrupt("return",{opList:new k.OperatorList,separateForm:!0,separateCanvas:!1});case 2:if(this._hasText){e.next=4;break}return e.abrupt("return",r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,l,c));case 4:return e.next=6,this._getAppearance(t,n,s,c);case 6:if(d=e.sent,!this.appearance||null!==d){e.next=9;break}return e.abrupt("return",r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,l,c));case 9:if(u=new k.OperatorList,this._defaultAppearance&&null!==d){e.next=12;break}return e.abrupt("return",{opList:u,separateForm:!1,separateCanvas:!1});case 12:if(m=[1,0,0,1,0,0],h=[0,0,this.data.rect[2]-this.data.rect[0],this.data.rect[3]-this.data.rect[1]],f=z(this.data.rect,h,m),!this.oc){e.next=19;break}return e.next=18,t.parseMarkedContentProps(this.oc,null);case 18:y=e.sent;case 19:return void 0!==y&&u.addOp(a.OPS.beginMarkedContentProps,["OC",y]),u.addOp(a.OPS.beginAnnotation,[this.data.id,this.data.rect,f,this.getRotationMatrix(c),!1]),b=new D.StringStream(d),e.next=24,t.getOperatorList({stream:b,task:n,resources:this._fieldResources.mergedResources,operatorList:u});case 24:return u.addOp(a.OPS.endAnnotation,[]),void 0!==y&&u.addOp(a.OPS.endMarkedContent,[]),e.abrupt("return",{opList:u,separateForm:!1,separateCanvas:!1});case 27:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n,r){return e.apply(this,arguments)}}()},{key:"_getMKDict",value:function(e){var t=new m.Dict(null);return e&&t.set("R",e),this.borderColor&&t.set("BC",T(this.borderColor)),this.backgroundColor&&t.set("BG",T(this.backgroundColor)),t.size>0?t:null}},{key:"amendSavedDict",value:function(e,t){}},{key:"save",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,l,c,d,u,f,y,b,g,_,A,x,w,S,C,k,R,I,M,T,P,z,B,F,E=this;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(r=n?n.get(this.data.id):void 0,o=r&&r.value,l=r&&r.rotation,o!==this.data.fieldValue&&void 0!==o){e.next=7;break}if(this._hasValueFromXFA||void 0!==l){e.next=6;break}return e.abrupt("return",null);case 6:o=o||this.data.fieldValue;case 7:if(void 0!==l||this._hasValueFromXFA||!Array.isArray(o)||!Array.isArray(this.data.fieldValue)||o.length!==this.data.fieldValue.length||!o.every((function(e,t){return e===E.data.fieldValue[t]}))){e.next=9;break}return e.abrupt("return",null);case 9:if(void 0===l&&(l=this.rotation),c=null,this._needAppearances){e.next=19;break}return e.next=14,this._getAppearance(t,i,a.RenderingIntentFlag.SAVE,n);case 14:if(null!==(c=e.sent)){e.next=17;break}return e.abrupt("return",null);case 17:e.next=19;break;case 19:if(d=!1,c&&c.needAppearances&&(d=!0,c=null),u=t.xref,(f=u.fetchIfRef(this.ref))instanceof m.Dict){e.next=25;break}return e.abrupt("return",null);case 25:y=new m.Dict(u),b=h(f.getKeys());try{for(b.s();!(g=b.n()).done;)"AP"!==(_=g.value)&&y.set(_,f.getRaw(_))}catch(p){b.e(p)}finally{b.f()}return A={path:this.data.fieldName,value:o},x=function(e){return(0,s.isAscii)(e)?e:(0,s.stringToUTF16String)(e,!0)},y.set("V",Array.isArray(o)?o.map(x):x(o)),this.amendSavedDict(n,y),(w=this._getMKDict(l))&&y.set("MK",w),S=u.encrypt,C=S?S.createCipherTransform(this.ref.num,this.ref.gen):null,k=[],R=[{ref:this.ref,data:"",xfa:A,needAppearances:d}],null!==c&&(I=u.getNewTemporaryRef(),M=new m.Dict(u),y.set("AP",M),M.set("N",I),T=null,S&&(T=S.createCipherTransform(I.num,I.gen)),P=this._getSaveFieldResources(u),z=new D.StringStream(c),(B=z.dict=new m.Dict(u)).set("Subtype",m.Name.get("Form")),B.set("Resources",P),B.set("BBox",[0,0,this.data.rect[2]-this.data.rect[0],this.data.rect[3]-this.data.rect[1]]),(F=this.getRotationMatrix(n))!==a.IDENTITY_MATRIX&&B.set("Matrix",F),(0,v.writeObject)(I,z,k,T),R.push({ref:I,data:k.join(""),xfa:null,needAppearances:!1}),k.length=0),y.set("M","D:".concat((0,a.getModificationDate)())),(0,v.writeObject)(this.ref,y,k,C),R[0].data=k.join(""),e.abrupt("return",R);case 43:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_getAppearance",value:function(){var e=y(p().mark((function e(t,n,r,o){var l,d,u,m,y,b,g,v,_,A,x,w,S,C,k,D,R,I,M,T,P,z,B,F,E,N,O,G,L,j,q,H,U,Y,X,V,Q,W,Z,J,K,$,ee,te;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.hasFieldFlag(a.AnnotationFieldFlag.PASSWORD)){e.next=3;break}return e.abrupt("return",null);case 3:if((l=o?o.get(this.data.id):void 0)&&(d=l.formattedValue||l.value,u=l.rotation),void 0!==u||void 0!==d||this._needAppearances){e.next=8;break}if(this._hasValueFromXFA&&!this.appearance){e.next=8;break}return e.abrupt("return",null);case 8:if(m=this.getBorderAndBackgroundAppearances(o),void 0!==d){e.next=13;break}if(d=this.data.fieldValue){e.next=13;break}return e.abrupt("return","/Tx BMC q ".concat(m,"Q EMC"));case 13:if(Array.isArray(d)&&1===d.length&&(d=d[0]),(0,a.assert)("string"===typeof d,"Expected `value` to be a string."),d=d.trim(),this.data.combo&&(y=this.data.options.find((function(e){var t=e.exportValue;return d===t})),d=y&&y.displayValue||d),""!==d){e.next=19;break}return e.abrupt("return","/Tx BMC q ".concat(m,"Q EMC"));case 19:return void 0===u&&(u=this.rotation),b=-1,this.data.multiLine?(g=d.split(/\r\n?|\n/).map((function(e){return e.normalize("NFC")})),b=g.length):g=[d.replace(/\r\n?|\n/,"").normalize("NFC")],v=1,_=2,A=this.data.rect[3]-this.data.rect[1],x=this.data.rect[2]-this.data.rect[0],90!==u&&270!==u||(x=(w=[A,x])[0],A=w[1]),this._defaultAppearance||(this.data.defaultAppearanceData=(0,c.parseDefaultAppearance)(this._defaultAppearance="/Helvetica 0 Tf 0 g")),e.next=30,i._getFontData(t,n,this.data.defaultAppearanceData,this._fieldResources.mergedResources);case 30:S=e.sent,R=[],I=!1,M=h(g);try{for(M.s();!(T=M.n()).done;)P=T.value,(z=S.encodeString(P)).length>1&&(I=!0),R.push(z.join(""))}catch(p){M.e(p)}finally{M.f()}if(!(I&&r&a.RenderingIntentFlag.SAVE)){e.next=37;break}return e.abrupt("return",{needAppearances:!0});case 37:if(!I||!this._isOffscreenCanvasSupported){e.next=59;break}if(B=this.data.comb?"monospace":"sans-serif",F=new c.FakeUnicodeFont(t.xref,B),E=F.createFontResources(g.join("")),N=E.getRaw("Font"),this._fieldResources.mergedResources.has("Font")){O=this._fieldResources.mergedResources.get("Font"),G=h(N.getKeys());try{for(G.s();!(L=G.n()).done;)j=L.value,O.set(j,N.getRaw(j))}catch(p){G.e(p)}finally{G.f()}}else this._fieldResources.mergedResources.set("Font",N);return q=F.fontName.name,e.next=46,i._getFontData(t,n,{fontName:q,fontSize:0},E);case 46:for(S=e.sent,H=0,U=R.length;H<U;H++)R[H]=(0,s.stringToUTF16String)(g[H]);Y=Object.assign(Object.create(null),this.data.defaultAppearanceData),this.data.defaultAppearanceData.fontSize=0,this.data.defaultAppearanceData.fontName=q,X=this._computeFontSize(A-2*v,x-2*_,d,S,b),V=f(X,3),C=V[0],k=V[1],D=V[2],this.data.defaultAppearanceData=Y,e.next=65;break;case 59:this._isOffscreenCanvasSupported||(0,a.warn)("_getAppearance: OffscreenCanvas is not supported, annotation may not render correctly."),Q=this._computeFontSize(A-2*v,x-2*_,d,S,b),W=f(Q,3),C=W[0],k=W[1],D=W[2];case 65:if(Z=S.descent,Z=isNaN(Z)?a.BASELINE_FACTOR*D:Math.max(a.BASELINE_FACTOR*D,Math.abs(Z)*k),J=Math.min(Math.floor((A-k)/2),v),K=this.data.textAlignment,!this.data.multiLine){e.next=71;break}return e.abrupt("return",this._getMultilineAppearance(C,R,S,k,x,A,K,_,J,Z,D,o));case 71:if(!this.data.comb){e.next=73;break}return e.abrupt("return",this._getCombAppearance(C,S,R[0],k,x,A,_,J,Z,D,o));case 73:if($=J+Z,!(0===K||K>2)){e.next=76;break}return e.abrupt("return","/Tx BMC q ".concat(m,"BT ")+C+" 1 0 0 1 ".concat((0,s.numberToString)(_)," ").concat((0,s.numberToString)($)," Tm (").concat((0,s.escapeString)(R[0]),") Tj")+" ET Q EMC");case 76:return ee={shift:0},te=this._renderText(R[0],S,k,x,K,ee,_,$),e.abrupt("return","/Tx BMC q ".concat(m,"BT ")+C+" 1 0 0 1 0 0 Tm ".concat(te)+" ET Q EMC");case 79:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n){return e.apply(this,arguments)}}()},{key:"_getTextWidth",value:function(e,t){return t.charsToGlyphs(e).reduce((function(e,t){return e+t.width}),0)/1e3}},{key:"_computeFontSize",value:function(e,t,i,n,r){var o=this,s=this.data.defaultAppearanceData.fontSize,l=(s||12)*a.LINE_FACTOR,d=Math.round(e/l);if(!s){var u=function(e){return Math.floor(100*e)/100};if(-1===r){var p=this._getTextWidth(i,n);s=u(Math.min(e/a.LINE_FACTOR,p>t?t/p:1/0)),d=1}else{var m,f=i.split(/\r\n?|\n/),y=[],b=h(f);try{for(b.s();!(m=b.n()).done;){var g=m.value,v=n.encodeString(g).join(""),_=n.charsToGlyphs(v),A=n.getCharPositions(v);y.push({line:v,glyphs:_,positions:A})}}catch(k){b.e(k)}finally{b.f()}var x=function(i){for(var a=0,r=0,s=y;r<s.length;r++){var l=s[r];if((a+=o._splitLine(null,n,i,t,l).length*i)>e)return!0}return!1};for(d=Math.max(d,r);x(s=u((l=e/d)/a.LINE_FACTOR));)d++}var w=this.data.defaultAppearanceData,S=w.fontName,C=w.fontColor;this._defaultAppearance=(0,c.createDefaultAppearance)({fontSize:s,fontName:S,fontColor:C})}return[this._defaultAppearance,s,e/d]}},{key:"_renderText",value:function(e,t,i,a,n,r,o,l){var c;c=1===n?(a-this._getTextWidth(e,t)*i)/2:2===n?a-this._getTextWidth(e,t)*i-o:o;var d=(0,s.numberToString)(c-r.shift);return r.shift=c,l=(0,s.numberToString)(l),"".concat(d," ").concat(l," Td (").concat((0,s.escapeString)(e),") Tj")}},{key:"_getSaveFieldResources",value:function(e){var t=this._fieldResources,i=t.localResources,a=t.appearanceResources,n=t.acroFormResources,r=this.data.defaultAppearanceData&&this.data.defaultAppearanceData.fontName;if(!r)return i||m.Dict.empty;for(var o=0,s=[i,a];o<s.length;o++){var l=s[o];if(l instanceof m.Dict){var c=l.get("Font");if(c instanceof m.Dict&&c.has(r))return l}}if(n instanceof m.Dict){var d=n.get("Font");if(d instanceof m.Dict&&d.has(r)){var u=new m.Dict(e);u.set(r,d.getRaw(r));var p=new m.Dict(e);return p.set("Font",u),m.Dict.merge({xref:e,dictArray:[p,i],mergeSubDicts:!0})}}return i||m.Dict.empty}},{key:"getFieldObject",value:function(){return null}}],[{key:"_getFontData",value:function(){var e=y(p().mark((function e(t,i,a,n){var r,o,s,l;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return r=new k.OperatorList,o={font:null,clone:function(){return this}},s=a.fontName,l=a.fontSize,e.next=5,t.handleSetFont(n,[s&&m.Name.get(s),l],null,r,i,o,null);case 5:return e.abrupt("return",o.font);case 6:case"end":return e.stop()}}),e)})));return function(t,i,a,n){return e.apply(this,arguments)}}()}]),i}(B),O=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),(n=t.call(this,e))._hasText=!0;var r=e.dict;"string"!==typeof n.data.fieldValue&&(n.data.fieldValue="");var o=(0,s.getInheritableProperty)({dict:r,key:"Q"});(!Number.isInteger(o)||o<0||o>2)&&(o=null),n.data.textAlignment=o;var l=(0,s.getInheritableProperty)({dict:r,key:"MaxLen"});return(!Number.isInteger(l)||l<0)&&(l=0),n.data.maxLen=l,n.data.multiLine=n.hasFieldFlag(a.AnnotationFieldFlag.MULTILINE),n.data.comb=n.hasFieldFlag(a.AnnotationFieldFlag.COMB)&&!n.hasFieldFlag(a.AnnotationFieldFlag.MULTILINE)&&!n.hasFieldFlag(a.AnnotationFieldFlag.PASSWORD)&&!n.hasFieldFlag(a.AnnotationFieldFlag.FILESELECT)&&0!==n.data.maxLen,n.data.doNotScroll=n.hasFieldFlag(a.AnnotationFieldFlag.DONOTSCROLL),n}return g(i,[{key:"_getCombAppearance",value:function(e,t,i,a,n,r,o,l,c,d,u){var p,m=n/this.data.maxLen,y=this.getBorderAndBackgroundAppearances(u),b=[],g=t.getCharPositions(i),v=h(g);try{for(v.s();!(p=v.n()).done;){var _=f(p.value,2),A=_[0],x=_[1];b.push("(".concat((0,s.escapeString)(i.substring(A,x)),") Tj"))}}catch(S){v.e(S)}finally{v.f()}var w=b.join(" ".concat((0,s.numberToString)(m)," 0 Td "));return"/Tx BMC q ".concat(y,"BT ")+e+" 1 0 0 1 ".concat((0,s.numberToString)(o)," ").concat((0,s.numberToString)(l+c)," Tm ").concat(w)+" ET Q EMC"}},{key:"_getMultilineAppearance",value:function(e,t,i,a,n,r,o,l,c,d,u,p){for(var m=[],h=n-2*l,f={shift:0},y=0,b=t.length;y<b;y++)for(var g=t[y],v=this._splitLine(g,i,a,h),_=0,A=v.length;_<A;_++){var x=v[_],w=0===y&&0===_?-c-(u-d):-u;m.push(this._renderText(x,i,a,n,o,f,l,w))}var S=this.getBorderAndBackgroundAppearances(p),C=m.join("\n");return"/Tx BMC q ".concat(S,"BT ")+e+" 1 0 0 1 0 ".concat((0,s.numberToString)(r)," Tm ").concat(C)+" ET Q EMC"}},{key:"_splitLine",value:function(e,t,i,a){var n=arguments.length>4&&void 0!==arguments[4]?arguments[4]:{};e=n.line||e;var r=n.glyphs||t.charsToGlyphs(e);if(r.length<=1)return[e];for(var o=n.positions||t.getCharPositions(e),s=i/1e3,l=[],c=-1,d=-1,u=-1,p=0,m=0,h=0,y=r.length;h<y;h++){var b=f(o[h],2),g=b[0],v=b[1],_=r[h],A=_.width*s;" "===_.unicode?m+A>a?(l.push(e.substring(p,g)),p=g,m=A,c=-1,u=-1):(m+=A,c=g,d=v,u=h):m+A>a?-1!==c?(l.push(e.substring(p,d)),p=d,h=u+1,c=-1,m=0):(l.push(e.substring(p,g)),p=g,m=A):m+=A}return p<e.length&&l.push(e.substring(p,e.length)),l}},{key:"getFieldObject",value:function(){return{id:this.data.id,value:this.data.fieldValue,defaultValue:this.data.defaultFieldValue||"",multiline:this.data.multiLine,password:this.hasFieldFlag(a.AnnotationFieldFlag.PASSWORD),charLimit:this.data.maxLen,comb:this.data.comb,editable:!this.data.readOnly,hidden:this.data.hidden,name:this.data.fieldName,rect:this.data.rect,actions:this.data.actions,page:this.data.pageIndex,strokeColor:this.data.borderColor,fillColor:this.data.backgroundColor,rotation:this.rotation,type:"text"}}}]),i}(N),G=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).checkedAppearance=null,n.uncheckedAppearance=null,n.data.checkBox=!n.hasFieldFlag(a.AnnotationFieldFlag.RADIO)&&!n.hasFieldFlag(a.AnnotationFieldFlag.PUSHBUTTON),n.data.radioButton=n.hasFieldFlag(a.AnnotationFieldFlag.RADIO)&&!n.hasFieldFlag(a.AnnotationFieldFlag.PUSHBUTTON),n.data.pushButton=n.hasFieldFlag(a.AnnotationFieldFlag.PUSHBUTTON),n.data.isTooltipOnly=!1,n.data.checkBox?n._processCheckBox(e):n.data.radioButton?n._processRadioButton(e):n.data.pushButton?(n.data.hasOwnCanvas=!0,n._processPushButton(e)):(0,a.warn)("Invalid field flags for button widget annotation"),n}return g(i,[{key:"getOperatorList",value:function(){var e=y(p().mark((function e(t,n,s,l,c){var d,u,m,h,f,y,b;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.data.pushButton){e.next=2;break}return e.abrupt("return",r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,!1,c));case 2:if(d=null,u=null,c&&(m=c.get(this.data.id),d=m?m.value:null,u=m?m.rotation:null),null!==d||!this.appearance){e.next=7;break}return e.abrupt("return",r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,l,c));case 7:if(null!==d&&void 0!==d||(d=this.data.checkBox?this.data.fieldValue===this.data.exportValue:this.data.fieldValue===this.data.buttonValue),!(h=d?this.checkedAppearance:this.uncheckedAppearance)){e.next=18;break}return f=this.appearance,y=h.dict.getArray("Matrix")||a.IDENTITY_MATRIX,u&&h.dict.set("Matrix",this.getRotationMatrix(c)),this.appearance=h,b=r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,l,c),this.appearance=f,h.dict.set("Matrix",y),e.abrupt("return",b);case 18:return e.abrupt("return",{opList:new k.OperatorList,separateForm:!1,separateCanvas:!1});case 19:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n,r){return e.apply(this,arguments)}}()},{key:"save",value:function(){var e=y(p().mark((function e(t,i,a){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.data.checkBox){e.next=2;break}return e.abrupt("return",this._saveCheckbox(t,i,a));case 2:if(!this.data.radioButton){e.next=4;break}return e.abrupt("return",this._saveRadioButton(t,i,a));case 4:return e.abrupt("return",null);case 5:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_saveCheckbox",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c,d,u,h,f,y;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(n){e.next=2;break}return e.abrupt("return",null);case 2:if(r=n.get(this.data.id),o=r&&r.rotation,s=r&&r.value,void 0!==o){e.next=11;break}if(void 0!==s){e.next=8;break}return e.abrupt("return",null);case 8:if(this.data.fieldValue===this.data.exportValue!==s){e.next=11;break}return e.abrupt("return",null);case 11:if((l=t.xref.fetchIfRef(this.ref))instanceof m.Dict){e.next=14;break}return e.abrupt("return",null);case 14:return void 0===o&&(o=this.rotation),void 0===s&&(s=this.data.fieldValue===this.data.exportValue),c={path:this.data.fieldName,value:s?this.data.exportValue:""},d=m.Name.get(s?this.data.exportValue:"Off"),l.set("V",d),l.set("AS",d),l.set("M","D:".concat((0,a.getModificationDate)())),(u=this._getMKDict(o))&&l.set("MK",u),h=t.xref.encrypt,f=null,h&&(f=h.createCipherTransform(this.ref.num,this.ref.gen)),y=["".concat(this.ref.num," ").concat(this.ref.gen," obj\n")],(0,v.writeDict)(l,y,f),y.push("\nendobj\n"),e.abrupt("return",[{ref:this.ref,data:y.join(""),xfa:c}]);case 30:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_saveRadioButton",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c,d,u,h,f,y,b,g,_,A;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(n){e.next=2;break}return e.abrupt("return",null);case 2:if(r=n.get(this.data.id),o=r&&r.rotation,s=r&&r.value,void 0!==o){e.next=11;break}if(void 0!==s){e.next=8;break}return e.abrupt("return",null);case 8:if(this.data.fieldValue===this.data.buttonValue!==s){e.next=11;break}return e.abrupt("return",null);case 11:if((l=t.xref.fetchIfRef(this.ref))instanceof m.Dict){e.next=14;break}return e.abrupt("return",null);case 14:return void 0===s&&(s=this.data.fieldValue===this.data.buttonValue),void 0===o&&(o=this.rotation),c={path:this.data.fieldName,value:s?this.data.buttonValue:""},d=m.Name.get(s?this.data.buttonValue:"Off"),u=null,h=t.xref.encrypt,s&&(this.parent instanceof m.Ref?(f=t.xref.fetch(this.parent),y=null,h&&(y=h.createCipherTransform(this.parent.num,this.parent.gen)),f.set("V",d),u=["".concat(this.parent.num," ").concat(this.parent.gen," obj\n")],(0,v.writeDict)(f,u,y),u.push("\nendobj\n")):this.parent instanceof m.Dict&&this.parent.set("V",d)),l.set("AS",d),l.set("M","D:".concat((0,a.getModificationDate)())),(b=this._getMKDict(o))&&l.set("MK",b),g=null,h&&(g=h.createCipherTransform(this.ref.num,this.ref.gen)),_=["".concat(this.ref.num," ").concat(this.ref.gen," obj\n")],(0,v.writeDict)(l,_,g),_.push("\nendobj\n"),A=[{ref:this.ref,data:_.join(""),xfa:c}],null!==u&&A.push({ref:this.parent,data:u.join(""),xfa:null}),e.abrupt("return",A);case 33:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_getDefaultCheckedAppearance",value:function(e,t){var i,n,r=this.data.rect[2]-this.data.rect[0],o=this.data.rect[3]-this.data.rect[1],l=[0,0,r,o],c=.8*Math.min(r,o);"check"===t?(i={width:.755*c,height:.705*c},n="3"):"disc"===t?(i={width:.791*c,height:.705*c},n="l"):(0,a.unreachable)("_getDefaultCheckedAppearance - unsupported type: ".concat(t));var d=(0,s.numberToString)((r-i.width)/2),u=(0,s.numberToString)((o-i.height)/2),p="q BT /PdfJsZaDb ".concat(c," Tf 0 g ").concat(d," ").concat(u," Td (").concat(n,") Tj ET Q"),h=new m.Dict(e.xref);h.set("FormType",1),h.set("Subtype",m.Name.get("Form")),h.set("Type",m.Name.get("XObject")),h.set("BBox",l),h.set("Matrix",[1,0,0,1,0,0]),h.set("Length",p.length);var f=new m.Dict(e.xref),y=new m.Dict(e.xref);y.set("PdfJsZaDb",this.fallbackFontDict),f.set("Font",y),h.set("Resources",f),this.checkedAppearance=new D.StringStream(p),this.checkedAppearance.dict=h,this._streams.push(this.checkedAppearance)}},{key:"_processCheckBox",value:function(e){var t=e.dict.get("AP");if(t instanceof m.Dict){var i=t.get("N");if(i instanceof m.Dict){var a=this._decodeFormValue(e.dict.get("AS"));"string"===typeof a&&(this.data.fieldValue=a);var n=null!==this.data.fieldValue&&"Off"!==this.data.fieldValue?this.data.fieldValue:"Yes",r=i.getKeys();if(0===r.length)r.push("Off",n);else if(1===r.length)"Off"===r[0]?r.push(n):r.unshift("Off");else if(r.includes(n))r.length=0,r.push("Off",n);else{var o=r.find((function(e){return"Off"!==e}));r.length=0,r.push("Off",o)}r.includes(this.data.fieldValue)||(this.data.fieldValue="Off"),this.data.exportValue=r[1];var s=i.get(this.data.exportValue);this.checkedAppearance=s instanceof _.BaseStream?s:null;var l=i.get("Off");this.uncheckedAppearance=l instanceof _.BaseStream?l:null,this.checkedAppearance?this._streams.push(this.checkedAppearance):this._getDefaultCheckedAppearance(e,"check"),this.uncheckedAppearance&&this._streams.push(this.uncheckedAppearance),this._fallbackFontDict=this.fallbackFontDict}}}},{key:"_processRadioButton",value:function(e){this.data.fieldValue=this.data.buttonValue=null;var t=e.dict.get("Parent");if(t instanceof m.Dict){this.parent=e.dict.getRaw("Parent");var i=t.get("V");i instanceof m.Name&&(this.data.fieldValue=this._decodeFormValue(i))}var a=e.dict.get("AP");if(a instanceof m.Dict){var n=a.get("N");if(n instanceof m.Dict){var r,o=h(n.getKeys());try{for(o.s();!(r=o.n()).done;){var s=r.value;if("Off"!==s){this.data.buttonValue=this._decodeFormValue(s);break}}}catch(d){o.e(d)}finally{o.f()}var l=n.get(this.data.buttonValue);this.checkedAppearance=l instanceof _.BaseStream?l:null;var c=n.get("Off");this.uncheckedAppearance=c instanceof _.BaseStream?c:null,this.checkedAppearance?this._streams.push(this.checkedAppearance):this._getDefaultCheckedAppearance(e,"disc"),this.uncheckedAppearance&&this._streams.push(this.uncheckedAppearance),this._fallbackFontDict=this.fallbackFontDict}}}},{key:"_processPushButton",value:function(e){e.dict.has("A")||e.dict.has("AA")||this.data.alternativeText?(this.data.isTooltipOnly=!e.dict.has("A")&&!e.dict.has("AA"),x.Catalog.parseDestDictionary({destDict:e.dict,resultObj:this.data,docBaseUrl:e.pdfManager.docBaseUrl,docAttachments:e.attachments})):(0,a.warn)("Push buttons without action dictionaries are not supported")}},{key:"getFieldObject",value:function(){var e,t="button";return this.data.checkBox?(t="checkbox",e=this.data.exportValue):this.data.radioButton&&(t="radiobutton",e=this.data.buttonValue),{id:this.data.id,value:this.data.fieldValue||"Off",defaultValue:this.data.defaultFieldValue,exportValues:e,editable:!this.data.readOnly,name:this.data.fieldName,rect:this.data.rect,hidden:this.data.hidden,actions:this.data.actions,page:this.data.pageIndex,strokeColor:this.data.borderColor,fillColor:this.data.backgroundColor,rotation:this.rotation,type:t}}},{key:"fallbackFontDict",get:function(){var e=new m.Dict;return e.set("BaseFont",m.Name.get("ZapfDingbats")),e.set("Type",m.Name.get("FallbackType")),e.set("Subtype",m.Name.get("FallbackType")),e.set("Encoding",m.Name.get("ZapfDingbatsEncoding")),(0,a.shadow)(this,"fallbackFontDict",e)}}]),i}(N),L=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=e.xref;n.indices=r.getArray("I"),n.hasIndices=Array.isArray(n.indices)&&n.indices.length>0,n.data.options=[];var l=(0,s.getInheritableProperty)({dict:r,key:"Opt"});if(Array.isArray(l))for(var c=0,d=l.length;c<d;c++){var u=o.fetchIfRef(l[c]),p=Array.isArray(u);n.data.options[c]={exportValue:n._decodeFormValue(p?o.fetchIfRef(u[0]):u),displayValue:n._decodeFormValue(p?o.fetchIfRef(u[1]):u)}}if(n.hasIndices){n.data.fieldValue=[];var m,f=n.data.options.length,y=h(n.indices);try{for(y.s();!(m=y.n()).done;){var g=m.value;Number.isInteger(g)&&g>=0&&g<f&&n.data.fieldValue.push(n.data.options[g].exportValue)}}catch(v){y.e(v)}finally{y.f()}}else"string"===typeof n.data.fieldValue?n.data.fieldValue=[n.data.fieldValue]:n.data.fieldValue||(n.data.fieldValue=[]);return n.data.combo=n.hasFieldFlag(a.AnnotationFieldFlag.COMBO),n.data.multiSelect=n.hasFieldFlag(a.AnnotationFieldFlag.MULTISELECT),n._hasText=!0,n}return g(i,[{key:"getFieldObject",value:function(){var e=this.data.combo?"combobox":"listbox",t=this.data.fieldValue.length>0?this.data.fieldValue[0]:null;return{id:this.data.id,value:t,defaultValue:this.data.defaultFieldValue,editable:!this.data.readOnly,name:this.data.fieldName,rect:this.data.rect,numItems:this.data.fieldValue.length,multipleSelection:this.data.multiSelect,hidden:this.data.hidden,actions:this.data.actions,items:this.data.options,page:this.data.pageIndex,strokeColor:this.data.borderColor,fillColor:this.data.backgroundColor,rotation:this.rotation,type:e}}},{key:"amendSavedDict",value:function(e,t){if(this.hasIndices){var i=e?e.get(this.data.id):void 0,a=i&&i.value;Array.isArray(a)||(a=[a]);for(var n=[],r=this.data.options,o=0,s=0,l=r.length;o<l;o++)r[o].exportValue===a[s]&&(n.push(o),s+=1);t.set("I",n)}}},{key:"_getAppearance",value:function(){var e=y(p().mark((function e(t,n,s,l){var d,u,m,y,b,g,v,_,A,x,w,S,C,k,D,R,I,M,T,P,z,B,F,E,O,G,L,j,q,H,U,Y,X,V,Q,W,Z,J;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.data.combo){e.next=2;break}return e.abrupt("return",r(o(i.prototype),"_getAppearance",this).call(this,t,n,s,l));case 2:if((m=l?l.get(this.data.id):void 0)&&(u=m.rotation,d=m.value),void 0!==u||void 0!==d||this._needAppearances){e.next=6;break}return e.abrupt("return",null);case 6:for(void 0===d?d=this.data.fieldValue:Array.isArray(d)||(d=[d]),y=1,b=2,g=this.data.rect[3]-this.data.rect[1],v=this.data.rect[2]-this.data.rect[0],90!==u&&270!==u||(v=(_=[g,v])[0],g=_[1]),A=this.data.options.length,x=[],w=0;w<A;w++)S=this.data.options[w].exportValue,d.includes(S)&&x.push(w);return this._defaultAppearance||(this.data.defaultAppearanceData=(0,c.parseDefaultAppearance)(this._defaultAppearance="/Helvetica 0 Tf 0 g")),e.next=18,N._getFontData(t,n,this.data.defaultAppearanceData,this._fieldResources.mergedResources);case 18:if(C=e.sent,D=this.data.defaultAppearanceData.fontSize)k=this._defaultAppearance;else{R=(g-y)/A,I=-1,T=h(this.data.options);try{for(T.s();!(P=T.n()).done;)z=P.value.displayValue,(B=this._getTextWidth(z,C))>I&&(I=B,M=z)}catch(p){T.e(p)}finally{T.f()}F=this._computeFontSize(R,v-2*b,M,C,-1),E=f(F,2),k=E[0],D=E[1]}if(O=D*a.LINE_FACTOR,G=(O-D)/2,L=Math.floor(g/O),1===x.length?(q=x[0],j=q-q%L):j=x.length?x[0]:0,H=Math.min(j+L+1,A),U=["/Tx BMC q","1 1 ".concat(v," ").concat(g," re W n")],x.length){U.push("0.600006 0.756866 0.854904 rg"),Y=h(x);try{for(Y.s();!(X=Y.n()).done;)V=X.value,j<=V&&V<H&&U.push("1 ".concat(g-(V-j+1)*O," ").concat(v," ").concat(O," re f"))}catch(p){Y.e(p)}finally{Y.f()}}for(U.push("BT",k,"1 0 0 1 0 ".concat(g," Tm")),Q={shift:0},W=j;W<H;W++)Z=this.data.options[W].displayValue,J=W===j?G:0,U.push(this._renderText(Z,C,D,v,0,Q,b,-O+J));return U.push("ET Q EMC"),e.abrupt("return",U.join("\n"));case 33:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n){return e.apply(this,arguments)}}()}]),i}(N),j=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this,e)).data.fieldValue=null,a}return g(i,[{key:"getFieldObject",value:function(){return{id:this.data.id,value:null,page:this.data.pageIndex,type:"signature"}}}]),i}(N),q=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict;return n.data.annotationType=a.AnnotationType.TEXT,n.data.hasAppearance?n.data.name="NoIcon":(n.data.rect[1]=n.data.rect[3]-22,n.data.rect[2]=n.data.rect[0]+22,n.data.name=r.has("Name")?r.get("Name").name:"Note"),r.has("State")?(n.data.state=r.get("State")||null,n.data.stateModel=r.get("StateModel")||null):(n.data.state=null,n.data.stateModel=null),n}return g(i)}(E),H=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.LINK;var r=P(e.dict,n.rectangle);return r&&(n.data.quadPoints=r),n.data.borderColor=n.data.borderColor||n.data.color,x.Catalog.parseDestDictionary({destDict:e.dict,resultObj:n.data,docBaseUrl:e.pdfManager.docBaseUrl,docAttachments:e.attachments}),n}return g(i)}(B),U=function(e){d(i,e);var t=u(i);function i(e){var r;b(this,i),r=t.call(this,e);var o=e.dict;r.data.annotationType=a.AnnotationType.POPUP;var s=o.get("Parent");if(!s)return(0,a.warn)("Popup annotation has a missing or invalid parent annotation."),n(r);var l=s.get("Subtype");r.data.parentType=l instanceof m.Name?l.name:null;var c=o.getRaw("Parent");r.data.parentId=c instanceof m.Ref?c.toString():null;var d=s.getArray("Rect");Array.isArray(d)&&4===d.length?r.data.parentRect=a.Util.normalizeRect(d):r.data.parentRect=[0,0,0,0];var u=s.get("RT");if((0,m.isName)(u,a.AnnotationReplyType.GROUP)&&(s=s.get("IRT")),s.has("M")?(r.setModificationDate(s.get("M")),r.data.modificationDate=r.modificationDate):r.data.modificationDate=null,s.has("C")?(r.setColor(s.getArray("C")),r.data.color=r.color):r.data.color=null,!r.viewable){var p=s.get("F");r._isViewable(p)&&r.setFlags(p)}return r.setTitle(s.get("T")),r.data.titleObj=r._title,r.setContents(s.get("Contents")),r.data.contentsObj=r._contents,s.has("RC")&&(r.data.richText=R.XFAFactory.getRichTextAsHtml(s.get("RC"))),r}return g(i)}(B);t.PopupAnnotation=U;var Y=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.xref;if(n.data.annotationType=a.AnnotationType.FREETEXT,n.setDefaultAppearance(e),!n.appearance&&n._isOffscreenCanvasSupported){var o=e.dict.get("CA"),s=new c.FakeUnicodeFont(r,"sans-serif"),l=n.data.defaultAppearanceData;n.appearance=s.createAppearance(n._contents.str,n.rectangle,n.rotation,l.fontSize||10,l.fontColor,o),n._streams.push(n.appearance,c.FakeUnicodeFont.toUnicodeStream)}else n._isOffscreenCanvasSupported||(0,a.warn)("FreeTextAnnotation: OffscreenCanvas is not supported, annotation may not render correctly.");return n}return g(i,[{key:"hasTextContent",get:function(){return!!this.appearance}}],[{key:"createNewDict",value:function(e,t,i){var n=i.apRef,r=i.ap,o=e.color,l=e.fontSize,d=e.rect,u=e.rotation,p=e.user,h=e.value,f=new m.Dict(t);f.set("Type",m.Name.get("Annot")),f.set("Subtype",m.Name.get("FreeText")),f.set("CreationDate","D:".concat((0,a.getModificationDate)())),f.set("Rect",d);var y="/Helv ".concat(l," Tf ").concat((0,c.getPdfColor)(o,!0));if(f.set("DA",y),f.set("Contents",(0,s.isAscii)(h)?h:(0,s.stringToUTF16String)(h,!0)),f.set("F",4),f.set("Border",[0,0,0]),f.set("Rotate",u),p&&f.set("T",(0,s.isAscii)(p)?p:(0,s.stringToUTF16String)(p,!0)),n||r){var b=new m.Dict(t);f.set("AP",b),n?b.set("N",n):b.set("N",r)}return f}},{key:"createNewAppearanceStream",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,l,d,u,y,b,g,v,_,A,x,w,S,C,k,R,I,M,T,P,z,B,F,E,O,G,L,j,q,H,U,Y,X,V,Q,W,Z,J,K,$,ee,te,ie,ae,ne,re,oe,se;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return r=n.baseFontRef,o=n.evaluator,l=n.task,d=t.color,u=t.fontSize,y=t.rect,b=t.rotation,g=t.value,v=new m.Dict(i),_=new m.Dict(i),r?_.set("Helv",r):((A=new m.Dict(i)).set("BaseFont",m.Name.get("Helvetica")),A.set("Type",m.Name.get("Font")),A.set("Subtype",m.Name.get("Type1")),A.set("Encoding",m.Name.get("WinAnsiEncoding")),_.set("Helv",A)),v.set("Font",_),e.next=8,N._getFontData(o,l,{fontName:"Helvetica",fontSize:u},v);case 8:x=e.sent,w=f(y,4),S=w[0],C=w[1],k=w[2],R=w[3],I=k-S,M=R-C,b%180!==0&&(I=(T=[M,I])[0],M=T[1]),P=g.split("\n"),z=u/1e3,B=-1/0,F=[],E=h(P),e.prev=18,E.s();case 20:if((O=E.n()).done){e.next=34;break}if(G=O.value,!((L=x.encodeString(G)).length>1)){e.next=25;break}return e.abrupt("return",null);case 25:G=L.join(""),F.push(G),j=0,q=x.charsToGlyphs(G),H=h(q);try{for(H.s();!(U=H.n()).done;)Y=U.value,j+=Y.width*z}catch(p){H.e(p)}finally{H.f()}B=Math.max(B,j);case 32:e.next=20;break;case 34:e.next=39;break;case 36:e.prev=36,e.t0=e.catch(18),E.e(e.t0);case 39:return e.prev=39,E.f(),e.finish(39);case 42:for(X=1,B>I&&(X=I/B),V=1,Q=a.LINE_FACTOR*u,W=a.LINE_DESCENT_FACTOR*u,(Z=Q*P.length)>M&&(V=M/Z),J=Math.min(X,V),K=u*J,$=["q","0 0 ".concat((0,s.numberToString)(I)," ").concat((0,s.numberToString)(M)," re W n"),"BT","1 0 0 1 0 ".concat((0,s.numberToString)(M+W)," Tm 0 Tc ").concat((0,c.getPdfColor)(d,!0)),"/Helv ".concat((0,s.numberToString)(K)," Tf")],ee=(0,s.numberToString)(Q),te=0,ie=F;te<ie.length;te++)ae=ie[te],$.push("0 -".concat(ee," Td (").concat((0,s.escapeString)(ae),") Tj"));return $.push("ET","Q"),ne=$.join("\n"),(re=new m.Dict(i)).set("FormType",1),re.set("Subtype",m.Name.get("Form")),re.set("Type",m.Name.get("XObject")),re.set("BBox",[0,0,I,M]),re.set("Resources",v),b&&(oe=(0,s.getRotationMatrix)(b,I,M),re.set("Matrix",oe)),(se=new D.StringStream(ne)).dict=re,e.abrupt("return",se);case 66:case"end":return e.stop()}}),e,null,[[18,36,39,42]])})));return function(t,i,a){return e.apply(this,arguments)}}()}]),i}(E),X=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=e.xref;n.data.annotationType=a.AnnotationType.LINE;var s=r.getArray("L");if(n.data.lineCoordinates=a.Util.normalizeRect(s),n.setLineEndings(r.getArray("LE")),n.data.lineEndings=n.lineEndings,!n.appearance){var l=n.color?T(n.color):[0,0,0],c=r.get("CA"),d=M(r.getArray("IC"),null),u=d?T(d):null,p=u?c:null,m=n.borderStyle.width||1,h=2*m,f=[n.data.lineCoordinates[0]-h,n.data.lineCoordinates[1]-h,n.data.lineCoordinates[2]+h,n.data.lineCoordinates[3]+h];a.Util.intersect(n.rectangle,f)||(n.rectangle=f),n._setDefaultAppearance({xref:o,extra:"".concat(m," w"),strokeColor:l,fillColor:u,strokeAlpha:c,fillAlpha:p,pointsCallback:function(e,t){return e.push("".concat(s[0]," ").concat(s[1]," m"),"".concat(s[2]," ").concat(s[3]," l"),"S"),[t[0].x-m,t[1].x+m,t[3].y-m,t[1].y+m]}})}return n}return g(i)}(E),V=function(e){d(i,e);var t=u(i);function i(e){var r;b(this,i),r=t.call(this,e);var o=e.dict,s=e.xref;if(r.data.annotationType=a.AnnotationType.SQUARE,!r.appearance){var l=r.color?T(r.color):[0,0,0],c=o.get("CA"),d=M(o.getArray("IC"),null),u=d?T(d):null,p=u?c:null;if(0===r.borderStyle.width&&!u)return n(r);r._setDefaultAppearance({xref:s,extra:"".concat(r.borderStyle.width," w"),strokeColor:l,fillColor:u,strokeAlpha:c,fillAlpha:p,pointsCallback:function(e,t){var i=t[2].x+r.borderStyle.width/2,a=t[2].y+r.borderStyle.width/2,n=t[3].x-t[2].x-r.borderStyle.width,o=t[1].y-t[3].y-r.borderStyle.width;return e.push("".concat(i," ").concat(a," ").concat(n," ").concat(o," re")),u?e.push("B"):e.push("S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}return r}return g(i)}(E),Q=function(e){d(i,e);var t=u(i);function i(e){var r;b(this,i),r=t.call(this,e);var o=e.dict,s=e.xref;if(r.data.annotationType=a.AnnotationType.CIRCLE,!r.appearance){var l=r.color?T(r.color):[0,0,0],c=o.get("CA"),d=M(o.getArray("IC"),null),u=d?T(d):null,p=u?c:null;if(0===r.borderStyle.width&&!u)return n(r);var m=4/3*Math.tan(Math.PI/8);r._setDefaultAppearance({xref:s,extra:"".concat(r.borderStyle.width," w"),strokeColor:l,fillColor:u,strokeAlpha:c,fillAlpha:p,pointsCallback:function(e,t){var i=t[0].x+r.borderStyle.width/2,a=t[0].y-r.borderStyle.width/2,n=t[3].x-r.borderStyle.width/2,o=t[3].y+r.borderStyle.width/2,s=i+(n-i)/2,l=a+(o-a)/2,c=(n-i)/2*m,d=(o-a)/2*m;return e.push("".concat(s," ").concat(o," m"),"".concat(s+c," ").concat(o," ").concat(n," ").concat(l+d," ").concat(n," ").concat(l," c"),"".concat(n," ").concat(l-d," ").concat(s+c," ").concat(a," ").concat(s," ").concat(a," c"),"".concat(s-c," ").concat(a," ").concat(i," ").concat(l-d," ").concat(i," ").concat(l," c"),"".concat(i," ").concat(l+d," ").concat(s-c," ").concat(o," ").concat(s," ").concat(o," c"),"h"),u?e.push("B"):e.push("S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}return r}return g(i)}(E),W=function(e){d(i,e);var t=u(i);function i(e){var r;b(this,i),r=t.call(this,e);var o=e.dict,s=e.xref;r.data.annotationType=a.AnnotationType.POLYLINE,r.data.vertices=[],l(r)instanceof Z||(r.setLineEndings(o.getArray("LE")),r.data.lineEndings=r.lineEndings);var c=o.getArray("Vertices");if(!Array.isArray(c))return n(r);for(var d=0,u=c.length;d<u;d+=2)r.data.vertices.push({x:c[d],y:c[d+1]});if(!r.appearance){var p,m=r.color?T(r.color):[0,0,0],f=o.get("CA"),y=r.borderStyle.width||1,g=2*y,v=[1/0,1/0,-1/0,-1/0],_=h(r.data.vertices);try{for(_.s();!(p=_.n()).done;){var A=p.value;v[0]=Math.min(v[0],A.x-g),v[1]=Math.min(v[1],A.y-g),v[2]=Math.max(v[2],A.x+g),v[3]=Math.max(v[3],A.y+g)}}catch(x){_.e(x)}finally{_.f()}a.Util.intersect(r.rectangle,v)||(r.rectangle=v),r._setDefaultAppearance({xref:s,extra:"".concat(y," w"),strokeColor:m,strokeAlpha:f,pointsCallback:function(e,t){for(var i=r.data.vertices,a=0,n=i.length;a<n;a++)e.push("".concat(i[a].x," ").concat(i[a].y," ").concat(0===a?"m":"l"));return e.push("S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}return r}return g(i)}(E),Z=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.POLYGON,n}return g(i)}(W),J=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.CARET,n}return g(i)}(E),K=function(e){d(i,e);var t=u(i);function i(e){var r;b(this,i),r=t.call(this,e);var o=e.dict,s=e.xref;r.data.annotationType=a.AnnotationType.INK,r.data.inkLists=[];var l=o.getArray("InkList");if(!Array.isArray(l))return n(r);for(var c=0,d=l.length;c<d;++c){r.data.inkLists.push([]);for(var u=0,p=l[c].length;u<p;u+=2)r.data.inkLists[c].push({x:s.fetchIfRef(l[c][u]),y:s.fetchIfRef(l[c][u+1])})}if(!r.appearance){var m,f=r.color?T(r.color):[0,0,0],y=o.get("CA"),g=r.borderStyle.width||1,v=2*g,_=[1/0,1/0,-1/0,-1/0],A=h(r.data.inkLists);try{for(A.s();!(m=A.n()).done;){var x,w=m.value,S=h(w);try{for(S.s();!(x=S.n()).done;){var C=x.value;_[0]=Math.min(_[0],C.x-v),_[1]=Math.min(_[1],C.y-v),_[2]=Math.max(_[2],C.x+v),_[3]=Math.max(_[3],C.y+v)}}catch(k){S.e(k)}finally{S.f()}}}catch(k){A.e(k)}finally{A.f()}a.Util.intersect(r.rectangle,_)||(r.rectangle=_),r._setDefaultAppearance({xref:s,extra:"".concat(g," w"),strokeColor:f,strokeAlpha:y,pointsCallback:function(e,t){var i,a=h(r.data.inkLists);try{for(a.s();!(i=a.n()).done;){for(var n=i.value,o=0,s=n.length;o<s;o++)e.push("".concat(n[o].x," ").concat(n[o].y," ").concat(0===o?"m":"l"));e.push("S")}}catch(k){a.e(k)}finally{a.f()}return[t[0].x,t[1].x,t[3].y,t[1].y]}})}return r}return g(i,null,[{key:"createNewDict",value:function(e,t,i){var n=i.apRef,r=i.ap,o=e.paths,s=e.rect,l=e.rotation,c=new m.Dict(t);c.set("Type",m.Name.get("Annot")),c.set("Subtype",m.Name.get("Ink")),c.set("CreationDate","D:".concat((0,a.getModificationDate)())),c.set("Rect",s),c.set("InkList",o.map((function(e){return e.points}))),c.set("F",4),c.set("Border",[0,0,0]),c.set("Rotate",l);var d=new m.Dict(t);return c.set("AP",d),n?d.set("N",n):d.set("N",r),c}},{key:"createNewAppearanceStream",value:function(){var e=y(p().mark((function e(t,i,a){var n,r,o,l,d,u,y,b,g,v,_,A,x,w,S,C,k,R,I,M,T,P,z,B,F,E,N,O,G;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:n=t.color,r=t.rect,o=t.rotation,l=t.paths,d=t.thickness,u=t.opacity,y=f(r,4),b=y[0],g=y[1],v=y[2],_=y[3],A=v-b,x=_-g,o%180!==0&&(A=(w=[x,A])[0],x=w[1]),S=["".concat(d," w 1 J 1 j"),"".concat((0,c.getPdfColor)(n,!1))],1!==u&&S.push("/R0 gs"),C=[],k=h(l);try{for(k.s();!(R=k.n()).done;){for(I=R.value.bezier,C.length=0,C.push("".concat((0,s.numberToString)(I[0])," ").concat((0,s.numberToString)(I[1])," m")),M=2,T=I.length;M<T;M+=6)P=I.slice(M,M+6).map(s.numberToString).join(" "),C.push("".concat(P," c"));C.push("S"),S.push(C.join("\n"))}}catch(a){k.e(a)}finally{k.f()}return z=S.join("\n"),(B=new m.Dict(i)).set("FormType",1),B.set("Subtype",m.Name.get("Form")),B.set("Type",m.Name.get("XObject")),B.set("BBox",[0,0,A,x]),B.set("Length",z.length),o&&(F=(0,s.getRotationMatrix)(o,A,x),B.set("Matrix",F)),1!==u&&(E=new m.Dict(i),N=new m.Dict(i),(O=new m.Dict(i)).set("CA",u),O.set("Type",m.Name.get("ExtGState")),N.set("R0",O),E.set("ExtGState",N),B.set("Resources",E)),(G=new D.StringStream(z)).dict=B,e.abrupt("return",G);case 22:case"end":return e.stop()}}),e)})));return function(t,i,a){return e.apply(this,arguments)}}()}]),i}(E),$=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=e.xref;if(n.data.annotationType=a.AnnotationType.HIGHLIGHT,n.data.quadPoints=P(r,null)){var s=n.appearance&&n.appearance.dict.get("Resources");if(!n.appearance||!s||!s.has("ExtGState")){n.appearance&&(0,a.warn)("HighlightAnnotation - ignoring built-in appearance stream.");var l=n.color?T(n.color):[1,1,0],c=r.get("CA");n._setDefaultAppearance({xref:o,fillColor:l,blendMode:"Multiply",fillAlpha:c,pointsCallback:function(e,t){return e.push("".concat(t[0].x," ").concat(t[0].y," m"),"".concat(t[1].x," ").concat(t[1].y," l"),"".concat(t[3].x," ").concat(t[3].y," l"),"".concat(t[2].x," ").concat(t[2].y," l"),"f"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}}else n.data.hasPopup=!1;return n}return g(i)}(E),ee=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=e.xref;if(n.data.annotationType=a.AnnotationType.UNDERLINE,n.data.quadPoints=P(r,null)){if(!n.appearance){var s=n.color?T(n.color):[0,0,0],l=r.get("CA");n._setDefaultAppearance({xref:o,extra:"[] 0 d 1 w",strokeColor:s,strokeAlpha:l,pointsCallback:function(e,t){return e.push("".concat(t[2].x," ").concat(t[2].y," m"),"".concat(t[3].x," ").concat(t[3].y," l"),"S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}}else n.data.hasPopup=!1;return n}return g(i)}(E),te=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=e.xref;if(n.data.annotationType=a.AnnotationType.SQUIGGLY,n.data.quadPoints=P(r,null)){if(!n.appearance){var s=n.color?T(n.color):[0,0,0],l=r.get("CA");n._setDefaultAppearance({xref:o,extra:"[] 0 d 1 w",strokeColor:s,strokeAlpha:l,pointsCallback:function(e,t){var i=(t[0].y-t[2].y)/6,a=i,n=t[2].x,r=t[2].y,o=t[3].x;e.push("".concat(n," ").concat(r+a," m"));do{n+=2,a=0===a?i:0,e.push("".concat(n," ").concat(r+a," l"))}while(n<o);return e.push("S"),[t[2].x,o,r-2*i,r+2*i]}})}}else n.data.hasPopup=!1;return n}return g(i)}(E),ie=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=e.xref;if(n.data.annotationType=a.AnnotationType.STRIKEOUT,n.data.quadPoints=P(r,null)){if(!n.appearance){var s=n.color?T(n.color):[0,0,0],l=r.get("CA");n._setDefaultAppearance({xref:o,extra:"[] 0 d 1 w",strokeColor:s,strokeAlpha:l,pointsCallback:function(e,t){return e.push("".concat((t[0].x+t[2].x)/2," ")+"".concat((t[0].y+t[2].y)/2," m"),"".concat((t[1].x+t[3].x)/2," ")+"".concat((t[1].y+t[3].y)/2," l"),"S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}}else n.data.hasPopup=!1;return n}return g(i)}(E),ae=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.STAMP,n}return g(i)}(E),ne=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=e.xref,s=new S.FileSpec(r.get("FS"),o);n.data.annotationType=a.AnnotationType.FILEATTACHMENT,n.data.file=s.serializable;var l=r.get("Name");return n.data.name=l instanceof m.Name?(0,a.stringToPDFString)(l.name):"PushPin",n}return g(i)}(E)},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.FakeUnicodeFont=void 0,t.createDefaultAppearance=function(e){var t=e.fontSize,i=e.fontName,a=e.fontColor;return"/".concat((0,n.escapePDFName)(i)," ").concat(t," Tf ").concat(m(a,!0))},t.getPdfColor=m,t.parseDefaultAppearance=function(e){return new p(e).parse()};var a=i(137),n=i(136),r=i(2),o=i(145),s=i(146),l=i(141),p=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,new l.StringStream(e))}return g(i,[{key:"parse",value:function(){var e={fn:0,args:[]},t={fontSize:0,fontName:"",fontColor:new Uint8ClampedArray(3)};try{for(;e.args.length=0,this.read(e);)if(0===this.savedStatesDepth){var i=e.fn,n=e.args;switch(0|i){case r.OPS.setFont:var s=f(n,2),l=s[0],c=s[1];l instanceof a.Name&&(t.fontName=l.name),"number"===typeof c&&c>0&&(t.fontSize=c);break;case r.OPS.setFillRGBColor:o.ColorSpace.singletons.rgb.getRgbItem(n,0,t.fontColor,0);break;case r.OPS.setFillGray:o.ColorSpace.singletons.gray.getRgbItem(n,0,t.fontColor,0);break;case r.OPS.setFillColorSpace:o.ColorSpace.singletons.cmyk.getRgbItem(n,0,t.fontColor,0)}}}catch(d){(0,r.warn)('parseDefaultAppearance - ignoring errors: "'.concat(d,'".'))}return t}}]),i}(s.EvaluatorPreprocessor);function m(e,t){if(e[0]===e[1]&&e[1]===e[2]){var i=e[0]/255;return"".concat((0,n.numberToString)(i)," ").concat(t?"g":"G")}return Array.from(e,(function(e){return(0,n.numberToString)(e/255)})).join(" ")+" ".concat(t?"rg":"RG")}var y=function(){function e(t,i){b(this,e),this.xref=t,this.widths=null,this.firstChar=1/0,this.lastChar=-1/0,this.fontFamily=i;var n=new OffscreenCanvas(1,1);this.ctxMeasure=n.getContext("2d"),e._fontNameId||(e._fontNameId=1),this.fontName=a.Name.get("InvalidPDFjsFont_".concat(i,"_").concat(e._fontNameId++))}return g(e,[{key:"toUnicodeRef",get:function(){if(!e._toUnicodeRef){var t="/CIDInit /ProcSet findresource begin\n12 dict begin\nbegincmap\n/CIDSystemInfo\n<< /Registry (Adobe)\n/Ordering (UCS) /Supplement 0 >> def\n/CMapName /Adobe-Identity-UCS def\n/CMapType 2 def\n1 begincodespacerange\n<0000> <FFFF>\nendcodespacerange\n1 beginbfrange\n<0000> <FFFF> <0000>\nendbfrange\nendcmap CMapName currentdict /CMap defineresource pop end end",i=e.toUnicodeStream=new l.StringStream(t),n=new a.Dict(this.xref);i.dict=n,n.set("Length",t.length),e._toUnicodeRef=this.xref.getNewPersistentRef(i)}return e._toUnicodeRef}},{key:"fontDescriptorRef",get:function(){if(!e._fontDescriptorRef){var t=new a.Dict(this.xref);t.set("Type",a.Name.get("FontDescriptor")),t.set("FontName",this.fontName),t.set("FontFamily","MyriadPro Regular"),t.set("FontBBox",[0,0,0,0]),t.set("FontStretch",a.Name.get("Normal")),t.set("FontWeight",400),t.set("ItalicAngle",0),e._fontDescriptorRef=this.xref.getNewPersistentRef(t)}return e._fontDescriptorRef}},{key:"descendantFontRef",get:function(){var e=new a.Dict(this.xref);e.set("BaseFont",this.fontName),e.set("Type",a.Name.get("Font")),e.set("Subtype",a.Name.get("CIDFontType0")),e.set("CIDToGIDMap",a.Name.get("Identity")),e.set("FirstChar",this.firstChar),e.set("LastChar",this.lastChar),e.set("FontDescriptor",this.fontDescriptorRef),e.set("DW",1e3);var t,i=[],n=c(this.widths.entries()).sort(),r=null,o=null,s=h(n);try{for(s.s();!(t=s.n()).done;){var l=f(t.value,2),d=l[0],u=l[1];r?d===r+o.length?o.push(u):(i.push(r,o),r=d,o=[u]):(r=d,o=[u])}}catch(m){s.e(m)}finally{s.f()}r&&i.push(r,o),e.set("W",i);var p=new a.Dict(this.xref);return p.set("Ordering","Identity"),p.set("Registry","Adobe"),p.set("Supplement",0),e.set("CIDSystemInfo",p),this.xref.getNewPersistentRef(e)}},{key:"baseFontRef",get:function(){var e=new a.Dict(this.xref);return e.set("BaseFont",this.fontName),e.set("Type",a.Name.get("Font")),e.set("Subtype",a.Name.get("Type0")),e.set("Encoding",a.Name.get("Identity-H")),e.set("DescendantFonts",[this.descendantFontRef]),e.set("ToUnicode",this.toUnicodeRef),this.xref.getNewPersistentRef(e)}},{key:"resources",get:function(){var e=new a.Dict(this.xref),t=new a.Dict(this.xref);return t.set(this.fontName.name,this.baseFontRef),e.set("Font",t),e}},{key:"_createContext",value:function(){return this.widths=new Map,this.ctxMeasure.font="1000px ".concat(this.fontFamily),this.ctxMeasure}},{key:"createFontResources",value:function(e){var t,i=this._createContext(),a=h(e.split(/\r\n?|\n/));try{for(a.s();!(t=a.n()).done;){var n,r=t.value,o=h(r.split(""));try{for(o.s();!(n=o.n()).done;){var s=n.value,l=s.charCodeAt(0);if(!this.widths.has(l)){var c=i.measureText(s),d=Math.ceil(c.width);this.widths.set(l,d),this.firstChar=Math.min(l,this.firstChar),this.lastChar=Math.max(l,this.lastChar)}}}catch(u){o.e(u)}finally{o.f()}}}catch(u){a.e(u)}finally{a.f()}return this.resources}},{key:"createAppearance",value:function(e,t,i,o,s,c){var d,u=this._createContext(),p=[],y=-1/0,b=h(e.split(/\r\n?|\n/));try{for(b.s();!(d=b.n()).done;){var g=d.value;p.push(g);var v=u.measureText(g).width;y=Math.max(y,v);var _,A=h(g.split(""));try{for(A.s();!(_=A.n()).done;){var x=_.value,w=x.charCodeAt(0),S=this.widths.get(w);if(void 0===S){var C=u.measureText(x);S=Math.ceil(C.width),this.widths.set(w,S),this.firstChar=Math.min(w,this.firstChar),this.lastChar=Math.max(w,this.lastChar)}}}catch(Z){A.e(Z)}finally{A.f()}}}catch(Z){b.e(Z)}finally{b.f()}y*=o/1e3;var k=f(t,4),D=k[0],R=k[1],I=k[2]-D,M=k[3]-R;if(i%180!==0){var T=[M,I];I=T[0],M=T[1]}var P=1;y>I&&(P=I/y);var z=1,B=r.LINE_FACTOR*o,F=r.LINE_DESCENT_FACTOR*o,E=B*p.length;E>M&&(z=M/E);var N=o*Math.min(P,z),O=["q","0 0 ".concat((0,n.numberToString)(I)," ").concat((0,n.numberToString)(M)," re W n"),"BT","1 0 0 1 0 ".concat((0,n.numberToString)(M+F)," Tm 0 Tc ").concat(m(s,!0)),"/".concat(this.fontName.name," ").concat((0,n.numberToString)(N)," Tf")],G=this.resources;if(1!==(c="number"===typeof c&&c>=0&&c<=1?c:1)){O.push("/R0 gs");var L=new a.Dict(this.xref),j=new a.Dict(this.xref);j.set("ca",c),j.set("CA",c),j.set("Type",a.Name.get("ExtGState")),L.set("R0",j),G.set("ExtGState",L)}for(var q=(0,n.numberToString)(B),H=0,U=p;H<U.length;H++){var Y=U[H];O.push("0 -".concat(q," Td <").concat((0,n.stringToUTF16HexString)(Y),"> Tj"))}O.push("ET","Q");var X=O.join("\n"),V=new a.Dict(this.xref);if(V.set("Subtype",a.Name.get("Form")),V.set("Type",a.Name.get("XObject")),V.set("BBox",[0,0,I,M]),V.set("Length",X.length),V.set("Resources",G),i){var Q=(0,n.getRotationMatrix)(i,I,M);V.set("Matrix",Q)}var W=new l.StringStream(X);return W.dict=V,W}}]),e}();t.FakeUnicodeFont=y},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.ColorSpace=void 0;var a=i(2),n=i(137),r=i(138),o=i(136),s=function(){function e(t,i){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize ColorSpace."),this.name=t,this.numComps=i}return g(e,[{key:"getRgb",value:function(e,t){var i=new Uint8ClampedArray(3);return this.getRgbItem(e,t,i,0),i}},{key:"getRgbItem",value:function(e,t,i,n){(0,a.unreachable)("Should not call ColorSpace.getRgbItem")}},{key:"getRgbBuffer",value:function(e,t,i,n,r,o,s){(0,a.unreachable)("Should not call ColorSpace.getRgbBuffer")}},{key:"getOutputLength",value:function(e,t){(0,a.unreachable)("Should not call ColorSpace.getOutputLength")}},{key:"isPassthrough",value:function(e){return!1}},{key:"isDefaultDecode",value:function(t,i){return e.isDefaultDecode(t,this.numComps)}},{key:"fillRgb",value:function(e,t,i,a,n,r,o,s,l){var c=t*i,d=null,u=1<<o,p=i!==n||t!==a;if(this.isPassthrough(o))d=s;else if(1===this.numComps&&c>u&&"DeviceGray"!==this.name&&"DeviceRGB"!==this.name){for(var m=o<=8?new Uint8Array(u):new Uint16Array(u),h=0;h<u;h++)m[h]=h;var f=new Uint8ClampedArray(3*u);if(this.getRgbBuffer(m,0,u,f,0,o,0),p){d=new Uint8Array(3*c);for(var y=0,b=0;b<c;++b){var g=3*s[b];d[y++]=f[g],d[y++]=f[g+1],d[y++]=f[g+2]}}else for(var v=0,_=0;_<c;++_){var A=3*s[_];e[v++]=f[A],e[v++]=f[A+1],e[v++]=f[A+2],v+=l}}else p?(d=new Uint8ClampedArray(3*c),this.getRgbBuffer(s,0,c,d,0,o,0)):this.getRgbBuffer(s,0,a*r,e,0,o,l);if(d)if(p)!function(e,t,i,a,n,r,o){o=1!==o?0:o;for(var s,l=i/n,c=a/r,d=0,u=new Uint16Array(n),p=3*i,m=0;m<n;m++)u[m]=3*Math.floor(m*l);for(var h=0;h<r;h++)for(var f=Math.floor(h*c)*p,y=0;y<n;y++)s=f+u[y],t[d++]=e[s++],t[d++]=e[s++],t[d++]=e[s++],d+=o}(d,e,t,i,a,n,l);else for(var x=0,w=0,S=0,C=a*r;S<C;S++)e[x++]=d[w++],e[x++]=d[w++],e[x++]=d[w++],x+=l}},{key:"usesZeroToOneRange",get:function(){return(0,a.shadow)(this,"usesZeroToOneRange",!0)}}],[{key:"_cache",value:function(e,t,i,a){if(!i)throw new Error('ColorSpace._cache - expected "localColorSpaceCache" argument.');if(!a)throw new Error('ColorSpace._cache - expected "parsedColorSpace" argument.');var r,o;e instanceof n.Ref&&(o=e,e=t.fetch(e)),e instanceof n.Name&&(r=e.name),(r||o)&&i.set(r,o,a)}},{key:"getCached",value:function(e,t,i){if(!i)throw new Error('ColorSpace.getCached - expected "localColorSpaceCache" argument.');if(e instanceof n.Ref){var a=i.getByRef(e);if(a)return a;try{e=t.fetch(e)}catch(s){if(s instanceof o.MissingDataException)throw s}}if(e instanceof n.Name){var r=i.getByName(e.name);if(r)return r}return null}},{key:"parseAsync",value:function(){var e=y(p().mark((function e(t){var i,a,n,r,o,s,l;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return i=t.cs,a=t.xref,n=t.resources,r=void 0===n?null:n,o=t.pdfFunctionFactory,s=t.localColorSpaceCache,l=this._parse(i,a,r,o),this._cache(i,a,s,l),e.abrupt("return",l);case 4:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"parse",value:function(e){var t=e.cs,i=e.xref,a=e.resources,n=void 0===a?null:a,r=e.pdfFunctionFactory,o=e.localColorSpaceCache,s=this.getCached(t,i,o);if(s)return s;var l=this._parse(t,i,n,r);return this._cache(t,i,o,l),l}},{key:"_parse",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null,r=arguments.length>3?arguments[3]:void 0;if((e=t.fetchIfRef(e))instanceof n.Name)switch(e.name){case"G":case"DeviceGray":return this.singletons.gray;case"RGB":case"DeviceRGB":return this.singletons.rgb;case"CMYK":case"DeviceCMYK":return this.singletons.cmyk;case"Pattern":return new c(null);default:if(i instanceof n.Dict){var o=i.get("ColorSpace");if(o instanceof n.Dict){var s=o.get(e.name);if(s){if(s instanceof n.Name)return this._parse(s,t,i,r);e=s;break}}}throw new a.FormatError("Unrecognized ColorSpace: ".concat(e.name))}if(Array.isArray(e)){var d,u,p,h,f,y,b=t.fetchIfRef(e[0]).name;switch(b){case"G":case"DeviceGray":return this.singletons.gray;case"RGB":case"DeviceRGB":return this.singletons.rgb;case"CMYK":case"DeviceCMYK":return this.singletons.cmyk;case"CalGray":return h=(d=t.fetchIfRef(e[1])).getArray("WhitePoint"),f=d.getArray("BlackPoint"),y=d.get("Gamma"),new _(h,f,y);case"CalRGB":h=(d=t.fetchIfRef(e[1])).getArray("WhitePoint"),f=d.getArray("BlackPoint"),y=d.getArray("Gamma");var g=d.getArray("Matrix");return new A(h,f,y,g);case"ICCBased":var v=t.fetchIfRef(e[1]).dict;u=v.get("N");var w=v.get("Alternate");if(w){var S=this._parse(w,t,i,r);if(S.numComps===u)return S;(0,a.warn)("ICCBased color space: Ignoring incorrect /Alternate entry.")}if(1===u)return this.singletons.gray;if(3===u)return this.singletons.rgb;if(4===u)return this.singletons.cmyk;break;case"Pattern":return(p=e[1]||null)&&(p=this._parse(p,t,i,r)),new c(p);case"I":case"Indexed":p=this._parse(e[1],t,i,r);var C=t.fetchIfRef(e[2])+1,k=t.fetchIfRef(e[3]);return new m(p,C,k);case"Separation":case"DeviceN":var D=t.fetchIfRef(e[1]);u=Array.isArray(D)?D.length:1,p=this._parse(e[2],t,i,r);var R=r.create(e[3]);return new l(u,p,R);case"Lab":h=(d=t.fetchIfRef(e[1])).getArray("WhitePoint"),f=d.getArray("BlackPoint");var I=d.getArray("Range");return new x(h,f,I);default:throw new a.FormatError("Unimplemented ColorSpace object: ".concat(b))}}throw new a.FormatError("Unrecognized ColorSpace object: ".concat(e))}},{key:"isDefaultDecode",value:function(e,t){if(!Array.isArray(e))return!0;if(2*t!==e.length)return(0,a.warn)("The decode map is not the correct length"),!0;for(var i=0,n=e.length;i<n;i+=2)if(0!==e[i]||1!==e[i+1])return!1;return!0}},{key:"singletons",get:function(){return(0,a.shadow)(this,"singletons",{get gray(){return(0,a.shadow)(this,"gray",new h)},get rgb(){return(0,a.shadow)(this,"rgb",new f)},get cmyk(){return(0,a.shadow)(this,"cmyk",new v)}})}}]),e}();t.ColorSpace=s;var l=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,"Alternate",e)).base=a,r.tintFn=n,r.tmpBuf=new Float32Array(a.numComps),r}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){var n=this.tmpBuf;this.tintFn(e,t,n,0),this.base.getRgbItem(n,0,i,a)}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){var s,l,c=this.tintFn,d=this.base,u=1/((1<<r)-1),p=d.numComps,m=d.usesZeroToOneRange,h=(d.isPassthrough(8)||!m)&&0===o,f=h?n:0,y=h?a:new Uint8ClampedArray(p*i),b=this.numComps,g=new Float32Array(b),v=new Float32Array(p);for(s=0;s<i;s++){for(l=0;l<b;l++)g[l]=e[t++]*u;if(c(g,0,v,0),m)for(l=0;l<p;l++)y[f++]=255*v[l];else d.getRgbItem(v,0,y,f),f+=p}h||d.getRgbBuffer(y,0,i,a,n,8,o)}},{key:"getOutputLength",value:function(e,t){return this.base.getOutputLength(e*this.base.numComps/this.numComps,t)}}]),i}(s),c=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this,"Pattern",null)).base=e,a}return g(i,[{key:"isDefaultDecode",value:function(e,t){(0,a.unreachable)("Should not call PatternCS.isDefaultDecode")}}]),i}(s),m=function(e){d(i,e);var t=u(i);function i(e,n,o){var s;b(this,i),(s=t.call(this,"Indexed",1)).base=e,s.highVal=n;var l=e.numComps*n;if(s.lookup=new Uint8Array(l),o instanceof r.BaseStream){var c=o.getBytes(l);s.lookup.set(c)}else{if("string"!==typeof o)throw new a.FormatError("IndexedCS - unrecognized lookup table: ".concat(o));for(var d=0;d<l;++d)s.lookup[d]=255&o.charCodeAt(d)}return s}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){var n=this.base.numComps,r=e[t]*n;this.base.getRgbBuffer(this.lookup,r,1,i,a,8,0)}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){for(var s=this.base,l=s.numComps,c=s.getOutputLength(l,o),d=this.lookup,u=0;u<i;++u){var p=e[t++]*l;s.getRgbBuffer(d,p,1,a,n,8,o),n+=c}}},{key:"getOutputLength",value:function(e,t){return this.base.getOutputLength(e*this.base.numComps,t)}},{key:"isDefaultDecode",value:function(e,t){return!Array.isArray(e)||(2!==e.length?((0,a.warn)("Decode map length is not correct"),!0):!Number.isInteger(t)||t<1?((0,a.warn)("Bits per component is not correct"),!0):0===e[0]&&e[1]===(1<<t)-1)}}]),i}(s),h=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.call(this,"DeviceGray",1)}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){var n=255*e[t];i[a]=i[a+1]=i[a+2]=n}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){for(var s=255/((1<<r)-1),l=t,c=n,d=0;d<i;++d){var u=s*e[l++];a[c++]=u,a[c++]=u,a[c++]=u,c+=o}}},{key:"getOutputLength",value:function(e,t){return e*(3+t)}}]),i}(s),f=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.call(this,"DeviceRGB",3)}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){i[a]=255*e[t],i[a+1]=255*e[t+1],i[a+2]=255*e[t+2]}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){if(8!==r||0!==o)for(var s=255/((1<<r)-1),l=t,c=n,d=0;d<i;++d)a[c++]=s*e[l++],a[c++]=s*e[l++],a[c++]=s*e[l++],c+=o;else a.set(e.subarray(t,t+3*i),n)}},{key:"getOutputLength",value:function(e,t){return e*(3+t)/3|0}},{key:"isPassthrough",value:function(e){return 8===e}}]),i}(s),v=function(){function e(e,t,i,a,n){var r=e[t]*i,o=e[t+1]*i,s=e[t+2]*i,l=e[t+3]*i;a[n]=255+r*(-4.387332384609988*r+54.48615194189176*o+18.82290502165302*s+212.25662451639585*l-285.2331026137004)+o*(1.7149763477362134*o-5.6096736904047315*s+-17.873870861415444*l-5.497006427196366)+s*(-2.5217340131683033*s-21.248923337353073*l+17.5119270841813)+l*(-21.86122147463605*l-189.48180835922747),a[n+1]=255+r*(8.841041422036149*r+60.118027045597366*o+6.871425592049007*s+31.159100130055922*l-79.2970844816548)+o*(-15.310361306967817*o+17.575251261109482*s+131.35250912493976*l-190.9453302588951)+s*(4.444339102852739*s+9.8632861493405*l-24.86741582555878)+l*(-20.737325471181034*l-187.80453709719578),a[n+2]=255+r*(.8842522430003296*r+8.078677503112928*o+30.89978309703729*s-.23883238689178934*l-14.183576799673286)+o*(10.49593273432072*o+63.02378494754052*s+50.606957656360734*l-112.23884253719248)+s*(.03296041114873217*s+115.60384449646641*l-193.58209356861505)+l*(-22.33816807309886*l-180.12613974708367)}return function(t){d(a,t);var i=u(a);function a(){return b(this,a),i.call(this,"DeviceCMYK",4)}return g(a,[{key:"getRgbItem",value:function(t,i,a,n){e(t,i,1,a,n)}},{key:"getRgbBuffer",value:function(t,i,a,n,r,o,s){for(var l=1/((1<<o)-1),c=0;c<a;c++)e(t,i,l,n,r),i+=4,r+=3+s}},{key:"getOutputLength",value:function(e,t){return e/4*(3+t)|0}}]),a}(s)}(),_=function(){function e(e,t,i,a,n,r){var o=t[i]*r,s=Math.pow(o,e.G),l=e.YW*s,c=Math.max(295.8*Math.pow(l,.3333333333333333)-40.8,0);a[n]=c,a[n+1]=c,a[n+2]=c}return function(t){d(n,t);var i=u(n);function n(e,t,r){var o;if(b(this,n),o=i.call(this,"CalGray",1),!e)throw new a.FormatError("WhitePoint missing - required for color space CalGray");if(t=t||[0,0,0],r=r||1,o.XW=e[0],o.YW=e[1],o.ZW=e[2],o.XB=t[0],o.YB=t[1],o.ZB=t[2],o.G=r,o.XW<0||o.ZW<0||1!==o.YW)throw new a.FormatError("Invalid WhitePoint components for ".concat(o.name)+", no fallback available");return(o.XB<0||o.YB<0||o.ZB<0)&&((0,a.info)("Invalid BlackPoint for ".concat(o.name,", falling back to default.")),o.XB=o.YB=o.ZB=0),0===o.XB&&0===o.YB&&0===o.ZB||(0,a.warn)("".concat(o.name,", BlackPoint: XB: ").concat(o.XB,", YB: ").concat(o.YB,", ")+"ZB: ".concat(o.ZB,", only default values are supported.")),o.G<1&&((0,a.info)("Invalid Gamma: ".concat(o.G," for ").concat(o.name,", ")+"falling back to default."),o.G=1),o}return g(n,[{key:"getRgbItem",value:function(t,i,a,n){e(this,t,i,a,n,1)}},{key:"getRgbBuffer",value:function(t,i,a,n,r,o,s){for(var l=1/((1<<o)-1),c=0;c<a;++c)e(this,t,i,n,r,l),i+=1,r+=3+s}},{key:"getOutputLength",value:function(e,t){return e*(3+t)}}]),n}(s)}(),A=function(){var e=new Float32Array([.8951,.2664,-.1614,-.7502,1.7135,.0367,.0389,-.0685,1.0296]),t=new Float32Array([.9869929,-.1470543,.1599627,.4323053,.5183603,.0492912,-.0085287,.0400428,.9684867]),i=new Float32Array([3.2404542,-1.5371385,-.4985314,-.969266,1.8760108,.041556,.0556434,-.2040259,1.0572252]),n=new Float32Array([1,1,1]),r=new Float32Array(3),o=new Float32Array(3),l=new Float32Array(3),c=Math.pow(24/116,3)/8;function p(e,t,i){i[0]=e[0]*t[0]+e[1]*t[1]+e[2]*t[2],i[1]=e[3]*t[0]+e[4]*t[1]+e[5]*t[2],i[2]=e[6]*t[0]+e[7]*t[1]+e[8]*t[2]}function m(e){return e<=.0031308?h(0,1,12.92*e):e>=.99554525?1:h(0,1,1.055*Math.pow(e,1/2.4)-.055)}function h(e,t,i){return Math.max(e,Math.min(t,i))}function f(e){return e<0?-f(-e):e>8?Math.pow((e+16)/116,3):e*c}function y(a,s,c,d,u,y){var b=h(0,1,s[c]*y),g=h(0,1,s[c+1]*y),v=h(0,1,s[c+2]*y),_=1===b?1:Math.pow(b,a.GR),A=1===g?1:Math.pow(g,a.GG),x=1===v?1:Math.pow(v,a.GB),w=a.MXA*_+a.MXB*A+a.MXC*x,S=a.MYA*_+a.MYB*A+a.MYC*x,C=a.MZA*_+a.MZB*A+a.MZC*x,k=o;k[0]=w,k[1]=S,k[2]=C;var D=l;!function(i,a,n){if(1===i[0]&&1===i[2])return n[0]=a[0],n[1]=a[1],void(n[2]=a[2]);var o=n;p(e,a,o);var s=r;!function(e,t,i){i[0]=1*t[0]/e[0],i[1]=1*t[1]/e[1],i[2]=1*t[2]/e[2]}(i,o,s),p(t,s,n)}(a.whitePoint,k,D);var R=o;!function(e,t,i){if(0===e[0]&&0===e[1]&&0===e[2])return i[0]=t[0],i[1]=t[1],void(i[2]=t[2]);var a=f(0),n=(1-a)/(1-f(e[0])),r=1-n,o=(1-a)/(1-f(e[1])),s=1-o,l=(1-a)/(1-f(e[2])),c=1-l;i[0]=t[0]*n+r,i[1]=t[1]*o+s,i[2]=t[2]*l+c}(a.blackPoint,D,R);var I=l;!function(i,a,n){var o=n;p(e,a,o);var s=r;!function(e,t,i){i[0]=.95047*t[0]/e[0],i[1]=1*t[1]/e[1],i[2]=1.08883*t[2]/e[2]}(i,o,s),p(t,s,n)}(n,R,I);var M=o;p(i,I,M),d[u]=255*m(M[0]),d[u+1]=255*m(M[1]),d[u+2]=255*m(M[2])}return function(e){d(i,e);var t=u(i);function i(e,n,r,o){var s;if(b(this,i),s=t.call(this,"CalRGB",3),!e)throw new a.FormatError("WhitePoint missing - required for color space CalRGB");n=n||new Float32Array(3),r=r||new Float32Array([1,1,1]),o=o||new Float32Array([1,0,0,0,1,0,0,0,1]);var l=e[0],c=e[1],d=e[2];s.whitePoint=e;var u=n[0],p=n[1],m=n[2];if(s.blackPoint=n,s.GR=r[0],s.GG=r[1],s.GB=r[2],s.MXA=o[0],s.MYA=o[1],s.MZA=o[2],s.MXB=o[3],s.MYB=o[4],s.MZB=o[5],s.MXC=o[6],s.MYC=o[7],s.MZC=o[8],l<0||d<0||1!==c)throw new a.FormatError("Invalid WhitePoint components for ".concat(s.name)+", no fallback available");return(u<0||p<0||m<0)&&((0,a.info)("Invalid BlackPoint for ".concat(s.name," [").concat(u,", ").concat(p,", ").concat(m,"], ")+"falling back to default."),s.blackPoint=new Float32Array(3)),(s.GR<0||s.GG<0||s.GB<0)&&((0,a.info)("Invalid Gamma [".concat(s.GR,", ").concat(s.GG,", ").concat(s.GB,"] for ")+"".concat(s.name,", falling back to default.")),s.GR=s.GG=s.GB=1),s}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){y(this,e,t,i,a,1)}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){for(var s=1/((1<<r)-1),l=0;l<i;++l)y(this,e,t,a,n,s),t+=3,n+=3+o}},{key:"getOutputLength",value:function(e,t){return e*(3+t)/3|0}}]),i}(s)}(),x=function(){function e(e){return e>=6/29?Math.pow(e,3):108/841*(e-4/29)}function t(e,t,i,a){return i+e*(a-i)/t}function i(i,a,n,r,o,s){var l=a[n],c=a[n+1],d=a[n+2];!1!==r&&(l=t(l,r,0,100),c=t(c,r,i.amin,i.amax),d=t(d,r,i.bmin,i.bmax)),c>i.amax?c=i.amax:c<i.amin&&(c=i.amin),d>i.bmax?d=i.bmax:d<i.bmin&&(d=i.bmin);var u,p,m,h=(l+16)/116,f=h+c/500,y=h-d/200,b=i.XW*e(f),g=i.YW*e(h),v=i.ZW*e(y);i.ZW<1?(u=3.1339*b+-1.617*g+-.4906*v,p=-.9785*b+1.916*g+.0333*v,m=.072*b+-.229*g+1.4057*v):(u=3.2406*b+-1.5372*g+-.4986*v,p=-.9689*b+1.8758*g+.0415*v,m=.0557*b+-.204*g+1.057*v),o[s]=255*Math.sqrt(u),o[s+1]=255*Math.sqrt(p),o[s+2]=255*Math.sqrt(m)}return function(e){d(n,e);var t=u(n);function n(e,i,r){var o;if(b(this,n),o=t.call(this,"Lab",3),!e)throw new a.FormatError("WhitePoint missing - required for color space Lab");if(i=i||[0,0,0],r=r||[-100,100,-100,100],o.XW=e[0],o.YW=e[1],o.ZW=e[2],o.amin=r[0],o.amax=r[1],o.bmin=r[2],o.bmax=r[3],o.XB=i[0],o.YB=i[1],o.ZB=i[2],o.XW<0||o.ZW<0||1!==o.YW)throw new a.FormatError("Invalid WhitePoint components, no fallback available");return(o.XB<0||o.YB<0||o.ZB<0)&&((0,a.info)("Invalid BlackPoint, falling back to default"),o.XB=o.YB=o.ZB=0),(o.amin>o.amax||o.bmin>o.bmax)&&((0,a.info)("Invalid Range, falling back to defaults"),o.amin=-100,o.amax=100,o.bmin=-100,o.bmax=100),o}return g(n,[{key:"getRgbItem",value:function(e,t,a,n){i(this,e,t,!1,a,n)}},{key:"getRgbBuffer",value:function(e,t,a,n,r,o,s){for(var l=(1<<o)-1,c=0;c<a;c++)i(this,e,t,l,n,r),t+=3,r+=3+s}},{key:"getOutputLength",value:function(e,t){return e*(3+t)/3|0}},{key:"isDefaultDecode",value:function(e,t){return!0}},{key:"usesZeroToOneRange",get:function(){return(0,a.shadow)(this,"usesZeroToOneRange",!1)}}]),n}(s)}()},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.PartialEvaluator=t.EvaluatorPreprocessor=void 0;var a=i(2),n=i(147),r=i(137),o=i(165),s=i(168),l=i(172),d=i(181),u=i(182),m=i(173),v=i(188),_=i(148),A=i(190),x=i(141),w=i(138),S=i(191),C=i(145),k=i(150),D=i(169),R=i(170),I=i(136),M=i(176),T=i(171),P=i(192),z=i(193),B=i(194),F=Object.freeze({maxImageSize:-1,disableFontFace:!1,ignoreErrors:!1,isEvalSupported:!0,isOffscreenCanvasSupported:!0,fontExtraProperties:!1,useSystemFonts:!0,cMapUrl:null,standardFontDataUrl:null}),E=1,N=2,O=10,G=Promise.resolve();function L(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];if(Array.isArray(e)){var i,n=h(e);try{for(n.s();!(i=n.n()).done;){var o=L(i.value,!0);if(o)return o}}catch(s){n.e(s)}finally{n.f()}return(0,a.warn)("Unsupported blend mode Array: ".concat(e)),"source-over"}if(!(e instanceof r.Name))return t?null:"source-over";switch(e.name){case"Normal":case"Compatible":return"source-over";case"Multiply":return"multiply";case"Screen":return"screen";case"Overlay":return"overlay";case"Darken":return"darken";case"Lighten":return"lighten";case"ColorDodge":return"color-dodge";case"ColorBurn":return"color-burn";case"HardLight":return"hard-light";case"SoftLight":return"soft-light";case"Difference":return"difference";case"Exclusion":return"exclusion";case"Hue":return"hue";case"Saturation":return"saturation";case"Color":return"color";case"Luminosity":return"luminosity"}return t?null:((0,a.warn)("Unsupported blend mode: ".concat(e.name)),"source-over")}function j(e){e.fn===a.OPS.paintImageMaskXObject&&e.args[0]&&e.args[0].count>0&&e.args[0].count++}var q=function(){function e(){b(this,e),this.reset()}return g(e,[{key:"check",value:function(){return!(++this.checked<e.CHECK_TIME_EVERY)&&(this.checked=0,this.endTime<=Date.now())}},{key:"reset",value:function(){this.endTime=Date.now()+e.TIME_SLOT_DURATION_MS,this.checked=0}}],[{key:"TIME_SLOT_DURATION_MS",get:function(){return(0,a.shadow)(this,"TIME_SLOT_DURATION_MS",20)}},{key:"CHECK_TIME_EVERY",get:function(){return(0,a.shadow)(this,"CHECK_TIME_EVERY",100)}}]),e}(),H=function(){function e(t){b(this,e);var i=t.xref,a=t.handler,n=t.pageIndex,r=t.idFactory,o=t.fontCache,s=t.builtInCMapCache,l=t.standardFontDataCache,c=t.globalImageCache,d=t.options,u=void 0===d?null:d;this.xref=i,this.handler=a,this.pageIndex=n,this.idFactory=r,this.fontCache=o,this.builtInCMapCache=s,this.standardFontDataCache=l,this.globalImageCache=c,this.options=u||F,this.parsingType3Font=!1,this._fetchBuiltInCMapBound=this.fetchBuiltInCMap.bind(this)}return g(e,[{key:"_pdfFunctionFactory",get:function(){var e=new v.PDFFunctionFactory({xref:this.xref,isEvalSupported:this.options.isEvalSupported});return(0,a.shadow)(this,"_pdfFunctionFactory",e)}},{key:"clone",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:null,t=Object.create(this);return t.options=Object.assign(Object.create(null),this.options,e),t}},{key:"hasBlendModes",value:function(e,t){if(!(e instanceof r.Dict))return!1;if(e.objId&&t.has(e.objId))return!1;var i=new r.RefSet(t);e.objId&&i.put(e.objId);for(var n=[e],o=this.xref;n.length;){var s=n.shift(),l=s.get("ExtGState");if(l instanceof r.Dict){var c,d=h(l.getRawValues());try{for(d.s();!(c=d.n()).done;){var u=c.value;if(u instanceof r.Ref){if(i.has(u))continue;try{u=o.fetch(u)}catch(k){i.put(u),(0,a.info)('hasBlendModes - ignoring ExtGState: "'.concat(k,'".'));continue}}if(u instanceof r.Dict){u.objId&&i.put(u.objId);var p=u.get("BM");if(p instanceof r.Name){if("Normal"!==p.name)return!0}else if(void 0!==p&&Array.isArray(p)){var m,f=h(p);try{for(f.s();!(m=f.n()).done;){var y=m.value;if(y instanceof r.Name&&"Normal"!==y.name)return!0}}catch(D){f.e(D)}finally{f.f()}}}}}catch(D){d.e(D)}finally{d.f()}}var b=s.get("XObject");if(b instanceof r.Dict){var g,v=h(b.getRawValues());try{for(v.s();!(g=v.n()).done;){var _=g.value;if(_ instanceof r.Ref){if(i.has(_))continue;try{_=o.fetch(_)}catch(k){i.put(_),(0,a.info)('hasBlendModes - ignoring XObject: "'.concat(k,'".'));continue}}if(_ instanceof w.BaseStream){_.dict.objId&&i.put(_.dict.objId);var A=_.dict.get("Resources");A instanceof r.Dict&&(A.objId&&i.has(A.objId)||(n.push(A),A.objId&&i.put(A.objId)))}}}catch(D){v.e(D)}finally{v.f()}}}var x,S=h(i);try{for(S.s();!(x=S.n()).done;){var C=x.value;t.put(C)}}catch(D){S.e(D)}finally{S.f()}return!1}},{key:"fetchBuiltInCMap",value:function(){var e=y(p().mark((function e(t){var i,n,r,o;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(i=this.builtInCMapCache.get(t))){e.next=3;break}return e.abrupt("return",i);case 3:if(null===this.options.cMapUrl){e.next=19;break}return r="".concat(this.options.cMapUrl).concat(t,".bcmap"),e.next=7,fetch(r);case 7:if((o=e.sent).ok){e.next=10;break}throw new Error('fetchBuiltInCMap: failed to fetch file "'.concat(r,'" with "').concat(o.statusText,'".'));case 10:return e.t0=Uint8Array,e.next=13,o.arrayBuffer();case 13:e.t1=e.sent,e.t2=new e.t0(e.t1),e.t3=a.CMapCompressionType.BINARY,n={cMapData:e.t2,compressionType:e.t3},e.next=22;break;case 19:return e.next=21,this.handler.sendWithPromise("FetchBuiltInCMap",{name:t});case 21:n=e.sent;case 22:return n.compressionType!==a.CMapCompressionType.NONE&&this.builtInCMapCache.set(t,n),e.abrupt("return",n);case 24:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"fetchStandardFontData",value:function(){var e=y(p().mark((function e(t){var i,n,r,o,s,c;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(i=this.standardFontDataCache.get(t))){e.next=3;break}return e.abrupt("return",new x.Stream(i));case 3:if(!this.options.useSystemFonts||"Symbol"===t||"ZapfDingbats"===t){e.next=5;break}return e.abrupt("return",null);case 5:if(n=(0,l.getFontNameToFileMap)(),r=n[t],null===this.options.standardFontDataUrl){e.next=20;break}return s="".concat(this.options.standardFontDataUrl).concat(r),e.next=10,fetch(s);case 10:if((c=e.sent).ok){e.next=15;break}(0,a.warn)('fetchStandardFontData: failed to fetch file "'.concat(s,'" with "').concat(c.statusText,'".')),e.next=18;break;case 15:return e.next=17,c.arrayBuffer();case 17:o=e.sent;case 18:e.next=29;break;case 20:return e.prev=20,e.next=23,this.handler.sendWithPromise("FetchStandardFontData",{filename:r});case 23:o=e.sent,e.next=29;break;case 26:e.prev=26,e.t0=e.catch(20),(0,a.warn)('fetchStandardFontData: failed to fetch file "'.concat(r,'" with "').concat(e.t0,'".'));case 29:if(o){e.next=31;break}return e.abrupt("return",null);case 31:return this.standardFontDataCache.set(t,o),e.abrupt("return",new x.Stream(o));case 33:case"end":return e.stop()}}),e,this,[[20,26]])})));return function(t){return e.apply(this,arguments)}}()},{key:"buildFormXObject",value:function(){var e=y(p().mark((function e(t,i,n,o,s,l,c){var d,u,m,h,f,y,b,g,v,_,A;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(d=i.dict,u=d.getArray("Matrix"),m=d.getArray("BBox"),m=Array.isArray(m)&&4===m.length?a.Util.normalizeRect(m):null,!d.has("OC")){e.next=8;break}return e.next=7,this.parseMarkedContentProps(d.get("OC"),t);case 7:h=e.sent;case 8:if(void 0!==h&&o.addOp(a.OPS.beginMarkedContentProps,["OC",h]),!(y=d.get("Group"))){e.next=29;break}if(f={matrix:u,bbox:m,smask:n,isolated:!1,knockout:!1},b=y.get("S"),g=null,!(0,r.isName)(b,"Transparency")){e.next=27;break}if(f.isolated=y.get("I")||!1,f.knockout=y.get("K")||!1,!y.has("CS")){e.next=27;break}if(v=y.getRaw("CS"),!(_=C.ColorSpace.getCached(v,this.xref,c))){e.next=24;break}g=_,e.next=27;break;case 24:return e.next=26,this.parseColorSpace({cs:v,resources:t,localColorSpaceCache:c});case 26:g=e.sent;case 27:n&&n.backdrop&&(g=g||C.ColorSpace.singletons.rgb,n.backdrop=g.getRgb(n.backdrop,0)),o.addOp(a.OPS.beginGroup,[f]);case 29:return A=y?[u,null]:[u,m],o.addOp(a.OPS.paintFormXObjectBegin,A),e.abrupt("return",this.getOperatorList({stream:i,task:s,resources:d.get("Resources")||t,operatorList:o,initialState:l}).then((function(){o.addOp(a.OPS.paintFormXObjectEnd,[]),y&&o.addOp(a.OPS.endGroup,[f]),void 0!==h&&o.addOp(a.OPS.endMarkedContent,[])})));case 32:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n,r,o,s){return e.apply(this,arguments)}}()},{key:"_sendImgData",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]&&arguments[2],a=t?[t.bitmap||t.data.buffer]:null;return this.parsingType3Font||i?this.handler.send("commonobj",[e,"Image",t],a):this.handler.send("obj",[e,this.pageIndex,"Image",t],a)}},{key:"buildPaintImageXObject",value:function(){var e=y(p().mark((function e(t){var i,n,r,o,s,l,c,d,u,m,h,f,y,b,g,v,_,A,x,w,S,C,D,R,I,M,T,P=this;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(i=t.resources,n=t.image,r=t.isInline,o=void 0!==r&&r,s=t.operatorList,l=t.cacheKey,c=t.localImageCache,d=t.localColorSpaceCache,u=n.dict,m=u.objId,h=u.get("W","Width"),f=u.get("H","Height"),h&&"number"===typeof h&&f&&"number"===typeof f){e.next=8;break}return(0,a.warn)("Image dimensions are missing, or not numbers."),e.abrupt("return");case 8:if(!(-1!==(y=this.options.maxImageSize)&&h*f>y)){e.next=15;break}if(b="Image exceeded maximum allowed size and was removed.",!this.options.ignoreErrors){e.next=14;break}return(0,a.warn)(b),e.abrupt("return");case 14:throw new Error(b);case 15:if(!u.has("OC")){e.next=19;break}return e.next=18,this.parseMarkedContentProps(u.get("OC"),i);case 18:g=e.sent;case 19:if(!u.get("IM","ImageMask")){e.next=44;break}if(A=u.get("I","Interpolate"),x=h+7>>3,w=n.getBytes(x*f),S=u.getArray("D","Decode"),!this.parsingType3Font){e.next=32;break}return(v=B.PDFImage.createRawMask({imgArray:w,width:h,height:f,imageIsFromDecodeStream:n instanceof k.DecodeStream,inverseDecode:!!S&&S[0]>0,interpolate:A})).cached=!!l,_=[v],s.addImageOps(a.OPS.paintImageMaskXObject,_,g),l&&c.set(l,m,{fn:a.OPS.paintImageMaskXObject,args:_,optionalContent:g}),e.abrupt("return");case 32:if(!(v=B.PDFImage.createMask({imgArray:w,width:h,height:f,imageIsFromDecodeStream:n instanceof k.DecodeStream,inverseDecode:!!S&&S[0]>0,interpolate:A,isOffscreenCanvasSupported:this.options.isOffscreenCanvasSupported})).isSingleOpaquePixel){e.next=37;break}return s.addImageOps(a.OPS.paintSolidColorImageMask,[],g),l&&c.set(l,m,{fn:a.OPS.paintSolidColorImageMask,args:[],optionalContent:g}),e.abrupt("return");case 37:return C="mask_".concat(this.idFactory.createObjId()),s.addDependency(C),this._sendImgData(C,v),_=[{data:C,width:v.width,height:v.height,interpolate:v.interpolate,count:1}],s.addImageOps(a.OPS.paintImageMaskXObject,_,g),l&&c.set(l,m,{fn:a.OPS.paintImageMaskXObject,args:_,optionalContent:g}),e.abrupt("return");case 44:if(D=u.get("SM","SMask")||!1,R=u.get("Mask")||!1,!o||D||R||!(h+f<200)){e.next=52;break}return I=new B.PDFImage({xref:this.xref,res:i,image:n,isInline:o,pdfFunctionFactory:this._pdfFunctionFactory,localColorSpaceCache:d}),v=I.createImageData(!0),s.addImageOps(a.OPS.paintInlineImageXObject,[v],g),e.abrupt("return");case 52:M="img_".concat(this.idFactory.createObjId()),T=!1,this.parsingType3Font?M="".concat(this.idFactory.getDocId(),"_type3_").concat(M):m&&(T=this.globalImageCache.shouldCache(m,this.pageIndex))&&(M="".concat(this.idFactory.getDocId(),"_").concat(M)),s.addDependency(M),_=[M,h,f],B.PDFImage.buildImage({xref:this.xref,res:i,image:n,isInline:o,pdfFunctionFactory:this._pdfFunctionFactory,localColorSpaceCache:d}).then((function(e){return v=e.createImageData(!1),l&&m&&T&&P.globalImageCache.addByteSize(m,v.data.length),P._sendImgData(M,v,T)})).catch((function(e){return(0,a.warn)('Unable to decode image "'.concat(M,'": "').concat(e,'".')),P._sendImgData(M,null,T)})),s.addImageOps(a.OPS.paintImageXObject,_,g),l&&(c.set(l,m,{fn:a.OPS.paintImageXObject,args:_,optionalContent:g}),m&&((0,a.assert)(!o,"Cannot cache an inline image globally."),this.globalImageCache.addPageIndex(m,this.pageIndex),T&&this.globalImageCache.setData(m,{objId:M,fn:a.OPS.paintImageXObject,args:_,optionalContent:g,byteSize:0})));case 59:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"handleSMask",value:function(e,t,i,a,n,r){var o=e.get("G"),s={subtype:e.get("S").name,backdrop:e.get("BC")},l=e.get("TR");if((0,v.isPDFFunction)(l)){for(var c=this._pdfFunctionFactory.create(l),d=new Uint8Array(256),u=new Float32Array(1),p=0;p<256;p++)u[0]=p/255,c(u,0,u,0),d[p]=255*u[0]|0;s.transferMap=d}return this.buildFormXObject(t,o,s,i,a,n.state.clone(),r)}},{key:"handleTransferFunction",value:function(e){var t;if(Array.isArray(e))t=e;else{if(!(0,v.isPDFFunction)(e))return null;t=[e]}var i,a=[],n=0,o=0,s=h(t);try{for(s.s();!(i=s.n()).done;){var l=i.value,c=this.xref.fetchIfRef(l);if(n++,(0,r.isName)(c,"Identity"))a.push(null);else{if(!(0,v.isPDFFunction)(c))return null;for(var d=this._pdfFunctionFactory.create(c),u=new Uint8Array(256),p=new Float32Array(1),m=0;m<256;m++)p[0]=m/255,d(p,0,p,0),u[m]=255*p[0]|0;a.push(u),o++}}}catch(f){s.e(f)}finally{s.f()}return 1!==n&&4!==n||0===o?null:a}},{key:"handleTilingType",value:function(e,t,i,n,o,s,l,c){var u=this,p=new z.OperatorList,m=r.Dict.merge({xref:this.xref,dictArray:[o.get("Resources"),i]});return this.getOperatorList({stream:n,task:l,resources:m,operatorList:p}).then((function(){var i=p.getIR(),a=(0,d.getTilingPatternIR)(i,o,t);s.addDependencies(p.dependencies),s.addOp(e,a),o.objId&&c.set(null,o.objId,{operatorListIR:i,dict:o})})).catch((function(e){if(!(e instanceof a.AbortException)){if(u.options.ignoreErrors)return u.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorTilingPattern}),void(0,a.warn)('handleTilingType - ignoring pattern: "'.concat(e,'".'));throw e}}))}},{key:"handleSetFont",value:function(e,t,i,n,s,l){var c=this,d=arguments.length>6&&void 0!==arguments[6]?arguments[6]:null,u=arguments.length>7&&void 0!==arguments[7]?arguments[7]:null,p=t&&t[0]instanceof r.Name?t[0].name:null;return this.loadFont(p,i,e,d,u).then((function(t){return t.font.isType3Font?t.loadType3Data(c,e,s).then((function(){return n.addDependencies(t.type3Dependencies),t})).catch((function(e){return c.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontLoadType3}),new U({loadedName:"g_font_error",font:new o.ErrorFont("Type3 font load error: ".concat(e)),dict:t.font,evaluatorOptions:c.options})})):t})).then((function(e){return l.font=e.font,e.send(c.handler),e.loadedName}))}},{key:"handleText",value:function(t,i){var n=i.font,r=n.charsToGlyphs(t);return n.data&&(i.textRenderingMode&a.TextRenderingMode.ADD_TO_PATH_FLAG||"Pattern"===i.fillColorSpace.name||n.disableFontFace||this.options.disableFontFace)&&e.buildFontPaths(n,r,this.handler,this.options),r}},{key:"ensureStateFont",value:function(e){if(!e.font){var t=new a.FormatError("Missing setFont (Tf) operator before text rendering operator.");if(this.options.ignoreErrors)return this.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontState}),void(0,a.warn)('ensureStateFont: "'.concat(t,'".'));throw t}}},{key:"setGState",value:function(){var e=y(p().mark((function e(t){var i,n,o,s,l,c,d,u,m,f,y,b,g,v,_,A=this;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:i=t.resources,n=t.gState,o=t.operatorList,s=t.cacheKey,l=t.task,c=t.stateManager,d=t.localGStateCache,u=t.localColorSpaceCache,m=n.objId,f=!0,y=[],b=Promise.resolve(),g=h(n.getKeys()),e.prev=6,_=p().mark((function e(){var t,s,d;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:t=v.value,s=n.get(t),e.t0=t,e.next="Type"===e.t0?5:"LW"===e.t0||"LC"===e.t0||"LJ"===e.t0||"ML"===e.t0||"D"===e.t0||"RI"===e.t0||"FL"===e.t0||"CA"===e.t0||"ca"===e.t0?6:"Font"===e.t0?8:"BM"===e.t0?11:"SMask"===e.t0?13:"TR"===e.t0?18:"OP"===e.t0||"op"===e.t0||"OPM"===e.t0||"BG"===e.t0||"BG2"===e.t0||"UCR"===e.t0||"UCR2"===e.t0||"TR2"===e.t0||"HT"===e.t0||"SM"===e.t0||"SA"===e.t0||"AIS"===e.t0||"TK"===e.t0?21:23;break;case 5:return e.abrupt("break",25);case 6:return y.push([t,s]),e.abrupt("break",25);case 8:return f=!1,b=b.then((function(){return A.handleSetFont(i,null,s[0],o,l,c.state).then((function(e){o.addDependency(e),y.push([t,[e,s[1]]])}))})),e.abrupt("break",25);case 11:return y.push([t,L(s)]),e.abrupt("break",25);case 13:if(!(0,r.isName)(s,"None")){e.next=16;break}return y.push([t,!1]),e.abrupt("break",25);case 16:return s instanceof r.Dict?(f=!1,b=b.then((function(){return A.handleSMask(s,i,o,l,c,u)})),y.push([t,!0])):(0,a.warn)("Unsupported SMask type"),e.abrupt("break",25);case 18:return d=A.handleTransferFunction(s),y.push([t,d]),e.abrupt("break",25);case 21:return(0,a.info)("graphic state operator "+t),e.abrupt("break",25);case 23:return(0,a.info)("Unknown graphic state operator "+t),e.abrupt("break",25);case 25:case"end":return e.stop()}}),e)})),g.s();case 9:if((v=g.n()).done){e.next=13;break}return e.delegateYield(_(),"t0",11);case 11:e.next=9;break;case 13:e.next=18;break;case 15:e.prev=15,e.t1=e.catch(6),g.e(e.t1);case 18:return e.prev=18,g.f(),e.finish(18);case 21:return e.abrupt("return",b.then((function(){y.length>0&&o.addOp(a.OPS.setGState,[y]),f&&d.set(s,m,y)})));case 22:case"end":return e.stop()}}),e,null,[[6,15,18,21]])})));return function(t){return e.apply(this,arguments)}}()},{key:"loadFont",value:function(t,i,n){var s,l=this,c=arguments.length>3&&void 0!==arguments[3]?arguments[3]:null,d=arguments.length>4&&void 0!==arguments[4]?arguments[4]:null,u=function(){var e=y(p().mark((function e(){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.abrupt("return",new U({loadedName:"g_font_error",font:new o.ErrorFont('Font "'.concat(t,'" is not available.')),dict:i,evaluatorOptions:l.options}));case 1:case"end":return e.stop()}}),e)})));return function(){return e.apply(this,arguments)}}(),m=this.xref;if(i)i instanceof r.Ref&&(s=i);else{var h=n.get("Font");h&&(s=h.getRaw(t))}if(!s){var f='Font "'.concat(t||i&&i.toString(),'" is not available');if(!this.options.ignoreErrors&&!this.parsingType3Font)return(0,a.warn)("".concat(f,".")),u();this.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontMissing}),(0,a.warn)("".concat(f," -- attempting to fallback to a default font.")),s=c||e.fallbackFontDict}if(this.parsingType3Font&&this.type3FontRefs.has(s))return u();if(this.fontCache.has(s))return this.fontCache.get(s);if(!((i=m.fetchIfRef(s))instanceof r.Dict))return u();if(i.cacheKey&&this.fontCache.has(i.cacheKey))return this.fontCache.get(i.cacheKey);var b,g=(0,a.createPromiseCapability)();try{(b=this.preEvaluateFont(i)).cssFontInfo=d}catch(k){return(0,a.warn)('loadFont - preEvaluateFont failed: "'.concat(k,'".')),u()}var v,_=b,A=_.descriptor,x=_.hash,w=s instanceof r.Ref;if(w&&(v="f".concat(s.toString())),x&&A instanceof r.Dict){A.fontAliases||(A.fontAliases=Object.create(null));var S=A.fontAliases;if(S[x]){var C=S[x].aliasRef;if(w&&C&&this.fontCache.has(C))return this.fontCache.putAlias(s,C),this.fontCache.get(s)}else S[x]={fontID:this.idFactory.createFontId()};w&&(S[x].aliasRef=s),v=S[x].fontID}return w?this.fontCache.put(s,g.promise):(v||(v=this.idFactory.createFontId()),i.cacheKey="cacheKey_".concat(v),this.fontCache.put(i.cacheKey,g.promise)),(0,a.assert)(v&&v.startsWith("f"),'The "fontID" must be (correctly) defined.'),i.loadedName="".concat(this.idFactory.getDocId(),"_").concat(v),this.translateFont(b).then((function(e){g.resolve(new U({loadedName:i.loadedName,font:e,dict:i,evaluatorOptions:l.options}))})).catch((function(e){l.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontTranslate}),(0,a.warn)('loadFont - translateFont failed: "'.concat(e,'".')),g.resolve(new U({loadedName:i.loadedName,font:new o.ErrorFont(e instanceof Error?e.message:e),dict:i,evaluatorOptions:l.options}))})),g.promise}},{key:"buildPath",value:function(e,t,i){var n=arguments.length>3&&void 0!==arguments[3]&&arguments[3],r=e.length-1;if(i||(i=[]),r<0||e.fnArray[r]!==a.OPS.constructPath){var o;switch(n&&((0,a.warn)('Encountered path operator "'.concat(t,'" inside of a text object.')),e.addOp(a.OPS.save,null)),t){case a.OPS.rectangle:var s=i[0]+i[2],l=i[1]+i[3];o=[Math.min(i[0],s),Math.max(i[0],s),Math.min(i[1],l),Math.max(i[1],l)];break;case a.OPS.moveTo:case a.OPS.lineTo:o=[i[0],i[0],i[1],i[1]];break;default:o=[1/0,-1/0,1/0,-1/0]}e.addOp(a.OPS.constructPath,[[t],i,o]),n&&e.addOp(a.OPS.restore,null)}else{var d,u=e.argsArray[r];u[0].push(t),(d=u[1]).push.apply(d,c(i));var p=u[2];switch(t){case a.OPS.rectangle:var m=i[0]+i[2],h=i[1]+i[3];p[0]=Math.min(p[0],i[0],m),p[1]=Math.max(p[1],i[0],m),p[2]=Math.min(p[2],i[1],h),p[3]=Math.max(p[3],i[1],h);break;case a.OPS.moveTo:case a.OPS.lineTo:p[0]=Math.min(p[0],i[0]),p[1]=Math.max(p[1],i[0]),p[2]=Math.min(p[2],i[1]),p[3]=Math.max(p[3],i[1])}}}},{key:"parseColorSpace",value:function(e){var t=this,i=e.cs,n=e.resources,r=e.localColorSpaceCache;return C.ColorSpace.parseAsync({cs:i,xref:this.xref,resources:n,pdfFunctionFactory:this._pdfFunctionFactory,localColorSpaceCache:r}).catch((function(e){if(e instanceof a.AbortException)return null;if(t.options.ignoreErrors)return t.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorColorSpace}),(0,a.warn)('parseColorSpace - ignoring ColorSpace: "'.concat(e,'".')),null;throw e}))}},{key:"parseShading",value:function(e){var t=e.shading,i=e.resources,a=e.localColorSpaceCache,n=e.localShadingPatternCache,r=n.get(t);if(!r){var o=d.Pattern.parseShading(t,this.xref,i,this.handler,this._pdfFunctionFactory,a).getIR();r="pattern_".concat(this.idFactory.createObjId()),n.set(t,r),this.handler.send("obj",[r,this.pageIndex,"Pattern",o])}return r}},{key:"handleColorN",value:function(e,t,i,n,o,s,l,c,u,p){var m=i.pop();if(m instanceof r.Name){var h=o.getRaw(m.name),f=h instanceof r.Ref&&u.getByRef(h);if(f)try{var y=n.base?n.base.getRgb(i,0):null,b=(0,d.getTilingPatternIR)(f.operatorListIR,f.dict,y);return void e.addOp(t,b)}catch(k){}var g=this.xref.fetchIfRef(h);if(g){var v=g instanceof w.BaseStream?g.dict:g,_=v.get("PatternType");if(_===E){var A=n.base?n.base.getRgb(i,0):null;return this.handleTilingType(t,A,s,g,v,e,l,u)}if(_===N){var x=v.get("Shading"),S=v.getArray("Matrix"),C=this.parseShading({shading:x,resources:s,localColorSpaceCache:c,localShadingPatternCache:p});return void e.addOp(t,["Shading",C,S])}throw new a.FormatError("Unknown PatternType: ".concat(_))}}throw new a.FormatError("Unknown PatternName: ".concat(m))}},{key:"_parseVisibilityExpression",value:function(e,t,i){if(++t>10)(0,a.warn)("Visibility expression is too deeply nested");else{var n=e.length,o=this.xref.fetchIfRef(e[0]);if(!(n<2)&&o instanceof r.Name){switch(o.name){case"And":case"Or":case"Not":i.push(o.name);break;default:return void(0,a.warn)("Invalid operator ".concat(o.name," in visibility expression"))}for(var s=1;s<n;s++){var l=e[s],c=this.xref.fetchIfRef(l);if(Array.isArray(c)){var d=[];i.push(d),this._parseVisibilityExpression(c,t,d)}else l instanceof r.Ref&&i.push(l.toString())}}else(0,a.warn)("Invalid visibility expression")}}},{key:"parseMarkedContentProps",value:function(){var e=y(p().mark((function e(t,i){var n,o,s,l,c,d,u,m,f,y;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(t instanceof r.Name)){e.next=5;break}o=i.get("Properties"),n=o.get(t.name),e.next=10;break;case 5:if(!(t instanceof r.Dict)){e.next=9;break}n=t,e.next=10;break;case 9:throw new a.FormatError("Optional content properties malformed.");case 10:if("OCG"!==(s=n.get("Type").name)){e.next=15;break}return e.abrupt("return",{type:s,id:n.objId});case 15:if("OCMD"!==s){e.next=31;break}if(l=n.get("VE"),!Array.isArray(l)){e.next=22;break}if(c=[],this._parseVisibilityExpression(l,0,c),!(c.length>0)){e.next=22;break}return e.abrupt("return",{type:"OCMD",expression:c});case 22:if(d=n.get("OCGs"),!(Array.isArray(d)||d instanceof r.Dict)){e.next=29;break}if(u=[],Array.isArray(d)){m=h(d);try{for(m.s();!(f=m.n()).done;)y=f.value,u.push(y.toString())}catch(p){m.e(p)}finally{m.f()}}else u.push(d.objId);return e.abrupt("return",{type:s,ids:u,policy:n.get("P")instanceof r.Name?n.get("P").name:null,expression:null});case 29:if(!(d instanceof r.Ref)){e.next=31;break}return e.abrupt("return",{type:s,id:d.toString()});case 31:return e.abrupt("return",null);case 32:case"end":return e.stop()}}),e,this)})));return function(t,i){return e.apply(this,arguments)}}()},{key:"getOperatorList",value:function(e){var t=this,i=e.stream,n=e.task,o=e.resources,s=e.operatorList,l=e.initialState,d=void 0===l?null:l,u=e.fallbackFontDict,p=void 0===u?null:u;if(o=o||r.Dict.empty,d=d||new V,!s)throw new Error('getOperatorList: missing "operatorList" parameter');var m=this,f=this.xref,y=!1,b=new A.LocalImageCache,g=new A.LocalColorSpaceCache,v=new A.LocalGStateCache,_=new A.LocalTilingPatternCache,x=new Map,S=o.get("XObject")||r.Dict.empty,k=o.get("Pattern")||r.Dict.empty,D=new Y(d),R=new Q(i,f,D),I=new q;function M(e){for(var t=0,i=R.savedStatesDepth;t<i;t++)s.addOp(a.OPS.restore,[])}return new Promise((function e(t,i){var l=function(a){Promise.all([a,s.ready]).then((function(){try{e(t,i)}catch(a){i(a)}}),i)};n.ensureNotTerminated(),I.reset();for(var d,u,A,T,P,z,B={};!(d=I.check())&&(B.args=null,R.read(B));){var F=B.args,E=B.fn;switch(0|E){case a.OPS.paintXObject:if(z=F[0]instanceof r.Name,P=F[0].name,z){var N=b.getByName(P);if(N){s.addImageOps(N.fn,N.args,N.optionalContent),j(N),F=null;continue}}return void l(new Promise((function(e,t){if(!z)throw new a.FormatError("XObject must be referred to by name.");var i=S.getRaw(P);if(i instanceof r.Ref){var l=b.getByRef(i);if(l)return s.addImageOps(l.fn,l.args,l.optionalContent),j(l),void e();var c=m.globalImageCache.getData(i,m.pageIndex);if(c)return s.addDependency(c.objId),s.addImageOps(c.fn,c.args,c.optionalContent),void e();i=f.fetch(i)}if(!(i instanceof w.BaseStream))throw new a.FormatError("XObject should be a stream");var d=i.dict.get("Subtype");if(!(d instanceof r.Name))throw new a.FormatError("XObject should have a Name subtype");if("Form"===d.name)return D.save(),void m.buildFormXObject(o,i,null,s,n,D.state.clone(),g).then((function(){D.restore(),e()}),t);if("Image"!==d.name){if("PS"!==d.name)throw new a.FormatError("Unhandled XObject subtype ".concat(d.name));(0,a.info)("Ignored XObject subtype PS"),e()}else m.buildPaintImageXObject({resources:o,image:i,operatorList:s,cacheKey:P,localImageCache:b,localColorSpaceCache:g}).then(e,t)})).catch((function(e){if(!(e instanceof a.AbortException)){if(m.options.ignoreErrors)return m.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorXObject}),void(0,a.warn)('getOperatorList - ignoring XObject: "'.concat(e,'".'));throw e}})));case a.OPS.setFont:var O=F[1];return void l(m.handleSetFont(o,F,null,s,n,D.state,p).then((function(e){s.addDependency(e),s.addOp(a.OPS.setFont,[e,O])})));case a.OPS.beginText:y=!0;break;case a.OPS.endText:y=!1;break;case a.OPS.endInlineImage:var L=F[0].cacheKey;if(L){var q=b.getByName(L);if(q){s.addImageOps(q.fn,q.args,q.optionalContent),j(q),F=null;continue}}return void l(m.buildPaintImageXObject({resources:o,image:F[0],isInline:!0,operatorList:s,cacheKey:L,localImageCache:b,localColorSpaceCache:g}));case a.OPS.showText:if(!D.state.font){m.ensureStateFont(D.state);continue}F[0]=m.handleText(F[0],D.state);break;case a.OPS.showSpacedText:if(!D.state.font){m.ensureStateFont(D.state);continue}var H,U=[],Y=D.state,X=h(F[0]);try{for(X.s();!(H=X.n()).done;){var V,Q=H.value;"string"===typeof Q?(V=U).push.apply(V,c(m.handleText(Q,Y))):"number"===typeof Q&&U.push(Q)}}catch(ee){X.e(ee)}finally{X.f()}F[0]=U,E=a.OPS.showText;break;case a.OPS.nextLineShowText:if(!D.state.font){m.ensureStateFont(D.state);continue}s.addOp(a.OPS.nextLine),F[0]=m.handleText(F[0],D.state),E=a.OPS.showText;break;case a.OPS.nextLineSetSpacingShowText:if(!D.state.font){m.ensureStateFont(D.state);continue}s.addOp(a.OPS.nextLine),s.addOp(a.OPS.setWordSpacing,[F.shift()]),s.addOp(a.OPS.setCharSpacing,[F.shift()]),F[0]=m.handleText(F[0],D.state),E=a.OPS.showText;break;case a.OPS.setTextRenderingMode:D.state.textRenderingMode=F[0];break;case a.OPS.setFillColorSpace:var W=C.ColorSpace.getCached(F[0],f,g);if(W){D.state.fillColorSpace=W;continue}return void l(m.parseColorSpace({cs:F[0],resources:o,localColorSpaceCache:g}).then((function(e){e&&(D.state.fillColorSpace=e)})));case a.OPS.setStrokeColorSpace:var Z=C.ColorSpace.getCached(F[0],f,g);if(Z){D.state.strokeColorSpace=Z;continue}return void l(m.parseColorSpace({cs:F[0],resources:o,localColorSpaceCache:g}).then((function(e){e&&(D.state.strokeColorSpace=e)})));case a.OPS.setFillColor:F=(T=D.state.fillColorSpace).getRgb(F,0),E=a.OPS.setFillRGBColor;break;case a.OPS.setStrokeColor:F=(T=D.state.strokeColorSpace).getRgb(F,0),E=a.OPS.setStrokeRGBColor;break;case a.OPS.setFillGray:D.state.fillColorSpace=C.ColorSpace.singletons.gray,F=C.ColorSpace.singletons.gray.getRgb(F,0),E=a.OPS.setFillRGBColor;break;case a.OPS.setStrokeGray:D.state.strokeColorSpace=C.ColorSpace.singletons.gray,F=C.ColorSpace.singletons.gray.getRgb(F,0),E=a.OPS.setStrokeRGBColor;break;case a.OPS.setFillCMYKColor:D.state.fillColorSpace=C.ColorSpace.singletons.cmyk,F=C.ColorSpace.singletons.cmyk.getRgb(F,0),E=a.OPS.setFillRGBColor;break;case a.OPS.setStrokeCMYKColor:D.state.strokeColorSpace=C.ColorSpace.singletons.cmyk,F=C.ColorSpace.singletons.cmyk.getRgb(F,0),E=a.OPS.setStrokeRGBColor;break;case a.OPS.setFillRGBColor:D.state.fillColorSpace=C.ColorSpace.singletons.rgb,F=C.ColorSpace.singletons.rgb.getRgb(F,0);break;case a.OPS.setStrokeRGBColor:D.state.strokeColorSpace=C.ColorSpace.singletons.rgb,F=C.ColorSpace.singletons.rgb.getRgb(F,0);break;case a.OPS.setFillColorN:if("Pattern"===(T=D.state.fillColorSpace).name)return void l(m.handleColorN(s,a.OPS.setFillColorN,F,T,k,o,n,g,_,x));F=T.getRgb(F,0),E=a.OPS.setFillRGBColor;break;case a.OPS.setStrokeColorN:if("Pattern"===(T=D.state.strokeColorSpace).name)return void l(m.handleColorN(s,a.OPS.setStrokeColorN,F,T,k,o,n,g,_,x));F=T.getRgb(F,0),E=a.OPS.setStrokeRGBColor;break;case a.OPS.shadingFill:var J=o.get("Shading");if(!J)throw new a.FormatError("No shading resource found");var K=J.get(F[0].name);if(!K)throw new a.FormatError("No shading object found");F=[m.parseShading({shading:K,resources:o,localColorSpaceCache:g,localShadingPatternCache:x})],E=a.OPS.shadingFill;break;case a.OPS.setGState:if(z=F[0]instanceof r.Name,P=F[0].name,z){var $=v.getByName(P);if($){$.length>0&&s.addOp(a.OPS.setGState,[$]),F=null;continue}}return void l(new Promise((function(e,t){if(!z)throw new a.FormatError("GState must be referred to by name.");var i=o.get("ExtGState");if(!(i instanceof r.Dict))throw new a.FormatError("ExtGState should be a dictionary.");var l=i.get(P);if(!(l instanceof r.Dict))throw new a.FormatError("GState should be a dictionary.");m.setGState({resources:o,gState:l,operatorList:s,cacheKey:P,task:n,stateManager:D,localGStateCache:v,localColorSpaceCache:g}).then(e,t)})).catch((function(e){if(!(e instanceof a.AbortException)){if(m.options.ignoreErrors)return m.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorExtGState}),void(0,a.warn)('getOperatorList - ignoring ExtGState: "'.concat(e,'".'));throw e}})));case a.OPS.moveTo:case a.OPS.lineTo:case a.OPS.curveTo:case a.OPS.curveTo2:case a.OPS.curveTo3:case a.OPS.closePath:case a.OPS.rectangle:m.buildPath(s,E,F,y);continue;case a.OPS.markPoint:case a.OPS.markPointProps:case a.OPS.beginCompat:case a.OPS.endCompat:continue;case a.OPS.beginMarkedContentProps:if(!(F[0]instanceof r.Name)){(0,a.warn)("Expected name for beginMarkedContentProps arg0=".concat(F[0]));continue}if("OC"===F[0].name)return void l(m.parseMarkedContentProps(F[1],o).then((function(e){s.addOp(a.OPS.beginMarkedContentProps,["OC",e])})).catch((function(e){if(!(e instanceof a.AbortException)){if(m.options.ignoreErrors)return m.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorMarkedContent}),void(0,a.warn)('getOperatorList - ignoring beginMarkedContentProps: "'.concat(e,'".'));throw e}})));F=[F[0].name,F[1]instanceof r.Dict?F[1].get("MCID"):null];break;case a.OPS.beginMarkedContent:case a.OPS.endMarkedContent:default:if(null!==F){for(u=0,A=F.length;u<A&&!(F[u]instanceof r.Dict);u++);if(u<A){(0,a.warn)("getOperatorList - ignoring operator: "+E);continue}}}s.addOp(E,F)}d?l(G):(M(),t())})).catch((function(e){if(!(e instanceof a.AbortException)){if(t.options.ignoreErrors)return t.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorOperatorList}),(0,a.warn)('getOperatorList - ignoring errors during "'.concat(n.name,'" ')+'task: "'.concat(e,'".')),void M();throw e}}))}},{key:"getTextContent",value:function(e){var t=this,i=e.stream,n=e.task,o=e.resources,s=e.stateManager,l=void 0===s?null:s,c=e.combineTextItems,d=void 0!==c&&c,u=e.includeMarkedContent,p=void 0!==u&&u,m=e.sink,h=e.seenStyles,y=void 0===h?new Set:h,b=e.viewBox,g=e.markedContentData,v=void 0===g?null:g;o=o||r.Dict.empty,l=l||new Y(new X),p&&(v=v||{level:0});var _={items:[],styles:Object.create(null)},x={initialized:!1,str:[],totalWidth:0,totalHeight:0,width:0,height:0,vertical:!1,prevTransform:null,textAdvanceScale:0,spaceInFlowMin:0,spaceInFlowMax:0,trackingSpaceMin:1/0,negativeSpaceMax:-1/0,notASpace:-1/0,transform:null,fontName:null,hasEOL:!1},C=[" "," "],k=0;function D(e){var t=(k+1)%2,i=" "!==C[k]&&" "===C[t];return C[k]=e,k=t,i}function R(){C[0]=C[1]=" ",k=0}var I,M=.1,T=.03,P=-.2,z=.1,B=.6,F=this,E=this.xref,N=[],L=null,j=new A.LocalImageCache,H=new A.LocalGStateCache,U=new Q(i,E,l);function V(){var e=I.font,t=[I.fontSize*I.textHScale,0,0,I.fontSize,0,I.textRise];if(e.isType3Font&&(I.fontSize<=1||e.isCharBBox)&&!(0,a.isArrayEqual)(I.fontMatrix,a.FONT_IDENTITY_MATRIX)){var i=e.bbox[3]-e.bbox[1];i>0&&(t[3]*=i*I.fontMatrix[3])}return a.Util.transform(I.ctm,a.Util.transform(I.textMatrix,t))}function W(){if(x.initialized)return x;var e=I,t=e.font,i=e.loadedName;y.has(i)||(y.add(i),_.styles[i]={fontFamily:t.fallbackName,ascent:t.ascent,descent:t.descent,vertical:t.vertical}),x.fontName=i;var a=x.transform=V();t.vertical?(x.width=x.totalWidth=Math.hypot(a[0],a[1]),x.height=x.totalHeight=0,x.vertical=!0):(x.width=x.totalWidth=0,x.height=x.totalHeight=Math.hypot(a[2],a[3]),x.vertical=!1);var n=Math.hypot(I.textLineMatrix[0],I.textLineMatrix[1]),r=Math.hypot(I.ctm[0],I.ctm[1]);return x.textAdvanceScale=r*n,x.trackingSpaceMin=I.fontSize*M,x.notASpace=I.fontSize*T,x.negativeSpaceMax=I.fontSize*P,x.spaceInFlowMin=I.fontSize*z,x.spaceInFlowMax=I.fontSize*B,x.hasEOL=!1,x.initialized=!0,x}function Z(){if(x.initialized){var e=Math.hypot(I.textLineMatrix[0],I.textLineMatrix[1]),t=Math.hypot(I.ctm[0],I.ctm[1])*e;t!==x.textAdvanceScale&&(x.vertical?(x.totalHeight+=x.height*x.textAdvanceScale,x.height=0):(x.totalWidth+=x.width*x.textAdvanceScale,x.width=0),x.textAdvanceScale=t)}}function J(e,t){return F.loadFont(e,t,o).then((function(e){return e.font.isType3Font?e.loadType3Data(F,o,n).catch((function(){})).then((function(){return e})):e})).then((function(e){I.loadedName=e.loadedName,I.font=e.font,I.fontMatrix=e.font.fontMatrix||a.FONT_IDENTITY_MATRIX}))}function K(e,t,i){var a=Math.hypot(i[0],i[1]);return[(i[0]*e+i[1]*t)/a,(i[2]*e+i[3]*t)/a]}function $(){var e=V(),t=e[4],i=e[5],a=t-b[0],n=i-b[1];if(a<0||a>b[2]||n<0||n>b[3])return!1;if(!d||!I.font||!x.prevTransform)return!0;var r=x.prevTransform[4],o=x.prevTransform[5];if(r===t&&o===i)return!0;var s=-1;switch(e[0]&&0===e[1]&&0===e[2]?s=e[0]>0?0:180:e[1]&&0===e[0]&&0===e[3]&&(s=e[1]>0?90:270),s){case 0:break;case 90:var l=[i,t];t=l[0],i=l[1];var c=[o,r];r=c[0],o=c[1];break;case 180:var u=[-t,-i,-r,-o];t=u[0],i=u[1],r=u[2],o=u[3];break;case 270:var p=[-i,-t];t=p[0],i=p[1];var m=[-o,-r];r=m[0],o=m[1];break;default:var h=K(t,i,e),y=f(h,2);t=y[0],i=y[1];var g=K(r,o,x.prevTransform),v=f(g,2);r=v[0],o=v[1]}if(I.font.vertical){var A=(o-i)/x.textAdvanceScale,w=t-r,S=Math.sign(x.height);return A<S*x.negativeSpaceMax?Math.abs(w)>.5*x.width?(te(),!0):(R(),ae(),!0):Math.abs(w)>x.width?(te(),!0):(A<=S*x.notASpace&&R(),A<=S*x.trackingSpaceMin?x.height+=A:ie(A,x.prevTransform,S)||(0===x.str.length?(R(),_.items.push({str:" ",dir:"ltr",width:0,height:Math.abs(A),transform:x.prevTransform,fontName:x.fontName,hasEOL:!1})):x.height+=A),!0)}var C=(t-r)/x.textAdvanceScale,k=i-o,D=Math.sign(x.width);return C<D*x.negativeSpaceMax?Math.abs(k)>.5*x.height?(te(),!0):(R(),ae(),!0):Math.abs(k)>x.height?(te(),!0):(C<=D*x.notASpace&&R(),C<=D*x.trackingSpaceMin?x.width+=C:ie(C,x.prevTransform,D)||(0===x.str.length?(R(),_.items.push({str:" ",dir:"ltr",width:Math.abs(C),height:0,transform:x.prevTransform,fontName:x.fontName,hasEOL:!1})):x.width+=C),!0)}function ee(e){var t=e.chars,i=e.extraSpacing,a=I.font;if(t)for(var n=a.charsToGlyphs(t),r=I.fontMatrix[0]*I.fontSize,o=0,s=n.length;o<s;o++){var l=n[o],c=l.category;if(!c.isInvisibleFormatMark){var d=I.charSpacing+(o+1===s?i:0),u=l.width;a.vertical&&(u=l.vmetric?l.vmetric[0]:-u);var p=u*r;if(c.isWhitespace)a.vertical?(d+=-p+I.wordSpacing,I.translateTextMatrix(0,-d)):(d+=p+I.wordSpacing,I.translateTextMatrix(d*I.textHScale,0)),D(" ");else if(c.isZeroWidthDiacritic||$()){var m=W();c.isZeroWidthDiacritic&&(p=0),a.vertical?(I.translateTextMatrix(0,p),p=Math.abs(p),m.height+=p):(p*=I.textHScale,I.translateTextMatrix(p,0),m.width+=p),p&&(m.prevTransform=V());var h=l.normalizedUnicode;D(h)&&m.str.push(" "),m.str.push(h),d&&(a.vertical?I.translateTextMatrix(0,-d):I.translateTextMatrix(d*I.textHScale,0))}}}else{var f=I.charSpacing+i;f&&(a.vertical?I.translateTextMatrix(0,-f):I.translateTextMatrix(f*I.textHScale,0))}}function te(){R(),x.initialized?(x.hasEOL=!0,ae()):_.items.push({str:"",dir:"ltr",width:0,height:0,transform:V(),fontName:I.loadedName,hasEOL:!0})}function ie(e,t,i){if(i*x.spaceInFlowMin<=e&&e<=i*x.spaceInFlowMax)return x.initialized&&(R(),x.str.push(" ")),!1;var a=x.fontName,n=0;return x.vertical&&(n=e,e=0),ae(),R(),_.items.push({str:" ",dir:"ltr",width:Math.abs(e),height:Math.abs(n),transform:t||V(),fontName:a,hasEOL:!1}),!0}function ae(){x.initialized&&x.str&&(x.vertical?x.totalHeight+=x.height*x.textAdvanceScale:x.totalWidth+=x.width*x.textAdvanceScale,_.items.push(function(e){var t=e.str.join(""),i=(0,S.bidi)(t,-1,e.vertical);return{str:i.str,dir:i.dir,width:Math.abs(e.totalWidth),height:Math.abs(e.totalHeight),transform:e.transform,fontName:e.fontName,hasEOL:e.hasEOL}}(x)),x.initialized=!1,x.str.length=0)}function ne(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=_.items.length;0!==t&&(e&&t<O||(m.enqueue(_,t),_.items=[],_.styles=Object.create(null)))}var re=new q;return new Promise((function e(t,i){var s=function(a){ne(!0),Promise.all([a,m.ready]).then((function(){try{e(t,i)}catch(a){i(a)}}),i)};n.ensureNotTerminated(),re.reset();for(var c,u={},h=[];!(c=re.check())&&(h.length=0,u.args=h,U.read(u));){I=l.state;var f=u.fn;switch(h=u.args,0|f){case a.OPS.setFont:var g=h[0].name,A=h[1];if(I.font&&g===I.fontName&&A===I.fontSize)break;return ae(),I.fontName=g,I.fontSize=A,void s(J(g,null));case a.OPS.setTextRise:I.textRise=h[0];break;case a.OPS.setHScale:I.textHScale=h[0]/100;break;case a.OPS.setLeading:I.leading=h[0];break;case a.OPS.moveText:I.translateTextLineMatrix(h[0],h[1]),I.textMatrix=I.textLineMatrix.slice();break;case a.OPS.setLeadingMoveText:I.leading=-h[1],I.translateTextLineMatrix(h[0],h[1]),I.textMatrix=I.textLineMatrix.slice();break;case a.OPS.nextLine:I.carriageReturn();break;case a.OPS.setTextMatrix:I.setTextMatrix(h[0],h[1],h[2],h[3],h[4],h[5]),I.setTextLineMatrix(h[0],h[1],h[2],h[3],h[4],h[5]),Z();break;case a.OPS.setCharSpacing:I.charSpacing=h[0];break;case a.OPS.setWordSpacing:I.wordSpacing=h[0];break;case a.OPS.beginText:I.textMatrix=a.IDENTITY_MATRIX.slice(),I.textLineMatrix=a.IDENTITY_MATRIX.slice();break;case a.OPS.showSpacedText:if(!l.state.font){F.ensureStateFont(l.state);continue}for(var x=(I.font.vertical?1:-1)*I.fontSize/1e3,S=h[0],C=0,k=S.length;C<k-1;C++){var D=S[C];if("string"===typeof D)N.push(D);else if("number"===typeof D&&0!==D){var R=N.join("");N.length=0,ee({chars:R,extraSpacing:D*x})}}var M=S.at(-1);if("string"===typeof M&&N.push(M),N.length>0){var T=N.join("");N.length=0,ee({chars:T,extraSpacing:0})}break;case a.OPS.showText:if(!l.state.font){F.ensureStateFont(l.state);continue}ee({chars:h[0],extraSpacing:0});break;case a.OPS.nextLineShowText:if(!l.state.font){F.ensureStateFont(l.state);continue}I.carriageReturn(),ee({chars:h[0],extraSpacing:0});break;case a.OPS.nextLineSetSpacingShowText:if(!l.state.font){F.ensureStateFont(l.state);continue}I.wordSpacing=h[0],I.charSpacing=h[1],I.carriageReturn(),ee({chars:h[2],extraSpacing:0});break;case a.OPS.paintXObject:ae(),L||(L=o.get("XObject")||r.Dict.empty);var P=h[0]instanceof r.Name,z=h[0].name;if(P&&j.getByName(z))break;return void s(new Promise((function(e,t){if(!P)throw new a.FormatError("XObject must be referred to by name.");var i=L.getRaw(z);if(i instanceof r.Ref){if(j.getByRef(i))return void e();if(F.globalImageCache.getData(i,F.pageIndex))return void e();i=E.fetch(i)}if(!(i instanceof w.BaseStream))throw new a.FormatError("XObject should be a stream");var s=i.dict.get("Subtype");if(!(s instanceof r.Name))throw new a.FormatError("XObject should have a Name subtype");if("Form"!==s.name)return j.set(z,i.dict.objId,!0),void e();var c=l.state.clone(),u=new Y(c),h=i.dict.getArray("Matrix");Array.isArray(h)&&6===h.length&&u.transform(h),ne();var f={enqueueInvoked:!1,enqueue:function(e,t){this.enqueueInvoked=!0,m.enqueue(e,t)},get desiredSize(){return m.desiredSize},get ready(){return m.ready}};F.getTextContent({stream:i,task:n,resources:i.dict.get("Resources")||o,stateManager:u,combineTextItems:d,includeMarkedContent:p,sink:f,seenStyles:y,viewBox:b,markedContentData:v}).then((function(){f.enqueueInvoked||j.set(z,i.dict.objId,!0),e()}),t)})).catch((function(e){if(!(e instanceof a.AbortException)){if(!F.options.ignoreErrors)throw e;(0,a.warn)('getTextContent - ignoring XObject: "'.concat(e,'".'))}})));case a.OPS.setGState:if(P=h[0]instanceof r.Name,z=h[0].name,P&&H.getByName(z))break;return void s(new Promise((function(e,t){if(!P)throw new a.FormatError("GState must be referred to by name.");var i=o.get("ExtGState");if(!(i instanceof r.Dict))throw new a.FormatError("ExtGState should be a dictionary.");var n=i.get(z);if(!(n instanceof r.Dict))throw new a.FormatError("GState should be a dictionary.");var s=n.get("Font");if(!s)return H.set(z,n.objId,!0),void e();ae(),I.fontName=null,I.fontSize=s[1],J(null,s[0]).then(e,t)})).catch((function(e){if(!(e instanceof a.AbortException)){if(!F.options.ignoreErrors)throw e;(0,a.warn)('getTextContent - ignoring ExtGState: "'.concat(e,'".'))}})));case a.OPS.beginMarkedContent:ae(),p&&(v.level++,_.items.push({type:"beginMarkedContent",tag:h[0]instanceof r.Name?h[0].name:null}));break;case a.OPS.beginMarkedContentProps:if(ae(),p){v.level++;var B=null;h[1]instanceof r.Dict&&(B=h[1].get("MCID")),_.items.push({type:"beginMarkedContentProps",id:Number.isInteger(B)?"".concat(F.idFactory.getPageObjId(),"_mcid").concat(B):null,tag:h[0]instanceof r.Name?h[0].name:null})}break;case a.OPS.endMarkedContent:if(ae(),p){if(0===v.level)break;v.level--,_.items.push({type:"endMarkedContent"})}}if(_.items.length>=m.desiredSize){c=!0;break}}c?s(G):(ae(),ne(),t())})).catch((function(e){if(!(e instanceof a.AbortException)){if(t.options.ignoreErrors)return(0,a.warn)('getTextContent - ignoring errors during "'.concat(n.name,'" ')+'task: "'.concat(e,'".')),ae(),void ne();throw e}}))}},{key:"extractDataStructures",value:function(e,t,i){var n,o=this,l=this.xref,c=this.readToUnicode(i.toUnicode||e.get("ToUnicode")||t.get("ToUnicode"));if(i.composite){var d=e.get("CIDSystemInfo");d instanceof r.Dict&&(i.cidSystemInfo={registry:(0,a.stringToPDFString)(d.get("Registry")),ordering:(0,a.stringToPDFString)(d.get("Ordering")),supplement:d.get("Supplement")});try{var u=e.get("CIDToGIDMap");u instanceof w.BaseStream&&(n=u.getBytes())}catch(k){if(!this.options.ignoreErrors)throw k;(0,a.warn)('extractDataStructures - ignoring CIDToGIDMap data: "'.concat(k,'".'))}}var p,m=[],f=null;if(e.has("Encoding")){if((p=e.get("Encoding"))instanceof r.Dict){if(f=(f=p.get("BaseEncoding"))instanceof r.Name?f.name:null,p.has("Differences")){var y,b=p.get("Differences"),g=0,v=h(b);try{for(v.s();!(y=v.n()).done;){var _=y.value,A=l.fetchIfRef(_);if("number"===typeof A)g=A;else{if(!(A instanceof r.Name))throw new a.FormatError("Invalid entry in 'Differences' array: ".concat(A));m[g++]=A.name}}}catch(R){v.e(R)}finally{v.f()}}}else if(p instanceof r.Name)f=p.name;else{var x="Encoding is not a Name nor a Dict";if(!this.options.ignoreErrors)throw new a.FormatError(x);(0,a.warn)(x)}"MacRomanEncoding"!==f&&"MacExpertEncoding"!==f&&"WinAnsiEncoding"!==f&&(f=null)}if(f)i.defaultEncoding=(0,s.getEncoding)(f);else{var S=!!(i.flags&D.FontFlags.Symbolic),C=!!(i.flags&D.FontFlags.Nonsymbolic);p=s.StandardEncoding,"TrueType"!==i.type||C||(p=s.WinAnsiEncoding),S&&(p=s.MacRomanEncoding,i.file&&!i.isInternalFont||(/Symbol/i.test(i.name)?p=s.SymbolSetEncoding:/Dingbats|Wingdings/i.test(i.name)&&(p=s.ZapfDingbatsEncoding))),i.defaultEncoding=p}return i.differences=m,i.baseEncodingName=f,i.hasEncoding=!!f||m.length>0,i.dict=e,c.then((function(e){return i.toUnicode=e,o.buildToUnicode(i)})).then((function(e){return i.toUnicode=e,n&&(i.cidToGidMap=o.readCidToGidMap(n,e)),i}))}},{key:"_simpleFontToUnicode",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];(0,a.assert)(!e.composite,"Must be a simple font.");var i=[],n=e.defaultEncoding.slice(),r=e.baseEncodingName,o=e.differences;for(var l in o){var c=o[l];".notdef"!==c&&(n[l]=c)}var d=(0,R.getGlyphsUnicode)();for(var u in n){var p=n[u];if(""!==p){var m=d[p];if(void 0===m){var h=0;switch(p[0]){case"G":3===p.length&&(h=parseInt(p.substring(1),16));break;case"g":5===p.length&&(h=parseInt(p.substring(1),16));break;case"C":case"c":if(p.length>=3&&p.length<=4){var f=p.substring(1);if(t){h=parseInt(f,16);break}if(h=+f,Number.isNaN(h)&&Number.isInteger(parseInt(f,16)))return this._simpleFontToUnicode(e,!0)}break;case"u":-1!==(m=(0,T.getUnicodeForGlyph)(p,d))&&(h=m)}if(h>0&&h<=1114111&&Number.isInteger(h)){if(r&&h===+u){var y=(0,s.getEncoding)(r);if(y&&(p=y[u])){i[u]=String.fromCharCode(d[p]);continue}}i[u]=String.fromCodePoint(h)}}else i[u]=String.fromCharCode(m)}}return i}},{key:"buildToUnicode",value:function(){var e=y(p().mark((function e(t){var i,o,s,l,c,d;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(t.hasIncludedToUnicodeMap=!!t.toUnicode&&t.toUnicode.length>0,!t.hasIncludedToUnicodeMap){e.next=4;break}return!t.composite&&t.hasEncoding&&(t.fallbackToUnicode=this._simpleFontToUnicode(t)),e.abrupt("return",t.toUnicode);case 4:if(t.composite){e.next=6;break}return e.abrupt("return",new m.ToUnicodeMap(this._simpleFontToUnicode(t)));case 6:if(!t.composite||(!t.cMap.builtInCMap||t.cMap instanceof n.IdentityCMap)&&("Adobe"!==t.cidSystemInfo.registry||"GB1"!==t.cidSystemInfo.ordering&&"CNS1"!==t.cidSystemInfo.ordering&&"Japan1"!==t.cidSystemInfo.ordering&&"Korea1"!==t.cidSystemInfo.ordering)){e.next=15;break}return i=t.cidSystemInfo,o=i.registry,s=i.ordering,l=r.Name.get("".concat(o,"-").concat(s,"-UCS2")),e.next=11,n.CMapFactory.create({encoding:l,fetchBuiltInCMap:this._fetchBuiltInCMapBound,useCMap:null});case 11:return c=e.sent,d=[],t.cMap.forEach((function(e,t){if(t>65535)throw new a.FormatError("Max size of CID is 65,535");var i=c.lookup(t);i&&(d[e]=String.fromCharCode((i.charCodeAt(0)<<8)+i.charCodeAt(1)))})),e.abrupt("return",new m.ToUnicodeMap(d));case 15:return e.abrupt("return",new m.IdentityToUnicodeMap(t.firstChar,t.lastChar));case 16:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"readToUnicode",value:function(e){var t=this;return e?e instanceof r.Name?n.CMapFactory.create({encoding:e,fetchBuiltInCMap:this._fetchBuiltInCMapBound,useCMap:null}).then((function(e){return e instanceof n.IdentityCMap?new m.IdentityToUnicodeMap(0,65535):new m.ToUnicodeMap(e.getMap())})):e instanceof w.BaseStream?n.CMapFactory.create({encoding:e,fetchBuiltInCMap:this._fetchBuiltInCMapBound,useCMap:null}).then((function(e){if(e instanceof n.IdentityCMap)return new m.IdentityToUnicodeMap(0,65535);var t=new Array(e.length);return e.forEach((function(e,i){if("number"!==typeof i){for(var a=[],n=0;n<i.length;n+=2){var r=i.charCodeAt(n)<<8|i.charCodeAt(n+1);if(55296===(63488&r)){n+=2;var o=i.charCodeAt(n)<<8|i.charCodeAt(n+1);a.push(((1023&r)<<10)+(1023&o)+65536)}else a.push(r)}t[e]=String.fromCodePoint.apply(String,a)}else t[e]=String.fromCodePoint(i)})),new m.ToUnicodeMap(t)}),(function(e){if(e instanceof a.AbortException)return null;if(t.options.ignoreErrors)return t.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontToUnicode}),(0,a.warn)('readToUnicode - ignoring ToUnicode data: "'.concat(e,'".')),null;throw e})):Promise.resolve(null):Promise.resolve(null)}},{key:"readCidToGidMap",value:function(e,t){for(var i=[],a=0,n=e.length;a<n;a++){var r=e[a++]<<8|e[a],o=a>>1;(0!==r||t.has(o))&&(i[o]=r)}return i}},{key:"extractWidths",value:function(e,t,i){var a,n,o,s,l,c,d,u,p=this.xref,m=[],h=0,f=[];if(i.composite){if(h=e.has("DW")?e.get("DW"):1e3,u=e.get("W"))for(n=0,o=u.length;n<o;n++)if(c=p.fetchIfRef(u[n++]),d=p.fetchIfRef(u[n]),Array.isArray(d))for(s=0,l=d.length;s<l;s++)m[c++]=p.fetchIfRef(d[s]);else{var y=p.fetchIfRef(u[++n]);for(s=c;s<=d;s++)m[s]=y}if(i.vertical){var b=e.getArray("DW2")||[880,-1e3];if(a=[b[1],.5*h,b[0]],b=e.get("W2"))for(n=0,o=b.length;n<o;n++)if(c=p.fetchIfRef(b[n++]),d=p.fetchIfRef(b[n]),Array.isArray(d))for(s=0,l=d.length;s<l;s++)f[c++]=[p.fetchIfRef(d[s++]),p.fetchIfRef(d[s++]),p.fetchIfRef(d[s])];else{var g=[p.fetchIfRef(b[++n]),p.fetchIfRef(b[++n]),p.fetchIfRef(b[++n])];for(s=c;s<=d;s++)f[s]=g}}}else{var v=i.firstChar;if(u=e.get("Widths")){for(s=v,n=0,o=u.length;n<o;n++)m[s++]=p.fetchIfRef(u[n]);h=parseFloat(t.get("MissingWidth"))||0}else{var _=e.get("BaseFont");if(_ instanceof r.Name){var A=this.getBaseFontMetrics(_.name);m=this.buildCharCodeToWidth(A.widths,i),h=A.defaultWidth}}}var x=!0,w=h;for(var S in m){var C=m[S];if(C)if(w){if(w!==C){x=!1;break}}else w=C}x&&(i.flags|=D.FontFlags.FixedPitch),i.defaultWidth=h,i.widths=m,i.defaultVMetrics=a,i.vmetrics=f}},{key:"isSerifFont",value:function(e){var t=e.split("-")[0];return t in(0,l.getSerifFonts)()||/serif/gi.test(t)}},{key:"getBaseFontMetrics",value:function(e){var t=0,i=Object.create(null),a=!1,n=(0,l.getStdFontMap)()[e]||e,r=(0,M.getMetrics)();n in r||(n=this.isSerifFont(e)?"Times-Roman":"Helvetica");var o=r[n];return"number"===typeof o?(t=o,a=!0):i=o(),{defaultWidth:t,monospace:a,widths:i}}},{key:"buildCharCodeToWidth",value:function(e,t){for(var i=Object.create(null),a=t.differences,n=t.defaultEncoding,r=0;r<256;r++)r in a&&e[a[r]]?i[r]=e[a[r]]:r in n&&e[n[r]]&&(i[r]=e[n[r]]);return i}},{key:"preEvaluateFont",value:function(e){var t=e,i=e.get("Subtype");if(!(i instanceof r.Name))throw new a.FormatError("invalid font Subtype");var n,o,s=!1;if("Type0"===i.name){var l=e.get("DescendantFonts");if(!l)throw new a.FormatError("Descendant fonts are not specified");if(!((e=Array.isArray(l)?this.xref.fetchIfRef(l[0]):l)instanceof r.Dict))throw new a.FormatError("Descendant font is not a dictionary.");if(!((i=e.get("Subtype"))instanceof r.Name))throw new a.FormatError("invalid font Subtype");s=!0}var c=e.get("FirstChar")||0,d=e.get("LastChar")||(s?65535:255),u=e.get("FontDescriptor");if(u){n=new P.MurmurHash3_64;var p=t.getRaw("Encoding");if(p instanceof r.Name)n.update(p.name);else if(p instanceof r.Ref)n.update(p.toString());else if(p instanceof r.Dict){var m,f=h(p.getRawValues());try{for(f.s();!(m=f.n()).done;){var y=m.value;if(y instanceof r.Name)n.update(y.name);else if(y instanceof r.Ref)n.update(y.toString());else if(Array.isArray(y)){for(var b=y.length,g=new Array(b),v=0;v<b;v++){var _=y[v];_ instanceof r.Name?g[v]=_.name:("number"===typeof _||_ instanceof r.Ref)&&(g[v]=_.toString())}n.update(g.join())}}}catch(L){f.e(L)}finally{f.f()}}if(n.update("".concat(c,"-").concat(d)),(o=e.get("ToUnicode")||t.get("ToUnicode"))instanceof w.BaseStream){var A=o.str||o,x=A.buffer?new Uint8Array(A.buffer.buffer,0,A.bufferLength):new Uint8Array(A.bytes.buffer,A.start,A.end-A.start);n.update(x)}else o instanceof r.Name&&n.update(o.name);var S=e.get("Widths")||t.get("Widths");if(Array.isArray(S)){var C,k=[],D=h(S);try{for(D.s();!(C=D.n()).done;){var R=C.value;("number"===typeof R||R instanceof r.Ref)&&k.push(R.toString())}}catch(L){D.e(L)}finally{D.f()}n.update(k.join())}if(s){n.update("compositeFont");var I=e.get("W")||t.get("W");if(Array.isArray(I)){var M,T=[],z=h(I);try{for(z.s();!(M=z.n()).done;){var B=M.value;if("number"===typeof B||B instanceof r.Ref)T.push(B.toString());else if(Array.isArray(B)){var F,E=[],N=h(B);try{for(N.s();!(F=N.n()).done;){var O=F.value;("number"===typeof O||O instanceof r.Ref)&&E.push(O.toString())}}catch(L){N.e(L)}finally{N.f()}T.push("[".concat(E.join(),"]"))}}}catch(L){z.e(L)}finally{z.f()}n.update(T.join())}var G=e.getRaw("CIDToGIDMap")||t.getRaw("CIDToGIDMap");G instanceof r.Name?n.update(G.name):G instanceof r.Ref?n.update(G.toString()):G instanceof w.BaseStream&&n.update(G.peekBytes())}}return{descriptor:u,dict:e,baseDict:t,composite:s,type:i.name,firstChar:c,lastChar:d,toUnicode:o,hash:n?n.hexdigest():""}}},{key:"translateFont",value:function(){var e=y(p().mark((function e(t){var i,s,c,d,m,f,y,b,g,v,_,A,w,S,C,k,R,I,M,T,P,z,B,F,E,N,O,G,L,j,q,H,U,Y,X,V=this;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(i=t.descriptor,s=t.dict,c=t.baseDict,d=t.composite,m=t.type,f=t.firstChar,y=t.lastChar,b=t.toUnicode,g=t.cssFontInfo,v="Type3"===m,i){e.next=27;break}if(!v){e.next=9;break}(i=new r.Dict(null)).set("FontName",r.Name.get(m)),i.set("FontBBox",s.getArray("FontBBox")||[0,0,0,0]),e.next=27;break;case 9:if((A=s.get("BaseFont"))instanceof r.Name){e.next=12;break}throw new a.FormatError("Base font is not specified");case 12:if(A=A.name.replace(/[,_]/g,"-"),w=this.getBaseFontMetrics(A),S=A.split("-")[0],C=(this.isSerifFont(S)?D.FontFlags.Serif:0)|(w.monospace?D.FontFlags.FixedPitch:0)|((0,l.getSymbolsFonts)()[S]?D.FontFlags.Symbolic:D.FontFlags.Nonsymbolic),_={type:m,name:A,loadedName:c.loadedName,widths:w.widths,defaultWidth:w.defaultWidth,isSimulatedFlags:!0,flags:C,firstChar:f,lastChar:y,toUnicode:b,xHeight:0,capHeight:0,italicAngle:0,isType3Font:v},k=s.get("Widths"),R=(0,l.getStandardFontName)(A),I=null,!R){e.next=26;break}return _.isStandardFont=!0,e.next=24,this.fetchStandardFontData(R);case 24:I=e.sent,_.isInternalFont=!!I;case 26:return e.abrupt("return",this.extractDataStructures(s,s,_).then((function(e){if(k){var t,i=[],a=f,n=h(k);try{for(n.s();!(t=n.n()).done;){var r=t.value;i[a++]=V.xref.fetchIfRef(r)}}catch(s){n.e(s)}finally{n.f()}e.widths=i}else e.widths=V.buildCharCodeToWidth(w.widths,e);return new o.Font(A,I,e)})));case 27:if(M=i.get("FontName"),T=s.get("BaseFont"),"string"===typeof M&&(M=r.Name.get(M)),"string"===typeof T&&(T=r.Name.get(T)),v||(P=M&&M.name,z=T&&T.name,P!==z&&((0,a.info)("The FontDescriptor's FontName is \"".concat(P,'" but ')+"should be the same as the Font's BaseFont \"".concat(z,'".')),P&&z&&z.startsWith(P)&&(M=T))),(M=M||T)instanceof r.Name){e.next=35;break}throw new a.FormatError("invalid font name");case 35:e.prev=35,B=i.get("FontFile","FontFile2","FontFile3"),e.next=45;break;case 39:if(e.prev=39,e.t0=e.catch(35),this.options.ignoreErrors){e.next=43;break}throw e.t0;case 43:(0,a.warn)('translateFont - fetching "'.concat(M.name,'" font file: "').concat(e.t0,'".')),B=new x.NullStream;case 45:if(G=!1,L=!1,j=null,!B){e.next=52;break}B.dict&&((q=B.dict.get("Subtype"))instanceof r.Name&&(F=q.name),E=B.dict.get("Length1"),N=B.dict.get("Length2"),O=B.dict.get("Length3")),e.next=74;break;case 52:if(!g){e.next=66;break}if(!(H=(0,u.getXfaFontName)(M.name))){e.next=64;break}return g.fontFamily="".concat(g.fontFamily,"-PdfJS-XFA"),g.metrics=H.metrics||null,j=H.factors||null,e.next=60,this.fetchStandardFontData(H.name);case 60:B=e.sent,L=!!B,c=s=(0,u.getXfaFontDict)(M.name),d=!0;case 64:e.next=74;break;case 66:if(v){e.next=74;break}if(!(U=(0,l.getStandardFontName)(M.name))){e.next=74;break}return G=!0,e.next=72,this.fetchStandardFontData(U);case 72:B=e.sent,L=!!B;case 74:if(_={type:m,name:M.name,subtype:F,file:B,length1:E,length2:N,length3:O,isStandardFont:G,isInternalFont:L,loadedName:c.loadedName,composite:d,fixedPitch:!1,fontMatrix:s.getArray("FontMatrix")||a.FONT_IDENTITY_MATRIX,firstChar:f,lastChar:y,toUnicode:b,bbox:i.getArray("FontBBox")||s.getArray("FontBBox"),ascent:i.get("Ascent"),descent:i.get("Descent"),xHeight:i.get("XHeight")||0,capHeight:i.get("CapHeight")||0,flags:i.get("Flags"),italicAngle:i.get("ItalicAngle")||0,isType3Font:v,cssFontInfo:g,scaleFactors:j},!d){e.next=83;break}return(Y=c.get("Encoding"))instanceof r.Name&&(_.cidEncoding=Y.name),e.next=80,n.CMapFactory.create({encoding:Y,fetchBuiltInCMap:this._fetchBuiltInCMapBound,useCMap:null});case 80:X=e.sent,_.cMap=X,_.vertical=_.cMap.vertical;case 83:return e.abrupt("return",this.extractDataStructures(s,c,_).then((function(e){return V.extractWidths(s,i,e),new o.Font(M.name,B,e)})));case 84:case"end":return e.stop()}}),e,this,[[35,39]])})));return function(t){return e.apply(this,arguments)}}()}],[{key:"buildFontPaths",value:function(e,t,i,n){function r(t){var r="".concat(e.loadedName,"_path_").concat(t);try{if(e.renderer.hasBuiltPath(t))return;i.send("commonobj",[r,"FontPath",e.renderer.getPathJs(t)])}catch(o){if(n.ignoreErrors)return i.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontBuildPath}),void(0,a.warn)("buildFontPaths - ignoring ".concat(r,' glyph: "').concat(o,'".'));throw o}}var o,s=h(t);try{for(s.s();!(o=s.n()).done;){var l=o.value;r(l.fontChar);var c=l.accent;c&&c.fontChar&&r(c.fontChar)}}catch(d){s.e(d)}finally{s.f()}}},{key:"fallbackFontDict",get:function(){var e=new r.Dict;return e.set("BaseFont",r.Name.get("PDFJS-FallbackFont")),e.set("Type",r.Name.get("FallbackType")),e.set("Subtype",r.Name.get("FallbackType")),e.set("Encoding",r.Name.get("WinAnsiEncoding")),(0,a.shadow)(this,"fallbackFontDict",e)}}]),e}();t.PartialEvaluator=H;var U=function(){function e(t){b(this,e);var i=t.loadedName,a=t.font,n=t.dict,r=t.evaluatorOptions;this.loadedName=i,this.font=a,this.dict=n,this._evaluatorOptions=r||F,this.type3Loaded=null,this.type3Dependencies=a.isType3Font?new Set:null,this.sent=!1}return g(e,[{key:"send",value:function(e){this.sent||(this.sent=!0,e.send("commonobj",[this.loadedName,"Font",this.font.exportData(this._evaluatorOptions.fontExtraProperties)]))}},{key:"fallback",value:function(e){this.font.data&&(this.font.disableFontFace=!0,H.buildFontPaths(this.font,this.font.glyphCacheValues,e,this._evaluatorOptions))}},{key:"loadType3Data",value:function(e,t,i){var n=this;if(this.type3Loaded)return this.type3Loaded;if(!this.font.isType3Font)throw new Error("Must be a Type3 font.");var o=e.clone({ignoreErrors:!1});o.parsingType3Font=!0;var s=new r.RefSet(e.type3FontRefs);this.dict.objId&&!s.has(this.dict.objId)&&s.put(this.dict.objId),o.type3FontRefs=s;var l,c=this.font,d=this.type3Dependencies,u=Promise.resolve(),p=this.dict.get("CharProcs"),m=this.dict.get("Resources")||t,f=Object.create(null),y=a.Util.normalizeRect(c.bbox||[0,0,0,0]),b=y[2]-y[0],g=y[3]-y[1],v=Math.hypot(b,g),_=h(p.getKeys());try{var A=function(){var e=l.value;u=u.then((function(){var t=p.get(e),r=new z.OperatorList;return o.getOperatorList({stream:t,task:i,resources:m,operatorList:r}).then((function(){r.fnArray[0]===a.OPS.setCharWidthAndBounds&&n._removeType3ColorOperators(r,v),f[e]=r.getIR();var t,i=h(r.dependencies);try{for(i.s();!(t=i.n()).done;){var o=t.value;d.add(o)}}catch(s){i.e(s)}finally{i.f()}})).catch((function(t){(0,a.warn)('Type3 font resource "'.concat(e,'" is not available.'));var i=new z.OperatorList;f[e]=i.getIR()}))}))};for(_.s();!(l=_.n()).done;)A()}catch(x){_.e(x)}finally{_.f()}return this.type3Loaded=u.then((function(){c.charProcOperatorList=f,n._bbox&&(c.isCharBBox=!0,c.bbox=n._bbox)})),this.type3Loaded}},{key:"_removeType3ColorOperators",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:NaN,i=a.Util.normalizeRect(e.argsArray[0].slice(2)),n=i[2]-i[0],r=i[3]-i[1],o=Math.hypot(n,r);0===n||0===r?(e.fnArray.splice(0,1),e.argsArray.splice(0,1)):(0===t||Math.round(o/t)>=10)&&(this._bbox||(this._bbox=[1/0,1/0,-1/0,-1/0]),this._bbox[0]=Math.min(this._bbox[0],i[0]),this._bbox[1]=Math.min(this._bbox[1],i[1]),this._bbox[2]=Math.max(this._bbox[2],i[2]),this._bbox[3]=Math.max(this._bbox[3],i[3]));for(var s=0,l=e.length;s<l;){switch(e.fnArray[s]){case a.OPS.setCharWidthAndBounds:break;case a.OPS.setStrokeColorSpace:case a.OPS.setFillColorSpace:case a.OPS.setStrokeColor:case a.OPS.setStrokeColorN:case a.OPS.setFillColor:case a.OPS.setFillColorN:case a.OPS.setStrokeGray:case a.OPS.setFillGray:case a.OPS.setStrokeRGBColor:case a.OPS.setFillRGBColor:case a.OPS.setStrokeCMYKColor:case a.OPS.setFillCMYKColor:case a.OPS.shadingFill:case a.OPS.setRenderingIntent:e.fnArray.splice(s,1),e.argsArray.splice(s,1),l--;continue;case a.OPS.setGState:for(var c=f(e.argsArray[s],1)[0],d=0,u=c.length;d<u;){switch(f(c[d],1)[0]){case"TR":case"TR2":case"HT":case"BG":case"BG2":case"UCR":case"UCR2":c.splice(d,1),u--;continue}d++}}s++}}}]),e}(),Y=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:new V;this.state=t,this.stateStack=[]}return g(e,[{key:"save",value:function(){var e=this.state;this.stateStack.push(this.state),this.state=e.clone()}},{key:"restore",value:function(){var e=this.stateStack.pop();e&&(this.state=e)}},{key:"transform",value:function(e){this.state.ctm=a.Util.transform(this.state.ctm,e)}}]),e}(),X=function(){function e(){b(this,e),this.ctm=new Float32Array(a.IDENTITY_MATRIX),this.fontName=null,this.fontSize=0,this.loadedName=null,this.font=null,this.fontMatrix=a.FONT_IDENTITY_MATRIX,this.textMatrix=a.IDENTITY_MATRIX.slice(),this.textLineMatrix=a.IDENTITY_MATRIX.slice(),this.charSpacing=0,this.wordSpacing=0,this.leading=0,this.textHScale=1,this.textRise=0}return g(e,[{key:"setTextMatrix",value:function(e,t,i,a,n,r){var o=this.textMatrix;o[0]=e,o[1]=t,o[2]=i,o[3]=a,o[4]=n,o[5]=r}},{key:"setTextLineMatrix",value:function(e,t,i,a,n,r){var o=this.textLineMatrix;o[0]=e,o[1]=t,o[2]=i,o[3]=a,o[4]=n,o[5]=r}},{key:"translateTextMatrix",value:function(e,t){var i=this.textMatrix;i[4]=i[0]*e+i[2]*t+i[4],i[5]=i[1]*e+i[3]*t+i[5]}},{key:"translateTextLineMatrix",value:function(e,t){var i=this.textLineMatrix;i[4]=i[0]*e+i[2]*t+i[4],i[5]=i[1]*e+i[3]*t+i[5]}},{key:"carriageReturn",value:function(){this.translateTextLineMatrix(0,-this.leading),this.textMatrix=this.textLineMatrix.slice()}},{key:"clone",value:function(){var e=Object.create(this);return e.textMatrix=this.textMatrix.slice(),e.textLineMatrix=this.textLineMatrix.slice(),e.fontMatrix=this.fontMatrix.slice(),e}}]),e}(),V=function(){function e(){b(this,e),this.ctm=new Float32Array(a.IDENTITY_MATRIX),this.font=null,this.textRenderingMode=a.TextRenderingMode.FILL,this.fillColorSpace=C.ColorSpace.singletons.gray,this.strokeColorSpace=C.ColorSpace.singletons.gray}return g(e,[{key:"clone",value:function(){return Object.create(this)}}]),e}(),Q=function(){function e(t,i){b(this,e);var a=arguments.length>2&&void 0!==arguments[2]?arguments[2]:new Y;this.parser=new _.Parser({lexer:new _.Lexer(t,e.opMap),xref:i}),this.stateManager=a,this.nonProcessedArgs=[],this._isPathOp=!1,this._numInvalidPathOPS=0}return g(e,[{key:"savedStatesDepth",get:function(){return this.stateManager.stateStack.length}},{key:"read",value:function(t){for(var i=t.args;;){var n=this.parser.getObj();if(n instanceof r.Cmd){var o=n.cmd,s=e.opMap[o];if(!s){(0,a.warn)('Unknown command "'.concat(o,'".'));continue}var l=s.id,c=s.numArgs,d=null!==i?i.length:0;if(this._isPathOp||(this._numInvalidPathOPS=0),this._isPathOp=l>=a.OPS.moveTo&&l<=a.OPS.endPath,s.variableArgs)d>c&&(0,a.info)("Command ".concat(o,": expected [0, ").concat(c,"] args, ")+"but received ".concat(d," args."));else{if(d!==c){for(var u=this.nonProcessedArgs;d>c;)u.push(i.shift()),d--;for(;d<c&&0!==u.length;)null===i&&(i=[]),i.unshift(u.pop()),d++}if(d<c){var p="command ".concat(o,": expected ").concat(c," args, ")+"but received ".concat(d," args.");if(this._isPathOp&&++this._numInvalidPathOPS>e.MAX_INVALID_PATH_OPS)throw new a.FormatError("Invalid ".concat(p));(0,a.warn)("Skipping ".concat(p)),null!==i&&(i.length=0);continue}}return this.preprocessCommand(l,i),t.fn=l,t.args=i,!0}if(n===r.EOF)return!1;if(null!==n&&(null===i&&(i=[]),i.push(n),i.length>33))throw new a.FormatError("Too many arguments")}}},{key:"preprocessCommand",value:function(e,t){switch(0|e){case a.OPS.save:this.stateManager.save();break;case a.OPS.restore:this.stateManager.restore();break;case a.OPS.transform:this.stateManager.transform(t)}}}],[{key:"opMap",get:function(){var e=(0,I.getLookupTableFactory)((function(e){e.w={id:a.OPS.setLineWidth,numArgs:1,variableArgs:!1},e.J={id:a.OPS.setLineCap,numArgs:1,variableArgs:!1},e.j={id:a.OPS.setLineJoin,numArgs:1,variableArgs:!1},e.M={id:a.OPS.setMiterLimit,numArgs:1,variableArgs:!1},e.d={id:a.OPS.setDash,numArgs:2,variableArgs:!1},e.ri={id:a.OPS.setRenderingIntent,numArgs:1,variableArgs:!1},e.i={id:a.OPS.setFlatness,numArgs:1,variableArgs:!1},e.gs={id:a.OPS.setGState,numArgs:1,variableArgs:!1},e.q={id:a.OPS.save,numArgs:0,variableArgs:!1},e.Q={id:a.OPS.restore,numArgs:0,variableArgs:!1},e.cm={id:a.OPS.transform,numArgs:6,variableArgs:!1},e.m={id:a.OPS.moveTo,numArgs:2,variableArgs:!1},e.l={id:a.OPS.lineTo,numArgs:2,variableArgs:!1},e.c={id:a.OPS.curveTo,numArgs:6,variableArgs:!1},e.v={id:a.OPS.curveTo2,numArgs:4,variableArgs:!1},e.y={id:a.OPS.curveTo3,numArgs:4,variableArgs:!1},e.h={id:a.OPS.closePath,numArgs:0,variableArgs:!1},e.re={id:a.OPS.rectangle,numArgs:4,variableArgs:!1},e.S={id:a.OPS.stroke,numArgs:0,variableArgs:!1},e.s={id:a.OPS.closeStroke,numArgs:0,variableArgs:!1},e.f={id:a.OPS.fill,numArgs:0,variableArgs:!1},e.F={id:a.OPS.fill,numArgs:0,variableArgs:!1},e["f*"]={id:a.OPS.eoFill,numArgs:0,variableArgs:!1},e.B={id:a.OPS.fillStroke,numArgs:0,variableArgs:!1},e["B*"]={id:a.OPS.eoFillStroke,numArgs:0,variableArgs:!1},e.b={id:a.OPS.closeFillStroke,numArgs:0,variableArgs:!1},e["b*"]={id:a.OPS.closeEOFillStroke,numArgs:0,variableArgs:!1},e.n={id:a.OPS.endPath,numArgs:0,variableArgs:!1},e.W={id:a.OPS.clip,numArgs:0,variableArgs:!1},e["W*"]={id:a.OPS.eoClip,numArgs:0,variableArgs:!1},e.BT={id:a.OPS.beginText,numArgs:0,variableArgs:!1},e.ET={id:a.OPS.endText,numArgs:0,variableArgs:!1},e.Tc={id:a.OPS.setCharSpacing,numArgs:1,variableArgs:!1},e.Tw={id:a.OPS.setWordSpacing,numArgs:1,variableArgs:!1},e.Tz={id:a.OPS.setHScale,numArgs:1,variableArgs:!1},e.TL={id:a.OPS.setLeading,numArgs:1,variableArgs:!1},e.Tf={id:a.OPS.setFont,numArgs:2,variableArgs:!1},e.Tr={id:a.OPS.setTextRenderingMode,numArgs:1,variableArgs:!1},e.Ts={id:a.OPS.setTextRise,numArgs:1,variableArgs:!1},e.Td={id:a.OPS.moveText,numArgs:2,variableArgs:!1},e.TD={id:a.OPS.setLeadingMoveText,numArgs:2,variableArgs:!1},e.Tm={id:a.OPS.setTextMatrix,numArgs:6,variableArgs:!1},e["T*"]={id:a.OPS.nextLine,numArgs:0,variableArgs:!1},e.Tj={id:a.OPS.showText,numArgs:1,variableArgs:!1},e.TJ={id:a.OPS.showSpacedText,numArgs:1,variableArgs:!1},e["'"]={id:a.OPS.nextLineShowText,numArgs:1,variableArgs:!1},e['"']={id:a.OPS.nextLineSetSpacingShowText,numArgs:3,variableArgs:!1},e.d0={id:a.OPS.setCharWidth,numArgs:2,variableArgs:!1},e.d1={id:a.OPS.setCharWidthAndBounds,numArgs:6,variableArgs:!1},e.CS={id:a.OPS.setStrokeColorSpace,numArgs:1,variableArgs:!1},e.cs={id:a.OPS.setFillColorSpace,numArgs:1,variableArgs:!1},e.SC={id:a.OPS.setStrokeColor,numArgs:4,variableArgs:!0},e.SCN={id:a.OPS.setStrokeColorN,numArgs:33,variableArgs:!0},e.sc={id:a.OPS.setFillColor,numArgs:4,variableArgs:!0},e.scn={id:a.OPS.setFillColorN,numArgs:33,variableArgs:!0},e.G={id:a.OPS.setStrokeGray,numArgs:1,variableArgs:!1},e.g={id:a.OPS.setFillGray,numArgs:1,variableArgs:!1},e.RG={id:a.OPS.setStrokeRGBColor,numArgs:3,variableArgs:!1},e.rg={id:a.OPS.setFillRGBColor,numArgs:3,variableArgs:!1},e.K={id:a.OPS.setStrokeCMYKColor,numArgs:4,variableArgs:!1},e.k={id:a.OPS.setFillCMYKColor,numArgs:4,variableArgs:!1},e.sh={id:a.OPS.shadingFill,numArgs:1,variableArgs:!1},e.BI={id:a.OPS.beginInlineImage,numArgs:0,variableArgs:!1},e.ID={id:a.OPS.beginImageData,numArgs:0,variableArgs:!1},e.EI={id:a.OPS.endInlineImage,numArgs:1,variableArgs:!1},e.Do={id:a.OPS.paintXObject,numArgs:1,variableArgs:!1},e.MP={id:a.OPS.markPoint,numArgs:1,variableArgs:!1},e.DP={id:a.OPS.markPointProps,numArgs:2,variableArgs:!1},e.BMC={id:a.OPS.beginMarkedContent,numArgs:1,variableArgs:!1},e.BDC={id:a.OPS.beginMarkedContentProps,numArgs:2,variableArgs:!1},e.EMC={id:a.OPS.endMarkedContent,numArgs:0,variableArgs:!1},e.BX={id:a.OPS.beginCompat,numArgs:0,variableArgs:!1},e.EX={id:a.OPS.endCompat,numArgs:0,variableArgs:!1},e.BM=null,e.BD=null,e.true=null,e.fa=null,e.fal=null,e.fals=null,e.false=null,e.nu=null,e.nul=null,e.null=null}));return(0,a.shadow)(this,"opMap",e())}},{key:"MAX_INVALID_PATH_OPS",get:function(){return(0,a.shadow)(this,"MAX_INVALID_PATH_OPS",10)}}]),e}();t.EvaluatorPreprocessor=Q},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.IdentityCMap=t.CMapFactory=t.CMap=void 0;var a=i(2),n=i(137),r=i(138),o=i(148),s=i(136),l=i(141),c=["Adobe-GB1-UCS2","Adobe-CNS1-UCS2","Adobe-Japan1-UCS2","Adobe-Korea1-UCS2","78-EUC-H","78-EUC-V","78-H","78-RKSJ-H","78-RKSJ-V","78-V","78ms-RKSJ-H","78ms-RKSJ-V","83pv-RKSJ-H","90ms-RKSJ-H","90ms-RKSJ-V","90msp-RKSJ-H","90msp-RKSJ-V","90pv-RKSJ-H","90pv-RKSJ-V","Add-H","Add-RKSJ-H","Add-RKSJ-V","Add-V","Adobe-CNS1-0","Adobe-CNS1-1","Adobe-CNS1-2","Adobe-CNS1-3","Adobe-CNS1-4","Adobe-CNS1-5","Adobe-CNS1-6","Adobe-GB1-0","Adobe-GB1-1","Adobe-GB1-2","Adobe-GB1-3","Adobe-GB1-4","Adobe-GB1-5","Adobe-Japan1-0","Adobe-Japan1-1","Adobe-Japan1-2","Adobe-Japan1-3","Adobe-Japan1-4","Adobe-Japan1-5","Adobe-Japan1-6","Adobe-Korea1-0","Adobe-Korea1-1","Adobe-Korea1-2","B5-H","B5-V","B5pc-H","B5pc-V","CNS-EUC-H","CNS-EUC-V","CNS1-H","CNS1-V","CNS2-H","CNS2-V","ETHK-B5-H","ETHK-B5-V","ETen-B5-H","ETen-B5-V","ETenms-B5-H","ETenms-B5-V","EUC-H","EUC-V","Ext-H","Ext-RKSJ-H","Ext-RKSJ-V","Ext-V","GB-EUC-H","GB-EUC-V","GB-H","GB-V","GBK-EUC-H","GBK-EUC-V","GBK2K-H","GBK2K-V","GBKp-EUC-H","GBKp-EUC-V","GBT-EUC-H","GBT-EUC-V","GBT-H","GBT-V","GBTpc-EUC-H","GBTpc-EUC-V","GBpc-EUC-H","GBpc-EUC-V","H","HKdla-B5-H","HKdla-B5-V","HKdlb-B5-H","HKdlb-B5-V","HKgccs-B5-H","HKgccs-B5-V","HKm314-B5-H","HKm314-B5-V","HKm471-B5-H","HKm471-B5-V","HKscs-B5-H","HKscs-B5-V","Hankaku","Hiragana","KSC-EUC-H","KSC-EUC-V","KSC-H","KSC-Johab-H","KSC-Johab-V","KSC-V","KSCms-UHC-H","KSCms-UHC-HW-H","KSCms-UHC-HW-V","KSCms-UHC-V","KSCpc-EUC-H","KSCpc-EUC-V","Katakana","NWP-H","NWP-V","RKSJ-H","RKSJ-V","Roman","UniCNS-UCS2-H","UniCNS-UCS2-V","UniCNS-UTF16-H","UniCNS-UTF16-V","UniCNS-UTF32-H","UniCNS-UTF32-V","UniCNS-UTF8-H","UniCNS-UTF8-V","UniGB-UCS2-H","UniGB-UCS2-V","UniGB-UTF16-H","UniGB-UTF16-V","UniGB-UTF32-H","UniGB-UTF32-V","UniGB-UTF8-H","UniGB-UTF8-V","UniJIS-UCS2-H","UniJIS-UCS2-HW-H","UniJIS-UCS2-HW-V","UniJIS-UCS2-V","UniJIS-UTF16-H","UniJIS-UTF16-V","UniJIS-UTF32-H","UniJIS-UTF32-V","UniJIS-UTF8-H","UniJIS-UTF8-V","UniJIS2004-UTF16-H","UniJIS2004-UTF16-V","UniJIS2004-UTF32-H","UniJIS2004-UTF32-V","UniJIS2004-UTF8-H","UniJIS2004-UTF8-V","UniJISPro-UCS2-HW-V","UniJISPro-UCS2-V","UniJISPro-UTF8-V","UniJISX0213-UTF32-H","UniJISX0213-UTF32-V","UniJISX02132004-UTF32-H","UniJISX02132004-UTF32-V","UniKS-UCS2-H","UniKS-UCS2-V","UniKS-UTF16-H","UniKS-UTF16-V","UniKS-UTF32-H","UniKS-UTF32-V","UniKS-UTF8-H","UniKS-UTF8-V","V","WP-Symbol"],m=Math.pow(2,24)-1,h=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]&&arguments[0];this.codespaceRanges=[[],[],[],[]],this.numCodespaceRanges=0,this._map=[],this.name="",this.vertical=!1,this.useCMap=null,this.builtInCMap=t}return g(e,[{key:"addCodespaceRange",value:function(e,t,i){this.codespaceRanges[e-1].push(t,i),this.numCodespaceRanges++}},{key:"mapCidRange",value:function(e,t,i){if(t-e>m)throw new Error("mapCidRange - ignoring data above MAX_MAP_RANGE.");for(;e<=t;)this._map[e++]=i++}},{key:"mapBfRange",value:function(e,t,i){if(t-e>m)throw new Error("mapBfRange - ignoring data above MAX_MAP_RANGE.");for(var a=i.length-1;e<=t;){this._map[e++]=i;var n=i.charCodeAt(a)+1;i=n>255?i.substring(0,a-1)+String.fromCharCode(i.charCodeAt(a-1)+1)+"\0":i.substring(0,a)+String.fromCharCode(n)}}},{key:"mapBfRangeToArray",value:function(e,t,i){if(t-e>m)throw new Error("mapBfRangeToArray - ignoring data above MAX_MAP_RANGE.");for(var a=i.length,n=0;e<=t&&n<a;)this._map[e]=i[n++],++e}},{key:"mapOne",value:function(e,t){this._map[e]=t}},{key:"lookup",value:function(e){return this._map[e]}},{key:"contains",value:function(e){return void 0!==this._map[e]}},{key:"forEach",value:function(e){var t=this._map,i=t.length;if(i<=65536)for(var a=0;a<i;a++)void 0!==t[a]&&e(a,t[a]);else for(var n in t)e(n,t[n])}},{key:"charCodeOf",value:function(e){var t=this._map;if(t.length<=65536)return t.indexOf(e);for(var i in t)if(t[i]===e)return 0|i;return-1}},{key:"getMap",value:function(){return this._map}},{key:"readCharCode",value:function(e,t,i){for(var a=0,n=this.codespaceRanges,r=0,o=n.length;r<o;r++){a=(a<<8|e.charCodeAt(t+r))>>>0;for(var s=n[r],l=0,c=s.length;l<c;){var d=s[l++],u=s[l++];if(a>=d&&a<=u)return i.charcode=a,void(i.length=r+1)}}i.charcode=0,i.length=1}},{key:"getCharCodeLength",value:function(e){for(var t=this.codespaceRanges,i=0,a=t.length;i<a;i++)for(var n=t[i],r=0,o=n.length;r<o;){var s=n[r++],l=n[r++];if(e>=s&&e<=l)return i+1}return 1}},{key:"length",get:function(){return this._map.length}},{key:"isIdentityCMap",get:function(){if("Identity-H"!==this.name&&"Identity-V"!==this.name)return!1;if(65536!==this._map.length)return!1;for(var e=0;e<65536;e++)if(this._map[e]!==e)return!1;return!0}}]),e}();t.CMap=h;var f=function(e){d(i,e);var t=u(i);function i(e,a){var n;return b(this,i),(n=t.call(this)).vertical=e,n.addCodespaceRange(a,0,65535),n}return g(i,[{key:"mapCidRange",value:function(e,t,i){(0,a.unreachable)("should not call mapCidRange")}},{key:"mapBfRange",value:function(e,t,i){(0,a.unreachable)("should not call mapBfRange")}},{key:"mapBfRangeToArray",value:function(e,t,i){(0,a.unreachable)("should not call mapBfRangeToArray")}},{key:"mapOne",value:function(e,t){(0,a.unreachable)("should not call mapCidOne")}},{key:"lookup",value:function(e){return Number.isInteger(e)&&e<=65535?e:void 0}},{key:"contains",value:function(e){return Number.isInteger(e)&&e<=65535}},{key:"forEach",value:function(e){for(var t=0;t<=65535;t++)e(t,t)}},{key:"charCodeOf",value:function(e){return Number.isInteger(e)&&e<=65535?e:-1}},{key:"getMap",value:function(){for(var e=new Array(65536),t=0;t<=65535;t++)e[t]=t;return e}},{key:"length",get:function(){return 65536}},{key:"isIdentityCMap",get:function(){(0,a.unreachable)("should not access .isIdentityCMap")}}]),i}(h);t.IdentityCMap=f;var v=function(){function e(e,t){for(var i=0,a=0;a<=t;a++)i=i<<8|e[a];return i>>>0}function t(e,t){return 1===t?String.fromCharCode(e[0],e[1]):3===t?String.fromCharCode(e[0],e[1],e[2],e[3]):String.fromCharCode.apply(null,e.subarray(0,t+1))}function i(e,t,i){for(var a=0,n=i;n>=0;n--)a+=e[n]+t[n],e[n]=255&a,a>>=8}function n(e,t){for(var i=1,a=t;a>=0&&i>0;a--)i+=e[a],e[a]=255&i,i>>=8}var r=16,o=19,s=function(){function e(t){b(this,e),this.buffer=t,this.pos=0,this.end=t.length,this.tmpBuf=new Uint8Array(o)}return g(e,[{key:"readByte",value:function(){return this.pos>=this.end?-1:this.buffer[this.pos++]}},{key:"readNumber",value:function(){var e,t=0;do{var i=this.readByte();if(i<0)throw new a.FormatError("unexpected EOF in bcmap");e=!(128&i),t=t<<7|127&i}while(!e);return t}},{key:"readSigned",value:function(){var e=this.readNumber();return 1&e?~(e>>>1):e>>>1}},{key:"readHex",value:function(e,t){e.set(this.buffer.subarray(this.pos,this.pos+t+1)),this.pos+=t+1}},{key:"readHexNumber",value:function(e,t){var i,n=this.tmpBuf,r=0;do{var o=this.readByte();if(o<0)throw new a.FormatError("unexpected EOF in bcmap");i=!(128&o),n[r++]=127&o}while(!i);for(var s=t,l=0,c=0;s>=0;){for(;c<8&&n.length>0;)l|=n[--r]<<c,c+=7;e[s]=255&l,s--,l>>=8,c-=8}}},{key:"readHexSigned",value:function(e,t){this.readHexNumber(e,t);for(var i=1&e[t]?255:0,a=0,n=0;n<=t;n++)a=(1&a)<<8|e[n],e[n]=a>>1^i}},{key:"readString",value:function(){for(var e=this.readNumber(),t="",i=0;i<e;i++)t+=String.fromCharCode(this.readNumber());return t}}]),e}(),l=function(){function a(){b(this,a)}return g(a,[{key:"process",value:function(){var a=y(p().mark((function a(o,l,c){var d,u,m,h,f,y,b,g,v,_,A,x,w,S,C,k,D,R,I,M,T;return p().wrap((function(a){for(;;)switch(a.prev=a.next){case 0:d=new s(o),u=d.readByte(),l.vertical=!!(1&u),m=null,h=new Uint8Array(r),f=new Uint8Array(r),y=new Uint8Array(r),b=new Uint8Array(r),g=new Uint8Array(r);case 9:if(!((_=d.readByte())>=0)){a.next=68;break}if(7!==(A=_>>5)){a.next=20;break}a.t0=31&_,a.next=0===a.t0?15:1===a.t0?17:19;break;case 15:return d.readString(),a.abrupt("break",19);case 17:return m=d.readString(),a.abrupt("break",19);case 19:return a.abrupt("continue",9);case 20:if(x=!!(16&_),!(1+(w=15&_)>r)){a.next=24;break}throw new Error("BinaryCMapReader.process: Invalid dataSize.");case 24:S=1,C=d.readNumber(),a.t1=A,a.next=0===a.t1?29:1===a.t1?35:2===a.t1?41:3===a.t1?46:4===a.t1?53:5===a.t1?58:65;break;case 29:for(d.readHex(h,w),d.readHexNumber(f,w),i(f,h,w),l.addCodespaceRange(w+1,e(h,w),e(f,w)),k=1;k<C;k++)n(f,w),d.readHexNumber(h,w),i(h,f,w),d.readHexNumber(f,w),i(f,h,w),l.addCodespaceRange(w+1,e(h,w),e(f,w));return a.abrupt("break",66);case 35:for(d.readHex(h,w),d.readHexNumber(f,w),i(f,h,w),d.readNumber(),D=1;D<C;D++)n(f,w),d.readHexNumber(h,w),i(h,f,w),d.readHexNumber(f,w),i(f,h,w),d.readNumber();return a.abrupt("break",66);case 41:for(d.readHex(y,w),v=d.readNumber(),l.mapOne(e(y,w),v),R=1;R<C;R++)n(y,w),x||(d.readHexNumber(g,w),i(y,g,w)),v=d.readSigned()+(v+1),l.mapOne(e(y,w),v);return a.abrupt("break",66);case 46:for(d.readHex(h,w),d.readHexNumber(f,w),i(f,h,w),v=d.readNumber(),l.mapCidRange(e(h,w),e(f,w),v),I=1;I<C;I++)n(f,w),x?h.set(f):(d.readHexNumber(h,w),i(h,f,w)),d.readHexNumber(f,w),i(f,h,w),v=d.readNumber(),l.mapCidRange(e(h,w),e(f,w),v);return a.abrupt("break",66);case 53:for(d.readHex(y,S),d.readHex(b,w),l.mapOne(e(y,S),t(b,w)),M=1;M<C;M++)n(y,S),x||(d.readHexNumber(g,S),i(y,g,S)),n(b,w),d.readHexSigned(g,w),i(b,g,w),l.mapOne(e(y,S),t(b,w));return a.abrupt("break",66);case 58:for(d.readHex(h,S),d.readHexNumber(f,S),i(f,h,S),d.readHex(b,w),l.mapBfRange(e(h,S),e(f,S),t(b,w)),T=1;T<C;T++)n(f,S),x?h.set(f):(d.readHexNumber(h,S),i(h,f,S)),d.readHexNumber(f,S),i(f,h,S),d.readHex(b,w),l.mapBfRange(e(h,S),e(f,S),t(b,w));return a.abrupt("break",66);case 65:throw new Error("BinaryCMapReader.process - unknown type: ".concat(A));case 66:a.next=9;break;case 68:if(!m){a.next=70;break}return a.abrupt("return",c(m));case 70:return a.abrupt("return",l);case 71:case"end":return a.stop()}}),a)})));return function(e,t,i){return a.apply(this,arguments)}}()}]),a}();return l}(),_=function(){function e(e){for(var t=0,i=0;i<e.length;i++)t=t<<8|e.charCodeAt(i);return t>>>0}function t(e){if("string"!==typeof e)throw new a.FormatError("Malformed CMap: expected string.")}function i(e){if(!Number.isInteger(e))throw new a.FormatError("Malformed CMap: expected int.")}function d(i,a){for(;;){var r=a.getObj();if(r===n.EOF)break;if((0,n.isCmd)(r,"endbfchar"))return;t(r);var o=e(r);t(r=a.getObj());var s=r;i.mapOne(o,s)}}function u(i,r){for(;;){var o=r.getObj();if(o===n.EOF)break;if((0,n.isCmd)(o,"endbfrange"))return;t(o);var s=e(o);t(o=r.getObj());var l=e(o);if(o=r.getObj(),Number.isInteger(o)||"string"===typeof o){var c=Number.isInteger(o)?String.fromCharCode(o):o;i.mapBfRange(s,l,c)}else{if(!(0,n.isCmd)(o,"["))break;o=r.getObj();for(var d=[];!(0,n.isCmd)(o,"]")&&o!==n.EOF;)d.push(o),o=r.getObj();i.mapBfRangeToArray(s,l,d)}}throw new a.FormatError("Invalid bf range.")}function m(a,r){for(;;){var o=r.getObj();if(o===n.EOF)break;if((0,n.isCmd)(o,"endcidchar"))return;t(o);var s=e(o);i(o=r.getObj());var l=o;a.mapOne(s,l)}}function b(a,r){for(;;){var o=r.getObj();if(o===n.EOF)break;if((0,n.isCmd)(o,"endcidrange"))return;t(o);var s=e(o);t(o=r.getObj());var l=e(o);i(o=r.getObj());var c=o;a.mapCidRange(s,l,c)}}function g(t,i){for(;;){var r=i.getObj();if(r===n.EOF)break;if((0,n.isCmd)(r,"endcodespacerange"))return;if("string"!==typeof r)break;var o=e(r);if("string"!==typeof(r=i.getObj()))break;var s=e(r);t.addCodespaceRange(r.length,o,s)}throw new a.FormatError("Invalid codespace range.")}function _(e,t){var i=t.getObj();Number.isInteger(i)&&(e.vertical=!!i)}function A(e,t){var i=t.getObj();i instanceof n.Name&&(e.name=i.name)}function x(e,t,i,a){return w.apply(this,arguments)}function w(){return(w=y(p().mark((function e(t,i,r,o){var l,c,h;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(e.prev=1,(h=i.getObj())!==n.EOF){e.next=7;break}return e.abrupt("break",39);case 7:if(!(h instanceof n.Name)){e.next=12;break}"WMode"===h.name?_(t,i):"CMapName"===h.name&&A(t,i),l=h,e.next=29;break;case 12:if(!(h instanceof n.Cmd)){e.next=29;break}e.t0=h.cmd,e.next="endcmap"===e.t0?16:"usecmap"===e.t0?17:"begincodespacerange"===e.t0?19:"beginbfchar"===e.t0?21:"begincidchar"===e.t0?23:"beginbfrange"===e.t0?25:"begincidrange"===e.t0?27:29;break;case 16:return e.abrupt("break",39);case 17:return l instanceof n.Name&&(c=l.name),e.abrupt("break",29);case 19:return g(t,i),e.abrupt("break",29);case 21:return d(t,i),e.abrupt("break",29);case 23:return m(t,i),e.abrupt("break",29);case 25:return u(t,i),e.abrupt("break",29);case 27:return b(t,i),e.abrupt("break",29);case 29:e.next=37;break;case 31:if(e.prev=31,e.t1=e.catch(1),!(e.t1 instanceof s.MissingDataException)){e.next=35;break}throw e.t1;case 35:return(0,a.warn)("Invalid cMap data: "+e.t1),e.abrupt("continue",0);case 37:e.next=0;break;case 39:if(!o&&c&&(o=c),!o){e.next=42;break}return e.abrupt("return",S(t,r,o));case 42:return e.abrupt("return",t);case 43:case"end":return e.stop()}}),e,null,[[1,31]])})))).apply(this,arguments)}function S(e,t,i){return C.apply(this,arguments)}function C(){return(C=y(p().mark((function e(t,i,a){var n,r;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,k(a,i);case 2:if(t.useCMap=e.sent,0===t.numCodespaceRanges){for(n=t.useCMap.codespaceRanges,r=0;r<n.length;r++)t.codespaceRanges[r]=n[r].slice();t.numCodespaceRanges=t.useCMap.numCodespaceRanges}return t.useCMap.forEach((function(e,i){t.contains(e)||t.mapOne(e,t.useCMap.lookup(e))})),e.abrupt("return",t);case 6:case"end":return e.stop()}}),e)})))).apply(this,arguments)}function k(e,t){return D.apply(this,arguments)}function D(){return(D=y(p().mark((function e(t,i){var n,r,s,d,u;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if("Identity-H"!==t){e.next=4;break}return e.abrupt("return",new f(!1,2));case 4:if("Identity-V"!==t){e.next=6;break}return e.abrupt("return",new f(!0,2));case 6:if(c.includes(t)){e.next=8;break}throw new Error("Unknown CMap name: "+t);case 8:if(i){e.next=10;break}throw new Error("Built-in CMap parameters are not provided.");case 10:return e.next=12,i(t);case 12:if(n=e.sent,r=n.cMapData,s=n.compressionType,d=new h(!0),s!==a.CMapCompressionType.BINARY){e.next=18;break}return e.abrupt("return",(new v).process(r,d,(function(e){return S(d,i,e)})));case 18:if(s!==a.CMapCompressionType.NONE){e.next=21;break}return u=new o.Lexer(new l.Stream(r)),e.abrupt("return",x(d,u,i,null));case 21:throw new Error('Invalid CMap "compressionType" value: '.concat(s));case 22:case"end":return e.stop()}}),e)})))).apply(this,arguments)}return{create:function(e){return y(p().mark((function t(){var i,a,s,l;return p().wrap((function(t){for(;;)switch(t.prev=t.next){case 0:if(i=e.encoding,a=e.fetchBuiltInCMap,s=e.useCMap,!(i instanceof n.Name)){t.next=7;break}return t.abrupt("return",k(i.name,a));case 7:if(!(i instanceof r.BaseStream)){t.next=14;break}return t.next=10,x(new h,new o.Lexer(i),a,s);case 10:if(!(l=t.sent).isIdentityCMap){t.next=13;break}return t.abrupt("return",k(l.name,a));case 13:return t.abrupt("return",l);case 14:throw new Error("Encoding required.");case 15:case"end":return t.stop()}}),t)})))()}}}();t.CMapFactory=_},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Parser=t.Linearization=t.Lexer=void 0;var a=i(2),n=i(137),r=i(136),o=i(149),s=i(151),l=i(152),c=i(154),d=i(155),u=i(158),p=i(160),m=i(162),h=i(141),f=i(163),y=i(164),v=function(){function e(t){b(this,e);var i=t.lexer,a=t.xref,n=t.allowStreams,r=void 0!==n&&n,o=t.recoveryMode,s=void 0!==o&&o;this.lexer=i,this.xref=a,this.allowStreams=r,this.recoveryMode=s,this.imageCache=Object.create(null),this._imageId=0,this.refill()}return g(e,[{key:"refill",value:function(){this.buf1=this.lexer.getObj(),this.buf2=this.lexer.getObj()}},{key:"shift",value:function(){this.buf2 instanceof n.Cmd&&"ID"===this.buf2.cmd?(this.buf1=this.buf2,this.buf2=null):(this.buf1=this.buf2,this.buf2=this.lexer.getObj())}},{key:"tryShift",value:function(){try{return this.shift(),!0}catch(e){if(e instanceof r.MissingDataException)throw e;return!1}}},{key:"getObj",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:null,t=this.buf1;if(this.shift(),t instanceof n.Cmd)switch(t.cmd){case"BI":return this.makeInlineImage(e);case"[":for(var i=[];!(0,n.isCmd)(this.buf1,"]")&&this.buf1!==n.EOF;)i.push(this.getObj(e));if(this.buf1===n.EOF){if(this.recoveryMode)return i;throw new r.ParserEOFException("End of file inside array.")}return this.shift(),i;case"<<":for(var o=new n.Dict(this.xref);!(0,n.isCmd)(this.buf1,">>")&&this.buf1!==n.EOF;)if(this.buf1 instanceof n.Name){var s=this.buf1.name;if(this.shift(),this.buf1===n.EOF)break;o.set(s,this.getObj(e))}else(0,a.info)("Malformed dictionary: key must be a name object"),this.shift();if(this.buf1===n.EOF){if(this.recoveryMode)return o;throw new r.ParserEOFException("End of file inside dictionary.")}return(0,n.isCmd)(this.buf2,"stream")?this.allowStreams?this.makeStream(o,e):o:(this.shift(),o);default:return t}if(Number.isInteger(t)){if(Number.isInteger(this.buf1)&&(0,n.isCmd)(this.buf2,"R")){var l=n.Ref.get(t,this.buf1);return this.shift(),this.shift(),l}return t}return"string"===typeof t&&e?e.decryptString(t):t}},{key:"findDefaultInlineStreamEnd",value:function(e){for(var t,i,o=this.lexer,s=e.pos,l=0;-1!==(t=e.getByte());)if(0===l)l=69===t?1:0;else if(1===l)l=73===t?2:0;else if(32===t||10===t||13===t){i=e.pos;for(var c=e.peekBytes(10),d=0,u=c.length;d<u;d++)if((0!==(t=c[d])||0===c[d+1])&&10!==t&&13!==t&&(t<32||t>127)){l=0;break}if(2!==l)continue;if(o.knownCommands){var p=o.peekObj();p instanceof n.Cmd&&!o.knownCommands[p.cmd]&&(l=0)}else(0,a.warn)("findDefaultInlineStreamEnd - `lexer.knownCommands` is undefined.");if(2===l)break}else l=0;-1===t&&((0,a.warn)("findDefaultInlineStreamEnd: Reached the end of the stream without finding a valid EI marker"),i&&((0,a.warn)('... trying to recover by using the last "EI" occurrence.'),e.skip(-(e.pos-i))));var m=4;return e.skip(-m),t=e.peekByte(),e.skip(m),(0,r.isWhiteSpace)(t)||m--,e.pos-m-s}},{key:"findDCTDecodeInlineStreamEnd",value:function(e){for(var t,i,n=e.pos,r=!1;-1!==(t=e.getByte());)if(255===t){switch(e.getByte()){case 0:break;case 255:e.skip(-1);break;case 217:r=!0;break;case 192:case 193:case 194:case 195:case 197:case 198:case 199:case 201:case 202:case 203:case 205:case 206:case 207:case 196:case 204:case 218:case 219:case 220:case 221:case 222:case 223:case 224:case 225:case 226:case 227:case 228:case 229:case 230:case 231:case 232:case 233:case 234:case 235:case 236:case 237:case 238:case 239:case 254:(i=e.getUint16())>2?e.skip(i-2):e.skip(-2)}if(r)break}var o=e.pos-n;return-1===t?((0,a.warn)("Inline DCTDecode image stream: EOI marker not found, searching for /EI/ instead."),e.skip(-o),this.findDefaultInlineStreamEnd(e)):(this.inlineStreamSkipEI(e),o)}},{key:"findASCII85DecodeInlineStreamEnd",value:function(e){for(var t,i=e.pos;-1!==(t=e.getByte());)if(126===t){var n=e.pos;for(t=e.peekByte();(0,r.isWhiteSpace)(t);)e.skip(),t=e.peekByte();if(62===t){e.skip();break}if(e.pos>n){var o=e.peekBytes(2);if(69===o[0]&&73===o[1])break}}var s=e.pos-i;return-1===t?((0,a.warn)("Inline ASCII85Decode image stream: EOD marker not found, searching for /EI/ instead."),e.skip(-s),this.findDefaultInlineStreamEnd(e)):(this.inlineStreamSkipEI(e),s)}},{key:"findASCIIHexDecodeInlineStreamEnd",value:function(e){for(var t,i=e.pos;-1!==(t=e.getByte())&&62!==t;);var n=e.pos-i;return-1===t?((0,a.warn)("Inline ASCIIHexDecode image stream: EOD marker not found, searching for /EI/ instead."),e.skip(-n),this.findDefaultInlineStreamEnd(e)):(this.inlineStreamSkipEI(e),n)}},{key:"inlineStreamSkipEI",value:function(e){for(var t,i=0;-1!==(t=e.getByte());)if(0===i)i=69===t?1:0;else if(1===i)i=73===t?2:0;else if(2===i)break}},{key:"makeInlineImage",value:function(e){for(var t,i=this.lexer,r=i.stream,o=Object.create(null);!(0,n.isCmd)(this.buf1,"ID")&&this.buf1!==n.EOF;){if(!(this.buf1 instanceof n.Name))throw new a.FormatError("Dictionary key must be a name object");var s=this.buf1.name;if(this.shift(),this.buf1===n.EOF)break;o[s]=this.getObj(e)}-1!==i.beginInlineImagePos&&(t=r.pos-i.beginInlineImagePos);var l,c=this.xref.fetchIfRef(o.F||o.Filter);if(c instanceof n.Name)l=c.name;else if(Array.isArray(c)){var d=this.xref.fetchIfRef(c[0]);d instanceof n.Name&&(l=d.name)}var u,p,m=r.pos;switch(l){case"DCT":case"DCTDecode":u=this.findDCTDecodeInlineStreamEnd(r);break;case"A85":case"ASCII85Decode":u=this.findASCII85DecodeInlineStreamEnd(r);break;case"AHx":case"ASCIIHexDecode":u=this.findASCIIHexDecodeInlineStreamEnd(r);break;default:u=this.findDefaultInlineStreamEnd(r)}if(u<1e3&&t>0){var h=r.pos;r.pos=i.beginInlineImagePos,p=function(e){for(var t=[],i=e.length,a=0;a<i-1;)t.push(e[a++]<<8|e[a++]);return a<i&&t.push(e[a]),i+"_"+String.fromCharCode.apply(null,t)}(r.getBytes(t+u)),r.pos=h;var f=this.imageCache[p];if(void 0!==f)return this.buf2=n.Cmd.get("EI"),this.shift(),f.reset(),f}var y=new n.Dict(this.xref);for(var b in o)y.set(b,o[b]);var g=r.makeSubStream(m,u,y);return e&&(g=e.createStream(g,u)),(g=this.filter(g,y,u)).dict=y,void 0!==p&&(g.cacheKey="inline_img_".concat(++this._imageId),this.imageCache[p]=g),this.buf2=n.Cmd.get("EI"),this.shift(),g}},{key:"_findStreamLength",value:function(e,t){var i=this.lexer.stream;i.pos=e;for(var a=t.length;i.pos<i.end;){var n=i.peekBytes(2048),r=n.length-a;if(r<=0)break;for(var o=0;o<r;){for(var s=0;s<a&&n[o+s]===t[s];)s++;if(s>=a)return i.pos+=o,i.pos-e;o++}i.pos+=r}return-1}},{key:"makeStream",value:function(e,t){var i=this.lexer,o=i.stream;i.skipToNextLine();var s=o.pos-1,l=e.get("Length");if(Number.isInteger(l)||((0,a.info)('Bad length "'.concat(l&&l.toString(),'" in stream.')),l=0),o.pos=s+l,i.nextChar(),this.tryShift()&&(0,n.isCmd)(this.buf2,"endstream"))this.shift();else{var c=new Uint8Array([101,110,100,115,116,114,101,97,109]),d=this._findStreamLength(s,c);if(d<0){for(var u=1;u<=1;u++){var p=c.length-u,m=c.slice(0,p),h=this._findStreamLength(s,m);if(h>=0){var f=o.peekBytes(p+1)[p];if(!(0,r.isWhiteSpace)(f))break;(0,a.info)('Found "'.concat((0,a.bytesToString)(m),'" when ')+"searching for endstream command."),d=h;break}}if(d<0)throw new a.FormatError("Missing endstream command.")}l=d,i.nextChar(),this.shift(),this.shift()}return this.shift(),o=o.makeSubStream(s,l,e),t&&(o=t.createStream(o,l)),(o=this.filter(o,e,l)).dict=e,o}},{key:"filter",value:function(e,t,i){var r=t.get("F","Filter"),o=t.get("DP","DecodeParms");if(r instanceof n.Name)return Array.isArray(o)&&(0,a.warn)("/DecodeParms should not be an Array, when /Filter is a Name."),this.makeFilter(e,r.name,i,o);var s=i;if(Array.isArray(r))for(var l=r,c=o,d=0,u=l.length;d<u;++d){if(r=this.xref.fetchIfRef(l[d]),!(r instanceof n.Name))throw new a.FormatError('Bad filter name "'.concat(r,'"'));o=null,Array.isArray(c)&&d in c&&(o=this.xref.fetchIfRef(c[d])),e=this.makeFilter(e,r.name,s,o),s=null}return e}},{key:"makeFilter",value:function(e,t,i,n){if(0===i)return(0,a.warn)('Empty "'.concat(t,'" stream.')),new h.NullStream;try{switch(t){case"Fl":case"FlateDecode":return n?new f.PredictorStream(new c.FlateStream(e,i),i,n):new c.FlateStream(e,i);case"LZW":case"LZWDecode":var b=1;return n?(n.has("EarlyChange")&&(b=n.get("EarlyChange")),new f.PredictorStream(new m.LZWStream(e,i,b),i,n)):new m.LZWStream(e,i,b);case"DCT":case"DCTDecode":return new u.JpegStream(e,i,n);case"JPX":case"JPXDecode":return new p.JpxStream(e,i,n);case"A85":case"ASCII85Decode":return new o.Ascii85Stream(e,i);case"AHx":case"ASCIIHexDecode":return new s.AsciiHexStream(e,i);case"CCF":case"CCITTFaxDecode":return new l.CCITTFaxStream(e,i,n);case"RL":case"RunLengthDecode":return new y.RunLengthStream(e,i);case"JBIG2Decode":return new d.Jbig2Stream(e,i,n)}return(0,a.warn)('Filter "'.concat(t,'" is not supported.')),e}catch(g){if(g instanceof r.MissingDataException)throw g;return(0,a.warn)('Invalid stream: "'.concat(g,'"')),new h.NullStream}}}]),e}();t.Parser=v;var _=[1,0,0,0,0,0,0,0,0,1,1,0,1,1,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,1,0,0,0,0,2,0,0,2,2,0,0,0,0,0,2,0,0,0,0,0,0,0,0,0,0,0,0,2,0,2,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,2,0,2,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,2,0,2,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0];function A(e){return e>=48&&e<=57?15&e:e>=65&&e<=70||e>=97&&e<=102?9+(15&e):-1}var x=function(){function e(t){b(this,e);var i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;this.stream=t,this.nextChar(),this.strBuf=[],this.knownCommands=i,this._hexStringNumWarn=0,this.beginInlineImagePos=-1}return g(e,[{key:"nextChar",value:function(){return this.currentChar=this.stream.getByte()}},{key:"peekChar",value:function(){return this.stream.peekByte()}},{key:"getNumber",value:function(){var e=this.currentChar,t=!1,i=0,n=0;if(45===e?(n=-1,45===(e=this.nextChar())&&(e=this.nextChar())):43===e&&(n=1,e=this.nextChar()),10===e||13===e)do{e=this.nextChar()}while(10===e||13===e);if(46===e&&(i=10,e=this.nextChar()),e<48||e>57){var o="Invalid number: ".concat(String.fromCharCode(e)," (charCode ").concat(e,")");if((0,r.isWhiteSpace)(e)||-1===e)return(0,a.info)('Lexer.getNumber - "'.concat(o,'".')),0;throw new a.FormatError(o)}n=n||1;for(var s=e-48,l=0,c=1;(e=this.nextChar())>=0;)if(e>=48&&e<=57){var d=e-48;t?l=10*l+d:(0!==i&&(i*=10),s=10*s+d)}else if(46===e){if(0!==i)break;i=1}else if(45===e)(0,a.warn)("Badly formatted number: minus sign in the middle");else{if(69!==e&&101!==e)break;if(43===(e=this.peekChar())||45===e)c=45===e?-1:1,this.nextChar();else if(e<48||e>57)break;t=!0}return 0!==i&&(s/=i),t&&(s*=Math.pow(10,c*l)),n*s}},{key:"getString",value:function(){var e=1,t=!1,i=this.strBuf;i.length=0;for(var n=this.nextChar();;){var r=!1;switch(0|n){case-1:(0,a.warn)("Unterminated string"),t=!0;break;case 40:++e,i.push("(");break;case 41:0===--e?(this.nextChar(),t=!0):i.push(")");break;case 92:switch(n=this.nextChar()){case-1:(0,a.warn)("Unterminated string"),t=!0;break;case 110:i.push("\n");break;case 114:i.push("\r");break;case 116:i.push("\t");break;case 98:i.push("\b");break;case 102:i.push("\f");break;case 92:case 40:case 41:i.push(String.fromCharCode(n));break;case 48:case 49:case 50:case 51:case 52:case 53:case 54:case 55:var o=15&n;r=!0,(n=this.nextChar())>=48&&n<=55&&(o=(o<<3)+(15&n),(n=this.nextChar())>=48&&n<=55&&(r=!1,o=(o<<3)+(15&n))),i.push(String.fromCharCode(o));break;case 13:10===this.peekChar()&&this.nextChar();break;case 10:break;default:i.push(String.fromCharCode(n))}break;default:i.push(String.fromCharCode(n))}if(t)break;r||(n=this.nextChar())}return i.join("")}},{key:"getName",value:function(){var e,t,i=this.strBuf;for(i.length=0;(e=this.nextChar())>=0&&!_[e];)if(35===e){if(e=this.nextChar(),_[e]){(0,a.warn)("Lexer_getName: NUMBER SIGN (#) should be followed by a hexadecimal number."),i.push("#");break}var r=A(e);if(-1!==r){t=e;var o=A(e=this.nextChar());if(-1===o){if((0,a.warn)("Lexer_getName: Illegal digit (".concat(String.fromCharCode(e),") ")+"in hexadecimal number."),i.push("#",String.fromCharCode(t)),_[e])break;i.push(String.fromCharCode(e));continue}i.push(String.fromCharCode(r<<4|o))}else i.push("#",String.fromCharCode(e))}else i.push(String.fromCharCode(e));return 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e(t){b(this,e);var i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{};if(!t||"function"!==typeof t.next)throw new Error('CCITTFaxDecoder - invalid "source" parameter.');this.source=t,this.eof=!1,this.encoding=i.K||0,this.eoline=i.EndOfLine||!1,this.byteAlign=i.EncodedByteAlign||!1,this.columns=i.Columns||1728,this.rows=i.Rows||0;var a,n=i.EndOfBlock;for(null!==n&&void 0!==n||(n=!0),this.eoblock=n,this.black=i.BlackIs1||!1,this.codingLine=new Uint32Array(this.columns+1),this.refLine=new Uint32Array(this.columns+2),this.codingLine[0]=this.columns,this.codingPos=0,this.row=0,this.nextLine2D=this.encoding<0,this.inputBits=0,this.inputBuf=0,this.outputBits=0,this.rowsDone=!1;0===(a=this._lookBits(12));)this._eatBits(1);1===a&&this._eatBits(12),this.encoding>0&&(this.nextLine2D=!this._lookBits(1),this._eatBits(1))}return g(e,[{key:"readNextChar",value:function(){if(this.eof)return-1;var e,t,i,r,o,s=this.refLine,l=this.codingLine,c=this.columns;if(0===this.outputBits){if(this.rowsDone&&(this.eof=!0),this.eof)return-1;var d,u,p;if(this.err=!1,this.nextLine2D){for(r=0;l[r]<c;++r)s[r]=l[r];for(s[r++]=c,s[r]=c,l[0]=0,this.codingPos=0,e=0,t=0;l[this.codingPos]<c;)switch(d=this._getTwoDimCode()){case 0:this._addPixels(s[e+1],t),s[e+1]<c&&(e+=2);break;case 1:if(d=u=0,t){do{d+=p=this._getBlackCode()}while(p>=64);do{u+=p=this._getWhiteCode()}while(p>=64)}else{do{d+=p=this._getWhiteCode()}while(p>=64);do{u+=p=this._getBlackCode()}while(p>=64)}for(this._addPixels(l[this.codingPos]+d,t),l[this.codingPos]<c&&this._addPixels(l[this.codingPos]+u,1^t);s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 7:if(this._addPixels(s[e]+3,t),t^=1,l[this.codingPos]<c)for(++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 5:if(this._addPixels(s[e]+2,t),t^=1,l[this.codingPos]<c)for(++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 3:if(this._addPixels(s[e]+1,t),t^=1,l[this.codingPos]<c)for(++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 2:if(this._addPixels(s[e],t),t^=1,l[this.codingPos]<c)for(++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 8:if(this._addPixelsNeg(s[e]-3,t),t^=1,l[this.codingPos]<c)for(e>0?--e:++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 6:if(this._addPixelsNeg(s[e]-2,t),t^=1,l[this.codingPos]<c)for(e>0?--e:++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 4:if(this._addPixelsNeg(s[e]-1,t),t^=1,l[this.codingPos]<c)for(e>0?--e:++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case n:this._addPixels(c,0),this.eof=!0;break;default:(0,a.info)("bad 2d code"),this._addPixels(c,0),this.err=!0}}else for(l[0]=0,this.codingPos=0,t=0;l[this.codingPos]<c;){if(d=0,t)do{d+=p=this._getBlackCode()}while(p>=64);else do{d+=p=this._getWhiteCode()}while(p>=64);this._addPixels(l[this.codingPos]+d,t),t^=1}var m=!1;if(this.byteAlign&&(this.inputBits&=-8),this.eoblock||this.row!==this.rows-1){if(d=this._lookBits(12),this.eoline)for(;d!==n&&1!==d;)this._eatBits(1),d=this._lookBits(12);else for(;0===d;)this._eatBits(1),d=this._lookBits(12);1===d?(this._eatBits(12),m=!0):d===n&&(this.eof=!0)}else this.rowsDone=!0;if(!this.eof&&this.encoding>0&&!this.rowsDone&&(this.nextLine2D=!this._lookBits(1),this._eatBits(1)),this.eoblock&&m&&this.byteAlign){if(1===(d=this._lookBits(12))){if(this._eatBits(12),this.encoding>0&&(this._lookBits(1),this._eatBits(1)),this.encoding>=0)for(r=0;r<4;++r)1!==(d=this._lookBits(12))&&(0,a.info)("bad rtc code: "+d),this._eatBits(12),this.encoding>0&&(this._lookBits(1),this._eatBits(1));this.eof=!0}}else if(this.err&&this.eoline){for(;;){if((d=this._lookBits(13))===n)return this.eof=!0,-1;if(d>>1===1)break;this._eatBits(1)}this._eatBits(12),this.encoding>0&&(this._eatBits(1),this.nextLine2D=!(1&d))}l[0]>0?this.outputBits=l[this.codingPos=0]:this.outputBits=l[this.codingPos=1],this.row++}if(this.outputBits>=8)o=1&this.codingPos?0:255,this.outputBits-=8,0===this.outputBits&&l[this.codingPos]<c&&(this.codingPos++,this.outputBits=l[this.codingPos]-l[this.codingPos-1]);else{i=8,o=0;do{if("number"!==typeof this.outputBits)throw new a.FormatError('Invalid /CCITTFaxDecode data, "outputBits" must be a number.');this.outputBits>i?(o<<=i,1&this.codingPos||(o|=255>>8-i),this.outputBits-=i,i=0):(o<<=this.outputBits,1&this.codingPos||(o|=255>>8-this.outputBits),i-=this.outputBits,this.outputBits=0,l[this.codingPos]<c?(this.codingPos++,this.outputBits=l[this.codingPos]-l[this.codingPos-1]):i>0&&(o<<=i,i=0))}while(i)}return this.black&&(o^=255),o}},{key:"_addPixels",value:function(e,t){var i=this.codingLine,n=this.codingPos;e>i[n]&&(e>this.columns&&((0,a.info)("row is wrong length"),this.err=!0,e=this.columns),1&n^t&&++n,i[n]=e),this.codingPos=n}},{key:"_addPixelsNeg",value:function(e,t){var i=this.codingLine,n=this.codingPos;if(e>i[n])e>this.columns&&((0,a.info)("row is wrong length"),this.err=!0,e=this.columns),1&n^t&&++n,i[n]=e;else if(e<i[n]){for(e<0&&((0,a.info)("invalid code"),this.err=!0,e=0);n>0&&e<i[n-1];)--n;i[n]=e}this.codingPos=n}},{key:"_findTableCode",value:function(e,t,i,a){for(var r=a||0,o=e;o<=t;++o){var s=this._lookBits(o);if(s===n)return[!0,1,!1];if(o<t&&(s<<=t-o),!r||s>=r){var l=i[s-r];if(l[0]===o)return this._eatBits(o),[!0,l[1],!0]}}return[!1,0,!1]}},{key:"_getTwoDimCode",value:function(){var e,t=0;if(this.eoblock){if(t=this._lookBits(7),(e=r[t])&&e[0]>0)return this._eatBits(e[0]),e[1]}else{var i=this._findTableCode(1,7,r);if(i[0]&&i[2])return i[1]}return(0,a.info)("Bad two dim code"),n}},{key:"_getWhiteCode",value:function(){var e,t=0;if(this.eoblock){if((t=this._lookBits(12))===n)return 1;if((e=t>>5===0?o[t]:s[t>>3])[0]>0)return this._eatBits(e[0]),e[1]}else{var i=this._findTableCode(1,9,s);if(i[0])return i[1];if((i=this._findTableCode(11,12,o))[0])return i[1]}return(0,a.info)("bad white code"),this._eatBits(1),1}},{key:"_getBlackCode",value:function(){var e,t;if(this.eoblock){if((e=this._lookBits(13))===n)return 1;if((t=e>>7===0?l[e]:e>>9===0&&e>>7!==0?c[(e>>1)-64]:d[e>>7])[0]>0)return this._eatBits(t[0]),t[1]}else{var i=this._findTableCode(2,6,d);if(i[0])return i[1];if((i=this._findTableCode(7,12,c,64))[0])return i[1];if((i=this._findTableCode(10,13,l))[0])return i[1]}return(0,a.info)("bad black code"),this._eatBits(1),1}},{key:"_lookBits",value:function(e){for(var t;this.inputBits<e;){if(-1===(t=this.source.next()))return 0===this.inputBits?n:this.inputBuf<<e-this.inputBits&65535>>16-e;this.inputBuf=this.inputBuf<<8|t,this.inputBits+=8}return this.inputBuf>>this.inputBits-e&65535>>16-e}},{key:"_eatBits",value:function(e){(this.inputBits-=e)<0&&(this.inputBits=0)}}]),e}();t.CCITTFaxDecoder=u},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.FlateStream=void 0;var a=i(150),n=i(2),r=new Int32Array([16,17,18,0,8,7,9,6,10,5,11,4,12,3,13,2,14,1,15]),o=new Int32Array([3,4,5,6,7,8,9,10,65547,65549,65551,65553,131091,131095,131099,131103,196643,196651,196659,196667,262211,262227,262243,262259,327811,327843,327875,327907,258,258,258]),s=new Int32Array([1,2,3,4,65541,65543,131081,131085,196625,196633,262177,262193,327745,327777,393345,393409,459009,459137,524801,525057,590849,591361,657409,658433,724993,727041,794625,798721,868353,876545]),l=[new Int32Array([459008,524368,524304,524568,459024,524400,524336,590016,459016,524384,524320,589984,524288,524416,524352,590048,459012,524376,524312,589968,459028,524408,524344,590032,459020,524392,524328,59e4,524296,524424,524360,590064,459010,524372,524308,524572,459026,524404,524340,590024,459018,524388,524324,589992,524292,524420,524356,590056,459014,524380,524316,589976,459030,524412,524348,590040,459022,524396,524332,590008,524300,524428,524364,590072,459009,524370,524306,524570,459025,524402,524338,590020,459017,524386,524322,589988,524290,524418,524354,590052,459013,524378,524314,589972,459029,524410,524346,590036,459021,524394,524330,590004,524298,524426,524362,590068,459011,524374,524310,524574,459027,524406,524342,590028,459019,524390,524326,589996,524294,524422,524358,590060,459015,524382,524318,589980,459031,524414,524350,590044,459023,524398,524334,590012,524302,524430,524366,590076,459008,524369,524305,524569,459024,524401,524337,590018,459016,524385,524321,589986,524289,524417,524353,590050,459012,524377,524313,589970,459028,524409,524345,590034,459020,524393,524329,590002,524297,524425,524361,590066,459010,524373,524309,524573,459026,524405,524341,590026,459018,524389,524325,589994,524293,524421,524357,590058,459014,524381,524317,589978,459030,524413,524349,590042,459022,524397,524333,590010,524301,524429,524365,590074,459009,524371,524307,524571,459025,524403,524339,590022,459017,524387,524323,589990,524291,524419,524355,590054,459013,524379,524315,589974,459029,524411,524347,590038,459021,524395,524331,590006,524299,524427,524363,590070,459011,524375,524311,524575,459027,524407,524343,590030,459019,524391,524327,589998,524295,524423,524359,590062,459015,524383,524319,589982,459031,524415,524351,590046,459023,524399,524335,590014,524303,524431,524367,590078,459008,524368,524304,524568,459024,524400,524336,590017,459016,524384,524320,589985,524288,524416,524352,590049,459012,524376,524312,589969,459028,524408,524344,590033,459020,524392,524328,590001,524296,524424,524360,590065,459010,524372,524308,524572,459026,524404,524340,590025,459018,524388,524324,589993,524292,524420,524356,590057,459014,524380,524316,589977,459030,524412,524348,590041,459022,524396,524332,590009,524300,524428,524364,590073,459009,524370,524306,524570,459025,524402,524338,590021,459017,524386,524322,589989,524290,524418,524354,590053,459013,524378,524314,589973,459029,524410,524346,590037,459021,524394,524330,590005,524298,524426,524362,590069,459011,524374,524310,524574,459027,524406,524342,590029,459019,524390,524326,589997,524294,524422,524358,590061,459015,524382,524318,589981,459031,524414,524350,590045,459023,524398,524334,590013,524302,524430,524366,590077,459008,524369,524305,524569,459024,524401,524337,590019,459016,524385,524321,589987,524289,524417,524353,590051,459012,524377,524313,589971,459028,524409,524345,590035,459020,524393,524329,590003,524297,524425,524361,590067,459010,524373,524309,524573,459026,524405,524341,590027,459018,524389,524325,589995,524293,524421,524357,590059,459014,524381,524317,589979,459030,524413,524349,590043,459022,524397,524333,590011,524301,524429,524365,590075,459009,524371,524307,524571,459025,524403,524339,590023,459017,524387,524323,589991,524291,524419,524355,590055,459013,524379,524315,589975,459029,524411,524347,590039,459021,524395,524331,590007,524299,524427,524363,590071,459011,524375,524311,524575,459027,524407,524343,590031,459019,524391,524327,589999,524295,524423,524359,590063,459015,524383,524319,589983,459031,524415,524351,590047,459023,524399,524335,590015,524303,524431,524367,590079]),9],c=[new Int32Array([327680,327696,327688,327704,327684,327700,327692,327708,327682,327698,327690,327706,327686,327702,327694,0,327681,327697,327689,327705,327685,327701,327693,327709,327683,327699,327691,327707,327687,327703,327695,0]),5],p=function(e){d(i,e);var t=u(i);function i(e,a){var r;b(this,i),(r=t.call(this,a)).str=e,r.dict=e.dict;var o=e.getByte(),s=e.getByte();if(-1===o||-1===s)throw new n.FormatError("Invalid header in flate stream: ".concat(o,", ").concat(s));if(8!==(15&o))throw new n.FormatError("Unknown compression method in flate stream: ".concat(o,", ").concat(s));if(((o<<8)+s)%31!==0)throw new n.FormatError("Bad FCHECK in flate stream: ".concat(o,", ").concat(s));if(32&s)throw new n.FormatError("FDICT bit set in flate stream: ".concat(o,", ").concat(s));return r.codeSize=0,r.codeBuf=0,r}return g(i,[{key:"getBits",value:function(e){for(var t,i=this.str,a=this.codeSize,r=this.codeBuf;a<e;){if(-1===(t=i.getByte()))throw new n.FormatError("Bad encoding in flate stream");r|=t<<a,a+=8}return t=r&(1<<e)-1,this.codeBuf=r>>e,this.codeSize=a-=e,t}},{key:"getCode",value:function(e){for(var t,i=this.str,a=e[0],r=e[1],o=this.codeSize,s=this.codeBuf;o<r&&-1!==(t=i.getByte());)s|=t<<o,o+=8;var l=a[s&(1<<r)-1],c=l>>16,d=65535&l;if(c<1||o<c)throw new n.FormatError("Bad encoding in flate stream");return this.codeBuf=s>>c,this.codeSize=o-c,d}},{key:"generateHuffmanTable",value:function(e){var t,i=e.length,a=0;for(t=0;t<i;++t)e[t]>a&&(a=e[t]);for(var n=1<<a,r=new Int32Array(n),o=1,s=0,l=2;o<=a;++o,s<<=1,l<<=1)for(var c=0;c<i;++c)if(e[c]===o){var d=0,u=s;for(t=0;t<o;++t)d=d<<1|1&u,u>>=1;for(t=d;t<n;t+=l)r[t]=o<<16|c;++s}return[r,a]}},{key:"readBlock",value:function(){var e,t,i=this.str,a=this.getBits(3);if(1&a&&(this.eof=!0),0!==(a>>=1)){var d,u;if(1===a)d=l,u=c;else{if(2!==a)throw new n.FormatError("Unknown block type in flate stream");var p,m=this.getBits(5)+257,h=this.getBits(5)+1,f=this.getBits(4)+4,y=new Uint8Array(r.length);for(p=0;p<f;++p)y[r[p]]=this.getBits(3);var b=this.generateHuffmanTable(y);t=0,p=0;for(var g,v,_,A=m+h,x=new Uint8Array(A);p<A;){var w=this.getCode(b);if(16===w)g=2,v=3,_=t;else if(17===w)g=3,v=3,_=t=0;else{if(18!==w){x[p++]=t=w;continue}g=7,v=11,_=t=0}for(var S=this.getBits(g)+v;S-- >0;)x[p++]=_}d=this.generateHuffmanTable(x.subarray(0,m)),u=this.generateHuffmanTable(x.subarray(m,A))}for(var C=(e=this.buffer)?e.length:0,k=this.bufferLength;;){var D=this.getCode(d);if(D<256)k+1>=C&&(C=(e=this.ensureBuffer(k+1)).length),e[k++]=D;else{if(256===D)return void(this.bufferLength=k);var R=(D=o[D-=257])>>16;R>0&&(R=this.getBits(R)),t=(65535&D)+R,D=this.getCode(u),(R=(D=s[D])>>16)>0&&(R=this.getBits(R));var I=(65535&D)+R;k+t>=C&&(C=(e=this.ensureBuffer(k+t)).length);for(var M=0;M<t;++M,++k)e[k]=e[k-I]}}}else{var T;if(-1===(T=i.getByte()))throw new n.FormatError("Bad block header in flate stream");var P=T;if(-1===(T=i.getByte()))throw new n.FormatError("Bad block header in flate stream");if(P|=T<<8,-1===(T=i.getByte()))throw new n.FormatError("Bad block header in flate stream");var z=T;if(-1===(T=i.getByte()))throw new n.FormatError("Bad block header in flate stream");if((z|=T<<8)!==(65535&~P)&&(0!==P||0!==z))throw new n.FormatError("Bad uncompressed block length in flate stream");this.codeBuf=0,this.codeSize=0;var B=this.bufferLength,F=B+P;if(e=this.ensureBuffer(F),this.bufferLength=F,0===P)-1===i.peekByte()&&(this.eof=!0);else{var E=i.getBytes(P);e.set(E,B),E.length<P&&(this.eof=!0)}}}}]),i}(a.DecodeStream);t.FlateStream=p},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Jbig2Stream=void 0;var a=i(138),n=i(150),r=i(137),o=i(156),s=i(2),l=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,a)).stream=e,r.dict=e.dict,r.maybeLength=a,r.params=n,r}return g(i,[{key:"bytes",get:function(){return(0,s.shadow)(this,"bytes",this.stream.getBytes(this.maybeLength))}},{key:"ensureBuffer",value:function(e){}},{key:"readBlock",value:function(){if(!this.eof){var e=new o.Jbig2Image,t=[];if(this.params instanceof r.Dict){var i=this.params.get("JBIG2Globals");if(i instanceof a.BaseStream){var n=i.getBytes();t.push({data:n,start:0,end:n.length})}}t.push({data:this.bytes,start:0,end:this.bytes.length});for(var s=e.parseChunks(t),l=s.length,c=0;c<l;c++)s[c]^=255;this.buffer=s,this.bufferLength=l,this.eof=!0}}}]),i}(n.DecodeStream);t.Jbig2Stream=l},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Jbig2Image=void 0;var a=i(2),n=i(136),r=i(157),o=i(153),s=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,"JBIG2 error: ".concat(e),"Jbig2Error")}return g(i)}(a.BaseException),l=function(){function e(){b(this,e)}return g(e,[{key:"getContexts",value:function(e){return e in this?this[e]:this[e]=new 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_=["SymbolDictionary",null,null,null,"IntermediateTextRegion",null,"ImmediateTextRegion","ImmediateLosslessTextRegion",null,null,null,null,null,null,null,null,"PatternDictionary",null,null,null,"IntermediateHalftoneRegion",null,"ImmediateHalftoneRegion","ImmediateLosslessHalftoneRegion",null,null,null,null,null,null,null,null,null,null,null,null,"IntermediateGenericRegion",null,"ImmediateGenericRegion","ImmediateLosslessGenericRegion","IntermediateGenericRefinementRegion",null,"ImmediateGenericRefinementRegion","ImmediateLosslessGenericRefinementRegion",null,null,null,null,"PageInformation","EndOfPage","EndOfStripe","EndOfFile","Profiles","Tables",null,null,null,null,null,null,null,null,"Extension"],A=[[{x:-1,y:-2},{x:0,y:-2},{x:1,y:-2},{x:-2,y:-1},{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:2,y:-1},{x:-4,y:0},{x:-3,y:0},{x:-2,y:0},{x:-1,y:0}],[{x:-1,y:-2},{x:0,y:-2},{x:1,y:-2},{x:2,y:-2},{x:-2,y:-1},{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:2,y:-1},{x:-3,y:0},{x:-2,y:0},{x:-1,y:0}],[{x:-1,y:-2},{x:0,y:-2},{x:1,y:-2},{x:-2,y:-1},{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:-2,y:0},{x:-1,y:0}],[{x:-3,y:-1},{x:-2,y:-1},{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:-4,y:0},{x:-3,y:0},{x:-2,y:0},{x:-1,y:0}]],x=[{coding:[{x:0,y:-1},{x:1,y:-1},{x:-1,y:0}],reference:[{x:0,y:-1},{x:1,y:-1},{x:-1,y:0},{x:0,y:0},{x:1,y:0},{x:-1,y:1},{x:0,y:1},{x:1,y:1}]},{coding:[{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:-1,y:0}],reference:[{x:0,y:-1},{x:-1,y:0},{x:0,y:0},{x:1,y:0},{x:0,y:1},{x:1,y:1}]}],w=[39717,1941,229,405],S=[32,8];function C(e,t,i,a,n,r,o,s){if(e)return H(new L(s.data,s.start,s.end),t,i,!1);if(0===a&&!r&&!n&&4===o.length&&3===o[0].x&&-1===o[0].y&&-3===o[1].x&&-1===o[1].y&&2===o[2].x&&-2===o[2].y&&-2===o[3].x&&-2===o[3].y)return function(e,t,i){var a,n,r,o,s,l,c,d=i.decoder,u=i.contextCache.getContexts("GB"),p=[];for(n=0;n<t;n++)for(s=p[n]=new Uint8Array(e),l=n<1?s:p[n-1],a=(c=n<2?s:p[n-2])[0]<<13|c[1]<<12|c[2]<<11|l[0]<<7|l[1]<<6|l[2]<<5|l[3]<<4,r=0;r<e;r++)s[r]=o=d.readBit(u,a),a=(31735&a)<<1|(r+3<e?c[r+3]<<11:0)|(r+4<e?l[r+4]<<4:0)|o;return p}(t,i,s);var l=!!r,c=A[a].concat(o);c.sort((function(e,t){return e.y-t.y||e.x-t.x}));var d,u,p=c.length,m=new Int8Array(p),h=new Int8Array(p),f=[],y=0,b=0,g=0,v=0;for(u=0;u<p;u++)m[u]=c[u].x,h[u]=c[u].y,b=Math.min(b,c[u].x),g=Math.max(g,c[u].x),v=Math.min(v,c[u].y),u<p-1&&c[u].y===c[u+1].y&&c[u].x===c[u+1].x-1?y|=1<<p-1-u:f.push(u);var _=f.length,x=new Int8Array(_),S=new Int8Array(_),C=new Uint16Array(_);for(d=0;d<_;d++)u=f[d],x[d]=c[u].x,S[d]=c[u].y,C[d]=1<<p-1-u;for(var k,D,R,I,M,T=-b,P=-v,z=t-g,B=w[a],F=new Uint8Array(t),E=[],N=s.decoder,O=s.contextCache.getContexts("GB"),G=0,j=0,q=0;q<i;q++)if(n&&(G^=N.readBit(O,B)))E.push(F);else for(F=new Uint8Array(F),E.push(F),k=0;k<t;k++)if(l&&r[q][k])F[k]=0;else{if(k>=T&&k<z&&q>=P)for(j=j<<1&y,u=0;u<_;u++)D=q+S[u],R=k+x[u],(I=E[D][R])&&(j|=I=C[u]);else for(j=0,M=p-1,u=0;u<p;u++,M--)(R=k+m[u])>=0&&R<t&&(D=q+h[u])>=0&&(I=E[D][R])&&(j|=I<<M);var U=N.readBit(O,j);F[k]=U}return E}function k(e,t,i,a,n,r,o,l,c){var d=x[i].coding;0===i&&(d=d.concat([l[0]]));var u,p=d.length,m=new Int32Array(p),h=new Int32Array(p);for(u=0;u<p;u++)m[u]=d[u].x,h[u]=d[u].y;var f=x[i].reference;0===i&&(f=f.concat([l[1]]));var y=f.length,b=new Int32Array(y),g=new Int32Array(y);for(u=0;u<y;u++)b[u]=f[u].x,g[u]=f[u].y;for(var v=a[0].length,_=a.length,A=S[i],w=[],C=c.decoder,k=c.contextCache.getContexts("GR"),D=0,R=0;R<t;R++){if(o&&(D^=C.readBit(k,A)))throw new s("prediction is not supported");var I=new Uint8Array(e);w.push(I);for(var M=0;M<e;M++){var T=void 0,P=void 0,z=0;for(u=0;u<p;u++)T=R+h[u],P=M+m[u],T<0||P<0||P>=e?z<<=1:z=z<<1|w[T][P];for(u=0;u<y;u++)T=R+g[u]-r,P=M+b[u]-n,T<0||T>=_||P<0||P>=v?z<<=1:z=z<<1|a[T][P];var B=C.readBit(k,z);I[M]=B}}return w}function D(e,t,i,a,n,r,o,l,c,d,u,p,m,h,f,b,g,_,A){if(e&&t)throw new s("refinement with Huffman is not supported");var x,w,S=[];for(x=0;x<a;x++){if(w=new Uint8Array(i),n)for(var C=0;C<i;C++)w[C]=n;S.push(w)}var D=g.decoder,R=g.contextCache,I=e?-h.tableDeltaT.decode(A):-y(R,"IADT",D),M=0;for(x=0;x<r;){I+=e?h.tableDeltaT.decode(A):y(R,"IADT",D);for(var T=M+=e?h.tableFirstS.decode(A):y(R,"IAFS",D);;){var P=0;o>1&&(P=e?A.readBits(_):y(R,"IAIT",D));var z=o*I+P,B=e?h.symbolIDTable.decode(A):v(R,D,c),F=t&&(e?A.readBit():y(R,"IARI",D)),E=l[B],N=E[0].length,O=E.length;if(F){var G=y(R,"IARDW",D),L=y(R,"IARDH",D);E=k(N+=G,O+=L,f,E,(G>>1)+y(R,"IARDX",D),(L>>1)+y(R,"IARDY",D),!1,b,g)}var j=z-(1&p?0:O-1),q=T-(2&p?N-1:0),H=void 0,U=void 0,Y=void 0;if(d){for(H=0;H<O;H++)if(w=S[q+H]){Y=E[H];var X=Math.min(i-j,N);switch(m){case 0:for(U=0;U<X;U++)w[j+U]|=Y[U];break;case 2:for(U=0;U<X;U++)w[j+U]^=Y[U];break;default:throw new s("operator ".concat(m," is not supported"))}}T+=O-1}else{for(U=0;U<O;U++)if(w=S[j+U])switch(Y=E[U],m){case 0:for(H=0;H<N;H++)w[q+H]|=Y[H];break;case 2:for(H=0;H<N;H++)w[q+H]^=Y[H];break;default:throw new s("operator ".concat(m," is not supported"))}T+=N-1}x++;var V=e?h.tableDeltaS.decode(A):y(R,"IADS",D);if(null===V)break;T+=V+u}}return S}function R(e,t){var i={};i.number=(0,n.readUint32)(e,t);var a=e[t+4],r=63&a;if(!_[r])throw new s("invalid segment type: "+r);i.type=r,i.typeName=_[r],i.deferredNonRetain=!!(128&a);var o=!!(64&a),l=e[t+5],c=l>>5&7,d=[31&l],u=t+6;if(7===l){c=536870911&(0,n.readUint32)(e,u-1),u+=3;var p=c+7>>3;for(d[0]=e[u++];--p>0;)d.push(e[u++])}else if(5===l||6===l)throw new s("invalid referred-to flags");i.retainBits=d;var m=4;i.number<=256?m=1:i.number<=65536&&(m=2);var h,f,y=[];for(h=0;h<c;h++){var b=void 0;b=1===m?e[u]:2===m?(0,n.readUint16)(e,u):(0,n.readUint32)(e,u),y.push(b),u+=m}if(i.referredTo=y,o?(i.pageAssociation=(0,n.readUint32)(e,u),u+=4):i.pageAssociation=e[u++],i.length=(0,n.readUint32)(e,u),u+=4,4294967295===i.length){if(38!==r)throw new s("invalid unknown segment length");var g=M(e,u),v=!!(1&e[u+T]),A=new Uint8Array(6);for(v||(A[0]=255,A[1]=172),A[2]=g.height>>>24&255,A[3]=g.height>>16&255,A[4]=g.height>>8&255,A[5]=255&g.height,h=u,f=e.length;h<f;h++){for(var x=0;x<6&&A[x]===e[h+x];)x++;if(6===x){i.length=h+6;break}}if(4294967295===i.length)throw new s("segment end was not found")}return i.headerEnd=u,i}function I(e,t,i,a){for(var n=[],r=i;r<a;){var o=R(t,r);r=o.headerEnd;var s={header:o,data:t};if(e.randomAccess||(s.start=r,r+=o.length,s.end=r),n.push(s),51===o.type)break}if(e.randomAccess)for(var l=0,c=n.length;l<c;l++)n[l].start=r,r+=n[l].header.length,n[l].end=r;return n}function M(e,t){return{width:(0,n.readUint32)(e,t),height:(0,n.readUint32)(e,t+4),x:(0,n.readUint32)(e,t+8),y:(0,n.readUint32)(e,t+12),combinationOperator:7&e[t+16]}}var T=17;function P(e,t){var i,a,r,o,l=e.header,c=e.data,d=e.end,u=e.start;switch(l.type){case 0:var p={},m=(0,n.readUint16)(c,u);if(p.huffman=!!(1&m),p.refinement=!!(2&m),p.huffmanDHSelector=m>>2&3,p.huffmanDWSelector=m>>4&3,p.bitmapSizeSelector=m>>6&1,p.aggregationInstancesSelector=m>>7&1,p.bitmapCodingContextUsed=!!(256&m),p.bitmapCodingContextRetained=!!(512&m),p.template=m>>10&3,p.refinementTemplate=m>>12&1,u+=2,!p.huffman){for(o=0===p.template?4:1,a=[],r=0;r<o;r++)a.push({x:(0,n.readInt8)(c,u),y:(0,n.readInt8)(c,u+1)}),u+=2;p.at=a}if(p.refinement&&!p.refinementTemplate){for(a=[],r=0;r<2;r++)a.push({x:(0,n.readInt8)(c,u),y:(0,n.readInt8)(c,u+1)}),u+=2;p.refinementAt=a}p.numberOfExportedSymbols=(0,n.readUint32)(c,u),u+=4,p.numberOfNewSymbols=(0,n.readUint32)(c,u),u+=4,i=[p,l.number,l.referredTo,c,u,d];break;case 6:case 7:var h={};h.info=M(c,u),u+=T;var f=(0,n.readUint16)(c,u);if(u+=2,h.huffman=!!(1&f),h.refinement=!!(2&f),h.logStripSize=f>>2&3,h.stripSize=1<<h.logStripSize,h.referenceCorner=f>>4&3,h.transposed=!!(64&f),h.combinationOperator=f>>7&3,h.defaultPixelValue=f>>9&1,h.dsOffset=f<<17>>27,h.refinementTemplate=f>>15&1,h.huffman){var y=(0,n.readUint16)(c,u);u+=2,h.huffmanFS=3&y,h.huffmanDS=y>>2&3,h.huffmanDT=y>>4&3,h.huffmanRefinementDW=y>>6&3,h.huffmanRefinementDH=y>>8&3,h.huffmanRefinementDX=y>>10&3,h.huffmanRefinementDY=y>>12&3,h.huffmanRefinementSizeSelector=!!(16384&y)}if(h.refinement&&!h.refinementTemplate){for(a=[],r=0;r<2;r++)a.push({x:(0,n.readInt8)(c,u),y:(0,n.readInt8)(c,u+1)}),u+=2;h.refinementAt=a}h.numberOfSymbolInstances=(0,n.readUint32)(c,u),u+=4,i=[h,l.referredTo,c,u,d];break;case 16:var b={},g=c[u++];b.mmr=!!(1&g),b.template=g>>1&3,b.patternWidth=c[u++],b.patternHeight=c[u++],b.maxPatternIndex=(0,n.readUint32)(c,u),u+=4,i=[b,l.number,c,u,d];break;case 22:case 23:var v={};v.info=M(c,u),u+=T;var _=c[u++];v.mmr=!!(1&_),v.template=_>>1&3,v.enableSkip=!!(8&_),v.combinationOperator=_>>4&7,v.defaultPixelValue=_>>7&1,v.gridWidth=(0,n.readUint32)(c,u),u+=4,v.gridHeight=(0,n.readUint32)(c,u),u+=4,v.gridOffsetX=4294967295&(0,n.readUint32)(c,u),u+=4,v.gridOffsetY=4294967295&(0,n.readUint32)(c,u),u+=4,v.gridVectorX=(0,n.readUint16)(c,u),u+=2,v.gridVectorY=(0,n.readUint16)(c,u),u+=2,i=[v,l.referredTo,c,u,d];break;case 38:case 39:var A={};A.info=M(c,u),u+=T;var x=c[u++];if(A.mmr=!!(1&x),A.template=x>>1&3,A.prediction=!!(8&x),!A.mmr){for(o=0===A.template?4:1,a=[],r=0;r<o;r++)a.push({x:(0,n.readInt8)(c,u),y:(0,n.readInt8)(c,u+1)}),u+=2;A.at=a}i=[A,c,u,d];break;case 48:var w={width:(0,n.readUint32)(c,u),height:(0,n.readUint32)(c,u+4),resolutionX:(0,n.readUint32)(c,u+8),resolutionY:(0,n.readUint32)(c,u+12)};4294967295===w.height&&delete w.height;var S=c[u+16];(0,n.readUint16)(c,u+17),w.lossless=!!(1&S),w.refinement=!!(2&S),w.defaultPixelValue=S>>2&1,w.combinationOperator=S>>3&3,w.requiresBuffer=!!(32&S),w.combinationOperatorOverride=!!(64&S),i=[w];break;case 49:case 50:case 51:case 62:break;case 53:i=[l.number,c,u,d];break;default:throw new s("segment type ".concat(l.typeName,"(").concat(l.type,") is not implemented"))}var C="on"+l.typeName;C in t&&t[C].apply(t,i)}function z(e,t){for(var i=0,a=e.length;i<a;i++)P(e[i],t)}var B=function(){function e(){b(this,e)}return g(e,[{key:"onPageInformation",value:function(e){this.currentPageInfo=e;var t=e.width+7>>3,i=new Uint8ClampedArray(t*e.height);e.defaultPixelValue&&i.fill(255),this.buffer=i}},{key:"drawBitmap",value:function(e,t){var i,a,n,r,o=this.currentPageInfo,l=e.width,c=e.height,d=o.width+7>>3,u=o.combinationOperatorOverride?e.combinationOperator:o.combinationOperator,p=this.buffer,m=128>>(7&e.x),h=e.y*d+(e.x>>3);switch(u){case 0:for(i=0;i<c;i++){for(n=m,r=h,a=0;a<l;a++)t[i][a]&&(p[r]|=n),(n>>=1)||(n=128,r++);h+=d}break;case 2:for(i=0;i<c;i++){for(n=m,r=h,a=0;a<l;a++)t[i][a]&&(p[r]^=n),(n>>=1)||(n=128,r++);h+=d}break;default:throw new s("operator ".concat(u," is not supported"))}}},{key:"onImmediateGenericRegion",value:function(e,t,i,a){var n=e.info,r=new p(t,i,a),o=C(e.mmr,n.width,n.height,e.template,e.prediction,null,e.at,r);this.drawBitmap(n,o)}},{key:"onImmediateLosslessGenericRegion",value:function(){this.onImmediateGenericRegion.apply(this,arguments)}},{key:"onSymbolDictionary",value:function(e,t,i,a,r,o){var l,d;e.huffman&&(l=function(e,t,i){var a,n,r,o,l=0;switch(e.huffmanDHSelector){case 0:case 1:a=G(e.huffmanDHSelector+4);break;case 3:a=j(l,t,i),l++;break;default:throw new s("invalid Huffman DH selector")}switch(e.huffmanDWSelector){case 0:case 1:n=G(e.huffmanDWSelector+2);break;case 3:n=j(l,t,i),l++;break;default:throw new s("invalid Huffman DW selector")}return e.bitmapSizeSelector?(r=j(l,t,i),l++):r=G(1),o=e.aggregationInstancesSelector?j(l,t,i):G(1),{tableDeltaHeight:a,tableDeltaWidth:n,tableBitmapSize:r,tableAggregateInstances:o}}(e,i,this.customTables),d=new L(a,r,o));var u=this.symbols;u||(this.symbols=u={});var m,f=[],b=h(i);try{for(b.s();!(m=b.n()).done;){var g=u[m.value];g&&f.push.apply(f,c(g))}}catch(A){b.e(A)}finally{b.f()}var _=new p(a,r,o);u[t]=function(e,t,i,a,r,o,l,c,d,u,p,m){if(e&&t)throw new s("symbol refinement with Huffman is not supported");var h,f,b=[],g=0,_=(0,n.log2)(i.length+a),A=p.decoder,x=p.contextCache;for(e&&(h=G(1),f=[],_=Math.max(_,1));b.length<a;){g+=e?o.tableDeltaHeight.decode(m):y(x,"IADH",A);for(var w=0,S=0,R=e?f.length:0;;){var I=e?o.tableDeltaWidth.decode(m):y(x,"IADW",A);if(null===I)break;S+=w+=I;var M=void 0;if(t){var T=y(x,"IAAI",A);if(T>1)M=D(e,t,w,g,0,T,1,i.concat(b),_,0,0,1,0,o,d,u,p,0,m);else{var P=v(x,A,_),z=y(x,"IARDX",A),B=y(x,"IARDY",A);M=k(w,g,d,P<i.length?i[P]:b[P-i.length],z,B,!1,u,p)}b.push(M)}else e?f.push(w):(M=C(!1,w,g,l,!1,null,c,p),b.push(M))}if(e&&!t){var F=o.tableBitmapSize.decode(m);m.byteAlign();var E=void 0;if(0===F)E=q(m,S,g);else{var N=m.end,O=m.position+F;m.end=O,E=H(m,S,g,!1),m.end=N,m.position=O}var L=f.length;if(R===L-1)b.push(E);else{var j=void 0,U=void 0,Y=0,X=void 0,V=void 0;for(j=R;j<L;j++){for(X=Y+f[j],V=[],U=0;U<g;U++)V.push(E[U].subarray(Y,X));b.push(V),Y=X}}}}for(var Q,W,Z=[],J=[],K=!1,$=i.length+a;J.length<$;){for(var ee=e?h.decode(m):y(x,"IAEX",A);ee--;)J.push(K);K=!K}for(Q=0,W=i.length;Q<W;Q++)J[Q]&&Z.push(i[Q]);for(var te=0;te<a;Q++,te++)J[Q]&&Z.push(b[te]);return Z}(e.huffman,e.refinement,f,e.numberOfNewSymbols,e.numberOfExportedSymbols,l,e.template,e.at,e.refinementTemplate,e.refinementAt,_,d)}},{key:"onImmediateTextRegion",value:function(e,t,i,a,r){var o,l,d,u=e.info,m=this.symbols,f=[],y=h(t);try{for(y.s();!(d=y.n()).done;){var b=m[d.value];b&&f.push.apply(f,c(b))}}catch(A){y.e(A)}finally{y.f()}var g=(0,n.log2)(f.length);e.huffman&&(l=new L(i,a,r),o=function(e,t,i,a,n){for(var r=[],o=0;o<=34;o++){var l=n.readBits(4);r.push(new F([o,l,0,0]))}var c=new N(r,!1);r.length=0;for(var d=0;d<a;){var u=c.decode(n);if(u>=32){var p=void 0,m=void 0,h=void 0;switch(u){case 32:if(0===d)throw new s("no previous value in symbol ID table");m=n.readBits(2)+3,p=r[d-1].prefixLength;break;case 33:m=n.readBits(3)+3,p=0;break;case 34:m=n.readBits(7)+11,p=0;break;default:throw new s("invalid code length in symbol ID table")}for(h=0;h<m;h++)r.push(new F([d,p,0,0])),d++}else r.push(new F([d,u,0,0])),d++}n.byteAlign();var f,y,b,g=new N(r,!1),v=0;switch(e.huffmanFS){case 0:case 1:f=G(e.huffmanFS+6);break;case 3:f=j(v,t,i),v++;break;default:throw new s("invalid Huffman FS selector")}switch(e.huffmanDS){case 0:case 1:case 2:y=G(e.huffmanDS+8);break;case 3:y=j(v,t,i),v++;break;default:throw new s("invalid Huffman DS selector")}switch(e.huffmanDT){case 0:case 1:case 2:b=G(e.huffmanDT+11);break;case 3:b=j(v,t,i),v++;break;default:throw new s("invalid Huffman DT selector")}if(e.refinement)throw new s("refinement with Huffman is not supported");return{symbolIDTable:g,tableFirstS:f,tableDeltaS:y,tableDeltaT:b}}(e,t,this.customTables,f.length,l));var v=new p(i,a,r),_=D(e.huffman,e.refinement,u.width,u.height,e.defaultPixelValue,e.numberOfSymbolInstances,e.stripSize,f,g,e.transposed,e.dsOffset,e.referenceCorner,e.combinationOperator,o,e.refinementTemplate,e.refinementAt,v,e.logStripSize,l);this.drawBitmap(u,_)}},{key:"onImmediateLosslessTextRegion",value:function(){this.onImmediateTextRegion.apply(this,arguments)}},{key:"onPatternDictionary",value:function(e,t,i,a,n){var r=this.patterns;r||(this.patterns=r={});var o=new p(i,a,n);r[t]=function(e,t,i,a,n,r){var o=[];e||(o.push({x:-t,y:0}),0===n&&o.push({x:-3,y:-1},{x:2,y:-2},{x:-2,y:-2}));for(var s=C(e,(a+1)*t,i,n,!1,null,o,r),l=[],c=0;c<=a;c++){for(var d=[],u=t*c,p=u+t,m=0;m<i;m++)d.push(s[m].subarray(u,p));l.push(d)}return l}(e.mmr,e.patternWidth,e.patternHeight,e.maxPatternIndex,e.template,o)}},{key:"onImmediateHalftoneRegion",value:function(e,t,i,a,r){var o=this.patterns[t[0]],l=e.info,c=new p(i,a,r),d=function(e,t,i,a,r,o,l,c,d,u,p,m,h,f,y){if(l)throw new s("skip is not supported");if(0!==c)throw new s('operator "'.concat(c,'" is not supported in halftone region'));var b,g,v,_=[];for(b=0;b<r;b++){if(v=new Uint8Array(a),o)for(g=0;g<a;g++)v[g]=o;_.push(v)}var A=t.length,x=t[0],w=x[0].length,S=x.length,k=(0,n.log2)(A),D=[];e||(D.push({x:i<=1?3:2,y:-1}),0===i&&D.push({x:-3,y:-1},{x:2,y:-2},{x:-2,y:-2}));var R,I,M,T,P,z,B,F,E,N,O,G=[];for(e&&(R=new L(y.data,y.start,y.end)),b=k-1;b>=0;b--)I=e?H(R,d,u,!0):C(!1,d,u,i,!1,null,D,y),G[b]=I;for(M=0;M<u;M++)for(T=0;T<d;T++){for(P=0,z=0,g=k-1;g>=0;g--)z|=(P^=G[g][M][T])<<g;if(B=t[z],E=m+M*h-T*f>>8,(F=p+M*f+T*h>>8)>=0&&F+w<=a&&E>=0&&E+S<=r)for(b=0;b<S;b++)for(O=_[E+b],N=B[b],g=0;g<w;g++)O[F+g]|=N[g];else{var j=void 0,q=void 0;for(b=0;b<S;b++)if(!((q=E+b)<0||q>=r))for(O=_[q],N=B[b],g=0;g<w;g++)(j=F+g)>=0&&j<a&&(O[j]|=N[g])}}return _}(e.mmr,o,e.template,l.width,l.height,e.defaultPixelValue,e.enableSkip,e.combinationOperator,e.gridWidth,e.gridHeight,e.gridOffsetX,e.gridOffsetY,e.gridVectorX,e.gridVectorY,c);this.drawBitmap(l,d)}},{key:"onImmediateLosslessHalftoneRegion",value:function(){this.onImmediateHalftoneRegion.apply(this,arguments)}},{key:"onTables",value:function(e,t,i,a){var r=this.customTables;r||(this.customTables=r={}),r[e]=function(e,t,i){var a,r,o=e[t],s=4294967295&(0,n.readUint32)(e,t+1),l=4294967295&(0,n.readUint32)(e,t+5),c=new L(e,t+9,i),d=1+(o>>1&7),u=1+(o>>4&7),p=[],m=s;do{a=c.readBits(d),r=c.readBits(u),p.push(new F([m,a,r,0])),m+=1<<r}while(m<l);return a=c.readBits(d),p.push(new F([s-1,a,32,0,"lower"])),a=c.readBits(d),p.push(new F([l,a,32,0])),1&o&&(a=c.readBits(d),p.push(new F([a,0]))),new N(p,!1)}(t,i,a)}}]),e}(),F=g((function e(t){b(this,e),2===t.length?(this.isOOB=!0,this.rangeLow=0,this.prefixLength=t[0],this.rangeLength=0,this.prefixCode=t[1],this.isLowerRange=!1):(this.isOOB=!1,this.rangeLow=t[0],this.prefixLength=t[1],this.rangeLength=t[2],this.prefixCode=t[3],this.isLowerRange="lower"===t[4])})),E=function(){function e(t){b(this,e),this.children=[],t?(this.isLeaf=!0,this.rangeLength=t.rangeLength,this.rangeLow=t.rangeLow,this.isLowerRange=t.isLowerRange,this.isOOB=t.isOOB):this.isLeaf=!1}return g(e,[{key:"buildTree",value:function(t,i){var a=t.prefixCode>>i&1;if(i<=0)this.children[a]=new e(t);else{var n=this.children[a];n||(this.children[a]=n=new e(null)),n.buildTree(t,i-1)}}},{key:"decodeNode",value:function(e){if(this.isLeaf){if(this.isOOB)return null;var t=e.readBits(this.rangeLength);return this.rangeLow+(this.isLowerRange?-t:t)}var i=this.children[e.readBit()];if(!i)throw new s("invalid Huffman data");return i.decodeNode(e)}}]),e}(),N=function(){function e(t,i){b(this,e),i||this.assignPrefixCodes(t),this.rootNode=new E(null);for(var a=0,n=t.length;a<n;a++){var r=t[a];r.prefixLength>0&&this.rootNode.buildTree(r,r.prefixLength-1)}}return g(e,[{key:"decode",value:function(e){return this.rootNode.decodeNode(e)}},{key:"assignPrefixCodes",value:function(e){for(var t=e.length,i=0,a=0;a<t;a++)i=Math.max(i,e[a].prefixLength);for(var n=new Uint32Array(i+1),r=0;r<t;r++)n[e[r].prefixLength]++;var o,s,l,c=1,d=0;for(n[0]=0;c<=i;){for(o=d=d+n[c-1]<<1,s=0;s<t;)(l=e[s]).prefixLength===c&&(l.prefixCode=o,o++),s++;c++}}}]),e}(),O={};function G(e){var t,i=O[e];if(i)return i;switch(e){case 1:t=[[0,1,4,0],[16,2,8,2],[272,3,16,6],[65808,3,32,7]];break;case 2:t=[[0,1,0,0],[1,2,0,2],[2,3,0,6],[3,4,3,14],[11,5,6,30],[75,6,32,62],[6,63]];break;case 3:t=[[-256,8,8,254],[0,1,0,0],[1,2,0,2],[2,3,0,6],[3,4,3,14],[11,5,6,30],[-257,8,32,255,"lower"],[75,7,32,126],[6,62]];break;case 4:t=[[1,1,0,0],[2,2,0,2],[3,3,0,6],[4,4,3,14],[12,5,6,30],[76,5,32,31]];break;case 5:t=[[-255,7,8,126],[1,1,0,0],[2,2,0,2],[3,3,0,6],[4,4,3,14],[12,5,6,30],[-256,7,32,127,"lower"],[76,6,32,62]];break;case 6:t=[[-2048,5,10,28],[-1024,4,9,8],[-512,4,8,9],[-256,4,7,10],[-128,5,6,29],[-64,5,5,30],[-32,4,5,11],[0,2,7,0],[128,3,7,2],[256,3,8,3],[512,4,9,12],[1024,4,10,13],[-2049,6,32,62,"lower"],[2048,6,32,63]];break;case 7:t=[[-1024,4,9,8],[-512,3,8,0],[-256,4,7,9],[-128,5,6,26],[-64,5,5,27],[-32,4,5,10],[0,4,5,11],[32,5,5,28],[64,5,6,29],[128,4,7,12],[256,3,8,1],[512,3,9,2],[1024,3,10,3],[-1025,5,32,30,"lower"],[2048,5,32,31]];break;case 8:t=[[-15,8,3,252],[-7,9,1,508],[-5,8,1,253],[-3,9,0,509],[-2,7,0,124],[-1,4,0,10],[0,2,1,0],[2,5,0,26],[3,6,0,58],[4,3,4,4],[20,6,1,59],[22,4,4,11],[38,4,5,12],[70,5,6,27],[134,5,7,28],[262,6,7,60],[390,7,8,125],[646,6,10,61],[-16,9,32,510,"lower"],[1670,9,32,511],[2,1]];break;case 9:t=[[-31,8,4,252],[-15,9,2,508],[-11,8,2,253],[-7,9,1,509],[-5,7,1,124],[-3,4,1,10],[-1,3,1,2],[1,3,1,3],[3,5,1,26],[5,6,1,58],[7,3,5,4],[39,6,2,59],[43,4,5,11],[75,4,6,12],[139,5,7,27],[267,5,8,28],[523,6,8,60],[779,7,9,125],[1291,6,11,61],[-32,9,32,510,"lower"],[3339,9,32,511],[2,0]];break;case 10:t=[[-21,7,4,122],[-5,8,0,252],[-4,7,0,123],[-3,5,0,24],[-2,2,2,0],[2,5,0,25],[3,6,0,54],[4,7,0,124],[5,8,0,253],[6,2,6,1],[70,5,5,26],[102,6,5,55],[134,6,6,56],[198,6,7,57],[326,6,8,58],[582,6,9,59],[1094,6,10,60],[2118,7,11,125],[-22,8,32,254,"lower"],[4166,8,32,255],[2,2]];break;case 11:t=[[1,1,0,0],[2,2,1,2],[4,4,0,12],[5,4,1,13],[7,5,1,28],[9,5,2,29],[13,6,2,60],[17,7,2,122],[21,7,3,123],[29,7,4,124],[45,7,5,125],[77,7,6,126],[141,7,32,127]];break;case 12:t=[[1,1,0,0],[2,2,0,2],[3,3,1,6],[5,5,0,28],[6,5,1,29],[8,6,1,60],[10,7,0,122],[11,7,1,123],[13,7,2,124],[17,7,3,125],[25,7,4,126],[41,8,5,254],[73,8,32,255]];break;case 13:t=[[1,1,0,0],[2,3,0,4],[3,4,0,12],[4,5,0,28],[5,4,1,13],[7,3,3,5],[15,6,1,58],[17,6,2,59],[21,6,3,60],[29,6,4,61],[45,6,5,62],[77,7,6,126],[141,7,32,127]];break;case 14:t=[[-2,3,0,4],[-1,3,0,5],[0,1,0,0],[1,3,0,6],[2,3,0,7]];break;case 15:t=[[-24,7,4,124],[-8,6,2,60],[-4,5,1,28],[-2,4,0,12],[-1,3,0,4],[0,1,0,0],[1,3,0,5],[2,4,0,13],[3,5,1,29],[5,6,2,61],[9,7,4,125],[-25,7,32,126,"lower"],[25,7,32,127]];break;default:throw new s("standard table B.".concat(e," does not exist"))}for(var a=0,n=t.length;a<n;a++)t[a]=new F(t[a]);return i=new N(t,!0),O[e]=i,i}var L=function(){function e(t,i,a){b(this,e),this.data=t,this.start=i,this.end=a,this.position=i,this.shift=-1,this.currentByte=0}return g(e,[{key:"readBit",value:function(){if(this.shift<0){if(this.position>=this.end)throw new s("end of data while reading bit");this.currentByte=this.data[this.position++],this.shift=7}var e=this.currentByte>>this.shift&1;return this.shift--,e}},{key:"readBits",value:function(e){var t,i=0;for(t=e-1;t>=0;t--)i|=this.readBit()<<t;return i}},{key:"byteAlign",value:function(){this.shift=-1}},{key:"next",value:function(){return this.position>=this.end?-1:this.data[this.position++]}}]),e}();function j(e,t,i){for(var a=0,n=0,r=t.length;n<r;n++){var o=i[t[n]];if(o){if(e===a)return o;a++}}throw new s("can't find custom Huffman table")}function q(e,t,i){for(var a=[],n=0;n<i;n++){var r=new Uint8Array(t);a.push(r);for(var o=0;o<t;o++)r[o]=e.readBit();e.byteAlign()}return a}function H(e,t,i,a){for(var n,r={K:-1,Columns:t,Rows:i,BlackIs1:!0,EndOfBlock:a},s=new o.CCITTFaxDecoder(e,r),l=[],c=!1,d=0;d<i;d++){var u=new Uint8Array(t);l.push(u);for(var p=-1,m=0;m<t;m++)p<0&&(-1===(n=s.readNextChar())&&(n=0,c=!0),p=7),u[m]=n>>p&1,p--}if(a&&!c)for(var h=0;h<5&&-1!==s.readNextChar();h++);return l}var U=function(){function e(){b(this,e)}return g(e,[{key:"parseChunks",value:function(e){return function(e){for(var t=new B,i=0,a=e.length;i<a;i++){var n=e[i];z(I({},n.data,n.start,n.end),t)}return t.buffer}(e)}},{key:"parse",value:function(e){throw new Error("Not implemented: Jbig2Image.parse")}}]),e}();t.Jbig2Image=U},function(e,t){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.ArithmeticDecoder=void 0;var i=[{qe:22017,nmps:1,nlps:1,switchFlag:1},{qe:13313,nmps:2,nlps:6,switchFlag:0},{qe:6145,nmps:3,nlps:9,switchFlag:0},{qe:2753,nmps:4,nlps:12,switchFlag:0},{qe:1313,nmps:5,nlps:29,switchFlag:0},{qe:545,nmps:38,nlps:33,switchFlag:0},{qe:22017,nmps:7,nlps:6,switchFlag:1},{qe:21505,nmps:8,nlps:14,switchFlag:0},{qe:18433,nmps:9,nlps:14,switchFlag:0},{qe:14337,nmps:10,nlps:14,switchFlag:0},{qe:12289,nmps:11,nlps:17,switchFlag:0},{qe:9217,nmps:12,nlps:18,switchFlag:0},{qe:7169,nmps:13,nlps:20,switchFlag:0},{qe:5633,nmps:29,nlps:21,switchFlag:0},{qe:22017,nmps:15,nlps:14,switchFlag:1},{qe:21505,nmps:16,nlps:14,switchFlag:0},{qe:20737,nmps:17,nlps:15,switchFlag:0},{qe:18433,nmps:18,nlps:16,switchFlag:0},{qe:14337,nmps:19,nlps:17,switchFlag:0},{qe:13313,nmps:20,nlps:18,switchFlag:0},{qe:12289,nmps:21,nlps:19,switchFlag:0},{qe:10241,nmps:22,nlps:19,switchFlag:0},{qe:9217,nmps:23,nlps:20,switchFlag:0},{qe:8705,nmps:24,nlps:21,switchFlag:0},{qe:7169,nmps:25,nlps:22,switchFlag:0},{qe:6145,nmps:26,nlps:23,switchFlag:0},{qe:5633,nmps:27,nlps:24,switchFlag:0},{qe:5121,nmps:28,nlps:25,switchFlag:0},{qe:4609,nmps:29,nlps:26,switchFlag:0},{qe:4353,nmps:30,nlps:27,switchFlag:0},{qe:2753,nmps:31,nlps:28,switchFlag:0},{qe:2497,nmps:32,nlps:29,switchFlag:0},{qe:2209,nmps:33,nlps:30,switchFlag:0},{qe:1313,nmps:34,nlps:31,switchFlag:0},{qe:1089,nmps:35,nlps:32,switchFlag:0},{qe:673,nmps:36,nlps:33,switchFlag:0},{qe:545,nmps:37,nlps:34,switchFlag:0},{qe:321,nmps:38,nlps:35,switchFlag:0},{qe:273,nmps:39,nlps:36,switchFlag:0},{qe:133,nmps:40,nlps:37,switchFlag:0},{qe:73,nmps:41,nlps:38,switchFlag:0},{qe:37,nmps:42,nlps:39,switchFlag:0},{qe:21,nmps:43,nlps:40,switchFlag:0},{qe:9,nmps:44,nlps:41,switchFlag:0},{qe:5,nmps:45,nlps:42,switchFlag:0},{qe:1,nmps:45,nlps:43,switchFlag:0},{qe:22017,nmps:46,nlps:46,switchFlag:0}],a=function(){function e(t,i,a){b(this,e),this.data=t,this.bp=i,this.dataEnd=a,this.chigh=t[i],this.clow=0,this.byteIn(),this.chigh=this.chigh<<7&65535|this.clow>>9&127,this.clow=this.clow<<7&65535,this.ct-=7,this.a=32768}return g(e,[{key:"byteIn",value:function(){var e=this.data,t=this.bp;255===e[t]?e[t+1]>143?(this.clow+=65280,this.ct=8):(t++,this.clow+=e[t]<<9,this.ct=7,this.bp=t):(t++,this.clow+=t<this.dataEnd?e[t]<<8:65280,this.ct=8,this.bp=t),this.clow>65535&&(this.chigh+=this.clow>>16,this.clow&=65535)}},{key:"readBit",value:function(e,t){var a,n=e[t]>>1,r=1&e[t],o=i[n],s=o.qe,l=this.a-s;if(this.chigh<s)l<s?(l=s,a=r,n=o.nmps):(l=s,a=1^r,1===o.switchFlag&&(r=a),n=o.nlps);else{if(this.chigh-=s,0!==(32768&l))return this.a=l,r;l<s?(a=1^r,1===o.switchFlag&&(r=a),n=o.nlps):(a=r,n=o.nmps)}do{0===this.ct&&this.byteIn(),l<<=1,this.chigh=this.chigh<<1&65535|this.clow>>15&1,this.clow=this.clow<<1&65535,this.ct--}while(0===(32768&l));return this.a=l,e[t]=n<<1|r,a}}]),e}();t.ArithmeticDecoder=a},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.JpegStream=void 0;var a=i(150),n=i(137),r=i(159),o=i(2),s=function(e){d(i,e);var t=u(i);function i(e,a,n){var r,o;for(b(this,i);-1!==(o=e.getByte());)if(255===o){e.skip(-1);break}return(r=t.call(this,a)).stream=e,r.dict=e.dict,r.maybeLength=a,r.params=n,r}return g(i,[{key:"bytes",get:function(){return(0,o.shadow)(this,"bytes",this.stream.getBytes(this.maybeLength))}},{key:"ensureBuffer",value:function(e){}},{key:"readBlock",value:function(){if(!this.eof){var e={decodeTransform:void 0,colorTransform:void 0},t=this.dict.getArray("D","Decode");if(this.forceRGB&&Array.isArray(t)){for(var i=this.dict.get("BPC","BitsPerComponent")||8,a=t.length,o=new Int32Array(a),s=!1,l=(1<<i)-1,c=0;c<a;c+=2)o[c]=256*(t[c+1]-t[c])|0,o[c+1]=t[c]*l|0,256===o[c]&&0===o[c+1]||(s=!0);s&&(e.decodeTransform=o)}if(this.params instanceof n.Dict){var d=this.params.get("ColorTransform");Number.isInteger(d)&&(e.colorTransform=d)}var u=new r.JpegImage(e);u.parse(this.bytes);var p=u.getData({width:this.drawWidth,height:this.drawHeight,forceRGB:this.forceRGB,isSourcePDF:!0});this.buffer=p,this.bufferLength=p.length,this.eof=!0}}}]),i}(a.DecodeStream);t.JpegStream=s},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.JpegImage=void 0;var a=i(2),n=i(136),r=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,"JPEG error: ".concat(e),"JpegError")}return g(i)}(a.BaseException),o=function(e){d(i,e);var t=u(i);function i(e,a){var n;return b(this,i),(n=t.call(this,e,"DNLMarkerError")).scanLines=a,n}return g(i)}(a.BaseException),s=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"EOIMarkerError")}return g(i)}(a.BaseException),l=new 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new o("Found DNL marker (0xFFDC) while parsing scan data",l)}else if(217===a){if(f){var c=M*(8===i.precision?8:0);if(c>0&&Math.round(i.scanLines/c)>=5)throw new o("Found EOI marker (0xFFD9) while parsing scan data, possibly caused by incorrect `scanLines` parameter",c)}throw new s("Found EOI marker (0xFFD9) while parsing scan data")}throw new r("unexpected marker ".concat((v<<8|a).toString(16)))}}return _=7,v>>>7}function x(e){for(var t=e;;){switch(typeof(t=t[A()])){case"number":return t;case"object":continue}throw new r("invalid huffman sequence")}}function S(e){for(var t=0;e>0;)t=t<<1|A(),e--;return t}function C(e){if(1===e)return 1===A()?1:-1;var t=S(e);return t>=1<<e-1?t:t+(-1<<e)+1}var k,R=0,I=0,M=0;function T(e,t,i,a,n){var r=i%y;M=(i/y|0)*e.v+a;var o=r*e.h+n;t(e,w(e,M,o))}function P(e,t,i){M=i/e.blocksPerLine|0;var a=i%e.blocksPerLine;t(e,w(e,M,a))}var z,B,F,E,N,O,G=c.length;O=b?0===u?0===m?function(e,t){var i=x(e.huffmanTableDC),a=0===i?0:C(i)<<h;e.blockData[t]=e.pred+=a}:function(e,t){e.blockData[t]|=A()<<h}:0===m?function(e,t){if(R>0)R--;else for(var i=u,a=p;i<=a;){var n=x(e.huffmanTableAC),r=15&n,o=n>>4;if(0!==r){var s=l[i+=o];e.blockData[t+s]=C(r)*(1<<h),i++}else{if(o<15){R=S(o)+(1<<o)-1;break}i+=16}}}:function(e,t){for(var i,a,n=u,o=p,s=0;n<=o;){var c=t+l[n],d=e.blockData[c]<0?-1:1;switch(I){case 0:if(s=(a=x(e.huffmanTableAC))>>4,0===(i=15&a))s<15?(R=S(s)+(1<<s),I=4):(s=16,I=1);else{if(1!==i)throw new r("invalid ACn encoding");k=C(i),I=s?2:3}continue;case 1:case 2:e.blockData[c]?e.blockData[c]+=d*(A()<<h):0===--s&&(I=2===I?3:0);break;case 3:e.blockData[c]?e.blockData[c]+=d*(A()<<h):(e.blockData[c]=k<<h,I=0);break;case 4:e.blockData[c]&&(e.blockData[c]+=d*(A()<<h))}n++}4===I&&0===--R&&(I=0)}:function(e,t){var i=x(e.huffmanTableDC),a=0===i?0:C(i);e.blockData[t]=e.pred+=a;for(var n=1;n<64;){var r=x(e.huffmanTableAC),o=15&r,s=r>>4;if(0!==o){var c=l[n+=s];e.blockData[t+c]=C(o),n++}else{if(s<15)break;n+=16}}};var L,j,q,H,U=0;for(j=1===G?c[0].blocksPerLine*c[0].blocksPerColumn:y*i.mcusPerColumn;U<=j;){var Y=d?Math.min(j-U,d):j;if(Y>0){for(B=0;B<G;B++)c[B].pred=0;if(R=0,1===G)for(z=c[0],N=0;N<Y;N++)P(z,O,U),U++;else for(N=0;N<Y;N++){for(B=0;B<G;B++)for(q=(z=c[B]).h,H=z.v,F=0;F<H;F++)for(E=0;E<q;E++)T(z,O,U,F,E);U++}}if(_=0,!(L=D(e,t)))break;if(L.invalid){var X=Y>0?"unexpected":"excessive";(0,a.warn)("decodeScan - ".concat(X," MCU data, current marker is: ").concat(L.invalid)),t=L.offset}if(!(L.marker>=65488&&L.marker<=65495))break;t+=2}return t-g}function C(e,t,i){var a,n,o,s,l,d,u,h,b,g,x,w,S,C,k,D,R,I=e.quantizationTable,M=e.blockData;if(!I)throw new r("missing required Quantization Table.");for(var T=0;T<64;T+=8)b=M[t+T],g=M[t+T+1],x=M[t+T+2],w=M[t+T+3],S=M[t+T+4],C=M[t+T+5],k=M[t+T+6],D=M[t+T+7],b*=I[T],0!==(g|x|w|S|C|k|D)?(g*=I[T+1],x*=I[T+2],w*=I[T+3],S*=I[T+4],C*=I[T+5],k*=I[T+6],D*=I[T+7],n=(a=(a=_*b+128>>8)+(n=_*S+128>>8)+1>>1)-n,R=(o=x)*v+(s=k)*y+128>>8,o=o*y-s*v+128>>8,u=(l=(l=A*(g-D)+128>>8)+(u=C<<4)+1>>1)-u,d=(h=(h=A*(g+D)+128>>8)+(d=w<<4)+1>>1)-d,s=(a=a+(s=R)+1>>1)-s,o=(n=n+o+1>>1)-o,R=l*f+h*m+2048>>12,l=l*m-h*f+2048>>12,h=R,R=d*p+u*c+2048>>12,d=d*c-u*p+2048>>12,u=R,i[T]=a+h,i[T+7]=a-h,i[T+1]=n+u,i[T+6]=n-u,i[T+2]=o+d,i[T+5]=o-d,i[T+3]=s+l,i[T+4]=s-l):(R=_*b+512>>10,i[T]=R,i[T+1]=R,i[T+2]=R,i[T+3]=R,i[T+4]=R,i[T+5]=R,i[T+6]=R,i[T+7]=R);for(var P=0;P<8;++P)b=i[P],0!==((g=i[P+8])|(x=i[P+16])|(w=i[P+24])|(S=i[P+32])|(C=i[P+40])|(k=i[P+48])|(D=i[P+56]))?(n=(a=4112+((a=_*b+2048>>12)+(n=_*S+2048>>12)+1>>1))-n,R=(o=x)*v+(s=k)*y+2048>>12,o=o*y-s*v+2048>>12,s=R,u=(l=(l=A*(g-D)+2048>>12)+(u=C)+1>>1)-u,d=(h=(h=A*(g+D)+2048>>12)+(d=w)+1>>1)-d,R=l*f+h*m+2048>>12,l=l*m-h*f+2048>>12,h=R,R=d*p+u*c+2048>>12,d=d*c-u*p+2048>>12,(b=(a=a+s+1>>1)+h)<16?b=0:b>=4080?b=255:b>>=4,(g=(n=n+o+1>>1)+(u=R))<16?g=0:g>=4080?g=255:g>>=4,(x=(o=n-o)+d)<16?x=0:x>=4080?x=255:x>>=4,(w=(s=a-s)+l)<16?w=0:w>=4080?w=255:w>>=4,(S=s-l)<16?S=0:S>=4080?S=255:S>>=4,(C=o-d)<16?C=0:C>=4080?C=255:C>>=4,(k=n-u)<16?k=0:k>=4080?k=255:k>>=4,(D=a-h)<16?D=0:D>=4080?D=255:D>>=4,M[t+P]=b,M[t+P+8]=g,M[t+P+16]=x,M[t+P+24]=w,M[t+P+32]=S,M[t+P+40]=C,M[t+P+48]=k,M[t+P+56]=D):(R=(R=_*b+8192>>14)<-2040?0:R>=2024?255:R+2056>>4,M[t+P]=R,M[t+P+8]=R,M[t+P+16]=R,M[t+P+24]=R,M[t+P+32]=R,M[t+P+40]=R,M[t+P+48]=R,M[t+P+56]=R)}function k(e,t){for(var i=t.blocksPerLine,a=t.blocksPerColumn,n=new Int16Array(64),r=0;r<a;r++)for(var o=0;o<i;o++)C(t,w(t,r,o),n);return t.blockData}function D(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:t,a=e.length-1,r=i<t?i:t;if(t>=a)return null;var o=(0,n.readUint16)(e,t);if(o>=65472&&o<=65534)return{invalid:null,marker:o,offset:t};for(var s=(0,n.readUint16)(e,r);!(s>=65472&&s<=65534);){if(++r>=a)return null;s=(0,n.readUint16)(e,r)}return{invalid:o.toString(16),marker:s,offset:r}}var R=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{},i=t.decodeTransform,a=void 0===i?null:i,n=t.colorTransform,r=void 0===n?-1:n;this._decodeTransform=a,this._colorTransform=r}return g(e,[{key:"parse",value:function(e){var t=(arguments.length>1&&void 0!==arguments[1]?arguments[1]:{}).dnlScanLines,i=void 0===t?null:t;function c(){var t=(0,n.readUint16)(e,m),i=(m+=2)+t-2,r=D(e,i,m);r&&r.invalid&&((0,a.warn)("readDataBlock - incorrect length, current marker is: "+r.invalid),i=r.offset);var o=e.subarray(m,i);return m+=o.length,o}function d(e){var t,i=Math.ceil(e.samplesPerLine/8/e.maxH),a=Math.ceil(e.scanLines/8/e.maxV),n=h(e.components);try{for(n.s();!(t=n.n()).done;){var r=t.value,o=Math.ceil(Math.ceil(e.samplesPerLine/8)*r.h/e.maxH),s=Math.ceil(Math.ceil(e.scanLines/8)*r.v/e.maxV),l=i*r.h,c=a*r.v*64*(l+1);r.blockData=new Int16Array(c),r.blocksPerLine=o,r.blocksPerColumn=s}}catch(d){n.e(d)}finally{n.f()}e.mcusPerLine=i,e.mcusPerColumn=a}var u,p,m=0,f=null,y=null,b=0,g=[],v=[],_=[],A=(0,n.readUint16)(e,m);if(m+=2,65496!==A)throw new r("SOI not found");A=(0,n.readUint16)(e,m),m+=2;e:for(;65497!==A;){var w=void 0,C=void 0,R=void 0;switch(A){case 65504:case 65505:case 65506:case 65507:case 65508:case 65509:case 65510:case 65511:case 65512:case 65513:case 65514:case 65515:case 65516:case 65517:case 65518:case 65519:case 65534:var I=c();65504===A&&74===I[0]&&70===I[1]&&73===I[2]&&70===I[3]&&0===I[4]&&(f={version:{major:I[5],minor:I[6]},densityUnits:I[7],xDensity:I[8]<<8|I[9],yDensity:I[10]<<8|I[11],thumbWidth:I[12],thumbHeight:I[13],thumbData:I.subarray(14,14+3*I[12]*I[13])}),65518===A&&65===I[0]&&100===I[1]&&111===I[2]&&98===I[3]&&101===I[4]&&(y={version:I[5]<<8|I[6],flags0:I[7]<<8|I[8],flags1:I[9]<<8|I[10],transformCode:I[11]});break;case 65499:for(var M=(0,n.readUint16)(e,m)+(m+=2)-2;m<M;){var T=e[m++],P=new Uint16Array(64);if(T>>4===0)for(C=0;C<64;C++)P[l[C]]=e[m++];else{if(T>>4!==1)throw new r("DQT - invalid table spec");for(C=0;C<64;C++)P[l[C]]=(0,n.readUint16)(e,m),m+=2}g[15&T]=P}break;case 65472:case 65473:case 65474:if(u)throw new r("Only single frame JPEGs supported");m+=2,(u={}).extended=65473===A,u.progressive=65474===A,u.precision=e[m++];var z=(0,n.readUint16)(e,m);m+=2,u.scanLines=i||z,u.samplesPerLine=(0,n.readUint16)(e,m),m+=2,u.components=[],u.componentIds={};var B=e[m++],F=0,E=0;for(w=0;w<B;w++){var N=e[m],O=e[m+1]>>4,G=15&e[m+1];F<O&&(F=O),E<G&&(E=G);var L=e[m+2];R=u.components.push({h:O,v:G,quantizationId:L,quantizationTable:null}),u.componentIds[N]=R-1,m+=3}u.maxH=F,u.maxV=E,d(u);break;case 65476:var j=(0,n.readUint16)(e,m);for(m+=2,w=2;w<j;){var q=e[m++],H=new Uint8Array(16),U=0;for(C=0;C<16;C++,m++)U+=H[C]=e[m];var Y=new Uint8Array(U);for(C=0;C<U;C++,m++)Y[C]=e[m];w+=17+U,(q>>4===0?_:v)[15&q]=x(H,Y)}break;case 65501:m+=2,p=(0,n.readUint16)(e,m),m+=2;break;case 65498:var X=1===++b&&!i;m+=2;var V=e[m++],Q=[];for(w=0;w<V;w++){var W=e[m++],Z=u.componentIds[W],J=u.components[Z];J.index=W;var K=e[m++];J.huffmanTableDC=_[K>>4],J.huffmanTableAC=v[15&K],Q.push(J)}var $=e[m++],ee=e[m++],te=e[m++];try{var ie=S(e,m,u,Q,p,$,ee,te>>4,15&te,X);m+=ie}catch(le){if(le instanceof o)return(0,a.warn)("".concat(le.message," -- attempting to re-parse the JPEG image.")),this.parse(e,{dnlScanLines:le.scanLines});if(le instanceof s){(0,a.warn)("".concat(le.message," -- ignoring the rest of the image data."));break e}throw le}break;case 65500:m+=4;break;case 65535:255!==e[m]&&m--;break;default:var ae=D(e,m-2,m-3);if(ae&&ae.invalid){(0,a.warn)("JpegImage.parse - unexpected data, current marker is: "+ae.invalid),m=ae.offset;break}if(!ae||m>=e.length-1){(0,a.warn)("JpegImage.parse - reached the end of the image data without finding an EOI marker (0xFFD9).");break e}throw new r("JpegImage.parse - unknown marker: "+A.toString(16))}A=(0,n.readUint16)(e,m),m+=2}this.width=u.samplesPerLine,this.height=u.scanLines,this.jfif=f,this.adobe=y,this.components=[];var ne,re=h(u.components);try{for(re.s();!(ne=re.n()).done;){var oe=ne.value,se=g[oe.quantizationId];se&&(oe.quantizationTable=se),this.components.push({index:oe.index,output:k(0,oe),scaleX:oe.h/u.maxH,scaleY:oe.v/u.maxV,blocksPerLine:oe.blocksPerLine,blocksPerColumn:oe.blocksPerColumn})}}catch(ce){re.e(ce)}finally{re.f()}this.numComponents=this.components.length}},{key:"_getLinearizedBlockData",value:function(e,t){var i,a,n,r,o,s,l,c,d,u,p,m,h=arguments.length>2&&void 0!==arguments[2]&&arguments[2],f=this.width/e,y=this.height/t,b=0,g=this.components.length,v=e*t*g,_=new Uint8ClampedArray(v),A=new Uint32Array(e),x=4294967288;for(l=0;l<g;l++){if(a=(i=this.components[l]).scaleX*f,n=i.scaleY*y,b=l,p=i.output,r=i.blocksPerLine+1<<3,a!==m){for(o=0;o<e;o++)c=0|o*a,A[o]=(c&x)<<3|7&c;m=a}for(s=0;s<t;s++)for(u=r*((c=0|s*n)&x)|(7&c)<<3,o=0;o<e;o++)_[b]=p[u+A[o]],b+=g}var w=this._decodeTransform;if(h||4!==g||w||(w=new Int32Array([-256,255,-256,255,-256,255,-256,255])),w)for(l=0;l<v;)for(c=0,d=0;c<g;c++,l++,d+=2)_[l]=(_[l]*w[d]>>8)+w[d+1];return _}},{key:"_isColorConversionNeeded",get:function(){return this.adobe?!!this.adobe.transformCode:3===this.numComponents?0!==this._colorTransform&&(82!==this.components[0].index||71!==this.components[1].index||66!==this.components[2].index):1===this._colorTransform}},{key:"_convertYccToRgb",value:function(e){for(var t,i,a,n=0,r=e.length;n<r;n+=3)t=e[n],i=e[n+1],a=e[n+2],e[n]=t-179.456+1.402*a,e[n+1]=t+135.459-.344*i-.714*a,e[n+2]=t-226.816+1.772*i;return e}},{key:"_convertYcckToRgb",value:function(e){for(var t,i,a,n,r=0,o=0,s=e.length;o<s;o+=4)t=e[o],i=e[o+1],a=e[o+2],n=e[o+3],e[r++]=i*(-660635669420364e-19*i+.000437130475926232*a-54080610064599e-18*t+.00048449797120281*n-.154362151871126)-122.67195406894+a*(-.000957964378445773*a+.000817076911346625*t-.00477271405408747*n+1.53380253221734)+t*(.000961250184130688*t-.00266257332283933*n+.48357088451265)+n*(-.000336197177618394*n+.484791561490776),e[r++]=107.268039397724+i*(219927104525741e-19*i-.000640992018297945*a+.000659397001245577*t+.000426105652938837*n-.176491792462875)+a*(-.000778269941513683*a+.00130872261408275*t+.000770482631801132*n-.151051492775562)+t*(.00126935368114843*t-.00265090189010898*n+.25802910206845)+n*(-.000318913117588328*n-.213742400323665),e[r++]=i*(-.000570115196973677*i-263409051004589e-19*a+.0020741088115012*t-.00288260236853442*n+.814272968359295)-20.810012546947+a*(-153496057440975e-19*a-.000132689043961446*t+.000560833691242812*n-.195152027534049)+t*(.00174418132927582*t-.00255243321439347*n+.116935020465145)+n*(-.000343531996510555*n+.24165260232407);return e.subarray(0,r)}},{key:"_convertYcckToCmyk",value:function(e){for(var t,i,a,n=0,r=e.length;n<r;n+=4)t=e[n],i=e[n+1],a=e[n+2],e[n]=434.456-t-1.402*a,e[n+1]=119.541-t+.344*i+.714*a,e[n+2]=481.816-t-1.772*i;return e}},{key:"_convertCmykToRgb",value:function(e){for(var t,i,a,n,r=0,o=0,s=e.length;o<s;o+=4)t=e[o],i=e[o+1],a=e[o+2],n=e[o+3],e[r++]=255+t*(-6747147073602441e-20*t+.0008379262121013727*i+.0002894718188643294*a+.003264231057537806*n-1.1185611867203937)+i*(26374107616089405e-21*i-8626949158638572e-20*a-.0002748769067499491*n-.02155688794978967)+a*(-3878099212869363e-20*a-.0003267808279485286*n+.0686742238595345)-n*(.0003361971776183937*n+.7430659151342254),e[r++]=255+t*(.00013596372813588848*t+.000924537132573585*i+.00010567359618683593*a+.0004791864687436512*n-.3109689587515875)+i*(-.00023545346108370344*i+.0002702845253534714*a+.0020200308977307156*n-.7488052167015494)+a*(6834815998235662e-20*a+.00015168452363460973*n-.09751927774728933)-n*(.0003189131175883281*n+.7364883807733168),e[r++]=255+t*(13598650411385307e-21*t+.00012423956175490851*i+.0004751985097583589*a-36729317476630422e-22*n-.05562186980264034)+i*(.00016141380598724676*i+.0009692239130725186*a+.0007782692450036253*n-.44015232367526463)+a*(5.068882914068769e-7*a+.0017778369011375071*n-.7591454649749609)-n*(.0003435319965105553*n+.7063770186160144);return e.subarray(0,r)}},{key:"getData",value:function(e){var t=e.width,i=e.height,a=e.forceRGB,n=void 0!==a&&a,o=e.isSourcePDF,s=void 0!==o&&o;if(this.numComponents>4)throw new r("Unsupported color mode");var l=this._getLinearizedBlockData(t,i,s);if(1===this.numComponents&&n){var c,d=new Uint8ClampedArray(3*l.length),u=0,p=h(l);try{for(p.s();!(c=p.n()).done;){var m=c.value;d[u++]=m,d[u++]=m,d[u++]=m}}catch(f){p.e(f)}finally{p.f()}return d}if(3===this.numComponents&&this._isColorConversionNeeded)return this._convertYccToRgb(l);if(4===this.numComponents){if(this._isColorConversionNeeded)return n?this._convertYcckToRgb(l):this._convertYcckToCmyk(l);if(n)return this._convertCmykToRgb(l)}return l}}]),e}();t.JpegImage=R},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.JpxStream=void 0;var a=i(150),n=i(161),r=i(2),o=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,a)).stream=e,r.dict=e.dict,r.maybeLength=a,r.params=n,r}return g(i,[{key:"bytes",get:function(){return(0,r.shadow)(this,"bytes",this.stream.getBytes(this.maybeLength))}},{key:"ensureBuffer",value:function(e){}},{key:"readBlock",value:function(){if(!this.eof){var e=new n.JpxImage;e.parse(this.bytes);var t=e.width,i=e.height,a=e.componentsCount,r=e.tiles.length;if(1===r)this.buffer=e.tiles[0].items;else{for(var o=new Uint8ClampedArray(t*i*a),s=0;s<r;s++)for(var l=e.tiles[s],c=l.width,d=l.height,u=l.left,p=l.top,m=l.items,h=0,f=(t*p+u)*a,y=t*a,b=c*a,g=0;g<d;g++){var v=m.subarray(h,h+b);o.set(v,f),h+=b,f+=y}this.buffer=o}this.bufferLength=this.buffer.length,this.eof=!0}}}]),i}(a.DecodeStream);t.JpxStream=o},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.JpxImage=void 0;var a=i(2),n=i(136),r=i(157),o=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,"JPX error: ".concat(e),"JpxError")}return g(i)}(a.BaseException),s={LL:0,LH:1,HL:1,HH:2},l=function(){function e(){b(this,e),this.failOnCorruptedImage=!1}return g(e,[{key:"parse",value:function(e){if(65359!==(0,n.readUint16)(e,0))for(var t=e.length,i=0;i<t;){var r=8,s=(0,n.readUint32)(e,i),l=(0,n.readUint32)(e,i+4);if(i+=r,1===s&&(s=4294967296*(0,n.readUint32)(e,i)+(0,n.readUint32)(e,i+4),i+=8,r+=8),0===s&&(s=t-i+r),s<r)throw new o("Invalid box field size");var c=s-r,d=!0;switch(l){case 1785737832:d=!1;break;case 1668246642:var u=e[i];if(1===u){var p=(0,n.readUint32)(e,i+3);switch(p){case 16:case 17:case 18:break;default:(0,a.warn)("Unknown colorspace "+p)}}else 2===u&&(0,a.info)("ICC profile not supported");break;case 1785737827:this.parseCodestream(e,i,i+c);break;case 1783636e3:218793738!==(0,n.readUint32)(e,i)&&(0,a.warn)("Invalid JP2 signature");break;case 1783634458:case 1718909296:case 1920099697:case 1919251232:case 1768449138:break;default:var m=String.fromCharCode(l>>24&255,l>>16&255,l>>8&255,255&l);(0,a.warn)("Unsupported header type ".concat(l," (").concat(m,")."))}d&&(i+=c)}else this.parseCodestream(e,0,e.length)}},{key:"parseImageProperties",value:function(e){for(var t=e.getByte();t>=0;)if(65361===(t<<8|(t=e.getByte()))){e.skip(4);var i=e.getInt32()>>>0,a=e.getInt32()>>>0,n=e.getInt32()>>>0,r=e.getInt32()>>>0;e.skip(16);var s=e.getUint16();return this.width=i-n,this.height=a-r,this.componentsCount=s,void(this.bitsPerComponent=8)}throw new o("No size marker found in JPX stream")}},{key:"parseCodestream",value:function(e,t,i){var r={},s=!1;try{for(var l=t;l+1<i;){var d=(0,n.readUint16)(e,l);l+=2;var u=0,m=void 0,h=void 0,f=void 0,y=void 0,b=void 0,g=void 0;switch(d){case 65359:r.mainHeader=!0;break;case 65497:break;case 65361:u=(0,n.readUint16)(e,l);var v={};v.Xsiz=(0,n.readUint32)(e,l+4),v.Ysiz=(0,n.readUint32)(e,l+8),v.XOsiz=(0,n.readUint32)(e,l+12),v.YOsiz=(0,n.readUint32)(e,l+16),v.XTsiz=(0,n.readUint32)(e,l+20),v.YTsiz=(0,n.readUint32)(e,l+24),v.XTOsiz=(0,n.readUint32)(e,l+28),v.YTOsiz=(0,n.readUint32)(e,l+32);var _=(0,n.readUint16)(e,l+36);v.Csiz=_;var A=[];m=l+38;for(var x=0;x<_;x++){var w={precision:1+(127&e[m]),isSigned:!!(128&e[m]),XRsiz:e[m+1],YRsiz:e[m+2]};m+=3,c(w,v),A.push(w)}r.SIZ=v,r.components=A,p(r,A),r.QCC=[],r.COC=[];break;case 65372:u=(0,n.readUint16)(e,l);var S={};switch(m=l+2,31&(h=e[m++])){case 0:y=8,b=!0;break;case 1:y=16,b=!1;break;case 2:y=16,b=!0;break;default:throw new Error("Invalid SQcd value "+h)}for(S.noQuantization=8===y,S.scalarExpounded=b,S.guardBits=h>>5,f=[];m<u+l;){var C={};8===y?(C.epsilon=e[m++]>>3,C.mu=0):(C.epsilon=e[m]>>3,C.mu=(7&e[m])<<8|e[m+1],m+=2),f.push(C)}S.SPqcds=f,r.mainHeader?r.QCD=S:(r.currentTile.QCD=S,r.currentTile.QCC=[]);break;case 65373:u=(0,n.readUint16)(e,l);var R={};m=l+2;var T=void 0;switch(r.SIZ.Csiz<257?T=e[m++]:(T=(0,n.readUint16)(e,m),m+=2),31&(h=e[m++])){case 0:y=8,b=!0;break;case 1:y=16,b=!1;break;case 2:y=16,b=!0;break;default:throw new Error("Invalid SQcd value "+h)}for(R.noQuantization=8===y,R.scalarExpounded=b,R.guardBits=h>>5,f=[];m<u+l;){var P={};8===y?(P.epsilon=e[m++]>>3,P.mu=0):(P.epsilon=e[m]>>3,P.mu=(7&e[m])<<8|e[m+1],m+=2),f.push(P)}R.SPqcds=f,r.mainHeader?r.QCC[T]=R:r.currentTile.QCC[T]=R;break;case 65362:u=(0,n.readUint16)(e,l);var z={};m=l+2;var B=e[m++];z.entropyCoderWithCustomPrecincts=!!(1&B),z.sopMarkerUsed=!!(2&B),z.ephMarkerUsed=!!(4&B),z.progressionOrder=e[m++],z.layersCount=(0,n.readUint16)(e,m),m+=2,z.multipleComponentTransform=e[m++],z.decompositionLevelsCount=e[m++],z.xcb=2+(15&e[m++]),z.ycb=2+(15&e[m++]);var F=e[m++];if(z.selectiveArithmeticCodingBypass=!!(1&F),z.resetContextProbabilities=!!(2&F),z.terminationOnEachCodingPass=!!(4&F),z.verticallyStripe=!!(8&F),z.predictableTermination=!!(16&F),z.segmentationSymbolUsed=!!(32&F),z.reversibleTransformation=e[m++],z.entropyCoderWithCustomPrecincts){for(var E=[];m<u+l;){var N=e[m++];E.push({PPx:15&N,PPy:N>>4})}z.precinctsSizes=E}var O=[];z.selectiveArithmeticCodingBypass&&O.push("selectiveArithmeticCodingBypass"),z.terminationOnEachCodingPass&&O.push("terminationOnEachCodingPass"),z.verticallyStripe&&O.push("verticallyStripe"),z.predictableTermination&&O.push("predictableTermination"),O.length>0&&(s=!0,(0,a.warn)("JPX: Unsupported COD options (".concat(O.join(", "),")."))),r.mainHeader?r.COD=z:(r.currentTile.COD=z,r.currentTile.COC=[]);break;case 65424:u=(0,n.readUint16)(e,l),(g={}).index=(0,n.readUint16)(e,l+2),g.length=(0,n.readUint32)(e,l+4),g.dataEnd=g.length+l-2,g.partIndex=e[l+8],g.partsCount=e[l+9],r.mainHeader=!1,0===g.partIndex&&(g.COD=r.COD,g.COC=r.COC.slice(0),g.QCD=r.QCD,g.QCC=r.QCC.slice(0)),r.currentTile=g;break;case 65427:0===(g=r.currentTile).partIndex&&(M(r,g.index),k(r)),D(r,e,l,u=g.dataEnd-l);break;case 65363:(0,a.warn)("JPX: Codestream code 0xFF53 (COC) is not implemented.");case 65365:case 65367:case 65368:case 65380:u=(0,n.readUint16)(e,l);break;default:throw new Error("Unknown codestream code: "+d.toString(16))}l+=u}}catch(G){if(s||this.failOnCorruptedImage)throw new o(G.message);(0,a.warn)('JPX: Trying to recover from: "'.concat(G.message,'".'))}this.tiles=function(e){for(var t=e.SIZ,i=e.components,a=t.Csiz,n=[],r=0,o=e.tiles.length;r<o;r++){for(var s=e.tiles[r],l=[],c=0;c<a;c++)l[c]=I(e,s,c);var d=l[0],u=new Uint8ClampedArray(d.items.length*a),p={left:d.left,top:d.top,width:d.width,height:d.height,items:u},m=void 0,h=void 0,f=0,y=void 0,b=void 0,g=void 0,v=void 0,_=void 0;if(s.codingStyleDefaultParameters.multipleComponentTransform){var A=4===a,x=l[0].items,w=l[1].items,S=l[2].items,C=A?l[3].items:null;h=.5+(128<<(m=i[0].precision-8));var k=s.components[0],D=a-3;if(b=x.length,k.codingStyleParameters.reversibleTransformation)for(y=0;y<b;y++,f+=D){g=x[y]+h,v=w[y];var R=g-((_=S[y])+v>>2);u[f++]=R+_>>m,u[f++]=R>>m,u[f++]=R+v>>m}else for(y=0;y<b;y++,f+=D)g=x[y]+h,v=w[y],_=S[y],u[f++]=g+1.402*_>>m,u[f++]=g-.34413*v-.71414*_>>m,u[f++]=g+1.772*v>>m;if(A)for(y=0,f=3;y<b;y++,f+=4)u[f]=C[y]+h>>m}else for(var M=0;M<a;M++){var T=l[M].items;for(h=.5+(128<<(m=i[M].precision-8)),f=M,y=0,b=T.length;y<b;y++)u[f]=T[y]+h>>m,f+=a}n.push(p)}return n}(r),this.width=r.SIZ.Xsiz-r.SIZ.XOsiz,this.height=r.SIZ.Ysiz-r.SIZ.YOsiz,this.componentsCount=r.SIZ.Csiz}}]),e}();function c(e,t){e.x0=Math.ceil(t.XOsiz/e.XRsiz),e.x1=Math.ceil(t.Xsiz/e.XRsiz),e.y0=Math.ceil(t.YOsiz/e.YRsiz),e.y1=Math.ceil(t.Ysiz/e.YRsiz),e.width=e.x1-e.x0,e.height=e.y1-e.y0}function p(e,t){for(var i,a=e.SIZ,n=[],r=Math.ceil((a.Xsiz-a.XTOsiz)/a.XTsiz),o=Math.ceil((a.Ysiz-a.YTOsiz)/a.YTsiz),s=0;s<o;s++)for(var l=0;l<r;l++)(i={}).tx0=Math.max(a.XTOsiz+l*a.XTsiz,a.XOsiz),i.ty0=Math.max(a.YTOsiz+s*a.YTsiz,a.YOsiz),i.tx1=Math.min(a.XTOsiz+(l+1)*a.XTsiz,a.Xsiz),i.ty1=Math.min(a.YTOsiz+(s+1)*a.YTsiz,a.Ysiz),i.width=i.tx1-i.tx0,i.height=i.ty1-i.ty0,i.components=[],n.push(i);e.tiles=n;for(var c=0,d=a.Csiz;c<d;c++)for(var u=t[c],p=0,m=n.length;p<m;p++){var h={};i=n[p],h.tcx0=Math.ceil(i.tx0/u.XRsiz),h.tcy0=Math.ceil(i.ty0/u.YRsiz),h.tcx1=Math.ceil(i.tx1/u.XRsiz),h.tcy1=Math.ceil(i.ty1/u.YRsiz),h.width=h.tcx1-h.tcx0,h.height=h.tcy1-h.tcy0,i.components[c]=h}}function m(e,t,i){var a=t.codingStyleParameters,n={};return a.entropyCoderWithCustomPrecincts?(n.PPx=a.precinctsSizes[i].PPx,n.PPy=a.precinctsSizes[i].PPy):(n.PPx=15,n.PPy=15),n.xcb_=i>0?Math.min(a.xcb,n.PPx-1):Math.min(a.xcb,n.PPx),n.ycb_=i>0?Math.min(a.ycb,n.PPy-1):Math.min(a.ycb,n.PPy),n}function h(e,t,i){var a=1<<i.PPx,n=1<<i.PPy,r=0===t.resLevel,o=1<<i.PPx+(r?0:-1),s=1<<i.PPy+(r?0:-1),l=t.trx1>t.trx0?Math.ceil(t.trx1/a)-Math.floor(t.trx0/a):0,c=t.try1>t.try0?Math.ceil(t.try1/n)-Math.floor(t.try0/n):0,d=l*c;t.precinctParameters={precinctWidth:a,precinctHeight:n,numprecinctswide:l,numprecinctshigh:c,numprecincts:d,precinctWidthInSubband:o,precinctHeightInSubband:s}}function f(e,t,i){var a,n,r,o,s=i.xcb_,l=i.ycb_,c=1<<s,d=1<<l,u=t.tbx0>>s,p=t.tby0>>l,m=t.tbx1+c-1>>s,h=t.tby1+d-1>>l,f=t.resolution.precinctParameters,y=[],b=[];for(n=p;n<h;n++)for(a=u;a<m;a++)if((r={cbx:a,cby:n,tbx0:c*a,tby0:d*n,tbx1:c*(a+1),tby1:d*(n+1)}).tbx0_=Math.max(t.tbx0,r.tbx0),r.tby0_=Math.max(t.tby0,r.tby0),r.tbx1_=Math.min(t.tbx1,r.tbx1),r.tby1_=Math.min(t.tby1,r.tby1),o=Math.floor((r.tbx0_-t.tbx0)/f.precinctWidthInSubband)+Math.floor((r.tby0_-t.tby0)/f.precinctHeightInSubband)*f.numprecinctswide,r.precinctNumber=o,r.subbandType=t.type,r.Lblock=3,!(r.tbx1_<=r.tbx0_||r.tby1_<=r.tby0_)){y.push(r);var g=b[o];void 0!==g?(a<g.cbxMin?g.cbxMin=a:a>g.cbxMax&&(g.cbxMax=a),n<g.cbyMin?g.cbxMin=n:n>g.cbyMax&&(g.cbyMax=n)):b[o]=g={cbxMin:a,cbyMin:n,cbxMax:a,cbyMax:n},r.precinct=g}t.codeblockParameters={codeblockWidth:s,codeblockHeight:l,numcodeblockwide:m-u+1,numcodeblockhigh:h-p+1},t.codeblocks=y,t.precincts=b}function y(e,t,i){for(var a=[],n=e.subbands,r=0,o=n.length;r<o;r++)for(var s=n[r].codeblocks,l=0,c=s.length;l<c;l++){var d=s[l];d.precinctNumber===t&&a.push(d)}return{layerNumber:i,codeblocks:a}}function v(e){for(var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=a.codingStyleDefaultParameters.layersCount,r=t.Csiz,s=0,l=0;l<r;l++)s=Math.max(s,a.components[l].codingStyleParameters.decompositionLevelsCount);var c=0,d=0,u=0,p=0;this.nextPacket=function(){for(;c<n;c++){for(;d<=s;d++){for(;u<r;u++){var e=a.components[u];if(!(d>e.codingStyleParameters.decompositionLevelsCount)){for(var t=e.resolutions[d],i=t.precinctParameters.numprecincts;p<i;){var l=y(t,p,c);return p++,l}p=0}}u=0}d=0}throw new o("Out of packets")}}function _(e){for(var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=a.codingStyleDefaultParameters.layersCount,r=t.Csiz,s=0,l=0;l<r;l++)s=Math.max(s,a.components[l].codingStyleParameters.decompositionLevelsCount);var c=0,d=0,u=0,p=0;this.nextPacket=function(){for(;c<=s;c++){for(;d<n;d++){for(;u<r;u++){var e=a.components[u];if(!(c>e.codingStyleParameters.decompositionLevelsCount)){for(var t=e.resolutions[c],i=t.precinctParameters.numprecincts;p<i;){var l=y(t,p,d);return p++,l}p=0}}u=0}d=0}throw new o("Out of packets")}}function A(e){var t,i,a,n,r=e.SIZ,s=e.currentTile.index,l=e.tiles[s],c=l.codingStyleDefaultParameters.layersCount,d=r.Csiz,u=0;for(a=0;a<d;a++){var p=l.components[a];u=Math.max(u,p.codingStyleParameters.decompositionLevelsCount)}var m=new Int32Array(u+1);for(i=0;i<=u;++i){var h=0;for(a=0;a<d;++a){var f=l.components[a].resolutions;i<f.length&&(h=Math.max(h,f[i].precinctParameters.numprecincts))}m[i]=h}t=0,i=0,a=0,n=0,this.nextPacket=function(){for(;i<=u;i++){for(;n<m[i];n++){for(;a<d;a++){var e=l.components[a];if(!(i>e.codingStyleParameters.decompositionLevelsCount)){var r=e.resolutions[i],s=r.precinctParameters.numprecincts;if(!(n>=s)){for(;t<c;){var p=y(r,n,t);return t++,p}t=0}}}a=0}n=0}throw new o("Out of packets")}}function x(e){var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=a.codingStyleDefaultParameters.layersCount,r=t.Csiz,s=C(a),l=s,c=0,d=0,u=0,p=0,m=0;this.nextPacket=function(){for(;m<l.maxNumHigh;m++){for(;p<l.maxNumWide;p++){for(;u<r;u++){for(var e=a.components[u],t=e.codingStyleParameters.decompositionLevelsCount;d<=t;d++){var i=e.resolutions[d],h=s.components[u].resolutions[d],f=S(p,m,h,l,i);if(null!==f){for(;c<n;){var b=y(i,f,c);return c++,b}c=0}}d=0}u=0}p=0}throw new o("Out of packets")}}function w(e){var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=a.codingStyleDefaultParameters.layersCount,r=t.Csiz,s=C(a),l=0,c=0,d=0,u=0,p=0;this.nextPacket=function(){for(;d<r;++d){for(var e=a.components[d],t=s.components[d],i=e.codingStyleParameters.decompositionLevelsCount;p<t.maxNumHigh;p++){for(;u<t.maxNumWide;u++){for(;c<=i;c++){var m=e.resolutions[c],h=t.resolutions[c],f=S(u,p,h,t,m);if(null!==f){for(;l<n;){var b=y(m,f,l);return l++,b}l=0}}c=0}u=0}p=0}throw new o("Out of packets")}}function S(e,t,i,a,n){var r=e*a.minWidth,o=t*a.minHeight;if(r%i.width!==0||o%i.height!==0)return null;var s=o/i.width*n.precinctParameters.numprecinctswide;return r/i.height+s}function C(e){for(var t=e.components.length,i=Number.MAX_VALUE,a=Number.MAX_VALUE,n=0,r=0,o=new Array(t),s=0;s<t;s++){for(var l=e.components[s],c=l.codingStyleParameters.decompositionLevelsCount,d=new Array(c+1),u=Number.MAX_VALUE,p=Number.MAX_VALUE,m=0,h=0,f=1,y=c;y>=0;--y){var b=l.resolutions[y],g=f*b.precinctParameters.precinctWidth,v=f*b.precinctParameters.precinctHeight;u=Math.min(u,g),p=Math.min(p,v),m=Math.max(m,b.precinctParameters.numprecinctswide),h=Math.max(h,b.precinctParameters.numprecinctshigh),d[y]={width:g,height:v},f<<=1}i=Math.min(i,u),a=Math.min(a,p),n=Math.max(n,m),r=Math.max(r,h),o[s]={resolutions:d,minWidth:u,minHeight:p,maxNumWide:m,maxNumHigh:h}}return{components:o,minWidth:i,minHeight:a,maxNumWide:n,maxNumHigh:r}}function k(e){for(var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=t.Csiz,r=0;r<n;r++){for(var s=a.components[r],l=s.codingStyleParameters.decompositionLevelsCount,c=[],d=[],u=0;u<=l;u++){var p=m(0,s,u),y={},b=1<<l-u;y.trx0=Math.ceil(s.tcx0/b),y.try0=Math.ceil(s.tcy0/b),y.trx1=Math.ceil(s.tcx1/b),y.try1=Math.ceil(s.tcy1/b),y.resLevel=u,h(0,y,p),c.push(y);var g=void 0;if(0===u)(g={}).type="LL",g.tbx0=Math.ceil(s.tcx0/b),g.tby0=Math.ceil(s.tcy0/b),g.tbx1=Math.ceil(s.tcx1/b),g.tby1=Math.ceil(s.tcy1/b),g.resolution=y,f(0,g,p),d.push(g),y.subbands=[g];else{var S=1<<l-u+1,C=[];(g={}).type="HL",g.tbx0=Math.ceil(s.tcx0/S-.5),g.tby0=Math.ceil(s.tcy0/S),g.tbx1=Math.ceil(s.tcx1/S-.5),g.tby1=Math.ceil(s.tcy1/S),g.resolution=y,f(0,g,p),d.push(g),C.push(g),(g={}).type="LH",g.tbx0=Math.ceil(s.tcx0/S),g.tby0=Math.ceil(s.tcy0/S-.5),g.tbx1=Math.ceil(s.tcx1/S),g.tby1=Math.ceil(s.tcy1/S-.5),g.resolution=y,f(0,g,p),d.push(g),C.push(g),(g={}).type="HH",g.tbx0=Math.ceil(s.tcx0/S-.5),g.tby0=Math.ceil(s.tcy0/S-.5),g.tbx1=Math.ceil(s.tcx1/S-.5),g.tby1=Math.ceil(s.tcy1/S-.5),g.resolution=y,f(0,g,p),d.push(g),C.push(g),y.subbands=C}}s.resolutions=c,s.subbands=d}var k=a.codingStyleDefaultParameters.progressionOrder;switch(k){case 0:a.packetsIterator=new v(e);break;case 1:a.packetsIterator=new _(e);break;case 2:a.packetsIterator=new A(e);break;case 3:a.packetsIterator=new x(e);break;case 4:a.packetsIterator=new w(e);break;default:throw new o("Unsupported progression order ".concat(k))}}function D(e,t,i,a){var r,s=0,l=0,c=!1;function d(e){for(;l<e;){var a=t[i+s];s++,c?(r=r<<7|a,l+=7,c=!1):(r=r<<8|a,l+=8),255===a&&(c=!0)}return r>>>(l-=e)&(1<<e)-1}function u(e){return 255===t[i+s-1]&&t[i+s]===e?(p(1),!0):255===t[i+s]&&t[i+s+1]===e&&(p(2),!0)}function p(e){s+=e}function m(){l=0,c&&(s++,c=!1)}function h(){if(0===d(1))return 1;if(0===d(1))return 2;var e=d(2);return e<3?e+3:(e=d(5))<31?e+6:(e=d(7))+37}for(var f=e.currentTile.index,y=e.tiles[f],b=e.COD.sopMarkerUsed,g=e.COD.ephMarkerUsed,v=y.packetsIterator;s<a;){m(),b&&u(145)&&p(4);var _=v.nextPacket();if(d(1)){for(var A=_.layerNumber,x=[],w=void 0,S=0,C=_.codeblocks.length;S<C;S++){var k=(w=_.codeblocks[S]).precinct,D=w.cbx-k.cbxMin,R=w.cby-k.cbyMin,I=!1,M=!1,z=void 0;if(void 0!==w.included)I=!!d(1);else{var B=void 0;if(void 0!==(k=w.precinct).inclusionTree)B=k.inclusionTree;else{var F=k.cbxMax-k.cbxMin+1,E=k.cbyMax-k.cbyMin+1;B=new P(F,E,A),z=new T(F,E),k.inclusionTree=B,k.zeroBitPlanesTree=z;for(var N=0;N<A;N++)if(0!==d(1))throw new o("Invalid tag tree")}if(B.reset(D,R,A))for(;;){if(!d(1)){B.incrementValue(A);break}if(!B.nextLevel()){w.included=!0,I=M=!0;break}}}if(I){if(M){for((z=k.zeroBitPlanesTree).reset(D,R);;)if(d(1)){if(!z.nextLevel())break}else z.incrementValue();w.zeroBitPlanes=z.value}for(var O=h();d(1);)w.Lblock++;var G=(0,n.log2)(O),L=d((O<1<<G?G-1:G)+w.Lblock);x.push({codeblock:w,codingpasses:O,dataLength:L})}}for(m(),g&&u(146);x.length>0;){var j=x.shift();void 0===(w=j.codeblock).data&&(w.data=[]),w.data.push({data:t,start:i+s,end:i+s+j.dataLength,codingpasses:j.codingpasses}),s+=j.dataLength}}}return s}function R(e,t,i,a,n,o,s,l,c){for(var d=a.tbx0,u=a.tby0,p=a.tbx1-a.tbx0,m=a.codeblocks,h="H"===a.type.charAt(0)?1:0,f="H"===a.type.charAt(1)?t:0,y=0,b=m.length;y<b;++y){var g=m[y],v=g.tbx1_-g.tbx0_,_=g.tby1_-g.tby0_;if(0!==v&&0!==_&&void 0!==g.data){var A=new z(v,_,g.subbandType,g.zeroBitPlanes,o),x=2,w=g.data,S=0,C=0,k=void 0,D=void 0,R=void 0;for(k=0,D=w.length;k<D;k++)S+=(R=w[k]).end-R.start,C+=R.codingpasses;var I=new Uint8Array(S),M=0;for(k=0,D=w.length;k<D;k++){var T=(R=w[k]).data.subarray(R.start,R.end);I.set(T,M),M+=T.length}var P=new r.ArithmeticDecoder(I,0,S);for(A.setDecoder(P),k=0;k<C;k++){switch(x){case 0:A.runSignificancePropagationPass();break;case 1:A.runMagnitudeRefinementPass();break;case 2:A.runCleanupPass(),l&&A.checkSegmentationSymbol()}c&&A.reset(),x=(x+1)%3}var B=g.tbx0_-d+(g.tby0_-u)*p,F=A.coefficentsSign,E=A.coefficentsMagnitude,N=A.bitsDecoded,O=s?0:.5,G=void 0,L=void 0,j=void 0;M=0;var q="LL"!==a.type;for(k=0;k<_;k++){var H=2*(B/p|0)*(t-p)+h+f;for(G=0;G<v;G++){if(0!==(L=E[M])){L=(L+O)*n,0!==F[M]&&(L=-L),j=N[M];var U=q?H+(B<<1):B;e[U]=s&&j>=o?L:L*(1<<o-j)}B++,M++}B+=p-v}}}}function I(e,t,i){for(var a=t.components[i],n=a.codingStyleParameters,r=a.quantizationParameters,o=n.decompositionLevelsCount,l=r.SPqcds,c=r.scalarExpounded,d=r.guardBits,u=n.segmentationSymbolUsed,p=n.resetContextProbabilities,m=e.components[i].precision,h=n.reversibleTransformation,f=h?new E:new F,y=[],b=0,g=0;g<=o;g++){for(var v=a.resolutions[g],_=v.trx1-v.trx0,A=v.try1-v.try0,x=new Float32Array(_*A),w=0,S=v.subbands.length;w<S;w++){var C=void 0,k=void 0;c?(C=l[b].mu,k=l[b].epsilon,b++):(C=l[0].mu,k=l[0].epsilon+(g>0?1-g:0));var D=v.subbands[w],I=s[D.type];R(x,_,0,D,h?1:Math.pow(2,m+I-k)*(1+C/2048),d+k-1,h,u,p)}y.push({width:_,height:A,items:x})}var M=f.calculate(y,a.tcx0,a.tcy0);return{left:a.tcx0,top:a.tcy0,width:M.width,height:M.height,items:M.items}}function M(e,t){for(var i=e.SIZ.Csiz,a=e.tiles[t],n=0;n<i;n++){var r=a.components[n],o=void 0!==e.currentTile.QCC[n]?e.currentTile.QCC[n]:e.currentTile.QCD;r.quantizationParameters=o;var s=void 0!==e.currentTile.COC[n]?e.currentTile.COC[n]:e.currentTile.COD;r.codingStyleParameters=s}a.codingStyleDefaultParameters=e.currentTile.COD}t.JpxImage=l;var T=function(){function e(t,i){b(this,e);var a=(0,n.log2)(Math.max(t,i))+1;this.levels=[];for(var r=0;r<a;r++){var o={width:t,height:i,items:[]};this.levels.push(o),t=Math.ceil(t/2),i=Math.ceil(i/2)}}return g(e,[{key:"reset",value:function(e,t){for(var i,a=0,n=0;a<this.levels.length;){var r=e+t*(i=this.levels[a]).width;if(void 0!==i.items[r]){n=i.items[r];break}i.index=r,e>>=1,t>>=1,a++}a--,(i=this.levels[a]).items[i.index]=n,this.currentLevel=a,delete this.value}},{key:"incrementValue",value:function(){var e=this.levels[this.currentLevel];e.items[e.index]++}},{key:"nextLevel",value:function(){var e=this.currentLevel,t=this.levels[e],i=t.items[t.index];return--e<0?(this.value=i,!1):(this.currentLevel=e,(t=this.levels[e]).items[t.index]=i,!0)}}]),e}(),P=function(){function e(t,i,a){b(this,e);var r=(0,n.log2)(Math.max(t,i))+1;this.levels=[];for(var o=0;o<r;o++){for(var s=new Uint8Array(t*i),l=0,c=s.length;l<c;l++)s[l]=a;var d={width:t,height:i,items:s};this.levels.push(d),t=Math.ceil(t/2),i=Math.ceil(i/2)}}return g(e,[{key:"reset",value:function(e,t,i){for(var a=0;a<this.levels.length;){var n=this.levels[a],r=e+t*n.width;n.index=r;var o=n.items[r];if(255===o)break;if(o>i)return this.currentLevel=a,this.propagateValues(),!1;e>>=1,t>>=1,a++}return this.currentLevel=a-1,!0}},{key:"incrementValue",value:function(e){var t=this.levels[this.currentLevel];t.items[t.index]=e+1,this.propagateValues()}},{key:"propagateValues",value:function(){for(var e=this.currentLevel,t=this.levels[e],i=t.items[t.index];--e>=0;)(t=this.levels[e]).items[t.index]=i}},{key:"nextLevel",value:function(){var e=this.currentLevel,t=this.levels[e],i=t.items[t.index];return t.items[t.index]=255,!(--e<0)&&(this.currentLevel=e,(t=this.levels[e]).items[t.index]=i,!0)}}]),e}(),z=function(){var e=17,t=new Uint8Array([0,5,8,0,3,7,8,0,4,7,8,0,0,0,0,0,1,6,8,0,3,7,8,0,4,7,8,0,0,0,0,0,2,6,8,0,3,7,8,0,4,7,8,0,0,0,0,0,2,6,8,0,3,7,8,0,4,7,8,0,0,0,0,0,2,6,8,0,3,7,8,0,4,7,8]),i=new Uint8Array([0,3,4,0,5,7,7,0,8,8,8,0,0,0,0,0,1,3,4,0,6,7,7,0,8,8,8,0,0,0,0,0,2,3,4,0,6,7,7,0,8,8,8,0,0,0,0,0,2,3,4,0,6,7,7,0,8,8,8,0,0,0,0,0,2,3,4,0,6,7,7,0,8,8,8]),a=new Uint8Array([0,1,2,0,1,2,2,0,2,2,2,0,0,0,0,0,3,4,5,0,4,5,5,0,5,5,5,0,0,0,0,0,6,7,7,0,7,7,7,0,7,7,7,0,0,0,0,0,8,8,8,0,8,8,8,0,8,8,8,0,0,0,0,0,8,8,8,0,8,8,8,0,8,8,8]);return function(){function n(e,r,o,s,l){var c;b(this,n),this.width=e,this.height=r,c="HH"===o?a:"HL"===o?i:t,this.contextLabelTable=c;var d,u=e*r;this.neighborsSignificance=new Uint8Array(u),this.coefficentsSign=new Uint8Array(u),d=l>14?new Uint32Array(u):l>6?new Uint16Array(u):new Uint8Array(u),this.coefficentsMagnitude=d,this.processingFlags=new Uint8Array(u);var p=new Uint8Array(u);if(0!==s)for(var m=0;m<u;m++)p[m]=s;this.bitsDecoded=p,this.reset()}return g(n,[{key:"setDecoder",value:function(e){this.decoder=e}},{key:"reset",value:function(){this.contexts=new Int8Array(19),this.contexts[0]=8,this.contexts[17]=92,this.contexts[18]=6}},{key:"setNeighborsSignificance",value:function(e,t,i){var a,n=this.neighborsSignificance,r=this.width,o=this.height,s=t>0,l=t+1<r;e>0&&(a=i-r,s&&(n[a-1]+=16),l&&(n[a+1]+=16),n[a]+=4),e+1<o&&(a=i+r,s&&(n[a-1]+=16),l&&(n[a+1]+=16),n[a]+=4),s&&(n[i-1]+=1),l&&(n[i+1]+=1),n[i]|=128}},{key:"runSignificancePropagationPass",value:function(){for(var e=this.decoder,t=this.width,i=this.height,a=this.coefficentsMagnitude,n=this.coefficentsSign,r=this.neighborsSignificance,o=this.processingFlags,s=this.contexts,l=this.contextLabelTable,c=this.bitsDecoded,d=0;d<i;d+=4)for(var u=0;u<t;u++)for(var p=d*t+u,m=0;m<4;m++,p+=t){var h=d+m;if(h>=i)break;if(o[p]&=-2,!a[p]&&r[p]){var f=l[r[p]];if(e.readBit(s,f)){var y=this.decodeSignBit(h,u,p);n[p]=y,a[p]=1,this.setNeighborsSignificance(h,u,p),o[p]|=2}c[p]++,o[p]|=1}}}},{key:"decodeSignBit",value:function(e,t,i){var a,n,r,o,s,l,c=this.width,d=this.height,u=this.coefficentsMagnitude,p=this.coefficentsSign;o=t>0&&0!==u[i-1],t+1<c&&0!==u[i+1]?(r=p[i+1],a=o?1-r-(n=p[i-1]):1-r-r):a=o?1-(n=p[i-1])-n:0;var m=3*a;return o=e>0&&0!==u[i-c],e+1<d&&0!==u[i+c]?(r=p[i+c],a=o?1-r-(n=p[i-c])+m:1-r-r+m):a=o?1-(n=p[i-c])-n+m:m,a>=0?(s=9+a,l=this.decoder.readBit(this.contexts,s)):(s=9-a,l=1^this.decoder.readBit(this.contexts,s)),l}},{key:"runMagnitudeRefinementPass",value:function(){for(var e,t=this.decoder,i=this.width,a=this.height,n=this.coefficentsMagnitude,r=this.neighborsSignificance,o=this.contexts,s=this.bitsDecoded,l=this.processingFlags,c=i*a,d=4*i,u=0;u<c;u=e){e=Math.min(c,u+d);for(var p=0;p<i;p++)for(var m=u+p;m<e;m+=i)if(n[m]&&0===(1&l[m])){var h=16;0!==(2&l[m])&&(l[m]^=2,h=0===(127&r[m])?15:14);var f=t.readBit(o,h);n[m]=n[m]<<1|f,s[m]++,l[m]|=1}}}},{key:"runCleanupPass",value:function(){for(var t,i=this.decoder,a=this.width,n=this.height,r=this.neighborsSignificance,o=this.coefficentsMagnitude,s=this.coefficentsSign,l=this.contexts,c=this.contextLabelTable,d=this.bitsDecoded,u=this.processingFlags,p=a,m=2*a,h=3*a,f=0;f<n;f=t){t=Math.min(f+4,n);for(var y=f*a,b=f+3<n,g=0;g<a;g++){var v=y+g,_=0,A=v,x=f,w=void 0;if(b&&0===u[v]&&0===u[v+p]&&0===u[v+m]&&0===u[v+h]&&0===r[v]&&0===r[v+p]&&0===r[v+m]&&0===r[v+h]){if(!i.readBit(l,18)){d[v]++,d[v+p]++,d[v+m]++,d[v+h]++;continue}0!==(_=i.readBit(l,e)<<1|i.readBit(l,e))&&(x=f+_,A+=_*a),w=this.decodeSignBit(x,g,A),s[A]=w,o[A]=1,this.setNeighborsSignificance(x,g,A),u[A]|=2,A=v;for(var S=f;S<=x;S++,A+=a)d[A]++;_++}for(x=f+_;x<t;x++,A+=a)if(!o[A]&&0===(1&u[A])){var C=c[r[A]];1===i.readBit(l,C)&&(w=this.decodeSignBit(x,g,A),s[A]=w,o[A]=1,this.setNeighborsSignificance(x,g,A),u[A]|=2),d[A]++}}}}},{key:"checkSegmentationSymbol",value:function(){var t=this.decoder,i=this.contexts;if(10!==(t.readBit(i,e)<<3|t.readBit(i,e)<<2|t.readBit(i,e)<<1|t.readBit(i,e)))throw new o("Invalid segmentation symbol")}}]),n}()}(),B=function(){function e(){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize Transform.")}return g(e,[{key:"calculate",value:function(e,t,i){for(var a=e[0],n=1,r=e.length;n<r;n++)a=this.iterate(a,e[n],t,i);return a}},{key:"extend",value:function(e,t,i){var a=t-1,n=t+1,r=t+i-2,o=t+i;e[a--]=e[n++],e[o++]=e[r--],e[a--]=e[n++],e[o++]=e[r--],e[a--]=e[n++],e[o++]=e[r--],e[a]=e[n],e[o]=e[r]}},{key:"filter",value:function(e,t,i){(0,a.unreachable)("Abstract method `filter` called")}},{key:"iterate",value:function(e,t,i,a){var n,r,o,s,l,c,d=e.width,u=e.height,p=e.items,m=t.width,h=t.height,f=t.items;for(o=0,n=0;n<u;n++)for(s=2*n*m,r=0;r<d;r++,o++,s+=2)f[s]=p[o];p=e.items=null;var y=new Float32Array(m+8);if(1===m){if(0!==(1&i))for(c=0,o=0;c<h;c++,o+=m)f[o]*=.5}else for(c=0,o=0;c<h;c++,o+=m)y.set(f.subarray(o,o+m),4),this.extend(y,4,m),this.filter(y,4,m),f.set(y.subarray(4,4+m),o);var b=16,g=[];for(n=0;n<b;n++)g.push(new Float32Array(h+8));var v,_=0;if(e=4+h,1===h){if(0!==(1&a))for(l=0;l<m;l++)f[l]*=.5}else for(l=0;l<m;l++){if(0===_){for(b=Math.min(m-l,b),o=l,s=4;s<e;o+=m,s++)for(v=0;v<b;v++)g[v][s]=f[o+v];_=b}var A=g[--_];if(this.extend(A,4,h),this.filter(A,4,h),0===_)for(o=l-b+1,s=4;s<e;o+=m,s++)for(v=0;v<b;v++)f[o+v]=g[v][s]}return{width:m,height:h,items:f}}}]),e}(),F=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.apply(this,arguments)}return g(i,[{key:"filter",value:function(e,t,i){var a,n,r,o,s=i>>1,l=-1.586134342059924,c=-.052980118572961,d=.882911075530934,u=.443506852043971,p=1.230174104914001;for(a=(t|=0)-3,n=s+4;n--;a+=2)e[a]*=.8128930661159609;for(r=u*e[(a=t-2)-1],n=s+3;n--&&(o=u*e[a+1],e[a]=p*e[a]-r-o,n--);a+=2)r=u*e[(a+=2)+1],e[a]=p*e[a]-r-o;for(r=d*e[(a=t-1)-1],n=s+2;n--&&(o=d*e[a+1],e[a]-=r+o,n--);a+=2)r=d*e[(a+=2)+1],e[a]-=r+o;for(r=c*e[(a=t)-1],n=s+1;n--&&(o=c*e[a+1],e[a]-=r+o,n--);a+=2)r=c*e[(a+=2)+1],e[a]-=r+o;if(0!==s)for(r=l*e[(a=t+1)-1],n=s;n--&&(o=l*e[a+1],e[a]-=r+o,n--);a+=2)r=l*e[(a+=2)+1],e[a]-=r+o}}]),i}(B),E=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.apply(this,arguments)}return g(i,[{key:"filter",value:function(e,t,i){var a,n,r=i>>1;for(a=t|=0,n=r+1;n--;a+=2)e[a]-=e[a-1]+e[a+1]+2>>2;for(a=t+1,n=r;n--;a+=2)e[a]+=e[a-1]+e[a+1]>>1}}]),i}(B)},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.LZWStream=void 0;var a=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;b(this,i),(r=t.call(this,a)).str=e,r.dict=e.dict,r.cachedData=0,r.bitsCached=0;for(var o=4096,s={earlyChange:n,codeLength:9,nextCode:258,dictionaryValues:new Uint8Array(o),dictionaryLengths:new Uint16Array(o),dictionaryPrevCodes:new Uint16Array(o),currentSequence:new Uint8Array(o),currentSequenceLength:0},l=0;l<256;++l)s.dictionaryValues[l]=l,s.dictionaryLengths[l]=1;return r.lzwState=s,r}return g(i,[{key:"readBits",value:function(e){for(var t=this.bitsCached,i=this.cachedData;t<e;){var a=this.str.getByte();if(-1===a)return this.eof=!0,null;i=i<<8|a,t+=8}return this.bitsCached=t-=e,this.cachedData=i,this.lastCode=null,i>>>t&(1<<e)-1}},{key:"readBlock",value:function(){var e,t,i,a=1024,n=this.lzwState;if(n){var r=n.earlyChange,o=n.nextCode,s=n.dictionaryValues,l=n.dictionaryLengths,c=n.dictionaryPrevCodes,d=n.codeLength,u=n.prevCode,p=n.currentSequence,m=n.currentSequenceLength,h=0,f=this.bufferLength,y=this.ensureBuffer(this.bufferLength+a);for(e=0;e<512;e++){var b=this.readBits(d),g=m>0;if(b<256)p[0]=b,m=1;else{if(!(b>=258)){if(256===b){d=9,o=258,m=0;continue}this.eof=!0,delete this.lzwState;break}if(b<o)for(t=(m=l[b])-1,i=b;t>=0;t--)p[t]=s[i],i=c[i];else p[m++]=p[0]}if(g&&(c[o]=u,l[o]=l[u]+1,s[o]=p[0],d=++o+r&o+r-1?d:0|Math.min(Math.log(o+r)/.6931471805599453+1,12)),u=b,a<(h+=m)){do{a+=512}while(a<h);y=this.ensureBuffer(this.bufferLength+a)}for(t=0;t<m;t++)y[f++]=p[t]}n.nextCode=o,n.codeLength=d,n.prevCode=u,n.currentSequenceLength=m,this.bufferLength=f}}}]),i}(i(150).DecodeStream);t.LZWStream=a},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.PredictorStream=void 0;var a=i(150),r=i(137),o=i(2),s=function(e){d(i,e);var t=u(i);function i(e,a,s){var c;if(b(this,i),c=t.call(this,a),!(s instanceof r.Dict))return n(c,e);var d=c.predictor=s.get("Predictor")||1;if(d<=1)return n(c,e);if(2!==d&&(d<10||d>15))throw new o.FormatError("Unsupported predictor: 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_=0;_<n;++_)c<a&&(s=s<<8|255&r[b++],c+=8),f[_]=f[_]+(s>>c-a)&y,c-=a,l=l<<a|f[_],(d+=a)>=8&&(i[g++]=l>>d-8&255,d-=8);d>0&&(i[g++]=(l<<8-d)+(s&(1<<8-d)-1))}this.bufferLength+=e}}},{key:"readBlockPng",value:function(){var e=this.rowBytes,t=this.pixBytes,i=this.str.getByte(),a=this.str.getBytes(e);if(this.eof=!a.length,!this.eof){var n=this.bufferLength,r=this.ensureBuffer(n+e),s=r.subarray(n-e,n);0===s.length&&(s=new Uint8Array(e));var l,c,d,u=n;switch(i){case 0:for(l=0;l<e;++l)r[u++]=a[l];break;case 1:for(l=0;l<t;++l)r[u++]=a[l];for(;l<e;++l)r[u]=r[u-t]+a[l]&255,u++;break;case 2:for(l=0;l<e;++l)r[u++]=s[l]+a[l]&255;break;case 3:for(l=0;l<t;++l)r[u++]=(s[l]>>1)+a[l];for(;l<e;++l)r[u]=(s[l]+r[u-t]>>1)+a[l]&255,u++;break;case 4:for(l=0;l<t;++l)c=s[l],d=a[l],r[u++]=c+d;for(;l<e;++l){c=s[l];var p=s[l-t],m=r[u-t],h=m+c-p,f=h-m;f<0&&(f=-f);var y=h-c;y<0&&(y=-y);var b=h-p;b<0&&(b=-b),d=a[l],r[u++]=f<=y&&f<=b?m+d:y<=b?c+d:p+d}break;default:throw new o.FormatError("Unsupported predictor: 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a=i(2),n=i(166),r=i(169),o=i(171),s=i(170),l=i(168),c=i(172),d=i(173),u=i(174),p=i(175),m=i(176),y=i(177),v=i(147),_=i(178),A=i(136),x=i(141),w=i(179),S=[[57344,63743],[1048576,1114109]],C=1e3,k=["ascent","bbox","black","bold","charProcOperatorList","composite","cssFontInfo","data","defaultVMetrics","defaultWidth","descent","fallbackName","fontMatrix","isInvalidPDFjsFont","isType3Font","italic","loadedName","mimetype","missingFile","name","remeasure","subtype","type","vertical"],D=["cMap","defaultEncoding","differences","isMonospace","isSerifFont","isSymbolicFont","seacMap","toFontChar","toUnicode","vmetrics","widths"];function R(e){if(e.fontMatrix&&e.fontMatrix[0]!==a.FONT_IDENTITY_MATRIX[0]){var t=.001/e.fontMatrix[0],i=e.widths;for(var n in i)i[n]*=t;e.defaultWidth*=t}}function I(e){if(e.fallbackToUnicode&&!(e.toUnicode instanceof d.IdentityToUnicodeMap)){var t=[];for(var i in e.fallbackToUnicode)e.toUnicode.has(i)||(t[i]=e.fallbackToUnicode[i]);t.length>0&&e.toUnicode.amend(t)}}var M=function(){function e(t,i,a,n,r,o,s,l,c){b(this,e),this.originalCharCode=t,this.fontChar=i,this.unicode=a,this.accent=n,this.width=r,this.vmetric=o,this.operatorListId=s,this.isSpace=l,this.isInFont=c}return g(e,[{key:"category",get:function(){return(0,a.shadow)(this,"category",(0,o.getCharUnicodeCategory)(this.unicode),!0)}},{key:"normalizedUnicode",get:function(){return(0,a.shadow)(this,"normalizedUnicode",(0,o.reverseIfRtl)(e._NormalizedUnicodes[this.unicode]||this.unicode),!0)}}],[{key:"_NormalizedUnicodes",get:function(){return(0,a.shadow)(this,"_NormalizedUnicodes",(0,o.getNormalizedUnicodes)())}}]),e}();function T(e,t){return(e<<8)+t}function P(e,t,i){e[t+1]=i,e[t]=i>>>8}function z(e,t){var i=(e<<8)+t;return 32768&i?i-65536:i}function B(e){return String.fromCharCode(e>>8&255,255&e)}function F(e){return e>32767?e=32767:e<-32768&&(e=-32768),String.fromCharCode(e>>8&255,255&e)}function E(e){var t=e.peekBytes(4);return"ttcf"===(0,a.bytesToString)(t)}function N(e,t){var i,n,r=t.type,o=t.subtype,s=t.composite;return function(e){var t=e.peekBytes(4);return 65536===(0,A.readUint32)(t,0)||"true"===(0,a.bytesToString)(t)}(e)||E(e)?i=s?"CIDFontType2":"TrueType":function(e){var t=e.peekBytes(4);return"OTTO"===(0,a.bytesToString)(t)}(e)?i=s?"CIDFontType2":"OpenType":function(e){var t=e.peekBytes(2);return 37===t[0]&&33===t[1]||128===t[0]&&1===t[1]}(e)?i=s?"CIDFontType0":"MMType1"===r?"MMType1":"Type1":function(e){var t=e.peekBytes(4);return t[0]>=1&&t[3]>=1&&t[3]<=4}(e)?s?(i="CIDFontType0",n="CIDFontType0C"):(i="MMType1"===r?"MMType1":"Type1",n="Type1C"):((0,a.warn)("getFontFileType: Unable to detect correct font file Type/Subtype."),i=r,n=o),[i,n]}function O(e,t){for(var i in t)e[+i]=t[i]}function G(e,t,i){for(var a,n=[],r=0,s=e.length;r<s;r++)-1!==(a=(0,o.getUnicodeForGlyph)(e[r],t))&&(n[r]=a);for(var l in i)-1!==(a=(0,o.getUnicodeForGlyph)(i[l],t))&&(n[+l]=a);return n}function L(e){return 1===e.platform&&0===e.encoding&&0===e.language}function j(e){return 3===e.platform&&1===e.encoding&&1033===e.language}function q(e,t){var i=arguments.length>2&&void 0!==arguments[2]&&arguments[2];switch(t.length){case 1:return t.charCodeAt(0);case 2:return t.charCodeAt(0)<<8|t.charCodeAt(1)}var n="Unsupported CID string (charCode ".concat(e,'): "').concat(t,'".');if(i)throw new a.FormatError(n);return(0,a.warn)(n),t}function H(e,t,i,n){var r=Object.create(null),o=new Map,s=[],l=new Set,c=0,d=S[c][0],u=d,p=S[c][1];for(var m in e){var h=e[m|=0];if(t(h)){if(u>p){if(++c>=S.length){(0,a.warn)("Ran out of space in font private use area.");break}u=S[c][0],p=S[c][1]}var f=u++;0===h&&(h=i);var y=n.get(m);"string"===typeof y&&(y=y.codePointAt(0)),y&&y<d&&!l.has(h)&&(o.set(y,h),l.add(h)),r[f]=h,s[m]=f}}return{toFontChar:s,charCodeToGlyphId:r,toUnicodeExtraMap:o,nextAvailableFontCharCode:u}}function U(e,t,i){var n,r,o,s,l=function(e,t,i){var a=[];for(var n in e)e[n]>=i||a.push({fontCharCode:0|n,glyphId:e[n]});if(t){var r,o=h(t);try{for(o.s();!(r=o.n()).done;){var 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Q(e,t){t||(t=[[],[]]);var i,a,n,r,o,s=[t[0][0]||"Original licence",t[0][1]||e,t[0][2]||"Unknown",t[0][3]||"uniqueID",t[0][4]||e,t[0][5]||"Version 0.11",t[0][6]||V(e),t[0][7]||"Unknown",t[0][8]||"Unknown",t[0][9]||"Unknown"],l=[];for(i=0,a=s.length;i<a;i++){var c=[];for(n=0,r=(o=t[1][i]||s[i]).length;n<r;n++)c.push(B(o.charCodeAt(n)));l.push(c.join(""))}var d=[s,l],u=["\0\x01","\0\x03"],p=["\0\0","\0\x01"],m=["\0\0","\x04\t"],h=s.length*u.length,f="\0\0"+B(h)+B(12*h+6),y=0;for(i=0,a=u.length;i<a;i++){var b=d[i];for(n=0,r=b.length;n<r;n++)o=b[n],f+=u[i]+p[i]+m[i]+B(n)+B(o.length)+B(y),y+=o.length}return f+=s.join("")+l.join("")}var W=function(){function e(t,i,n){b(this,e),this.name=t,this.psName=null,this.mimetype=null,this.disableFontFace=!1,this.loadedName=n.loadedName,this.isType3Font=n.isType3Font,this.missingFile=!1,this.cssFontInfo=n.cssFontInfo,this._charsCache=Object.create(null),this._glyphCache=Object.create(null);var o=!!(n.flags&r.FontFlags.Serif);if(!o&&!n.isSimulatedFlags){var s,l=t.replace(/[,_]/g,"-").split("-")[0],d=(0,c.getSerifFonts)(),p=h(l.split("+"));try{for(p.s();!(s=p.n()).done;)if(d[s.value]){o=!0;break}}catch(k){p.e(k)}finally{p.f()}}this.isSerifFont=o,this.isSymbolicFont=!!(n.flags&r.FontFlags.Symbolic),this.isMonospace=!!(n.flags&r.FontFlags.FixedPitch);var m=n.type,y=n.subtype;this.type=m,this.subtype=y;var g=t.match(/^InvalidPDFjsFont_(.*)_\d+$/);if(this.isInvalidPDFjsFont=!!g,this.isInvalidPDFjsFont?this.fallbackName=g[1]:this.isMonospace?this.fallbackName="monospace":this.isSerifFont?this.fallbackName="serif":this.fallbackName="sans-serif",this.differences=n.differences,this.widths=n.widths,this.defaultWidth=n.defaultWidth,this.composite=n.composite,this.cMap=n.cMap,this.capHeight=n.capHeight/C,this.ascent=n.ascent/C,this.descent=n.descent/C,this.lineHeight=this.ascent-this.descent,this.fontMatrix=n.fontMatrix,this.bbox=n.bbox,this.defaultEncoding=n.defaultEncoding,this.toUnicode=n.toUnicode,this.toFontChar=[],"Type3"!==n.type){if(this.cidEncoding=n.cidEncoding||"",this.vertical=!!n.vertical,this.vertical&&(this.vmetrics=n.vmetrics,this.defaultVMetrics=n.defaultVMetrics),!i||i.isEmpty)return i&&(0,a.warn)('Font file is empty in "'+t+'" ('+this.loadedName+")"),void this.fallbackToSystemFont(n);var v,_=N(i,n),A=f(_,2);m=A[0],y=A[1],m===this.type&&y===this.subtype||(0,a.info)("Inconsistent font file Type/SubType, expected: "+"".concat(this.type,"/").concat(this.subtype," but found: ").concat(m,"/").concat(y,"."));try{switch(m){case"MMType1":(0,a.info)("MMType1 font ("+t+"), falling back to Type1.");case"Type1":case"CIDFontType0":this.mimetype="font/opentype";var x="Type1C"===y||"CIDFontType0C"===y?new u.CFFFont(i,n):new w.Type1Font(t,i,n);R(n),v=this.convert(t,x,n);break;case"OpenType":case"TrueType":case"CIDFontType2":this.mimetype="font/opentype",v=this.checkAndRepair(t,i,n),this.isOpenType&&(R(n),m="OpenType");break;default:throw new a.FormatError("Font ".concat(m," is not supported"))}}catch(D){return(0,a.warn)(D),void this.fallbackToSystemFont(n)}I(n),this.data=v,this.type=m,this.subtype=y,this.fontMatrix=n.fontMatrix,this.widths=n.widths,this.defaultWidth=n.defaultWidth,this.toUnicode=n.toUnicode,this.seacMap=n.seacMap}else for(var S=0;S<256;S++)this.toFontChar[S]=this.differences[S]||n.defaultEncoding[S]}return g(e,[{key:"renderer",get:function(){var e=p.FontRendererFactory.create(this,r.SEAC_ANALYSIS_ENABLED);return(0,a.shadow)(this,"renderer",e)}},{key:"exportData",value:function(){var e,t,i,a=arguments.length>0&&void 0!==arguments[0]&&arguments[0]?[].concat(k,D):k,n=Object.create(null),r=h(a);try{for(r.s();!(i=r.n()).done;)void 0!==(t=this[e=i.value])&&(n[e]=t)}catch(o){r.e(o)}finally{r.f()}return n}},{key:"fallbackToSystemFont",value:function(e){var t=this;this.missingFile=!0;var i=this.name,n=this.type,u=(0,r.normalizeFontName)(i),p=(0,c.getStdFontMap)(),h=(0,c.getNonStdFontMap)(),f=!!p[u],y=!(!h[u]||!p[h[u]]);u=p[u]||h[u]||u;var b=(0,m.getFontBasicMetrics)()[u];b&&(isNaN(this.ascent)&&(this.ascent=b.ascent/C),isNaN(this.descent)&&(this.descent=b.descent/C),isNaN(this.capHeight)&&(this.capHeight=b.capHeight/C)),this.bold=/bold/gi.test(u),this.italic=/oblique|italic/gi.test(u),this.black=/Black/g.test(i);var g=/Narrow/g.test(i);if(this.remeasure=(!f||g)&&Object.keys(this.widths).length>0,(f||y)&&"CIDFontType2"===n&&this.cidEncoding.startsWith("Identity-")){var v=e.cidToGidMap,_=[];if(O(_,(0,c.getGlyphMapForStandardFonts)()),/Arial-?Black/i.test(i)?O(_,(0,c.getSupplementalGlyphMapForArialBlack)()):/Calibri/i.test(i)&&O(_,(0,c.getSupplementalGlyphMapForCalibri)()),v){for(var A in _){var x=_[A];void 0!==v[x]&&(_[+A]=v[x])}v.length!==this.toUnicode.length&&e.hasIncludedToUnicodeMap&&this.toUnicode instanceof d.IdentityToUnicodeMap&&this.toUnicode.forEach((function(e,t){var i=_[e];void 0===v[i]&&(_[+e]=t)}))}this.toUnicode instanceof d.IdentityToUnicodeMap||this.toUnicode.forEach((function(e,t){_[+e]=t})),this.toFontChar=_,this.toUnicode=new d.ToUnicodeMap(_)}else if(/Symbol/i.test(u))this.toFontChar=G(l.SymbolSetEncoding,(0,s.getGlyphsUnicode)(),this.differences);else if(/Dingbats/i.test(u))/Wingdings/i.test(i)&&(0,a.warn)("Non-embedded Wingdings font, falling back to ZapfDingbats."),this.toFontChar=G(l.ZapfDingbatsEncoding,(0,s.getDingbatsGlyphsUnicode)(),this.differences);else if(f){var w=G(this.defaultEncoding,(0,s.getGlyphsUnicode)(),this.differences);"CIDFontType2"!==n||this.cidEncoding.startsWith("Identity-")||this.toUnicode instanceof d.IdentityToUnicodeMap||this.toUnicode.forEach((function(e,t){w[+e]=t})),this.toFontChar=w}else{var S=(0,s.getGlyphsUnicode)(),k=[];this.toUnicode.forEach((function(e,i){if(!t.composite){var a=t.differences[e]||t.defaultEncoding[e],n=(0,o.getUnicodeForGlyph)(a,S);-1!==n&&(i=n)}k[+e]=i})),this.composite&&this.toUnicode instanceof d.IdentityToUnicodeMap&&/Tahoma|Verdana/i.test(i)&&O(k,(0,c.getGlyphMapForStandardFonts)()),this.toFontChar=k}I(e),this.loadedName=u.split("-")[0]}},{key:"checkAndRepair",value:function(e,t,i){var o=["OS/2","cmap","head","hhea","hmtx","maxp","name","post","loca","glyf","fpgm","prep","cvt ","CFF "];function c(e,t){var i=Object.create(null);i["OS/2"]=null,i.cmap=null,i.head=null,i.hhea=null,i.hmtx=null,i.maxp=null,i.name=null,i.post=null;for(var a=0;a<t;a++){var n=p(e);o.includes(n.tag)&&0!==n.length&&(i[n.tag]=n)}return i}function p(e){var t=e.getString(4),i=e.getInt32()>>>0,a=e.getInt32()>>>0,n=e.getInt32()>>>0,r=e.pos;e.pos=e.start||0,e.skip(a);var o=e.getBytes(n);return e.pos=r,"head"===t&&(o[8]=o[9]=o[10]=o[11]=0,o[17]|=32),{tag:t,checksum:i,length:n,offset:a,data:o}}function m(e){return{version:e.getString(4),numTables:e.getUint16(),searchRange:e.getUint16(),entrySelector:e.getUint16(),rangeShift:e.getUint16()}}function b(e,t,i,a,n,r){var o={length:0,sizeOfInstructions:0};if(i-t<=12)return o;var s=e.subarray(t,i),l=z(s[0],s[1]);if(l<0)return P(s,0,l=-1),a.set(s,n),o.length=s.length,o;var c,d=10,u=0;for(c=0;c<l;c++)u=1+(s[d]<<8|s[d+1]),d+=2;var p=d,m=s[d]<<8|s[d+1];o.sizeOfInstructions=m;var h=d+=2+m,f=0;for(c=0;c<u;c++){var y=s[d++];192&y&&(s[d-1]=63&y);var b=2;2&y?b=1:16&y&&(b=0);var g=2;4&y?g=1:32&y&&(g=0);var v=b+g;if(f+=v,8&y){var _=s[d++];c+=_,f+=_*v}}if(0===f)return o;var A=d+f;return A>s.length?o:!r&&m>0?(a.set(s.subarray(0,p),n),a.set([0,0],n+p),a.set(s.subarray(h,A),n+p+2),A-=m,s.length-A>3&&(A=A+3&-4),o.length=A,o):s.length-A>3?(A=A+3&-4,a.set(s.subarray(0,A),n),o.length=A,o):(a.set(s,n),o.length=s.length,o)}function g(e){var i=(t.start||0)+e.offset;t.pos=i;var a=[[],[]],n=[],r=e.length,o=i+r;if(0!==t.getUint16()||r<6)return[a,n];var s,l,c=t.getUint16(),d=t.getUint16();for(s=0;s<c&&t.pos+12<=o;s++){var u={platform:t.getUint16(),encoding:t.getUint16(),language:t.getUint16(),name:t.getUint16(),length:t.getUint16(),offset:t.getUint16()};(L(u)||j(u))&&n.push(u)}for(s=0,l=n.length;s<l;s++){var p=n[s];if(!(p.length<=0)){var m=i+d+p.offset;if(!(m+p.length>o)){t.pos=m;var h=p.name;if(p.encoding){for(var f="",y=0,b=p.length;y<b;y+=2)f+=String.fromCharCode(t.getUint16());a[1][h]=f}else a[0][h]=t.getString(p.length)}}}return[a,n]}var A,w,S,C,k=[0,0,0,0,0,0,0,0,-2,-2,-2,-2,0,0,-2,-5,-1,-1,-1,-1,-1,-1,-1,-1,0,0,-1,0,-1,-1,-1,-1,1,-1,-999,0,1,0,-1,-2,0,-1,-2,-1,-1,0,-1,-1,0,0,-999,-999,-1,-1,-1,-1,-2,-999,-2,-2,-999,0,-2,-2,0,0,-2,0,-2,0,0,0,-2,-1,-1,1,1,0,0,-1,-1,-1,-1,-1,-1,-1,0,0,-1,0,-1,-1,0,-999,-1,-1,-1,-1,-1,-1,0,0,0,0,0,0,0,0,0,0,0,0,-2,-999,-999,-999,-999,-999,-1,-1,-2,-2,0,0,0,0,-1,-1,-999,-2,-2,0,0,-1,-2,-2,0,0,0,-1,-1,-1,-2];function D(e,t){for(var i,n,r,o,s,l=e.data,c=0,d=0,u=0,p=[],m=[],h=[],f=t.tooComplexToFollowFunctions,y=!1,b=0,g=0,v=l.length;c<v;){var _=l[c++];if(64===_)if(n=l[c++],y||g)c+=n;else for(i=0;i<n;i++)p.push(l[c++]);else if(65===_)if(n=l[c++],y||g)c+=2*n;else for(i=0;i<n;i++)r=l[c++],p.push(r<<8|l[c++]);else if(176===(248&_))if(n=_-176+1,y||g)c+=n;else for(i=0;i<n;i++)p.push(l[c++]);else if(184===(248&_))if(n=_-184+1,y||g)c+=2*n;else for(i=0;i<n;i++)r=l[c++],p.push(r<<8|l[c++]);else if(43!==_||f)if(44!==_||f){if(45===_)if(y)y=!1,d=c;else{if(!(s=m.pop()))return(0,a.warn)("TT: ENDF bad stack"),void(t.hintsValid=!1);o=h.pop(),l=s.data,c=s.i,t.functionsStackDeltas[o]=p.length-s.stackTop}else if(137===_)(y||g)&&((0,a.warn)("TT: nested IDEFs not allowed"),f=!0),y=!0,u=c;else if(88===_)++b;else if(27===_)g=b;else if(89===_)g===b&&(g=0),--b;else if(28===_&&!y&&!g){var A=p.at(-1);A>0&&(c+=A-1)}}else(y||g)&&((0,a.warn)("TT: nested FDEFs not allowed"),f=!0),y=!0,u=c,o=p.pop(),t.functionsDefined[o]={data:l,i:c};else if(!y&&!g)if(o=p.at(-1),isNaN(o))(0,a.info)("TT: CALL empty stack (or invalid entry).");else if(t.functionsUsed[o]=!0,o in t.functionsStackDeltas){var x=p.length+t.functionsStackDeltas[o];if(x<0)return(0,a.warn)("TT: CALL invalid functions stack delta."),void(t.hintsValid=!1);p.length=x}else if(o in t.functionsDefined&&!h.includes(o)){if(m.push({data:l,i:c,stackTop:p.length-1}),h.push(o),!(s=t.functionsDefined[o]))return(0,a.warn)("TT: CALL non-existent function"),void(t.hintsValid=!1);l=s.data,c=s.i}if(!y&&!g){var w=0;for(_<=142?w=k[_]:_>=192&&_<=223?w=-1:_>=224&&(w=-2),_>=113&&_<=117&&(n=p.pop(),isNaN(n)||(w=2*-n));w<0&&p.length>0;)p.pop(),w++;for(;w>0;)p.push(NaN),w--}}t.tooComplexToFollowFunctions=f;var S=[l];c>l.length&&S.push(new Uint8Array(c-l.length)),u>d&&((0,a.warn)("TT: complementing a missing function tail"),S.push(new Uint8Array([34,45]))),function(e,t){if(t.length>1){var i,a,n=0;for(i=0,a=t.length;i<a;i++)n+=t[i].length;n=n+3&-4;var r=new Uint8Array(n),o=0;for(i=0,a=t.length;i<a;i++)r.set(t[i],o),o+=t[i].length;e.data=r,e.length=n}}(e,S)}if(E(t=new x.Stream(new Uint8Array(t.getBytes())))){var I=function(e,t){for(var i,n=function(e){var t=e.getString(4);(0,a.assert)("ttcf"===t,"Must be a TrueType Collection font.");for(var i=e.getUint16(),n=e.getUint16(),r=e.getInt32()>>>0,o=[],s=0;s<r;s++)o.push(e.getInt32()>>>0);var l={ttcTag:t,majorVersion:i,minorVersion:n,numFonts:r,offsetTable:o};switch(i){case 1:return l;case 2:return l.dsigTag=e.getInt32()>>>0,l.dsigLength=e.getInt32()>>>0,l.dsigOffset=e.getInt32()>>>0,l}throw new a.FormatError("Invalid TrueType Collection majorVersion: ".concat(i,"."))}(e),r=n.numFonts,o=n.offsetTable,s=t.split("+"),l=0;l<r;l++){e.pos=(e.start||0)+o[l];var d=m(e),u=c(e,d.numTables);if(!u.name)throw new a.FormatError('TrueType Collection font must contain a "name" table.');for(var p=g(u.name),y=f(p,1)[0],b=0,v=y.length;b<v;b++)for(var _=0,A=y[b].length;_<A;_++){var x=y[b][_]&&y[b][_].replace(/\s/g,"");if(x){if(x===t)return{header:d,tables:u};if(!(s.length<2)){var w,S=h(s);try{for(S.s();!(w=S.n()).done;){var C=w.value;x===C&&(i={name:C,header:d,tables:u})}}catch(k){S.e(k)}finally{S.f()}}}}}if(i)return(0,a.warn)('TrueType Collection does not contain "'.concat(t,'" font, ')+'falling back to "'.concat(i.name,'" font instead.')),{header:i.header,tables:i.tables};throw new a.FormatError('TrueType Collection does not contain "'.concat(t,'" font.'))}(t,this.name);A=I.header,w=I.tables}else A=m(t),w=c(t,A.numTables);var M=!w["CFF "];if(M){if(!w.loca)throw new a.FormatError('Required "loca" table is not found');w.glyf||((0,a.warn)('Required "glyf" table is not found -- trying to recover.'),w.glyf={tag:"glyf",data:new Uint8Array(0)}),this.isOpenType=!1}else{var B=i.composite&&((i.cidToGidMap||[]).length>0||!(i.cMap instanceof v.IdentityCMap));if("OTTO"===A.version&&!B||!w.head||!w.hhea||!w.maxp||!w.post)return C=new x.Stream(w["CFF "].data),S=new u.CFFFont(C,i),R(i),this.convert(e,S,i);delete w.glyf,delete w.loca,delete w.fpgm,delete w.prep,delete w["cvt "],this.isOpenType=!0}if(!w.maxp)throw new a.FormatError('Required "maxp" table is not found');t.pos=(t.start||0)+w.maxp.offset;var F=t.getInt32(),N=t.getUint16();if(i.scaleFactors&&i.scaleFactors.length===N&&M){var O=i.scaleFactors,G=T(w.head.data[50],w.head.data[51]),V=new y.GlyfTable({glyfTable:w.glyf.data,isGlyphLocationsLong:G,locaTable:w.loca.data,numGlyphs:N});V.scale(O);var W=V.write(),Z=W.glyf,J=W.loca,K=W.isLocationLong;w.glyf.data=Z,w.loca.data=J,K!==!!G&&(w.head.data[50]=0,w.head.data[51]=K?1:0);for(var $=w.hmtx.data,ee=0;ee<N;ee++){var te=4*ee,ie=Math.round(O[ee]*T($[te],$[te+1]));$[te]=ie>>8&255,$[te+1]=255&ie,P($,te+2,Math.round(O[ee]*z($[te+2],$[te+3])))}}var ae=N+1,ne=!0;ae>65535&&(ne=!1,ae=N,(0,a.warn)("Not enough space in glyfs to duplicate first glyph."));var re=0,oe=0;F>=65536&&w.maxp.length>=22&&(t.pos+=8,t.getUint16()>2&&(w.maxp.data[14]=0,w.maxp.data[15]=2),t.pos+=4,re=t.getUint16(),t.pos+=4,oe=t.getUint16()),w.maxp.data[4]=ae>>8,w.maxp.data[5]=255&ae;var se=function(e,t,i,n){var r={functionsDefined:[],functionsUsed:[],functionsStackDeltas:[],tooComplexToFollowFunctions:!1,hintsValid:!0};if(e&&D(e,r),t&&D(t,r),e&&function(e,t){if(!e.tooComplexToFollowFunctions){if(e.functionsDefined.length>t)return(0,a.warn)("TT: more functions defined than expected"),void(e.hintsValid=!1);for(var i=0,n=e.functionsUsed.length;i<n;i++){if(i>t)return(0,a.warn)("TT: invalid function id: "+i),void(e.hintsValid=!1);if(e.functionsUsed[i]&&!e.functionsDefined[i])return(0,a.warn)("TT: undefined function: "+i),void(e.hintsValid=!1)}}}(r,n),i&&1&i.length){var o=new Uint8Array(i.length+1);o.set(i.data),i.data=o}return r.hintsValid}(w.fpgm,w.prep,w["cvt "],re);if(se||(delete w.fpgm,delete w.prep,delete w["cvt "]),function(e,t,i,n,r,o){if(t){e.pos=(e.start||0)+t.offset,e.pos+=4,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2;var s=e.getUint16();e.pos+=8,e.pos+=2;var l=e.getUint16();0!==s&&(2&T(n.data[44],n.data[45])||(t.data[22]=0,t.data[23]=0)),l>r&&((0,a.info)("The numOfMetrics (".concat(l,") should not be ")+"greater than the numGlyphs (".concat(r,").")),l=r,t.data[34]=(65280&l)>>8,t.data[35]=255&l);var c=r-l-(i.length-4*l>>1);if(c>0){var d=new Uint8Array(i.length+2*c);d.set(i.data),o&&(d[i.length]=i.data[2],d[i.length+1]=i.data[3]),i.data=d}}else i&&(i.data=null)}(t,w.hhea,w.hmtx,w.head,ae,ne),!w.head)throw new a.FormatError('Required "head" table is not found');!function(e,t,i){var n,r,o,s,l=e.data,c=(n=l[0],r=l[1],o=l[2],s=l[3],(n<<24)+(r<<16)+(o<<8)+s);c>>16!==1&&((0,a.info)("Attempting to fix invalid version in head table: "+c),l[0]=0,l[1]=1,l[2]=0,l[3]=0);var d=T(l[50],l[51]);if(d<0||d>1){(0,a.info)("Attempting to fix invalid indexToLocFormat in head table: "+d);var u=t+1;if(i===u<<1)l[50]=0,l[51]=0;else{if(i!==u<<2)throw new a.FormatError("Could not fix indexToLocFormat: "+d);l[50]=0,l[51]=1}}}(w.head,N,M?w.loca.length:0);var le=Object.create(null);if(M){var ce=T(w.head.data[50],w.head.data[51]),de=function(e,t,i,a,n,r,o){var s,l,c;a?(s=4,l=function(e,t){return e[t]<<24|e[t+1]<<16|e[t+2]<<8|e[t+3]},c=function(e,t,i){e[t]=i>>>24&255,e[t+1]=i>>16&255,e[t+2]=i>>8&255,e[t+3]=255&i}):(s=2,l=function(e,t){return e[t]<<9|e[t+1]<<1},c=function(e,t,i){e[t]=i>>9&255,e[t+1]=i>>1&255});var d=r?i+1:i,u=s*(1+d),p=new Uint8Array(u);p.set(e.data.subarray(0,u)),e.data=p;var m,h,f=t.data,y=f.length,g=new Uint8Array(y),v=[];for(m=0,h=0;m<i+1;m++,h+=s){var _=l(p,h);_>y&&(_=y),v.push({index:m,offset:_,endOffset:0})}for(v.sort((function(e,t){return e.offset-t.offset})),m=0;m<i;m++)v[m].endOffset=v[m+1].offset;for(v.sort((function(e,t){return e.index-t.index})),m=0;m<i;m++){var A=v[m],x=A.offset,w=A.endOffset;if(0!==x||0!==w)break;var S=v[m+1].offset;if(0!==S){v[m].endOffset=S;break}}var C=Object.create(null),k=0;for(c(p,0,k),m=0,h=s;m<i;m++,h+=s){var D=b(f,v[m].offset,v[m].endOffset,g,k,n),R=D.length;0===R&&(C[m]=!0),D.sizeOfInstructions>o&&(o=D.sizeOfInstructions),c(p,h,k+=R)}if(0===k){var I=new Uint8Array([0,1,0,0,0,0,0,0,0,0,0,0,0,0,49,0]);for(m=0,h=s;m<d;m++,h+=s)c(p,h,I.length);t.data=I}else if(r){var M=l(p,s);g.length>M+k?t.data=g.subarray(0,M+k):(t.data=new Uint8Array(M+k),t.data.set(g.subarray(0,k))),t.data.set(g.subarray(0,M),k),c(e.data,p.length-s,k+M)}else t.data=g.subarray(0,k);return{missingGlyphs:C,maxSizeOfInstructions:o}}(w.loca,w.glyf,N,ce,se,ne,oe);le=de.missingGlyphs,F>=65536&&w.maxp.length>=22&&(w.maxp.data[26]=de.maxSizeOfInstructions>>8,w.maxp.data[27]=255&de.maxSizeOfInstructions)}if(!w.hhea)throw new a.FormatError('Required "hhea" table is not found');0===w.hhea.data[10]&&0===w.hhea.data[11]&&(w.hhea.data[10]=255,w.hhea.data[11]=255);var ue={unitsPerEm:T(w.head.data[18],w.head.data[19]),yMax:T(w.head.data[42],w.head.data[43]),yMin:z(w.head.data[38],w.head.data[39]),ascent:z(w.hhea.data[4],w.hhea.data[5]),descent:z(w.hhea.data[6],w.hhea.data[7]),lineGap:z(w.hhea.data[8],w.hhea.data[9])};this.ascent=ue.ascent/ue.unitsPerEm,this.descent=ue.descent/ue.unitsPerEm,this.lineGap=ue.lineGap/ue.unitsPerEm,this.cssFontInfo&&this.cssFontInfo.lineHeight?(this.lineHeight=this.cssFontInfo.metrics.lineHeight,this.lineGap=this.cssFontInfo.metrics.lineGap):this.lineHeight=this.ascent-this.descent+this.lineGap,w.post&&function(e,i,n){var o=(t.start||0)+e.offset;t.pos=o;var s,l=o+e.length,c=t.getInt32();t.skip(28);var d,u=!0;switch(c){case 65536:s=r.MacStandardGlyphOrdering;break;case 131072:var p=t.getUint16();if(p!==n){u=!1;break}var m=[];for(d=0;d<p;++d){var h=t.getUint16();if(h>=32768){u=!1;break}m.push(h)}if(!u)break;for(var f=[],y=[];t.pos<l;){var b=t.getByte();for(y.length=b,d=0;d<b;++d)y[d]=String.fromCharCode(t.getByte());f.push(y.join(""))}for(s=[],d=0;d<p;++d){var g=m[d];g<258?s.push(r.MacStandardGlyphOrdering[g]):s.push(f[g-258])}break;case 196608:break;default:(0,a.warn)("Unknown/unsupported post table version "+c),u=!1,i.defaultEncoding&&(s=i.defaultEncoding)}i.glyphNames=s}(w.post,i,N),w.post={tag:"post",data:X(i)};var pe=[];function me(e){return!le[e]}if(i.composite){var he=i.cidToGidMap||[],fe=0===he.length;i.cMap.forEach((function(e,t){if("string"===typeof t&&(t=q(e,t,!0)),t>65535)throw new a.FormatError("Max size of CID is 65,535");var i=-1;fe?i=t:void 0!==he[t]&&(i=he[t]),i>=0&&i<N&&me(i)&&(pe[e]=i)}))}else{var ye=function(e,t,i,n){if(!e)return(0,a.warn)("No cmap table available."),{platformId:-1,encodingId:-1,mappings:[],hasShortCmap:!1};var r,o=(t.start||0)+e.offset;t.pos=o,t.skip(2);for(var s,l=t.getUint16(),c=!1,d=0;d<l;d++){var u=t.getUint16(),p=t.getUint16(),m=t.getInt32()>>>0,h=!1;if(!s||s.platformId!==u||s.encodingId!==p){if(0!==u||0!==p&&1!==p&&3!==p)if(1===u&&0===p)h=!0;else if(3!==u||1!==p||!n&&s){if(i&&3===u&&0===p){h=!0;var f=!0;if(d<l-1){var y=t.peekBytes(2);T(y[0],y[1])<u&&(f=!1)}f&&(c=!0)}}else h=!0,i||(c=!0);else h=!0;if(h&&(s={platformId:u,encodingId:p,offset:m}),c)break}}if(s&&(t.pos=o+s.offset),!s||-1===t.peekByte())return(0,a.warn)("Could not find a preferred cmap table."),{platformId:-1,encodingId:-1,mappings:[],hasShortCmap:!1};var b,g,v=t.getUint16(),_=!1,A=[];if(0===v){for(t.skip(4),b=0;b<256;b++){var x=t.getByte();x&&A.push({charCode:b,glyphId:x})}_=!0}else if(2===v){t.skip(4);for(var w=[],S=0,C=0;C<256;C++){var k=t.getUint16()>>3;w.push(k),S=Math.max(k,S)}for(var D=[],R=0;R<=S;R++)D.push({firstCode:t.getUint16(),entryCount:t.getUint16(),idDelta:z(t.getByte(),t.getByte()),idRangePos:t.pos+t.getUint16()});for(var I=0;I<256;I++)if(0===w[I])t.pos=D[0].idRangePos+2*I,g=t.getUint16(),A.push({charCode:I,glyphId:g});else{var M=D[w[I]];for(b=0;b<M.entryCount;b++){var P=(I<<8)+b+M.firstCode;t.pos=M.idRangePos+2*b,0!==(g=t.getUint16())&&(g=(g+M.idDelta)%65536),A.push({charCode:P,glyphId:g})}}}else if(4===v){t.skip(4);var B=t.getUint16()>>1;t.skip(6);var F,E=[];for(F=0;F<B;F++)E.push({end:t.getUint16()});for(t.skip(2),F=0;F<B;F++)E[F].start=t.getUint16();for(F=0;F<B;F++)E[F].delta=t.getUint16();var N,O=0;for(F=0;F<B;F++){r=E[F];var G=t.getUint16();G?(N=(G>>1)-(B-F),r.offsetIndex=N,O=Math.max(O,N+r.end-r.start+1)):r.offsetIndex=-1}var L=[];for(b=0;b<O;b++)L.push(t.getUint16());for(F=0;F<B;F++){o=(r=E[F]).start;var j=r.end,q=r.delta;for(N=r.offsetIndex,b=o;b<=j;b++)65535!==b&&(g=(g=N<0?b:L[N+b-o])+q&65535,A.push({charCode:b,glyphId:g}))}}else if(6===v){t.skip(4);var H=t.getUint16(),U=t.getUint16();for(b=0;b<U;b++){g=t.getUint16();var Y=H+b;A.push({charCode:Y,glyphId:g})}}else{if(12!==v)return(0,a.warn)("cmap table has unsupported format: "+v),{platformId:-1,encodingId:-1,mappings:[],hasShortCmap:!1};t.skip(10);var X=t.getInt32()>>>0;for(b=0;b<X;b++)for(var V=t.getInt32()>>>0,Q=t.getInt32()>>>0,W=t.getInt32()>>>0,Z=V;Z<=Q;Z++)A.push({charCode:Z,glyphId:W++})}A.sort((function(e,t){return e.charCode-t.charCode}));for(var J=1;J<A.length;J++)A[J-1].charCode===A[J].charCode&&(A.splice(J,1),J--);return{platformId:s.platformId,encodingId:s.encodingId,mappings:A,hasShortCmap:_}}(w.cmap,t,this.isSymbolicFont,i.hasEncoding),be=ye.platformId,ge=ye.encodingId,ve=ye.mappings,_e=[],Ae=!1;if(!i.hasEncoding||"MacRomanEncoding"!==i.baseEncodingName&&"WinAnsiEncoding"!==i.baseEncodingName||(_e=(0,l.getEncoding)(i.baseEncodingName)),i.hasEncoding&&!this.isSymbolicFont&&(3===be&&1===ge||1===be&&0===ge))for(var xe=(0,s.getGlyphsUnicode)(),we=0;we<256;we++){var Se=void 0;if(Se=void 0!==this.differences[we]?this.differences[we]:_e.length&&""!==_e[we]?_e[we]:l.StandardEncoding[we]){var Ce=(0,r.recoverGlyphName)(Se,xe),ke=void 0;if(3===be&&1===ge?ke=xe[Ce]:1===be&&0===ge&&(ke=l.MacRomanEncoding.indexOf(Ce)),void 0===ke){if(!i.glyphNames&&i.hasIncludedToUnicodeMap&&!(this.toUnicode instanceof d.IdentityToUnicodeMap)){var De=this.toUnicode.get(we);De&&(ke=De.codePointAt(0))}if(void 0===ke)continue}var Re,Ie=h(ve);try{for(Ie.s();!(Re=Ie.n()).done;){var Me=Re.value;if(Me.charCode===ke){pe[we]=Me.glyphId;break}}}catch(Ze){Ie.e(Ze)}finally{Ie.f()}}}else if(0===be){var Te,Pe=h(ve);try{for(Pe.s();!(Te=Pe.n()).done;){var ze=Te.value;pe[ze.charCode]=ze.glyphId}}catch(Ze){Pe.e(Ze)}finally{Pe.f()}Ae=!0}else{var Be,Fe=h(ve);try{for(Fe.s();!(Be=Fe.n()).done;){var Ee=Be.value,Ne=Ee.charCode;3===be&&Ne>=61440&&Ne<=61695&&(Ne&=255),pe[Ne]=Ee.glyphId}}catch(Ze){Fe.e(Ze)}finally{Fe.f()}}if(i.glyphNames&&(_e.length||this.differences.length))for(var Oe=0;Oe<256;++Oe)if(Ae||void 0===pe[Oe]){var Ge=this.differences[Oe]||_e[Oe];if(Ge){var Le=i.glyphNames.indexOf(Ge);Le>0&&me(Le)&&(pe[Oe]=Le)}}}0===pe.length&&(pe[0]=0);var je=ae-1;if(ne||(je=0),!i.cssFontInfo){var qe=H(pe,me,je,this.toUnicode);this.toFontChar=qe.toFontChar,w.cmap={tag:"cmap",data:U(qe.charCodeToGlyphId,qe.toUnicodeExtraMap,ae)},w["OS/2"]&&function(e,t){t.pos=(t.start||0)+e.offset;var i=t.getUint16();t.skip(60);var a=t.getUint16();return!(i<4&&768&a)&&!(t.getUint16()>t.getUint16())&&(t.skip(6),0!==t.getUint16()&&(e.data[8]=e.data[9]=0,!0))}(w["OS/2"],t)||(w["OS/2"]={tag:"OS/2",data:Y(i,qe.charCodeToGlyphId,ue)})}if(!M)try{C=new x.Stream(w["CFF "].data),(S=new n.CFFParser(C,i,r.SEAC_ANALYSIS_ENABLED).parse()).duplicateFirstGlyph();var He=new n.CFFCompiler(S);w["CFF "].data=He.compile()}catch(Je){(0,a.warn)("Failed to compile font "+i.loadedName)}if(w.name){var Ue=g(w.name),Ye=f(Ue,2),Xe=Ye[0],Ve=Ye[1];w.name.data=Q(e,Xe),this.psName=Xe[0][6]||null,i.composite||function(e,t,i){if(!e.isInternalFont&&!e.hasIncludedToUnicodeMap&&!e.hasEncoding&&!(e.toUnicode instanceof d.IdentityToUnicodeMap)&&t&&0!==i.length&&e.defaultEncoding!==l.WinAnsiEncoding){var a,n=h(i);try{for(n.s();!(a=n.n()).done;)if(!j(a.value))return}catch(Ze){n.e(Ze)}finally{n.f()}var r=l.WinAnsiEncoding,o=[],c=(0,s.getGlyphsUnicode)();for(var u in r){var p=r[u];if(""!==p){var m=c[p];void 0!==m&&(o[u]=String.fromCharCode(m))}}o.length>0&&e.toUnicode.amend(o)}}(i,this.isSymbolicFont,Ve)}else w.name={tag:"name",data:Q(this.name)};var Qe=new _.OpenTypeFileBuilder(A.version);for(var We in w)Qe.addTable(We,w[We].data);return Qe.toArray()}},{key:"convert",value:function(e,t,i){i.fixedPitch=!1,i.builtInEncoding&&function(e,t){if(!e.isInternalFont&&!e.hasIncludedToUnicodeMap&&t!==e.defaultEncoding&&!(e.toUnicode instanceof d.IdentityToUnicodeMap)){var i=[],a=(0,s.getGlyphsUnicode)();for(var n in t)if(!e.hasEncoding||!e.baseEncodingName&&void 0===e.differences[n]){var r=t[n],l=(0,o.getUnicodeForGlyph)(r,a);-1!==l&&(i[n]=String.fromCharCode(l))}i.length>0&&e.toUnicode.amend(i)}}(i,i.builtInEncoding);var n=1;t instanceof u.CFFFont&&(n=t.numGlyphs-1);var c=t.getGlyphMapping(i),p=null,m=c,f=null;i.cssFontInfo||(p=H(c,t.hasGlyphId.bind(t),n,this.toUnicode),this.toFontChar=p.toFontChar,m=p.charCodeToGlyphId,f=p.toUnicodeExtraMap);var y=t.numGlyphs;function b(e,t){var i=null;for(var a in e)t===e[a]&&(i||(i=[]),i.push(0|a));return i}function g(e,t){for(var i in e)if(t===e[i])return 0|i;return p.charCodeToGlyphId[p.nextAvailableFontCharCode]=t,p.nextAvailableFontCharCode++}var v=t.seacs;if(p&&r.SEAC_ANALYSIS_ENABLED&&v&&v.length){var A=i.fontMatrix||a.FONT_IDENTITY_MATRIX,x=t.getCharset(),w=Object.create(null);for(var S in v){var C=v[S|=0],k=l.StandardEncoding[C[2]],D=l.StandardEncoding[C[3]],R=x.indexOf(k),I=x.indexOf(D);if(!(R<0||I<0)){var M={x:C[0]*A[0]+C[1]*A[2]+A[4],y:C[0]*A[1]+C[1]*A[3]+A[5]},T=b(c,S);if(T){var P,z=h(T);try{for(z.s();!(P=z.n()).done;){var E=P.value,N=p.charCodeToGlyphId,O=g(N,R),G=g(N,I);w[E]={baseFontCharCode:O,accentFontCharCode:G,accentOffset:M}}}catch(q){z.e(q)}finally{z.f()}}}}i.seacMap=w}var L=1/(i.fontMatrix||a.FONT_IDENTITY_MATRIX)[0],j=new _.OpenTypeFileBuilder("OTTO");return j.addTable("CFF ",t.data),j.addTable("OS/2",Y(i,m)),j.addTable("cmap",U(m,f,y)),j.addTable("head","\0\x01\0\0\0\0\x10\0\0\0\0\0_\x0f<\xf5\0\0"+F(L)+"\0\0\0\0\x9e\v~'\0\0\0\0\x9e\v~'\0\0"+F(i.descent)+"\x0f\xff"+F(i.ascent)+B(i.italicAngle?2:0)+"\0\x11\0\0\0\0\0\0"),j.addTable("hhea","\0\x01\0\0"+F(i.ascent)+F(i.descent)+"\0\0\xff\xff\0\0\0\0\0\0"+F(i.capHeight)+F(Math.tan(i.italicAngle)*i.xHeight)+"\0\0\0\0\0\0\0\0\0\0\0\0"+B(y)),j.addTable("hmtx",function(){for(var e=t.charstrings,i=t.cff?t.cff.widths:null,a="\0\0\0\0",n=1,r=y;n<r;n++){var o=0;if(e){var s=e[n-1];o="width"in s?s.width:0}else i&&(o=Math.ceil(i[n]||0));a+=B(o)+B(0)}return a}()),j.addTable("maxp","\0\0P\0"+B(y)),j.addTable("name",Q(e)),j.addTable("post",X(i)),j.toArray()}},{key:"spaceWidth",get:function(){for(var e,t=0,i=["space","minus","one","i","I"];t<i.length;t++){var n=i[t];if(n in this.widths){e=this.widths[n];break}var r=(0,s.getGlyphsUnicode)()[n],o=0;if(this.composite&&this.cMap.contains(r)&&"string"===typeof(o=this.cMap.lookup(r))&&(o=q(r,o)),!o&&this.toUnicode&&(o=this.toUnicode.charCodeOf(r)),o<=0&&(o=r),e=this.widths[o])break}return e=e||this.defaultWidth,(0,a.shadow)(this,"spaceWidth",e)}},{key:"_charToGlyph",value:function(e){var t,i,n,r=arguments.length>1&&void 0!==arguments[1]&&arguments[1],s=this._glyphCache[e];if(s&&s.isSpace===r)return s;var l=e;this.cMap&&this.cMap.contains(e)&&"string"===typeof(l=this.cMap.lookup(e))&&(l=q(e,l)),"number"!==typeof(i=this.widths[l])&&(i=this.defaultWidth);var c=this.vmetrics&&this.vmetrics[l],d=this.toUnicode.get(e)||e;"number"===typeof d&&(d=String.fromCharCode(d));var u=void 0!==this.toFontChar[e];if(t=this.toFontChar[e]||e,this.missingFile){var p=this.differences[e]||this.defaultEncoding[e];".notdef"!==p&&""!==p||"Type1"!==this.type||(t=32),t=(0,o.mapSpecialUnicodeValues)(t)}this.isType3Font&&(n=t);var m=null;if(this.seacMap&&this.seacMap[e]){u=!0;var h=this.seacMap[e];t=h.baseFontCharCode,m={fontChar:String.fromCodePoint(h.accentFontCharCode),offset:h.accentOffset}}var f="";return"number"===typeof t&&(t<=1114111?f=String.fromCodePoint(t):(0,a.warn)("charToGlyph - invalid fontCharCode: ".concat(t))),s=new M(e,f,d,m,i,c,n,r,u),this._glyphCache[e]=s}},{key:"charsToGlyphs",value:function(e){var t=this._charsCache[e];if(t)return t;if(t=[],this.cMap)for(var i=Object.create(null),a=e.length,n=0;n<a;){this.cMap.readCharCode(e,n,i);var r=i.charcode,o=i.length;n+=o;var s=this._charToGlyph(r,1===o&&32===e.charCodeAt(n-1));t.push(s)}else for(var l=0,c=e.length;l<c;++l){var d=e.charCodeAt(l),u=this._charToGlyph(d,32===d);t.push(u)}return this._charsCache[e]=t}},{key:"getCharPositions",value:function(e){var t=[];if(this.cMap)for(var i=Object.create(null),a=0;a<e.length;){this.cMap.readCharCode(e,a,i);var n=i.length;t.push([a,a+n]),a+=n}else for(var r=0,o=e.length;r<o;++r)t.push([r,r+1]);return t}},{key:"glyphCacheValues",get:function(){return Object.values(this._glyphCache)}},{key:"encodeString",value:function(e){for(var t=this,i=[],a=[],n=function(){return i.length%2===1},r=this.toUnicode instanceof d.IdentityToUnicodeMap?function(e){return t.toUnicode.charCodeOf(e)}:function(e){return t.toUnicode.charCodeOf(String.fromCodePoint(e))},o=0,s=e.length;o<s;o++){var l=e.codePointAt(o);if(l>55295&&(l<57344||l>65533)&&o++,this.toUnicode){var c=r(l);if(-1!==c){n()&&(i.push(a.join("")),a.length=0);for(var u=(this.cMap?this.cMap.getCharCodeLength(c):1)-1;u>=0;u--)a.push(String.fromCharCode(c>>8*u&255));continue}}n()||(i.push(a.join("")),a.length=0),a.push(String.fromCodePoint(l))}return i.push(a.join("")),i}}]),e}();t.Font=W;var Z=function(){function e(t){b(this,e),this.error=t,this.loadedName="g_font_error",this.missingFile=!0}return g(e,[{key:"charsToGlyphs",value:function(){return[]}},{key:"encodeString",value:function(e){return[e]}},{key:"exportData",value:function(){return{error:this.error}}}]),e}();t.ErrorFont=Z},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.CFFTopDict=t.CFFStrings=t.CFFStandardStrings=t.CFFPrivateDict=t.CFFParser=t.CFFIndex=t.CFFHeader=t.CFFFDSelect=t.CFFCompiler=t.CFFCharset=t.CFF=void 0;var a=i(2),n=i(167),r=i(168),o=[".notdef","space","exclam","quotedbl","numbersign","dollar","percent","ampersand","quoteright","parenleft","parenright","asterisk","plus","comma","hyphen","period","slash","zero","one","two","three","four","five","six","seven","eight","nine","colon","semicolon","less","equal","greater","question","at","A","B","C","D","E","F","G","H","I","J","K","L","M","N","O","P","Q","R","S","T","U","V","W","X","Y","Z","bracketleft","backslash","bracketright","asciicircum","underscore","quoteleft","a","b","c","d","e","f","g","h","i","j","k","l","m","n","o","p","q","r","s","t","u","v","w","x","y","z","braceleft","bar","braceright","asciitilde","exclamdown","cent","sterling","fraction","yen","florin","section","currency","quotesingle","quotedblleft","guillemotleft","guilsinglleft","guilsinglright","fi","fl","endash","dagger","daggerdbl","periodcentered","paragraph","bullet","quotesinglbase","quotedblbase","quotedblright","guillemotright","ellipsis","perthousand","questiondown","grave","acute","circumflex","tilde","macron","breve","dotaccent","dieresis","ring","cedilla","hungarumlaut","ogonek","caron","emdash","AE","ordfeminine","Lslash","Oslash","OE","ordmasculine","ae","dotlessi","lslash","oslash","oe","germandbls","onesuperior","logicalnot","mu","trademark","Eth","onehalf","plusminus","Thorn","onequarter","divide","brokenbar","degree","thorn","threequarters","twosuperior","registered","minus","eth","multiply","threesuperior","copyright","Aacute","Acircumflex","Adieresis","Agrave","Aring","Atilde","Ccedilla","Eacute","Ecircumflex","Edieresis","Egrave","Iacute","Icircumflex","Idieresis","Igrave","Ntilde","Oacute","Ocircumflex","Odieresis","Ograve","Otilde","Scaron","Uacute","Ucircumflex","Udieresis","Ugrave","Yacute","Ydieresis","Zcaron","aacute","acircumflex","adieresis","agrave","aring","atilde","ccedilla","eacute","ecircumflex","edieresis","egrave","iacute","icircumflex","idieresis","igrave","ntilde","oacute","ocircumflex","odieresis","ograve","otilde","scaron","uacute","ucircumflex","udieresis","ugrave","yacute","ydieresis","zcaron","exclamsmall","Hungarumlautsmall","dollaroldstyle","dollarsuperior","ampersandsmall","Acutesmall","parenleftsuperior","parenrightsuperior","twodotenleader","onedotenleader","zerooldstyle","oneoldstyle","twooldstyle","threeoldstyle","fouroldstyle","fiveoldstyle","sixoldstyle","sevenoldstyle","eightoldstyle","nineoldstyle","commasuperior","threequartersemdash","periodsuperior","questionsmall","asuperior","bsuperior","centsuperior","dsuperior","esuperior","isuperior","lsuperior","msuperior","nsuperior","osuperior","rsuperior","ssuperior","tsuperior","ff","ffi","ffl","parenleftinferior","parenrightinferior","Circumflexsmall","hyphensuperior","Gravesmall","Asmall","Bsmall","Csmall","Dsmall","Esmall","Fsmall","Gsmall","Hsmall","Ismall","Jsmall","Ksmall","Lsmall","Msmall","Nsmall","Osmall","Psmall","Qsmall","Rsmall","Ssmall","Tsmall","Usmall","Vsmall","Wsmall","Xsmall","Ysmall","Zsmall","colonmonetary","onefitted","rupiah","Tildesmall","exclamdownsmall","centoldstyle","Lslashsmall","Scaronsmall","Zcaronsmall","Dieresissmall","Brevesmall","Caronsmall","Dotaccentsmall","Macronsmall","figuredash","hypheninferior","Ogoneksmall","Ringsmall","Cedillasmall","questiondownsmall","oneeighth","threeeighths","fiveeighths","seveneighths","onethird","twothirds","zerosuperior","foursuperior","fivesuperior","sixsuperior","sevensuperior","eightsuperior","ninesuperior","zeroinferior","oneinferior","twoinferior","threeinferior","fourinferior","fiveinferior","sixinferior","seveninferior","eightinferior","nineinferior","centinferior","dollarinferior","periodinferior","commainferior","Agravesmall","Aacutesmall","Acircumflexsmall","Atildesmall","Adieresissmall","Aringsmall","AEsmall","Ccedillasmall","Egravesmall","Eacutesmall","Ecircumflexsmall","Edieresissmall","Igravesmall","Iacutesmall","Icircumflexsmall","Idieresissmall","Ethsmall","Ntildesmall","Ogravesmall","Oacutesmall","Ocircumflexsmall","Otildesmall","Odieresissmall","OEsmall","Oslashsmall","Ugravesmall","Uacutesmall","Ucircumflexsmall","Udieresissmall","Yacutesmall","Thornsmall","Ydieresissmall","001.000","001.001","001.002","001.003","Black","Bold","Book","Light","Medium","Regular","Roman","Semibold"];t.CFFStandardStrings=o;var s=391,l=[null,{id:"hstem",min:2,stackClearing:!0,stem:!0},null,{id:"vstem",min:2,stackClearing:!0,stem:!0},{id:"vmoveto",min:1,stackClearing:!0},{id:"rlineto",min:2,resetStack:!0},{id:"hlineto",min:1,resetStack:!0},{id:"vlineto",min:1,resetStack:!0},{id:"rrcurveto",min:6,resetStack:!0},null,{id:"callsubr",min:1,undefStack:!0},{id:"return",min:0,undefStack:!0},null,null,{id:"endchar",min:0,stackClearing:!0},null,null,null,{id:"hstemhm",min:2,stackClearing:!0,stem:!0},{id:"hintmask",min:0,stackClearing:!0},{id:"cntrmask",min:0,stackClearing:!0},{id:"rmoveto",min:2,stackClearing:!0},{id:"hmoveto",min:1,stackClearing:!0},{id:"vstemhm",min:2,stackClearing:!0,stem:!0},{id:"rcurveline",min:8,resetStack:!0},{id:"rlinecurve",min:8,resetStack:!0},{id:"vvcurveto",min:4,resetStack:!0},{id:"hhcurveto",min:4,resetStack:!0},null,{id:"callgsubr",min:1,undefStack:!0},{id:"vhcurveto",min:4,resetStack:!0},{id:"hvcurveto",min:4,resetStack:!0}],p=[null,null,null,{id:"and",min:2,stackDelta:-1},{id:"or",min:2,stackDelta:-1},{id:"not",min:1,stackDelta:0},null,null,null,{id:"abs",min:1,stackDelta:0},{id:"add",min:2,stackDelta:-1,stackFn:function(e,t){e[t-2]=e[t-2]+e[t-1]}},{id:"sub",min:2,stackDelta:-1,stackFn:function(e,t){e[t-2]=e[t-2]-e[t-1]}},{id:"div",min:2,stackDelta:-1,stackFn:function(e,t){e[t-2]=e[t-2]/e[t-1]}},null,{id:"neg",min:1,stackDelta:0,stackFn:function(e,t){e[t-1]=-e[t-1]}},{id:"eq",min:2,stackDelta:-1},null,null,{id:"drop",min:1,stackDelta:-1},null,{id:"put",min:2,stackDelta:-2},{id:"get",min:1,stackDelta:0},{id:"ifelse",min:4,stackDelta:-3},{id:"random",min:0,stackDelta:1},{id:"mul",min:2,stackDelta:-1,stackFn:function(e,t){e[t-2]=e[t-2]*e[t-1]}},null,{id:"sqrt",min:1,stackDelta:0},{id:"dup",min:1,stackDelta:1},{id:"exch",min:2,stackDelta:0},{id:"index",min:2,stackDelta:0},{id:"roll",min:3,stackDelta:-2},null,null,null,{id:"hflex",min:7,resetStack:!0},{id:"flex",min:13,resetStack:!0},{id:"hflex1",min:9,resetStack:!0},{id:"flex1",min:11,resetStack:!0}],m=function(){function e(t,i,a){b(this,e),this.bytes=t.getBytes(),this.properties=i,this.seacAnalysisEnabled=!!a}return g(e,[{key:"parse",value:function(){var e=this.properties,t=new y;this.cff=t;var i=this.parseHeader(),a=this.parseIndex(i.endPos),n=this.parseIndex(a.endPos),r=this.parseIndex(n.endPos),o=this.parseIndex(r.endPos),s=this.parseDict(n.obj.get(0)),l=this.createDict(S,s,t.strings);t.header=i.obj,t.names=this.parseNameIndex(a.obj),t.strings=this.parseStringIndex(r.obj),t.topDict=l,t.globalSubrIndex=o.obj,this.parsePrivateDict(t.topDict),t.isCIDFont=l.hasName("ROS");var c=l.getByName("CharStrings"),d=this.parseIndex(c).obj,u=l.getByName("FontMatrix");u&&(e.fontMatrix=u);var p,m,h=l.getByName("FontBBox");if(h&&(e.ascent=Math.max(h[3],h[1]),e.descent=Math.min(h[1],h[3]),e.ascentScaled=!0),t.isCIDFont){for(var f=this.parseIndex(l.getByName("FDArray")).obj,b=0,g=f.count;b<g;++b){var v=f.get(b),_=this.createDict(S,this.parseDict(v),t.strings);this.parsePrivateDict(_),t.fdArray.push(_)}m=null,p=this.parseCharsets(l.getByName("charset"),d.count,t.strings,!0),t.fdSelect=this.parseFDSelect(l.getByName("FDSelect"),d.count)}else p=this.parseCharsets(l.getByName("charset"),d.count,t.strings,!1),m=this.parseEncoding(l.getByName("Encoding"),e,t.strings,p.charset);t.charset=p,t.encoding=m;var A=this.parseCharStrings({charStrings:d,localSubrIndex:l.privateDict.subrsIndex,globalSubrIndex:o.obj,fdSelect:t.fdSelect,fdArray:t.fdArray,privateDict:l.privateDict});return t.charStrings=A.charStrings,t.seacs=A.seacs,t.widths=A.widths,t}},{key:"parseHeader",value:function(){for(var e=this.bytes,t=e.length,i=0;i<t&&1!==e[i];)++i;if(i>=t)throw new a.FormatError("Invalid CFF header");0!==i&&((0,a.info)("cff data is shifted"),e=e.subarray(i),this.bytes=e);var n=e[0],r=e[1],o=e[2],s=e[3];return{obj:new v(n,r,o,s),endPos:o}}},{key:"parseDict",value:function(e){var t=0;function i(){var i=e[t++];return 30===i?function(){for(var i="",a=15,n=["0","1","2","3","4","5","6","7","8","9",".","E","E-",null,"-"],r=e.length;t<r;){var o=e[t++],s=o>>4,l=15&o;if(s===a)break;if(i+=n[s],l===a)break;i+=n[l]}return parseFloat(i)}():28===i?i=((i=e[t++])<<24|e[t++]<<16)>>16:29===i?i=(i=(i=(i=e[t++])<<8|e[t++])<<8|e[t++])<<8|e[t++]:i>=32&&i<=246?i-139:i>=247&&i<=250?256*(i-247)+e[t++]+108:i>=251&&i<=254?-256*(i-251)-e[t++]-108:((0,a.warn)('CFFParser_parseDict: "'+i+'" is a reserved command.'),NaN)}var n=[],r=[];t=0;for(var o=e.length;t<o;){var s=e[t];s<=21?(12===s&&(s=s<<8|e[++t]),r.push([s,n]),n=[],++t):n.push(i())}return r}},{key:"parseIndex",value:function(e){var t,i,a=new A,n=this.bytes,r=n[e++]<<8|n[e++],o=[],s=e;if(0!==r){var l=n[e++],c=e+(r+1)*l-1;for(t=0,i=r+1;t<i;++t){for(var d=0,u=0;u<l;++u)d<<=8,d+=n[e++];o.push(c+d)}s=o[r]}for(t=0,i=o.length-1;t<i;++t){var p=o[t],m=o[t+1];a.add(n.subarray(p,m))}return{obj:a,endPos:s}}},{key:"parseNameIndex",value:function(e){for(var t=[],i=0,n=e.count;i<n;++i){var r=e.get(i);t.push((0,a.bytesToString)(r))}return t}},{key:"parseStringIndex",value:function(e){for(var t=new _,i=0,n=e.count;i<n;++i){var r=e.get(i);t.add((0,a.bytesToString)(r))}return t}},{key:"createDict",value:function(e,t,i){var a,n=new e(i),r=h(t);try{for(r.s();!(a=r.n()).done;){var o=f(a.value,2),s=o[0],l=o[1];n.setByKey(s,l)}}catch(c){r.e(c)}finally{r.f()}return n}},{key:"parseCharString",value:function(e,t,i,n){if(!t||e.callDepth>10)return!1;for(var r=e.stackSize,o=e.stack,s=t.length,c=0;c<s;){var d=t[c++],u=null;if(12===d){var m=t[c++];0===m?(t[c-2]=139,t[c-1]=22,r=0):u=p[m]}else if(28===d)o[r]=(t[c]<<24|t[c+1]<<16)>>16,c+=2,r++;else if(14===d){if(r>=4&&(r-=4,this.seacAnalysisEnabled))return e.seac=o.slice(r,r+4),!1;u=l[d]}else if(d>=32&&d<=246)o[r]=d-139,r++;else if(d>=247&&d<=254)o[r]=d<251?(d-247<<8)+t[c]+108:-(d-251<<8)-t[c]-108,c++,r++;else if(255===d)o[r]=(t[c]<<24|t[c+1]<<16|t[c+2]<<8|t[c+3])/65536,c+=4,r++;else if(19===d||20===d)e.hints+=r>>1,c+=e.hints+7>>3,r%=2,u=l[d];else{if(10===d||29===d){var h=void 0;if(!(h=10===d?i:n))return u=l[d],(0,a.warn)("Missing subrsIndex for "+u.id),!1;var f=32768;h.count<1240?f=107:h.count<33900&&(f=1131);var y=o[--r]+f;if(y<0||y>=h.count||isNaN(y))return u=l[d],(0,a.warn)("Out of bounds subrIndex for "+u.id),!1;if(e.stackSize=r,e.callDepth++,!this.parseCharString(e,h.get(y),i,n))return!1;e.callDepth--,r=e.stackSize;continue}if(11===d)return e.stackSize=r,!0;if(0===d&&c===t.length)t[c-1]=14,u=l[14];else{if(9===d){t.copyWithin(c-1,c,-1),c-=1,s-=1;continue}u=l[d]}}if(u){if(u.stem&&(e.hints+=r>>1,3===d||23===d?e.hasVStems=!0:!e.hasVStems||1!==d&&18!==d||((0,a.warn)("CFF stem hints are in wrong order"),t[c-1]=1===d?3:23)),"min"in u&&!e.undefStack&&r<u.min)return(0,a.warn)("Not enough parameters for "+u.id+"; actual: "+r+", expected: "+u.min),0===r&&(t[c-1]=14,!0);e.firstStackClearing&&u.stackClearing&&(e.firstStackClearing=!1,(r-=u.min)>=2&&u.stem?r%=2:r>1&&(0,a.warn)("Found too many parameters for stack-clearing command"),r>0&&(e.width=o[r-1])),"stackDelta"in u?("stackFn"in u&&u.stackFn(o,r),r+=u.stackDelta):u.stackClearing?r=0:u.resetStack?(r=0,e.undefStack=!1):u.undefStack&&(r=0,e.undefStack=!0,e.firstStackClearing=!1)}}return s<t.length&&t.fill(14,s),e.stackSize=r,!0}},{key:"parseCharStrings",value:function(e){for(var t=e.charStrings,i=e.localSubrIndex,n=e.globalSubrIndex,r=e.fdSelect,o=e.fdArray,s=e.privateDict,l=[],c=[],d=t.count,u=0;u<d;u++){var p=t.get(u),m={callDepth:0,stackSize:0,stack:[],undefStack:!0,hints:0,firstStackClearing:!0,seac:null,width:null,hasVStems:!1},h=!0,f=null,y=s;if(r&&o.length){var b=r.getFDIndex(u);-1===b&&((0,a.warn)("Glyph index is not in fd select."),h=!1),b>=o.length&&((0,a.warn)("Invalid fd index for glyph index."),h=!1),h&&(f=(y=o[b].privateDict).subrsIndex)}else i&&(f=i);if(h&&(h=this.parseCharString(m,p,f,n)),null!==m.width){var g=y.getByName("nominalWidthX");c[u]=g+m.width}else{var v=y.getByName("defaultWidthX");c[u]=v}null!==m.seac&&(l[u]=m.seac),h||t.set(u,new Uint8Array([14]))}return{charStrings:t,seacs:l,widths:c}}},{key:"emptyPrivateDictionary",value:function(e){var t=this.createDict(k,[],e.strings);e.setByKey(18,[0,0]),e.privateDict=t}},{key:"parsePrivateDict",value:function(e){if(e.hasName("Private")){var t=e.getByName("Private");if(Array.isArray(t)&&2===t.length){var i=t[0],a=t[1];if(0===i||a>=this.bytes.length)this.emptyPrivateDictionary(e);else{var n=a+i,r=this.bytes.subarray(a,n),o=this.parseDict(r),s=this.createDict(k,o,e.strings);if(e.privateDict=s,0===s.getByName("ExpansionFactor")&&s.setByName("ExpansionFactor",.06),s.getByName("Subrs")){var l=s.getByName("Subrs"),c=a+l;if(0===l||c>=this.bytes.length)this.emptyPrivateDictionary(e);else{var d=this.parseIndex(c);s.subrsIndex=d.obj}}}}else e.removeByName("Private")}else this.emptyPrivateDictionary(e)}},{key:"parseCharsets",value:function(e,t,i,r){if(0===e)return new R(!0,D.ISO_ADOBE,n.ISOAdobeCharset);if(1===e)return new R(!0,D.EXPERT,n.ExpertCharset);if(2===e)return new R(!0,D.EXPERT_SUBSET,n.ExpertSubsetCharset);var o,s,l,c=this.bytes,d=e,u=c[e++],p=[r?0:".notdef"];switch(t-=1,u){case 0:for(l=0;l<t;l++)o=c[e++]<<8|c[e++],p.push(r?o:i.get(o));break;case 1:for(;p.length<=t;)for(o=c[e++]<<8|c[e++],s=c[e++],l=0;l<=s;l++)p.push(r?o++:i.get(o++));break;case 2:for(;p.length<=t;)for(o=c[e++]<<8|c[e++],s=c[e++]<<8|c[e++],l=0;l<=s;l++)p.push(r?o++:i.get(o++));break;default:throw new a.FormatError("Unknown charset format")}var m=e,h=c.subarray(d,m);return new R(!1,u,p,h)}},{key:"parseEncoding",value:function(e,t,i,n){var o,s,l,c=Object.create(null),d=this.bytes,u=!1,p=null;if(0===e||1===e){u=!0,o=e;var m=e?r.ExpertEncoding:r.StandardEncoding;for(s=0,l=n.length;s<l;s++){var h=m.indexOf(n[s]);-1!==h&&(c[h]=s)}}else{var f=e;switch(127&(o=d[e++])){case 0:var y=d[e++];for(s=1;s<=y;s++)c[d[e++]]=s;break;case 1:var b=d[e++],g=1;for(s=0;s<b;s++)for(var v=d[e++],_=d[e++],A=v;A<=v+_;A++)c[A]=g++;break;default:throw new a.FormatError("Unknown encoding format: ".concat(o," in CFF"))}var x=e;128&o&&(d[f]&=127,function(){var t=d[e++];for(s=0;s<t;s++){var a=d[e++],r=(d[e++]<<8)+(255&d[e++]);c[a]=n.indexOf(i.get(r))}}()),p=d.subarray(f,x)}return new I(u,o&=127,c,p)}},{key:"parseFDSelect",value:function(e,t){var i,n=this.bytes,r=n[e++],o=[];switch(r){case 0:for(i=0;i<t;++i){var s=n[e++];o.push(s)}break;case 3:var l=n[e++]<<8|n[e++];for(i=0;i<l;++i){var c=n[e++]<<8|n[e++];0===i&&0!==c&&((0,a.warn)("parseFDSelect: The first range must have a first GID of 0 -- trying to recover."),c=0);for(var d=n[e++],u=n[e]<<8|n[e+1],p=c;p<u;++p)o.push(d)}e+=2;break;default:throw new a.FormatError('parseFDSelect: Unknown format "'.concat(r,'".'))}if(o.length!==t)throw new a.FormatError("parseFDSelect: Invalid font data.");return new M(r,o)}}]),e}();t.CFFParser=m;var 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p=(0,a.getLookupTableFactory)((function(e){e[1]=32,e[4]=65,e[5]=192,e[6]=193,e[9]=196,e[17]=66,e[18]=67,e[21]=268,e[24]=68,e[28]=69,e[29]=200,e[30]=201,e[32]=282,e[38]=70,e[39]=71,e[44]=72,e[47]=73,e[48]=204,e[49]=205,e[58]=74,e[60]=75,e[62]=76,e[68]=77,e[69]=78,e[75]=79,e[76]=210,e[80]=214,e[87]=80,e[89]=81,e[90]=82,e[92]=344,e[94]=83,e[97]=352,e[100]=84,e[104]=85,e[109]=220,e[115]=86,e[116]=87,e[121]=88,e[122]=89,e[124]=221,e[127]=90,e[129]=381,e[258]=97,e[259]=224,e[260]=225,e[263]=228,e[268]=261,e[271]=98,e[272]=99,e[273]=263,e[275]=269,e[282]=100,e[286]=101,e[287]=232,e[288]=233,e[290]=283,e[295]=281,e[296]=102,e[336]=103,e[346]=104,e[349]=105,e[350]=236,e[351]=237,e[361]=106,e[364]=107,e[367]=108,e[371]=322,e[373]=109,e[374]=110,e[381]=111,e[382]=242,e[383]=243,e[386]=246,e[393]=112,e[395]=113,e[396]=114,e[398]=345,e[400]=115,e[401]=347,e[403]=353,e[410]=116,e[437]=117,e[442]=252,e[448]=118,e[449]=119,e[454]=120,e[455]=121,e[457]=253,e[460]=122,e[462]=382,e[463]=380,e[853]=44,e[855]=58,e[856]=46,e[876]=47,e[878]=45,e[882]=45,e[894]=40,e[895]=41,e[896]=91,e[897]=93,e[923]=64,e[1004]=48,e[1005]=49,e[1006]=50,e[1007]=51,e[1008]=52,e[1009]=53,e[1010]=54,e[1011]=55,e[1012]=56,e[1013]=57,e[1081]=37,e[1085]=43,e[1086]=45}));t.getSupplementalGlyphMapForCalibri=p},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.ToUnicodeMap=t.IdentityToUnicodeMap=void 0;var a=i(2),n=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:[];this._map=t}return g(e,[{key:"length",get:function(){return this._map.length}},{key:"forEach",value:function(e){for(var t in this._map)e(t,this._map[t].charCodeAt(0))}},{key:"has",value:function(e){return void 0!==this._map[e]}},{key:"get",value:function(e){return this._map[e]}},{key:"charCodeOf",value:function(e){var t=this._map;if(t.length<=65536)return t.indexOf(e);for(var i in t)if(t[i]===e)return 0|i;return-1}},{key:"amend",value:function(e){for(var t in e)this._map[t]=e[t]}}]),e}();t.ToUnicodeMap=n;var r=function(){function e(t,i){b(this,e),this.firstChar=t,this.lastChar=i}return g(e,[{key:"length",get:function(){return this.lastChar+1-this.firstChar}},{key:"forEach",value:function(e){for(var t=this.firstChar,i=this.lastChar;t<=i;t++)e(t,t)}},{key:"has",value:function(e){return this.firstChar<=e&&e<=this.lastChar}},{key:"get",value:function(e){if(this.firstChar<=e&&e<=this.lastChar)return String.fromCharCode(e)}},{key:"charCodeOf",value:function(e){return Number.isInteger(e)&&e>=this.firstChar&&e<=this.lastChar?e:-1}},{key:"amend",value:function(e){(0,a.unreachable)("Should not call amend()")}}]),e}();t.IdentityToUnicodeMap=r},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.CFFFont=void 0;var a=i(166),n=i(169),r=i(2),o=function(){function e(t,i){b(this,e),this.properties=i;var o=new a.CFFParser(t,i,n.SEAC_ANALYSIS_ENABLED);this.cff=o.parse(),this.cff.duplicateFirstGlyph();var s=new a.CFFCompiler(this.cff);this.seacs=this.cff.seacs;try{this.data=s.compile()}catch(l){(0,r.warn)("Failed to compile font "+i.loadedName),this.data=t}this._createBuiltInEncoding()}return g(e,[{key:"numGlyphs",get:function(){return this.cff.charStrings.count}},{key:"getCharset",value:function(){return this.cff.charset.charset}},{key:"getGlyphMapping",value:function(){var e,t,i=this.cff,a=this.properties,r=a.cidToGidMap,o=a.cMap,s=i.charset.charset;if(a.composite){var l,c;if(r&&r.length>0){l=Object.create(null);for(var d=0,u=r.length;d<u;d++){var p=r[d];void 0!==p&&(l[p]=d)}}if(e=Object.create(null),i.isCIDFont)for(t=0;t<s.length;t++){var m=s[t];c=o.charCodeOf(m),l&&void 0!==l[c]&&(c=l[c]),e[c]=t}else for(t=0;t<i.charStrings.count;t++)e[c=o.charCodeOf(t)]=t;return e}var h=i.encoding?i.encoding.encoding:null;return a.isInternalFont&&(h=a.defaultEncoding),e=(0,n.type1FontGlyphMapping)(a,h,s)}},{key:"hasGlyphId",value:function(e){return this.cff.hasGlyphId(e)}},{key:"_createBuiltInEncoding",value:function(){var e=this.cff,t=e.charset,i=e.encoding;if(t&&i){var a=t.charset,n=i.encoding,r=[];for(var o in n){var s=n[o];if(s>=0){var l=a[s];l&&(r[o]=l)}}r.length>0&&(this.properties.builtInEncoding=r)}}}]),e}();t.CFFFont=o},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.FontRendererFactory=void 0;var a=i(2),n=i(166),r=i(170),o=i(168),s=i(141);function l(e,t){return(e[t]<<24|e[t+1]<<16|e[t+2]<<8|e[t+3])>>>0}function c(e,t){return e[t]<<8|e[t+1]}function p(e,t){return(e[t]<<24|e[t+1]<<16)>>16}function m(e,t){return e[t]<<24>>24}function h(e,t){return p(e,t)/16384}function f(e){var t=e.length,i=32768;return t<1240?i=107:t<33900&&(i=1131),i}function y(e,t,i){var n,r,o,s=1===c(e,t+2)?l(e,t+8):l(e,t+16),d=c(e,t+s);if(4===d){c(e,t+s+2);var u=c(e,t+s+6)>>1;for(r=t+s+14,n=[],o=0;o<u;o++,r+=2)n[o]={end:c(e,r)};for(r+=2,o=0;o<u;o++,r+=2)n[o].start=c(e,r);for(o=0;o<u;o++,r+=2)n[o].idDelta=c(e,r);for(o=0;o<u;o++,r+=2){var p=c(e,r);if(0!==p){n[o].ids=[];for(var m=0,h=n[o].end-n[o].start+1;m<h;m++)n[o].ids[m]=c(e,r+p),p+=2}}return n}if(12===d){var f=l(e,t+s+12);for(r=t+s+16,n=[],o=0;o<f;o++)t=l(e,r),n.push({start:t,end:l(e,r+4),idDelta:l(e,r+8)-t}),r+=12;return n}throw new a.FormatError("unsupported cmap: ".concat(d))}function v(e,t,i,a){var r=new n.CFFParser(new s.Stream(e,t,i-t),{},a).parse();return{glyphs:r.charStrings.objects,subrs:r.topDict.privateDict&&r.topDict.privateDict.subrsIndex&&r.topDict.privateDict.subrsIndex.objects,gsubrs:r.globalSubrIndex&&r.globalSubrIndex.objects,isCFFCIDFont:r.isCIDFont,fdSelect:r.fdSelect,fdArray:r.fdArray}}function _(e,t){for(var i=t.codePointAt(0),a=0,n=0,r=e.length-1;n<r;){var o=n+r+1>>1;i<e[o].start?r=o-1:n=o}return e[n].start<=i&&i<=e[n].end&&(a=e[n].idDelta+(e[n].ids?e[n].ids[i-e[n].start]:i)&65535),{charCode:i,glyphId:a}}function A(e,t,i){function a(e,i){t.push({cmd:"moveTo",args:[e,i]})}function n(e,i){t.push({cmd:"lineTo",args:[e,i]})}function r(e,i,a,n){t.push({cmd:"quadraticCurveTo",args:[e,i,a,n]})}var o,s=0,l=p(e,s),d=0,u=0;if(s+=10,l<0)do{o=c(e,s);var f=c(e,s+2);s+=4;var y=void 0,b=void 0;1&o?(2&o?(y=p(e,s),b=p(e,s+2)):(y=c(e,s),b=c(e,s+2)),s+=4):2&o?(y=m(e,s++),b=m(e,s++)):(y=e[s++],b=e[s++]),2&o?(d=y,u=b):(d=0,u=0);var g=1,v=1,_=0,x=0;8&o?(g=v=h(e,s),s+=2):64&o?(g=h(e,s),v=h(e,s+2),s+=4):128&o&&(g=h(e,s),_=h(e,s+2),x=h(e,s+4),v=h(e,s+6),s+=8);var w=i.glyphs[f];w&&(t.push({cmd:"save"},{cmd:"transform",args:[g,_,x,v,d,u]}),A(w,t,i),t.push({cmd:"restore"}))}while(32&o);else{var S,C,k=[];for(S=0;S<l;S++)k.push(c(e,s)),s+=2;s+=2+c(e,s);for(var D=k.at(-1)+1,R=[];R.length<D;){var I=1;for(8&(o=e[s++])&&(I+=e[s++]);I-- >0;)R.push({flags:o})}for(S=0;S<D;S++){switch(18&R[S].flags){case 0:d+=p(e,s),s+=2;break;case 2:d-=e[s++];break;case 18:d+=e[s++]}R[S].x=d}for(S=0;S<D;S++){switch(36&R[S].flags){case 0:u+=p(e,s),s+=2;break;case 4:u-=e[s++];break;case 36:u+=e[s++]}R[S].y=u}var M=0;for(s=0;s<l;s++){var T=k[s],P=R.slice(M,T+1);if(1&P[0].flags)P.push(P[0]);else if(1&P.at(-1).flags)P.unshift(P.at(-1));else{var z={flags:1,x:(P[0].x+P.at(-1).x)/2,y:(P[0].y+P.at(-1).y)/2};P.unshift(z),P.push(z)}for(a(P[0].x,P[0].y),S=1,C=P.length;S<C;S++)1&P[S].flags?n(P[S].x,P[S].y):1&P[S+1].flags?(r(P[S].x,P[S].y,P[S+1].x,P[S+1].y),S++):r(P[S].x,P[S].y,(P[S].x+P[S+1].x)/2,(P[S].y+P[S+1].y)/2);M=T+1}}}function x(e,t,i,n){function r(e,i){t.push({cmd:"moveTo",args:[e,i]})}function s(e,i){t.push({cmd:"lineTo",args:[e,i]})}function l(e,i,a,n,r,o){t.push({cmd:"bezierCurveTo",args:[e,i,a,n,r,o]})}var c=[],d=0,u=0,p=0;!function e(m){for(var h=0;h<m.length;){var y=!1,b=m[h++],g=void 0,v=void 0,A=void 0,w=void 0,S=void 0,C=void 0,k=void 0,D=void 0;switch(b){case 1:case 3:case 18:case 23:p+=c.length>>1,y=!0;break;case 4:u+=c.pop(),r(d,u),y=!0;break;case 5:for(;c.length>0;)d+=c.shift(),u+=c.shift(),s(d,u);break;case 6:for(;c.length>0&&(s(d+=c.shift(),u),0!==c.length);)u+=c.shift(),s(d,u);break;case 7:for(;c.length>0&&(u+=c.shift(),s(d,u),0!==c.length);)s(d+=c.shift(),u);break;case 8:for(;c.length>0;)g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u);break;case 10:if(k=c.pop(),D=null,i.isCFFCIDFont){var R=i.fdSelect.getFDIndex(n);if(R>=0&&R<i.fdArray.length){var I=i.fdArray[R],M=void 0;I.privateDict&&I.privateDict.subrsIndex&&(M=I.privateDict.subrsIndex.objects),M&&(D=M[k+=f(M)])}else(0,a.warn)("Invalid fd index for glyph index.")}else D=i.subrs[k+i.subrsBias];D&&e(D);break;case 11:return;case 12:switch(b=m[h++]){case 34:v=(g=d+c.shift())+c.shift(),S=u+c.shift(),d=v+c.shift(),l(g,u,v,S,d,S),v=(g=d+c.shift())+c.shift(),d=v+c.shift(),l(g,S,v,u,d,u);break;case 35:g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u),g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u),c.pop();break;case 36:l(g=d+c.shift(),S=u+c.shift(),v=g+c.shift(),C=S+c.shift(),d=v+c.shift(),C),l(g=d+c.shift(),C,v=g+c.shift(),C+c.shift(),d=v+c.shift(),u);break;case 37:var T=d,P=u;g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u),g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v,u=w,Math.abs(d-T)>Math.abs(u-P)?d+=c.shift():u+=c.shift(),l(g,A,v,w,d,u);break;default:throw new a.FormatError("unknown operator: 12 ".concat(b))}break;case 14:if(c.length>=4){var z=c.pop(),B=c.pop();u=c.pop(),d=c.pop(),t.push({cmd:"save"},{cmd:"translate",args:[d,u]});var F=_(i.cmap,String.fromCharCode(i.glyphNameMap[o.StandardEncoding[z]]));x(i.glyphs[F.glyphId],t,i,F.glyphId),t.push({cmd:"restore"}),F=_(i.cmap,String.fromCharCode(i.glyphNameMap[o.StandardEncoding[B]])),x(i.glyphs[F.glyphId],t,i,F.glyphId)}return;case 19:case 20:h+=(p+=c.length>>1)+7>>3,y=!0;break;case 21:u+=c.pop(),r(d+=c.pop(),u),y=!0;break;case 22:r(d+=c.pop(),u),y=!0;break;case 24:for(;c.length>2;)g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u);d+=c.shift(),u+=c.shift(),s(d,u);break;case 25:for(;c.length>6;)d+=c.shift(),u+=c.shift(),s(d,u);g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u);break;case 26:for(c.length%2&&(d+=c.shift());c.length>0;)g=d,A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v,u=w+c.shift(),l(g,A,v,w,d,u);break;case 27:for(c.length%2&&(u+=c.shift());c.length>0;)l(g=d+c.shift(),A=u,v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w);break;case 28:c.push((m[h]<<24|m[h+1]<<16)>>16),h+=2;break;case 29:k=c.pop()+i.gsubrsBias,(D=i.gsubrs[k])&&e(D);break;case 30:for(;c.length>0&&(g=d,A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+(1===c.length?c.shift():0),l(g,A,v,w,d,u),0!==c.length);)g=d+c.shift(),A=u,v=g+c.shift(),w=A+c.shift(),u=w+c.shift(),l(g,A,v,w,d=v+(1===c.length?c.shift():0),u);break;case 31:for(;c.length>0&&(g=d+c.shift(),A=u,v=g+c.shift(),w=A+c.shift(),u=w+c.shift(),l(g,A,v,w,d=v+(1===c.length?c.shift():0),u),0!==c.length);)g=d,A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+(1===c.length?c.shift():0),l(g,A,v,w,d,u);break;default:if(b<32)throw new a.FormatError("unknown operator: ".concat(b));b<247?c.push(b-139):b<251?c.push(256*(b-247)+m[h++]+108):b<255?c.push(256*-(b-251)-m[h++]-108):(c.push((m[h]<<24|m[h+1]<<16|m[h+2]<<8|m[h+3])/65536),h+=4)}y&&(c.length=0)}}(e)}var w=[],S=function(){function e(t){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize CompiledFont."),this.fontMatrix=t,this.compiledGlyphs=Object.create(null),this.compiledCharCodeToGlyphId=Object.create(null)}return g(e,[{key:"getPathJs",value:function(e){var t=_(this.cmap,e),i=t.charCode,a=t.glyphId,n=this.compiledGlyphs[a];if(!n)try{n=this.compileGlyph(this.glyphs[a],a),this.compiledGlyphs[a]=n}catch(r){throw this.compiledGlyphs[a]=w,void 0===this.compiledCharCodeToGlyphId[i]&&(this.compiledCharCodeToGlyphId[i]=a),r}return void 0===this.compiledCharCodeToGlyphId[i]&&(this.compiledCharCodeToGlyphId[i]=a),n}},{key:"compileGlyph",value:function(e,t){if(!e||0===e.length||14===e[0])return w;var i=this.fontMatrix;if(this.isCFFCIDFont){var n=this.fdSelect.getFDIndex(t);n>=0&&n<this.fdArray.length?i=this.fdArray[n].getByName("FontMatrix")||a.FONT_IDENTITY_MATRIX:(0,a.warn)("Invalid fd index for glyph index.")}var r=[{cmd:"save"},{cmd:"transform",args:i.slice()},{cmd:"scale",args:["size","-size"]}];return this.compileGlyphImpl(e,r,t),r.push({cmd:"restore"}),r}},{key:"compileGlyphImpl",value:function(){(0,a.unreachable)("Children classes should implement this.")}},{key:"hasBuiltPath",value:function(e){var t=_(this.cmap,e),i=t.charCode,a=t.glyphId;return void 0!==this.compiledGlyphs[a]&&void 0!==this.compiledCharCodeToGlyphId[i]}}]),e}(),C=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return 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a,n=h(this.composites);try{for(n.s();!(a=n.n()).done;)e+=a.value.write(e,t)}catch(r){n.e(r)}finally{n.f()}}return e-i}},{key:"scale",value:function(e){if(this.header){var t=(this.header.xMin+this.header.xMax)/2;if(this.header.scale(t,e),this.simple)this.simple.scale(t,e);else{var i,a=h(this.composites);try{for(a.s();!(i=a.n()).done;)i.value.scale(t,e)}catch(n){a.e(n)}finally{a.f()}}}}}],[{key:"parse",value:function(t,i){var a=n.parse(t,i),r=f(a,2),l=r[0],c=r[1];if(t+=l,c.numberOfContours<0){for(var d=[];;){var u=s.parse(t,i),p=f(u,2),m=p[0],h=p[1];if(t+=m,d.push(h),!(32&h.flags))break}return new e({header:c,composites:d})}return new e({header:c,simple:o.parse(t,i,c.numberOfContours)})}}]),e}(),n=function(){function e(t){b(this,e);var i=t.numberOfContours,a=t.xMin,n=t.yMin,r=t.xMax,o=t.yMax;this.numberOfContours=i,this.xMin=a,this.yMin=n,this.xMax=r,this.yMax=o}return g(e,[{key:"getSize",value:function(){return 10}},{key:"write",value:function(e,t){return t.setInt16(e,this.numberOfContours),t.setInt16(e+2,this.xMin),t.setInt16(e+4,this.yMin),t.setInt16(e+6,this.xMax),t.setInt16(e+8,this.yMax),10}},{key:"scale",value:function(e,t){this.xMin=Math.round(e+(this.xMin-e)*t),this.xMax=Math.round(e+(this.xMax-e)*t)}}],[{key:"parse",value:function(t,i){return[10,new e({numberOfContours:i.getInt16(t),xMin:i.getInt16(t+2),yMin:i.getInt16(t+4),xMax:i.getInt16(t+6),yMax:i.getInt16(t+8)})]}}]),e}(),r=g((function e(t){b(this,e);var i=t.flags,a=t.xCoordinates,n=t.yCoordinates;this.xCoordinates=a,this.yCoordinates=n,this.flags=i})),o=function(){function e(t){b(this,e);var i=t.contours,a=t.instructions;this.contours=i,this.instructions=a}return g(e,[{key:"getSize",value:function(){var e,t=2*this.contours.length+2+this.instructions.length,i=0,a=0,n=h(this.contours);try{for(n.s();!(e=n.n()).done;){var r=e.value;t+=r.flags.length;for(var o=0,s=r.xCoordinates.length;o<s;o++){var l=r.xCoordinates[o],c=r.yCoordinates[o],d=Math.abs(l-i);d>255?t+=2:d>0&&(t+=1),i=l,(d=Math.abs(c-a))>255?t+=2:d>0&&(t+=1),a=c}}}catch(u){n.e(u)}finally{n.f()}return t}},{key:"write",value:function(e,t){var i,a=e,n=[],r=[],o=[],s=0,l=0,c=h(this.contours);try{for(c.s();!(i=c.n()).done;){for(var d=i.value,u=0,p=d.xCoordinates.length;u<p;u++){var m=d.flags[u],f=d.xCoordinates[u],y=f-s;if(0===y)m|=16,n.push(0);else{var b=Math.abs(y);b<=255?(m|=y>=0?18:2,n.push(b)):n.push(y)}s=f;var g=d.yCoordinates[u];if(0===(y=g-l))m|=32,r.push(0);else{var v=Math.abs(y);v<=255?(m|=y>=0?36:4,r.push(v)):r.push(y)}l=g,o.push(m)}t.setUint16(e,n.length-1),e+=2}}catch(T){c.e(T)}finally{c.f()}t.setUint16(e,this.instructions.length),e+=2,this.instructions.length&&(new Uint8Array(t.buffer,0,t.buffer.byteLength).set(this.instructions,e),e+=this.instructions.length);for(var _=0,A=o;_<A.length;_++){var x=A[_];t.setUint8(e++,x)}for(var w=0,S=n.length;w<S;w++){var C=n[w],k=o[w];2&k?t.setUint8(e++,C):16&k||(t.setInt16(e,C),e+=2)}for(var D=0,R=r.length;D<R;D++){var I=r[D],M=o[D];4&M?t.setUint8(e++,I):32&M||(t.setInt16(e,I),e+=2)}return e-a}},{key:"scale",value:function(e,t){var i,a=h(this.contours);try{for(a.s();!(i=a.n()).done;){var n=i.value;if(0!==n.xCoordinates.length)for(var r=0,o=n.xCoordinates.length;r<o;r++)n.xCoordinates[r]=Math.round(e+(n.xCoordinates[r]-e)*t)}}catch(s){a.e(s)}finally{a.f()}}}],[{key:"parse",value:function(t,i,a){for(var n=[],o=0;o<a;o++){var s=i.getUint16(t);t+=2,n.push(s)}var l=n[a-1]+1,c=i.getUint16(t);t+=2;var d=new Uint8Array(i).slice(t,t+c);t+=c;for(var u=[],p=0;p<l;t++,p++){var m=i.getUint8(t);if(u.push(m),8&m){var h=i.getUint8(++t);m^=8;for(var f=0;f<h;f++)u.push(m);p+=h}}for(var y=[],b=[],g=[],v=[],_=[],A=0,x=0,w=0;w<l;w++){var S=u[w];if(2&S){var C=i.getUint8(t++);x+=16&S?C:-C,b.push(x)}else 16&S||(x+=i.getInt16(t),t+=2),b.push(x);n[A]===w&&(A++,y.push(b),b=[])}x=0,A=0;for(var k=0;k<l;k++){var D=u[k];if(4&D){var R=i.getUint8(t++);x+=32&D?R:-R,g.push(x)}else 32&D||(x+=i.getInt16(t),t+=2),g.push(x);v.push(1&D|64&D),n[A]===k&&(b=y[A],A++,_.push(new r({flags:v,xCoordinates:b,yCoordinates:g})),g=[],v=[])}return new e({contours:_,instructions:d})}}]),e}(),s=function(){function e(t){b(this,e);var i=t.flags,a=t.glyphIndex,n=t.argument1,r=t.argument2,o=t.transf,s=t.instructions;this.flags=i,this.glyphIndex=a,this.argument1=n,this.argument2=r,this.transf=o,this.instructions=s}return g(e,[{key:"getSize",value:function(){var e=4+2*this.transf.length;return 256&this.flags&&(e+=2+this.instructions.length),e+=2,2&this.flags?this.argument1>=-128&&this.argument1<=127&&this.argument2>=-128&&this.argument2<=127||(e+=2):this.argument1>=0&&this.argument1<=255&&this.argument2>=0&&this.argument2<=255||(e+=2),e}},{key:"write",value:function(e,t){var i=e;return 2&this.flags?this.argument1>=-128&&this.argument1<=127&&this.argument2>=-128&&this.argument2<=127||(this.flags|=1):this.argument1>=0&&this.argument1<=255&&this.argument2>=0&&this.argument2<=255||(this.flags|=1),t.setUint16(e,this.flags),t.setUint16(e+2,this.glyphIndex),e+=4,1&this.flags?(2&this.flags?(t.setInt16(e,this.argument1),t.setInt16(e+2,this.argument2)):(t.setUint16(e,this.argument1),t.setUint16(e+2,this.argument2)),e+=4):(t.setUint8(e,this.argument1),t.setUint8(e+1,this.argument2),e+=2),256&this.flags&&(t.setUint16(e,this.instructions.length),e+=2,this.instructions.length&&(new Uint8Array(t.buffer,0,t.buffer.byteLength).set(this.instructions,e),e+=this.instructions.length)),e-i}},{key:"scale",value:function(e,t){}}],[{key:"parse",value:function(t,i){var a,n,r=t,o=[],s=i.getUint16(t),l=i.getUint16(t+2);t+=4,1&s?(2&s?(a=i.getInt16(t),n=i.getInt16(t+2)):(a=i.getUint16(t),n=i.getUint16(t+2)),t+=4,s^=1):(2&s?(a=i.getInt8(t),n=i.getInt8(t+1)):(a=i.getUint8(t),n=i.getUint8(t+1)),t+=2),8&s?(o.push(i.getUint16(t)),t+=2):64&s?(o.push(i.getUint16(t),i.getUint16(t+2)),t+=4):128&s&&(o.push(i.getUint16(t),i.getUint16(t+2),i.getUint16(t+4),i.getUint16(t+6)),t+=8);var c=null;if(256&s){var d=i.getUint16(t);t+=2,c=new Uint8Array(i).slice(t,t+d),t+=d}return[t-r,new e({flags:s,glyphIndex:l,argument1:a,argument2:n,transf:o,instructions:c})]}}]),e}()},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.OpenTypeFileBuilder=void 0;var a=i(136),n=i(2);function r(e,t,i){e[t]=i>>8&255,e[t+1]=255&i}function o(e,t,i){e[t]=i>>24&255,e[t+1]=i>>16&255,e[t+2]=i>>8&255,e[t+3]=255&i}function s(e,t,i){if(i instanceof Uint8Array)e.set(i,t);else if("string"===typeof i)for(var a=0,n=i.length;a<n;a++)e[t++]=255&i.charCodeAt(a);else{var r,o=h(i);try{for(o.s();!(r=o.n()).done;){var s=r.value;e[t++]=255&s}}catch(l){o.e(l)}finally{o.f()}}}var l=function(){function e(t){b(this,e),this.sfnt=t,this.tables=Object.create(null)}return g(e,[{key:"toArray",value:function(){var t=this.sfnt,i=this.tables,l=Object.keys(i);l.sort();var c,d,u,p,m,h=l.length,f=12+16*h,y=[f];for(c=0;c<h;c++)f+=((p=i[l[c]]).length+3&-4)>>>0,y.push(f);var b=new Uint8Array(f);for(c=0;c<h;c++)p=i[l[c]],s(b,y[c],p);"true"===t&&(t=(0,n.string32)(65536)),b[0]=255&t.charCodeAt(0),b[1]=255&t.charCodeAt(1),b[2]=255&t.charCodeAt(2),b[3]=255&t.charCodeAt(3),r(b,4,h);var g=e.getSearchParams(h,16);for(r(b,6,g.range),r(b,8,g.entry),r(b,10,g.rangeShift),f=12,c=0;c<h;c++){m=l[c],b[f]=255&m.charCodeAt(0),b[f+1]=255&m.charCodeAt(1),b[f+2]=255&m.charCodeAt(2),b[f+3]=255&m.charCodeAt(3);var v=0;for(d=y[c],u=y[c+1];d<u;d+=4)v=v+(0,a.readUint32)(b,d)>>>0;o(b,f+4,v),o(b,f+8,y[c]),o(b,f+12,i[m].length),f+=16}return b}},{key:"addTable",value:function(e,t){if(e in this.tables)throw new Error("Table "+e+" already exists");this.tables[e]=t}}],[{key:"getSearchParams",value:function(e,t){for(var i=1,a=0;(i^e)>i;)i<<=1,a++;var n=i*t;return{range:n,entry:a,rangeShift:t*e-n}}}]),e}();t.OpenTypeFileBuilder=l},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Type1Font=void 0;var a=i(166),n=i(2),r=i(169),o=i(136),s=i(141),l=i(180);function c(e,t,i){for(var a=e.length,n=t.length,r=a-n,s=i,l=!1;s<r;){for(var c=0;c<n&&e[s+c]===t[c];)c++;if(c>=n){for(s+=c;s<a&&(0,o.isWhiteSpace)(e[s]);)s++;l=!0;break}s++}return{found:l,length:s}}var d=function(){function e(t,i,a){b(this,e);var o=a.length1,d=(a.length2,i.peekBytes(6)),u=128===d[0]&&1===d[1];u&&(i.skip(6),o=d[5]<<24|d[4]<<16|d[3]<<8|d[2]);var p=function(e,t){var i,a,r,o,l=[101,101,120,101,99],d=e.pos;try{a=(i=e.getBytes(t)).length}catch(u){}if(a===t&&(r=c(i,l,t-2*l.length)).found&&r.length===t)return{stream:new s.Stream(i),length:t};for((0,n.warn)('Invalid "Length1" property in Type1 font -- trying to recover.'),e.pos=d;0!==(r=c(e.peekBytes(2048),l,0)).length;)if(e.pos+=r.length,r.found){o=e.pos-d;break}return e.pos=d,o?{stream:new s.Stream(e.getBytes(o)),length:o}:((0,n.warn)('Unable to recover "Length1" property in Type1 font -- using as is.'),{stream:new s.Stream(e.getBytes(t)),length:t})}(i,o);new l.Type1Parser(p.stream,!1,r.SEAC_ANALYSIS_ENABLED).extractFontHeader(a),u&&((d=i.getBytes(6))[5],d[4],d[3],d[2]);var m=function(e,t){var i=e.getBytes();if(0===i.length)throw new n.FormatError("getEexecBlock - no font program found.");return{stream:new s.Stream(i),length:i.length}}(i),h=new l.Type1Parser(m.stream,!0,r.SEAC_ANALYSIS_ENABLED).extractFontProgram(a);for(var f in h.properties)a[f]=h.properties[f];var y=h.charstrings,g=this.getType2Charstrings(y),v=this.getType2Subrs(h.subrs);this.charstrings=y,this.data=this.wrap(t,g,this.charstrings,v,a),this.seacs=this.getSeacs(h.charstrings)}return g(e,[{key:"numGlyphs",get:function(){return this.charstrings.length+1}},{key:"getCharset",value:function(){var e,t=[".notdef"],i=h(this.charstrings);try{for(i.s();!(e=i.n()).done;){var a=e.value.glyphName;t.push(a)}}catch(n){i.e(n)}finally{i.f()}return t}},{key:"getGlyphMapping",value:function(e){var t=this.charstrings;if(e.composite){for(var i=Object.create(null),a=0,n=t.length;a<n;a++)i[e.cMap.charCodeOf(a)]=a+1;return i}var o,s,l=[".notdef"];for(s=0;s<t.length;s++)l.push(t[s].glyphName);var c=e.builtInEncoding;if(c)for(var d in o=Object.create(null),c)(s=l.indexOf(c[d]))>=0&&(o[d]=s);return(0,r.type1FontGlyphMapping)(e,o,l)}},{key:"hasGlyphId",value:function(e){return!(e<0||e>=this.numGlyphs)&&(0===e||this.charstrings[e-1].charstring.length>0)}},{key:"getSeacs",value:function(e){for(var t=[],i=0,a=e.length;i<a;i++){var n=e[i];n.seac&&(t[i+1]=n.seac)}return t}},{key:"getType2Charstrings",value:function(e){var t,i=[],a=h(e);try{for(a.s();!(t=a.n()).done;){var n=t.value;i.push(n.charstring)}}catch(r){a.e(r)}finally{a.f()}return i}},{key:"getType2Subrs",value:function(e){var t=0,i=e.length;t=i<1133?107:i<33769?1131:32768;var a,n=[];for(a=0;a<t;a++)n.push([11]);for(a=0;a<i;a++)n.push(e[a]);return n}},{key:"wrap",value:function(e,t,i,n,r){var o=new a.CFF;o.header=new a.CFFHeader(1,0,4,4),o.names=[e];var s=new a.CFFTopDict;s.setByName("version",391),s.setByName("Notice",392),s.setByName("FullName",393),s.setByName("FamilyName",394),s.setByName("Weight",395),s.setByName("Encoding",null),s.setByName("FontMatrix",r.fontMatrix),s.setByName("FontBBox",r.bbox),s.setByName("charset",null),s.setByName("CharStrings",null),s.setByName("Private",null),o.topDict=s;var l=new a.CFFStrings;l.add("Version 0.11"),l.add("See original notice"),l.add(e),l.add(e),l.add("Medium"),o.strings=l,o.globalSubrIndex=new a.CFFIndex;var c,d,u=t.length,p=[".notdef"];for(c=0;c<u;c++){var m=i[c].glyphName;-1===a.CFFStandardStrings.indexOf(m)&&l.add(m),p.push(m)}o.charset=new a.CFFCharset(!1,0,p);var h=new a.CFFIndex;for(h.add([139,14]),c=0;c<u;c++)h.add(t[c]);o.charStrings=h;var f=new a.CFFPrivateDict;f.setByName("Subrs",null);var y=["BlueValues","OtherBlues","FamilyBlues","FamilyOtherBlues","StemSnapH","StemSnapV","BlueShift","BlueFuzz","BlueScale","LanguageGroup","ExpansionFactor","ForceBold","StdHW","StdVW"];for(c=0,d=y.length;c<d;c++){var b=y[c];if(b in r.privateData){var g=r.privateData[b];if(Array.isArray(g))for(var v=g.length-1;v>0;v--)g[v]-=g[v-1];f.setByName(b,g)}}o.topDict.privateDict=f;var _=new a.CFFIndex;for(c=0,d=n.length;c<d;c++)_.add(n[c]);return f.subrsIndex=_,new a.CFFCompiler(o).compile()}}]),e}();t.Type1Font=d},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Type1Parser=void 0;var a=i(168),n=i(136),r=i(141),o=i(2),s=[4],l=[5],d=[6],u=[7],p=[8],m=[12,35],h=[14],f=[21],y=[22],v=[30],_=[31],A=function(){function e(){b(this,e),this.width=0,this.lsb=0,this.flexing=!1,this.output=[],this.stack=[]}return g(e,[{key:"convert",value:function(e,t,i){for(var a,n,r,c=e.length,b=!1,g=0;g<c;g++){var A=e[g];if(A<32){switch(12===A&&(A=(A<<8)+e[++g]),A){case 1:case 3:case 9:case 3072:case 3073:case 3074:case 3105:this.stack=[];break;case 4:if(this.flexing){if(this.stack.length<1){b=!0;break}var x=this.stack.pop();this.stack.push(0,x);break}b=this.executeCommand(1,s);break;case 5:b=this.executeCommand(2,l);break;case 6:b=this.executeCommand(1,d);break;case 7:b=this.executeCommand(1,u);break;case 8:b=this.executeCommand(6,p);break;case 10:if(this.stack.length<1){b=!0;break}if(!t[r=this.stack.pop()]){b=!0;break}b=this.convert(t[r],t,i);break;case 11:return b;case 13:if(this.stack.length<2){b=!0;break}a=this.stack.pop(),n=this.stack.pop(),this.lsb=n,this.width=a,this.stack.push(a,n),b=this.executeCommand(2,y);break;case 14:this.output.push(h[0]);break;case 21:if(this.flexing)break;b=this.executeCommand(2,f);break;case 22:if(this.flexing){this.stack.push(0);break}b=this.executeCommand(1,y);break;case 30:b=this.executeCommand(4,v);break;case 31:b=this.executeCommand(4,_);break;case 3078:if(i){var w=this.stack.at(-5);this.seac=this.stack.splice(-4,4),this.seac[0]+=this.lsb-w,b=this.executeCommand(0,h)}else b=this.executeCommand(4,h);break;case 3079:if(this.stack.length<4){b=!0;break}this.stack.pop(),a=this.stack.pop();var S=this.stack.pop();n=this.stack.pop(),this.lsb=n,this.width=a,this.stack.push(a,n,S),b=this.executeCommand(3,f);break;case 3084:if(this.stack.length<2){b=!0;break}var C=this.stack.pop(),k=this.stack.pop();this.stack.push(k/C);break;case 3088:if(this.stack.length<2){b=!0;break}r=this.stack.pop();var D=this.stack.pop();if(0===r&&3===D){var R=this.stack.splice(this.stack.length-17,17);this.stack.push(R[2]+R[0],R[3]+R[1],R[4],R[5],R[6],R[7],R[8],R[9],R[10],R[11],R[12],R[13],R[14]),b=this.executeCommand(13,m,!0),this.flexing=!1,this.stack.push(R[15],R[16])}else 1===r&&0===D&&(this.flexing=!0);break;case 3089:break;default:(0,o.warn)('Unknown type 1 charstring command of "'+A+'"')}if(b)break}else A<=246?A-=139:A=A<=250?256*(A-247)+e[++g]+108:A<=254?-256*(A-251)-e[++g]-108:(255&e[++g])<<24|(255&e[++g])<<16|(255&e[++g])<<8|(255&e[++g])<<0,this.stack.push(A)}return b}},{key:"executeCommand",value:function(e,t,i){var a,n=this.stack.length;if(e>n)return!0;for(var r=n-e,o=r;o<n;o++){var s=this.stack[o];Number.isInteger(s)?this.output.push(28,s>>8&255,255&s):(s=65536*s|0,this.output.push(255,s>>24&255,s>>16&255,s>>8&255,255&s))}return(a=this.output).push.apply(a,c(t)),i?this.stack.splice(r,e):this.stack.length=0,!1}}]),e}(),x=55665;function w(e){return e>=48&&e<=57||e>=65&&e<=70||e>=97&&e<=102}function S(e,t,i){if(i>=e.length)return new Uint8Array(0);var a,n,r=0|t;for(a=0;a<i;a++)r=52845*(e[a]+r)+22719&65535;var o=e.length-i,s=new Uint8Array(o);for(a=i,n=0;n<o;a++,n++){var l=e[a];s[n]=l^r>>8,r=52845*(l+r)+22719&65535}return s}function C(e){return 47===e||91===e||93===e||123===e||125===e||40===e||41===e}var k=function(){function e(t,i,a){if(b(this,e),i){var o=t.getBytes(),s=!((w(o[0])||(0,n.isWhiteSpace)(o[0]))&&w(o[1])&&w(o[2])&&w(o[3])&&w(o[4])&&w(o[5])&&w(o[6])&&w(o[7]));t=new r.Stream(s?S(o,x,4):function(e,t,i){var a,n,r=0|t,o=e.length,s=new Uint8Array(o>>>1);for(a=0,n=0;a<o;a++){var l=e[a];if(w(l)){a++;for(var c=void 0;a<o&&!w(c=e[a]);)a++;if(a<o){var d=parseInt(String.fromCharCode(l,c),16);s[n++]=d^r>>8,r=52845*(d+r)+22719&65535}}}return s.slice(i,n)}(o,x,4))}this.seacAnalysisEnabled=!!a,this.stream=t,this.nextChar()}return g(e,[{key:"readNumberArray",value:function(){this.getToken();for(var e=[];;){var t=this.getToken();if(null===t||"]"===t||"}"===t)break;e.push(parseFloat(t||0))}return e}},{key:"readNumber",value:function(){var e=this.getToken();return parseFloat(e||0)}},{key:"readInt",value:function(){var e=this.getToken();return 0|parseInt(e||0,10)}},{key:"readBoolean",value:function(){return"true"===this.getToken()?1:0}},{key:"nextChar",value:function(){return this.currentChar=this.stream.getByte()}},{key:"prevChar",value:function(){return this.stream.skip(-2),this.currentChar=this.stream.getByte()}},{key:"getToken",value:function(){for(var e=!1,t=this.currentChar;;){if(-1===t)return null;if(e)10!==t&&13!==t||(e=!1);else if(37===t)e=!0;else if(!(0,n.isWhiteSpace)(t))break;t=this.nextChar()}if(C(t))return this.nextChar(),String.fromCharCode(t);var i="";do{i+=String.fromCharCode(t),t=this.nextChar()}while(t>=0&&!(0,n.isWhiteSpace)(t)&&!C(t));return i}},{key:"readCharStrings",value:function(e,t){return-1===t?e:S(e,4330,t)}},{key:"extractFontProgram",value:function(e){var t=this.stream,i=[],a=[],n=Object.create(null);n.lenIV=4;for(var r,o,s,l,c={subrs:[],charstrings:[],properties:{privateData:n}};null!==(r=this.getToken());)if("/"===r)switch(r=this.getToken()){case"CharStrings":for(this.getToken(),this.getToken(),this.getToken(),this.getToken();null!==(r=this.getToken())&&"end"!==r;)if("/"===r){var d=this.getToken();o=this.readInt(),this.getToken(),s=o>0?t.getBytes(o):new Uint8Array(0),l=c.properties.privateData.lenIV;var u=this.readCharStrings(s,l);this.nextChar(),"noaccess"===(r=this.getToken())?this.getToken():"/"===r&&this.prevChar(),a.push({glyph:d,encoded:u})}break;case"Subrs":for(this.readInt(),this.getToken();"dup"===this.getToken();){var p=this.readInt();o=this.readInt(),this.getToken(),s=o>0?t.getBytes(o):new Uint8Array(0),l=c.properties.privateData.lenIV;var m=this.readCharStrings(s,l);this.nextChar(),"noaccess"===(r=this.getToken())&&this.getToken(),i[p]=m}break;case"BlueValues":case"OtherBlues":case"FamilyBlues":case"FamilyOtherBlues":var h=this.readNumberArray();h.length>0&&h.length;break;case"StemSnapH":case"StemSnapV":c.properties.privateData[r]=this.readNumberArray();break;case"StdHW":case"StdVW":c.properties.privateData[r]=this.readNumberArray()[0];break;case"BlueShift":case"lenIV":case"BlueFuzz":case"BlueScale":case"LanguageGroup":c.properties.privateData[r]=this.readNumber();break;case"ExpansionFactor":c.properties.privateData[r]=this.readNumber()||.06;break;case"ForceBold":c.properties.privateData[r]=this.readBoolean()}for(var f=0,y=a;f<y.length;f++){var b=y[f],g=b.encoded,v=b.glyph,_=new A,x=_.convert(g,i,this.seacAnalysisEnabled),w=_.output;x&&(w=[14]);var S={glyphName:v,charstring:w,width:_.width,lsb:_.lsb,seac:_.seac};if(".notdef"===v?c.charstrings.unshift(S):c.charstrings.push(S),e.builtInEncoding){var C=e.builtInEncoding.indexOf(v);C>-1&&void 0===e.widths[C]&&C>=e.firstChar&&C<=e.lastChar&&(e.widths[C]=_.width)}}return c}},{key:"extractFontHeader",value:function(e){for(var t;null!==(t=this.getToken());)if("/"===t)switch(t=this.getToken()){case"FontMatrix":var i=this.readNumberArray();e.fontMatrix=i;break;case"Encoding":var n=this.getToken(),r=void 0;if(/^\d+$/.test(n)){r=[];var o=0|parseInt(n,10);this.getToken();for(var s=0;s<o;s++){for(t=this.getToken();"dup"!==t&&"def"!==t;)if(null===(t=this.getToken()))return;if("def"===t)break;var l=this.readInt();this.getToken();var c=this.getToken();r[l]=c,this.getToken()}}else r=(0,a.getEncoding)(n);e.builtInEncoding=r;break;case"FontBBox":var d=this.readNumberArray();e.ascent=Math.max(d[3],d[1]),e.descent=Math.min(d[1],d[3]),e.ascentScaled=!0}}}]),e}();t.Type1Parser=k},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Pattern=void 0,t.getTilingPatternIR=function(e,t,i){var n=t.getArray("Matrix"),r=a.Util.normalizeRect(t.getArray("BBox")),o=t.get("XStep"),s=t.get("YStep"),l=t.get("PaintType"),c=t.get("TilingType");if(r[2]-r[0]===0||r[3]-r[1]===0)throw new a.FormatError("Invalid getTilingPatternIR /BBox array: [".concat(r,"]."));return["TilingPattern",i,e,n,r,o,s,l,c]};var a=i(2),r=i(138),o=i(145),s=i(136),l={FUNCTION_BASED:1,AXIAL:2,RADIAL:3,FREE_FORM_MESH:4,LATTICE_FORM_MESH:5,COONS_PATCH_MESH:6,TENSOR_PATCH_MESH:7},c=function(){function e(){b(this,e),(0,a.unreachable)("Cannot initialize Pattern.")}return g(e,null,[{key:"parseShading",value:function(e,t,i,n,o,c){var d=e instanceof r.BaseStream?e.dict:e,u=d.get("ShadingType");try{switch(u){case l.AXIAL:case l.RADIAL:return new m(d,t,i,o,c);case l.FREE_FORM_MESH:case l.LATTICE_FORM_MESH:case l.COONS_PATCH_MESH:case l.TENSOR_PATCH_MESH:return new v(e,t,i,o,c);default:throw new a.FormatError("Unsupported ShadingType: "+u)}}catch(p){if(p instanceof s.MissingDataException)throw p;return n.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.shadingPattern}),(0,a.warn)(p),new _}}}]),e}();t.Pattern=c;var p=function(){function e(){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize BaseShading.")}return g(e,[{key:"getIR",value:function(){(0,a.unreachable)("Abstract method `getIR` called.")}}],[{key:"SMALL_NUMBER",get:function(){return(0,a.shadow)(this,"SMALL_NUMBER",1e-6)}}]),e}(),m=function(e){d(i,e);var t=u(i);function i(e,r,s,c,d){var u;b(this,i),(u=t.call(this)).coordsArr=e.getArray("Coords"),u.shadingType=e.get("ShadingType");var m=o.ColorSpace.parse({cs:e.getRaw("CS")||e.getRaw("ColorSpace"),xref:r,resources:s,pdfFunctionFactory:c,localColorSpaceCache:d}),h=e.getArray("BBox");Array.isArray(h)&&4===h.length?u.bbox=a.Util.normalizeRect(h):u.bbox=null;var y=0,g=1;if(e.has("Domain")){var v=e.getArray("Domain");y=v[0],g=v[1]}var _=!1,A=!1;if(e.has("Extend")){var x=e.getArray("Extend");_=x[0],A=x[1]}if(u.shadingType===l.RADIAL&&(!_||!A)){var w=f(u.coordsArr,6),S=w[0],C=w[1],k=w[2],D=w[3],R=w[4],I=w[5],M=Math.hypot(S-D,C-R);k<=I+M&&I<=k+M&&(0,a.warn)("Unsupported radial gradient.")}u.extendStart=_,u.extendEnd=A;var T=e.getRaw("Function"),P=c.createFromArray(T),z=(g-y)/10,B=u.colorStops=[];if(y>=g||z<=0)return(0,a.info)("Bad shading domain."),n(u);for(var F,E=new Float32Array(m.numComps),N=new Float32Array(1),O=0;O<=10;O++){N[0]=y+O*z,P(N,0,E,0),F=m.getRgb(E,0);var G=a.Util.makeHexColor(F[0],F[1],F[2]);B.push([O/10,G])}var L="transparent";return e.has("Background")&&(F=m.getRgb(e.get("Background"),0),L=a.Util.makeHexColor(F[0],F[1],F[2])),_||(B.unshift([0,L]),B[1][0]+=p.SMALL_NUMBER),A||(B.at(-1)[0]-=p.SMALL_NUMBER,B.push([1,L])),u.colorStops=B,u}return g(i,[{key:"getIR",value:function(){var e,t,i,n,r,o=this.coordsArr,s=this.shadingType;return s===l.AXIAL?(t=[o[0],o[1]],i=[o[2],o[3]],n=null,r=null,e="axial"):s===l.RADIAL?(t=[o[0],o[1]],i=[o[3],o[4]],n=o[2],r=o[5],e="radial"):(0,a.unreachable)("getPattern type unknown: ".concat(s)),["RadialAxial",e,this.bbox,this.colorStops,t,i,n,r]}}]),i}(p),h=function(){function e(t,i){b(this,e),this.stream=t,this.context=i,this.buffer=0,this.bufferLength=0;var a=i.numComps;this.tmpCompsBuf=new Float32Array(a);var n=i.colorSpace.numComps;this.tmpCsCompsBuf=i.colorFn?new Float32Array(n):this.tmpCompsBuf}return g(e,[{key:"hasData",get:function(){if(this.stream.end)return this.stream.pos<this.stream.end;if(this.bufferLength>0)return!0;var e=this.stream.getByte();return!(e<0)&&(this.buffer=e,this.bufferLength=8,!0)}},{key:"readBits",value:function(e){var t=this.buffer,i=this.bufferLength;if(32===e){if(0===i)return(this.stream.getByte()<<24|this.stream.getByte()<<16|this.stream.getByte()<<8|this.stream.getByte())>>>0;t=t<<24|this.stream.getByte()<<16|this.stream.getByte()<<8|this.stream.getByte();var a=this.stream.getByte();return this.buffer=a&(1<<i)-1,(t<<8-i|(255&a)>>i)>>>0}if(8===e&&0===i)return this.stream.getByte();for(;i<e;)t=t<<8|this.stream.getByte(),i+=8;return i-=e,this.bufferLength=i,this.buffer=t&(1<<i)-1,t>>i}},{key:"align",value:function(){this.buffer=0,this.bufferLength=0}},{key:"readFlag",value:function(){return this.readBits(this.context.bitsPerFlag)}},{key:"readCoordinate",value:function(){var e=this.context.bitsPerCoordinate,t=this.readBits(e),i=this.readBits(e),a=this.context.decode,n=e<32?1/((1<<e)-1):2.3283064365386963e-10;return[t*n*(a[1]-a[0])+a[0],i*n*(a[3]-a[2])+a[2]]}},{key:"readComponents",value:function(){for(var e=this.context.numComps,t=this.context.bitsPerComponent,i=t<32?1/((1<<t)-1):2.3283064365386963e-10,a=this.context.decode,n=this.tmpCompsBuf,r=0,o=4;r<e;r++,o+=2){var s=this.readBits(t);n[r]=s*i*(a[o+1]-a[o])+a[o]}var l=this.tmpCsCompsBuf;return this.context.colorFn&&this.context.colorFn(n,0,l,0),this.context.colorSpace.getRgb(l,0)}}]),e}(),y=function(){var e=[];return function(t){return e[t]||(e[t]=function(e){for(var t=[],i=0;i<=e;i++){var a=i/e,n=1-a;t.push(new Float32Array([n*n*n,3*a*n*n,3*a*a*n,a*a*a]))}return t}(t)),e[t]}}(),v=function(e){d(i,e);var t=u(i);function i(e,n,s,c,d){var u;if(b(this,i),u=t.call(this),!(e instanceof r.BaseStream))throw new a.FormatError("Mesh data is not a stream");var p=e.dict;u.shadingType=p.get("ShadingType");var m=p.getArray("BBox");Array.isArray(m)&&4===m.length?u.bbox=a.Util.normalizeRect(m):u.bbox=null;var f=o.ColorSpace.parse({cs:p.getRaw("CS")||p.getRaw("ColorSpace"),xref:n,resources:s,pdfFunctionFactory:c,localColorSpaceCache:d});u.background=p.has("Background")?f.getRgb(p.get("Background"),0):null;var y=p.getRaw("Function"),g=y?c.createFromArray(y):null;u.coords=[],u.colors=[],u.figures=[];var v={bitsPerCoordinate:p.get("BitsPerCoordinate"),bitsPerComponent:p.get("BitsPerComponent"),bitsPerFlag:p.get("BitsPerFlag"),decode:p.getArray("Decode"),colorFn:g,colorSpace:f,numComps:g?1:f.numComps},_=new h(e,v),A=!1;switch(u.shadingType){case l.FREE_FORM_MESH:u._decodeType4Shading(_);break;case l.LATTICE_FORM_MESH:var x=0|p.get("VerticesPerRow");if(x<2)throw new a.FormatError("Invalid VerticesPerRow");u._decodeType5Shading(_,x);break;case l.COONS_PATCH_MESH:u._decodeType6Shading(_),A=!0;break;case l.TENSOR_PATCH_MESH:u._decodeType7Shading(_),A=!0;break;default:(0,a.unreachable)("Unsupported mesh type.")}if(A){u._updateBounds();for(var w=0,S=u.figures.length;w<S;w++)u._buildFigureFromPatch(w)}return u._updateBounds(),u._packData(),u}return g(i,[{key:"_decodeType4Shading",value:function(e){for(var t=this.coords,i=this.colors,n=[],r=[],o=0;e.hasData;){var s=e.readFlag(),l=e.readCoordinate(),c=e.readComponents();if(0===o){if(!(0<=s&&s<=2))throw new a.FormatError("Unknown type4 flag");switch(s){case 0:o=3;break;case 1:r.push(r.at(-2),r.at(-1)),o=1;break;case 2:r.push(r.at(-3),r.at(-1)),o=1}n.push(s)}r.push(t.length),t.push(l),i.push(c),o--,e.align()}this.figures.push({type:"triangles",coords:new Int32Array(r),colors:new Int32Array(r)})}},{key:"_decodeType5Shading",value:function(e,t){for(var i=this.coords,a=this.colors,n=[];e.hasData;){var r=e.readCoordinate(),o=e.readComponents();n.push(i.length),i.push(r),a.push(o)}this.figures.push({type:"lattice",coords:new Int32Array(n),colors:new Int32Array(n),verticesPerRow:t})}},{key:"_decodeType6Shading",value:function(e){for(var t=this.coords,i=this.colors,n=new Int32Array(16),r=new Int32Array(4);e.hasData;){var o=e.readFlag();if(!(0<=o&&o<=3))throw new a.FormatError("Unknown type6 flag");for(var s=t.length,l=0,c=0!==o?8:12;l<c;l++)t.push(e.readCoordinate());for(var d=i.length,u=0,p=0!==o?2:4;u<p;u++)i.push(e.readComponents());var m=void 0,h=void 0,f=void 0,y=void 0;switch(o){case 0:n[12]=s+3,n[13]=s+4,n[14]=s+5,n[15]=s+6,n[8]=s+2,n[11]=s+7,n[4]=s+1,n[7]=s+8,n[0]=s,n[1]=s+11,n[2]=s+10,n[3]=s+9,r[2]=d+1,r[3]=d+2,r[0]=d,r[1]=d+3;break;case 1:m=n[12],h=n[13],f=n[14],y=n[15],n[12]=y,n[13]=s+0,n[14]=s+1,n[15]=s+2,n[8]=f,n[11]=s+3,n[4]=h,n[7]=s+4,n[0]=m,n[1]=s+7,n[2]=s+6,n[3]=s+5,m=r[2],h=r[3],r[2]=h,r[3]=d,r[0]=m,r[1]=d+1;break;case 2:m=n[15],h=n[11],n[12]=n[3],n[13]=s+0,n[14]=s+1,n[15]=s+2,n[8]=n[7],n[11]=s+3,n[4]=h,n[7]=s+4,n[0]=m,n[1]=s+7,n[2]=s+6,n[3]=s+5,m=r[3],r[2]=r[1],r[3]=d,r[0]=m,r[1]=d+1;break;case 3:n[12]=n[0],n[13]=s+0,n[14]=s+1,n[15]=s+2,n[8]=n[1],n[11]=s+3,n[4]=n[2],n[7]=s+4,n[0]=n[3],n[1]=s+7,n[2]=s+6,n[3]=s+5,r[2]=r[0],r[3]=d,r[0]=r[1],r[1]=d+1}n[5]=t.length,t.push([(-4*t[n[0]][0]-t[n[15]][0]+6*(t[n[4]][0]+t[n[1]][0])-2*(t[n[12]][0]+t[n[3]][0])+3*(t[n[13]][0]+t[n[7]][0]))/9,(-4*t[n[0]][1]-t[n[15]][1]+6*(t[n[4]][1]+t[n[1]][1])-2*(t[n[12]][1]+t[n[3]][1])+3*(t[n[13]][1]+t[n[7]][1]))/9]),n[6]=t.length,t.push([(-4*t[n[3]][0]-t[n[12]][0]+6*(t[n[2]][0]+t[n[7]][0])-2*(t[n[0]][0]+t[n[15]][0])+3*(t[n[4]][0]+t[n[14]][0]))/9,(-4*t[n[3]][1]-t[n[12]][1]+6*(t[n[2]][1]+t[n[7]][1])-2*(t[n[0]][1]+t[n[15]][1])+3*(t[n[4]][1]+t[n[14]][1]))/9]),n[9]=t.length,t.push([(-4*t[n[12]][0]-t[n[3]][0]+6*(t[n[8]][0]+t[n[13]][0])-2*(t[n[0]][0]+t[n[15]][0])+3*(t[n[11]][0]+t[n[1]][0]))/9,(-4*t[n[12]][1]-t[n[3]][1]+6*(t[n[8]][1]+t[n[13]][1])-2*(t[n[0]][1]+t[n[15]][1])+3*(t[n[11]][1]+t[n[1]][1]))/9]),n[10]=t.length,t.push([(-4*t[n[15]][0]-t[n[0]][0]+6*(t[n[11]][0]+t[n[14]][0])-2*(t[n[12]][0]+t[n[3]][0])+3*(t[n[2]][0]+t[n[8]][0]))/9,(-4*t[n[15]][1]-t[n[0]][1]+6*(t[n[11]][1]+t[n[14]][1])-2*(t[n[12]][1]+t[n[3]][1])+3*(t[n[2]][1]+t[n[8]][1]))/9]),this.figures.push({type:"patch",coords:new 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d,u,p=!1,m=n[l][0],h=n[s][0],f=n[s][1],y=n[s][2],b=n[s][3];if(f===y){p=!0,d=s+4;for(var g=l+4,v=1;v<c;v++,d+=4,g+=4)if(u=n[d],n[g][0]!==m||u[0]!==h||u[1]!==f||u[2]!==y||u[3]!==b){v<10?p=!1:c=v;break}}if(p){c=Math.min(c,1e3);var _=new Float32Array(2*c);d=s;for(var A=0;A<c;A++,d+=4)u=n[d],_[A<<1]=u[4],_[1+(A<<1)]=u[5];i.splice(o,4*c,a.OPS.paintImageMaskXObjectRepeat),n.splice(o,4*c,[m,h,f,y,b,_])}else{c=Math.min(c,100);for(var x=[],w=0;w<c;w++){u=n[s+(w<<2)];var S=n[l+(w<<2)][0];x.push({data:S.data,width:S.width,height:S.height,interpolate:S.interpolate,count:S.count,transform:u})}i.splice(o,4*c,a.OPS.paintImageMaskXObjectGroup),n.splice(o,4*c,[x])}return o+1})),n(r,[a.OPS.save,a.OPS.transform,a.OPS.paintImageXObject,a.OPS.restore],(function(e){var t=e.argsArray,i=e.iCurr-2;return 0===t[i][1]&&0===t[i][2]}),(function(e,t){var i=e.fnArray,n=e.argsArray,r=(t-(e.iCurr-3))%4;switch(r){case 0:return i[t]===a.OPS.save;case 1:if(i[t]!==a.OPS.transform)return!1;var o=e.iCurr-2,s=n[o][0],l=n[o][3];return n[t][0]===s&&0===n[t][1]&&0===n[t][2]&&n[t][3]===l;case 2:if(i[t]!==a.OPS.paintImageXObject)return!1;var c=n[e.iCurr-1][0];return n[t][0]===c;case 3:return i[t]===a.OPS.restore}throw new Error("iterateImageGroup - invalid pos: ".concat(r))}),(function(e,t){var i=e.fnArray,n=e.argsArray,r=e.iCurr,o=r-3,s=r-2,l=n[r-1][0],c=n[s][0],d=n[s][3],u=Math.min(Math.floor((t-o)/4),1e3);if(u<3)return t-(t-o)%4;for(var p=new Float32Array(2*u),m=s,h=0;h<u;h++,m+=4){var f=n[m];p[h<<1]=f[4],p[1+(h<<1)]=f[5]}var y=[l,c,d,p];return i.splice(o,4*u,a.OPS.paintImageXObjectRepeat),n.splice(o,4*u,y),o+1})),n(r,[a.OPS.beginText,a.OPS.setFont,a.OPS.setTextMatrix,a.OPS.showText,a.OPS.endText],null,(function(e,t){var i=e.fnArray,n=e.argsArray,r=(t-(e.iCurr-4))%5;switch(r){case 0:return i[t]===a.OPS.beginText;case 1:return i[t]===a.OPS.setFont;case 2:return i[t]===a.OPS.setTextMatrix;case 3:if(i[t]!==a.OPS.showText)return!1;var o=e.iCurr-3,s=n[o][0],l=n[o][1];return n[t][0]===s&&n[t][1]===l;case 4:return i[t]===a.OPS.endText}throw new Error("iterateShowTextGroup - invalid pos: ".concat(r))}),(function(e,t){var i=e.fnArray,a=e.argsArray,n=e.iCurr,r=n-4,o=n-3,s=n-2,l=n-1,c=n,d=a[o][0],u=a[o][1],p=Math.min(Math.floor((t-r)/5),1e3);if(p<3)return t-(t-r)%5;var m=r;r>=4&&i[r-4]===i[o]&&i[r-3]===i[s]&&i[r-2]===i[l]&&i[r-1]===i[c]&&a[r-4][0]===d&&a[r-4][1]===u&&(p++,m-=5);for(var h=m+4,f=1;f<p;f++)i.splice(h,3),a.splice(h,3),h+=2;return h+1}));var o=function(){function e(t){b(this,e),this.queue=t}return g(e,[{key:"_optimize",value:function(){}},{key:"push",value:function(e,t){this.queue.fnArray.push(e),this.queue.argsArray.push(t),this._optimize()}},{key:"flush",value:function(){}},{key:"reset",value:function(){}}]),e}(),s=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this,e)).state=null,a.context={iCurr:0,fnArray:e.fnArray,argsArray:e.argsArray},a.match=null,a.lastProcessed=0,a}return g(i,[{key:"_optimize",value:function(){var e=this.queue.fnArray,t=this.lastProcessed,i=e.length,a=this.state,n=this.match;if(a||n||t+1!==i||r[e[t]]){for(var o=this.context;t<i;){if(n){if((0,n.iterateFn)(o,t)){t++;continue}if(t=(0,n.processFn)(o,t+1),n=null,a=null,t>=(i=e.length))break}(a=(a||r)[e[t]])&&!Array.isArray(a)?(o.iCurr=t,t++,!a.checkFn||(0,a.checkFn)(o)?(n=a,a=null):a=null):t++}this.state=a,this.match=n,this.lastProcessed=t}else this.lastProcessed=i}},{key:"flush",value:function(){for(;this.match;){var e=this.queue.fnArray.length;this.lastProcessed=(0,this.match.processFn)(this.context,e),this.match=null,this.state=null,this._optimize()}}},{key:"reset",value:function(){this.state=null,this.match=null,this.lastProcessed=0}}]),i}(o),l=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:0,i=arguments.length>1?arguments[1]:void 0;this._streamSink=i,this.fnArray=[],this.argsArray=[],!i||t&a.RenderingIntentFlag.OPLIST?this.optimizer=new o(this):this.optimizer=new s(this),this.dependencies=new Set,this._totalLength=0,this.weight=0,this._resolved=i?null:Promise.resolve()}return g(e,[{key:"length",get:function(){return this.argsArray.length}},{key:"ready",get:function(){return this._resolved||this._streamSink.ready}},{key:"totalLength",get:function(){return this._totalLength+this.length}},{key:"addOp",value:function(t,i){this.optimizer.push(t,i),this.weight++,this._streamSink&&(this.weight>=e.CHUNK_SIZE||this.weight>=e.CHUNK_SIZE_ABOUT&&(t===a.OPS.restore||t===a.OPS.endText))&&this.flush()}},{key:"addImageOps",value:function(e,t,i){void 0!==i&&this.addOp(a.OPS.beginMarkedContentProps,["OC",i]),this.addOp(e,t),void 0!==i&&this.addOp(a.OPS.endMarkedContent,[])}},{key:"addDependency",value:function(e){this.dependencies.has(e)||(this.dependencies.add(e),this.addOp(a.OPS.dependency,[e]))}},{key:"addDependencies",value:function(e){var t,i=h(e);try{for(i.s();!(t=i.n()).done;){var a=t.value;this.addDependency(a)}}catch(n){i.e(n)}finally{i.f()}}},{key:"addOpList",value:function(t){if(t instanceof e){var i,n=h(t.dependencies);try{for(n.s();!(i=n.n()).done;){var r=i.value;this.dependencies.add(r)}}catch(l){n.e(l)}finally{n.f()}for(var o=0,s=t.length;o<s;o++)this.addOp(t.fnArray[o],t.argsArray[o])}else(0,a.warn)('addOpList - ignoring invalid "opList" parameter.')}},{key:"getIR",value:function(){return{fnArray:this.fnArray,argsArray:this.argsArray,length:this.length}}},{key:"_transfers",get:function(){for(var e=[],t=this.fnArray,i=this.argsArray,n=this.length,r=0;r<n;r++)switch(t[r]){case a.OPS.paintInlineImageXObject:case a.OPS.paintInlineImageXObjectGroup:case a.OPS.paintImageMaskXObject:var o=i[r][0];!o.cached&&o.data&&o.data.buffer instanceof ArrayBuffer&&e.push(o.data.buffer)}return e}},{key:"flush",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;this.optimizer.flush();var i=this.length;this._totalLength+=i,this._streamSink.enqueue({fnArray:this.fnArray,argsArray:this.argsArray,lastChunk:e,separateAnnots:t,length:i},1,this._transfers),this.dependencies.clear(),this.fnArray.length=0,this.argsArray.length=0,this.weight=0,this.optimizer.reset()}}],[{key:"CHUNK_SIZE",get:function(){return(0,a.shadow)(this,"CHUNK_SIZE",1e3)}},{key:"CHUNK_SIZE_ABOUT",get:function(){return(0,a.shadow)(this,"CHUNK_SIZE_ABOUT",this.CHUNK_SIZE-5)}}]),e}();t.OperatorList=l},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.PDFImage=void 0;var a=i(2),n=i(195),r=i(138),o=i(145),s=i(150),l=i(158),c=i(161),d=i(137);function u(e,t,i,a){return(e=t+e*i)<0?e=0:e>a&&(e=a),e}function m(e,t,i,a,n,r){var o,s=n*r;o=t<=8?new Uint8Array(s):t<=16?new Uint16Array(s):new Uint32Array(s);var l,c,d,u,p=i/n,m=a/r,h=0,f=new Uint16Array(n),y=i;for(l=0;l<n;l++)f[l]=Math.floor(l*p);for(l=0;l<r;l++)for(d=Math.floor(l*m)*y,c=0;c<n;c++)u=d+f[c],o[h++]=e[u];return o}var h=function(){function e(t){b(this,e);var i=t.xref,n=t.res,s=t.image,l=t.isInline,u=void 0!==l&&l,p=t.smask,m=void 0===p?null:p,h=t.mask,f=void 0===h?null:h,y=t.isMask,g=void 0!==y&&y,v=t.pdfFunctionFactory,_=t.localColorSpaceCache;this.image=s;var A,x=s.dict,w=x.get("F","Filter");if(w instanceof d.Name)A=w.name;else if(Array.isArray(w)){var S=i.fetchIfRef(w[0]);S instanceof d.Name&&(A=S.name)}switch(A){case"JPXDecode":var C=new c.JpxImage;C.parseImageProperties(s.stream),s.stream.reset(),s.width=C.width,s.height=C.height,s.bitsPerComponent=C.bitsPerComponent,s.numComps=C.componentsCount;break;case"JBIG2Decode":s.bitsPerComponent=1,s.numComps=1}var k=x.get("W","Width"),D=x.get("H","Height");if(Number.isInteger(s.width)&&s.width>0&&Number.isInteger(s.height)&&s.height>0&&(s.width!==k||s.height!==D)&&((0,a.warn)("PDFImage - using the Width/Height of the image data, rather than the image dictionary."),k=s.width,D=s.height),k<1||D<1)throw new a.FormatError("Invalid image width: ".concat(k," or height: ").concat(D));this.width=k,this.height=D,this.interpolate=x.get("I","Interpolate"),this.imageMask=x.get("IM","ImageMask")||!1,this.matte=x.get("Matte")||!1;var R=s.bitsPerComponent;if(!R&&!(R=x.get("BPC","BitsPerComponent"))){if(!this.imageMask)throw new a.FormatError("Bits per component missing in image: ".concat(this.imageMask));R=1}if(this.bpc=R,!this.imageMask){var I=x.getRaw("CS")||x.getRaw("ColorSpace");if(!I)switch((0,a.info)("JPX images (which do not require color spaces)"),s.numComps){case 1:I=d.Name.get("DeviceGray");break;case 3:I=d.Name.get("DeviceRGB");break;case 4:I=d.Name.get("DeviceCMYK");break;default:throw new Error("JPX images with ".concat(s.numComps," color components not supported."))}this.colorSpace=o.ColorSpace.parse({cs:I,xref:i,resources:u?n:null,pdfFunctionFactory:v,localColorSpaceCache:_}),this.numComps=this.colorSpace.numComps}if(this.decode=x.getArray("D","Decode"),this.needsDecode=!1,this.decode&&(this.colorSpace&&!this.colorSpace.isDefaultDecode(this.decode,R)||g&&!o.ColorSpace.isDefaultDecode(this.decode,1))){this.needsDecode=!0;var M=(1<<R)-1;this.decodeCoefficients=[],this.decodeAddends=[];for(var T=this.colorSpace&&"Indexed"===this.colorSpace.name,P=0,z=0;P<this.decode.length;P+=2,++z){var B=this.decode[P],F=this.decode[P+1];this.decodeCoefficients[z]=T?(F-B)/M:F-B,this.decodeAddends[z]=T?B:M*B}}m?this.smask=new e({xref:i,res:n,image:m,isInline:u,pdfFunctionFactory:v,localColorSpaceCache:_}):f&&(f instanceof r.BaseStream?f.dict.get("IM","ImageMask")?this.mask=new e({xref:i,res:n,image:f,isInline:u,isMask:!0,pdfFunctionFactory:v,localColorSpaceCache:_}):(0,a.warn)("Ignoring /Mask in image without /ImageMask."):this.mask=f)}return g(e,[{key:"drawWidth",get:function(){return Math.max(this.width,this.smask&&this.smask.width||0,this.mask&&this.mask.width||0)}},{key:"drawHeight",get:function(){return Math.max(this.height,this.smask&&this.smask.height||0,this.mask&&this.mask.height||0)}},{key:"decodeBuffer",value:function(e){var t,i,a=this.bpc,n=this.numComps,r=this.decodeAddends,o=this.decodeCoefficients,s=(1<<a)-1;if(1!==a){var l=0;for(t=0,i=this.width*this.height;t<i;t++)for(var c=0;c<n;c++)e[l]=u(e[l],r[c],o[c],s),l++}else for(t=0,i=e.length;t<i;t++)e[t]=+!e[t]}},{key:"getComponents",value:function(e){var t=this.bpc;if(8===t)return e;var i,a=this.width,n=this.height,r=this.numComps,o=a*n*r,s=0;i=t<=8?new Uint8Array(o):t<=16?new Uint16Array(o):new Uint32Array(o);var l,c,d=a*r,u=(1<<t)-1,p=0;if(1===t)for(var m,h,f,y=0;y<n;y++){for(h=p+(-8&d),f=p+d;p<h;)c=e[s++],i[p]=c>>7&1,i[p+1]=c>>6&1,i[p+2]=c>>5&1,i[p+3]=c>>4&1,i[p+4]=c>>3&1,i[p+5]=c>>2&1,i[p+6]=c>>1&1,i[p+7]=1&c,p+=8;if(p<f)for(c=e[s++],m=128;p<f;)i[p++]=+!!(c&m),m>>=1}else{var b=0;for(c=0,p=0,l=o;p<l;++p){for(p%d===0&&(c=0,b=0);b<t;)c=c<<8|e[s++],b+=8;var g=b-t,v=c>>g;v<0?v=0:v>u&&(v=u),i[p]=v,c&=(1<<g)-1,b=g}}return i}},{key:"fillOpacity",value:function(t,i,n,r,o){var s,l,c,d,u,p,h=this.smask,f=this.mask;if(h)l=h.width,c=h.height,s=new Uint8ClampedArray(l*c),h.fillGrayBuffer(s),l===i&&c===n||(s=m(s,h.bpc,l,c,i,n));else if(f)if(f instanceof e){for(l=f.width,c=f.height,s=new Uint8ClampedArray(l*c),f.numComps=1,f.fillGrayBuffer(s),d=0,u=l*c;d<u;++d)s[d]=255-s[d];l===i&&c===n||(s=m(s,f.bpc,l,c,i,n))}else{if(!Array.isArray(f))throw new a.FormatError("Unknown mask format.");s=new Uint8ClampedArray(i*n);var y=this.numComps;for(d=0,u=i*n;d<u;++d){var b=0,g=d*y;for(p=0;p<y;++p){var v=o[g+p],_=2*p;if(v<f[_]||v>f[_+1]){b=255;break}}s[d]=b}}if(s)for(d=0,p=3,u=i*r;d<u;++d,p+=4)t[p]=s[d];else for(d=0,p=3,u=i*r;d<u;++d,p+=4)t[p]=255}},{key:"undoPreblend",value:function(e,t,i){var a=this.smask&&this.smask.matte;if(a)for(var n=this.colorSpace.getRgb(a,0),r=n[0],o=n[1],s=n[2],l=t*i*4,c=0;c<l;c+=4){var d=e[c+3];if(0!==d){var u=255/d;e[c]=(e[c]-r)*u+r,e[c+1]=(e[c+1]-o)*u+o,e[c+2]=(e[c+2]-s)*u+s}else e[c]=255,e[c+1]=255,e[c+2]=255}}},{key:"createImageData",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=this.drawWidth,i=this.drawHeight,n={width:t,height:i,interpolate:this.interpolate,kind:0,data:null},r=this.numComps,o=this.width,s=this.height,c=this.bpc,d=o*r*c+7>>3;if(!e){var u;if("DeviceGray"===this.colorSpace.name&&1===c?u=a.ImageKind.GRAYSCALE_1BPP:"DeviceRGB"!==this.colorSpace.name||8!==c||this.needsDecode||(u=a.ImageKind.RGB_24BPP),u&&!this.smask&&!this.mask&&t===o&&i===s){if(n.kind=u,n.data=this.getImageBytes(s*d,{}),this.needsDecode){(0,a.assert)(u===a.ImageKind.GRAYSCALE_1BPP,"PDFImage.createImageData: The image must be grayscale.");for(var p=n.data,m=0,h=p.length;m<h;m++)p[m]^=255}return n}if(this.image instanceof l.JpegStream&&!this.smask&&!this.mask){var f=s*d;switch(this.colorSpace.name){case"DeviceGray":f*=3;case"DeviceRGB":case"DeviceCMYK":return n.kind=a.ImageKind.RGB_24BPP,n.data=this.getImageBytes(f,{drawWidth:t,drawHeight:i,forceRGB:!0}),n}}}var y,b,g=this.getImageBytes(s*d,{internal:!0}),v=0|g.length/d*i/s,_=this.getComponents(g);return e||this.smask||this.mask?(n.kind=a.ImageKind.RGBA_32BPP,n.data=new Uint8ClampedArray(t*i*4),y=1,b=!0,this.fillOpacity(n.data,t,i,v,_)):(n.kind=a.ImageKind.RGB_24BPP,n.data=new Uint8ClampedArray(t*i*3),y=0,b=!1),this.needsDecode&&this.decodeBuffer(_),this.colorSpace.fillRgb(n.data,o,s,t,i,v,c,_,y),b&&this.undoPreblend(n.data,t,v),n}},{key:"fillGrayBuffer",value:function(e){var t=this.numComps;if(1!==t)throw new a.FormatError("Reading gray scale from a color image: ".concat(t));var i,n,r=this.width,o=this.height,s=this.bpc,l=r*t*s+7>>3,c=this.getImageBytes(o*l,{internal:!0}),d=this.getComponents(c);if(1!==s){this.needsDecode&&this.decodeBuffer(d),n=r*o;var u=255/((1<<s)-1);for(i=0;i<n;++i)e[i]=u*d[i]}else if(n=r*o,this.needsDecode)for(i=0;i<n;++i)e[i]=d[i]-1&255;else for(i=0;i<n;++i)e[i]=255&-d[i]}},{key:"getImageBytes",value:function(e,t){var i=t.drawWidth,n=t.drawHeight,r=t.forceRGB,o=void 0!==r&&r,l=t.internal,c=void 0!==l&&l;this.image.reset(),this.image.drawWidth=i||this.width,this.image.drawHeight=n||this.height,this.image.forceRGB=!!o;var d=this.image.getBytes(e);return c||this.image instanceof s.DecodeStream?d:((0,a.assert)(d instanceof Uint8Array,'PDFImage.getImageBytes: Unsupported "imageBytes" type.'),new Uint8Array(d))}}],[{key:"buildImage",value:function(){var t=y(p().mark((function t(i){var n,o,s,l,c,d,u,m,h,f,y,b;return p().wrap((function(t){for(;;)switch(t.prev=t.next){case 0:return n=i.xref,o=i.res,s=i.image,l=i.isInline,c=void 0!==l&&l,d=i.pdfFunctionFactory,u=i.localColorSpaceCache,m=s,h=null,f=null,y=s.dict.get("SMask"),b=s.dict.get("Mask"),y?y instanceof r.BaseStream?h=y:(0,a.warn)("Unsupported /SMask format."):b&&(b instanceof r.BaseStream||Array.isArray(b)?f=b:(0,a.warn)("Unsupported /Mask format.")),t.abrupt("return",new e({xref:n,res:o,image:m,isInline:c,smask:h,mask:f,pdfFunctionFactory:d,localColorSpaceCache:u}));case 8:case"end":return t.stop()}}),t)})));return function(e){return t.apply(this,arguments)}}()},{key:"createRawMask",value:function(e){var t,i,a=e.imgArray,n=e.width,r=e.height,o=e.imageIsFromDecodeStream,s=e.inverseDecode,l=e.interpolate,c=(n+7>>3)*r,d=a.byteLength;if(!o||s&&c!==d?s?((t=new Uint8Array(c)).set(a),t.fill(255,d)):t=new Uint8Array(a):t=a,s)for(i=0;i<d;i++)t[i]^=255;return{data:t,width:n,height:r,interpolate:l}}},{key:"createMask",value:function(e){var t=e.imgArray,i=e.width,r=e.height,o=e.imageIsFromDecodeStream,s=e.inverseDecode,l=e.interpolate,c=e.isOffscreenCanvasSupported,d=void 0===c||c,u=1===i&&1===r&&s===(0===t.length||!!(128&t[0]));if(u)return{isSingleOpaquePixel:u};if(d&&a.FeatureTest.isOffscreenCanvasSupported){var p=new OffscreenCanvas(i,r),m=p.getContext("2d"),h=m.createImageData(i,r);return(0,n.applyMaskImageData)({src:t,dest:h.data,width:i,height:r,inverseDecode:s}),m.putImageData(h,0,0),{data:null,width:i,height:r,interpolate:l,bitmap:p.transferToImageBitmap()}}return this.createRawMask({imgArray:t,width:i,height:r,inverseDecode:s,imageIsFromDecodeStream:o,interpolate:l})}}]),e}();t.PDFImage=h},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.applyMaskImageData=function(e){var t=e.src,i=e.srcPos,n=void 0===i?0:i,r=e.dest,o=e.destPos,s=void 0===o?0:o,l=e.width,c=e.height,d=e.inverseDecode,u=void 0!==d&&d,p=a.FeatureTest.isLittleEndian?4278190080:255,m=f(u?[0,p]:[p,0],2),h=m[0],y=m[1],b=l>>3,g=7&l,v=t.length;r=new Uint32Array(r.buffer);for(var _=0;_<c;_++){for(var A=n+b;n<A;n++){var x=n<v?t[n]:255;r[s++]=128&x?y:h,r[s++]=64&x?y:h,r[s++]=32&x?y:h,r[s++]=16&x?y:h,r[s++]=8&x?y:h,r[s++]=4&x?y:h,r[s++]=2&x?y:h,r[s++]=1&x?y:h}if(0!==g)for(var w=n<v?t[n++]:255,S=0;S<g;S++)r[s++]=w&1<<7-S?y:h}return{srcPos:n,destPos:s}};var a=i(2)},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.incrementalUpdate=function(e){var t=e.originalData,i=e.xrefInfo,s=e.newRefs,u=e.xref,p=void 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r,o,s=1732584193,l=-271733879,c=-1732584194,d=271733878,u=n+72&-64,p=new Uint8Array(u);for(r=0;r<n;++r)p[r]=i[a++];p[r++]=128;for(var m=u-8;r<m;)p[r++]=0;p[r++]=n<<3&255,p[r++]=n>>5&255,p[r++]=n>>13&255,p[r++]=n>>21&255,p[r++]=n>>>29&255,p[r++]=0,p[r++]=0,p[r++]=0;var h=new Int32Array(16);for(r=0;r<u;){for(o=0;o<16;++o,r+=4)h[o]=p[r]|p[r+1]<<8|p[r+2]<<16|p[r+3]<<24;var f=s,y=l,b=c,g=d,v=void 0,_=void 0;for(o=0;o<64;++o){o<16?(v=y&b|~y&g,_=o):o<32?(v=g&y|~g&b,_=5*o+1&15):o<48?(v=y^b^g,_=3*o+5&15):(v=b^(y|~g),_=7*o&15);var A=g,x=f+v+t[o]+h[_]|0,w=e[o];g=b,b=y,y=y+(x<<w|x>>>32-w)|0,f=A}s=s+f|0,l=l+y|0,c=c+b|0,d=d+g|0}return new Uint8Array([255&s,s>>8&255,s>>16&255,s>>>24&255,255&l,l>>8&255,l>>16&255,l>>>24&255,255&c,c>>8&255,c>>16&255,c>>>24&255,255&d,d>>8&255,d>>16&255,d>>>24&255])}}();t.calculateMD5=s;var l=function(){function e(t,i){b(this,e),this.high=0|t,this.low=0|i}return g(e,[{key:"and",value:function(e){this.high&=e.high,this.low&=e.low}},{key:"xor",value:function(e){this.high^=e.high,this.low^=e.low}},{key:"or",value:function(e){this.high|=e.high,this.low|=e.low}},{key:"shiftRight",value:function(e){e>=32?(this.low=this.high>>>e-32|0,this.high=0):(this.low=this.low>>>e|this.high<<32-e,this.high=this.high>>>e|0)}},{key:"shiftLeft",value:function(e){e>=32?(this.high=this.low<<e-32,this.low=0):(this.high=this.high<<e|this.low>>>32-e,this.low<<=e)}},{key:"rotateRight",value:function(e){var t,i;32&e?(i=this.low,t=this.high):(t=this.low,i=this.high),e&=31,this.low=t>>>e|i<<32-e,this.high=i>>>e|t<<32-e}},{key:"not",value:function(){this.high=~this.high,this.low=~this.low}},{key:"add",value:function(e){var t=(this.low>>>0)+(e.low>>>0),i=(this.high>>>0)+(e.high>>>0);t>4294967295&&(i+=1),this.low=0|t,this.high=0|i}},{key:"copyTo",value:function(e,t){e[t]=this.high>>>24&255,e[t+1]=this.high>>16&255,e[t+2]=this.high>>8&255,e[t+3]=255&this.high,e[t+4]=this.low>>>24&255,e[t+5]=this.low>>16&255,e[t+6]=this.low>>8&255,e[t+7]=255&this.low}},{key:"assign",value:function(e){this.high=e.high,this.low=e.low}}]),e}(),c=function(){function e(e,t){return e>>>t|e<<32-t}function t(e,t,i){return e&t^~e&i}function i(e,t,i){return e&t^e&i^t&i}function a(t){return e(t,2)^e(t,13)^e(t,22)}function n(t){return e(t,6)^e(t,11)^e(t,25)}function r(t){return e(t,7)^e(t,18)^t>>>3}var o=[1116352408,1899447441,3049323471,3921009573,961987163,1508970993,2453635748,2870763221,3624381080,310598401,607225278,1426881987,1925078388,2162078206,2614888103,3248222580,3835390401,4022224774,264347078,604807628,770255983,1249150122,1555081692,1996064986,2554220882,2821834349,2952996808,3210313671,3336571891,3584528711,113926993,338241895,666307205,773529912,1294757372,1396182291,1695183700,1986661051,2177026350,2456956037,2730485921,2820302411,3259730800,3345764771,3516065817,3600352804,4094571909,275423344,430227734,506948616,659060556,883997877,958139571,1322822218,1537002063,1747873779,1955562222,2024104815,2227730452,2361852424,2428436474,2756734187,3204031479,3329325298];return function(s,l,c){var d,u,p=1779033703,m=3144134277,h=1013904242,f=2773480762,y=1359893119,b=2600822924,g=528734635,v=1541459225,_=64*Math.ceil((c+9)/64),A=new Uint8Array(_);for(d=0;d<c;++d)A[d]=s[l++];A[d++]=128;for(var x=_-8;d<x;)A[d++]=0;A[d++]=0,A[d++]=0,A[d++]=0,A[d++]=c>>>29&255,A[d++]=c>>21&255,A[d++]=c>>13&255,A[d++]=c>>5&255,A[d++]=c<<3&255;var w,S=new Uint32Array(64);for(d=0;d<_;){for(u=0;u<16;++u)S[u]=A[d]<<24|A[d+1]<<16|A[d+2]<<8|A[d+3],d+=4;for(u=16;u<64;++u)S[u]=0|(e(w=S[u-2],17)^e(w,19)^w>>>10)+S[u-7]+r(S[u-15])+S[u-16];var C=p,k=m,D=h,R=f,I=y,M=b,T=g,P=v,z=void 0,B=void 0;for(u=0;u<64;++u)z=P+n(I)+t(I,M,T)+o[u]+S[u],B=a(C)+i(C,k,D),P=T,T=M,M=I,I=R+z|0,R=D,D=k,k=C,C=z+B|0;p=p+C|0,m=m+k|0,h=h+D|0,f=f+R|0,y=y+I|0,b=b+M|0,g=g+T|0,v=v+P|0}return new Uint8Array([p>>24&255,p>>16&255,p>>8&255,255&p,m>>24&255,m>>16&255,m>>8&255,255&m,h>>24&255,h>>16&255,h>>8&255,255&h,f>>24&255,f>>16&255,f>>8&255,255&f,y>>24&255,y>>16&255,y>>8&255,255&y,b>>24&255,b>>16&255,b>>8&255,255&b,g>>24&255,g>>16&255,g>>8&255,255&g,v>>24&255,v>>16&255,v>>8&255,255&v])}}();t.calculateSHA256=c;var p=function(){function e(e,t,i,a,n){e.assign(t),e.and(i),n.assign(t),n.not(),n.and(a),e.xor(n)}function t(e,t,i,a,n){e.assign(t),e.and(i),n.assign(t),n.and(a),e.xor(n),n.assign(i),n.and(a),e.xor(n)}function i(e,t,i){e.assign(t),e.rotateRight(28),i.assign(t),i.rotateRight(34),e.xor(i),i.assign(t),i.rotateRight(39),e.xor(i)}function a(e,t,i){e.assign(t),e.rotateRight(14),i.assign(t),i.rotateRight(18),e.xor(i),i.assign(t),i.rotateRight(41),e.xor(i)}function n(e,t,i){e.assign(t),e.rotateRight(1),i.assign(t),i.rotateRight(8),e.xor(i),i.assign(t),i.shiftRight(7),e.xor(i)}function r(e,t,i){e.assign(t),e.rotateRight(19),i.assign(t),i.rotateRight(61),e.xor(i),i.assign(t),i.shiftRight(6),e.xor(i)}var o=[new l(1116352408,3609767458),new l(1899447441,602891725),new l(3049323471,3964484399),new l(3921009573,2173295548),new l(961987163,4081628472),new l(1508970993,3053834265),new l(2453635748,2937671579),new l(2870763221,3664609560),new l(3624381080,2734883394),new l(310598401,1164996542),new l(607225278,1323610764),new l(1426881987,3590304994),new l(1925078388,4068182383),new l(2162078206,991336113),new l(2614888103,633803317),new l(3248222580,3479774868),new l(3835390401,2666613458),new l(4022224774,944711139),new l(264347078,2341262773),new l(604807628,2007800933),new l(770255983,1495990901),new l(1249150122,1856431235),new l(1555081692,3175218132),new l(1996064986,2198950837),new l(2554220882,3999719339),new l(2821834349,766784016),new l(2952996808,2566594879),new l(3210313671,3203337956),new l(3336571891,1034457026),new l(3584528711,2466948901),new l(113926993,3758326383),new l(338241895,168717936),new l(666307205,1188179964),new l(773529912,1546045734),new l(1294757372,1522805485),new l(1396182291,2643833823),new l(1695183700,2343527390),new l(1986661051,1014477480),new l(2177026350,1206759142),new l(2456956037,344077627),new l(2730485921,1290863460),new l(2820302411,3158454273),new l(3259730800,3505952657),new l(3345764771,106217008),new l(3516065817,3606008344),new l(3600352804,1432725776),new l(4094571909,1467031594),new l(275423344,851169720),new l(430227734,3100823752),new l(506948616,1363258195),new l(659060556,3750685593),new l(883997877,3785050280),new l(958139571,3318307427),new l(1322822218,3812723403),new l(1537002063,2003034995),new l(1747873779,3602036899),new l(1955562222,1575990012),new l(2024104815,1125592928),new l(2227730452,2716904306),new l(2361852424,442776044),new l(2428436474,593698344),new l(2756734187,3733110249),new l(3204031479,2999351573),new l(3329325298,3815920427),new l(3391569614,3928383900),new l(3515267271,566280711),new l(3940187606,3454069534),new l(4118630271,4000239992),new l(116418474,1914138554),new l(174292421,2731055270),new l(289380356,3203993006),new l(460393269,320620315),new l(685471733,587496836),new l(852142971,1086792851),new l(1017036298,365543100),new l(1126000580,2618297676),new l(1288033470,3409855158),new l(1501505948,4234509866),new l(1607167915,987167468),new l(1816402316,1246189591)];return function(s,c,d){var u,p,m,h,f,y,b,g,v=arguments.length>3&&void 0!==arguments[3]&&arguments[3];v?(u=new l(3418070365,3238371032),p=new l(1654270250,914150663),m=new l(2438529370,812702999),h=new l(355462360,4144912697),f=new l(1731405415,4290775857),y=new l(2394180231,1750603025),b=new l(3675008525,1694076839),g=new l(1203062813,3204075428)):(u=new l(1779033703,4089235720),p=new l(3144134277,2227873595),m=new l(1013904242,4271175723),h=new l(2773480762,1595750129),f=new l(1359893119,2917565137),y=new l(2600822924,725511199),b=new l(528734635,4215389547),g=new l(1541459225,327033209));var _,A,x=128*Math.ceil((d+17)/128),w=new Uint8Array(x);for(_=0;_<d;++_)w[_]=s[c++];w[_++]=128;for(var S=x-16;_<S;)w[_++]=0;w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=d>>>29&255,w[_++]=d>>21&255,w[_++]=d>>13&255,w[_++]=d>>5&255,w[_++]=d<<3&255;var C=new Array(80);for(_=0;_<80;_++)C[_]=new l(0,0);var k,D,R=new l(0,0),I=new l(0,0),M=new l(0,0),T=new l(0,0),P=new l(0,0),z=new l(0,0),B=new l(0,0),F=new l(0,0),E=new l(0,0),N=new l(0,0),O=new l(0,0),G=new l(0,0);for(_=0;_<x;){for(A=0;A<16;++A)C[A].high=w[_]<<24|w[_+1]<<16|w[_+2]<<8|w[_+3],C[A].low=w[_+4]<<24|w[_+5]<<16|w[_+6]<<8|w[_+7],_+=8;for(A=16;A<80;++A)r(k=C[A],C[A-2],G),k.add(C[A-7]),n(O,C[A-15],G),k.add(O),k.add(C[A-16]);for(R.assign(u),I.assign(p),M.assign(m),T.assign(h),P.assign(f),z.assign(y),B.assign(b),F.assign(g),A=0;A<80;++A)E.assign(F),a(O,P,G),E.add(O),e(O,P,z,B,G),E.add(O),E.add(o[A]),E.add(C[A]),i(N,R,G),t(O,R,I,M,G),N.add(O),k=F,F=B,B=z,z=P,T.add(E),P=T,T=M,M=I,I=R,k.assign(E),k.add(N),R=k;u.add(R),p.add(I),m.add(M),h.add(T),f.add(P),y.add(z),b.add(B),g.add(F)}return v?(D=new Uint8Array(48),u.copyTo(D,0),p.copyTo(D,8),m.copyTo(D,16),h.copyTo(D,24),f.copyTo(D,32),y.copyTo(D,40)):(D=new Uint8Array(64),u.copyTo(D,0),p.copyTo(D,8),m.copyTo(D,16),h.copyTo(D,24),f.copyTo(D,32),y.copyTo(D,40),b.copyTo(D,48),g.copyTo(D,56)),D}}();function m(e,t,i){return p(e,t,i,!0)}t.calculateSHA512=p;var h=function(){function e(){b(this,e)}return g(e,[{key:"decryptBlock",value:function(e){return e}},{key:"encrypt",value:function(e){return e}}]),e}(),f=function(){function e(){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize AESBaseCipher."),this._s=new 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Uint8Array([82,9,106,213,48,54,165,56,191,64,163,158,129,243,215,251,124,227,57,130,155,47,255,135,52,142,67,68,196,222,233,203,84,123,148,50,166,194,35,61,238,76,149,11,66,250,195,78,8,46,161,102,40,217,36,178,118,91,162,73,109,139,209,37,114,248,246,100,134,104,152,22,212,164,92,204,93,101,182,146,108,112,72,80,253,237,185,218,94,21,70,87,167,141,157,132,144,216,171,0,140,188,211,10,247,228,88,5,184,179,69,6,208,44,30,143,202,63,15,2,193,175,189,3,1,19,138,107,58,145,17,65,79,103,220,234,151,242,207,206,240,180,230,115,150,172,116,34,231,173,53,133,226,249,55,232,28,117,223,110,71,241,26,113,29,41,197,137,111,183,98,14,170,24,190,27,252,86,62,75,198,210,121,32,154,219,192,254,120,205,90,244,31,221,168,51,136,7,199,49,177,18,16,89,39,128,236,95,96,81,127,169,25,181,74,13,45,229,122,159,147,201,156,239,160,224,59,77,174,42,245,176,200,235,187,60,131,83,153,97,23,43,4,126,186,119,214,38,225,105,20,99,85,33,12,125]),this._mix=new Uint32Array([0,235474187,470948374,303765277,941896748,908933415,607530554,708780849,1883793496,2118214995,1817866830,1649639237,1215061108,1181045119,1417561698,1517767529,3767586992,4003061179,4236429990,4069246893,3635733660,3602770327,3299278474,3400528769,2430122216,2664543715,2362090238,2193862645,2835123396,2801107407,3035535058,3135740889,3678124923,3576870512,3341394285,3374361702,3810496343,3977675356,4279080257,4043610186,2876494627,2776292904,3076639029,3110650942,2472011535,2640243204,2403728665,2169303058,1001089995,899835584,666464733,699432150,59727847,226906860,530400753,294930682,1273168787,1172967064,1475418501,1509430414,1942435775,2110667444,1876241833,1641816226,2910219766,2743034109,2976151520,3211623147,2505202138,2606453969,2302690252,2269728455,3711829422,3543599269,3240894392,3475313331,3843699074,3943906441,4178062228,4144047775,1306967366,1139781709,1374988112,1610459739,1975683434,2076935265,1775276924,1742315127,1034867998,866637845,566021896,800440835,92987698,193195065,429456164,395441711,1984812685,2017778566,1784663195,1683407248,1315562145,1080094634,1383856311,1551037884,101039829,135050206,437757123,337553864,1042385657,807962610,573804783,742039012,2531067453,2564033334,2328828971,2227573024,2935566865,2700099354,3001755655,3168937228,3868552805,3902563182,4203181171,4102977912,3736164937,3501741890,3265478751,3433712980,1106041591,1340463100,1576976609,1408749034,2043211483,2009195472,1708848333,1809054150,832877231,1068351396,766945465,599762354,159417987,126454664,361929877,463180190,2709260871,2943682380,3178106961,3009879386,2572697195,2538681184,2236228733,2336434550,3509871135,3745345300,3441850377,3274667266,3910161971,3877198648,4110568485,4211818798,2597806476,2497604743,2261089178,2295101073,2733856160,2902087851,3202437046,2968011453,3936291284,3835036895,4136440770,4169408201,3535486456,3702665459,3467192302,3231722213,2051518780,1951317047,1716890410,1750902305,1113818384,1282050075,1584504582,1350078989,168810852,67556463,371049330,404016761,841739592,1008918595,775550814,540080725,3969562369,3801332234,4035489047,4269907996,3569255213,3669462566,3366754619,3332740144,2631065433,2463879762,2160117071,2395588676,2767645557,2868897406,3102011747,3069049960,202008497,33778362,270040487,504459436,875451293,975658646,675039627,641025152,2084704233,1917518562,1615861247,1851332852,1147550661,1248802510,1484005843,1451044056,933301370,967311729,733156972,632953703,260388950,25965917,328671808,496906059,1206477858,1239443753,1543208500,1441952575,2144161806,1908694277,1675577880,1842759443,3610369226,3644379585,3408119516,3307916247,4011190502,3776767469,4077384432,4245618683,2809771154,2842737049,3144396420,3043140495,2673705150,2438237621,2203032232,2370213795]),this._mixCol=new Uint8Array(256);for(var t=0;t<256;t++)this._mixCol[t]=t<128?t<<1:t<<1^27;this.buffer=new Uint8Array(16),this.bufferPosition=0}return g(e,[{key:"_expandKey",value:function(e){(0,a.unreachable)("Cannot call `_expandKey` on the base class")}},{key:"_decrypt",value:function(e,t){var i,a,n,r=new Uint8Array(16);r.set(e);for(var o=0,s=this._keySize;o<16;++o,++s)r[o]^=t[s];for(var l=this._cyclesOfRepetition-1;l>=1;--l){i=r[13],r[13]=r[9],r[9]=r[5],r[5]=r[1],r[1]=i,i=r[14],a=r[10],r[14]=r[6],r[10]=r[2],r[6]=i,r[2]=a,i=r[15],a=r[11],n=r[7],r[15]=r[3],r[11]=i,r[7]=a,r[3]=n;for(var c=0;c<16;++c)r[c]=this._inv_s[r[c]];for(var d=0,u=16*l;d<16;++d,++u)r[d]^=t[u];for(var p=0;p<16;p+=4){var m=this._mix[r[p]],h=this._mix[r[p+1]],f=this._mix[r[p+2]],y=this._mix[r[p+3]];i=m^h>>>8^h<<24^f>>>16^f<<16^y>>>24^y<<8,r[p]=i>>>24&255,r[p+1]=i>>16&255,r[p+2]=i>>8&255,r[p+3]=255&i}}i=r[13],r[13]=r[9],r[9]=r[5],r[5]=r[1],r[1]=i,i=r[14],a=r[10],r[14]=r[6],r[10]=r[2],r[6]=i,r[2]=a,i=r[15],a=r[11],n=r[7],r[15]=r[3],r[11]=i,r[7]=a,r[3]=n;for(var b=0;b<16;++b)r[b]=this._inv_s[r[b]],r[b]^=t[b];return r}},{key:"_encrypt",value:function(e,t){var i,a,n,r=this._s,o=new Uint8Array(16);o.set(e);for(var s=0;s<16;++s)o[s]^=t[s];for(var l=1;l<this._cyclesOfRepetition;l++){for(var c=0;c<16;++c)o[c]=r[o[c]];n=o[1],o[1]=o[5],o[5]=o[9],o[9]=o[13],o[13]=n,n=o[2],a=o[6],o[2]=o[10],o[6]=o[14],o[10]=n,o[14]=a,n=o[3],a=o[7],i=o[11],o[3]=o[15],o[7]=n,o[11]=a,o[15]=i;for(var d=0;d<16;d+=4){var u=o[d+0],p=o[d+1],m=o[d+2],h=o[d+3];i=u^p^m^h,o[d+0]^=i^this._mixCol[u^p],o[d+1]^=i^this._mixCol[p^m],o[d+2]^=i^this._mixCol[m^h],o[d+3]^=i^this._mixCol[h^u]}for(var f=0,y=16*l;f<16;++f,++y)o[f]^=t[y]}for(var b=0;b<16;++b)o[b]=r[o[b]];n=o[1],o[1]=o[5],o[5]=o[9],o[9]=o[13],o[13]=n,n=o[2],a=o[6],o[2]=o[10],o[6]=o[14],o[10]=n,o[14]=a,n=o[3],a=o[7],i=o[11],o[3]=o[15],o[7]=n,o[11]=a,o[15]=i;for(var g=0,v=this._keySize;g<16;++g,++v)o[g]^=t[v];return o}},{key:"_decryptBlock2",value:function(e,t){for(var i=e.length,a=this.buffer,n=this.bufferPosition,r=[],o=this.iv,s=0;s<i;++s)if(a[n]=e[s],!(++n<16)){for(var l=this._decrypt(a,this._key),c=0;c<16;++c)l[c]^=o[c];o=a,r.push(l),a=new Uint8Array(16),n=0}if(this.buffer=a,this.bufferLength=n,this.iv=o,0===r.length)return new Uint8Array(0);var d=16*r.length;if(t){var u=r.at(-1),p=u[15];if(p<=16){for(var m=15,h=16-p;m>=h;--m)if(u[m]!==p){p=0;break}d-=p,r[r.length-1]=u.subarray(0,16-p)}}for(var f=new Uint8Array(d),y=0,b=0,g=r.length;y<g;++y,b+=16)f.set(r[y],b);return f}},{key:"decryptBlock",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null,a=e.length,n=this.buffer,r=this.bufferPosition;if(i)this.iv=i;else{for(var o=0;r<16&&o<a;++o,++r)n[r]=e[o];if(r<16)return this.bufferLength=r,new Uint8Array(0);this.iv=n,e=e.subarray(16)}return this.buffer=new Uint8Array(16),this.bufferLength=0,this.decryptBlock=this._decryptBlock2,this.decryptBlock(e,t)}},{key:"encrypt",value:function(e,t){var i=e.length,a=this.buffer,n=this.bufferPosition,r=[];t||(t=new Uint8Array(16));for(var o=0;o<i;++o)if(a[n]=e[o],!(++n<16)){for(var s=0;s<16;++s)a[s]^=t[s];var l=this._encrypt(a,this._key);t=l,r.push(l),a=new Uint8Array(16),n=0}if(this.buffer=a,this.bufferLength=n,this.iv=t,0===r.length)return new Uint8Array(0);for(var c=16*r.length,d=new Uint8Array(c),u=0,p=0,m=r.length;u<m;++u,p+=16)d.set(r[u],p);return d}}]),e}(),y=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this))._cyclesOfRepetition=10,a._keySize=160,a._rcon=new Uint8Array([141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141]),a._key=a._expandKey(e),a}return g(i,[{key:"_expandKey",value:function(e){var t=this._s,i=this._rcon,a=new Uint8Array(176);a.set(e);for(var n=16,r=1;n<176;++r){var o=a[n-3],s=a[n-2],l=a[n-1],c=a[n-4];o=t[o],s=t[s],l=t[l],c=t[c],o^=i[r];for(var d=0;d<4;++d)a[n]=o^=a[n-16],a[++n]=s^=a[n-16],a[++n]=l^=a[n-16],a[++n]=c^=a[n-16],n++}return a}}]),i}(f);t.AES128Cipher=y;var v=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this))._cyclesOfRepetition=14,a._keySize=224,a._key=a._expandKey(e),a}return g(i,[{key:"_expandKey",value:function(e){var t=this._s,i=new Uint8Array(240);i.set(e);for(var a,n,r,o,s=1,l=32,c=1;l<240;++c){l%32===16?(a=t[a],n=t[n],r=t[r],o=t[o]):l%32===0&&(a=i[l-3],n=i[l-2],r=i[l-1],o=i[l-4],a=t[a],n=t[n],r=t[r],o=t[o],a^=s,(s<<=1)>=256&&(s=255&(27^s)));for(var d=0;d<4;++d)i[l]=a^=i[l-32],i[++l]=n^=i[l-32],i[++l]=r^=i[l-32],i[++l]=o^=i[l-32],l++}return i}}]),i}(f);t.AES256Cipher=v;var _=function(){function e(){b(this,e)}return g(e,[{key:"checkOwnerPassword",value:function(e,t,i,n){var r=new Uint8Array(e.length+56);r.set(e,0),r.set(t,e.length),r.set(i,e.length+t.length);var o=c(r,0,r.length);return(0,a.isArrayEqual)(o,n)}},{key:"checkUserPassword",value:function(e,t,i){var n=new Uint8Array(e.length+8);n.set(e,0),n.set(t,e.length);var r=c(n,0,n.length);return(0,a.isArrayEqual)(r,i)}},{key:"getOwnerKey",value:function(e,t,i,a){var n=new Uint8Array(e.length+56);n.set(e,0),n.set(t,e.length),n.set(i,e.length+t.length);var r=c(n,0,n.length);return new v(r).decryptBlock(a,!1,new Uint8Array(16))}},{key:"getUserKey",value:function(e,t,i){var a=new Uint8Array(e.length+8);a.set(e,0),a.set(t,e.length);var n=c(a,0,a.length);return new v(n).decryptBlock(i,!1,new Uint8Array(16))}}]),e}();t.PDF17=_;var A=function(){function e(e,t,i){for(var a=c(t,0,t.length).subarray(0,32),n=[0],r=0;r<64||n.at(-1)>r-32;){var o=e.length+a.length+i.length,s=new Uint8Array(o),l=0;s.set(e,l),l+=e.length,s.set(a,l),l+=a.length,s.set(i,l);for(var d=new Uint8Array(64*o),u=0,h=0;u<64;u++,h+=o)d.set(s,h);var f=(n=new y(a.subarray(0,16)).encrypt(d,a.subarray(16,32))).slice(0,16).reduce((function(e,t){return e+t}),0)%3;0===f?a=c(n,0,n.length):1===f?a=m(n,0,n.length):2===f&&(a=p(n,0,n.length)),r++}return a.subarray(0,32)}return function(){function t(){b(this,t)}return g(t,[{key:"hash",value:function(t,i,a){return e(t,i,a)}},{key:"checkOwnerPassword",value:function(t,i,n,r){var o=new Uint8Array(t.length+56);o.set(t,0),o.set(i,t.length),o.set(n,t.length+i.length);var s=e(t,o,n);return(0,a.isArrayEqual)(s,r)}},{key:"checkUserPassword",value:function(t,i,n){var r=new Uint8Array(t.length+8);r.set(t,0),r.set(i,t.length);var o=e(t,r,[]);return(0,a.isArrayEqual)(o,n)}},{key:"getOwnerKey",value:function(t,i,a,n){var r=new Uint8Array(t.length+56);r.set(t,0),r.set(i,t.length),r.set(a,t.length+i.length);var o=e(t,r,a);return new v(o).decryptBlock(n,!1,new Uint8Array(16))}},{key:"getUserKey",value:function(t,i,a){var n=new Uint8Array(t.length+8);n.set(t,0),n.set(i,t.length);var r=e(t,n,[]);return new v(r).decryptBlock(a,!1,new Uint8Array(16))}}]),t}()}();t.PDF20=A;var x=function(){function e(t,i){b(this,e),this.StringCipherConstructor=t,this.StreamCipherConstructor=i}return g(e,[{key:"createStream",value:function(e,t){var i=new this.StreamCipherConstructor;return new r.DecryptStream(e,t,(function(e,t){return i.decryptBlock(e,t)}))}},{key:"decryptString",value:function(e){var t=new this.StringCipherConstructor,i=(0,a.stringToBytes)(e);return i=t.decryptBlock(i,!0),(0,a.bytesToString)(i)}},{key:"encryptString",value:function(e){var t=new this.StringCipherConstructor;if(t instanceof f){var i=16-e.length%16;e+=String.fromCharCode(i).repeat(i);var n=new Uint8Array(16);if("undefined"!==typeof crypto)crypto.getRandomValues(n);else for(var r=0;r<16;r++)n[r]=Math.floor(256*Math.random());var o=(0,a.stringToBytes)(e);o=t.encrypt(o,n);var s=new Uint8Array(16+o.length);return s.set(n),s.set(o,16),(0,a.bytesToString)(s)}var l=(0,a.stringToBytes)(e);return l=t.encrypt(l),(0,a.bytesToString)(l)}}]),e}(),w=function(){var e=new Uint8Array([40,191,78,94,78,117,138,65,100,0,78,86,255,250,1,8,46,46,0,182,208,104,62,128,47,12,169,254,100,83,105,122]);function t(t,i,a,n,r,l,c,d){var u,p,m=40+a.length+t.length,h=new Uint8Array(m),f=0;if(i)for(p=Math.min(32,i.length);f<p;++f)h[f]=i[f];for(u=0;f<32;)h[f++]=e[u++];for(u=0,p=a.length;u<p;++u)h[f++]=a[u];for(h[f++]=255&r,h[f++]=r>>8&255,h[f++]=r>>16&255,h[f++]=r>>>24&255,u=0,p=t.length;u<p;++u)h[f++]=t[u];l>=4&&!d&&(h[f++]=255,h[f++]=255,h[f++]=255,h[f++]=255);var y=s(h,0,f),b=c>>3;if(l>=3)for(u=0;u<50;++u)y=s(y,0,b);var g,v=y.subarray(0,b);if(l>=3){for(f=0;f<32;++f)h[f]=e[f];for(u=0,p=t.length;u<p;++u)h[f++]=t[u];g=new o(v).encryptBlock(s(h,0,f)),p=v.length;var _=new Uint8Array(p);for(u=1;u<=19;++u){for(var A=0;A<p;++A)_[A]=v[A]^u;g=new o(_).encryptBlock(g)}for(u=0,p=g.length;u<p;++u)if(n[u]!==g[u])return null}else for(u=0,p=(g=new o(v).encryptBlock(e)).length;u<p;++u)if(n[u]!==g[u])return null;return v}var i=n.Name.get("Identity");function r(e,t,i){var a,n=arguments.length>3&&void 0!==arguments[3]&&arguments[3],r=new Uint8Array(i.length+9),o=i.length;for(a=0;a<o;++a)r[a]=i[a];return r[a++]=255&e,r[a++]=e>>8&255,r[a++]=e>>16&255,r[a++]=255&t,r[a++]=t>>8&255,n&&(r[a++]=115,r[a++]=65,r[a++]=108,r[a++]=84),s(r,0,a).subarray(0,Math.min(i.length+5,16))}function l(e,t,i,s,l){if(!(t instanceof n.Name))throw new a.FormatError("Invalid crypt filter name.");var c,d=e.get(t.name);if(null!==d&&void 0!==d&&(c=d.get("CFM")),!c||"None"===c.name)return function(){return new h};if("V2"===c.name)return function(){return new o(r(i,s,l,!1))};if("AESV2"===c.name)return function(){return new y(r(i,s,l,!0))};if("AESV3"===c.name)return function(){return new v(l)};throw new a.FormatError("Unknown crypto method")}return function(){function c(r,l,d){b(this,c);var u=r.get("Filter");if(!(0,n.isName)(u,"Standard"))throw new a.FormatError("unknown encryption method");this.filterName=u.name,this.dict=r;var p=r.get("V");if(!Number.isInteger(p)||1!==p&&2!==p&&4!==p&&5!==p)throw new a.FormatError("unsupported encryption algorithm");this.algorithm=p;var m=r.get("Length");if(!m)if(p<=3)m=40;else{var h=r.get("CF"),f=r.get("StmF");if(h instanceof n.Dict&&f instanceof n.Name){h.suppressEncryption=!0;var y=h.get(f.name);(m=y&&y.get("Length")||128)<40&&(m<<=3)}}if(!Number.isInteger(m)||m<40||m%8!==0)throw new a.FormatError("invalid key length");var g=(0,a.stringToBytes)(r.get("O")).subarray(0,32),v=(0,a.stringToBytes)(r.get("U")).subarray(0,32),x=r.get("P"),w=r.get("R"),S=(4===p||5===p)&&!1!==r.get("EncryptMetadata");this.encryptMetadata=S;var C,k,D=(0,a.stringToBytes)(l);if(d){if(6===w)try{d=(0,a.utf8StringToString)(d)}catch(N){(0,a.warn)("CipherTransformFactory: Unable to convert UTF8 encoded password.")}C=(0,a.stringToBytes)(d)}if(5!==p)k=t(D,C,g,v,x,w,m,S);else{var R=(0,a.stringToBytes)(r.get("O")).subarray(32,40),I=(0,a.stringToBytes)(r.get("O")).subarray(40,48),M=(0,a.stringToBytes)(r.get("U")).subarray(0,48),T=(0,a.stringToBytes)(r.get("U")).subarray(32,40),P=(0,a.stringToBytes)(r.get("U")).subarray(40,48),z=(0,a.stringToBytes)(r.get("OE")),B=(0,a.stringToBytes)(r.get("UE"));(0,a.stringToBytes)(r.get("Perms")),k=function(e,t,i,a,n,r,o,s,l,c,d,u){if(t){var p=Math.min(127,t.length);t=t.subarray(0,p)}else t=[];var m;return(m=6===e?new A:new _).checkUserPassword(t,s,o)?m.getUserKey(t,l,d):t.length&&m.checkOwnerPassword(t,a,r,i)?m.getOwnerKey(t,n,r,c):null}(w,C,g,R,I,M,v,T,P,z,B)}if(!k&&!d)throw new a.PasswordException("No password given",a.PasswordResponses.NEED_PASSWORD);if(!k&&d){var F=function(t,i,a,n){for(var r=new Uint8Array(32),l=0,c=Math.min(32,t.length);l<c;++l)r[l]=t[l];for(var d=0;l<32;)r[l++]=e[d++];var u,p=s(r,0,l),m=n>>3;if(a>=3)for(d=0;d<50;++d)p=s(p,0,p.length);if(a>=3){u=i;var h=new Uint8Array(m);for(d=19;d>=0;d--){for(var f=0;f<m;++f)h[f]=p[f]^d;u=new o(h).encryptBlock(u)}}else u=new o(p.subarray(0,m)).encryptBlock(i);return u}(C,g,w,m);k=t(D,F,g,v,x,w,m,S)}if(!k)throw new a.PasswordException("Incorrect Password",a.PasswordResponses.INCORRECT_PASSWORD);if(this.encryptionKey=k,p>=4){var E=r.get("CF");E instanceof n.Dict&&(E.suppressEncryption=!0),this.cf=E,this.stmf=r.get("StmF")||i,this.strf=r.get("StrF")||i,this.eff=r.get("EFF")||this.stmf}}return g(c,[{key:"createCipherTransform",value:function(e,t){if(4===this.algorithm||5===this.algorithm)return new x(l(this.cf,this.strf,e,t,this.encryptionKey),l(this.cf,this.stmf,e,t,this.encryptionKey));var i=r(e,t,this.encryptionKey,!1),a=function(){return new o(i)};return new x(a,a)}}]),c}()}();t.CipherTransformFactory=w},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.DecryptStream=void 0;var a=i(150),n=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,a)).str=e,r.dict=e.dict,r.decrypt=n,r.nextChunk=null,r.initialized=!1,r}return g(i,[{key:"readBlock",value:function(){var e;if(this.initialized?e=this.nextChunk:(e=this.str.getBytes(512),this.initialized=!0),e&&0!==e.length){this.nextChunk=this.str.getBytes(512);var t=this.nextChunk&&this.nextChunk.length>0;e=(0,this.decrypt)(e,!t);var i=this.bufferLength,a=i+e.length;this.ensureBuffer(a).set(e,i),this.bufferLength=a}else this.eof=!0}}]),i}(a.DecodeStream);t.DecryptStream=n},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Catalog=void 0;var a=i(136),n=i(2),r=i(137),o=i(201),s=i(138),l=i(202),d=i(145),u=i(203),m=i(190),v=i(204),_=i(205);function A(e){return e instanceof r.Dict&&(e=e.get("D")),Array.isArray(e)?e:null}var x=function(){function e(t,i){if(b(this,e),this.pdfManager=t,this.xref=i,this._catDict=i.getCatalogObj(),!(this._catDict instanceof r.Dict))throw new n.FormatError("Catalog object is not a dictionary.");this.toplevelPagesDict,this._actualNumPages=null,this.fontCache=new r.RefSetCache,this.builtInCMapCache=new Map,this.standardFontDataCache=new Map,this.globalImageCache=new m.GlobalImageCache,this.pageKidsCountCache=new r.RefSetCache,this.pageIndexCache=new r.RefSetCache,this.nonBlendModesSet=new r.RefSet}return g(e,[{key:"version",get:function(){var e=this._catDict.get("Version");if(e instanceof r.Name){if(a.PDF_VERSION_REGEXP.test(e.name))return(0,n.shadow)(this,"version",e.name);(0,n.warn)("Invalid PDF catalog version: ".concat(e.name))}return(0,n.shadow)(this,"version",null)}},{key:"lang",get:function(){var e=this._catDict.get("Lang");return(0,n.shadow)(this,"lang","string"===typeof e?(0,n.stringToPDFString)(e):null)}},{key:"needsRendering",get:function(){var e=this._catDict.get("NeedsRendering");return(0,n.shadow)(this,"needsRendering","boolean"===typeof e&&e)}},{key:"collection",get:function(){var e=null;try{var t=this._catDict.get("Collection");t instanceof r.Dict&&t.size>0&&(e=t)}catch(i){if(i instanceof a.MissingDataException)throw i;(0,n.info)("Cannot fetch Collection entry; assuming no collection is present.")}return(0,n.shadow)(this,"collection",e)}},{key:"acroForm",get:function(){var e=null;try{var t=this._catDict.get("AcroForm");t instanceof r.Dict&&t.size>0&&(e=t)}catch(i){if(i instanceof a.MissingDataException)throw i;(0,n.info)("Cannot fetch AcroForm entry; assuming no forms are present.")}return(0,n.shadow)(this,"acroForm",e)}},{key:"acroFormRef",get:function(){var e=this._catDict.getRaw("AcroForm");return(0,n.shadow)(this,"acroFormRef",e instanceof r.Ref?e:null)}},{key:"metadata",get:function(){var e=this._catDict.getRaw("Metadata");if(!(e instanceof r.Ref))return(0,n.shadow)(this,"metadata",null);var t=null;try{var i=!(this.xref.encrypt&&this.xref.encrypt.encryptMetadata),o=this.xref.fetch(e,i);if(o instanceof s.BaseStream&&o.dict instanceof r.Dict){var l=o.dict.get("Type"),c=o.dict.get("Subtype");if((0,r.isName)(l,"Metadata")&&(0,r.isName)(c,"XML")){var d=(0,n.stringToUTF8String)(o.getString());d&&(t=new v.MetadataParser(d).serializable)}}}catch(u){if(u instanceof a.MissingDataException)throw u;(0,n.info)('Skipping invalid Metadata: "'.concat(u,'".'))}return(0,n.shadow)(this,"metadata",t)}},{key:"markInfo",get:function(){var e=null;try{e=this._readMarkInfo()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable to read mark info.")}return(0,n.shadow)(this,"markInfo",e)}},{key:"_readMarkInfo",value:function(){var e=this._catDict.get("MarkInfo");if(!(e instanceof r.Dict))return null;var t={Marked:!1,UserProperties:!1,Suspects:!1};for(var i in t){var a=e.get(i);"boolean"===typeof a&&(t[i]=a)}return t}},{key:"structTreeRoot",get:function(){var e=null;try{e=this._readStructTreeRoot()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable read to structTreeRoot info.")}return(0,n.shadow)(this,"structTreeRoot",e)}},{key:"_readStructTreeRoot",value:function(){var e=this._catDict.get("StructTreeRoot");if(!(e instanceof r.Dict))return null;var t=new _.StructTreeRoot(e);return t.init(),t}},{key:"toplevelPagesDict",get:function(){var e=this._catDict.get("Pages");if(!(e instanceof r.Dict))throw new n.FormatError("Invalid top-level pages dictionary.");return(0,n.shadow)(this,"toplevelPagesDict",e)}},{key:"documentOutline",get:function(){var e=null;try{e=this._readDocumentOutline()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable to read document outline.")}return(0,n.shadow)(this,"documentOutline",e)}},{key:"_readDocumentOutline",value:function(){var t=this._catDict.get("Outlines");if(!(t instanceof r.Dict))return null;if(!((t=t.getRaw("First"))instanceof r.Ref))return null;var i={items:[]},a=[{obj:t,parent:i}],o=new r.RefSet;o.put(t);for(var s=this.xref,l=new Uint8ClampedArray(3);a.length>0;){var c=a.shift(),u=s.fetchIfRef(c.obj);if(null!==u){if(!u.has("Title"))throw new n.FormatError("Invalid outline item encountered.");var p={url:null,dest:null,action:null};e.parseDestDictionary({destDict:u,resultObj:p,docBaseUrl:this.pdfManager.docBaseUrl,docAttachments:this.attachments});var m=u.get("Title"),h=u.get("F")||0,f=u.getArray("C"),y=u.get("Count"),b=l;!Array.isArray(f)||3!==f.length||0===f[0]&&0===f[1]&&0===f[2]||(b=d.ColorSpace.singletons.rgb.getRgb(f,0));var g={action:p.action,attachment:p.attachment,dest:p.dest,url:p.url,unsafeUrl:p.unsafeUrl,newWindow:p.newWindow,setOCGState:p.setOCGState,title:(0,n.stringToPDFString)(m),color:b,count:Number.isInteger(y)?y:void 0,bold:!!(2&h),italic:!!(1&h),items:[]};c.parent.items.push(g),(t=u.getRaw("First"))instanceof r.Ref&&!o.has(t)&&(a.push({obj:t,parent:g}),o.put(t)),(t=u.getRaw("Next"))instanceof r.Ref&&!o.has(t)&&(a.push({obj:t,parent:c.parent}),o.put(t))}}return i.items.length>0?i.items:null}},{key:"permissions",get:function(){var e=null;try{e=this._readPermissions()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable to read permissions.")}return(0,n.shadow)(this,"permissions",e)}},{key:"_readPermissions",value:function(){var e=this.xref.trailer.get("Encrypt");if(!(e instanceof r.Dict))return null;var t=e.get("P");if("number"!==typeof t)return null;t+=Math.pow(2,32);var i=[];for(var a in n.PermissionFlag){var o=n.PermissionFlag[a];t&o&&i.push(o)}return i}},{key:"optionalContentConfig",get:function(){var e=null;try{var t=this._catDict.get("OCProperties");if(!t)return(0,n.shadow)(this,"optionalContentConfig",null);var i=t.get("D");if(!i)return(0,n.shadow)(this,"optionalContentConfig",null);var o=t.get("OCGs");if(!Array.isArray(o))return(0,n.shadow)(this,"optionalContentConfig",null);var s,l=[],c=[],d=h(o);try{for(d.s();!(s=d.n()).done;){var u=s.value;if(u instanceof r.Ref){c.push(u);var p=this.xref.fetchIfRef(u);l.push({id:u.toString(),name:"string"===typeof p.get("Name")?(0,n.stringToPDFString)(p.get("Name")):null,intent:"string"===typeof p.get("Intent")?(0,n.stringToPDFString)(p.get("Intent")):null})}}}catch(m){d.e(m)}finally{d.f()}(e=this._readOptionalContentConfig(i,c)).groups=l}catch(f){if(f instanceof a.MissingDataException)throw f;(0,n.warn)("Unable to read optional content config: ".concat(f))}return(0,n.shadow)(this,"optionalContentConfig",e)}},{key:"_readOptionalContentConfig",value:function(e,t){function i(e){var i=[];if(Array.isArray(e)){var a,n=h(e);try{for(n.s();!(a=n.n()).done;){var o=a.value;o instanceof r.Ref&&t.includes(o)&&i.push(o.toString())}}catch(s){n.e(s)}finally{n.f()}}return i}function a(e){var i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:0;if(!Array.isArray(e))return null;var a,n=[],s=h(e);try{for(s.s();!(a=s.n()).done;){var c=a.value;if(c instanceof r.Ref&&t.includes(c))l.put(c),n.push(c.toString());else{var d=o(c,i);d&&n.push(d)}}}catch(y){s.e(y)}finally{s.f()}if(i>0)return n;var u,p=[],m=h(t);try{for(m.s();!(u=m.n()).done;){var f=u.value;l.has(f)||p.push(f.toString())}}catch(y){m.e(y)}finally{m.f()}return p.length&&n.push({name:null,order:p}),n}function o(e,t){if(++t>c)return(0,n.warn)("parseNestedOrder - reached MAX_NESTED_LEVELS."),null;var i=s.fetchIfRef(e);if(!Array.isArray(i))return null;var r=s.fetchIfRef(i[0]);if("string"!==typeof r)return null;var o=a(i.slice(1),t);return o&&o.length?{name:(0,n.stringToPDFString)(r),order:o}:null}var s=this.xref,l=new r.RefSet,c=10;return{name:"string"===typeof e.get("Name")?(0,n.stringToPDFString)(e.get("Name")):null,creator:"string"===typeof e.get("Creator")?(0,n.stringToPDFString)(e.get("Creator")):null,baseState:e.get("BaseState")instanceof r.Name?e.get("BaseState").name:null,on:i(e.get("ON")),off:i(e.get("OFF")),order:a(e.get("Order")),groups:null}}},{key:"setActualNumPages",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:null;this._actualNumPages=e}},{key:"hasActualNumPages",get:function(){return null!==this._actualNumPages}},{key:"_pagesCount",get:function(){var e=this.toplevelPagesDict.get("Count");if(!Number.isInteger(e))throw new n.FormatError("Page count in top-level pages dictionary is not an integer.");return(0,n.shadow)(this,"_pagesCount",e)}},{key:"numPages",get:function(){return this.hasActualNumPages?this._actualNumPages:this._pagesCount}},{key:"destinations",get:function(){var e=this._readDests(),t=Object.create(null);if(e instanceof o.NameTree){var i,a=h(e.getAll());try{for(a.s();!(i=a.n()).done;){var s=f(i.value,2),l=s[0],c=A(s[1]);c&&(t[(0,n.stringToPDFString)(l)]=c)}}catch(d){a.e(d)}finally{a.f()}}else e instanceof r.Dict&&e.forEach((function(e,i){var a=A(i);a&&(t[e]=a)}));return(0,n.shadow)(this,"destinations",t)}},{key:"getDestination",value:function(e){var t=this._readDests();if(t instanceof o.NameTree){var i=A(t.get(e));if(i)return i;var a=this.destinations[e];if(a)return(0,n.warn)('Found "'.concat(e,'" at an incorrect position in the NameTree.')),a}else if(t instanceof r.Dict){var s=A(t.get(e));if(s)return s}return null}},{key:"_readDests",value:function(){var e=this._catDict.get("Names");return e&&e.has("Dests")?new o.NameTree(e.getRaw("Dests"),this.xref):this._catDict.has("Dests")?this._catDict.get("Dests"):void 0}},{key:"pageLabels",get:function(){var e=null;try{e=this._readPageLabels()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable to read page labels.")}return(0,n.shadow)(this,"pageLabels",e)}},{key:"_readPageLabels",value:function(){var e=this._catDict.getRaw("PageLabels");if(!e)return null;for(var t=new Array(this.numPages),i=null,s="",l=new o.NumberTree(e,this.xref).getAll(),c="",d=1,u=0,p=this.numPages;u<p;u++){var m=l.get(u);if(void 0!==m){if(!(m instanceof r.Dict))throw new n.FormatError("PageLabel is not a dictionary.");if(m.has("Type")&&!(0,r.isName)(m.get("Type"),"PageLabel"))throw new n.FormatError("Invalid type in PageLabel dictionary.");if(m.has("S")){var h=m.get("S");if(!(h instanceof r.Name))throw new n.FormatError("Invalid style in PageLabel dictionary.");i=h.name}else i=null;if(m.has("P")){var f=m.get("P");if("string"!==typeof f)throw new n.FormatError("Invalid prefix in PageLabel dictionary.");s=(0,n.stringToPDFString)(f)}else s="";if(m.has("St")){var y=m.get("St");if(!(Number.isInteger(y)&&y>=1))throw new n.FormatError("Invalid start in PageLabel dictionary.");d=y}else d=1}switch(i){case"D":c=d;break;case"R":case"r":c=(0,a.toRomanNumerals)(d,"r"===i);break;case"A":case"a":var b="a"===i?97:65,g=d-1;c=String.fromCharCode(b+g%26).repeat(Math.floor(g/26)+1);break;default:if(i)throw new n.FormatError('Invalid style "'.concat(i,'" in PageLabel dictionary.'));c=""}t[u]=s+c,d++}return t}},{key:"pageLayout",get:function(){var e=this._catDict.get("PageLayout"),t="";if(e instanceof r.Name)switch(e.name){case"SinglePage":case"OneColumn":case"TwoColumnLeft":case"TwoColumnRight":case"TwoPageLeft":case"TwoPageRight":t=e.name}return(0,n.shadow)(this,"pageLayout",t)}},{key:"pageMode",get:function(){var e=this._catDict.get("PageMode"),t="UseNone";if(e instanceof r.Name)switch(e.name){case"UseNone":case"UseOutlines":case"UseThumbs":case"FullScreen":case"UseOC":case"UseAttachments":t=e.name}return(0,n.shadow)(this,"pageMode",t)}},{key:"viewerPreferences",get:function(){var e=this,t=this._catDict.get("ViewerPreferences");if(!(t instanceof r.Dict))return(0,n.shadow)(this,"viewerPreferences",null);var i,a=null,o=h(t.getKeys());try{for(o.s();!(i=o.n()).done;){var s=i.value,l=t.get(s),c=void 0;switch(s){case"HideToolbar":case"HideMenubar":case"HideWindowUI":case"FitWindow":case"CenterWindow":case"DisplayDocTitle":case"PickTrayByPDFSize":"boolean"===typeof l&&(c=l);break;case"NonFullScreenPageMode":if(l instanceof r.Name)switch(l.name){case"UseNone":case"UseOutlines":case"UseThumbs":case"UseOC":c=l.name;break;default:c="UseNone"}break;case"Direction":if(l instanceof r.Name)switch(l.name){case"L2R":case"R2L":c=l.name;break;default:c="L2R"}break;case"ViewArea":case"ViewClip":case"PrintArea":case"PrintClip":if(l instanceof r.Name)switch(l.name){case"MediaBox":case"CropBox":case"BleedBox":case"TrimBox":case"ArtBox":c=l.name;break;default:c="CropBox"}break;case"PrintScaling":if(l instanceof r.Name)switch(l.name){case"None":case"AppDefault":c=l.name;break;default:c="AppDefault"}break;case"Duplex":if(l instanceof r.Name)switch(l.name){case"Simplex":case"DuplexFlipShortEdge":case"DuplexFlipLongEdge":c=l.name;break;default:c="None"}break;case"PrintPageRange":Array.isArray(l)&&l.length%2===0&&l.every((function(t,i,a){return Number.isInteger(t)&&t>0&&(0===i||t>=a[i-1])&&t<=e.numPages}))&&(c=l);break;case"NumCopies":Number.isInteger(l)&&l>0&&(c=l);break;default:(0,n.warn)("Ignoring non-standard key in ViewerPreferences: ".concat(s,"."));continue}void 0!==c?(a||(a=Object.create(null)),a[s]=c):(0,n.warn)('Bad value, for key "'.concat(s,'", in ViewerPreferences: ').concat(l,"."))}}catch(d){o.e(d)}finally{o.f()}return(0,n.shadow)(this,"viewerPreferences",a)}},{key:"openAction",get:function(){var t=this._catDict.get("OpenAction"),i=Object.create(null);if(t instanceof r.Dict){var a=new r.Dict(this.xref);a.set("A",t);var o={url:null,dest:null,action:null};e.parseDestDictionary({destDict:a,resultObj:o}),Array.isArray(o.dest)?i.dest=o.dest:o.action&&(i.action=o.action)}else Array.isArray(t)&&(i.dest=t);return(0,n.shadow)(this,"openAction",(0,n.objectSize)(i)>0?i:null)}},{key:"attachments",get:function(){var e=this._catDict.get("Names"),t=null;if(e instanceof r.Dict&&e.has("EmbeddedFiles")){var i,a=new o.NameTree(e.getRaw("EmbeddedFiles"),this.xref),s=h(a.getAll());try{for(s.s();!(i=s.n()).done;){var l=f(i.value,2),c=l[0],d=l[1],p=new u.FileSpec(d,this.xref);t||(t=Object.create(null)),t[(0,n.stringToPDFString)(c)]=p.serializable}}catch(m){s.e(m)}finally{s.f()}}return(0,n.shadow)(this,"attachments",t)}},{key:"xfaImages",get:function(){var e=this._catDict.get("Names"),t=null;if(e instanceof r.Dict&&e.has("XFAImages")){var i,a=new o.NameTree(e.getRaw("XFAImages"),this.xref),s=h(a.getAll());try{for(s.s();!(i=s.n()).done;){var l=f(i.value,2),c=l[0],d=l[1];t||(t=new r.Dict(this.xref)),t.set((0,n.stringToPDFString)(c),d)}}catch(u){s.e(u)}finally{s.f()}}return(0,n.shadow)(this,"xfaImages",t)}},{key:"_collectJavaScript",value:function(){var e=this._catDict.get("Names"),t=null;function i(e,i){if(i instanceof r.Dict&&(0,r.isName)(i.get("S"),"JavaScript")){var a=i.get("JS");if(a instanceof s.BaseStream)a=a.getString();else if("string"!==typeof a)return;null===t&&(t=new Map),a=(0,n.stringToPDFString)(a).replace(/\u0000/g,""),t.set(e,a)}}if(e instanceof r.Dict&&e.has("JavaScript")){var a,l=new o.NameTree(e.getRaw("JavaScript"),this.xref),c=h(l.getAll());try{for(c.s();!(a=c.n()).done;){var d=f(a.value,2),u=d[0],p=d[1];i((0,n.stringToPDFString)(u),p)}}catch(y){c.e(y)}finally{c.f()}}var m=this._catDict.get("OpenAction");return m&&i("OpenAction",m),t}},{key:"javaScript",get:function(){var e=this._collectJavaScript();return(0,n.shadow)(this,"javaScript",e?c(e.values()):null)}},{key:"jsActions",get:function(){var e=this._collectJavaScript(),t=(0,a.collectActions)(this.xref,this._catDict,n.DocumentActionEventType);if(e){t||(t=Object.create(null));var i,r=h(e);try{for(r.s();!(i=r.n()).done;){var o=f(i.value,2),s=o[0],l=o[1];s in t?t[s].push(l):t[s]=[l]}}catch(c){r.e(c)}finally{r.f()}}return(0,n.shadow)(this,"jsActions",t)}},{key:"fontFallback",value:function(){var e=y(p().mark((function e(t,i){var a,n,r,o;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,Promise.all(this.fontCache);case 2:a=e.sent,n=h(a),e.prev=4,n.s();case 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25:if(!(0,r.isName)(f,"Page")&&h.has("Kids")){e.next=32;break}if(l.has(u)||l.put(u,1),c.has(u)||c.put(u,d),d!==t){e.next=30;break}return e.abrupt("return",[h,u]);case 30:return d++,e.abrupt("continue",6);case 32:return i.push(h),e.abrupt("continue",6);case 34:if(u instanceof r.Dict){e.next=36;break}throw new n.FormatError("Page dictionary kid reference points to wrong type of object.");case 36:if(y=u.objId,!((b=u.getRaw("Count"))instanceof r.Ref)){e.next=42;break}return e.next=41,s.fetchAsync(b);case 41:b=e.sent;case 42:if(!(Number.isInteger(b)&&b>=0)){e.next=47;break}if(y&&!l.has(y)&&l.put(y,b),!(d+b<=t)){e.next=47;break}return d+=b,e.abrupt("continue",6);case 47:if(!((g=u.getRaw("Kids"))instanceof r.Ref)){e.next=52;break}return e.next=51,s.fetchAsync(g);case 51:g=e.sent;case 52:if(Array.isArray(g)){e.next=64;break}if(!((v=u.getRaw("Type"))instanceof r.Ref)){e.next=58;break}return e.next=57,s.fetchAsync(v);case 57:v=e.sent;case 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s.put(_),e.prev=38,e.next=41,d.fetchAsync(_);case 41:A=e.sent,e.next=48;break;case 44:return e.prev=44,e.t1=e.catch(38),f(e.t1),e.abrupt("break",70);case 48:e.next=51;break;case 50:A=_;case 51:if(A instanceof r.Dict){e.next=54;break}return f(new n.FormatError("Page dictionary kid reference points to wrong type of object.")),e.abrupt("break",70);case 54:if(!((x=A.getRaw("Type"))instanceof r.Ref)){e.next=66;break}return e.prev=56,e.next=59,d.fetchAsync(x);case 59:x=e.sent,e.next=66;break;case 62:return e.prev=62,e.t2=e.catch(56),f(e.t2),e.abrupt("break",70);case 66:(0,r.isName)(x,"Page")||!A.has("Kids")?h(A,_ instanceof r.Ref?_:null):o.push({currentNode:A,posInKids:0}),y.posInKids++,e.next=10;break;case 70:return e.abrupt("return",c);case 71:case"end":return e.stop()}}),e,this,[[15,21],[38,44],[56,62]])})));return function(){return e.apply(this,arguments)}}()},{key:"getPageIndex",value:function(e){var t=this,i=this.pageIndexCache.get(e);if(void 0!==i)return Promise.resolve(i);var a=this.xref,o=0;return function i(s){return function(t){var i,o=0;return a.fetchAsync(t).then((function(a){if((0,r.isRefsEqual)(t,e)&&!(0,r.isDict)(a,"Page")&&!(a instanceof r.Dict&&!a.has("Type")&&a.has("Contents")))throw new n.FormatError("The reference does not point to a /Page dictionary.");if(!a)return null;if(!(a instanceof r.Dict))throw new n.FormatError("Node must be a dictionary.");return i=a.getRaw("Parent"),a.getAsync("Parent")})).then((function(e){if(!e)return null;if(!(e instanceof r.Dict))throw new n.FormatError("Parent must be a dictionary.");return e.getAsync("Kids")})).then((function(e){if(!e)return null;var s,l=[],c=!1,d=h(e);try{for(d.s();!(s=d.n()).done;){var u=s.value;if(!(u instanceof r.Ref))throw new n.FormatError("Kid must be a reference.");if((0,r.isRefsEqual)(u,t)){c=!0;break}l.push(a.fetchAsync(u).then((function(e){if(!(e instanceof r.Dict))throw new n.FormatError("Kid node must be a 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p=u.get("S");if(!(p instanceof r.Name))return void(0,n.warn)("parseDestDictionary: Invalid type in Action dictionary.");var m=p.name;switch(m){case"ResetForm":var f,y=u.get("Flags"),b=0===(1&("number"===typeof y?y:0)),g=[],v=[],_=h(u.get("Fields")||[]);try{for(_.s();!(f=_.n()).done;){var A=f.value;A instanceof r.Ref?v.push(A.toString()):"string"===typeof A&&g.push((0,n.stringToPDFString)(A))}}catch(j){_.e(j)}finally{_.f()}i.resetForm={fields:g,refs:v,include:b};break;case"URI":(o=u.get("URI"))instanceof r.Name&&(o="/"+o.name);break;case"GoTo":l=u.get("D");break;case"Launch":case"GoToR":var x=u.get("F");x instanceof r.Dict?o=x.get("F")||null:"string"===typeof x&&(o=x);var w=u.get("D");if(w&&(w instanceof r.Name&&(w=w.name),"string"===typeof o)){var S=o.split("#")[0];"string"===typeof w?o=S+"#"+w:Array.isArray(w)&&(o=S+"#"+JSON.stringify(w))}var C=u.get("NewWindow");"boolean"===typeof C&&(i.newWindow=C);break;case"GoToE":var k,D=u.get("T");if(d&&D instanceof r.Dict){var R=D.get("R"),I=D.get("N");(0,r.isName)(R,"C")&&"string"===typeof I&&(k=d[(0,n.stringToPDFString)(I)])}k?i.attachment=k:(0,n.warn)('parseDestDictionary - unimplemented "GoToE" action.');break;case"Named":var M=u.get("N");M instanceof r.Name&&(i.action=M.name);break;case"SetOCGState":var T=u.get("State"),P=u.get("PreserveRB");if(!Array.isArray(T)||0===T.length)break;var z,B=[],F=h(T);try{for(F.s();!(z=F.n()).done;){var E=z.value;if(E instanceof r.Name)switch(E.name){case"ON":case"OFF":case"Toggle":B.push(E.name)}else E instanceof r.Ref&&B.push(E.toString())}}catch(j){F.e(j)}finally{F.f()}if(B.length!==T.length)break;i.setOCGState={state:B,preserveRB:"boolean"!==typeof P||P};break;case"JavaScript":var N,O=u.get("JS");O instanceof s.BaseStream?N=O.getString():"string"===typeof O&&(N=O);var G=N&&(0,a.recoverJsURL)((0,n.stringToPDFString)(N));if(G){o=G.url,i.newWindow=G.newWindow;break}default:if("JavaScript"===m||"SubmitForm"===m)break;(0,n.warn)('parseDestDictionary - unsupported action: 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h=p+m>>1,f=h+(1&h),y=t.fetchIfRef(u[f]);if(e<y)m=f-2;else{if(!(e>y))return t.fetchIfRef(u[f+1]);p=f+2}}return null}}]),e}(),o=function(e){d(i,e);var t=u(i);function i(e,a){return b(this,i),t.call(this,e,a,"Names")}return g(i)}(r);t.NameTree=o;var s=function(e){d(i,e);var t=u(i);function i(e,a){return b(this,i),t.call(this,e,a,"Nums")}return g(i)}(r);t.NumberTree=s},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.clearGlobalCaches=function(){(0,a.clearPrimitiveCaches)(),(0,n.clearUnicodeCaches)()};var a=i(137),n=i(171)},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.FileSpec=void 0;var a=i(2),n=i(138),r=i(137);function o(e){return e.has("UF")?e.get("UF"):e.has("F")?e.get("F"):e.has("Unix")?e.get("Unix"):e.has("Mac")?e.get("Mac"):e.has("DOS")?e.get("DOS"):null}var s=function(){function e(t,i){b(this,e),t instanceof r.Dict&&(this.xref=i,this.root=t,t.has("FS")&&(this.fs=t.get("FS")),this.description=t.has("Desc")?(0,a.stringToPDFString)(t.get("Desc")):"",t.has("RF")&&(0,a.warn)("Related file specifications are not supported"),this.contentAvailable=!0,t.has("EF")||(this.contentAvailable=!1,(0,a.warn)("Non-embedded file specifications are not supported")))}return g(e,[{key:"filename",get:function(){if(!this._filename&&this.root){var e=o(this.root)||"unnamed";this._filename=(0,a.stringToPDFString)(e).replace(/\\\\/g,"\\").replace(/\\\//g,"/").replace(/\\/g,"/")}return this._filename}},{key:"content",get:function(){if(!this.contentAvailable)return null;!this.contentRef&&this.root&&(this.contentRef=o(this.root.get("EF")));var e=null;if(this.contentRef){var t=this.xref.fetchIfRef(this.contentRef);t instanceof n.BaseStream?e=t.getBytes():(0,a.warn)("Embedded file specification points to non-existing/invalid content")}else(0,a.warn)("Embedded file specification does not have a content");return e}},{key:"serializable",get:function(){return{filename:this.filename,content:this.content}}}]),e}();t.FileSpec=s},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.MetadataParser=void 0;var a=i(197),n=function(){function e(t){b(this,e),t=this._repair(t);var i=new a.SimpleXMLParser({lowerCaseName:!0}).parseFromString(t);this._metadataMap=new Map,this._data=t,i&&this._parse(i)}return g(e,[{key:"_repair",value:function(e){return e.replace(/^[^<]+/,"").replace(/>\\376\\377([^<]+)/g,(function(e,t){for(var i=t.replace(/\\([0-3])([0-7])([0-7])/g,(function(e,t,i,a){return String.fromCharCode(64*t+8*i+1*a)})).replace(/&(amp|apos|gt|lt|quot);/g,(function(e,t){switch(t){case"amp":return"&";case"apos":return"'";case"gt":return">";case"lt":return"<";case"quot":return'"'}throw new Error("_repair: ".concat(t," isn't defined."))})),a=[">"],n=0,r=i.length;n<r;n+=2){var 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S.padding,"div"===i.name&&(i.name="span"),B.children.push(i),m.HTMLResult.success(I,T);switch(this.ui.checkButton&&(i.attributes.class[0]="xfaCaptionForCheckButton"),B.attributes.class||(B.attributes.class=[]),B.children.splice(0,0,i),this.caption.placement){case"left":case"inline":B.attributes.class.push("xfaLeft");break;case"right":B.attributes.class.push("xfaRight");break;case"top":B.attributes.class.push("xfaTop");break;case"bottom":B.attributes.class.push("xfaBottom")}return this.w=a,this.h=r,m.HTMLResult.success((0,c.createWrapper)(this,I),T)}}]),o}(n.XFAObject,n.$isBindable,n.$setValue,n.$toHTML);t.Field=Be;var Fe=function(e,t){d(a,e);var i=u(a);function a(e){var t;return b(this,a),(t=i.call(this,x,"fill",!0)).id=e.id||"",t.presence=(0,m.getStringOption)(e.presence,["visible","hidden","inactive","invisible"]),t.use=e.use||"",t.usehref=e.usehref||"",t.color=null,t.extras=null,t.linear=null,t.pattern=null,t.radial=null,t.solid=null,t.stipple=null,t}return 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0,l.HTMLResult.success({name:this[a.$nodeName],attributes:{href:this.href,style:x(this.style,this,this[p])},children:i,value:t})):l.HTMLResult.EMPTY}}]),C}(a.XmlObject,a.$clean,a.$acceptWhitespace,a.$onText,a.$pushGlyphs,a.$toHTML),C=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this,e,"a")).href=(0,s.fixURL)(e.href)||"",a}return g(i)}(S),k=function(e,t){d(n,e);var i=u(n);function n(e){return b(this,n),i.call(this,e,"b")}return g(n,[{key:t,value:function(e){e.pushFont({weight:"bold"}),r(o(n.prototype),a.$pushGlyphs,this).call(this,e),e.popFont()}}]),n}(S,a.$pushGlyphs),D=function(e,t){d(n,e);var i=u(n);function n(e){return b(this,n),i.call(this,e,"body")}return g(n,[{key:t,value:function(e){var t=r(o(n.prototype),a.$toHTML,this).call(this,e),i=t.html;return i?(i.name="div",i.attributes.class=["xfaRich"],t):l.HTMLResult.EMPTY}}]),n}(S,a.$toHTML),R=function(e,t,i,a){d(r,e);var n=u(r);function r(e){return b(this,r),n.call(this,e,"br")}return g(r,[{key:t,value:function(){return"\n"}},{key:i,value:function(e){e.addString("\n")}},{key:a,value:function(e){return l.HTMLResult.success({name:"br"})}}]),r}(S,a.$text,a.$pushGlyphs,a.$toHTML),I=function(e,t){d(n,e);var i=u(n);function n(e){return b(this,n),i.call(this,e,"html")}return g(n,[{key:t,value:function(e){var t=[];if(this[a.$extra]={children:t},this[a.$childrenToHTML]({}),0===t.length)return l.HTMLResult.success({name:"div",attributes:{class:["xfaRich"],style:{}},value:this[a.$content]||""});if(1===t.length){var i=t[0];if(i.attributes&&i.attributes.class.includes("xfaRich"))return l.HTMLResult.success(i)}return l.HTMLResult.success({name:"div",attributes:{class:["xfaRich"],style:{}},children:t})}}]),n}(S,a.$toHTML),M=function(e,t){d(n,e);var i=u(n);function n(e){return b(this,n),i.call(this,e,"i")}return g(n,[{key:t,value:function(e){e.pushFont({posture:"italic"}),r(o(n.prototype),a.$pushGlyphs,this).call(this,e),e.popFont()}}]),n}(S,a.$pushGlyphs),T=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"li")}return g(i)}(S),P=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"ol")}return g(i)}(S),z=function(e,t,i){d(s,e);var n=u(s);function s(e){return b(this,s),n.call(this,e,"p")}return g(s,[{key:t,value:function(e){r(o(s.prototype),a.$pushGlyphs,this).call(this,e,!1),e.addString("\n"),e.addPara(),e.popFont()}},{key:i,value:function(){return this[a.$getParent]()[a.$getChildren]().at(-1)===this?r(o(s.prototype),a.$text,this).call(this):r(o(s.prototype),a.$text,this).call(this)+"\n"}}]),s}(S,a.$pushGlyphs,a.$text),B=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"span")}return g(i)}(S),F=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"sub")}return g(i)}(S),E=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"sup")}return g(i)}(S),N=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"ul")}return g(i)}(S),O=function(e){function t(){b(this,t)}return g(t,null,[{key:e,value:function(e,i){if(t.hasOwnProperty(e))return t[e](i)}},{key:"a",value:function(e){return new C(e)}},{key:"b",value:function(e){return new k(e)}},{key:"body",value:function(e){return new D(e)}},{key:"br",value:function(e){return new R(e)}},{key:"html",value:function(e){return new I(e)}},{key:"i",value:function(e){return new M(e)}},{key:"li",value:function(e){return new T(e)}},{key:"ol",value:function(e){return new P(e)}},{key:"p",value:function(e){return new z(e)}},{key:"span",value:function(e){return new B(e)}},{key:"sub",value:function(e){return new F(e)}},{key:"sup",value:function(e){return new E(e)}},{key:"ul",value:function(e){return new N(e)}}]),t}(n.$buildXFAObject);t.XhtmlNamespace=O},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.UnknownNamespace=void 0;var a=i(210),n=i(208),r=function(e){function t(e){b(this,t),this.namespaceId=e}return g(t,[{key:e,value:function(e,t){return new n.XmlObject(this.namespaceId,e,t)}}]),t}(a.$buildXFAObject);t.UnknownNamespace=r},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.DatasetReader=void 0;var a=i(2),n=i(136),s=i(197);function l(e){try{return(0,a.stringToUTF8String)(e)}catch(t){return(0,a.warn)('UTF-8 decoding failed: "'.concat(t,'".')),e}}var c=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this,e)).node=null,a}return g(i,[{key:"onEndElement",value:function(e){var t=r(o(i.prototype),"onEndElement",this).call(this,e);if(t&&"xfa:datasets"===e)throw this.node=t,new Error("Aborting DatasetXMLParser.")}}]),i}(s.SimpleXMLParser),p=function(){function e(t){if(b(this,e),t.datasets)this.node=new s.SimpleXMLParser({hasAttributes:!0}).parseFromString(t.datasets).documentElement;else{var i=new c({hasAttributes:!0});try{i.parseFromString(t["xdp:xdp"])}catch(a){}this.node=i.node}}return g(e,[{key:"getValue",value:function(e){if(!this.node||!e)return"";var t=this.node.searchNode((0,n.parseXFAPath)(e),0);if(!t)return"";var i=t.firstChild;return i&&"value"===i.nodeName?t.children.map((function(e){return l(e.textContent)})):l(t.textContent)}}]),e}();t.DatasetReader=p},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.XRef=void 0;var a=i(2),n=i(137),r=i(148),o=i(136),s=i(138),l=i(198),c=function(){function e(t,i){b(this,e),this.stream=t,this.pdfManager=i,this.entries=[],this.xrefstms=Object.create(null),this._cacheMap=new Map,this._pendingRefs=new n.RefSet,this._newPersistentRefNum=null,this._newTemporaryRefNum=null}return g(e,[{key:"getNewPersistentRef",value:function(e){null===this._newPersistentRefNum&&(this._newPersistentRefNum=this.entries.length||1);var t=this._newPersistentRefNum++;return this._cacheMap.set(t,e),n.Ref.get(t,0)}},{key:"getNewTemporaryRef",value:function(){return null===this._newTemporaryRefNum&&(this._newTemporaryRefNum=this.entries.length||1),n.Ref.get(this._newTemporaryRefNum++,0)}},{key:"resetNewTemporaryRef",value:function(){this._newTemporaryRefNum=null}},{key:"setStartXRef",value:function(e){this.startXRefQueue=[e]}},{key:"parse",value:function(){var e,t,i,r=arguments.length>0&&void 0!==arguments[0]&&arguments[0];r?((0,a.warn)("Indexing all PDF objects"),e=this.indexObjects()):e=this.readXRef(),e.assignXref(this),this.trailer=e;try{t=e.get("Encrypt")}catch(d){if(d instanceof o.MissingDataException)throw d;(0,a.warn)('XRef.parse - Invalid "Encrypt" reference: "'.concat(d,'".'))}if(t instanceof n.Dict){var s=e.get("ID"),c=s&&s.length?s[0]:"";t.suppressEncryption=!0,this.encrypt=new l.CipherTransformFactory(t,c,this.pdfManager.password)}try{i=e.get("Root")}catch(d){if(d instanceof o.MissingDataException)throw d;(0,a.warn)('XRef.parse - Invalid "Root" reference: "'.concat(d,'".'))}if(i instanceof n.Dict)try{if(i.get("Pages")instanceof n.Dict)return void(this.root=i)}catch(d){if(d instanceof o.MissingDataException)throw d;(0,a.warn)('XRef.parse - Invalid "Pages" reference: "'.concat(d,'".'))}if(!r)throw new o.XRefParseException;throw new a.InvalidPDFException("Invalid Root reference.")}},{key:"processXRefTable",value:function(e){"tableState"in this||(this.tableState={entryNum:0,streamPos:e.lexer.stream.pos,parserBuf1:e.buf1,parserBuf2:e.buf2});var t=this.readXRefTable(e);if(!(0,n.isCmd)(t,"trailer"))throw new a.FormatError("Invalid XRef table: could not find trailer dictionary");var i=e.getObj();if(i instanceof n.Dict||!i.dict||(i=i.dict),!(i instanceof n.Dict))throw new a.FormatError("Invalid XRef table: could not parse trailer dictionary");return delete this.tableState,i}},{key:"readXRefTable",value:function(e){var t,i=e.lexer.stream,r=this.tableState;for(i.pos=r.streamPos,e.buf1=r.parserBuf1,e.buf2=r.parserBuf2;;){if(!("firstEntryNum"in r)||!("entryCount"in r)){if((0,n.isCmd)(t=e.getObj(),"trailer"))break;r.firstEntryNum=t,r.entryCount=e.getObj()}var o=r.firstEntryNum,s=r.entryCount;if(!Number.isInteger(o)||!Number.isInteger(s))throw new a.FormatError("Invalid XRef table: wrong types in subsection header");for(var l=r.entryNum;l<s;l++){r.streamPos=i.pos,r.entryNum=l,r.parserBuf1=e.buf1,r.parserBuf2=e.buf2;var c={};c.offset=e.getObj(),c.gen=e.getObj();var d=e.getObj();if(d instanceof n.Cmd)switch(d.cmd){case"f":c.free=!0;break;case"n":c.uncompressed=!0}if(!Number.isInteger(c.offset)||!Number.isInteger(c.gen)||!c.free&&!c.uncompressed)throw new a.FormatError("Invalid entry in XRef subsection: ".concat(o,", ").concat(s));0===l&&c.free&&1===o&&(o=0),this.entries[l+o]||(this.entries[l+o]=c)}r.entryNum=0,r.streamPos=i.pos,r.parserBuf1=e.buf1,r.parserBuf2=e.buf2,delete r.firstEntryNum,delete r.entryCount}if(this.entries[0]&&!this.entries[0].free)throw new a.FormatError("Invalid XRef table: unexpected first object");return t}},{key:"processXRefStream",value:function(e){if(!("streamState"in this)){var t=e.dict,i=t.get("W"),a=t.get("Index");a||(a=[0,t.get("Size")]),this.streamState={entryRanges:a,byteWidths:i,entryNum:0,streamPos:e.pos}}return this.readXRefStream(e),delete this.streamState,e.dict}},{key:"readXRefStream",value:function(e){var t=this.streamState;e.pos=t.streamPos;for(var i=f(t.byteWidths,3),n=i[0],r=i[1],o=i[2],s=t.entryRanges;s.length>0;){var l=f(s,2),c=l[0],d=l[1];if(!Number.isInteger(c)||!Number.isInteger(d))throw new a.FormatError("Invalid XRef range fields: ".concat(c,", ").concat(d));if(!Number.isInteger(n)||!Number.isInteger(r)||!Number.isInteger(o))throw new a.FormatError("Invalid XRef entry fields length: ".concat(c,", ").concat(d));for(var u=t.entryNum;u<d;++u){t.entryNum=u,t.streamPos=e.pos;for(var p=0,m=0,h=0,y=0;y<n;++y){var b=e.getByte();if(-1===b)throw new a.FormatError("Invalid XRef byteWidths 'type'.");p=p<<8|b}0===n&&(p=1);for(var g=0;g<r;++g){var v=e.getByte();if(-1===v)throw new a.FormatError("Invalid XRef byteWidths 'offset'.");m=m<<8|v}for(var _=0;_<o;++_){var A=e.getByte();if(-1===A)throw new a.FormatError("Invalid XRef byteWidths 'generation'.");h=h<<8|A}var x={};switch(x.offset=m,x.gen=h,p){case 0:x.free=!0;break;case 1:x.uncompressed=!0;break;case 2:break;default:throw new a.FormatError("Invalid XRef entry type: ".concat(p))}this.entries[c+u]||(this.entries[c+u]=x)}t.entryNum=0,t.streamPos=e.pos,s.splice(0,2)}}},{key:"indexObjects",value:function(){var e=10,t=13,i=60;function s(a,n){for(var r="",o=a[n];o!==e&&o!==t&&o!==i&&!(++n>=a.length);)r+=String.fromCharCode(o),o=a[n];return r}function l(e,t,i){for(var a=i.length,n=e.length,r=0;t<n;){for(var o=0;o<a&&e[t+o]===i[o];)++o;if(o>=a)break;t++,r++}return r}var c=/\b(endobj|\d+\s+\d+\s+obj|xref|trailer)\b/g,d=/\b(startxref|\d+\s+\d+\s+obj)\b/g,u=/^(\d+)\s+(\d+)\s+obj\b/,p=new Uint8Array([116,114,97,105,108,101,114]),m=new Uint8Array([115,116,97,114,116,120,114,101,102]),h=new Uint8Array([47,88,82,101,102]);this.entries.length=0,this._cacheMap.clear();var f=this.stream;f.pos=0;for(var y=f.getBytes(),b=(0,a.bytesToString)(y),g=y.length,v=f.start,_=[],A=[];v<g;){var x=y[v];if(9!==x&&x!==e&&x!==t&&32!==x)if(37!==x){var w=s(y,v),S=void 0;if(w.startsWith("xref")&&(4===w.length||/\s/.test(w[4])))v+=l(y,v,p),_.push(v),v+=l(y,v,m);else if(S=u.exec(w)){var C=0|S[1],k=0|S[2],D=v+w.length,R=void 0,I=!1;if(this.entries[C]){if(this.entries[C].gen===k)try{new r.Parser({lexer:new r.Lexer(f.makeSubStream(D))}).getObj(),I=!0}catch(ie){ie instanceof o.ParserEOFException?(0,a.warn)("indexObjects -- checking object (".concat(w,'): "').concat(ie,'".')):I=!0}}else I=!0;I&&(this.entries[C]={offset:v-f.start,gen:k,uncompressed:!0}),c.lastIndex=D;var M=c.exec(b);M?(R=c.lastIndex+1-v,"endobj"!==M[1]&&((0,a.warn)('indexObjects: Found "'.concat(M[1],'" inside of another "obj", ')+'caused by missing "endobj" -- trying to recover.'),R-=M[1].length+1)):R=g-v;var T=y.subarray(v,v+R),P=l(T,0,h);P<R&&T[P+5]<64&&(A.push(v-f.start),this.xrefstms[v-f.start]=1),v+=R}else if(w.startsWith("trailer")&&(7===w.length||/\s/.test(w[7]))){_.push(v);var z=v+w.length,B=void 0;d.lastIndex=z;var F=d.exec(b);F?(B=d.lastIndex+1-v,"startxref"!==F[1]&&((0,a.warn)('indexObjects: Found "'.concat(F[1],'" after "trailer", ')+'caused by missing "startxref" -- trying to recover.'),B-=F[1].length+1)):B=g-v,v+=B}else v+=w.length+1}else do{if(++v>=g)break;x=y[v]}while(x!==e&&x!==t);else++v}for(var E=0,N=A;E<N.length;E++){var O=N[E];this.startXRefQueue.push(O),this.readXRef(!0)}for(var G,L,j=[],q=!1,H=0,U=_;H<U.length;H++){var Y=U[H];f.pos=Y;var X=new r.Parser({lexer:new r.Lexer(f),xref:this,allowStreams:!0,recoveryMode:!0}),V=X.getObj();if((0,n.isCmd)(V,"trailer")){var Q=X.getObj();Q instanceof n.Dict&&(j.push(Q),Q.has("Encrypt")&&(q=!0))}}for(var W=0,Z=[].concat(j,["genFallback"],j);W<Z.length;W++){var J=Z[W];if("genFallback"!==J){var K=!1;try{var $=J.get("Root");if(!($ instanceof n.Dict))continue;var ee=$.get("Pages");if(!(ee instanceof n.Dict))continue;var te=ee.get("Count");Number.isInteger(te)&&(K=!0)}catch(ie){L=ie;continue}if(K&&(!q||J.has("Encrypt"))&&J.has("ID"))return J;G=J}else{if(!L)break;this._generationFallback=!0}}if(G)return G;if(this.topDict)return this.topDict;throw new a.InvalidPDFException("Invalid PDF structure.")}},{key:"readXRef",value:function(){for(var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=this.stream,i=new Set;this.startXRefQueue.length;){try{var l=this.startXRefQueue[0];if(i.has(l)){(0,a.warn)("readXRef - skipping XRef table since it was already parsed."),this.startXRefQueue.shift();continue}i.add(l),t.pos=l+t.start;var c=new r.Parser({lexer:new r.Lexer(t),xref:this,allowStreams:!0}),d=c.getObj(),u=void 0;if((0,n.isCmd)(d,"xref")){if(u=this.processXRefTable(c),this.topDict||(this.topDict=u),d=u.get("XRefStm"),Number.isInteger(d)){var p=d;p in this.xrefstms||(this.xrefstms[p]=1,this.startXRefQueue.push(p))}}else{if(!Number.isInteger(d))throw new a.FormatError("Invalid XRef stream header");if(!Number.isInteger(c.getObj())||!(0,n.isCmd)(c.getObj(),"obj")||!((d=c.getObj())instanceof s.BaseStream))throw new a.FormatError("Invalid XRef stream");if(u=this.processXRefStream(d),this.topDict||(this.topDict=u),!u)throw new a.FormatError("Failed to read XRef stream")}d=u.get("Prev"),Number.isInteger(d)?this.startXRefQueue.push(d):d instanceof n.Ref&&this.startXRefQueue.push(d.num)}catch(m){if(m instanceof o.MissingDataException)throw m;(0,a.info)("(while reading XRef): "+m)}this.startXRefQueue.shift()}if(this.topDict)return this.topDict;if(!e)throw new o.XRefParseException}},{key:"getEntry",value:function(e){var t=this.entries[e];return t&&!t.free&&t.offset?t:null}},{key:"fetchIfRef",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];return e instanceof n.Ref?this.fetch(e,t):e}},{key:"fetch",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];if(!(e instanceof n.Ref))throw new Error("ref object is not a reference");var i=e.num,r=this._cacheMap.get(i);if(void 0!==r)return r instanceof n.Dict&&!r.objId&&(r.objId=e.toString()),r;var o=this.getEntry(i);if(null===o)return this._cacheMap.set(i,o),o;if(this._pendingRefs.has(e))return this._pendingRefs.remove(e),(0,a.warn)("Ignoring circular reference: ".concat(e,".")),n.CIRCULAR_REF;this._pendingRefs.put(e);try{o=o.uncompressed?this.fetchUncompressed(e,o,t):this.fetchCompressed(e,o,t),this._pendingRefs.remove(e)}catch(l){throw this._pendingRefs.remove(e),l}return o instanceof n.Dict?o.objId=e.toString():o instanceof s.BaseStream&&(o.dict.objId=e.toString()),o}},{key:"fetchUncompressed",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]&&arguments[2],l=e.gen,c=e.num;if(t.gen!==l){var d="Inconsistent generation in XRef: ".concat(e);if(this._generationFallback&&t.gen<l)return(0,a.warn)(d),this.fetchUncompressed(n.Ref.get(c,t.gen),t,i);throw new o.XRefEntryException(d)}var u=this.stream.makeSubStream(t.offset+this.stream.start),p=new r.Parser({lexer:new r.Lexer(u),xref:this,allowStreams:!0}),m=p.getObj(),h=p.getObj(),f=p.getObj();if(m!==c||h!==l||!(f instanceof n.Cmd))throw new o.XRefEntryException("Bad (uncompressed) XRef entry: ".concat(e));if("obj"!==f.cmd){if(f.cmd.startsWith("obj")&&(c=parseInt(f.cmd.substring(3),10),!Number.isNaN(c)))return c;throw new o.XRefEntryException("Bad (uncompressed) XRef entry: ".concat(e))}return(t=this.encrypt&&!i?p.getObj(this.encrypt.createCipherTransform(c,l)):p.getObj())instanceof s.BaseStream||this._cacheMap.set(c,t),t}},{key:"fetchCompressed",value:function(e,t){var i=t.offset,l=this.fetch(n.Ref.get(i,0));if(!(l instanceof s.BaseStream))throw new a.FormatError("bad ObjStm stream");var c=l.dict.get("First"),d=l.dict.get("N");if(!Number.isInteger(c)||!Number.isInteger(d))throw new a.FormatError("invalid first and n parameters for ObjStm stream");for(var u=new r.Parser({lexer:new r.Lexer(l),xref:this,allowStreams:!0}),p=new Array(d),m=new Array(d),h=0;h<d;++h){var f=u.getObj();if(!Number.isInteger(f))throw new a.FormatError("invalid object number in the ObjStm stream: ".concat(f));var y=u.getObj();if(!Number.isInteger(y))throw new a.FormatError("invalid object offset in the ObjStm stream: ".concat(y));p[h]=f,m[h]=y}for(var b=(l.start||0)+c,g=new Array(d),v=0;v<d;++v){var _=v<d-1?m[v+1]-m[v]:void 0;if(_<0)throw new a.FormatError("Invalid offset in the ObjStm stream.");var A=(u=new r.Parser({lexer:new r.Lexer(l.makeSubStream(b+m[v],_,l.dict)),xref:this,allowStreams:!0})).getObj();if(g[v]=A,!(A instanceof s.BaseStream)){var x=p[v],w=this.entries[x];w&&w.offset===i&&w.gen===v&&this._cacheMap.set(x,A)}}if(void 0===(t=g[t.gen]))throw new o.XRefEntryException("Bad 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a=e.applyTransform(t,i),n=e.applyTransform(t.slice(2,4),i),r=e.applyTransform([t[0],t[3]],i),o=e.applyTransform([t[2],t[1]],i);return[Math.min(a[0],n[0],r[0],o[0]),Math.min(a[1],n[1],r[1],o[1]),Math.max(a[0],n[0],r[0],o[0]),Math.max(a[1],n[1],r[1],o[1])]}},{key:"inverseTransform",value:function(e){var t=e[0]*e[3]-e[1]*e[2];return[e[3]/t,-e[1]/t,-e[2]/t,e[0]/t,(e[2]*e[5]-e[4]*e[3])/t,(e[4]*e[1]-e[5]*e[0])/t]}},{key:"apply3dTransform",value:function(e,t){return[e[0]*t[0]+e[1]*t[1]+e[2]*t[2],e[3]*t[0]+e[4]*t[1]+e[5]*t[2],e[6]*t[0]+e[7]*t[1]+e[8]*t[2]]}},{key:"singularValueDecompose2dScale",value:function(e){var t=[e[0],e[2],e[1],e[3]],i=e[0]*t[0]+e[1]*t[2],a=e[0]*t[1]+e[1]*t[3],n=e[2]*t[0]+e[3]*t[2],r=e[2]*t[1]+e[3]*t[3],o=(i+r)/2,s=Math.sqrt(Math.pow(i+r,2)-4*(i*r-n*a))/2,l=o+s||1,c=o-s||1;return[Math.sqrt(l),Math.sqrt(c)]}},{key:"normalizeRect",value:function(e){var t=e.slice(0);return 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process]"&&!process.versions.nw&&!(process.versions.electron&&process.type&&"browser"!==process.type);t.isNodeJS=i},function(__unused_webpack_module,exports,__w_pdfjs_require__){Object.defineProperty(exports,"__esModule",{value:!0}),exports.build=exports.RenderTask=exports.PDFWorkerUtil=exports.PDFWorker=exports.PDFPageProxy=exports.PDFDocumentProxy=exports.PDFDocumentLoadingTask=exports.PDFDataRangeTransport=exports.LoopbackPort=exports.DefaultStandardFontDataFactory=exports.DefaultCanvasFactory=exports.DefaultCMapReaderFactory=void 0,exports.getDocument=getDocument,exports.setPDFNetworkStreamFactory=setPDFNetworkStreamFactory,exports.version=void 0;var _util=__w_pdfjs_require__(1),_annotation_storage=__w_pdfjs_require__(5),_display_utils=__w_pdfjs_require__(8),_font_loader=__w_pdfjs_require__(11),_canvas=__w_pdfjs_require__(12),_worker_options=__w_pdfjs_require__(15),_is_node=__w_pdfjs_require__(3),_message_handler=__w_pdfjs_require__(16),_metadata=__w_pdfjs_require__(17),_optional_content_config=__w_pdfjs_require__(18),_transport_stream=__w_pdfjs_require__(19),_xfa_text=__w_pdfjs_require__(20),DEFAULT_RANGE_CHUNK_SIZE=65536,RENDERING_CANCELLED_TIMEOUT=100,DefaultCanvasFactory=_display_utils.DOMCanvasFactory;exports.DefaultCanvasFactory=DefaultCanvasFactory;var DefaultCMapReaderFactory=_display_utils.DOMCMapReaderFactory;exports.DefaultCMapReaderFactory=DefaultCMapReaderFactory;var DefaultStandardFontDataFactory=_display_utils.DOMStandardFontDataFactory,createPDFNetworkStream;if(exports.DefaultStandardFontDataFactory=DefaultStandardFontDataFactory,_is_node.isNodeJS){var _w_pdfjs_require__=__w_pdfjs_require__(21),NodeCanvasFactory=_w_pdfjs_require__.NodeCanvasFactory,NodeCMapReaderFactory=_w_pdfjs_require__.NodeCMapReaderFactory,NodeStandardFontDataFactory=_w_pdfjs_require__.NodeStandardFontDataFactory;exports.DefaultCanvasFactory=DefaultCanvasFactory=NodeCanvasFactory,exports.DefaultCMapReaderFactory=DefaultCMapReaderFactory=NodeCMapReaderFactory,exports.DefaultStandardFontDataFactory=DefaultStandardFontDataFactory=NodeStandardFontDataFactory}function setPDFNetworkStreamFactory(e){createPDFNetworkStream=e}function getDocument(e){var t,i=new PDFDocumentLoadingTask;if("string"===typeof e||e instanceof URL)t={url:e};else if((0,_util.isArrayBuffer)(e))t={data:e};else if(e instanceof PDFDataRangeTransport)t={range:e};else{if("object"!==typeof e)throw new Error("Invalid parameter in getDocument, need either string, URL, TypedArray, or parameter object.");if(!e.url&&!e.data&&!e.range)throw new Error("Invalid parameter object: need either .data, .range or .url");t=e}var a=Object.create(null),n=null,r=null;for(var o in t){var s=t[o];switch(o){case"url":if("undefined"!==typeof window)try{a[o]=new URL(s,window.location).href;continue}catch(d){(0,_util.warn)('Cannot create valid URL: "'.concat(d,'".'))}else if("string"===typeof s||s instanceof URL){a[o]=s.toString();continue}throw new Error("Invalid PDF url data: either string or URL-object is expected in the url property.");case"range":n=s;continue;case"worker":r=s;continue;case"data":if(_is_node.isNodeJS&&"undefined"!==typeof Buffer&&s instanceof Buffer)a[o]=new Uint8Array(s);else{if(s instanceof Uint8Array)break;if("string"===typeof s)a[o]=(0,_util.stringToBytes)(s);else if("object"!==typeof s||null===s||isNaN(s.length)){if(!(0,_util.isArrayBuffer)(s))throw new Error("Invalid PDF binary data: either TypedArray, string, or array-like object is expected in the data property.");a[o]=new Uint8Array(s)}else a[o]=new Uint8Array(s)}continue}a[o]=s}if(a.CMapReaderFactory=a.CMapReaderFactory||DefaultCMapReaderFactory,a.StandardFontDataFactory=a.StandardFontDataFactory||DefaultStandardFontDataFactory,a.ignoreErrors=!0!==a.stopAtErrors,a.fontExtraProperties=!0===a.fontExtraProperties,a.pdfBug=!0===a.pdfBug,a.enableXfa=!0===a.enableXfa,(!Number.isInteger(a.rangeChunkSize)||a.rangeChunkSize<1)&&(a.rangeChunkSize=DEFAULT_RANGE_CHUNK_SIZE),("string"!==typeof a.docBaseUrl||(0,_display_utils.isDataScheme)(a.docBaseUrl))&&(a.docBaseUrl=null),(!Number.isInteger(a.maxImageSize)||a.maxImageSize<-1)&&(a.maxImageSize=-1),"string"!==typeof a.cMapUrl&&(a.cMapUrl=null),"string"!==typeof a.standardFontDataUrl&&(a.standardFontDataUrl=null),"boolean"!==typeof a.useWorkerFetch&&(a.useWorkerFetch=a.CMapReaderFactory===_display_utils.DOMCMapReaderFactory&&a.StandardFontDataFactory===_display_utils.DOMStandardFontDataFactory),"boolean"!==typeof a.isEvalSupported&&(a.isEvalSupported=!0),"boolean"!==typeof a.disableFontFace&&(a.disableFontFace=_is_node.isNodeJS),"boolean"!==typeof a.useSystemFonts&&(a.useSystemFonts=!_is_node.isNodeJS&&!a.disableFontFace),"object"===typeof a.ownerDocument&&null!==a.ownerDocument||(a.ownerDocument=globalThis.document),"boolean"!==typeof a.disableRange&&(a.disableRange=!1),"boolean"!==typeof a.disableStream&&(a.disableStream=!1),"boolean"!==typeof a.disableAutoFetch&&(a.disableAutoFetch=!1),(0,_util.setVerbosityLevel)(a.verbosity),!r){var l={verbosity:a.verbosity,port:_worker_options.GlobalWorkerOptions.workerPort};r=l.port?PDFWorker.fromPort(l):new PDFWorker(l),i._worker=r}var c=i.docId;return r.promise.then((function(){if(i.destroyed)throw new Error("Loading aborted");var e=_fetchDocument(r,a,n,c),t=new Promise((function(e){var t;n?t=new _transport_stream.PDFDataTransportStream({length:a.length,initialData:a.initialData,progressiveDone:a.progressiveDone,contentDispositionFilename:a.contentDispositionFilename,disableRange:a.disableRange,disableStream:a.disableStream},n):a.data||(t=createPDFNetworkStream({url:a.url,length:a.length,httpHeaders:a.httpHeaders,withCredentials:a.withCredentials,rangeChunkSize:a.rangeChunkSize,disableRange:a.disableRange,disableStream:a.disableStream})),e(t)}));return Promise.all([e,t]).then((function(e){var t=_slicedToArray(e,2),n=t[0],o=t[1];if(i.destroyed)throw new Error("Loading aborted");var s=new _message_handler.MessageHandler(c,n,r.port),l=new WorkerTransport(s,i,o,a);i._transport=l,s.send("Ready",null)}))})).catch(i._capability.reject),i}function _fetchDocument(e,t,i,a){return _fetchDocument2.apply(this,arguments)}function _fetchDocument2(){return(_fetchDocument2=_asyncToGenerator(_regeneratorRuntime().mark((function e(t,i,a,n){var r;return _regeneratorRuntime().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!t.destroyed){e.next=2;break}throw new Error("Worker was destroyed");case 2:return a&&(i.length=a.length,i.initialData=a.initialData,i.progressiveDone=a.progressiveDone,i.contentDispositionFilename=a.contentDispositionFilename),e.next=5,t.messageHandler.sendWithPromise("GetDocRequest",{docId:n,apiVersion:"2.16.105",source:{data:i.data,url:i.url,password:i.password,disableAutoFetch:i.disableAutoFetch,rangeChunkSize:i.rangeChunkSize,length:i.length},maxImageSize:i.maxImageSize,disableFontFace:i.disableFontFace,docBaseUrl:i.docBaseUrl,ignoreErrors:i.ignoreErrors,isEvalSupported:i.isEvalSupported,fontExtraProperties:i.fontExtraProperties,enableXfa:i.enableXfa,useSystemFonts:i.useSystemFonts,cMapUrl:i.useWorkerFetch?i.cMapUrl:null,standardFontDataUrl:i.useWorkerFetch?i.standardFontDataUrl:null});case 5:if(r=e.sent,i.data&&(i.data=null),!t.destroyed){e.next=9;break}throw new Error("Worker was destroyed");case 9:return e.abrupt("return",r);case 10:case"end":return e.stop()}}),e)})))).apply(this,arguments)}var PDFDocumentLoadingTask=function(){function e(){var t,i;_classCallCheck(this,e),this._capability=(0,_util.createPromiseCapability)(),this._transport=null,this._worker=null,this.docId="d".concat((_classStaticPrivateFieldSpecSet(e,e,_docId,(t=_classStaticPrivateFieldSpecGet(e,e,_docId),i=t++,t)),i)),this.destroyed=!1,this.onPassword=null,this.onProgress=null,this.onUnsupportedFeature=null}return _createClass(e,[{key:"promise",get:function(){return this._capability.promise}},{key:"destroy",value:function(){var e=_asyncToGenerator(_regeneratorRuntime().mark((function e(){var t;return _regeneratorRuntime().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return this.destroyed=!0,e.next=3,null===(t=this._transport)||void 0===t?void 0:t.destroy();case 3:this._transport=null,this._worker&&(this._worker.destroy(),this._worker=null);case 5:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()}]),e}(),_docId={writable:!0,value:0};exports.PDFDocumentLoadingTask=PDFDocumentLoadingTask;var PDFDataRangeTransport=function(){function e(t,i){var a=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3&&void 0!==arguments[3]?arguments[3]:null;_classCallCheck(this,e),this.length=t,this.initialData=i,this.progressiveDone=a,this.contentDispositionFilename=n,this._rangeListeners=[],this._progressListeners=[],this._progressiveReadListeners=[],this._progressiveDoneListeners=[],this._readyCapability=(0,_util.createPromiseCapability)()}return _createClass(e,[{key:"addRangeListener",value:function(e){this._rangeListeners.push(e)}},{key:"addProgressListener",value:function(e){this._progressListeners.push(e)}},{key:"addProgressiveReadListener",value:function(e){this._progressiveReadListeners.push(e)}},{key:"addProgressiveDoneListener",value:function(e){this._progressiveDoneListeners.push(e)}},{key:"onDataRange",value:function(e,t){var i,a=_createForOfIteratorHelper(this._rangeListeners);try{for(a.s();!(i=a.n()).done;)(0,i.value)(e,t)}catch(n){a.e(n)}finally{a.f()}}},{key:"onDataProgress",value:function(e,t){var i=this;this._readyCapability.promise.then((function(){var a,n=_createForOfIteratorHelper(i._progressListeners);try{for(n.s();!(a=n.n()).done;)(0,a.value)(e,t)}catch(r){n.e(r)}finally{n.f()}}))}},{key:"onDataProgressiveRead",value:function(e){var t=this;this._readyCapability.promise.then((function(){var i,a=_createForOfIteratorHelper(t._progressiveReadListeners);try{for(a.s();!(i=a.n()).done;)(0,i.value)(e)}catch(n){a.e(n)}finally{a.f()}}))}},{key:"onDataProgressiveDone",value:function(){var e=this;this._readyCapability.promise.then((function(){var t,i=_createForOfIteratorHelper(e._progressiveDoneListeners);try{for(i.s();!(t=i.n()).done;)(0,t.value)()}catch(a){i.e(a)}finally{i.f()}}))}},{key:"transportReady",value:function(){this._readyCapability.resolve()}},{key:"requestDataRange",value:function(e,t){(0,_util.unreachable)("Abstract method PDFDataRangeTransport.requestDataRange")}},{key:"abort",value:function(){}}]),e}();exports.PDFDataRangeTransport=PDFDataRangeTransport;var PDFDocumentProxy=function(){function e(t,i){var a=this;_classCallCheck(this,e),this._pdfInfo=t,this._transport=i,Object.defineProperty(this,"fingerprint",{get:function(){return(0,_display_utils.deprecated)("`PDFDocumentProxy.fingerprint`, please use `PDFDocumentProxy.fingerprints` instead."),this.fingerprints[0]}}),Object.defineProperty(this,"getStats",{value:function(){var e=_asyncToGenerator(_regeneratorRuntime().mark((function e(){return _regeneratorRuntime().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return(0,_display_utils.deprecated)("`PDFDocumentProxy.getStats`, please use the `PDFDocumentProxy.stats`-getter instead."),e.abrupt("return",a.stats||{streamTypes:{},fontTypes:{}});case 2:case"end":return e.stop()}}),e)})));return function(){return e.apply(this,arguments)}}()})}return _createClass(e,[{key:"annotationStorage",get:function(){return this._transport.annotationStorage}},{key:"numPages",get:function(){return this._pdfInfo.numPages}},{key:"fingerprints",get:function(){return this._pdfInfo.fingerprints}},{key:"stats",get:function(){return this._transport.stats}},{key:"isPureXfa",get:function(){return!!this._transport._htmlForXfa}},{key:"allXfaHtml",get:function(){return this._transport._htmlForXfa}},{key:"getPage",value:function(e){return this._transport.getPage(e)}},{key:"getPageIndex",value:function(e){return this._transport.getPageIndex(e)}},{key:"getDestinations",value:function(){return this._transport.getDestinations()}},{key:"getDestination",value:function(e){return this._transport.getDestination(e)}},{key:"getPageLabels",value:function(){return this._transport.getPageLabels()}},{key:"getPageLayout",value:function(){return this._transport.getPageLayout()}},{key:"getPageMode",value:function(){return this._transport.getPageMode()}},{key:"getViewerPreferences",value:function(){return this._transport.getViewerPreferences()}},{key:"getOpenAction",value:function(){return this._transport.getOpenAction()}},{key:"getAttachments",value:function(){return this._transport.getAttachments()}},{key:"getJavaScript",value:function(){return this._transport.getJavaScript()}},{key:"getJSActions",value:function(){return this._transport.getDocJSActions()}},{key:"getOutline",value:function(){return this._transport.getOutline()}},{key:"getOptionalContentConfig",value:function(){return this._transport.getOptionalContentConfig()}},{key:"getPermissions",value:function(){return this._transport.getPermissions()}},{key:"getMetadata",value:function(){return this._transport.getMetadata()}},{key:"getMarkInfo",value:function(){return this._transport.getMarkInfo()}},{key:"getData",value:function(){return this._transport.getData()}},{key:"getDownloadInfo",value:function(){return this._transport.downloadInfoCapability.promise}},{key:"cleanup",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0];return this._transport.startCleanup(e||this.isPureXfa)}},{key:"destroy",value:function(){return this.loadingTask.destroy()}},{key:"loadingParams",get:function(){return this._transport.loadingParams}},{key:"loadingTask",get:function(){return this._transport.loadingTask}},{key:"saveDocument",value:function(){return this._transport.annotationStorage.size<=0&&(0,_display_utils.deprecated)("saveDocument called while `annotationStorage` is empty, please use the getData-method instead."),this._transport.saveDocument()}},{key:"getFieldObjects",value:function(){return this._transport.getFieldObjects()}},{key:"hasJSActions",value:function(){return this._transport.hasJSActions()}},{key:"getCalculationOrderIds",value:function(){return this._transport.getCalculationOrderIds()}}]),e}();exports.PDFDocumentProxy=PDFDocumentProxy;var PDFPageProxy=function(){function e(t,i,a,n){var r=arguments.length>4&&void 0!==arguments[4]&&arguments[4];_classCallCheck(this,e),this._pageIndex=t,this._pageInfo=i,this._ownerDocument=n,this._transport=a,this._stats=r?new _display_utils.StatTimer:null,this._pdfBug=r,this.commonObjs=a.commonObjs,this.objs=new PDFObjects,this._bitmaps=new Set,this.cleanupAfterRender=!1,this.pendingCleanup=!1,this._intentStates=new Map,this._annotationPromises=new Map,this.destroyed=!1}return _createClass(e,[{key:"pageNumber",get:function(){return this._pageIndex+1}},{key:"rotate",get:function(){return this._pageInfo.rotate}},{key:"ref",get:function(){return this._pageInfo.ref}},{key:"userUnit",get:function(){return this._pageInfo.userUnit}},{key:"view",get:function(){return this._pageInfo.view}},{key:"getViewport",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{},t=e.scale,i=e.rotation,a=void 0===i?this.rotate:i,n=e.offsetX,r=void 0===n?0:n,o=e.offsetY,s=void 0===o?0:o,l=e.dontFlip,c=void 0!==l&&l;return new _display_utils.PageViewport({viewBox:this.view,scale:t,rotation:a,offsetX:r,offsetY:s,dontFlip:c})}},{key:"getAnnotations",value:function(){var e=(arguments.length>0&&void 0!==arguments[0]?arguments[0]:{}).intent,t=void 0===e?"display":e,i=this._transport.getRenderingIntent(t),a=this._annotationPromises.get(i.cacheKey);return a||(a=this._transport.getAnnotations(this._pageIndex,i.renderingIntent),this._annotationPromises.set(i.cacheKey,a),a=a.then((function(e){var t,i=_createForOfIteratorHelper(e);try{var a=function(){var e=t.value;void 0!==e.titleObj&&Object.defineProperty(e,"title",{get:function(){return(0,_display_utils.deprecated)("`title`-property on annotation, please use `titleObj` instead."),e.titleObj.str}}),void 0!==e.contentsObj&&Object.defineProperty(e,"contents",{get:function(){return(0,_display_utils.deprecated)("`contents`-property on annotation, please use `contentsObj` instead."),e.contentsObj.str}})};for(i.s();!(t=i.n()).done;)a()}catch(n){i.e(n)}finally{i.f()}return e}))),a}},{key:"getJSActions",value:function(){return this._jsActionsPromise||(this._jsActionsPromise=this._transport.getPageJSActions(this._pageIndex))}},{key:"getXfa",value:function(){var e=_asyncToGenerator(_regeneratorRuntime().mark((function e(){var t;return _regeneratorRuntime().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.abrupt("return",(null===(t=this._transport._htmlForXfa)||void 0===t?void 0:t.children[this._pageIndex])||null);case 1:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"render",value:function(e){var t,i,a,n=this,r=e.canvasContext,o=e.viewport,s=e.intent,l=void 0===s?"display":s,c=e.annotationMode,d=void 0===c?_util.AnnotationMode.ENABLE:c,u=e.transform,p=void 0===u?null:u,m=e.imageLayer,h=void 0===m?null:m,f=e.canvasFactory,y=void 0===f?null:f,b=e.background,g=void 0===b?null:b,v=e.optionalContentConfigPromise,_=void 0===v?null:v,A=e.annotationCanvasMap,x=void 0===A?null:A,w=e.pageColors,S=void 0===w?null:w,C=e.printAnnotationStorage,k=void 0===C?null:C;void 0!==(null===(t=arguments[0])||void 0===t?void 0:t.renderInteractiveForms)&&((0,_display_utils.deprecated)("render no longer accepts the `renderInteractiveForms`-option, please use the `annotationMode`-option instead."),!0===arguments[0].renderInteractiveForms&&d===_util.AnnotationMode.ENABLE&&(d=_util.AnnotationMode.ENABLE_FORMS)),void 0!==(null===(i=arguments[0])||void 0===i?void 0:i.includeAnnotationStorage)&&((0,_display_utils.deprecated)("render no longer accepts the `includeAnnotationStorage`-option, please use the `annotationMode`-option instead."),!0===arguments[0].includeAnnotationStorage&&d===_util.AnnotationMode.ENABLE&&(d=_util.AnnotationMode.ENABLE_STORAGE)),this._stats&&this._stats.time("Overall");var D=this._transport.getRenderingIntent(l,d,k);this.pendingCleanup=!1,_||(_=this._transport.getOptionalContentConfig());var R=this._intentStates.get(D.cacheKey);R||(R=Object.create(null),this._intentStates.set(D.cacheKey,R)),R.streamReaderCancelTimeout&&(clearTimeout(R.streamReaderCancelTimeout),R.streamReaderCancelTimeout=null);var I=y||new DefaultCanvasFactory({ownerDocument:this._ownerDocument}),M=!!(D.renderingIntent&_util.RenderingIntentFlag.PRINT);R.displayReadyCapability||(R.displayReadyCapability=(0,_util.createPromiseCapability)(),R.operatorList={fnArray:[],argsArray:[],lastChunk:!1,separateAnnots:null},this._stats&&this._stats.time("Page Request"),this._pumpOperatorList(D));var T=function(e){R.renderTasks.delete(P),(n.cleanupAfterRender||M)&&(n.pendingCleanup=!0),n._tryCleanup(),e?(P.capability.reject(e),n._abortOperatorList({intentState:R,reason:e instanceof Error?e:new Error(e)})):P.capability.resolve(),n._stats&&(n._stats.timeEnd("Rendering"),n._stats.timeEnd("Overall"))},P=new InternalRenderTask({callback:T,params:{canvasContext:r,viewport:o,transform:p,imageLayer:h,background:g},objs:this.objs,commonObjs:this.commonObjs,annotationCanvasMap:x,operatorList:R.operatorList,pageIndex:this._pageIndex,canvasFactory:I,useRequestAnimationFrame:!M,pdfBug:this._pdfBug,pageColors:S});((a=R).renderTasks||(a.renderTasks=new Set)).add(P);var z=P.task;return Promise.all([R.displayReadyCapability.promise,_]).then((function(e){var t=_slicedToArray(e,2),i=t[0],a=t[1];n.pendingCleanup?T():(n._stats&&n._stats.time("Rendering"),P.initializeGraphics({transparency:i,optionalContentConfig:a}),P.operatorListChanged())})).catch(T),z}},{key:"getOperatorList",value:function(){var e,t,i=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{},a=i.intent,n=void 0===a?"display":a,r=i.annotationMode,o=void 0===r?_util.AnnotationMode.ENABLE:r,s=i.printAnnotationStorage,l=void 0===s?null:s,c=this._transport.getRenderingIntent(n,o,l,!0),d=this._intentStates.get(c.cacheKey);return d||(d=Object.create(null),this._intentStates.set(c.cacheKey,d)),d.opListReadCapability||((e=Object.create(null)).operatorListChanged=function(){d.operatorList.lastChunk&&(d.opListReadCapability.resolve(d.operatorList),d.renderTasks.delete(e))},d.opListReadCapability=(0,_util.createPromiseCapability)(),((t=d).renderTasks||(t.renderTasks=new Set)).add(e),d.operatorList={fnArray:[],argsArray:[],lastChunk:!1,separateAnnots:null},this._stats&&this._stats.time("Page Request"),this._pumpOperatorList(c)),d.opListReadCapability.promise}},{key:"streamTextContent",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{},t=e.disableCombineTextItems,i=void 0!==t&&t,a=e.includeMarkedContent,n=void 0!==a&&a;return this._transport.messageHandler.sendWithStream("GetTextContent",{pageIndex:this._pageIndex,combineTextItems:!0!==i,includeMarkedContent:!0===n},{highWaterMark:100,size:function(e){return e.items.length}})}},{key:"getTextContent",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this._transport._htmlForXfa)return this.getXfa().then((function(e){return _xfa_text.XfaText.textContent(e)}));var t=this.streamTextContent(e);return new Promise((function(e,i){var a=t.getReader(),n={items:[],styles:Object.create(null)};!function t(){a.read().then((function(i){var a,r=i.value;i.done?e(n):(Object.assign(n.styles,r.styles),(a=n.items).push.apply(a,_toConsumableArray(r.items)),t())}),i)}()}))}},{key:"getStructTree",value:function(){return this._structTreePromise||(this._structTreePromise=this._transport.getStructTree(this._pageIndex))}},{key:"_destroy",value:function(){this.destroyed=!0;var e,t=[],i=_createForOfIteratorHelper(this._intentStates.values());try{for(i.s();!(e=i.n()).done;){var a=e.value;if(this._abortOperatorList({intentState:a,reason:new Error("Page was destroyed."),force:!0}),!a.opListReadCapability){var n,r=_createForOfIteratorHelper(a.renderTasks);try{for(r.s();!(n=r.n()).done;){var o=n.value;t.push(o.completed),o.cancel()}}catch(c){r.e(c)}finally{r.f()}}}}catch(c){i.e(c)}finally{i.f()}this.objs.clear();var s,l=_createForOfIteratorHelper(this._bitmaps);try{for(l.s();!(s=l.n()).done;)s.value.close()}catch(c){l.e(c)}finally{l.f()}return this._bitmaps.clear(),this._annotationPromises.clear(),this._jsActionsPromise=null,this._structTreePromise=null,this.pendingCleanup=!1,Promise.all(t)}},{key:"cleanup",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0];return this.pendingCleanup=!0,this._tryCleanup(e)}},{key:"_tryCleanup",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0];if(!this.pendingCleanup)return!1;var t,i=_createForOfIteratorHelper(this._intentStates.values());try{for(i.s();!(t=i.n()).done;){var a=t.value,n=a.renderTasks,r=a.operatorList;if(n.size>0||!r.lastChunk)return!1}}catch(l){i.e(l)}finally{i.f()}this._intentStates.clear(),this.objs.clear(),this._annotationPromises.clear(),this._jsActionsPromise=null,this._structTreePromise=null,e&&this._stats&&(this._stats=new _display_utils.StatTimer);var o,s=_createForOfIteratorHelper(this._bitmaps);try{for(s.s();!(o=s.n()).done;)o.value.close()}catch(l){s.e(l)}finally{s.f()}return this._bitmaps.clear(),this.pendingCleanup=!1,!0}},{key:"_startRenderPage",value:function(e,t){var i=this._intentStates.get(t);i&&(this._stats&&this._stats.timeEnd("Page Request"),i.displayReadyCapability&&i.displayReadyCapability.resolve(e))}},{key:"_renderPageChunk",value:function(e,t){for(var i=0,a=e.length;i<a;i++)t.operatorList.fnArray.push(e.fnArray[i]),t.operatorList.argsArray.push(e.argsArray[i]);t.operatorList.lastChunk=e.lastChunk,t.operatorList.separateAnnots=e.separateAnnots;var n,r=_createForOfIteratorHelper(t.renderTasks);try{for(r.s();!(n=r.n()).done;)n.value.operatorListChanged()}catch(o){r.e(o)}finally{r.f()}e.lastChunk&&this._tryCleanup()}},{key:"_pumpOperatorList",value:function(e){var t=this,i=e.renderingIntent,a=e.cacheKey,n=e.annotationStorageMap,r=this._transport.messageHandler.sendWithStream("GetOperatorList",{pageIndex:this._pageIndex,intent:i,cacheKey:a,annotationStorage:n}).getReader(),o=this._intentStates.get(a);o.streamReader=r,function e(){r.read().then((function(i){var a=i.value;i.done?o.streamReader=null:t._transport.destroyed||(t._renderPageChunk(a,o),e())}),(function(e){if(o.streamReader=null,!t._transport.destroyed){if(o.operatorList){o.operatorList.lastChunk=!0;var i,a=_createForOfIteratorHelper(o.renderTasks);try{for(a.s();!(i=a.n()).done;)i.value.operatorListChanged()}catch(n){a.e(n)}finally{a.f()}t._tryCleanup()}if(o.displayReadyCapability)o.displayReadyCapability.reject(e);else{if(!o.opListReadCapability)throw e;o.opListReadCapability.reject(e)}}}))}()}},{key:"_abortOperatorList",value:function(e){var t=this,i=e.intentState,a=e.reason,n=e.force,r=void 0!==n&&n;if(i.streamReader){if(!r){if(i.renderTasks.size>0)return;if(a instanceof _display_utils.RenderingCancelledException)return void(i.streamReaderCancelTimeout=setTimeout((function(){t._abortOperatorList({intentState:i,reason:a,force:!0}),i.streamReaderCancelTimeout=null}),RENDERING_CANCELLED_TIMEOUT))}if(i.streamReader.cancel(new _util.AbortException(a.message)).catch((function(){})),i.streamReader=null,!this._transport.destroyed){var o,s=_createForOfIteratorHelper(this._intentStates);try{for(s.s();!(o=s.n()).done;){var l=_slicedToArray(o.value,2),c=l[0];if(l[1]===i){this._intentStates.delete(c);break}}}catch(d){s.e(d)}finally{s.f()}this.cleanup()}}}},{key:"stats",get:function(){return this._stats}}]),e}();exports.PDFPageProxy=PDFPageProxy;var LoopbackPort=function(){function e(){_classCallCheck(this,e),this._listeners=[],this._deferred=Promise.resolve()}return _createClass(e,[{key:"postMessage",value:function(e,t){var i=this,a={data:structuredClone(e,t)};this._deferred.then((function(){var e,t=_createForOfIteratorHelper(i._listeners);try{for(t.s();!(e=t.n()).done;)e.value.call(i,a)}catch(n){t.e(n)}finally{t.f()}}))}},{key:"addEventListener",value:function(e,t){this._listeners.push(t)}},{key:"removeEventListener",value:function(e,t){var i=this._listeners.indexOf(t);this._listeners.splice(i,1)}},{key:"terminate",value:function(){this._listeners.length=0}}]),e}();exports.LoopbackPort=LoopbackPort;var PDFWorkerUtil={isWorkerDisabled:!1,fallbackWorkerSrc:null,fakeWorkerId:0};if(exports.PDFWorkerUtil=PDFWorkerUtil,_is_node.isNodeJS)PDFWorkerUtil.isWorkerDisabled=!0,PDFWorkerUtil.fallbackWorkerSrc="./pdf.worker.js";else if("object"===typeof document){var _document,_document$currentScri,pdfjsFilePath=null===(_document=document)||void 0===_document||null===(_document$currentScri=_document.currentScript)||void 0===_document$currentScri?void 0:_document$currentScri.src;pdfjsFilePath&&(PDFWorkerUtil.fallbackWorkerSrc=pdfjsFilePath.replace(/(\.(?:min\.)?js)(\?.*)?$/i,".worker$1$2"))}PDFWorkerUtil.isSameOrigin=function(e,t){var i;try{if(!(i=new URL(e)).origin||"null"===i.origin)return!1}catch(n){return!1}var a=new URL(t,i);return i.origin===a.origin},PDFWorkerUtil.createCDNWrapper=function(e){var t='importScripts("'.concat(e,'");');return URL.createObjectURL(new Blob([t]))};var PDFWorker=function(){function PDFWorker(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{},t=e.name,i=void 0===t?null:t,a=e.port,n=void 0===a?null:a,r=e.verbosity,o=void 0===r?(0,_util.getVerbosityLevel)():r;if(_classCallCheck(this,PDFWorker),n&&_classStaticPrivateFieldSpecGet(PDFWorker,PDFWorker,_workerPorts).has(n))throw new Error("Cannot use more than one PDFWorker per port.");if(this.name=i,this.destroyed=!1,this.verbosity=o,this._readyCapability=(0,_util.createPromiseCapability)(),this._port=null,this._webWorker=null,this._messageHandler=null,n)return _classStaticPrivateFieldSpecGet(PDFWorker,PDFWorker,_workerPorts).set(n,this),void this._initializeFromPort(n);this._initialize()}return _createClass(PDFWorker,[{key:"promise",get:function(){return this._readyCapability.promise}},{key:"port",get:function(){return this._port}},{key:"messageHandler",get:function(){return this._messageHandler}},{key:"_initializeFromPort",value:function(e){this._port=e,this._messageHandler=new _message_handler.MessageHandler("main","worker",e),this._messageHandler.on("ready",(function(){})),this._readyCapability.resolve()}},{key:"_initialize",value:function(){var e=this;if(!PDFWorkerUtil.isWorkerDisabled&&!PDFWorker._mainThreadWorkerMessageHandler){var t=PDFWorker.workerSrc;try{PDFWorkerUtil.isSameOrigin(window.location.href,t)||(t=PDFWorkerUtil.createCDNWrapper(new URL(t,window.location).href));var i=new Worker(t),a=new _message_handler.MessageHandler("main","worker",i),n=function(){i.removeEventListener("error",r),a.destroy(),i.terminate(),e.destroyed?e._readyCapability.reject(new Error("Worker was destroyed")):e._setupFakeWorker()},r=function(){e._webWorker||n()};i.addEventListener("error",r),a.on("test",(function(t){i.removeEventListener("error",r),e.destroyed?n():t?(e._messageHandler=a,e._port=i,e._webWorker=i,e._readyCapability.resolve(),a.send("configure",{verbosity:e.verbosity})):(e._setupFakeWorker(),a.destroy(),i.terminate())})),a.on("ready",(function(t){if(i.removeEventListener("error",r),e.destroyed)n();else try{o()}catch(a){e._setupFakeWorker()}}));var o=function(){var e=new Uint8Array;a.send("test",e,[e.buffer])};return void o()}catch(s){(0,_util.info)("The worker has been disabled.")}}this._setupFakeWorker()}},{key:"_setupFakeWorker",value:function(){var e=this;PDFWorkerUtil.isWorkerDisabled||((0,_util.warn)("Setting up fake worker."),PDFWorkerUtil.isWorkerDisabled=!0),PDFWorker._setupFakeWorkerGlobal.then((function(t){if(e.destroyed)e._readyCapability.reject(new Error("Worker was destroyed"));else{var i=new LoopbackPort;e._port=i;var a="fake".concat(PDFWorkerUtil.fakeWorkerId++),n=new _message_handler.MessageHandler(a+"_worker",a,i);t.setup(n,i);var r=new _message_handler.MessageHandler(a,a+"_worker",i);e._messageHandler=r,e._readyCapability.resolve(),r.send("configure",{verbosity:e.verbosity})}})).catch((function(t){e._readyCapability.reject(new Error('Setting up fake worker failed: "'.concat(t.message,'".')))}))}},{key:"destroy",value:function(){this.destroyed=!0,this._webWorker&&(this._webWorker.terminate(),this._webWorker=null),_classStaticPrivateFieldSpecGet(PDFWorker,PDFWorker,_workerPorts).delete(this._port),this._port=null,this._messageHandler&&(this._messageHandler.destroy(),this._messageHandler=null)}}],[{key:"fromPort",value:function(e){if(null===e||void 0===e||!e.port)throw new Error("PDFWorker.fromPort - invalid method signature.");return _classStaticPrivateFieldSpecGet(this,PDFWorker,_workerPorts).has(e.port)?_classStaticPrivateFieldSpecGet(this,PDFWorker,_workerPorts).get(e.port):new PDFWorker(e)}},{key:"workerSrc",get:function(){if(_worker_options.GlobalWorkerOptions.workerSrc)return _worker_options.GlobalWorkerOptions.workerSrc;if(null!==PDFWorkerUtil.fallbackWorkerSrc)return _is_node.isNodeJS||(0,_display_utils.deprecated)('No "GlobalWorkerOptions.workerSrc" specified.'),PDFWorkerUtil.fallbackWorkerSrc;throw new Error('No "GlobalWorkerOptions.workerSrc" specified.')}},{key:"_mainThreadWorkerMessageHandler",get:function(){try{var e;return(null===(e=globalThis.pdfjsWorker)||void 0===e?void 0:e.WorkerMessageHandler)||null}catch(t){return null}}},{key:"_setupFakeWorkerGlobal",get:function get(){var _this14=this,loader=function(){var _ref15=_asyncToGenerator(_regeneratorRuntime().mark((function _callee4(){var mainWorkerMessageHandler,worker;return _regeneratorRuntime().wrap((function _callee4$(_context4){for(;;)switch(_context4.prev=_context4.next){case 0:if(mainWorkerMessageHandler=_this14._mainThreadWorkerMessageHandler,!mainWorkerMessageHandler){_context4.next=3;break}return _context4.abrupt("return",mainWorkerMessageHandler);case 3:if(!_is_node.isNodeJS){_context4.next=6;break}return worker=eval("require")(_this14.workerSrc),_context4.abrupt("return",worker.WorkerMessageHandler);case 6:return _context4.next=8,(0,_display_utils.loadScript)(_this14.workerSrc);case 8:return _context4.abrupt("return",window.pdfjsWorker.WorkerMessageHandler);case 9:case"end":return _context4.stop()}}),_callee4)})));return function(){return _ref15.apply(this,arguments)}}();return(0,_util.shadow)(this,"_setupFakeWorkerGlobal",loader())}}]),PDFWorker}(),_workerPorts={writable:!0,value:new WeakMap};exports.PDFWorker=PDFWorker,PDFWorker.getWorkerSrc=function(){return(0,_display_utils.deprecated)("`PDFWorker.getWorkerSrc()`, please use `PDFWorker.workerSrc` instead."),this.workerSrc};var _docStats=new WeakMap,_pageCache=new WeakMap,_pagePromises=new WeakMap,_metadataPromise=new WeakMap,WorkerTransport=function(){function e(t,i,a,n){_classCallCheck(this,e),_classPrivateFieldInitSpec(this,_docStats,{writable:!0,value:null}),_classPrivateFieldInitSpec(this,_pageCache,{writable:!0,value:new Map}),_classPrivateFieldInitSpec(this,_pagePromises,{writable:!0,value:new Map}),_classPrivateFieldInitSpec(this,_metadataPromise,{writable:!0,value:null}),this.messageHandler=t,this.loadingTask=i,this.commonObjs=new PDFObjects,this.fontLoader=new _font_loader.FontLoader({docId:i.docId,onUnsupportedFeature:this._onUnsupportedFeature.bind(this),ownerDocument:n.ownerDocument,styleElement:n.styleElement}),this._params=n,n.useWorkerFetch||(this.CMapReaderFactory=new n.CMapReaderFactory({baseUrl:n.cMapUrl,isCompressed:n.cMapPacked}),this.StandardFontDataFactory=new n.StandardFontDataFactory({baseUrl:n.standardFontDataUrl})),this.destroyed=!1,this.destroyCapability=null,this._passwordCapability=null,this._networkStream=a,this._fullReader=null,this._lastProgress=null,this.downloadInfoCapability=(0,_util.createPromiseCapability)(),this.setupMessageHandler()}return _createClass(e,[{key:"annotationStorage",get:function(){return(0,_util.shadow)(this,"annotationStorage",new _annotation_storage.AnnotationStorage)}},{key:"stats",get:function(){return _classPrivateFieldGet(this,_docStats)}},{key:"getRenderingIntent",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:_util.AnnotationMode.ENABLE,i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null,a=arguments.length>3&&void 0!==arguments[3]&&arguments[3],n=_util.RenderingIntentFlag.DISPLAY,r=null;switch(e){case"any":n=_util.RenderingIntentFlag.ANY;break;case"display":break;case"print":n=_util.RenderingIntentFlag.PRINT;break;default:(0,_util.warn)("getRenderingIntent - invalid intent: ".concat(e))}switch(t){case _util.AnnotationMode.DISABLE:n+=_util.RenderingIntentFlag.ANNOTATIONS_DISABLE;break;case _util.AnnotationMode.ENABLE:break;case _util.AnnotationMode.ENABLE_FORMS:n+=_util.RenderingIntentFlag.ANNOTATIONS_FORMS;break;case _util.AnnotationMode.ENABLE_STORAGE:r=((n+=_util.RenderingIntentFlag.ANNOTATIONS_STORAGE)&_util.RenderingIntentFlag.PRINT&&i instanceof _annotation_storage.PrintAnnotationStorage?i:this.annotationStorage).serializable;break;default:(0,_util.warn)("getRenderingIntent - invalid annotationMode: ".concat(t))}return a&&(n+=_util.RenderingIntentFlag.OPLIST),{renderingIntent:n,cacheKey:"".concat(n,"_").concat(_annotation_storage.AnnotationStorage.getHash(r)),annotationStorageMap:r}}},{key:"destroy",value:function(){var e=this;if(this.destroyCapability)return this.destroyCapability.promise;this.destroyed=!0,this.destroyCapability=(0,_util.createPromiseCapability)(),this._passwordCapability&&this._passwordCapability.reject(new Error("Worker was destroyed during onPassword callback"));var t,i=[],a=_createForOfIteratorHelper(_classPrivateFieldGet(this,_pageCache).values());try{for(a.s();!(t=a.n()).done;){var n=t.value;i.push(n._destroy())}}catch(o){a.e(o)}finally{a.f()}_classPrivateFieldGet(this,_pageCache).clear(),_classPrivateFieldGet(this,_pagePromises).clear(),this.hasOwnProperty("annotationStorage")&&this.annotationStorage.resetModified();var r=this.messageHandler.sendWithPromise("Terminate",null);return i.push(r),Promise.all(i).then((function(){e.commonObjs.clear(),e.fontLoader.clear(),_classPrivateFieldSet(e,_metadataPromise,null),e._getFieldObjectsPromise=null,e._hasJSActionsPromise=null,e._networkStream&&e._networkStream.cancelAllRequests(new _util.AbortException("Worker was terminated.")),e.messageHandler&&(e.messageHandler.destroy(),e.messageHandler=null),e.destroyCapability.resolve()}),this.destroyCapability.reject),this.destroyCapability.promise}},{key:"setupMessageHandler",value:function(){var e=this,t=this.messageHandler,i=this.loadingTask;t.on("GetReader",(function(t,i){(0,_util.assert)(e._networkStream,"GetReader - no `IPDFStream` instance available."),e._fullReader=e._networkStream.getFullReader(),e._fullReader.onProgress=function(t){e._lastProgress={loaded:t.loaded,total:t.total}},i.onPull=function(){e._fullReader.read().then((function(e){var t=e.value;e.done?i.close():((0,_util.assert)((0,_util.isArrayBuffer)(t),"GetReader - expected an ArrayBuffer."),i.enqueue(new Uint8Array(t),1,[t]))})).catch((function(e){i.error(e)}))},i.onCancel=function(t){e._fullReader.cancel(t),i.ready.catch((function(t){if(!e.destroyed)throw t}))}})),t.on("ReaderHeadersReady",(function(t){var a=(0,_util.createPromiseCapability)(),n=e._fullReader;return n.headersReady.then((function(){var t;n.isStreamingSupported&&n.isRangeSupported||(e._lastProgress&&(null===(t=i.onProgress)||void 0===t||t.call(i,e._lastProgress)),n.onProgress=function(e){var t;null===(t=i.onProgress)||void 0===t||t.call(i,{loaded:e.loaded,total:e.total})});a.resolve({isStreamingSupported:n.isStreamingSupported,isRangeSupported:n.isRangeSupported,contentLength:n.contentLength})}),a.reject),a.promise})),t.on("GetRangeReader",(function(t,i){(0,_util.assert)(e._networkStream,"GetRangeReader - no `IPDFStream` instance available.");var a=e._networkStream.getRangeReader(t.begin,t.end);a?(i.onPull=function(){a.read().then((function(e){var t=e.value;e.done?i.close():((0,_util.assert)((0,_util.isArrayBuffer)(t),"GetRangeReader - expected an ArrayBuffer."),i.enqueue(new Uint8Array(t),1,[t]))})).catch((function(e){i.error(e)}))},i.onCancel=function(t){a.cancel(t),i.ready.catch((function(t){if(!e.destroyed)throw t}))}):i.close()})),t.on("GetDoc",(function(t){var a=t.pdfInfo;e._numPages=a.numPages,e._htmlForXfa=a.htmlForXfa,delete a.htmlForXfa,i._capability.resolve(new PDFDocumentProxy(a,e))})),t.on("DocException",(function(e){var t;switch(e.name){case"PasswordException":t=new _util.PasswordException(e.message,e.code);break;case"InvalidPDFException":t=new _util.InvalidPDFException(e.message);break;case"MissingPDFException":t=new _util.MissingPDFException(e.message);break;case"UnexpectedResponseException":t=new _util.UnexpectedResponseException(e.message,e.status);break;case"UnknownErrorException":t=new _util.UnknownErrorException(e.message,e.details);break;default:(0,_util.unreachable)("DocException - expected a valid Error.")}i._capability.reject(t)})),t.on("PasswordRequest",(function(t){if(e._passwordCapability=(0,_util.createPromiseCapability)(),i.onPassword)try{i.onPassword((function(t){t instanceof Error?e._passwordCapability.reject(t):e._passwordCapability.resolve({password:t})}),t.code)}catch(a){e._passwordCapability.reject(a)}else e._passwordCapability.reject(new _util.PasswordException(t.message,t.code));return e._passwordCapability.promise})),t.on("DataLoaded",(function(t){var a;null===(a=i.onProgress)||void 0===a||a.call(i,{loaded:t.length,total:t.length}),e.downloadInfoCapability.resolve(t)})),t.on("StartRenderPage",(function(t){e.destroyed||_classPrivateFieldGet(e,_pageCache).get(t.pageIndex)._startRenderPage(t.transparency,t.cacheKey)})),t.on("commonobj",(function(i){var a,n=_slicedToArray(i,3),r=n[0],o=n[1],s=n[2];if(!e.destroyed&&!e.commonObjs.has(r))switch(o){case"Font":var l=e._params;if("error"in s){var c=s.error;(0,_util.warn)("Error during font loading: ".concat(c)),e.commonObjs.resolve(r,c);break}var d=null;l.pdfBug&&null!==(a=globalThis.FontInspector)&&void 0!==a&&a.enabled&&(d={registerFont:function(e,t){globalThis.FontInspector.fontAdded(e,t)}});var u=new _font_loader.FontFaceObject(s,{isEvalSupported:l.isEvalSupported,disableFontFace:l.disableFontFace,ignoreErrors:l.ignoreErrors,onUnsupportedFeature:e._onUnsupportedFeature.bind(e),fontRegistry:d});e.fontLoader.bind(u).catch((function(e){return t.sendWithPromise("FontFallback",{id:r})})).finally((function(){!l.fontExtraProperties&&u.data&&(u.data=null),e.commonObjs.resolve(r,u)}));break;case"FontPath":case"Image":e.commonObjs.resolve(r,s);break;default:throw new Error("Got unknown common object type ".concat(o))}})),t.on("obj",(function(t){var i=_slicedToArray(t,4),a=i[0],n=i[1],r=i[2],o=i[3];if(!e.destroyed){var s=_classPrivateFieldGet(e,_pageCache).get(n);if(!s.objs.has(a))switch(r){case"Image":if(s.objs.resolve(a,o),o){var l;if(o.bitmap){var c=o.bitmap;l=o.width*o.height*4,s._bitmaps.add(c)}else{var d;l=(null===(d=o.data)||void 0===d?void 0:d.length)||0}l>8e6&&(s.cleanupAfterRender=!0)}break;case"Pattern":s.objs.resolve(a,o);break;default:throw new Error("Got unknown object type ".concat(r))}}})),t.on("DocProgress",(function(t){var a;e.destroyed||null===(a=i.onProgress)||void 0===a||a.call(i,{loaded:t.loaded,total:t.total})})),t.on("DocStats",(function(t){e.destroyed||_classPrivateFieldSet(e,_docStats,Object.freeze({streamTypes:Object.freeze(t.streamTypes),fontTypes:Object.freeze(t.fontTypes)}))})),t.on("UnsupportedFeature",this._onUnsupportedFeature.bind(this)),t.on("FetchBuiltInCMap",(function(t){return e.destroyed?Promise.reject(new Error("Worker was destroyed.")):e.CMapReaderFactory?e.CMapReaderFactory.fetch(t):Promise.reject(new Error("CMapReaderFactory not initialized, see the `useWorkerFetch` parameter."))})),t.on("FetchStandardFontData",(function(t){return e.destroyed?Promise.reject(new Error("Worker was destroyed.")):e.StandardFontDataFactory?e.StandardFontDataFactory.fetch(t):Promise.reject(new Error("StandardFontDataFactory not initialized, see the `useWorkerFetch` parameter."))}))}},{key:"_onUnsupportedFeature",value:function(e){var t,i,a=e.featureId;this.destroyed||null===(t=(i=this.loadingTask).onUnsupportedFeature)||void 0===t||t.call(i,a)}},{key:"getData",value:function(){return this.messageHandler.sendWithPromise("GetData",null)}},{key:"getPage",value:function(e){var t=this;if(!Number.isInteger(e)||e<=0||e>this._numPages)return Promise.reject(new Error("Invalid page request."));var i=e-1,a=_classPrivateFieldGet(this,_pagePromises).get(i);if(a)return a;var n=this.messageHandler.sendWithPromise("GetPage",{pageIndex:i}).then((function(e){if(t.destroyed)throw new Error("Transport destroyed");var a=new PDFPageProxy(i,e,t,t._params.ownerDocument,t._params.pdfBug);return _classPrivateFieldGet(t,_pageCache).set(i,a),a}));return _classPrivateFieldGet(this,_pagePromises).set(i,n),n}},{key:"getPageIndex",value:function(e){return"object"!==typeof e||null===e||!Number.isInteger(e.num)||e.num<0||!Number.isInteger(e.gen)||e.gen<0?Promise.reject(new Error("Invalid pageIndex request.")):this.messageHandler.sendWithPromise("GetPageIndex",{num:e.num,gen:e.gen})}},{key:"getAnnotations",value:function(e,t){return this.messageHandler.sendWithPromise("GetAnnotations",{pageIndex:e,intent:t})}},{key:"saveDocument",value:function(){var e,t,i=this;return this.messageHandler.sendWithPromise("SaveDocument",{isPureXfa:!!this._htmlForXfa,numPages:this._numPages,annotationStorage:this.annotationStorage.serializable,filename:null!==(e=null===(t=this._fullReader)||void 0===t?void 0:t.filename)&&void 0!==e?e:null}).finally((function(){i.annotationStorage.resetModified()}))}},{key:"getFieldObjects",value:function(){return this._getFieldObjectsPromise||(this._getFieldObjectsPromise=this.messageHandler.sendWithPromise("GetFieldObjects",null))}},{key:"hasJSActions",value:function(){return this._hasJSActionsPromise||(this._hasJSActionsPromise=this.messageHandler.sendWithPromise("HasJSActions",null))}},{key:"getCalculationOrderIds",value:function(){return this.messageHandler.sendWithPromise("GetCalculationOrderIds",null)}},{key:"getDestinations",value:function(){return this.messageHandler.sendWithPromise("GetDestinations",null)}},{key:"getDestination",value:function(e){return"string"!==typeof e?Promise.reject(new Error("Invalid destination request.")):this.messageHandler.sendWithPromise("GetDestination",{id:e})}},{key:"getPageLabels",value:function(){return this.messageHandler.sendWithPromise("GetPageLabels",null)}},{key:"getPageLayout",value:function(){return this.messageHandler.sendWithPromise("GetPageLayout",null)}},{key:"getPageMode",value:function(){return this.messageHandler.sendWithPromise("GetPageMode",null)}},{key:"getViewerPreferences",value:function(){return this.messageHandler.sendWithPromise("GetViewerPreferences",null)}},{key:"getOpenAction",value:function(){return this.messageHandler.sendWithPromise("GetOpenAction",null)}},{key:"getAttachments",value:function(){return this.messageHandler.sendWithPromise("GetAttachments",null)}},{key:"getJavaScript",value:function(){return this.messageHandler.sendWithPromise("GetJavaScript",null)}},{key:"getDocJSActions",value:function(){return this.messageHandler.sendWithPromise("GetDocJSActions",null)}},{key:"getPageJSActions",value:function(e){return this.messageHandler.sendWithPromise("GetPageJSActions",{pageIndex:e})}},{key:"getStructTree",value:function(e){return this.messageHandler.sendWithPromise("GetStructTree",{pageIndex:e})}},{key:"getOutline",value:function(){return this.messageHandler.sendWithPromise("GetOutline",null)}},{key:"getOptionalContentConfig",value:function(){return this.messageHandler.sendWithPromise("GetOptionalContentConfig",null).then((function(e){return new _optional_content_config.OptionalContentConfig(e)}))}},{key:"getPermissions",value:function(){return this.messageHandler.sendWithPromise("GetPermissions",null)}},{key:"getMetadata",value:function(){var e=this;return _classPrivateFieldGet(this,_metadataPromise)||_classPrivateFieldSet(this,_metadataPromise,this.messageHandler.sendWithPromise("GetMetadata",null).then((function(t){var i,a,n,r;return{info:t[0],metadata:t[1]?new _metadata.Metadata(t[1]):null,contentDispositionFilename:null!==(i=null===(a=e._fullReader)||void 0===a?void 0:a.filename)&&void 0!==i?i:null,contentLength:null!==(n=null===(r=e._fullReader)||void 0===r?void 0:r.contentLength)&&void 0!==n?n:null}})))}},{key:"getMarkInfo",value:function(){return this.messageHandler.sendWithPromise("GetMarkInfo",null)}},{key:"startCleanup",value:function(){var e=_asyncToGenerator(_regeneratorRuntime().mark((function e(){var t,i,a,n,r=arguments;return _regeneratorRuntime().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return t=r.length>0&&void 0!==r[0]&&r[0],e.next=3,this.messageHandler.sendWithPromise("Cleanup",null);case 3:if(!this.destroyed){e.next=5;break}return e.abrupt("return");case 5:i=_createForOfIteratorHelper(_classPrivateFieldGet(this,_pageCache).values()),e.prev=6,i.s();case 8:if((a=i.n()).done){e.next=15;break}if((n=a.value).cleanup()){e.next=13;break}throw new Error("startCleanup: Page ".concat(n.pageNumber," is currently rendering."));case 13:e.next=8;break;case 15:e.next=20;break;case 17:e.prev=17,e.t0=e.catch(6),i.e(e.t0);case 20:return e.prev=20,i.f(),e.finish(20);case 23:this.commonObjs.clear(),t||this.fontLoader.clear(),_classPrivateFieldSet(this,_metadataPromise,null),this._getFieldObjectsPromise=null,this._hasJSActionsPromise=null;case 28:case"end":return e.stop()}}),e,this,[[6,17,20,23]])})));return function(){return e.apply(this,arguments)}}()},{key:"loadingParams",get:function(){var e=this._params;return(0,_util.shadow)(this,"loadingParams",{disableAutoFetch:e.disableAutoFetch,enableXfa:e.enableXfa})}}]),e}(),_objs=new WeakMap,_ensureObj=new WeakSet,PDFObjects=function(){function e(){_classCallCheck(this,e),_classPrivateMethodInitSpec(this,_ensureObj),_classPrivateFieldInitSpec(this,_objs,{writable:!0,value:Object.create(null)})}return _createClass(e,[{key:"get",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;if(t){var i=_classPrivateMethodGet(this,_ensureObj,_ensureObj2).call(this,e);return i.capability.promise.then((function(){return t(i.data)})),null}var a=_classPrivateFieldGet(this,_objs)[e];if(null===a||void 0===a||!a.capability.settled)throw new Error("Requesting object that isn't resolved yet ".concat(e,"."));return a.data}},{key:"has",value:function(e){var t=_classPrivateFieldGet(this,_objs)[e];return(null===t||void 0===t?void 0:t.capability.settled)||!1}},{key:"resolve",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null,i=_classPrivateMethodGet(this,_ensureObj,_ensureObj2).call(this,e);i.data=t,i.capability.resolve()}},{key:"clear",value:function(){_classPrivateFieldSet(this,_objs,Object.create(null))}}]),e}();function _ensureObj2(e){var t=_classPrivateFieldGet(this,_objs)[e];return t||(_classPrivateFieldGet(this,_objs)[e]={capability:(0,_util.createPromiseCapability)(),data:null})}var _internalRenderTask=new WeakMap,RenderTask=function(){function e(t){_classCallCheck(this,e),_classPrivateFieldInitSpec(this,_internalRenderTask,{writable:!0,value:null}),_classPrivateFieldSet(this,_internalRenderTask,t),this.onContinue=null}return _createClass(e,[{key:"promise",get:function(){return _classPrivateFieldGet(this,_internalRenderTask).capability.promise}},{key:"cancel",value:function(){_classPrivateFieldGet(this,_internalRenderTask).cancel()}},{key:"separateAnnots",get:function(){var e=_classPrivateFieldGet(this,_internalRenderTask).operatorList.separateAnnots;if(!e)return!1;var t=_classPrivateFieldGet(this,_internalRenderTask).annotationCanvasMap;return e.form||e.canvas&&(null===t||void 0===t?void 0:t.size)>0}}]),e}();exports.RenderTask=RenderTask;var InternalRenderTask=function(){function e(t){var i=t.callback,a=t.params,n=t.objs,r=t.commonObjs,o=t.annotationCanvasMap,s=t.operatorList,l=t.pageIndex,c=t.canvasFactory,d=t.useRequestAnimationFrame,u=void 0!==d&&d,p=t.pdfBug,m=void 0!==p&&p,h=t.pageColors,f=void 0===h?null:h;_classCallCheck(this,e),this.callback=i,this.params=a,this.objs=n,this.commonObjs=r,this.annotationCanvasMap=o,this.operatorListIdx=null,this.operatorList=s,this._pageIndex=l,this.canvasFactory=c,this._pdfBug=m,this.pageColors=f,this.running=!1,this.graphicsReadyCallback=null,this.graphicsReady=!1,this._useRequestAnimationFrame=!0===u&&"undefined"!==typeof window,this.cancelled=!1,this.capability=(0,_util.createPromiseCapability)(),this.task=new RenderTask(this),this._cancelBound=this.cancel.bind(this),this._continueBound=this._continue.bind(this),this._scheduleNextBound=this._scheduleNext.bind(this),this._nextBound=this._next.bind(this),this._canvas=a.canvasContext.canvas}return _createClass(e,[{key:"completed",get:function(){return this.capability.promise.catch((function(){}))}},{key:"initializeGraphics",value:function(t){var i,a=t.transparency,n=void 0!==a&&a,r=t.optionalContentConfig;if(!this.cancelled){if(this._canvas){if(_classStaticPrivateFieldSpecGet(e,e,_canvasInUse).has(this._canvas))throw new Error("Cannot use the same canvas during multiple render() operations. Use different canvas or ensure previous operations were cancelled or completed.");_classStaticPrivateFieldSpecGet(e,e,_canvasInUse).add(this._canvas)}this._pdfBug&&null!==(i=globalThis.StepperManager)&&void 0!==i&&i.enabled&&(this.stepper=globalThis.StepperManager.create(this._pageIndex),this.stepper.init(this.operatorList),this.stepper.nextBreakPoint=this.stepper.getNextBreakPoint());var o=this.params,s=o.canvasContext,l=o.viewport,c=o.transform,d=o.imageLayer,u=o.background;this.gfx=new _canvas.CanvasGraphics(s,this.commonObjs,this.objs,this.canvasFactory,d,r,this.annotationCanvasMap,this.pageColors),this.gfx.beginDrawing({transform:c,viewport:l,transparency:n,background:u}),this.operatorListIdx=0,this.graphicsReady=!0,this.graphicsReadyCallback&&this.graphicsReadyCallback()}}},{key:"cancel",value:function(){var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:null;this.running=!1,this.cancelled=!0,this.gfx&&this.gfx.endDrawing(),this._canvas&&_classStaticPrivateFieldSpecGet(e,e,_canvasInUse).delete(this._canvas),this.callback(t||new _display_utils.RenderingCancelledException("Rendering cancelled, page ".concat(this._pageIndex+1),"canvas"))}},{key:"operatorListChanged",value:function(){this.graphicsReady?(this.stepper&&this.stepper.updateOperatorList(this.operatorList),this.running||this._continue()):this.graphicsReadyCallback||(this.graphicsReadyCallback=this._continueBound)}},{key:"_continue",value:function(){this.running=!0,this.cancelled||(this.task.onContinue?this.task.onContinue(this._scheduleNextBound):this._scheduleNext())}},{key:"_scheduleNext",value:function(){var e=this;this._useRequestAnimationFrame?window.requestAnimationFrame((function(){e._nextBound().catch(e._cancelBound)})):Promise.resolve().then(this._nextBound).catch(this._cancelBound)}},{key:"_next",value:function(){var t=_asyncToGenerator(_regeneratorRuntime().mark((function t(){return _regeneratorRuntime().wrap((function(t){for(;;)switch(t.prev=t.next){case 0:if(!this.cancelled){t.next=2;break}return t.abrupt("return");case 2:this.operatorListIdx=this.gfx.executeOperatorList(this.operatorList,this.operatorListIdx,this._continueBound,this.stepper),this.operatorListIdx===this.operatorList.argsArray.length&&(this.running=!1,this.operatorList.lastChunk&&(this.gfx.endDrawing(),this._canvas&&_classStaticPrivateFieldSpecGet(e,e,_canvasInUse).delete(this._canvas),this.callback()));case 4:case"end":return t.stop()}}),t,this)})));return function(){return t.apply(this,arguments)}}()}]),e}(),_canvasInUse={writable:!0,value:new WeakSet},version="2.16.105";exports.version=version;var build="172ccdbe5";exports.build=build},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.PrintAnnotationStorage=t.AnnotationStorage=void 0;var a=i(1),n=i(6),r=i(10),o=new WeakSet,s=function(){function e(){_classCallCheck(this,e),_classPrivateMethodInitSpec(this,o),this._storage=new Map,this._modified=!1,this.onSetModified=null,this.onResetModified=null,this.onAnnotationEditor=null}return _createClass(e,[{key:"getValue",value:function(e,t){var i=this._storage.get(e);return void 0===i?t:Object.assign(t,i)}},{key:"getRawValue",value:function(e){return this._storage.get(e)}},{key:"remove",value:function(e){if(this._storage.delete(e),0===this._storage.size&&this.resetModified(),"function"===typeof this.onAnnotationEditor){var t,i=_createForOfIteratorHelper(this._storage.values());try{for(i.s();!(t=i.n()).done;)if(t.value instanceof n.AnnotationEditor)return}catch(a){i.e(a)}finally{i.f()}this.onAnnotationEditor(null)}}},{key:"setValue",value:function(e,t){var i=this._storage.get(e),a=!1;if(void 0!==i)for(var r=0,s=Object.entries(t);r<s.length;r++){var c=_slicedToArray(s[r],2),d=c[0],u=c[1];i[d]!==u&&(a=!0,i[d]=u)}else a=!0,this._storage.set(e,t);a&&_classPrivateMethodGet(this,o,l).call(this),t instanceof n.AnnotationEditor&&"function"===typeof this.onAnnotationEditor&&this.onAnnotationEditor(t.constructor._type)}},{key:"has",value:function(e){return this._storage.has(e)}},{key:"getAll",value:function(){return this._storage.size>0?(0,a.objectFromMap)(this._storage):null}},{key:"size",get:function(){return this._storage.size}},{key:"resetModified",value:function(){this._modified&&(this._modified=!1,"function"===typeof this.onResetModified&&this.onResetModified())}},{key:"print",get:function(){return new d(this)}},{key:"serializable",get:function(){if(0===this._storage.size)return null;var e,t=new Map,i=_createForOfIteratorHelper(this._storage);try{for(i.s();!(e=i.n()).done;){var a=_slicedToArray(e.value,2),r=a[0],o=a[1],s=o instanceof n.AnnotationEditor?o.serialize():o;s&&t.set(r,s)}}catch(l){i.e(l)}finally{i.f()}return t}}],[{key:"getHash",value:function(e){if(!e)return"";var t,i=new r.MurmurHash3_64,a=_createForOfIteratorHelper(e);try{for(a.s();!(t=a.n()).done;){var n=_slicedToArray(t.value,2),o=n[0],s=n[1];i.update("".concat(o,":").concat(JSON.stringify(s)))}}catch(l){a.e(l)}finally{a.f()}return i.hexdigest()}}]),e}();function l(){this._modified||(this._modified=!0,"function"===typeof this.onSetModified&&this.onSetModified())}t.AnnotationStorage=s;var c=new WeakMap,d=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a;return _classCallCheck(this,i),a=t.call(this),_classPrivateFieldInitSpec(_assertThisInitialized(a),c,{writable:!0,value:null}),_classPrivateFieldSet(_assertThisInitialized(a),c,structuredClone(e.serializable)),a}return _createClass(i,[{key:"print",get:function(){(0,a.unreachable)("Should not call PrintAnnotationStorage.print")}},{key:"serializable",get:function(){return _classPrivateFieldGet(this,c)}}]),i}(s);t.PrintAnnotationStorage=d},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.AnnotationEditor=void 0;var a=i(7),n=i(1),r=new WeakMap,o=new WeakMap,s=new WeakMap,l=new WeakMap,c=new WeakMap,d=new WeakMap,u=function(){function e(t){_classCallCheck(this,e),_classPrivateFieldInitSpec(this,r,{writable:!0,value:this.focusin.bind(this)}),_classPrivateFieldInitSpec(this,o,{writable:!0,value:this.focusout.bind(this)}),_classPrivateFieldInitSpec(this,s,{writable:!0,value:!1}),_classPrivateFieldInitSpec(this,l,{writable:!0,value:!1}),_classPrivateFieldInitSpec(this,c,{writable:!0,value:!1}),_classPrivateFieldInitSpec(this,d,{writable:!0,value:e._zIndex++}),this.constructor===e&&(0,n.unreachable)("Cannot initialize AnnotationEditor."),this.parent=t.parent,this.id=t.id,this.width=this.height=null,this.pageIndex=t.parent.pageIndex,this.name=t.name,this.div=null;var i=_slicedToArray(this.parent.viewportBaseDimensions,2),a=i[0],u=i[1];this.x=t.x/a,this.y=t.y/u,this.rotation=this.parent.viewport.rotation,this.isAttachedToDOM=!1}return _createClass(e,[{key:"setInBackground",value:function(){this.div.style.zIndex=0}},{key:"setInForeground",value:function(){this.div.style.zIndex=_classPrivateFieldGet(this,d)}},{key:"focusin",value:function(e){_classPrivateFieldGet(this,s)?_classPrivateFieldSet(this,s,!1):this.parent.setSelected(this)}},{key:"focusout",value:function(e){if(this.isAttachedToDOM){var t=e.relatedTarget;null!==t&&void 0!==t&&t.closest("#".concat(this.id))||(e.preventDefault(),this.parent.isMultipleSelection||this.commitOrRemove())}}},{key:"commitOrRemove",value:function(){this.isEmpty()?this.remove():this.commit()}},{key:"commit",value:function(){this.parent.addToAnnotationStorage(this)}},{key:"dragstart",value:function(e){var t=this.parent.div.getBoundingClientRect();this.startX=e.clientX-t.x,this.startY=e.clientY-t.y,e.dataTransfer.setData("text/plain",this.id),e.dataTransfer.effectAllowed="move"}},{key:"setAt",value:function(e,t,i,a){var n=_slicedToArray(this.parent.viewportBaseDimensions,2),r=n[0],o=n[1],s=this.screenToPageTranslation(i,a),l=_slicedToArray(s,2);i=l[0],a=l[1],this.x=(e+i)/r,this.y=(t+a)/o,this.div.style.left="".concat(100*this.x,"%"),this.div.style.top="".concat(100*this.y,"%")}},{key:"translate",value:function(e,t){var i=_slicedToArray(this.parent.viewportBaseDimensions,2),a=i[0],n=i[1],r=this.screenToPageTranslation(e,t),o=_slicedToArray(r,2);e=o[0],t=o[1],this.x+=e/a,this.y+=t/n,this.div.style.left="".concat(100*this.x,"%"),this.div.style.top="".concat(100*this.y,"%")}},{key:"screenToPageTranslation",value:function(e,t){switch(this.parent.viewport.rotation){case 90:return[t,-e];case 180:return[-e,-t];case 270:return[-t,e];default:return[e,t]}}},{key:"setDims",value:function(e,t){var i=_slicedToArray(this.parent.viewportBaseDimensions,2),a=i[0],n=i[1];this.div.style.width="".concat(100*e/a,"%"),this.div.style.height="".concat(100*t/n,"%")}},{key:"getInitialTranslation",value:function(){return[0,0]}},{key:"render",value:function(){this.div=document.createElement("div"),this.div.setAttribute("data-editor-rotation",(360-this.rotation)%360),this.div.className=this.name,this.div.setAttribute("id",this.id),this.div.setAttribute("tabIndex",0),this.setInForeground(),this.div.addEventListener("focusin",_classPrivateFieldGet(this,r)),this.div.addEventListener("focusout",_classPrivateFieldGet(this,o));var e=this.getInitialTranslation(),t=_slicedToArray(e,2),i=t[0],n=t[1];return this.translate(i,n),(0,a.bindEvents)(this,this.div,["dragstart","pointerdown"]),this.div}},{key:"pointerdown",value:function(e){var t=a.KeyboardManager.platform.isMac;0!==e.button||e.ctrlKey&&t?e.preventDefault():(e.ctrlKey&&!t||e.shiftKey||e.metaKey&&t?this.parent.toggleSelected(this):this.parent.setSelected(this),_classPrivateFieldSet(this,s,!0))}},{key:"getRect",value:function(e,t){var i=_slicedToArray(this.parent.viewportBaseDimensions,2),a=i[0],n=i[1],r=_slicedToArray(this.parent.pageDimensions,2),o=r[0],s=r[1],l=o*e/a,c=s*t/n,d=this.x*o,u=this.y*s,p=this.width*o,m=this.height*s;switch(this.rotation){case 0:return[d+l,s-u-c-m,d+l+p,s-u-c];case 90:return[d+c,s-u+l,d+c+m,s-u+l+p];case 180:return[d-l-p,s-u+c,d-l,s-u+c+m];case 270:return[d-c-m,s-u-l-p,d-c,s-u-l];default:throw new Error("Invalid rotation")}}},{key:"getRectInCurrentCoords",value:function(e,t){var i=_slicedToArray(e,4),a=i[0],n=i[1],r=i[2],o=i[3],s=r-a,l=o-n;switch(this.rotation){case 0:return[a,t-o,s,l];case 90:return[a,t-n,l,s];case 180:return[r,t-n,s,l];case 270:return[r,t-o,l,s];default:throw new Error("Invalid rotation")}}},{key:"onceAdded",value:function(){}},{key:"isEmpty",value:function(){return!1}},{key:"enableEditMode",value:function(){_classPrivateFieldSet(this,c,!0)}},{key:"disableEditMode",value:function(){_classPrivateFieldSet(this,c,!1)}},{key:"isInEditMode",value:function(){return _classPrivateFieldGet(this,c)}},{key:"shouldGetKeyboardEvents",value:function(){return!1}},{key:"needsToBeRebuilt",value:function(){return this.div&&!this.isAttachedToDOM}},{key:"rebuild",value:function(){var e;null===(e=this.div)||void 0===e||e.addEventListener("focusin",_classPrivateFieldGet(this,r))}},{key:"serialize",value:function(){(0,n.unreachable)("An editor must be serializable")}},{key:"remove",value:function(){this.div.removeEventListener("focusin",_classPrivateFieldGet(this,r)),this.div.removeEventListener("focusout",_classPrivateFieldGet(this,o)),this.isEmpty()||this.commit(),this.parent.remove(this)}},{key:"select",value:function(){var e;null===(e=this.div)||void 0===e||e.classList.add("selectedEditor")}},{key:"unselect",value:function(){var e;null===(e=this.div)||void 0===e||e.classList.remove("selectedEditor")}},{key:"updateParams",value:function(e,t){}},{key:"disableEditing",value:function(){}},{key:"enableEditing",value:function(){}},{key:"propertiesToUpdate",get:function(){return{}}},{key:"contentDiv",get:function(){return this.div}},{key:"isEditing",get:function(){return _classPrivateFieldGet(this,l)},set:function(e){_classPrivateFieldSet(this,l,e),e?(this.parent.setSelected(this),this.parent.setActiveEditor(this)):this.parent.setActiveEditor(null)}}],[{key:"_defaultLineColor",get:function(){return(0,n.shadow)(this,"_defaultLineColor",this._colorManager.getHexCode("CanvasText"))}},{key:"deserialize",value:function(e,t){var i=new this.prototype.constructor({parent:t,id:t.getNextId()});i.rotation=e.rotation;var a=_slicedToArray(t.pageDimensions,2),n=a[0],r=a[1],o=i.getRectInCurrentCoords(e.rect,r),s=_slicedToArray(o,4),l=s[0],c=s[1],d=s[2],u=s[3];return i.x=l/n,i.y=c/r,i.width=d/n,i.height=u/r,i}}]),e}();_defineProperty(u,"_colorManager",new a.ColorManager),_defineProperty(u,"_zIndex",1),t.AnnotationEditor=u},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.KeyboardManager=t.CommandManager=t.ColorManager=t.AnnotationEditorUIManager=void 0,t.bindEvents=function(e,t,i){var a,n=_createForOfIteratorHelper(i);try{for(n.s();!(a=n.n()).done;){var r=a.value;t.addEventListener(r,e[r].bind(e))}}catch(o){n.e(o)}finally{n.f()}},t.opacityToHex=function(e){return Math.round(Math.min(255,Math.max(1,255*e))).toString(16).padStart(2,"0")};var a=i(1),n=i(8),r=new WeakMap,o=function(){function e(){_classCallCheck(this,e),_classPrivateFieldInitSpec(this,r,{writable:!0,value:0})}return _createClass(e,[{key:"getId",value:function(){var e,t;return"".concat(a.AnnotationEditorPrefix).concat((_classPrivateFieldSet(this,r,(e=_classPrivateFieldGet(this,r),t=e++,e)),t))}}]),e}(),s=new WeakMap,l=new WeakMap,c=new WeakMap,d=new WeakMap,u=function(){function e(){var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:128;_classCallCheck(this,e),_classPrivateFieldInitSpec(this,s,{writable:!0,value:[]}),_classPrivateFieldInitSpec(this,l,{writable:!0,value:!1}),_classPrivateFieldInitSpec(this,c,{writable:!0,value:void 0}),_classPrivateFieldInitSpec(this,d,{writable:!0,value:-1}),_classPrivateFieldSet(this,c,t)}return _createClass(e,[{key:"add",value:function(e){var t=e.cmd,i=e.undo,a=e.mustExec,n=e.type,r=void 0===n?NaN:n,o=e.overwriteIfSameType,u=void 0!==o&&o,p=e.keepUndo,m=void 0!==p&&p;if(a&&t(),!_classPrivateFieldGet(this,l)){var h={cmd:t,undo:i,type:r};if(-1===_classPrivateFieldGet(this,d))return _classPrivateFieldGet(this,s).length>0&&(_classPrivateFieldGet(this,s).length=0),_classPrivateFieldSet(this,d,0),void _classPrivateFieldGet(this,s).push(h);if(u&&_classPrivateFieldGet(this,s)[_classPrivateFieldGet(this,d)].type===r)return m&&(h.undo=_classPrivateFieldGet(this,s)[_classPrivateFieldGet(this,d)].undo),void(_classPrivateFieldGet(this,s)[_classPrivateFieldGet(this,d)]=h);var f=_classPrivateFieldGet(this,d)+1;f===_classPrivateFieldGet(this,c)?_classPrivateFieldGet(this,s).splice(0,1):(_classPrivateFieldSet(this,d,f),f<_classPrivateFieldGet(this,s).length&&_classPrivateFieldGet(this,s).splice(f)),_classPrivateFieldGet(this,s).push(h)}}},{key:"undo",value:function(){-1!==_classPrivateFieldGet(this,d)&&(_classPrivateFieldSet(this,l,!0),_classPrivateFieldGet(this,s)[_classPrivateFieldGet(this,d)].undo(),_classPrivateFieldSet(this,l,!1),_classPrivateFieldSet(this,d,_classPrivateFieldGet(this,d)-1))}},{key:"redo",value:function(){_classPrivateFieldGet(this,d)<_classPrivateFieldGet(this,s).length-1&&(_classPrivateFieldSet(this,d,_classPrivateFieldGet(this,d)+1),_classPrivateFieldSet(this,l,!0),_classPrivateFieldGet(this,s)[_classPrivateFieldGet(this,d)].cmd(),_classPrivateFieldSet(this,l,!1))}},{key:"hasSomethingToUndo",value:function(){return-1!==_classPrivateFieldGet(this,d)}},{key:"hasSomethingToRedo",value:function(){return _classPrivateFieldGet(this,d)<_classPrivateFieldGet(this,s).length-1}},{key:"destroy",value:function(){_classPrivateFieldSet(this,s,null)}}]),e}();t.CommandManager=u;var p=new WeakSet,m=function(){function e(t){_classCallCheck(this,e),_classPrivateMethodInitSpec(this,p),this.buffer=[],this.callbacks=new Map,this.allKeys=new Set;var i,a=e.platform.isMac,n=_createForOfIteratorHelper(t);try{for(n.s();!(i=n.n()).done;){var r,o=_slicedToArray(i.value,2),s=o[0],l=o[1],c=_createForOfIteratorHelper(s);try{for(c.s();!(r=c.n()).done;){var d=r.value,u=d.startsWith("mac+");a&&u?(this.callbacks.set(d.slice(4),l),this.allKeys.add(d.split("+").at(-1))):a||u||(this.callbacks.set(d,l),this.allKeys.add(d.split("+").at(-1)))}}catch(m){c.e(m)}finally{c.f()}}}catch(m){n.e(m)}finally{n.f()}}return _createClass(e,[{key:"exec",value:function(e,t){if(this.allKeys.has(t.key)){var i=this.callbacks.get(_classPrivateMethodGet(this,p,h).call(this,t));i&&(i.bind(e)(),t.stopPropagation(),t.preventDefault())}}}],[{key:"platform",get:function(){var e="undefined"!==typeof navigator?navigator.platform:"";return(0,a.shadow)(this,"platform",{isWin:e.includes("Win"),isMac:e.includes("Mac")})}}]),e}();function h(e){e.altKey&&this.buffer.push("alt"),e.ctrlKey&&this.buffer.push("ctrl"),e.metaKey&&this.buffer.push("meta"),e.shiftKey&&this.buffer.push("shift"),this.buffer.push(e.key);var t=this.buffer.join("+");return this.buffer.length=0,t}t.KeyboardManager=m;var f=new WeakMap,y=function(){function e(){_classCallCheck(this,e),_classPrivateFieldInitSpec(this,f,{writable:!0,value:null})}return _createClass(e,[{key:"copy",value:function(e){e&&(Array.isArray(e)?_classPrivateFieldSet(this,f,e.map((function(e){return e.serialize()}))):_classPrivateFieldSet(this,f,[e.serialize()]),_classPrivateFieldSet(this,f,_classPrivateFieldGet(this,f).filter((function(e){return!!e}))),0===_classPrivateFieldGet(this,f).length&&_classPrivateFieldSet(this,f,null))}},{key:"paste",value:function(){return _classPrivateFieldGet(this,f)}},{key:"isEmpty",value:function(){return null===_classPrivateFieldGet(this,f)}},{key:"destroy",value:function(){_classPrivateFieldSet(this,f,null)}}]),e}(),b=function(){function e(){_classCallCheck(this,e)}return _createClass(e,[{key:"_colors",get:function(){var e=new Map([["CanvasText",null],["Canvas",null]]);return(0,n.getColorValues)(e),(0,a.shadow)(this,"_colors",e)}},{key:"convert",value:function(t){var i=(0,n.getRGB)(t);if(!window.matchMedia("(forced-colors: active)").matches)return i;var a,r=_createForOfIteratorHelper(this._colors);try{for(r.s();!(a=r.n()).done;){var o=_slicedToArray(a.value,2),s=o[0];if(o[1].every((function(e,t){return e===i[t]})))return e._colorsMapping.get(s)}}catch(l){r.e(l)}finally{r.f()}return i}},{key:"getHexCode",value:function(e){var t,i=this._colors.get(e);return i?(t=a.Util).makeHexColor.apply(t,_toConsumableArray(i)):e}}]),e}();_defineProperty(b,"_colorsMapping",new Map([["CanvasText",[0,0,0]],["Canvas",[255,255,255]]])),t.ColorManager=b;var g=new WeakMap,v=new WeakMap,_=new WeakMap,A=new WeakMap,x=new WeakMap,w=new WeakMap,S=new WeakMap,C=new WeakMap,k=new WeakMap,D=new WeakMap,R=new WeakMap,I=new WeakMap,M=new WeakMap,T=new WeakMap,P=new WeakMap,z=new WeakMap,B=new WeakMap,F=new WeakSet,E=new WeakSet,N=new WeakSet,O=new WeakSet,G=new WeakSet,L=new WeakSet,j=new WeakSet,q=new WeakSet,H=new WeakSet,U=function(){function e(t,i){_classCallCheck(this,e),_classPrivateMethodInitSpec(this,H),_classPrivateMethodInitSpec(this,q),_classPrivateMethodInitSpec(this,j),_classPrivateMethodInitSpec(this,L),_classPrivateMethodInitSpec(this,G),_classPrivateMethodInitSpec(this,O),_classPrivateMethodInitSpec(this,N),_classPrivateMethodInitSpec(this,E),_classPrivateMethodInitSpec(this,F),_classPrivateFieldInitSpec(this,g,{writable:!0,value:null}),_classPrivateFieldInitSpec(this,v,{writable:!0,value:new Map}),_classPrivateFieldInitSpec(this,_,{writable:!0,value:new Map}),_classPrivateFieldInitSpec(this,A,{writable:!0,value:new y}),_classPrivateFieldInitSpec(this,x,{writable:!0,value:new u}),_classPrivateFieldInitSpec(this,w,{writable:!0,value:0}),_classPrivateFieldInitSpec(this,S,{writable:!0,value:null}),_classPrivateFieldInitSpec(this,C,{writable:!0,value:null}),_classPrivateFieldInitSpec(this,k,{writable:!0,value:new o}),_classPrivateFieldInitSpec(this,D,{writable:!0,value:!1}),_classPrivateFieldInitSpec(this,R,{writable:!0,value:a.AnnotationEditorType.NONE}),_classPrivateFieldInitSpec(this,I,{writable:!0,value:new Set}),_classPrivateFieldInitSpec(this,M,{writable:!0,value:this.keydown.bind(this)}),_classPrivateFieldInitSpec(this,T,{writable:!0,value:this.onEditingAction.bind(this)}),_classPrivateFieldInitSpec(this,P,{writable:!0,value:this.onPageChanging.bind(this)}),_classPrivateFieldInitSpec(this,z,{writable:!0,value:{isEditing:!1,isEmpty:!0,hasEmptyClipboard:!0,hasSomethingToUndo:!1,hasSomethingToRedo:!1,hasSelectedEditor:!1}}),_classPrivateFieldInitSpec(this,B,{writable:!0,value:null}),_classPrivateFieldSet(this,B,t),_classPrivateFieldSet(this,C,i),_classPrivateFieldGet(this,C)._on("editingaction",_classPrivateFieldGet(this,T)),_classPrivateFieldGet(this,C)._on("pagechanging",_classPrivateFieldGet(this,P))}return _createClass(e,[{key:"destroy",value:function(){_classPrivateMethodGet(this,E,X).call(this),_classPrivateFieldGet(this,C)._off("editingaction",_classPrivateFieldGet(this,T)),_classPrivateFieldGet(this,C)._off("pagechanging",_classPrivateFieldGet(this,P));var e,t=_createForOfIteratorHelper(_classPrivateFieldGet(this,_).values());try{for(t.s();!(e=t.n()).done;)e.value.destroy()}catch(i){t.e(i)}finally{t.f()}_classPrivateFieldGet(this,_).clear(),_classPrivateFieldGet(this,v).clear(),_classPrivateFieldSet(this,g,null),_classPrivateFieldGet(this,I).clear(),_classPrivateFieldGet(this,A).destroy(),_classPrivateFieldGet(this,x).destroy()}},{key:"onPageChanging",value:function(e){var t=e.pageNumber;_classPrivateFieldSet(this,w,t-1)}},{key:"focusMainContainer",value:function(){_classPrivateFieldGet(this,B).focus()}},{key:"keydown",value:function(t){var i;null!==(i=this.getActive())&&void 0!==i&&i.shouldGetKeyboardEvents()||e._keyboardManager.exec(this,t)}},{key:"onEditingAction",value:function(e){["undo","redo","cut","copy","paste","delete","selectAll"].includes(e.name)&&this[e.name]()}},{key:"setEditingState",value:function(e){e?(_classPrivateMethodGet(this,F,Y).call(this),_classPrivateMethodGet(this,N,V).call(this,{isEditing:_classPrivateFieldGet(this,R)!==a.AnnotationEditorType.NONE,isEmpty:_classPrivateMethodGet(this,q,K).call(this),hasSomethingToUndo:_classPrivateFieldGet(this,x).hasSomethingToUndo(),hasSomethingToRedo:_classPrivateFieldGet(this,x).hasSomethingToRedo(),hasSelectedEditor:!1,hasEmptyClipboard:_classPrivateFieldGet(this,A).isEmpty()})):(_classPrivateMethodGet(this,E,X).call(this),_classPrivateMethodGet(this,N,V).call(this,{isEditing:!1}))}},{key:"registerEditorTypes",value:function(e){_classPrivateFieldSet(this,S,e);var t,i=_createForOfIteratorHelper(_classPrivateFieldGet(this,S));try{for(i.s();!(t=i.n()).done;){var a=t.value;_classPrivateMethodGet(this,O,Q).call(this,a.defaultPropertiesToUpdate)}}catch(n){i.e(n)}finally{i.f()}}},{key:"getId",value:function(){return _classPrivateFieldGet(this,k).getId()}},{key:"addLayer",value:function(e){_classPrivateFieldGet(this,_).set(e.pageIndex,e),_classPrivateFieldGet(this,D)?e.enable():e.disable()}},{key:"removeLayer",value:function(e){_classPrivateFieldGet(this,_).delete(e.pageIndex)}},{key:"updateMode",value:function(e){if(_classPrivateFieldSet(this,R,e),e===a.AnnotationEditorType.NONE)this.setEditingState(!1),_classPrivateMethodGet(this,L,Z).call(this);else{this.setEditingState(!0),_classPrivateMethodGet(this,G,W).call(this);var t,i=_createForOfIteratorHelper(_classPrivateFieldGet(this,_).values());try{for(i.s();!(t=i.n()).done;)t.value.updateMode(e)}catch(n){i.e(n)}finally{i.f()}}}},{key:"updateToolbar",value:function(e){e!==_classPrivateFieldGet(this,R)&&_classPrivateFieldGet(this,C).dispatch("switchannotationeditormode",{source:this,mode:e})}},{key:"updateParams",value:function(e,t){var i,a=_createForOfIteratorHelper(_classPrivateFieldGet(this,I));try{for(a.s();!(i=a.n()).done;)i.value.updateParams(e,t)}catch(o){a.e(o)}finally{a.f()}var n,r=_createForOfIteratorHelper(_classPrivateFieldGet(this,S));try{for(r.s();!(n=r.n()).done;)n.value.updateDefaultParams(e,t)}catch(o){r.e(o)}finally{r.f()}}},{key:"getEditors",value:function(e){var t,i=[],a=_createForOfIteratorHelper(_classPrivateFieldGet(this,v).values());try{for(a.s();!(t=a.n()).done;){var n=t.value;n.pageIndex===e&&i.push(n)}}catch(r){a.e(r)}finally{a.f()}return i}},{key:"getEditor",value:function(e){return _classPrivateFieldGet(this,v).get(e)}},{key:"addEditor",value:function(e){_classPrivateFieldGet(this,v).set(e.id,e)}},{key:"removeEditor",value:function(e){_classPrivateFieldGet(this,v).delete(e.id),this.unselect(e)}},{key:"setActiveEditor",value:function(e){_classPrivateFieldGet(this,g)!==e&&(_classPrivateFieldSet(this,g,e),e&&_classPrivateMethodGet(this,O,Q).call(this,e.propertiesToUpdate))}},{key:"toggleSelected",value:function(e){if(_classPrivateFieldGet(this,I).has(e))return _classPrivateFieldGet(this,I).delete(e),e.unselect(),void _classPrivateMethodGet(this,N,V).call(this,{hasSelectedEditor:this.hasSelection});_classPrivateFieldGet(this,I).add(e),e.select(),_classPrivateMethodGet(this,O,Q).call(this,e.propertiesToUpdate),_classPrivateMethodGet(this,N,V).call(this,{hasSelectedEditor:!0})}},{key:"setSelected",value:function(e){var t,i=_createForOfIteratorHelper(_classPrivateFieldGet(this,I));try{for(i.s();!(t=i.n()).done;){var a=t.value;a!==e&&a.unselect()}}catch(n){i.e(n)}finally{i.f()}_classPrivateFieldGet(this,I).clear(),_classPrivateFieldGet(this,I).add(e),e.select(),_classPrivateMethodGet(this,O,Q).call(this,e.propertiesToUpdate),_classPrivateMethodGet(this,N,V).call(this,{hasSelectedEditor:!0})}},{key:"isSelected",value:function(e){return _classPrivateFieldGet(this,I).has(e)}},{key:"unselect",value:function(e){e.unselect(),_classPrivateFieldGet(this,I).delete(e),_classPrivateMethodGet(this,N,V).call(this,{hasSelectedEditor:this.hasSelection})}},{key:"hasSelection",get:function(){return 0!==_classPrivateFieldGet(this,I).size}},{key:"undo",value:function(){_classPrivateFieldGet(this,x).undo(),_classPrivateMethodGet(this,N,V).call(this,{hasSomethingToUndo:_classPrivateFieldGet(this,x).hasSomethingToUndo(),hasSomethingToRedo:!0,isEmpty:_classPrivateMethodGet(this,q,K).call(this)})}},{key:"redo",value:function(){_classPrivateFieldGet(this,x).redo(),_classPrivateMethodGet(this,N,V).call(this,{hasSomethingToUndo:!0,hasSomethingToRedo:_classPrivateFieldGet(this,x).hasSomethingToRedo(),isEmpty:_classPrivateMethodGet(this,q,K).call(this)})}},{key:"addCommands",value:function(e){_classPrivateFieldGet(this,x).add(e),_classPrivateMethodGet(this,N,V).call(this,{hasSomethingToUndo:!0,hasSomethingToRedo:!1,isEmpty:_classPrivateMethodGet(this,q,K).call(this)})}},{key:"delete",value:function(){var e=this;if(_classPrivateFieldGet(this,g)&&_classPrivateFieldGet(this,g).commitOrRemove(),this.hasSelection){var t=_toConsumableArray(_classPrivateFieldGet(this,I));this.addCommands({cmd:function(){var e,i=_createForOfIteratorHelper(t);try{for(i.s();!(e=i.n()).done;)e.value.remove()}catch(a){i.e(a)}finally{i.f()}},undo:function(){var i,a=_createForOfIteratorHelper(t);try{for(a.s();!(i=a.n()).done;){var n=i.value;_classPrivateMethodGet(e,j,J).call(e,n)}}catch(r){a.e(r)}finally{a.f()}},mustExec:!0})}}},{key:"copy",value:function(){if(_classPrivateFieldGet(this,g)&&_classPrivateFieldGet(this,g).commitOrRemove(),this.hasSelection){var e,t=[],i=_createForOfIteratorHelper(_classPrivateFieldGet(this,I));try{for(i.s();!(e=i.n()).done;){var a=e.value;a.isEmpty()||t.push(a)}}catch(n){i.e(n)}finally{i.f()}if(0===t.length)return;_classPrivateFieldGet(this,A).copy(t),_classPrivateMethodGet(this,N,V).call(this,{hasEmptyClipboard:!1})}}},{key:"cut",value:function(){this.copy(),this.delete()}},{key:"paste",value:function(){var e=this;if(!_classPrivateFieldGet(this,A).isEmpty()){this.unselectAll();var t=_classPrivateFieldGet(this,_).get(_classPrivateFieldGet(this,w)),i=_classPrivateFieldGet(this,A).paste().map((function(e){return t.deserialize(e)}));this.addCommands({cmd:function(){var t,a=_createForOfIteratorHelper(i);try{for(a.s();!(t=a.n()).done;){var n=t.value;_classPrivateMethodGet(e,j,J).call(e,n)}}catch(r){a.e(r)}finally{a.f()}_classPrivateMethodGet(e,H,$).call(e,i)},undo:function(){var e,t=_createForOfIteratorHelper(i);try{for(t.s();!(e=t.n()).done;)e.value.remove()}catch(a){t.e(a)}finally{t.f()}},mustExec:!0})}}},{key:"selectAll",value:function(){var e,t=_createForOfIteratorHelper(_classPrivateFieldGet(this,I));try{for(t.s();!(e=t.n()).done;)e.value.commit()}catch(i){t.e(i)}finally{t.f()}_classPrivateMethodGet(this,H,$).call(this,_classPrivateFieldGet(this,v).values())}},{key:"unselectAll",value:function(){if(_classPrivateFieldGet(this,g))_classPrivateFieldGet(this,g).commitOrRemove();else if(0!==_classPrivateMethodGet(this,H,$).size){var 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Input must be a string or array.");i=(t=e.slice()).byteLength}for(var c=i>>2,d=i-4*c,u=new Uint32Array(t.buffer,0,c),p=0,m=0,h=this.h1,f=this.h2,y=3432918353,b=461845907,g=11601,v=13715,_=0;_<c;_++)1&_?h=5*(h=(h^=p=(p=(p=(p=u[_])*y&r|p*g&o)<<15|p>>>17)*b&r|p*v&o)<<13|h>>>19)+3864292196:f=5*(f=(f^=m=(m=(m=(m=u[_])*y&r|m*g&o)<<15|m>>>17)*b&r|m*v&o)<<13|f>>>19)+3864292196;switch(p=0,d){case 3:p^=t[4*c+2]<<16;case 2:p^=t[4*c+1]<<8;case 1:p=(p=(p=(p^=t[4*c])*y&r|p*g&o)<<15|p>>>17)*b&r|p*v&o,1&c?h^=p:f^=p}this.h1=h,this.h2=f}},{key:"hexdigest",value:function(){var e=this.h1,t=this.h2;e=3981806797*(e^=t>>>1)&r|36045*e&o,e=444984403*(e^=(t=4283543511*t&r|(2950163797*(t<<16|e>>>16)&r)>>>16)>>>1)&r|60499*e&o;var i=((e^=(t=3301882366*t&r|(3120437893*(t<<16|e>>>16)&r)>>>16)>>>1)>>>0).toString(16),a=(t>>>0).toString(16);return i.padStart(8,"0")+a.padStart(8,"0")}}]),e}();t.MurmurHash3_64=s},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.FontLoader=t.FontFaceObject=void 0;var a,n=i(1),r=function(){function e(t){var i=t.docId,a=t.onUnsupportedFeature,r=t.ownerDocument,o=void 0===r?globalThis.document:r;t.styleElement,_classCallCheck(this,e),this.constructor===e&&(0,n.unreachable)("Cannot initialize BaseFontLoader."),this.docId=i,this._onUnsupportedFeature=a,this._document=o,this.nativeFontFaces=[],this.styleElement=null}return _createClass(e,[{key:"addNativeFontFace",value:function(e){this.nativeFontFaces.push(e),this._document.fonts.add(e)}},{key:"insertRule",value:function(e){var t=this.styleElement;t||((t=this.styleElement=this._document.createElement("style")).id="PDFJS_FONT_STYLE_TAG_".concat(this.docId),this._document.documentElement.getElementsByTagName("head")[0].append(t));var i=t.sheet;i.insertRule(e,i.cssRules.length)}},{key:"clear",value:function(){var e,t=_createForOfIteratorHelper(this.nativeFontFaces);try{for(t.s();!(e=t.n()).done;){var i=e.value;this._document.fonts.delete(i)}}catch(a){t.e(a)}finally{t.f()}this.nativeFontFaces.length=0,this.styleElement&&(this.styleElement.remove(),this.styleElement=null)}},{key:"bind",value:function(){var e=_asyncToGenerator(_regeneratorRuntime().mark((function e(t){var i,a,r=this;return _regeneratorRuntime().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!t.attached&&!t.missingFile){e.next=2;break}return e.abrupt("return");case 2:if(t.attached=!0,!this.isFontLoadingAPISupported){e.next=19;break}if(!(i=t.createNativeFontFace())){e.next=18;break}return this.addNativeFontFace(i),e.prev=7,e.next=10,i.loaded;case 10:e.next=18;break;case 12:throw e.prev=12,e.t0=e.catch(7),this._onUnsupportedFeature({featureId:n.UNSUPPORTED_FEATURES.errorFontLoadNative}),(0,n.warn)("Failed to load font '".concat(i.family,"': '").concat(e.t0,"'.")),t.disableFontFace=!0,e.t0;case 18:return e.abrupt("return");case 19:if(!(a=t.createFontFaceRule())){e.next=26;break}if(this.insertRule(a),!this.isSyncFontLoadingSupported){e.next=24;break}return e.abrupt("return");case 24:return e.next=26,new Promise((function(e){var i=r._queueLoadingCallback(e);r._prepareFontLoadEvent([a],[t],i)}));case 26:case"end":return e.stop()}}),e,this,[[7,12]])})));return function(t){return e.apply(this,arguments)}}()},{key:"_queueLoadingCallback",value:function(e){(0,n.unreachable)("Abstract method `_queueLoadingCallback`.")}},{key:"isFontLoadingAPISupported",get:function(){var e,t=!(null===(e=this._document)||void 0===e||!e.fonts);return(0,n.shadow)(this,"isFontLoadingAPISupported",t)}},{key:"isSyncFontLoadingSupported",get:function(){(0,n.unreachable)("Abstract method `isSyncFontLoadingSupported`.")}},{key:"_loadTestFont",get:function(){(0,n.unreachable)("Abstract method `_loadTestFont`.")}},{key:"_prepareFontLoadEvent",value:function(e,t,i){(0,n.unreachable)("Abstract method `_prepareFontLoadEvent`.")}}]),e}();t.FontLoader=a,t.FontLoader=a=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a;return _classCallCheck(this,i),(a=t.call(this,e)).loadingContext={requests:[],nextRequestId:0},a.loadTestFontId=0,a}return _createClass(i,[{key:"isSyncFontLoadingSupported",get:function(){var e=!1;if("undefined"===typeof navigator)e=!0;else{var t=/Mozilla\/5.0.*?rv:(\d+).*? Gecko/.exec(navigator.userAgent);(null===t||void 0===t?void 0:t[1])>=14&&(e=!0)}return(0,n.shadow)(this,"isSyncFontLoadingSupported",e)}},{key:"_queueLoadingCallback",value:function(e){var t=this.loadingContext,i={id:"pdfjs-font-loading-".concat(t.nextRequestId++),done:!1,complete:function(){for((0,n.assert)(!i.done,"completeRequest() cannot be called twice."),i.done=!0;t.requests.length>0&&t.requests[0].done;){var e=t.requests.shift();setTimeout(e.callback,0)}},callback:e};return t.requests.push(i),i}},{key:"_loadTestFont",get:function(){return(0,n.shadow)(this,"_loadTestFont",atob("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"))}},{key:"_prepareFontLoadEvent",value:function(e,t,i){function a(e,t){return e.charCodeAt(t)<<24|e.charCodeAt(t+1)<<16|e.charCodeAt(t+2)<<8|255&e.charCodeAt(t+3)}function r(e,t,i,a){return e.substring(0,t)+a+e.substring(t+i)}var o,s,l=this._document.createElement("canvas");l.width=1,l.height=1;var c=l.getContext("2d"),d=0,u="lt".concat(Date.now()).concat(this.loadTestFontId++),p=this._loadTestFont,m=1482184792,h=a(p=r(p,976,u.length,u),16);for(o=0,s=u.length-3;o<s;o+=4)h=h-m+a(u,o)|0;o<u.length&&(h=h-m+a(u+"XXX",o)|0),p=r(p,16,4,(0,n.string32)(h));var f="url(data:font/opentype;base64,".concat(btoa(p),");"),y='@font-face {font-family:"'.concat(u,'";src:').concat(f,"}");this.insertRule(y);var b,g=[],v=_createForOfIteratorHelper(t);try{for(v.s();!(b=v.n()).done;){var _=b.value;g.push(_.loadedName)}}catch(k){v.e(k)}finally{v.f()}g.push(u);var A=this._document.createElement("div");A.style.visibility="hidden",A.style.width=A.style.height="10px",A.style.position="absolute",A.style.top=A.style.left="0px";for(var x=0,w=g;x<w.length;x++){var S=w[x],C=this._document.createElement("span");C.textContent="Hi",C.style.fontFamily=S,A.append(C)}this._document.body.append(A),function e(t,i){if(++d>30)return(0,n.warn)("Load test font never loaded."),void i();c.font="30px "+t,c.fillText(".",0,20),c.getImageData(0,0,1,1).data[3]>0?i():setTimeout(e.bind(null,t,i))}(u,(function(){A.remove(),i.complete()}))}}]),i}(r);var o=function(){function e(t,i){var a=i.isEvalSupported,n=void 0===a||a,r=i.disableFontFace,o=void 0!==r&&r,s=i.ignoreErrors,l=void 0!==s&&s,c=i.onUnsupportedFeature,d=i.fontRegistry,u=void 0===d?null:d;for(var p in _classCallCheck(this,e),this.compiledGlyphs=Object.create(null),t)this[p]=t[p];this.isEvalSupported=!1!==n,this.disableFontFace=!0===o,this.ignoreErrors=!0===l,this._onUnsupportedFeature=c,this.fontRegistry=u}return _createClass(e,[{key:"createNativeFontFace",value:function(){if(!this.data||this.disableFontFace)return null;var e;if(this.cssFontInfo){var t={weight:this.cssFontInfo.fontWeight};this.cssFontInfo.italicAngle&&(t.style="oblique ".concat(this.cssFontInfo.italicAngle,"deg")),e=new FontFace(this.cssFontInfo.fontFamily,this.data,t)}else e=new FontFace(this.loadedName,this.data,{});return this.fontRegistry&&this.fontRegistry.registerFont(this),e}},{key:"createFontFaceRule",value:function(){if(!this.data||this.disableFontFace)return null;var e,t=(0,n.bytesToString)(this.data),i="url(data:".concat(this.mimetype,";base64,").concat(btoa(t),");");if(this.cssFontInfo){var a="font-weight: ".concat(this.cssFontInfo.fontWeight,";");this.cssFontInfo.italicAngle&&(a+="font-style: oblique ".concat(this.cssFontInfo.italicAngle,"deg;")),e='@font-face {font-family:"'.concat(this.cssFontInfo.fontFamily,'";').concat(a,"src:").concat(i,"}")}else e='@font-face {font-family:"'.concat(this.loadedName,'";src:').concat(i,"}");return this.fontRegistry&&this.fontRegistry.registerFont(this,i),e}},{key:"getPathGenerator",value:function(e,t){if(void 0!==this.compiledGlyphs[t])return this.compiledGlyphs[t];var i;try{i=e.get(this.loadedName+"_path_"+t)}catch(c){if(!this.ignoreErrors)throw c;return this._onUnsupportedFeature({featureId:n.UNSUPPORTED_FEATURES.errorFontGetPath}),(0,n.warn)('getPathGenerator - ignoring character: "'.concat(c,'".')),this.compiledGlyphs[t]=function(e,t){}}if(this.isEvalSupported&&n.FeatureTest.isEvalSupported){var a,r=[],o=_createForOfIteratorHelper(i);try{for(o.s();!(a=o.n()).done;){var s=a.value,l=void 0!==s.args?s.args.join(","):"";r.push("c.",s.cmd,"(",l,");\n")}}catch(d){o.e(d)}finally{o.f()}return this.compiledGlyphs[t]=new Function("c","size",r.join(""))}return this.compiledGlyphs[t]=function(e,t){var a,n=_createForOfIteratorHelper(i);try{for(n.s();!(a=n.n()).done;){var r=a.value;"scale"===r.cmd&&(r.args=[t,-t]),e[r.cmd].apply(e,r.args)}}catch(d){n.e(d)}finally{n.f()}}}}]),e}();t.FontFaceObject=o},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.CanvasGraphics=void 0;var a=i(8),n=i(1),r=i(13),o=i(14),s=i(3),l=4096,c=s.isNodeJS&&"undefined"===typeof Path2D?-1:1e3,d=16,u=function(){function e(t){_classCallCheck(this,e),this.canvasFactory=t,this.cache=Object.create(null)}return _createClass(e,[{key:"getCanvas",value:function(e,t,i){var a;return void 0!==this.cache[e]?(a=this.cache[e],this.canvasFactory.reset(a,t,i)):(a=this.canvasFactory.create(t,i),this.cache[e]=a),a}},{key:"delete",value:function(e){delete this.cache[e]}},{key:"clear",value:function(){for(var e in this.cache){var t=this.cache[e];this.canvasFactory.destroy(t),delete this.cache[e]}}}]),e}();function p(e,t,i,n,r,o,s,l,c,d){var u=(0,a.getCurrentTransform)(e),p=_slicedToArray(u,6),m=p[0],h=p[1],f=p[2],y=p[3],b=p[4],g=p[5];if(0===h&&0===f){var v=s*m+b,_=Math.round(v),A=l*y+g,x=Math.round(A),w=(s+c)*m+b,S=Math.abs(Math.round(w)-_)||1,C=(l+d)*y+g,k=Math.abs(Math.round(C)-x)||1;return e.setTransform(Math.sign(m),0,0,Math.sign(y),_,x),e.drawImage(t,i,n,r,o,0,0,S,k),e.setTransform(m,h,f,y,b,g),[S,k]}if(0===m&&0===y){var D=l*f+b,R=Math.round(D),I=s*h+g,M=Math.round(I),T=(l+d)*f+b,P=Math.abs(Math.round(T)-R)||1,z=(s+c)*h+g,B=Math.abs(Math.round(z)-M)||1;return e.setTransform(0,Math.sign(h),Math.sign(f),0,R,M),e.drawImage(t,i,n,r,o,0,0,B,P),e.setTransform(m,h,f,y,b,g),[B,P]}return e.drawImage(t,i,n,r,o,s,l,c,d),[Math.hypot(m,h)*c,Math.hypot(f,y)*d]}var m=function(){function e(t,i){_classCallCheck(this,e),this.alphaIsShape=!1,this.fontSize=0,this.fontSizeScale=1,this.textMatrix=n.IDENTITY_MATRIX,this.textMatrixScale=1,this.fontMatrix=n.FONT_IDENTITY_MATRIX,this.leading=0,this.x=0,this.y=0,this.lineX=0,this.lineY=0,this.charSpacing=0,this.wordSpacing=0,this.textHScale=1,this.textRenderingMode=n.TextRenderingMode.FILL,this.textRise=0,this.fillColor="#000000",this.strokeColor="#000000",this.patternFill=!1,this.fillAlpha=1,this.strokeAlpha=1,this.lineWidth=1,this.activeSMask=null,this.transferMaps=null,this.startNewPathAndClipBox([0,0,t,i])}return _createClass(e,[{key:"clone",value:function(){var e=Object.create(this);return e.clipBox=this.clipBox.slice(),e}},{key:"setCurrentPoint",value:function(e,t){this.x=e,this.y=t}},{key:"updatePathMinMax",value:function(e,t,i){var a=n.Util.applyTransform([t,i],e),r=_slicedToArray(a,2);t=r[0],i=r[1],this.minX=Math.min(this.minX,t),this.minY=Math.min(this.minY,i),this.maxX=Math.max(this.maxX,t),this.maxY=Math.max(this.maxY,i)}},{key:"updateRectMinMax",value:function(e,t){var i=n.Util.applyTransform(t,e),a=n.Util.applyTransform(t.slice(2),e);this.minX=Math.min(this.minX,i[0],a[0]),this.minY=Math.min(this.minY,i[1],a[1]),this.maxX=Math.max(this.maxX,i[0],a[0]),this.maxY=Math.max(this.maxY,i[1],a[1])}},{key:"updateScalingPathMinMax",value:function(e,t){n.Util.scaleMinMax(e,t),this.minX=Math.min(this.minX,t[0]),this.maxX=Math.max(this.maxX,t[1]),this.minY=Math.min(this.minY,t[2]),this.maxY=Math.max(this.maxY,t[3])}},{key:"updateCurvePathMinMax",value:function(e,t,i,a,r,o,s,l,c,d){var u=n.Util.bezierBoundingBox(t,i,a,r,o,s,l,c);if(d)return d[0]=Math.min(d[0],u[0],u[2]),d[1]=Math.max(d[1],u[0],u[2]),d[2]=Math.min(d[2],u[1],u[3]),void(d[3]=Math.max(d[3],u[1],u[3]));this.updateRectMinMax(e,u)}},{key:"getPathBoundingBox",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:r.PathType.FILL,t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null,i=[this.minX,this.minY,this.maxX,this.maxY];if(e===r.PathType.STROKE){t||(0,n.unreachable)("Stroke bounding box must include transform.");var a=n.Util.singularValueDecompose2dScale(t),o=a[0]*this.lineWidth/2,s=a[1]*this.lineWidth/2;i[0]-=o,i[1]-=s,i[2]+=o,i[3]+=s}return i}},{key:"updateClipFromPath",value:function(){var e=n.Util.intersect(this.clipBox,this.getPathBoundingBox());this.startNewPathAndClipBox(e||[0,0,0,0])}},{key:"isEmptyClip",value:function(){return this.minX===1/0}},{key:"startNewPathAndClipBox",value:function(e){this.clipBox=e,this.minX=1/0,this.minY=1/0,this.maxX=0,this.maxY=0}},{key:"getClippedPathBoundingBox",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:r.PathType.FILL,t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;return n.Util.intersect(this.clipBox,this.getPathBoundingBox(e,t))}}]),e}();function h(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null;if("undefined"!==typeof ImageData&&t instanceof ImageData)e.putImageData(t,0,0);else{var a,r,o,s,l,c,u,p,m,h=t.height,f=t.width,y=h%d,b=(h-y)/d,g=0===y?b:b+1,v=e.createImageData(f,d),_=0,A=t.data,x=v.data;if(i)switch(i.length){case 1:c=i[0],u=i[0],p=i[0],m=i[0];break;case 4:c=i[0],u=i[1],p=i[2],m=i[3]}if(t.kind===n.ImageKind.GRAYSCALE_1BPP){var w=A.byteLength,S=new Uint32Array(x.buffer,0,x.byteLength>>2),C=S.length,k=f+7>>3,D=4294967295,R=n.FeatureTest.isLittleEndian?4278190080:255;if(m&&255===m[0]&&0===m[255]){var I=[R,D];D=I[0],R=I[1]}for(r=0;r<g;r++){for(s=r<b?d:y,a=0,o=0;o<s;o++){for(var M=w-_,T=0,P=M>k?f:8*M-7,z=-8&P,B=0,F=0;T<z;T+=8)F=A[_++],S[a++]=128&F?D:R,S[a++]=64&F?D:R,S[a++]=32&F?D:R,S[a++]=16&F?D:R,S[a++]=8&F?D:R,S[a++]=4&F?D:R,S[a++]=2&F?D:R,S[a++]=1&F?D:R;for(;T<P;T++)0===B&&(F=A[_++],B=128),S[a++]=F&B?D:R,B>>=1}for(;a<C;)S[a++]=0;e.putImageData(v,0,r*d)}}else if(t.kind===n.ImageKind.RGBA_32BPP){var E=!!(c||u||p);for(o=0,l=f*d*4,r=0;r<b;r++){if(x.set(A.subarray(_,_+l)),_+=l,E)for(var N=0;N<l;N+=4)c&&(x[N+0]=c[x[N+0]]),u&&(x[N+1]=u[x[N+1]]),p&&(x[N+2]=p[x[N+2]]);e.putImageData(v,0,o),o+=d}if(r<g){if(l=f*y*4,x.set(A.subarray(_,_+l)),E)for(var O=0;O<l;O+=4)c&&(x[O+0]=c[x[O+0]]),u&&(x[O+1]=u[x[O+1]]),p&&(x[O+2]=p[x[O+2]]);e.putImageData(v,0,o)}}else{if(t.kind!==n.ImageKind.RGB_24BPP)throw new Error("bad image kind: ".concat(t.kind));var G=!!(c||u||p);for(l=f*(s=d),r=0;r<g;r++){for(r>=b&&(l=f*(s=y)),a=0,o=l;o--;)x[a++]=A[_++],x[a++]=A[_++],x[a++]=A[_++],x[a++]=255;if(G)for(var L=0;L<a;L+=4)c&&(x[L+0]=c[x[L+0]]),u&&(x[L+1]=u[x[L+1]]),p&&(x[L+2]=p[x[L+2]]);e.putImageData(v,0,r*d)}}}}function f(e,t){if(t.bitmap)e.drawImage(t.bitmap,0,0);else for(var i=t.height,a=t.width,n=i%d,r=(i-n)/d,s=0===n?r:r+1,l=e.createImageData(a,d),c=0,u=t.data,p=l.data,m=0;m<s;m++){var h=m<r?d:n;c=(0,o.applyMaskImageData)({src:u,srcPos:c,dest:p,width:a,height:h}).srcPos,e.putImageData(l,0,m*d)}}function y(e,t){for(var i=["strokeStyle","fillStyle","fillRule","globalAlpha","lineWidth","lineCap","lineJoin","miterLimit","globalCompositeOperation","font"],a=0,n=i.length;a<n;a++){var r=i[a];void 0!==e[r]&&(t[r]=e[r])}void 0!==e.setLineDash&&(t.setLineDash(e.getLineDash()),t.lineDashOffset=e.lineDashOffset)}function b(e,t){e.strokeStyle=e.fillStyle=t||"#000000",e.fillRule="nonzero",e.globalAlpha=1,e.lineWidth=1,e.lineCap="butt",e.lineJoin="miter",e.miterLimit=10,e.globalCompositeOperation="source-over",e.font="10px sans-serif",void 0!==e.setLineDash&&(e.setLineDash([]),e.lineDashOffset=0)}function g(e,t,i,a){for(var n=e.length,r=3;r<n;r+=4){var o=e[r];if(0===o)e[r-3]=t,e[r-2]=i,e[r-1]=a;else if(o<255){var s=255-o;e[r-3]=e[r-3]*o+t*s>>8,e[r-2]=e[r-2]*o+i*s>>8,e[r-1]=e[r-1]*o+a*s>>8}}}function v(e,t,i){for(var a=e.length,n=3;n<a;n+=4){var r=i?i[e[n]]:e[n];t[n]=t[n]*r*.00392156862745098|0}}function _(e,t,i){for(var a=e.length,n=3;n<a;n+=4){var r=77*e[n-3]+152*e[n-2]+28*e[n-1];t[n]=i?t[n]*i[r>>8]>>8:t[n]*r>>16}}function A(e,t,i,a){var n=a[0],r=a[1],o=a[2]-n,s=a[3]-r;0!==o&&0!==s&&(function(e,t,i,a,n,r,o,s,l,c,d){var u,p=!!r,m=p?r[0]:0,h=p?r[1]:0,f=p?r[2]:0;u="Luminosity"===n?_:v;for(var y=Math.min(a,Math.ceil(1048576/i)),b=0;b<a;b+=y){var A=Math.min(y,a-b),x=e.getImageData(s-c,b+(l-d),i,A),w=t.getImageData(s,b+l,i,A);p&&g(x.data,m,h,f),u(x.data,w.data,o),t.putImageData(w,s,b+l)}}(t.context,i,o,s,t.subtype,t.backdrop,t.transferMap,n,r,t.offsetX,t.offsetY),e.save(),e.globalAlpha=1,e.globalCompositeOperation="source-over",e.setTransform(1,0,0,1,0,0),e.drawImage(i.canvas,0,0),e.restore())}function x(e,t){var i=n.Util.singularValueDecompose2dScale(e);i[0]=Math.fround(i[0]),i[1]=Math.fround(i[1]);var r=Math.fround((globalThis.devicePixelRatio||1)*a.PixelsPerInch.PDF_TO_CSS_UNITS);return void 0!==t?t:i[0]<=r||i[1]<=r}var w=["butt","round","square"],S=["miter","round","bevel"],C={},k={},D=new WeakSet,R=function(){function e(t,i,a,n,r,o,s,l){_classCallCheck(this,e),_classPrivateMethodInitSpec(this,D),this.ctx=t,this.current=new m(this.ctx.canvas.width,this.ctx.canvas.height),this.stateStack=[],this.pendingClip=null,this.pendingEOFill=!1,this.res=null,this.xobjs=null,this.commonObjs=i,this.objs=a,this.canvasFactory=n,this.imageLayer=r,this.groupStack=[],this.processingType3=null,this.baseTransform=null,this.baseTransformStack=[],this.groupLevel=0,this.smaskStack=[],this.smaskCounter=0,this.tempSMask=null,this.suspendedCtx=null,this.contentVisible=!0,this.markedContentStack=[],this.optionalContentConfig=o,this.cachedCanvases=new u(this.canvasFactory),this.cachedPatterns=new Map,this.annotationCanvasMap=s,this.viewportScale=1,this.outputScaleX=1,this.outputScaleY=1,this.backgroundColor=(null===l||void 0===l?void 0:l.background)||null,this.foregroundColor=(null===l||void 0===l?void 0:l.foreground)||null,this._cachedScaleForStroking=null,this._cachedGetSinglePixelWidth=null,this._cachedBitmapsMap=new Map}return _createClass(e,[{key:"getObject",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;return"string"===typeof e?e.startsWith("g_")?this.commonObjs.get(e):this.objs.get(e):t}},{key:"beginDrawing",value:function(e){var t,i,n=e.transform,r=e.viewport,o=e.transparency,s=void 0!==o&&o,l=e.background,c=void 0===l?null:l,d=this.ctx.canvas.width,u=this.ctx.canvas.height,p=c||"#ffffff";if(this.ctx.save(),this.foregroundColor&&this.backgroundColor){this.ctx.fillStyle=this.foregroundColor;var m=this.foregroundColor=this.ctx.fillStyle;this.ctx.fillStyle=this.backgroundColor;var h,f,y=this.backgroundColor=this.ctx.fillStyle;if(this.ctx.fillStyle=p,h="string"===typeof(f=this.ctx.fillStyle)&&/^#[0-9A-Fa-f]{6}$/.test(f),"#000000"===m&&"#ffffff"===y||m===y||!h)this.foregroundColor=this.backgroundColor=null;else{var g=(0,a.getRGB)(f),v=_slicedToArray(g,3),_=v[0],A=v[1],x=v[2],w=function(e){return(e/=255)<=.03928?e/12.92:Math.pow((e+.055)/1.055,2.4)},S=Math.round(.2126*w(_)+.7152*w(A)+.0722*w(x));this.selectColor=function(e,t,i){var a=.2126*w(e)+.7152*w(t)+.0722*w(i);return Math.round(a)===S?y:m}}}if(this.ctx.fillStyle=this.backgroundColor||p,this.ctx.fillRect(0,0,d,u),this.ctx.restore(),s){var C,k=this.cachedCanvases.getCanvas("transparent",d,u);this.compositeCtx=this.ctx,this.transparentCanvas=k.canvas,this.ctx=k.context,this.ctx.save(),(C=this.ctx).transform.apply(C,_toConsumableArray((0,a.getCurrentTransform)(this.compositeCtx)))}this.ctx.save(),b(this.ctx,this.foregroundColor),n&&((i=this.ctx).transform.apply(i,_toConsumableArray(n)),this.outputScaleX=n[0],this.outputScaleY=n[0]),(t=this.ctx).transform.apply(t,_toConsumableArray(r.transform)),this.viewportScale=r.scale,this.baseTransform=(0,a.getCurrentTransform)(this.ctx),this.imageLayer&&((0,a.deprecated)("The `imageLayer` functionality will be removed in the future."),this.imageLayer.beginLayout())}},{key:"executeOperatorList",value:function(e,t,i,a){var r=e.argsArray,o=e.fnArray,s=t||0,l=r.length;if(l===s)return s;for(var c,d=l-s>10&&"function"===typeof i,u=d?Date.now()+15:0,p=0,m=this.commonObjs,h=this.objs;;){if(void 0!==a&&s===a.nextBreakPoint)return a.breakIt(s,i),s;if((c=o[s])!==n.OPS.dependency)this[c].apply(this,r[s]);else{var f,y=_createForOfIteratorHelper(r[s]);try{for(y.s();!(f=y.n()).done;){var b=f.value,g=b.startsWith("g_")?m:h;if(!g.has(b))return g.get(b,i),s}}catch(v){y.e(v)}finally{y.f()}}if(++s===l)return s;if(d&&++p>10){if(Date.now()>u)return i(),s;p=0}}}},{key:"endDrawing",value:function(){_classPrivateMethodGet(this,D,I).call(this),this.cachedCanvases.clear(),this.cachedPatterns.clear();var e,t=_createForOfIteratorHelper(this._cachedBitmapsMap.values());try{for(t.s();!(e=t.n()).done;){var i,a=e.value,n=_createForOfIteratorHelper(a.values());try{for(n.s();!(i=n.n()).done;){var r=i.value;"undefined"!==typeof HTMLCanvasElement&&r instanceof HTMLCanvasElement&&(r.width=r.height=0)}}catch(o){n.e(o)}finally{n.f()}a.clear()}}catch(o){t.e(o)}finally{t.f()}this._cachedBitmapsMap.clear(),this.imageLayer&&this.imageLayer.endLayout()}},{key:"_scaleImage",value:function(e,t){for(var i,a,n=e.width,r=e.height,o=Math.max(Math.hypot(t[0],t[1]),1),s=Math.max(Math.hypot(t[2],t[3]),1),l=n,c=r,d="prescale1";o>2&&l>1||s>2&&c>1;){var u=l,p=c;o>2&&l>1&&(o/=l/(u=Math.ceil(l/2))),s>2&&c>1&&(s/=c/(p=Math.ceil(c/2))),(a=(i=this.cachedCanvases.getCanvas(d,u,p)).context).clearRect(0,0,u,p),a.drawImage(e,0,0,l,c,0,0,u,p),e=i.canvas,l=u,c=p,d="prescale1"===d?"prescale2":"prescale1"}return{img:e,paintWidth:l,paintHeight:c}}},{key:"_createMaskCanvas",value:function(e){var t,i,o,s,l=this.ctx,c=e.width,d=e.height,u=this.current.fillColor,m=this.current.patternFill,h=(0,a.getCurrentTransform)(l);if((e.bitmap||e.data)&&e.count>1){var y=e.bitmap||e.data.buffer,b=h.slice(0,4);i=JSON.stringify(m?b:[b,u]),(t=this._cachedBitmapsMap.get(y))||(t=new Map,this._cachedBitmapsMap.set(y,t));var g=t.get(i);if(g&&!m)return{canvas:g,offsetX:Math.round(Math.min(h[0],h[2])+h[4]),offsetY:Math.round(Math.min(h[1],h[3])+h[5])};o=g}o||f((s=this.cachedCanvases.getCanvas("maskCanvas",c,d)).context,e);var v=n.Util.transform(h,[1/c,0,0,-1/d,0,0]);v=n.Util.transform(v,[1,0,0,1,0,-d]);var _=n.Util.applyTransform([0,0],v),A=n.Util.applyTransform([c,d],v),w=n.Util.normalizeRect([_[0],_[1],A[0],A[1]]),S=Math.round(w[2]-w[0])||1,C=Math.round(w[3]-w[1])||1,k=this.cachedCanvases.getCanvas("fillCanvas",S,C),D=k.context,R=Math.min(_[0],A[0]),I=Math.min(_[1],A[1]);D.translate(-R,-I),D.transform.apply(D,_toConsumableArray(v)),o||(o=(o=this._scaleImage(s.canvas,(0,a.getCurrentTransformInverse)(D))).img,t&&m&&t.set(i,o)),D.imageSmoothingEnabled=x((0,a.getCurrentTransform)(D),e.interpolate),p(D,o,0,0,o.width,o.height,0,0,c,d),D.globalCompositeOperation="source-in";var M=n.Util.transform((0,a.getCurrentTransformInverse)(D),[1,0,0,1,-R,-I]);return D.fillStyle=m?u.getPattern(l,this,M,r.PathType.FILL):u,D.fillRect(0,0,c,d),t&&!m&&(this.cachedCanvases.delete("fillCanvas"),t.set(i,k.canvas)),{canvas:k.canvas,offsetX:Math.round(R),offsetY:Math.round(I)}}},{key:"setLineWidth",value:function(e){e!==this.current.lineWidth&&(this._cachedScaleForStroking=null),this.current.lineWidth=e,this.ctx.lineWidth=e}},{key:"setLineCap",value:function(e){this.ctx.lineCap=w[e]}},{key:"setLineJoin",value:function(e){this.ctx.lineJoin=S[e]}},{key:"setMiterLimit",value:function(e){this.ctx.miterLimit=e}},{key:"setDash",value:function(e,t){var i=this.ctx;void 0!==i.setLineDash&&(i.setLineDash(e),i.lineDashOffset=t)}},{key:"setRenderingIntent",value:function(e){}},{key:"setFlatness",value:function(e){}},{key:"setGState",value:function(e){for(var t=0,i=e.length;t<i;t++){var a=e[t],n=a[0],r=a[1];switch(n){case"LW":this.setLineWidth(r);break;case"LC":this.setLineCap(r);break;case"LJ":this.setLineJoin(r);break;case"ML":this.setMiterLimit(r);break;case"D":this.setDash(r[0],r[1]);break;case"RI":this.setRenderingIntent(r);break;case"FL":this.setFlatness(r);break;case"Font":this.setFont(r[0],r[1]);break;case"CA":this.current.strokeAlpha=a[1];break;case"ca":this.current.fillAlpha=a[1],this.ctx.globalAlpha=a[1];break;case"BM":this.ctx.globalCompositeOperation=r;break;case"SMask":this.current.activeSMask=r?this.tempSMask:null,this.tempSMask=null,this.checkSMaskState();break;case"TR":this.current.transferMaps=r}}}},{key:"inSMaskMode",get:function(){return!!this.suspendedCtx}},{key:"checkSMaskState",value:function(){var e=this.inSMaskMode;this.current.activeSMask&&!e?this.beginSMaskMode():!this.current.activeSMask&&e&&this.endSMaskMode()}},{key:"beginSMaskMode",value:function(){if(this.inSMaskMode)throw new Error("beginSMaskMode called while already in smask mode");var e=this.ctx.canvas.width,t=this.ctx.canvas.height,i="smaskGroupAt"+this.groupLevel,n=this.cachedCanvases.getCanvas(i,e,t);this.suspendedCtx=this.ctx,this.ctx=n.context;var r=this.ctx;r.setTransform.apply(r,_toConsumableArray((0,a.getCurrentTransform)(this.suspendedCtx))),y(this.suspendedCtx,r),function(e,t){if(e._removeMirroring)throw new Error("Context is already forwarding operations.");e.__originalSave=e.save,e.__originalRestore=e.restore,e.__originalRotate=e.rotate,e.__originalScale=e.scale,e.__originalTranslate=e.translate,e.__originalTransform=e.transform,e.__originalSetTransform=e.setTransform,e.__originalResetTransform=e.resetTransform,e.__originalClip=e.clip,e.__originalMoveTo=e.moveTo,e.__originalLineTo=e.lineTo,e.__originalBezierCurveTo=e.bezierCurveTo,e.__originalRect=e.rect,e.__originalClosePath=e.closePath,e.__originalBeginPath=e.beginPath,e._removeMirroring=function(){e.save=e.__originalSave,e.restore=e.__originalRestore,e.rotate=e.__originalRotate,e.scale=e.__originalScale,e.translate=e.__originalTranslate,e.transform=e.__originalTransform,e.setTransform=e.__originalSetTransform,e.resetTransform=e.__originalResetTransform,e.clip=e.__originalClip,e.moveTo=e.__originalMoveTo,e.lineTo=e.__originalLineTo,e.bezierCurveTo=e.__originalBezierCurveTo,e.rect=e.__originalRect,e.closePath=e.__originalClosePath,e.beginPath=e.__originalBeginPath,delete e._removeMirroring},e.save=function(){t.save(),this.__originalSave()},e.restore=function(){t.restore(),this.__originalRestore()},e.translate=function(e,i){t.translate(e,i),this.__originalTranslate(e,i)},e.scale=function(e,i){t.scale(e,i),this.__originalScale(e,i)},e.transform=function(e,i,a,n,r,o){t.transform(e,i,a,n,r,o),this.__originalTransform(e,i,a,n,r,o)},e.setTransform=function(e,i,a,n,r,o){t.setTransform(e,i,a,n,r,o),this.__originalSetTransform(e,i,a,n,r,o)},e.resetTransform=function(){t.resetTransform(),this.__originalResetTransform()},e.rotate=function(e){t.rotate(e),this.__originalRotate(e)},e.clip=function(e){t.clip(e),this.__originalClip(e)},e.moveTo=function(e,i){t.moveTo(e,i),this.__originalMoveTo(e,i)},e.lineTo=function(e,i){t.lineTo(e,i),this.__originalLineTo(e,i)},e.bezierCurveTo=function(e,i,a,n,r,o){t.bezierCurveTo(e,i,a,n,r,o),this.__originalBezierCurveTo(e,i,a,n,r,o)},e.rect=function(e,i,a,n){t.rect(e,i,a,n),this.__originalRect(e,i,a,n)},e.closePath=function(){t.closePath(),this.__originalClosePath()},e.beginPath=function(){t.beginPath(),this.__originalBeginPath()}}(r,this.suspendedCtx),this.setGState([["BM","source-over"],["ca",1],["CA",1]])}},{key:"endSMaskMode",value:function(){if(!this.inSMaskMode)throw new Error("endSMaskMode called while not in smask mode");this.ctx._removeMirroring(),y(this.ctx,this.suspendedCtx),this.ctx=this.suspendedCtx,this.suspendedCtx=null}},{key:"compose",value:function(e){if(this.current.activeSMask){e?(e[0]=Math.floor(e[0]),e[1]=Math.floor(e[1]),e[2]=Math.ceil(e[2]),e[3]=Math.ceil(e[3])):e=[0,0,this.ctx.canvas.width,this.ctx.canvas.height];var t=this.current.activeSMask;A(this.suspendedCtx,t,this.ctx,e),this.ctx.save(),this.ctx.setTransform(1,0,0,1,0,0),this.ctx.clearRect(0,0,this.ctx.canvas.width,this.ctx.canvas.height),this.ctx.restore()}}},{key:"save",value:function(){this.inSMaskMode?(y(this.ctx,this.suspendedCtx),this.suspendedCtx.save()):this.ctx.save();var e=this.current;this.stateStack.push(e),this.current=e.clone()}},{key:"restore",value:function(){0===this.stateStack.length&&this.inSMaskMode&&this.endSMaskMode(),0!==this.stateStack.length&&(this.current=this.stateStack.pop(),this.inSMaskMode?(this.suspendedCtx.restore(),y(this.suspendedCtx,this.ctx)):this.ctx.restore(),this.checkSMaskState(),this.pendingClip=null,this._cachedScaleForStroking=null,this._cachedGetSinglePixelWidth=null)}},{key:"transform",value:function(e,t,i,a,n,r){this.ctx.transform(e,t,i,a,n,r),this._cachedScaleForStroking=null,this._cachedGetSinglePixelWidth=null}},{key:"constructPath",value:function(e,t,i){for(var r,o,s=this.ctx,l=this.current,c=l.x,d=l.y,u=(0,a.getCurrentTransform)(s),p=0===u[0]&&0===u[3]||0===u[1]&&0===u[2],m=p?i.slice(0):null,h=0,f=0,y=e.length;h<y;h++)switch(0|e[h]){case n.OPS.rectangle:c=t[f++],d=t[f++];var b=t[f++],g=t[f++],v=c+b,_=d+g;s.moveTo(c,d),0===b||0===g?s.lineTo(v,_):(s.lineTo(v,d),s.lineTo(v,_),s.lineTo(c,_)),p||l.updateRectMinMax(u,[c,d,v,_]),s.closePath();break;case n.OPS.moveTo:c=t[f++],d=t[f++],s.moveTo(c,d),p||l.updatePathMinMax(u,c,d);break;case n.OPS.lineTo:c=t[f++],d=t[f++],s.lineTo(c,d),p||l.updatePathMinMax(u,c,d);break;case n.OPS.curveTo:r=c,o=d,c=t[f+4],d=t[f+5],s.bezierCurveTo(t[f],t[f+1],t[f+2],t[f+3],c,d),l.updateCurvePathMinMax(u,r,o,t[f],t[f+1],t[f+2],t[f+3],c,d,m),f+=6;break;case n.OPS.curveTo2:r=c,o=d,s.bezierCurveTo(c,d,t[f],t[f+1],t[f+2],t[f+3]),l.updateCurvePathMinMax(u,r,o,c,d,t[f],t[f+1],t[f+2],t[f+3],m),c=t[f+2],d=t[f+3],f+=4;break;case n.OPS.curveTo3:r=c,o=d,c=t[f+2],d=t[f+3],s.bezierCurveTo(t[f],t[f+1],c,d,c,d),l.updateCurvePathMinMax(u,r,o,t[f],t[f+1],c,d,c,d,m),f+=4;break;case n.OPS.closePath:s.closePath()}p&&l.updateScalingPathMinMax(u,m),l.setCurrentPoint(c,d)}},{key:"closePath",value:function(){this.ctx.closePath()}},{key:"stroke",value:function(e){e="undefined"===typeof e||e;var t=this.ctx,i=this.current.strokeColor;t.globalAlpha=this.current.strokeAlpha,this.contentVisible&&("object"===typeof i&&null!==i&&void 0!==i&&i.getPattern?(t.save(),t.strokeStyle=i.getPattern(t,this,(0,a.getCurrentTransformInverse)(t),r.PathType.STROKE),this.rescaleAndStroke(!1),t.restore()):this.rescaleAndStroke(!0)),e&&this.consumePath(this.current.getClippedPathBoundingBox()),t.globalAlpha=this.current.fillAlpha}},{key:"closeStroke",value:function(){this.closePath(),this.stroke()}},{key:"fill",value:function(e){e="undefined"===typeof e||e;var t=this.ctx,i=this.current.fillColor,n=!1;this.current.patternFill&&(t.save(),t.fillStyle=i.getPattern(t,this,(0,a.getCurrentTransformInverse)(t),r.PathType.FILL),n=!0);var o=this.current.getClippedPathBoundingBox();this.contentVisible&&null!==o&&(this.pendingEOFill?(t.fill("evenodd"),this.pendingEOFill=!1):t.fill()),n&&t.restore(),e&&this.consumePath(o)}},{key:"eoFill",value:function(){this.pendingEOFill=!0,this.fill()}},{key:"fillStroke",value:function(){this.fill(!1),this.stroke(!1),this.consumePath()}},{key:"eoFillStroke",value:function(){this.pendingEOFill=!0,this.fillStroke()}},{key:"closeFillStroke",value:function(){this.closePath(),this.fillStroke()}},{key:"closeEOFillStroke",value:function(){this.pendingEOFill=!0,this.closePath(),this.fillStroke()}},{key:"endPath",value:function(){this.consumePath()}},{key:"clip",value:function(){this.pendingClip=C}},{key:"eoClip",value:function(){this.pendingClip=k}},{key:"beginText",value:function(){this.current.textMatrix=n.IDENTITY_MATRIX,this.current.textMatrixScale=1,this.current.x=this.current.lineX=0,this.current.y=this.current.lineY=0}},{key:"endText",value:function(){var e=this.pendingTextPaths,t=this.ctx;if(void 0!==e){t.save(),t.beginPath();var i,a=_createForOfIteratorHelper(e);try{for(a.s();!(i=a.n()).done;){var n=i.value;t.setTransform.apply(t,_toConsumableArray(n.transform)),t.translate(n.x,n.y),n.addToPath(t,n.fontSize)}}catch(r){a.e(r)}finally{a.f()}t.restore(),t.clip(),t.beginPath(),delete this.pendingTextPaths}else t.beginPath()}},{key:"setCharSpacing",value:function(e){this.current.charSpacing=e}},{key:"setWordSpacing",value:function(e){this.current.wordSpacing=e}},{key:"setHScale",value:function(e){this.current.textHScale=e/100}},{key:"setLeading",value:function(e){this.current.leading=-e}},{key:"setFont",value:function(e,t){var i=this.commonObjs.get(e),a=this.current;if(!i)throw new Error("Can't find font for ".concat(e));if(a.fontMatrix=i.fontMatrix||n.FONT_IDENTITY_MATRIX,0!==a.fontMatrix[0]&&0!==a.fontMatrix[3]||(0,n.warn)("Invalid font matrix for font "+e),t<0?(t=-t,a.fontDirection=-1):a.fontDirection=1,this.current.font=i,this.current.fontSize=t,!i.isType3Font){var r=i.loadedName||"sans-serif",o="normal";i.black?o="900":i.bold&&(o="bold");var s=i.italic?"italic":"normal",l='"'.concat(r,'", ').concat(i.fallbackName),c=t;t<16?c=16:t>100&&(c=100),this.current.fontSizeScale=t/c,this.ctx.font="".concat(s," ").concat(o," ").concat(c,"px ").concat(l)}}},{key:"setTextRenderingMode",value:function(e){this.current.textRenderingMode=e}},{key:"setTextRise",value:function(e){this.current.textRise=e}},{key:"moveText",value:function(e,t){this.current.x=this.current.lineX+=e,this.current.y=this.current.lineY+=t}},{key:"setLeadingMoveText",value:function(e,t){this.setLeading(-t),this.moveText(e,t)}},{key:"setTextMatrix",value:function(e,t,i,a,n,r){this.current.textMatrix=[e,t,i,a,n,r],this.current.textMatrixScale=Math.hypot(e,t),this.current.x=this.current.lineX=0,this.current.y=this.current.lineY=0}},{key:"nextLine",value:function(){this.moveText(0,this.current.leading)}},{key:"paintChar",value:function(e,t,i,r){var o,s=this.ctx,l=this.current,c=l.font,d=l.textRenderingMode,u=l.fontSize/l.fontSizeScale,p=d&n.TextRenderingMode.FILL_STROKE_MASK,m=!!(d&n.TextRenderingMode.ADD_TO_PATH_FLAG),h=l.patternFill&&!c.missingFile;(c.disableFontFace||m||h)&&(o=c.getPathGenerator(this.commonObjs,e)),c.disableFontFace||h?(s.save(),s.translate(t,i),s.beginPath(),o(s,u),r&&s.setTransform.apply(s,_toConsumableArray(r)),p!==n.TextRenderingMode.FILL&&p!==n.TextRenderingMode.FILL_STROKE||s.fill(),p!==n.TextRenderingMode.STROKE&&p!==n.TextRenderingMode.FILL_STROKE||s.stroke(),s.restore()):(p!==n.TextRenderingMode.FILL&&p!==n.TextRenderingMode.FILL_STROKE||s.fillText(e,t,i),p!==n.TextRenderingMode.STROKE&&p!==n.TextRenderingMode.FILL_STROKE||s.strokeText(e,t,i)),m&&(this.pendingTextPaths||(this.pendingTextPaths=[])).push({transform:(0,a.getCurrentTransform)(s),x:t,y:i,fontSize:u,addToPath:o})}},{key:"isFontSubpixelAAEnabled",get:function(){var e=this.cachedCanvases.getCanvas("isFontSubpixelAAEnabled",10,10).context;e.scale(1.5,1),e.fillText("I",0,10);for(var t=e.getImageData(0,0,10,10).data,i=!1,a=3;a<t.length;a+=4)if(t[a]>0&&t[a]<255){i=!0;break}return(0,n.shadow)(this,"isFontSubpixelAAEnabled",i)}},{key:"showText",value:function(e){var t=this.current,i=t.font;if(i.isType3Font)return this.showType3Text(e);var o=t.fontSize;if(0!==o){var s,l=this.ctx,c=t.fontSizeScale,d=t.charSpacing,u=t.wordSpacing,p=t.fontDirection,m=t.textHScale*p,h=e.length,f=i.vertical,y=f?1:-1,b=i.defaultVMetrics,g=o*t.fontMatrix[0],v=t.textRenderingMode===n.TextRenderingMode.FILL&&!i.disableFontFace&&!t.patternFill;if(l.save(),l.transform.apply(l,_toConsumableArray(t.textMatrix)),l.translate(t.x,t.y+t.textRise),p>0?l.scale(m,-1):l.scale(m,1),t.patternFill){l.save();var _=t.fillColor.getPattern(l,this,(0,a.getCurrentTransformInverse)(l),r.PathType.FILL);s=(0,a.getCurrentTransform)(l),l.restore(),l.fillStyle=_}var A=t.lineWidth,x=t.textMatrixScale;if(0===x||0===A){var w=t.textRenderingMode&n.TextRenderingMode.FILL_STROKE_MASK;w!==n.TextRenderingMode.STROKE&&w!==n.TextRenderingMode.FILL_STROKE||(A=this.getSinglePixelWidth())}else A/=x;1!==c&&(l.scale(c,c),A/=c),l.lineWidth=A;var S,C=0;for(S=0;S<h;++S){var k=e[S];if("number"!==typeof k){var D=!1,R=(k.isSpace?u:0)+d,I=k.fontChar,M=k.accent,T=void 0,P=void 0,z=k.width;if(f){var B=k.vmetric||b,F=-(k.vmetric?B[1]:.5*z)*g,E=B[2]*g;z=B?-B[0]:z,T=F/c,P=(C+E)/c}else T=C/c,P=0;if(i.remeasure&&z>0){var N=1e3*l.measureText(I).width/o*c;if(z<N&&this.isFontSubpixelAAEnabled){var O=z/N;D=!0,l.save(),l.scale(O,1),T/=O}else z!==N&&(T+=(z-N)/2e3*o/c)}if(this.contentVisible&&(k.isInFont||i.missingFile))if(v&&!M)l.fillText(I,T,P);else if(this.paintChar(I,T,P,s),M){var G=T+o*M.offset.x/c,L=P-o*M.offset.y/c;this.paintChar(M.fontChar,G,L,s)}C+=f?z*g-R*p:z*g+R*p,D&&l.restore()}else C+=y*k*o/1e3}f?t.y-=C:t.x+=C*m,l.restore(),this.compose()}}},{key:"showType3Text",value:function(e){var t,i,a,r,o=this.ctx,s=this.current,l=s.font,c=s.fontSize,d=s.fontDirection,u=l.vertical?1:-1,p=s.charSpacing,m=s.wordSpacing,h=s.textHScale*d,f=s.fontMatrix||n.FONT_IDENTITY_MATRIX,y=e.length;if(s.textRenderingMode!==n.TextRenderingMode.INVISIBLE&&0!==c){for(this._cachedScaleForStroking=null,this._cachedGetSinglePixelWidth=null,o.save(),o.transform.apply(o,_toConsumableArray(s.textMatrix)),o.translate(s.x,s.y),o.scale(h,d),t=0;t<y;++t)if("number"!==typeof(i=e[t])){var b=(i.isSpace?m:0)+p,g=l.charProcOperatorList[i.operatorListId];g?(this.contentVisible&&(this.processingType3=i,this.save(),o.scale(c,c),o.transform.apply(o,_toConsumableArray(f)),this.executeOperatorList(g),this.restore()),a=n.Util.applyTransform([i.width,0],f)[0]*c+b,o.translate(a,0),s.x+=a*h):(0,n.warn)('Type3 character "'.concat(i.operatorListId,'" is not available.'))}else r=u*i*c/1e3,this.ctx.translate(r,0),s.x+=r*h;o.restore(),this.processingType3=null}}},{key:"setCharWidth",value:function(e,t){}},{key:"setCharWidthAndBounds",value:function(e,t,i,a,n,r){this.ctx.rect(i,a,n-i,r-a),this.ctx.clip(),this.endPath()}},{key:"getColorN_Pattern",value:function(t){var i,n=this;if("TilingPattern"===t[0]){var o=t[1],s=this.baseTransform||(0,a.getCurrentTransform)(this.ctx),l={createCanvasGraphics:function(t){return new e(t,n.commonObjs,n.objs,n.canvasFactory)}};i=new r.TilingPattern(t,o,this.ctx,l,s)}else i=this._getPattern(t[1],t[2]);return i}},{key:"setStrokeColorN",value:function(){this.current.strokeColor=this.getColorN_Pattern(arguments)}},{key:"setFillColorN",value:function(){this.current.fillColor=this.getColorN_Pattern(arguments),this.current.patternFill=!0}},{key:"setStrokeRGBColor",value:function(e,t,i){var a,r=(null===(a=this.selectColor)||void 0===a?void 0:a.call(this,e,t,i))||n.Util.makeHexColor(e,t,i);this.ctx.strokeStyle=r,this.current.strokeColor=r}},{key:"setFillRGBColor",value:function(e,t,i){var a,r=(null===(a=this.selectColor)||void 0===a?void 0:a.call(this,e,t,i))||n.Util.makeHexColor(e,t,i);this.ctx.fillStyle=r,this.current.fillColor=r,this.current.patternFill=!1}},{key:"_getPattern",value:function(e){var t,i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;return this.cachedPatterns.has(e)?t=this.cachedPatterns.get(e):(t=(0,r.getShadingPattern)(this.objs.get(e)),this.cachedPatterns.set(e,t)),i&&(t.matrix=i),t}},{key:"shadingFill",value:function(e){if(this.contentVisible){var t=this.ctx;this.save();var i=this._getPattern(e);t.fillStyle=i.getPattern(t,this,(0,a.getCurrentTransformInverse)(t),r.PathType.SHADING);var o=(0,a.getCurrentTransformInverse)(t);if(o){var s=t.canvas,l=s.width,c=s.height,d=n.Util.applyTransform([0,0],o),u=n.Util.applyTransform([0,c],o),p=n.Util.applyTransform([l,0],o),m=n.Util.applyTransform([l,c],o),h=Math.min(d[0],u[0],p[0],m[0]),f=Math.min(d[1],u[1],p[1],m[1]),y=Math.max(d[0],u[0],p[0],m[0]),b=Math.max(d[1],u[1],p[1],m[1]);this.ctx.fillRect(h,f,y-h,b-f)}else this.ctx.fillRect(-1e10,-1e10,2e10,2e10);this.compose(this.current.getClippedPathBoundingBox()),this.restore()}}},{key:"beginInlineImage",value:function(){(0,n.unreachable)("Should not call beginInlineImage")}},{key:"beginImageData",value:function(){(0,n.unreachable)("Should not call beginImageData")}},{key:"paintFormXObjectBegin",value:function(e,t){if(this.contentVisible&&(this.save(),this.baseTransformStack.push(this.baseTransform),Array.isArray(e)&&6===e.length&&this.transform.apply(this,_toConsumableArray(e)),this.baseTransform=(0,a.getCurrentTransform)(this.ctx),t)){var i=t[2]-t[0],n=t[3]-t[1];this.ctx.rect(t[0],t[1],i,n),this.current.updateRectMinMax((0,a.getCurrentTransform)(this.ctx),t),this.clip(),this.endPath()}}},{key:"paintFormXObjectEnd",value:function(){this.contentVisible&&(this.restore(),this.baseTransform=this.baseTransformStack.pop())}},{key:"beginGroup",value:function(e){if(this.contentVisible){this.save(),this.inSMaskMode&&(this.endSMaskMode(),this.current.activeSMask=null);var t=this.ctx;e.isolated||(0,n.info)("TODO: Support non-isolated groups."),e.knockout&&(0,n.warn)("Knockout groups not supported.");var i=(0,a.getCurrentTransform)(t);if(e.matrix&&t.transform.apply(t,_toConsumableArray(e.matrix)),!e.bbox)throw new Error("Bounding box is required.");var r=n.Util.getAxialAlignedBoundingBox(e.bbox,(0,a.getCurrentTransform)(t)),o=[0,0,t.canvas.width,t.canvas.height];r=n.Util.intersect(r,o)||[0,0,0,0];var s=Math.floor(r[0]),c=Math.floor(r[1]),d=Math.max(Math.ceil(r[2])-s,1),u=Math.max(Math.ceil(r[3])-c,1),p=1,m=1;d>l&&(p=d/l,d=l),u>l&&(m=u/l,u=l),this.current.startNewPathAndClipBox([0,0,d,u]);var h="groupAt"+this.groupLevel;e.smask&&(h+="_smask_"+this.smaskCounter++%2);var f=this.cachedCanvases.getCanvas(h,d,u),b=f.context;b.scale(1/p,1/m),b.translate(-s,-c),b.transform.apply(b,_toConsumableArray(i)),e.smask?this.smaskStack.push({canvas:f.canvas,context:b,offsetX:s,offsetY:c,scaleX:p,scaleY:m,subtype:e.smask.subtype,backdrop:e.smask.backdrop,transferMap:e.smask.transferMap||null,startTransformInverse:null}):(t.setTransform(1,0,0,1,0,0),t.translate(s,c),t.scale(p,m),t.save()),y(t,b),this.ctx=b,this.setGState([["BM","source-over"],["ca",1],["CA",1]]),this.groupStack.push(t),this.groupLevel++}}},{key:"endGroup",value:function(e){if(this.contentVisible){this.groupLevel--;var t=this.ctx,i=this.groupStack.pop();if(this.ctx=i,this.ctx.imageSmoothingEnabled=!1,e.smask)this.tempSMask=this.smaskStack.pop(),this.restore();else{var r;this.ctx.restore();var o=(0,a.getCurrentTransform)(this.ctx);this.restore(),this.ctx.save(),(r=this.ctx).setTransform.apply(r,_toConsumableArray(o));var s=n.Util.getAxialAlignedBoundingBox([0,0,t.canvas.width,t.canvas.height],o);this.ctx.drawImage(t.canvas,0,0),this.ctx.restore(),this.compose(s)}}}},{key:"beginAnnotation",value:function(e,t,i,r,o){var s;if(_classPrivateMethodGet(this,D,I).call(this),b(this.ctx,this.foregroundColor),this.ctx.save(),this.save(),this.baseTransform&&(s=this.ctx).setTransform.apply(s,_toConsumableArray(this.baseTransform)),Array.isArray(t)&&4===t.length){var l=t[2]-t[0],c=t[3]-t[1];if(o&&this.annotationCanvasMap){(i=i.slice())[4]-=t[0],i[5]-=t[1],(t=t.slice())[0]=t[1]=0,t[2]=l,t[3]=c;var d=n.Util.singularValueDecompose2dScale((0,a.getCurrentTransform)(this.ctx)),u=_slicedToArray(d,2),p=u[0],h=u[1],f=this.viewportScale,y=Math.ceil(l*this.outputScaleX*f),g=Math.ceil(c*this.outputScaleY*f);this.annotationCanvas=this.canvasFactory.create(y,g);var v=this.annotationCanvas,_=v.canvas,A=v.context;this.annotationCanvasMap.set(e,_),this.annotationCanvas.savedCtx=this.ctx,this.ctx=A,this.ctx.setTransform(p,0,0,-h,0,c*h),b(this.ctx,this.foregroundColor)}else b(this.ctx,this.foregroundColor),this.ctx.rect(t[0],t[1],l,c),this.ctx.clip(),this.endPath()}this.current=new m(this.ctx.canvas.width,this.ctx.canvas.height),this.transform.apply(this,_toConsumableArray(i)),this.transform.apply(this,_toConsumableArray(r))}},{key:"endAnnotation",value:function(){this.annotationCanvas&&(this.ctx=this.annotationCanvas.savedCtx,delete this.annotationCanvas.savedCtx,delete this.annotationCanvas)}},{key:"paintImageMaskXObject",value:function(e){if(this.contentVisible){var t=e.count;(e=this.getObject(e.data,e)).count=t;var i=this.ctx,a=this.processingType3;if(a&&(void 0===a.compiled&&(a.compiled=function(e){var t=e.width,i=e.height;if(t>c||i>c)return null;var a,n,r,o,s=new Uint8Array([0,2,4,0,1,0,5,4,8,10,0,8,0,2,1,0]),l=t+1,d=new Uint8Array(l*(i+1)),u=t+7&-8,p=new Uint8Array(u*i),m=0,h=_createForOfIteratorHelper(e.data);try{for(h.s();!(o=h.n()).done;)for(var f=o.value,y=128;y>0;)p[m++]=f&y?0:255,y>>=1}catch(D){h.e(D)}finally{h.f()}var b=0;for(0!==p[m=0]&&(d[0]=1,++b),n=1;n<t;n++)p[m]!==p[m+1]&&(d[n]=p[m]?2:1,++b),m++;for(0!==p[m]&&(d[n]=2,++b),a=1;a<i;a++){r=a*l,p[(m=a*u)-u]!==p[m]&&(d[r]=p[m]?1:8,++b);var g=(p[m]?4:0)+(p[m-u]?8:0);for(n=1;n<t;n++)s[g=(g>>2)+(p[m+1]?4:0)+(p[m-u+1]?8:0)]&&(d[r+n]=s[g],++b),m++;if(p[m-u]!==p[m]&&(d[r+n]=p[m]?2:4,++b),b>1e3)return null}for(r=a*l,0!==p[m=u*(i-1)]&&(d[r]=8,++b),n=1;n<t;n++)p[m]!==p[m+1]&&(d[r+n]=p[m]?4:8,++b),m++;if(0!==p[m]&&(d[r+n]=4,++b),b>1e3)return null;var v=new Int32Array([0,l,-1,0,-l,0,0,0,1]),_=new Path2D;for(a=0;b&&a<=i;a++){for(var A=a*l,x=A+t;A<x&&!d[A];)A++;if(A!==x){_.moveTo(A%l,a);var w=A,S=d[A];do{var C=v[S];do{A+=C}while(!d[A]);var k=d[A];5!==k&&10!==k?(S=k,d[A]=0):(S=k&51*S>>4,d[A]&=S>>2|S<<2),_.lineTo(A%l,A/l|0),d[A]||--b}while(w!==A);--a}}return p=null,d=null,function(e){e.save(),e.scale(1/t,-1/i),e.translate(0,-i),e.fill(_),e.beginPath(),e.restore()}}(e)),a.compiled))a.compiled(i);else{var n=this._createMaskCanvas(e),r=n.canvas;i.save(),i.setTransform(1,0,0,1,0,0),i.drawImage(r,n.offsetX,n.offsetY),i.restore(),this.compose()}}}},{key:"paintImageMaskXObjectRepeat",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:0,r=arguments.length>3&&void 0!==arguments[3]?arguments[3]:0,o=arguments.length>4?arguments[4]:void 0,s=arguments.length>5?arguments[5]:void 0;if(this.contentVisible){e=this.getObject(e.data,e);var l=this.ctx;l.save();var c=(0,a.getCurrentTransform)(l);l.transform(t,i,r,o,0,0);var d=this._createMaskCanvas(e);l.setTransform(1,0,0,1,0,0);for(var u=0,p=s.length;u<p;u+=2){var m=n.Util.transform(c,[t,i,r,o,s[u],s[u+1]]),h=n.Util.applyTransform([0,0],m),f=_slicedToArray(h,2),y=f[0],b=f[1];l.drawImage(d.canvas,y,b)}l.restore(),this.compose()}}},{key:"paintImageMaskXObjectGroup",value:function(e){if(this.contentVisible){var t,i=this.ctx,n=this.current.fillColor,o=this.current.patternFill,s=_createForOfIteratorHelper(e);try{for(s.s();!(t=s.n()).done;){var l=t.value,c=l.data,d=l.width,u=l.height,m=l.transform,h=this.cachedCanvases.getCanvas("maskCanvas",d,u),y=h.context;y.save(),f(y,this.getObject(c,l)),y.globalCompositeOperation="source-in",y.fillStyle=o?n.getPattern(y,this,(0,a.getCurrentTransformInverse)(i),r.PathType.FILL):n,y.fillRect(0,0,d,u),y.restore(),i.save(),i.transform.apply(i,_toConsumableArray(m)),i.scale(1,-1),p(i,h.canvas,0,0,d,u,0,-1,1,1),i.restore()}}catch(b){s.e(b)}finally{s.f()}this.compose()}}},{key:"paintImageXObject",value:function(e){if(this.contentVisible){var t=this.getObject(e);t?this.paintInlineImageXObject(t):(0,n.warn)("Dependent image isn't ready yet")}}},{key:"paintImageXObjectRepeat",value:function(e,t,i,a){if(this.contentVisible){var r=this.getObject(e);if(r){for(var o=r.width,s=r.height,l=[],c=0,d=a.length;c<d;c+=2)l.push({transform:[t,0,0,i,a[c],a[c+1]],x:0,y:0,w:o,h:s});this.paintInlineImageXObjectGroup(r,l)}else(0,n.warn)("Dependent image isn't ready yet")}}},{key:"paintInlineImageXObject",value:function(e){if(this.contentVisible){var t,i=e.width,r=e.height,o=this.ctx;if(this.save(),o.scale(1/i,-1/r),"function"===typeof HTMLElement&&e instanceof HTMLElement||!e.data)t=e;else{var s=this.cachedCanvases.getCanvas("inlineImage",i,r);h(s.context,e,this.current.transferMaps),t=s.canvas}var l=this._scaleImage(t,(0,a.getCurrentTransformInverse)(o));o.imageSmoothingEnabled=x((0,a.getCurrentTransform)(o),e.interpolate);var c=p(o,l.img,0,0,l.paintWidth,l.paintHeight,0,-r,i,r),d=_slicedToArray(c,2),u=d[0],m=d[1];if(this.imageLayer){var f=n.Util.applyTransform([0,-r],(0,a.getCurrentTransform)(this.ctx)),y=_slicedToArray(f,2),b=y[0],g=y[1];this.imageLayer.appendImage({imgData:e,left:b,top:g,width:u,height:m})}this.compose(),this.restore()}}},{key:"paintInlineImageXObjectGroup",value:function(e,t){if(this.contentVisible){var i=this.ctx,r=e.width,o=e.height,s=this.cachedCanvases.getCanvas("inlineImage",r,o);h(s.context,e,this.current.transferMaps);var l,c=_createForOfIteratorHelper(t);try{for(c.s();!(l=c.n()).done;){var d=l.value;if(i.save(),i.transform.apply(i,_toConsumableArray(d.transform)),i.scale(1,-1),p(i,s.canvas,d.x,d.y,d.w,d.h,0,-1,1,1),this.imageLayer){var u=n.Util.applyTransform([d.x,d.y],(0,a.getCurrentTransform)(this.ctx)),m=_slicedToArray(u,2),f=m[0],y=m[1];this.imageLayer.appendImage({imgData:e,left:f,top:y,width:r,height:o})}i.restore()}}catch(b){c.e(b)}finally{c.f()}this.compose()}}},{key:"paintSolidColorImageMask",value:function(){this.contentVisible&&(this.ctx.fillRect(0,0,1,1),this.compose())}},{key:"markPoint",value:function(e){}},{key:"markPointProps",value:function(e,t){}},{key:"beginMarkedContent",value:function(e){this.markedContentStack.push({visible:!0})}},{key:"beginMarkedContentProps",value:function(e,t){"OC"===e?this.markedContentStack.push({visible:this.optionalContentConfig.isVisible(t)}):this.markedContentStack.push({visible:!0}),this.contentVisible=this.isContentVisible()}},{key:"endMarkedContent",value:function(){this.markedContentStack.pop(),this.contentVisible=this.isContentVisible()}},{key:"beginCompat",value:function(){}},{key:"endCompat",value:function(){}},{key:"consumePath",value:function(e){var t=this.current.isEmptyClip();this.pendingClip&&this.current.updateClipFromPath(),this.pendingClip||this.compose(e);var i=this.ctx;this.pendingClip&&(t||(this.pendingClip===k?i.clip("evenodd"):i.clip()),this.pendingClip=null),this.current.startNewPathAndClipBox(this.current.clipBox),i.beginPath()}},{key:"getSinglePixelWidth",value:function(){if(!this._cachedGetSinglePixelWidth){var e=(0,a.getCurrentTransform)(this.ctx);if(0===e[1]&&0===e[2])this._cachedGetSinglePixelWidth=1/Math.min(Math.abs(e[0]),Math.abs(e[3]));else{var t=Math.abs(e[0]*e[3]-e[2]*e[1]),i=Math.hypot(e[0],e[2]),n=Math.hypot(e[1],e[3]);this._cachedGetSinglePixelWidth=Math.max(i,n)/t}}return this._cachedGetSinglePixelWidth}},{key:"getScaleForStroking",value:function(){if(!this._cachedScaleForStroking){var e,t,i=this.current.lineWidth,n=(0,a.getCurrentTransform)(this.ctx);if(0===n[1]&&0===n[2]){var r=Math.abs(n[0]),o=Math.abs(n[3]);if(0===i)e=1/r,t=1/o;else{var s=r*i,l=o*i;e=s<1?1/s:1,t=l<1?1/l:1}}else{var c=Math.abs(n[0]*n[3]-n[2]*n[1]),d=Math.hypot(n[0],n[1]),u=Math.hypot(n[2],n[3]);if(0===i)e=u/c,t=d/c;else{var p=i*c;e=u>p?u/p:1,t=d>p?d/p:1}}this._cachedScaleForStroking=[e,t]}return this._cachedScaleForStroking}},{key:"rescaleAndStroke",value:function(e){var t=this.ctx,i=this.current.lineWidth,n=this.getScaleForStroking(),r=_slicedToArray(n,2),o=r[0],s=r[1];if(t.lineWidth=i||1,1!==o||1!==s){var l,c,d;e&&(l=(0,a.getCurrentTransform)(t),c=t.getLineDash().slice(),d=t.lineDashOffset),t.scale(o,s);var u=Math.max(o,s);t.setLineDash(t.getLineDash().map((function(e){return e/u}))),t.lineDashOffset/=u,t.stroke(),e&&(t.setTransform.apply(t,_toConsumableArray(l)),t.setLineDash(c),t.lineDashOffset=d)}else t.stroke()}},{key:"isContentVisible",value:function(){for(var e=this.markedContentStack.length-1;e>=0;e--)if(!this.markedContentStack[e].visible)return!1;return!0}}]),e}();function I(){for(;this.stateStack.length||this.inSMaskMode;)this.restore();this.ctx.restore(),this.transparentCanvas&&(this.ctx=this.compositeCtx,this.ctx.save(),this.ctx.setTransform(1,0,0,1,0,0),this.ctx.drawImage(this.transparentCanvas,0,0),this.ctx.restore(),this.transparentCanvas=null)}for(var M in t.CanvasGraphics=R,n.OPS)void 0!==R.prototype[M]&&(R.prototype[n.OPS[M]]=R.prototype[M])},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.TilingPattern=t.PathType=void 0,t.getShadingPattern=function(e){switch(e[0]){case"RadialAxial":return new c(e);case"Mesh":return new p(e);case"Dummy":return new m}throw new Error("Unknown IR type: ".concat(e[0]))};var a=i(1),n=i(8),r=i(3),o={FILL:"Fill",STROKE:"Stroke",SHADING:"Shading"};function s(e,t){if(t&&!r.isNodeJS){var i=t[2]-t[0],a=t[3]-t[1],n=new Path2D;n.rect(t[0],t[1],i,a),e.clip(n)}}t.PathType=o;var l=function(){function e(){_classCallCheck(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize BaseShadingPattern.")}return _createClass(e,[{key:"getPattern",value:function(){(0,a.unreachable)("Abstract method `getPattern` called.")}}]),e}(),c=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a;return _classCallCheck(this,i),(a=t.call(this))._type=e[1],a._bbox=e[2],a._colorStops=e[3],a._p0=e[4],a._p1=e[5],a._r0=e[6],a._r1=e[7],a.matrix=null,a}return _createClass(i,[{key:"_createGradient",value:function(e){var t;"axial"===this._type?t=e.createLinearGradient(this._p0[0],this._p0[1],this._p1[0],this._p1[1]):"radial"===this._type&&(t=e.createRadialGradient(this._p0[0],this._p0[1],this._r0,this._p1[0],this._p1[1],this._r1));var i,a=_createForOfIteratorHelper(this._colorStops);try{for(a.s();!(i=a.n()).done;){var n=i.value;t.addColorStop(n[0],n[1])}}catch(r){a.e(r)}finally{a.f()}return t}},{key:"getPattern",value:function(e,t,i,r){var l;if(r===o.STROKE||r===o.FILL){var c=t.current.getClippedPathBoundingBox(r,(0,n.getCurrentTransform)(e))||[0,0,0,0],d=Math.ceil(c[2]-c[0])||1,u=Math.ceil(c[3]-c[1])||1,p=t.cachedCanvases.getCanvas("pattern",d,u,!0),m=p.context;m.clearRect(0,0,m.canvas.width,m.canvas.height),m.beginPath(),m.rect(0,0,m.canvas.width,m.canvas.height),m.translate(-c[0],-c[1]),i=a.Util.transform(i,[1,0,0,1,c[0],c[1]]),m.transform.apply(m,_toConsumableArray(t.baseTransform)),this.matrix&&m.transform.apply(m,_toConsumableArray(this.matrix)),s(m,this._bbox),m.fillStyle=this._createGradient(m),m.fill(),l=e.createPattern(p.canvas,"no-repeat");var h=new DOMMatrix(i);try{l.setTransform(h)}catch(f){(0,a.warn)('RadialAxialShadingPattern.getPattern: "'.concat(null===f||void 0===f?void 0:f.message,'".'))}}else s(e,this._bbox),l=this._createGradient(e);return l}}]),i}(l);function d(e,t,i,a,n,r,o,s){var l,c=t.coords,d=t.colors,u=e.data,p=4*e.width;c[i+1]>c[a+1]&&(l=i,i=a,a=l,l=r,r=o,o=l),c[a+1]>c[n+1]&&(l=a,a=n,n=l,l=o,o=s,s=l),c[i+1]>c[a+1]&&(l=i,i=a,a=l,l=r,r=o,o=l);var m=(c[i]+t.offsetX)*t.scaleX,h=(c[i+1]+t.offsetY)*t.scaleY,f=(c[a]+t.offsetX)*t.scaleX,y=(c[a+1]+t.offsetY)*t.scaleY,b=(c[n]+t.offsetX)*t.scaleX,g=(c[n+1]+t.offsetY)*t.scaleY;if(!(h>=g))for(var v,_,A,x,w,S,C,k,D=d[r],R=d[r+1],I=d[r+2],M=d[o],T=d[o+1],P=d[o+2],z=d[s],B=d[s+1],F=d[s+2],E=Math.round(h),N=Math.round(g),O=E;O<=N;O++){if(O<y){var G=void 0;v=m-(m-f)*(G=O<h?0:(h-O)/(h-y)),_=D-(D-M)*G,A=R-(R-T)*G,x=I-(I-P)*G}else{var L=void 0;v=f-(f-b)*(L=O>g?1:y===g?0:(y-O)/(y-g)),_=M-(M-z)*L,A=T-(T-B)*L,x=P-(P-F)*L}var j=void 0;w=m-(m-b)*(j=O<h?0:O>g?1:(h-O)/(h-g)),S=D-(D-z)*j,C=R-(R-B)*j,k=I-(I-F)*j;for(var q=Math.round(Math.min(v,w)),H=Math.round(Math.max(v,w)),U=p*O+4*q,Y=q;Y<=H;Y++)(j=(v-Y)/(v-w))<0?j=0:j>1&&(j=1),u[U++]=_-(_-S)*j|0,u[U++]=A-(A-C)*j|0,u[U++]=x-(x-k)*j|0,u[U++]=255}}function u(e,t,i){var a,n,r=t.coords,o=t.colors;switch(t.type){case"lattice":var s=t.verticesPerRow,l=Math.floor(r.length/s)-1,c=s-1;for(a=0;a<l;a++)for(var u=a*s,p=0;p<c;p++,u++)d(e,i,r[u],r[u+1],r[u+s],o[u],o[u+1],o[u+s]),d(e,i,r[u+s+1],r[u+1],r[u+s],o[u+s+1],o[u+1],o[u+s]);break;case"triangles":for(a=0,n=r.length;a<n;a+=3)d(e,i,r[a],r[a+1],r[a+2],o[a],o[a+1],o[a+2]);break;default:throw new Error("illegal figure")}}var p=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a;return _classCallCheck(this,i),(a=t.call(this))._coords=e[2],a._colors=e[3],a._figures=e[4],a._bounds=e[5],a._bbox=e[7],a._background=e[8],a.matrix=null,a}return _createClass(i,[{key:"_createMeshCanvas",value:function(e,t,i){var a=Math.floor(this._bounds[0]),n=Math.floor(this._bounds[1]),r=Math.ceil(this._bounds[2])-a,o=Math.ceil(this._bounds[3])-n,s=Math.min(Math.ceil(Math.abs(r*e[0]*1.1)),3e3),l=Math.min(Math.ceil(Math.abs(o*e[1]*1.1)),3e3),c=r/s,d=o/l,p={coords:this._coords,colors:this._colors,offsetX:-a,offsetY:-n,scaleX:1/c,scaleY:1/d},m=s+4,h=l+4,f=i.getCanvas("mesh",m,h,!1),y=f.context,b=y.createImageData(s,l);if(t)for(var g=b.data,v=0,_=g.length;v<_;v+=4)g[v]=t[0],g[v+1]=t[1],g[v+2]=t[2],g[v+3]=255;var A,x=_createForOfIteratorHelper(this._figures);try{for(x.s();!(A=x.n()).done;)u(b,A.value,p)}catch(w){x.e(w)}finally{x.f()}return y.putImageData(b,2,2),{canvas:f.canvas,offsetX:a-2*c,offsetY:n-2*d,scaleX:c,scaleY:d}}},{key:"getPattern",value:function(e,t,i,r){var l;if(s(e,this._bbox),r===o.SHADING)l=a.Util.singularValueDecompose2dScale((0,n.getCurrentTransform)(e));else if(l=a.Util.singularValueDecompose2dScale(t.baseTransform),this.matrix){var c=a.Util.singularValueDecompose2dScale(this.matrix);l=[l[0]*c[0],l[1]*c[1]]}var d=this._createMeshCanvas(l,r===o.SHADING?null:this._background,t.cachedCanvases);return r!==o.SHADING&&(e.setTransform.apply(e,_toConsumableArray(t.baseTransform)),this.matrix&&e.transform.apply(e,_toConsumableArray(this.matrix))),e.translate(d.offsetX,d.offsetY),e.scale(d.scaleX,d.scaleY),e.createPattern(d.canvas,"no-repeat")}}]),i}(l),m=function(e){_inherits(i,e);var t=_createSuper(i);function i(){return _classCallCheck(this,i),t.apply(this,arguments)}return _createClass(i,[{key:"getPattern",value:function(){return"hotpink"}}]),i}(l),h=1,f=2,y=function(){function e(t,i,a,n,r){_classCallCheck(this,e),this.operatorList=t[2],this.matrix=t[3]||[1,0,0,1,0,0],this.bbox=t[4],this.xstep=t[5],this.ystep=t[6],this.paintType=t[7],this.tilingType=t[8],this.color=i,this.ctx=a,this.canvasGraphicsFactory=n,this.baseTransform=r}return _createClass(e,[{key:"createPatternCanvas",value:function(e){var t=this.operatorList,i=this.bbox,r=this.xstep,o=this.ystep,s=this.paintType,l=this.tilingType,c=this.color,d=this.canvasGraphicsFactory;(0,a.info)("TilingType: "+l);var u=i[0],p=i[1],m=i[2],h=i[3],f=a.Util.singularValueDecompose2dScale(this.matrix),y=a.Util.singularValueDecompose2dScale(this.baseTransform),b=[f[0]*y[0],f[1]*y[1]],g=this.getSizeAndScale(r,this.ctx.canvas.width,b[0]),v=this.getSizeAndScale(o,this.ctx.canvas.height,b[1]),_=e.cachedCanvases.getCanvas("pattern",g.size,v.size,!0),A=_.context,x=d.createCanvasGraphics(A);x.groupLevel=e.groupLevel,this.setFillAndStrokeStyleToContext(x,s,c);var w=u,S=p,C=m,k=h;return u<0&&(w=0,C+=Math.abs(u)),p<0&&(S=0,k+=Math.abs(p)),A.translate(-g.scale*w,-v.scale*S),x.transform(g.scale,0,0,v.scale,0,0),A.save(),this.clipBbox(x,w,S,C,k),x.baseTransform=(0,n.getCurrentTransform)(x.ctx),x.executeOperatorList(t),x.endDrawing(),{canvas:_.canvas,scaleX:g.scale,scaleY:v.scale,offsetX:w,offsetY:S}}},{key:"getSizeAndScale",value:function(t,i,a){t=Math.abs(t);var n=Math.max(e.MAX_PATTERN_SIZE,i),r=Math.ceil(t*a);return r>=n?r=n:a=r/t,{scale:a,size:r}}},{key:"clipBbox",value:function(e,t,i,a,r){var o=a-t,s=r-i;e.ctx.rect(t,i,o,s),e.current.updateRectMinMax((0,n.getCurrentTransform)(e.ctx),[t,i,a,r]),e.clip(),e.endPath()}},{key:"setFillAndStrokeStyleToContext",value:function(e,t,i){var n=e.ctx,r=e.current;switch(t){case h:var o=this.ctx;n.fillStyle=o.fillStyle,n.strokeStyle=o.strokeStyle,r.fillColor=o.fillStyle,r.strokeColor=o.strokeStyle;break;case f:var s=a.Util.makeHexColor(i[0],i[1],i[2]);n.fillStyle=s,n.strokeStyle=s,r.fillColor=s,r.strokeColor=s;break;default:throw new a.FormatError("Unsupported paint type: ".concat(t))}}},{key:"getPattern",value:function(e,t,i,n){var r=i;n!==o.SHADING&&(r=a.Util.transform(r,t.baseTransform),this.matrix&&(r=a.Util.transform(r,this.matrix)));var s=this.createPatternCanvas(t),l=new DOMMatrix(r);l=(l=l.translate(s.offsetX,s.offsetY)).scale(1/s.scaleX,1/s.scaleY);var c=e.createPattern(s.canvas,"repeat");try{c.setTransform(l)}catch(d){(0,a.warn)('TilingPattern.getPattern: "'.concat(null===d||void 0===d?void 0:d.message,'".'))}return c}}],[{key:"MAX_PATTERN_SIZE",get:function(){return(0,a.shadow)(this,"MAX_PATTERN_SIZE",3e3)}}]),e}();t.TilingPattern=y},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.applyMaskImageData=function(e){var t=e.src,i=e.srcPos,n=void 0===i?0:i,r=e.dest,o=e.destPos,s=void 0===o?0:o,l=e.width,c=e.height,d=e.inverseDecode,u=void 0!==d&&d,p=a.FeatureTest.isLittleEndian?4278190080:255,m=_slicedToArray(u?[0,p]:[p,0],2),h=m[0],f=m[1],y=l>>3,b=7&l,g=t.length;r=new Uint32Array(r.buffer);for(var v=0;v<c;v++){for(var _=n+y;n<_;n++){var A=n<g?t[n]:255;r[s++]=128&A?f:h,r[s++]=64&A?f:h,r[s++]=32&A?f:h,r[s++]=16&A?f:h,r[s++]=8&A?f:h,r[s++]=4&A?f:h,r[s++]=2&A?f:h,r[s++]=1&A?f:h}if(0!==b)for(var x=n<g?t[n++]:255,w=0;w<b;w++)r[s++]=x&1<<7-w?f:h}return{srcPos:n,destPos:s}};var a=i(1)},function(e,t){Object.defineProperty(t,"__esModule",{value:!0}),t.GlobalWorkerOptions=void 0;var i=Object.create(null);t.GlobalWorkerOptions=i,i.workerPort=void 0===i.workerPort?null:i.workerPort,i.workerSrc=void 0===i.workerSrc?"":i.workerSrc},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.MessageHandler=void 0;var a=i(1),n={UNKNOWN:0,DATA:1,ERROR:2},r={UNKNOWN:0,CANCEL:1,CANCEL_COMPLETE:2,CLOSE:3,ENQUEUE:4,ERROR:5,PULL:6,PULL_COMPLETE:7,START_COMPLETE:8};function o(e){switch(e instanceof Error||"object"===typeof e&&null!==e||(0,a.unreachable)('wrapReason: Expected "reason" to be a (possibly cloned) Error.'),e.name){case"AbortException":return new a.AbortException(e.message);case"MissingPDFException":return new a.MissingPDFException(e.message);case"PasswordException":return new a.PasswordException(e.message,e.code);case"UnexpectedResponseException":return new a.UnexpectedResponseException(e.message,e.status);case"UnknownErrorException":return new a.UnknownErrorException(e.message,e.details);default:return new a.UnknownErrorException(e.message,e.toString())}}var s=function(){function e(t,i,a){var r=this;_classCallCheck(this,e),this.sourceName=t,this.targetName=i,this.comObj=a,this.callbackId=1,this.streamId=1,this.streamSinks=Object.create(null),this.streamControllers=Object.create(null),this.callbackCapabilities=Object.create(null),this.actionHandler=Object.create(null),this._onComObjOnMessage=function(e){var t=e.data;if(t.targetName===r.sourceName)if(t.stream)r._processStreamMessage(t);else if(t.callback){var i=t.callbackId,s=r.callbackCapabilities[i];if(!s)throw new Error("Cannot resolve callback ".concat(i));if(delete r.callbackCapabilities[i],t.callback===n.DATA)s.resolve(t.data);else{if(t.callback!==n.ERROR)throw new Error("Unexpected callback case");s.reject(o(t.reason))}}else{var l=r.actionHandler[t.action];if(!l)throw new Error("Unknown action from worker: ".concat(t.action));if(t.callbackId){var c=r.sourceName,d=t.sourceName;new Promise((function(e){e(l(t.data))})).then((function(e){a.postMessage({sourceName:c,targetName:d,callback:n.DATA,callbackId:t.callbackId,data:e})}),(function(e){a.postMessage({sourceName:c,targetName:d,callback:n.ERROR,callbackId:t.callbackId,reason:o(e)})}))}else t.streamId?r._createStreamSink(t):l(t.data)}},a.addEventListener("message",this._onComObjOnMessage)}return _createClass(e,[{key:"on",value:function(e,t){var i=this.actionHandler;if(i[e])throw new Error('There is already an actionName called "'.concat(e,'"'));i[e]=t}},{key:"send",value:function(e,t,i){this.comObj.postMessage({sourceName:this.sourceName,targetName:this.targetName,action:e,data:t},i)}},{key:"sendWithPromise",value:function(e,t,i){var n=this.callbackId++,r=(0,a.createPromiseCapability)();this.callbackCapabilities[n]=r;try{this.comObj.postMessage({sourceName:this.sourceName,targetName:this.targetName,action:e,callbackId:n,data:t},i)}catch(o){r.reject(o)}return r.promise}},{key:"sendWithStream",value:function(e,t,i,n){var s=this,l=this.streamId++,c=this.sourceName,d=this.targetName,u=this.comObj;return new ReadableStream({start:function(i){var r=(0,a.createPromiseCapability)();return s.streamControllers[l]={controller:i,startCall:r,pullCall:null,cancelCall:null,isClosed:!1},u.postMessage({sourceName:c,targetName:d,action:e,streamId:l,data:t,desiredSize:i.desiredSize},n),r.promise},pull:function(e){var t=(0,a.createPromiseCapability)();return s.streamControllers[l].pullCall=t,u.postMessage({sourceName:c,targetName:d,stream:r.PULL,streamId:l,desiredSize:e.desiredSize}),t.promise},cancel:function(e){(0,a.assert)(e instanceof Error,"cancel must have a valid reason");var t=(0,a.createPromiseCapability)();return s.streamControllers[l].cancelCall=t,s.streamControllers[l].isClosed=!0,u.postMessage({sourceName:c,targetName:d,stream:r.CANCEL,streamId:l,reason:o(e)}),t.promise}},i)}},{key:"_createStreamSink",value:function(e){var t=e.streamId,i=this.sourceName,n=e.sourceName,s=this.comObj,l=this,c=this.actionHandler[e.action],d={enqueue:function(e){var o=arguments.length>1&&void 0!==arguments[1]?arguments[1]:1,l=arguments.length>2?arguments[2]:void 0;if(!this.isCancelled){var c=this.desiredSize;this.desiredSize-=o,c>0&&this.desiredSize<=0&&(this.sinkCapability=(0,a.createPromiseCapability)(),this.ready=this.sinkCapability.promise),s.postMessage({sourceName:i,targetName:n,stream:r.ENQUEUE,streamId:t,chunk:e},l)}},close:function(){this.isCancelled||(this.isCancelled=!0,s.postMessage({sourceName:i,targetName:n,stream:r.CLOSE,streamId:t}),delete l.streamSinks[t])},error:function(e){(0,a.assert)(e instanceof Error,"error must have a valid reason"),this.isCancelled||(this.isCancelled=!0,s.postMessage({sourceName:i,targetName:n,stream:r.ERROR,streamId:t,reason:o(e)}))},sinkCapability:(0,a.createPromiseCapability)(),onPull:null,onCancel:null,isCancelled:!1,desiredSize:e.desiredSize,ready:null};d.sinkCapability.resolve(),d.ready=d.sinkCapability.promise,this.streamSinks[t]=d,new Promise((function(t){t(c(e.data,d))})).then((function(){s.postMessage({sourceName:i,targetName:n,stream:r.START_COMPLETE,streamId:t,success:!0})}),(function(e){s.postMessage({sourceName:i,targetName:n,stream:r.START_COMPLETE,streamId:t,reason:o(e)})}))}},{key:"_processStreamMessage",value:function(e){var t=e.streamId,i=this.sourceName,n=e.sourceName,s=this.comObj,l=this.streamControllers[t],c=this.streamSinks[t];switch(e.stream){case r.START_COMPLETE:e.success?l.startCall.resolve():l.startCall.reject(o(e.reason));break;case r.PULL_COMPLETE:e.success?l.pullCall.resolve():l.pullCall.reject(o(e.reason));break;case r.PULL:if(!c){s.postMessage({sourceName:i,targetName:n,stream:r.PULL_COMPLETE,streamId:t,success:!0});break}c.desiredSize<=0&&e.desiredSize>0&&c.sinkCapability.resolve(),c.desiredSize=e.desiredSize,new Promise((function(e){e(c.onPull&&c.onPull())})).then((function(){s.postMessage({sourceName:i,targetName:n,stream:r.PULL_COMPLETE,streamId:t,success:!0})}),(function(e){s.postMessage({sourceName:i,targetName:n,stream:r.PULL_COMPLETE,streamId:t,reason:o(e)})}));break;case r.ENQUEUE:if((0,a.assert)(l,"enqueue should have stream controller"),l.isClosed)break;l.controller.enqueue(e.chunk);break;case r.CLOSE:if((0,a.assert)(l,"close should have stream controller"),l.isClosed)break;l.isClosed=!0,l.controller.close(),this._deleteStreamController(l,t);break;case r.ERROR:(0,a.assert)(l,"error should have stream controller"),l.controller.error(o(e.reason)),this._deleteStreamController(l,t);break;case r.CANCEL_COMPLETE:e.success?l.cancelCall.resolve():l.cancelCall.reject(o(e.reason)),this._deleteStreamController(l,t);break;case r.CANCEL:if(!c)break;new Promise((function(t){t(c.onCancel&&c.onCancel(o(e.reason)))})).then((function(){s.postMessage({sourceName:i,targetName:n,stream:r.CANCEL_COMPLETE,streamId:t,success:!0})}),(function(e){s.postMessage({sourceName:i,targetName:n,stream:r.CANCEL_COMPLETE,streamId:t,reason:o(e)})})),c.sinkCapability.reject(o(e.reason)),c.isCancelled=!0,delete this.streamSinks[t];break;default:throw new Error("Unexpected stream case")}}},{key:"_deleteStreamController",value:function(){var e=_asyncToGenerator(_regeneratorRuntime().mark((function e(t,i){return _regeneratorRuntime().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,Promise.allSettled([t.startCall&&t.startCall.promise,t.pullCall&&t.pullCall.promise,t.cancelCall&&t.cancelCall.promise]);case 2:delete this.streamControllers[i];case 3:case"end":return e.stop()}}),e,this)})));return function(t,i){return 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Map}),_classPrivateFieldInitSpec(this,c,{writable:!0,value:null}),_classPrivateFieldInitSpec(this,d,{writable:!0,value:null}),this.name=null,this.creator=null,null!==t){this.name=t.name,this.creator=t.creator,_classPrivateFieldSet(this,d,t.order);var i,a=_createForOfIteratorHelper(t.groups);try{for(a.s();!(i=a.n()).done;){var r=i.value;_classPrivateFieldGet(this,l).set(r.id,new o(r.name,r.intent))}}catch(C){a.e(C)}finally{a.f()}if("OFF"===t.baseState){var p,m=_createForOfIteratorHelper(_classPrivateFieldGet(this,l).values());try{for(m.s();!(p=m.n()).done;)p.value._setVisible(n,!1)}catch(C){m.e(C)}finally{m.f()}}var h,f=_createForOfIteratorHelper(t.on);try{for(f.s();!(h=f.n()).done;){var y=h.value;_classPrivateFieldGet(this,l).get(y)._setVisible(n,!0)}}catch(C){f.e(C)}finally{f.f()}var b,g=_createForOfIteratorHelper(t.off);try{for(g.s();!(b=g.n()).done;){var v=b.value;_classPrivateFieldGet(this,l).get(v)._setVisible(n,!1)}}catch(C){g.e(C)}finally{g.f()}_classPrivateFieldSet(this,c,new 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_classPrivateFieldSet(this,s,!0)}},{key:"getOrder",value:function(){return _classPrivateFieldGet(this,l).size?_classPrivateFieldGet(this,d)?_classPrivateFieldGet(this,d).slice():_toConsumableArray(_classPrivateFieldGet(this,l).keys()):null}},{key:"getGroups",value:function(){return _classPrivateFieldGet(this,l).size>0?(0,a.objectFromMap)(_classPrivateFieldGet(this,l)):null}},{key:"getGroup",value:function(e){return _classPrivateFieldGet(this,l).get(e)||null}}]),e}();function m(e){var t=e.length;if(t<2)return!0;for(var i=e[0],n=1;n<t;n++){var r=e[n],o=void 0;if(Array.isArray(r))o=_classPrivateMethodGet(this,u,m).call(this,r);else{if(!_classPrivateFieldGet(this,l).has(r))return(0,a.warn)("Optional content group not found: 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i._begin===e.begin&&(i._enqueue(t),!0)}));(0,a.assert)(i,"_onReceiveData - no `PDFDataTransportStreamRangeReader` instance found.")}}},{key:"_progressiveDataLength",get:function(){var e,t;return null!==(e=null===(t=this._fullRequestReader)||void 0===t?void 0:t._loaded)&&void 0!==e?e:0}},{key:"_onProgress",value:function(e){if(void 0===e.total){var t=this._rangeReaders[0];null!==t&&void 0!==t&&t.onProgress&&t.onProgress({loaded:e.loaded})}else{var i=this._fullRequestReader;null!==i&&void 0!==i&&i.onProgress&&i.onProgress({loaded:e.loaded,total:e.total})}}},{key:"_onProgressiveDone",value:function(){this._fullRequestReader&&this._fullRequestReader.progressiveDone(),this._progressiveDone=!0}},{key:"_removeRangeReader",value:function(e){var t=this._rangeReaders.indexOf(e);t>=0&&this._rangeReaders.splice(t,1)}},{key:"getFullReader",value:function(){(0,a.assert)(!this._fullRequestReader,"PDFDataTransportStream.getFullReader can only be called once.");var e=this._queuedChunks;return 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e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"cancel",value:function(e){this._done=!0;var t,i=_createForOfIteratorHelper(this._requests);try{for(i.s();!(t=i.n()).done;)t.value.resolve({value:void 0,done:!0})}catch(a){i.e(a)}finally{i.f()}this._requests.length=0,this._stream._removeRangeReader(this)}}]),e}()},function(e,t){Object.defineProperty(t,"__esModule",{value:!0}),t.XfaText=void 0;var i=function(){function e(){_classCallCheck(this,e)}return _createClass(e,null,[{key:"textContent",value:function(t){var i=[],a={items:i,styles:Object.create(null)};return function t(a){var n;if(a){var r=null,o=a.name;if("#text"===o)r=a.value;else{if(!e.shouldBuildText(o))return;null!==a&&void 0!==a&&null!==(n=a.attributes)&&void 0!==n&&n.textContent?r=a.attributes.textContent:a.value&&(r=a.value)}if(null!==r&&i.push({str:r}),a.children){var s,l=_createForOfIteratorHelper(a.children);try{for(l.s();!(s=l.n()).done;)t(s.value)}catch(c){l.e(c)}finally{l.f()}}}}(t),a}},{key:"shouldBuildText",value:function(e){return!("textarea"===e||"input"===e||"option"===e||"select"===e)}}]),e}();t.XfaText=i},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.NodeStandardFontDataFactory=t.NodeCanvasFactory=t.NodeCMapReaderFactory=void 0;var a=i(9),n=function(e){return new Promise((function(t,i){__webpack_require__(9080).readFile(e,(function(e,a){!e&&a?t(new Uint8Array(a)):i(new Error(e))}))}))},r=function(e){_inherits(i,e);var t=_createSuper(i);function i(){return _classCallCheck(this,i),t.apply(this,arguments)}return _createClass(i,[{key:"_createCanvas",value:function(e,t){return __webpack_require__(9349).createCanvas(e,t)}}]),i}(a.BaseCanvasFactory);t.NodeCanvasFactory=r;var o=function(e){_inherits(i,e);var t=_createSuper(i);function i(){return _classCallCheck(this,i),t.apply(this,arguments)}return _createClass(i,[{key:"_fetchData",value:function(e,t){return n(e).then((function(e){return{cMapData:e,compressionType:t}}))}}]),i}(a.BaseCMapReaderFactory);t.NodeCMapReaderFactory=o;var s=function(e){_inherits(i,e);var t=_createSuper(i);function i(){return _classCallCheck(this,i),t.apply(this,arguments)}return _createClass(i,[{key:"_fetchData",value:function(e){return n(e)}}]),i}(a.BaseStandardFontDataFactory);t.NodeStandardFontDataFactory=s},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.AnnotationEditorLayer=void 0;var a=i(7),n=i(1),r=i(23),o=i(24),s=new WeakMap,l=new WeakMap,c=new WeakMap,d=new WeakMap,u=new WeakMap,p=new WeakMap,m=new WeakMap,h=new WeakMap,f=new WeakSet,y=new WeakSet,b=new WeakSet,g=new WeakSet,v=function(){function e(t){_classCallCheck(this,e),_classPrivateMethodInitSpec(this,g),_classPrivateMethodInitSpec(this,b),_classPrivateMethodInitSpec(this,y),_classPrivateMethodInitSpec(this,f),_classPrivateFieldInitSpec(this,s,{writable:!0,value:void 0}),_classPrivateFieldInitSpec(this,l,{writable:!0,value:!1}),_classPrivateFieldInitSpec(this,c,{writable:!0,value:this.pointerup.bind(this)}),_classPrivateFieldInitSpec(this,d,{writable:!0,value:this.pointerdown.bind(this)}),_classPrivateFieldInitSpec(this,u,{writable:!0,value:new Map}),_classPrivateFieldInitSpec(this,p,{writable:!0,value:!1}),_classPrivateFieldInitSpec(this,m,{writable:!0,value:!1}),_classPrivateFieldInitSpec(this,h,{writable:!0,value:void 0}),e._initialized||(e._initialized=!0,r.FreeTextEditor.initialize(t.l10n),o.InkEditor.initialize(t.l10n),t.uiManager.registerEditorTypes([r.FreeTextEditor,o.InkEditor])),_classPrivateFieldSet(this,h,t.uiManager),this.annotationStorage=t.annotationStorage,this.pageIndex=t.pageIndex,this.div=t.div,_classPrivateFieldSet(this,s,t.accessibilityManager),_classPrivateFieldGet(this,h).addLayer(this)}return _createClass(e,[{key:"updateToolbar",value:function(e){_classPrivateFieldGet(this,h).updateToolbar(e)}},{key:"updateMode",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:_classPrivateFieldGet(this,h).getMode();_classPrivateMethodGet(this,g,w).call(this),e===n.AnnotationEditorType.INK?(this.addInkEditorIfNeeded(!1),this.disableClick()):this.enableClick(),_classPrivateFieldGet(this,h).unselectAll()}},{key:"addInkEditorIfNeeded",value:function(e){if(e||_classPrivateFieldGet(this,h).getMode()===n.AnnotationEditorType.INK){if(!e){var t,i=_createForOfIteratorHelper(_classPrivateFieldGet(this,u).values());try{for(i.s();!(t=i.n()).done;){var a=t.value;if(a.isEmpty())return void a.setInBackground()}}catch(r){i.e(r)}finally{i.f()}}_classPrivateMethodGet(this,b,x).call(this,{offsetX:0,offsetY:0}).setInBackground()}}},{key:"setEditingState",value:function(e){_classPrivateFieldGet(this,h).setEditingState(e)}},{key:"addCommands",value:function(e){_classPrivateFieldGet(this,h).addCommands(e)}},{key:"enable",value:function(){this.div.style.pointerEvents="auto";var e,t=_createForOfIteratorHelper(_classPrivateFieldGet(this,u).values());try{for(t.s();!(e=t.n()).done;)e.value.enableEditing()}catch(i){t.e(i)}finally{t.f()}}},{key:"disable",value:function(){this.div.style.pointerEvents="none";var e,t=_createForOfIteratorHelper(_classPrivateFieldGet(this,u).values());try{for(t.s();!(e=t.n()).done;)e.value.disableEditing()}catch(i){t.e(i)}finally{t.f()}}},{key:"setActiveEditor",value:function(e){_classPrivateFieldGet(this,h).getActive()!==e&&_classPrivateFieldGet(this,h).setActiveEditor(e)}},{key:"enableClick",value:function(){this.div.addEventListener("pointerdown",_classPrivateFieldGet(this,d)),this.div.addEventListener("pointerup",_classPrivateFieldGet(this,c))}},{key:"disableClick",value:function(){this.div.removeEventListener("pointerdown",_classPrivateFieldGet(this,d)),this.div.removeEventListener("pointerup",_classPrivateFieldGet(this,c))}},{key:"attach",value:function(e){_classPrivateFieldGet(this,u).set(e.id,e)}},{key:"detach",value:function(e){var t;_classPrivateFieldGet(this,u).delete(e.id),null===(t=_classPrivateFieldGet(this,s))||void 0===t||t.removePointerInTextLayer(e.contentDiv)}},{key:"remove",value:function(e){var t=this;_classPrivateFieldGet(this,h).removeEditor(e),this.detach(e),this.annotationStorage.remove(e.id),e.div.style.display="none",setTimeout((function(){e.div.style.display="",e.div.remove(),e.isAttachedToDOM=!1,document.activeElement===document.body&&_classPrivateFieldGet(t,h).focusMainContainer()}),0),_classPrivateFieldGet(this,m)||this.addInkEditorIfNeeded(!1)}},{key:"add",value:function(e){if(_classPrivateMethodGet(this,f,_).call(this,e),_classPrivateFieldGet(this,h).addEditor(e),this.attach(e),!e.isAttachedToDOM){var t=e.render();this.div.append(t),e.isAttachedToDOM=!0}this.moveEditorInDOM(e),e.onceAdded(),this.addToAnnotationStorage(e)}},{key:"moveEditorInDOM",value:function(e){var t;null===(t=_classPrivateFieldGet(this,s))||void 0===t||t.moveElementInDOM(this.div,e.div,e.contentDiv,!0)}},{key:"addToAnnotationStorage",value:function(e){e.isEmpty()||this.annotationStorage.has(e.id)||this.annotationStorage.setValue(e.id,e)}},{key:"addOrRebuild",value:function(e){e.needsToBeRebuilt()?e.rebuild():this.add(e)}},{key:"addANewEditor",value:function(e){var t=this;this.addCommands({cmd:function(){t.addOrRebuild(e)},undo:function(){e.remove()},mustExec:!0})}},{key:"addUndoableEditor",value:function(e){var t=this;this.addCommands({cmd:function(){t.addOrRebuild(e)},undo:function(){e.remove()},mustExec:!1})}},{key:"getNextId",value:function(){return _classPrivateFieldGet(this,h).getId()}},{key:"deserialize",value:function(e){switch(e.annotationType){case n.AnnotationEditorType.FREETEXT:return r.FreeTextEditor.deserialize(e,this);case n.AnnotationEditorType.INK:return o.InkEditor.deserialize(e,this)}return null}},{key:"setSelected",value:function(e){_classPrivateFieldGet(this,h).setSelected(e)}},{key:"toggleSelected",value:function(e){_classPrivateFieldGet(this,h).toggleSelected(e)}},{key:"isSelected",value:function(e){return _classPrivateFieldGet(this,h).isSelected(e)}},{key:"unselect",value:function(e){_classPrivateFieldGet(this,h).unselect(e)}},{key:"pointerup",value:function(e){var t=a.KeyboardManager.platform.isMac;0!==e.button||e.ctrlKey&&t||e.target===this.div&&_classPrivateFieldGet(this,p)&&(_classPrivateFieldSet(this,p,!1),_classPrivateFieldGet(this,l)?_classPrivateMethodGet(this,b,x).call(this,e):_classPrivateFieldSet(this,l,!0))}},{key:"pointerdown",value:function(e){var t=a.KeyboardManager.platform.isMac;if(!(0!==e.button||e.ctrlKey&&t)&&e.target===this.div){_classPrivateFieldSet(this,p,!0);var i=_classPrivateFieldGet(this,h).getActive();_classPrivateFieldSet(this,l,!i||i.isEmpty())}}},{key:"drop",value:function(e){var t=e.dataTransfer.getData("text/plain"),i=_classPrivateFieldGet(this,h).getEditor(t);if(i){e.preventDefault(),e.dataTransfer.dropEffect="move",_classPrivateMethodGet(this,f,_).call(this,i);var a=this.div.getBoundingClientRect(),n=e.clientX-a.x,r=e.clientY-a.y;i.translate(n-i.startX,r-i.startY),this.moveEditorInDOM(i),i.div.focus()}}},{key:"dragover",value:function(e){e.preventDefault()}},{key:"destroy",value:function(){var e;(null===(e=_classPrivateFieldGet(this,h).getActive())||void 0===e?void 0:e.parent)===this&&_classPrivateFieldGet(this,h).setActiveEditor(null);var t,i=_createForOfIteratorHelper(_classPrivateFieldGet(this,u).values());try{for(i.s();!(t=i.n()).done;){var a,n=t.value;null===(a=_classPrivateFieldGet(this,s))||void 0===a||a.removePointerInTextLayer(n.contentDiv),n.isAttachedToDOM=!1,n.div.remove(),n.parent=null}}catch(r){i.e(r)}finally{i.f()}this.div=null,_classPrivateFieldGet(this,u).clear(),_classPrivateFieldGet(this,h).removeLayer(this)}},{key:"render",value:function(e){this.viewport=e.viewport,(0,a.bindEvents)(this,this.div,["dragover","drop"]),this.setDimensions();var t,i=_createForOfIteratorHelper(_classPrivateFieldGet(this,h).getEditors(this.pageIndex));try{for(i.s();!(t=i.n()).done;){var n=t.value;this.add(n)}}catch(r){i.e(r)}finally{i.f()}this.updateMode()}},{key:"update",value:function(e){this.viewport=e.viewport,this.setDimensions(),this.updateMode()}},{key:"scaleFactor",get:function(){return this.viewport.scale}},{key:"pageDimensions",get:function(){var e=_slicedToArray(this.viewport.viewBox,4),t=e[0],i=e[1];return[e[2]-t,e[3]-i]}},{key:"viewportBaseDimensions",get:function(){var e=this.viewport,t=e.width,i=e.height;return e.rotation%180===0?[t,i]:[i,t]}},{key:"setDimensions",value:function(){var e=this.viewport,t=e.width,i=e.height,a=e.rotation,n=a%180!==0,r=Math.floor(t)+"px",o=Math.floor(i)+"px";this.div.style.width=n?o:r,this.div.style.height=n?r:o,this.div.setAttribute("data-main-rotation",a)}}]),e}();function _(e){var t;e.parent!==this&&(this.attach(e),e.pageIndex=this.pageIndex,null===(t=e.parent)||void 0===t||t.detach(e),e.parent=this,e.div&&e.isAttachedToDOM&&(e.div.remove(),this.div.append(e.div)))}function A(e){switch(_classPrivateFieldGet(this,h).getMode()){case n.AnnotationEditorType.FREETEXT:return new r.FreeTextEditor(e);case n.AnnotationEditorType.INK:return new o.InkEditor(e)}return null}function x(e){var t=this.getNextId(),i=_classPrivateMethodGet(this,y,A).call(this,{parent:this,id:t,x:e.offsetX,y:e.offsetY});return i&&this.add(i),i}function w(){_classPrivateFieldSet(this,m,!0);var e,t=_createForOfIteratorHelper(_classPrivateFieldGet(this,u).values());try{for(t.s();!(e=t.n()).done;){var i=e.value;i.isEmpty()&&i.remove()}}catch(a){t.e(a)}finally{t.f()}_classPrivateFieldSet(this,m,!1)}_defineProperty(v,"_initialized",!1),t.AnnotationEditorLayer=v},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.FreeTextEditor=void 0;var a=i(1),n=i(7),r=i(6),o=new WeakMap,s=new WeakMap,l=new WeakMap,c=new WeakMap,d=new WeakMap,u=new WeakMap,p=new WeakMap,m=new WeakSet,h=new WeakSet,f=new WeakSet,y=new WeakSet,b=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a;return _classCallCheck(this,i),a=t.call(this,_objectSpread(_objectSpread({},e),{},{name:"freeTextEditor"})),_classPrivateMethodInitSpec(_assertThisInitialized(a),y),_classPrivateMethodInitSpec(_assertThisInitialized(a),f),_classPrivateMethodInitSpec(_assertThisInitialized(a),h),_classPrivateMethodInitSpec(_assertThisInitialized(a),m),_classPrivateFieldInitSpec(_assertThisInitialized(a),o,{writable:!0,value:a.editorDivBlur.bind(_assertThisInitialized(a))}),_classPrivateFieldInitSpec(_assertThisInitialized(a),s,{writable:!0,value:a.editorDivFocus.bind(_assertThisInitialized(a))}),_classPrivateFieldInitSpec(_assertThisInitialized(a),l,{writable:!0,value:a.editorDivKeydown.bind(_assertThisInitialized(a))}),_classPrivateFieldInitSpec(_assertThisInitialized(a),c,{writable:!0,value:void 0}),_classPrivateFieldInitSpec(_assertThisInitialized(a),d,{writable:!0,value:""}),_classPrivateFieldInitSpec(_assertThisInitialized(a),u,{writable:!0,value:!1}),_classPrivateFieldInitSpec(_assertThisInitialized(a),p,{writable:!0,value:void 0}),_classPrivateFieldSet(_assertThisInitialized(a),c,e.color||i._defaultColor||r.AnnotationEditor._defaultLineColor),_classPrivateFieldSet(_assertThisInitialized(a),p,e.fontSize||i._defaultFontSize),a}return _createClass(i,[{key:"updateParams",value:function(e,t){switch(e){case a.AnnotationEditorParamsType.FREETEXT_SIZE:_classPrivateMethodGet(this,m,g).call(this,t);break;case a.AnnotationEditorParamsType.FREETEXT_COLOR:_classPrivateMethodGet(this,h,v).call(this,t)}}},{key:"propertiesToUpdate",get:function(){return[[a.AnnotationEditorParamsType.FREETEXT_SIZE,_classPrivateFieldGet(this,p)],[a.AnnotationEditorParamsType.FREETEXT_COLOR,_classPrivateFieldGet(this,c)]]}},{key:"getInitialTranslation",value:function(){return[-i._internalPadding*this.parent.scaleFactor,-(i._internalPadding+_classPrivateFieldGet(this,p))*this.parent.scaleFactor]}},{key:"rebuild",value:function(){_get(_getPrototypeOf(i.prototype),"rebuild",this).call(this),null!==this.div&&(this.isAttachedToDOM||this.parent.add(this))}},{key:"enableEditMode",value:function(){this.isInEditMode()||(this.parent.setEditingState(!1),this.parent.updateToolbar(a.AnnotationEditorType.FREETEXT),_get(_getPrototypeOf(i.prototype),"enableEditMode",this).call(this),this.enableEditing(),this.overlayDiv.classList.remove("enabled"),this.editorDiv.contentEditable=!0,this.div.draggable=!1,this.editorDiv.addEventListener("keydown",_classPrivateFieldGet(this,l)),this.editorDiv.addEventListener("focus",_classPrivateFieldGet(this,s)),this.editorDiv.addEventListener("blur",_classPrivateFieldGet(this,o)))}},{key:"disableEditMode",value:function(){this.isInEditMode()&&(this.parent.setEditingState(!0),_get(_getPrototypeOf(i.prototype),"disableEditMode",this).call(this),this.disableEditing(),this.overlayDiv.classList.add("enabled"),this.editorDiv.contentEditable=!1,this.div.draggable=!0,this.editorDiv.removeEventListener("keydown",_classPrivateFieldGet(this,l)),this.editorDiv.removeEventListener("focus",_classPrivateFieldGet(this,s)),this.editorDiv.removeEventListener("blur",_classPrivateFieldGet(this,o)),this.div.focus(),this.isEditing=!1)}},{key:"focusin",value:function(e){_get(_getPrototypeOf(i.prototype),"focusin",this).call(this,e),e.target!==this.editorDiv&&this.editorDiv.focus()}},{key:"onceAdded",value:function(){this.width||(this.enableEditMode(),this.editorDiv.focus())}},{key:"isEmpty",value:function(){return!this.editorDiv||""===this.editorDiv.innerText.trim()}},{key:"remove",value:function(){this.isEditing=!1,this.parent.setEditingState(!0),_get(_getPrototypeOf(i.prototype),"remove",this).call(this)}},{key:"commit",value:function(){_get(_getPrototypeOf(i.prototype),"commit",this).call(this),_classPrivateFieldGet(this,u)||(_classPrivateFieldSet(this,u,!0),this.parent.addUndoableEditor(this)),this.disableEditMode(),_classPrivateFieldSet(this,d,_classPrivateMethodGet(this,f,_).call(this).trimEnd()),_classPrivateMethodGet(this,y,A).call(this)}},{key:"shouldGetKeyboardEvents",value:function(){return this.isInEditMode()}},{key:"dblclick",value:function(e){this.enableEditMode(),this.editorDiv.focus()}},{key:"keydown",value:function(e){e.target===this.div&&"Enter"===e.key&&(this.enableEditMode(),this.editorDiv.focus())}},{key:"editorDivKeydown",value:function(e){i._keyboardManager.exec(this,e)}},{key:"editorDivFocus",value:function(e){this.isEditing=!0}},{key:"editorDivBlur",value:function(e){this.isEditing=!1}},{key:"disableEditing",value:function(){this.editorDiv.setAttribute("role","comment"),this.editorDiv.removeAttribute("aria-multiline")}},{key:"enableEditing",value:function(){this.editorDiv.setAttribute("role","textbox"),this.editorDiv.setAttribute("aria-multiline",!0)}},{key:"render",value:function(){var e,t,a=this;if(this.div)return this.div;this.width&&(e=this.x,t=this.y),_get(_getPrototypeOf(i.prototype),"render",this).call(this),this.editorDiv=document.createElement("div"),this.editorDiv.className="internal",this.editorDiv.setAttribute("id","".concat(this.id,"-editor")),this.enableEditing(),i._l10nPromise.get("editor_free_text_aria_label").then((function(e){var t;return null===(t=a.editorDiv)||void 0===t?void 0:t.setAttribute("aria-label",e)})),i._l10nPromise.get("free_text_default_content").then((function(e){var t;return null===(t=a.editorDiv)||void 0===t?void 0:t.setAttribute("default-content",e)})),this.editorDiv.contentEditable=!0;var r=this.editorDiv.style;if(r.fontSize="calc(".concat(_classPrivateFieldGet(this,p),"px * var(--scale-factor))"),r.color=_classPrivateFieldGet(this,c),this.div.append(this.editorDiv),this.overlayDiv=document.createElement("div"),this.overlayDiv.classList.add("overlay","enabled"),this.div.append(this.overlayDiv),(0,n.bindEvents)(this,this.div,["dblclick","keydown"]),this.width){var o=_slicedToArray(this.parent.viewportBaseDimensions,2),s=o[0],l=o[1];this.setAt(e*s,t*l,this.width*s,this.height*l);var u,m=_createForOfIteratorHelper(_classPrivateFieldGet(this,d).split("\n"));try{for(m.s();!(u=m.n()).done;){var h=u.value,f=document.createElement("div");f.append(h?document.createTextNode(h):document.createElement("br")),this.editorDiv.append(f)}}catch(y){m.e(y)}finally{m.f()}this.div.draggable=!0,this.editorDiv.contentEditable=!1}else this.div.draggable=!1,this.editorDiv.contentEditable=!0;return this.div}},{key:"contentDiv",get:function(){return this.editorDiv}},{key:"serialize",value:function(){if(this.isEmpty())return null;var e=i._internalPadding*this.parent.scaleFactor,t=this.getRect(e,e),n=r.AnnotationEditor._colorManager.convert(getComputedStyle(this.editorDiv).color);return{annotationType:a.AnnotationEditorType.FREETEXT,color:n,fontSize:_classPrivateFieldGet(this,p),value:_classPrivateFieldGet(this,d),pageIndex:this.parent.pageIndex,rect:t,rotation:this.rotation}}}],[{key:"initialize",value:function(e){this._l10nPromise=new Map(["free_text_default_content","editor_free_text_aria_label"].map((function(t){return[t,e.get(t)]})));var t=getComputedStyle(document.documentElement);this._internalPadding=parseFloat(t.getPropertyValue("--freetext-padding"))}},{key:"updateDefaultParams",value:function(e,t){switch(e){case a.AnnotationEditorParamsType.FREETEXT_SIZE:i._defaultFontSize=t;break;case a.AnnotationEditorParamsType.FREETEXT_COLOR:i._defaultColor=t}}},{key:"defaultPropertiesToUpdate",get:function(){return[[a.AnnotationEditorParamsType.FREETEXT_SIZE,i._defaultFontSize],[a.AnnotationEditorParamsType.FREETEXT_COLOR,i._defaultColor||r.AnnotationEditor._defaultLineColor]]}},{key:"deserialize",value:function(e,t){var n,r=_get(_getPrototypeOf(i),"deserialize",this).call(this,e,t);return _classPrivateFieldSet(r,p,e.fontSize),_classPrivateFieldSet(r,c,(n=a.Util).makeHexColor.apply(n,_toConsumableArray(e.color))),_classPrivateFieldSet(r,d,e.value),r}}]),i}(r.AnnotationEditor);function g(e){var t=this,i=function(e){t.editorDiv.style.fontSize="calc(".concat(e,"px * var(--scale-factor))"),t.translate(0,-(e-_classPrivateFieldGet(t,p))*t.parent.scaleFactor),_classPrivateFieldSet(t,p,e),_classPrivateMethodGet(t,y,A).call(t)},n=_classPrivateFieldGet(this,p);this.parent.addCommands({cmd:function(){i(e)},undo:function(){i(n)},mustExec:!0,type:a.AnnotationEditorParamsType.FREETEXT_SIZE,overwriteIfSameType:!0,keepUndo:!0})}function v(e){var t=this,i=_classPrivateFieldGet(this,c);this.parent.addCommands({cmd:function(){_classPrivateFieldSet(t,c,e),t.editorDiv.style.color=e},undo:function(){_classPrivateFieldSet(t,c,i),t.editorDiv.style.color=i},mustExec:!0,type:a.AnnotationEditorParamsType.FREETEXT_COLOR,overwriteIfSameType:!0,keepUndo:!0})}function _(){var e=this.editorDiv.getElementsByTagName("div");if(0===e.length)return this.editorDiv.innerText;for(var t=[],i=0,a=e.length;i<a;i++){var n=e[i].firstChild;"#text"===(null===n||void 0===n?void 0:n.nodeName)?t.push(n.data):t.push("")}return t.join("\n")}function A(){var e=_slicedToArray(this.parent.viewportBaseDimensions,2),t=e[0],i=e[1],a=this.div.getBoundingClientRect();this.width=a.width/t,this.height=a.height/i}_defineProperty(b,"_freeTextDefaultContent",""),_defineProperty(b,"_l10nPromise",void 0),_defineProperty(b,"_internalPadding",0),_defineProperty(b,"_defaultColor",null),_defineProperty(b,"_defaultFontSize",10),_defineProperty(b,"_keyboardManager",new n.KeyboardManager([[["ctrl+Enter","mac+meta+Enter","Escape","mac+Escape"],b.prototype.commitOrRemove]])),_defineProperty(b,"_type","freetext"),t.FreeTextEditor=b},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.InkEditor=void 0,Object.defineProperty(t,"fitCurve",{enumerable:!0,get:function(){return r.fitCurve}});var a=i(1),n=i(6),r=i(25),o=i(7),s=16,l=new WeakMap,c=new WeakMap,d=new WeakMap,u=new WeakMap,p=new WeakMap,m=new WeakMap,h=new WeakMap,f=new WeakMap,y=new WeakMap,b=new WeakMap,g=new WeakMap,v=new WeakMap,_=new WeakMap,A=new WeakMap,x=new WeakSet,w=new WeakSet,S=new WeakSet,C=new WeakSet,k=new WeakSet,D=new WeakSet,R=new WeakSet,I=new WeakSet,M=new WeakSet,T=new WeakSet,P=new WeakSet,z=new WeakSet,B=new WeakSet,F=new WeakSet,E=new WeakSet,N=new WeakSet,O=new WeakSet,G=new WeakSet,L=new WeakSet,j=new WeakSet,q=new WeakSet,H=new WeakSet,U=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a;return _classCallCheck(this,i),a=t.call(this,_objectSpread(_objectSpread({},e),{},{name:"inkEditor"})),_classPrivateMethodInitSpec(_assertThisInitialized(a),H),_classPrivateMethodInitSpec(_assertThisInitialized(a),q),_classPrivateMethodInitSpec(_assertThisInitialized(a),j),_classPrivateMethodInitSpec(_assertThisInitialized(a),L),_classPrivateMethodInitSpec(_assertThisInitialized(a),G),_classPrivateMethodInitSpec(_assertThisInitialized(a),O),_classPrivateMethodInitSpec(_assertThisInitialized(a),N),_classPrivateMethodInitSpec(_assertThisInitialized(a),E),_classPrivateMethodInitSpec(_assertThisInitialized(a),F),_classPrivateMethodInitSpec(_assertThisInitialized(a),B),_classPrivateMethodInitSpec(_assertThisInitialized(a),z),_classPrivateMethodInitSpec(_assertThisInitialized(a),P),_classPrivateMethodInitSpec(_assertThisInitialized(a),T),_classPrivateMethodInitSpec(_assertThisInitialized(a),M),_classPrivateMethodInitSpec(_assertThisInitialized(a),I),_classPrivateMethodInitSpec(_assertThisInitialized(a),R),_classPrivateMethodInitSpec(_assertThisInitialized(a),D),_classPrivateMethodInitSpec(_assertThisInitialized(a),k),_classPrivateMethodInitSpec(_assertThisInitialized(a),C),_classPrivateMethodInitSpec(_assertThisInitialized(a),S),_classPrivateMethodInitSpec(_assertThisInitialized(a),w),_classPrivateMethodInitSpec(_assertThisInitialized(a),x),_classPrivateFieldInitSpec(_assertThisInitialized(a),l,{writable:!0,value:0}),_classPrivateFieldInitSpec(_assertThisInitialized(a),c,{writable:!0,value:0}),_classPrivateFieldInitSpec(_assertThisInitialized(a),d,{writable:!0,value:0}),_classPrivateFieldInitSpec(_assertThisInitialized(a),u,{writable:!0,value:a.canvasPointermove.bind(_assertThisInitialized(a))}),_classPrivateFieldInitSpec(_assertThisInitialized(a),p,{writable:!0,value:a.canvasPointerleave.bind(_assertThisInitialized(a))}),_classPrivateFieldInitSpec(_assertThisInitialized(a),m,{writable:!0,value:a.canvasPointerup.bind(_assertThisInitialized(a))}),_classPrivateFieldInitSpec(_assertThisInitialized(a),h,{writable:!0,value:a.canvasPointerdown.bind(_assertThisInitialized(a))}),_classPrivateFieldInitSpec(_assertThisInitialized(a),f,{writable:!0,value:!1}),_classPrivateFieldInitSpec(_assertThisInitialized(a),y,{writable:!0,value:!1}),_classPrivateFieldInitSpec(_assertThisInitialized(a),b,{writable:!0,value:null}),_classPrivateFieldInitSpec(_assertThisInitialized(a),g,{writable:!0,value:null}),_classPrivateFieldInitSpec(_assertThisInitialized(a),v,{writable:!0,value:0}),_classPrivateFieldInitSpec(_assertThisInitialized(a),_,{writable:!0,value:0}),_classPrivateFieldInitSpec(_assertThisInitialized(a),A,{writable:!0,value:null}),a.color=e.color||null,a.thickness=e.thickness||null,a.opacity=e.opacity||null,a.paths=[],a.bezierPath2D=[],a.currentPath=[],a.scaleFactor=1,a.translationX=a.translationY=0,a.x=0,a.y=0,a}return _createClass(i,[{key:"updateParams",value:function(e,t){switch(e){case a.AnnotationEditorParamsType.INK_THICKNESS:_classPrivateMethodGet(this,x,Y).call(this,t);break;case a.AnnotationEditorParamsType.INK_COLOR:_classPrivateMethodGet(this,w,X).call(this,t);break;case a.AnnotationEditorParamsType.INK_OPACITY:_classPrivateMethodGet(this,S,V).call(this,t)}}},{key:"propertiesToUpdate",get:function(){var e;return[[a.AnnotationEditorParamsType.INK_THICKNESS,this.thickness||i._defaultThickness],[a.AnnotationEditorParamsType.INK_COLOR,this.color||i._defaultColor||n.AnnotationEditor._defaultLineColor],[a.AnnotationEditorParamsType.INK_OPACITY,Math.round(100*(null!==(e=this.opacity)&&void 0!==e?e:i._defaultOpacity))]]}},{key:"rebuild",value:function(){_get(_getPrototypeOf(i.prototype),"rebuild",this).call(this),null!==this.div&&(this.canvas||(_classPrivateMethodGet(this,P,te).call(this),_classPrivateMethodGet(this,z,ie).call(this)),this.isAttachedToDOM||(this.parent.add(this),_classPrivateMethodGet(this,B,ae).call(this)),_classPrivateMethodGet(this,q,pe).call(this))}},{key:"remove",value:function(){null!==this.canvas&&(this.isEmpty()||this.commit(),this.canvas.width=this.canvas.height=0,this.canvas.remove(),this.canvas=null,_classPrivateFieldGet(this,g).disconnect(),_classPrivateFieldSet(this,g,null),_get(_getPrototypeOf(i.prototype),"remove",this).call(this))}},{key:"enableEditMode",value:function(){_classPrivateFieldGet(this,f)||null===this.canvas||(_get(_getPrototypeOf(i.prototype),"enableEditMode",this).call(this),this.div.draggable=!1,this.canvas.addEventListener("pointerdown",_classPrivateFieldGet(this,h)),this.canvas.addEventListener("pointerup",_classPrivateFieldGet(this,m)))}},{key:"disableEditMode",value:function(){this.isInEditMode()&&null!==this.canvas&&(_get(_getPrototypeOf(i.prototype),"disableEditMode",this).call(this),this.div.draggable=!this.isEmpty(),this.div.classList.remove("editing"),this.canvas.removeEventListener("pointerdown",_classPrivateFieldGet(this,h)),this.canvas.removeEventListener("pointerup",_classPrivateFieldGet(this,m)))}},{key:"onceAdded",value:function(){this.div.draggable=!this.isEmpty()}},{key:"isEmpty",value:function(){return 0===this.paths.length||1===this.paths.length&&0===this.paths[0].length}},{key:"commit",value:function(){_classPrivateFieldGet(this,f)||(_get(_getPrototypeOf(i.prototype),"commit",this).call(this),this.isEditing=!1,this.disableEditMode(),this.setInForeground(),_classPrivateFieldSet(this,f,!0),this.div.classList.add("disabled"),_classPrivateMethodGet(this,q,pe).call(this,!0),this.parent.addInkEditorIfNeeded(!0),this.parent.moveEditorInDOM(this),this.div.focus())}},{key:"focusin",value:function(e){_get(_getPrototypeOf(i.prototype),"focusin",this).call(this,e),this.enableEditMode()}},{key:"canvasPointerdown",value:function(e){0===e.button&&this.isInEditMode()&&!_classPrivateFieldGet(this,f)&&(this.setInForeground(),"mouse"!==e.type&&this.div.focus(),e.stopPropagation(),this.canvas.addEventListener("pointerleave",_classPrivateFieldGet(this,p)),this.canvas.addEventListener("pointermove",_classPrivateFieldGet(this,u)),_classPrivateMethodGet(this,D,Z).call(this,e.offsetX,e.offsetY))}},{key:"canvasPointermove",value:function(e){e.stopPropagation(),_classPrivateMethodGet(this,R,J).call(this,e.offsetX,e.offsetY)}},{key:"canvasPointerup",value:function(e){0===e.button&&this.isInEditMode()&&0!==this.currentPath.length&&(e.stopPropagation(),_classPrivateMethodGet(this,T,ee).call(this,e),this.setInBackground())}},{key:"canvasPointerleave",value:function(e){_classPrivateMethodGet(this,T,ee).call(this,e),this.setInBackground()}},{key:"render",value:function(){var e,t,a=this;if(this.div)return this.div;this.width&&(e=this.x,t=this.y),_get(_getPrototypeOf(i.prototype),"render",this).call(this),i._l10nPromise.get("editor_ink_aria_label").then((function(e){var t;return null===(t=a.div)||void 0===t?void 0:t.setAttribute("aria-label",e)}));var n=_classPrivateMethodGet(this,C,Q).call(this),r=_slicedToArray(n,4),o=r[0],s=r[1],l=r[2],c=r[3];if(this.setAt(o,s,0,0),this.setDims(l,c),_classPrivateMethodGet(this,P,te).call(this),this.width){var d=_slicedToArray(this.parent.viewportBaseDimensions,2),u=d[0],p=d[1];this.setAt(e*u,t*p,this.width*u,this.height*p),_classPrivateFieldSet(this,y,!0),_classPrivateMethodGet(this,B,ae).call(this),this.setDims(this.width*u,this.height*p),_classPrivateMethodGet(this,M,$).call(this),_classPrivateMethodGet(this,H,me).call(this),this.div.classList.add("disabled")}else this.div.classList.add("editing"),this.enableEditMode();return _classPrivateMethodGet(this,z,ie).call(this),this.div}},{key:"setDimensions",value:function(e,t){var i=Math.round(e),a=Math.round(t);if(_classPrivateFieldGet(this,v)!==i||_classPrivateFieldGet(this,_)!==a){_classPrivateFieldSet(this,v,i),_classPrivateFieldSet(this,_,a),this.canvas.style.visibility="hidden",_classPrivateFieldGet(this,l)&&Math.abs(_classPrivateFieldGet(this,l)-e/t)>.01&&(t=Math.ceil(e/_classPrivateFieldGet(this,l)),this.setDims(e,t));var n=_slicedToArray(this.parent.viewportBaseDimensions,2),r=n[0],o=n[1];this.width=e/r,this.height=t/o,_classPrivateFieldGet(this,f)&&_classPrivateMethodGet(this,F,ne).call(this,e,t),_classPrivateMethodGet(this,B,ae).call(this),_classPrivateMethodGet(this,M,$).call(this),this.canvas.style.visibility="visible"}}},{key:"serialize",value:function(){if(this.isEmpty())return null;var e=this.getRect(0,0),t=this.rotation%180===0?e[3]-e[1]:e[2]-e[0],i=n.AnnotationEditor._colorManager.convert(this.ctx.strokeStyle);return{annotationType:a.AnnotationEditorType.INK,color:i,thickness:this.thickness,opacity:this.opacity,paths:_classPrivateMethodGet(this,N,se).call(this,this.scaleFactor/this.parent.scaleFactor,this.translationX,this.translationY,t),pageIndex:this.parent.pageIndex,rect:e,rotation:this.rotation}}}],[{key:"initialize",value:function(e){this._l10nPromise=new Map(["editor_ink_canvas_aria_label","editor_ink_aria_label"].map((function(t){return[t,e.get(t)]})))}},{key:"updateDefaultParams",value:function(e,t){switch(e){case a.AnnotationEditorParamsType.INK_THICKNESS:i._defaultThickness=t;break;case a.AnnotationEditorParamsType.INK_COLOR:i._defaultColor=t;break;case a.AnnotationEditorParamsType.INK_OPACITY:i._defaultOpacity=t/100}}},{key:"defaultPropertiesToUpdate",get:function(){return[[a.AnnotationEditorParamsType.INK_THICKNESS,i._defaultThickness],[a.AnnotationEditorParamsType.INK_COLOR,i._defaultColor||n.AnnotationEditor._defaultLineColor],[a.AnnotationEditorParamsType.INK_OPACITY,Math.round(100*i._defaultOpacity)]]}},{key:"deserialize",value:function(e,t){var n,r=_get(_getPrototypeOf(i),"deserialize",this).call(this,e,t);r.thickness=e.thickness,r.color=(n=a.Util).makeHexColor.apply(n,_toConsumableArray(e.color)),r.opacity=e.opacity;var o=_slicedToArray(t.pageDimensions,2),u=o[0],p=o[1],m=r.width*u,h=r.height*p,y=t.scaleFactor,b=e.thickness/2;_classPrivateFieldSet(r,l,m/h),_classPrivateFieldSet(r,f,!0),_classPrivateFieldSet(r,v,Math.round(m)),_classPrivateFieldSet(r,_,Math.round(h));var g,A=_createForOfIteratorHelper(e.paths);try{for(A.s();!(g=A.n()).done;){var x=g.value.bezier,w=[];r.paths.push(w);for(var S=y*(x[0]-b),C=y*(h-x[1]-b),k=2,D=x.length;k<D;k+=6){var R=y*(x[k]-b),I=y*(h-x[k+1]-b),M=y*(x[k+2]-b),T=y*(h-x[k+3]-b),P=y*(x[k+4]-b),z=y*(h-x[k+5]-b);w.push([[S,C],[R,I],[M,T],[P,z]]),S=P,C=z}var B=_classStaticPrivateMethodGet(this,i,oe).call(this,w);r.bezierPath2D.push(B)}}catch(N){A.e(N)}finally{A.f()}var E=_classPrivateMethodGet(r,L,de).call(r);return _classPrivateFieldSet(r,d,Math.max(s,E[2]-E[0])),_classPrivateFieldSet(r,c,Math.max(s,E[3]-E[1])),_classPrivateMethodGet(r,F,ne).call(r,m,h),r}}]),i}(n.AnnotationEditor);function Y(e){var t=this,i=this.thickness;this.parent.addCommands({cmd:function(){t.thickness=e,_classPrivateMethodGet(t,q,pe).call(t)},undo:function(){t.thickness=i,_classPrivateMethodGet(t,q,pe).call(t)},mustExec:!0,type:a.AnnotationEditorParamsType.INK_THICKNESS,overwriteIfSameType:!0,keepUndo:!0})}function X(e){var t=this,i=this.color;this.parent.addCommands({cmd:function(){t.color=e,_classPrivateMethodGet(t,M,$).call(t)},undo:function(){t.color=i,_classPrivateMethodGet(t,M,$).call(t)},mustExec:!0,type:a.AnnotationEditorParamsType.INK_COLOR,overwriteIfSameType:!0,keepUndo:!0})}function V(e){var t=this;e/=100;var i=this.opacity;this.parent.addCommands({cmd:function(){t.opacity=e,_classPrivateMethodGet(t,M,$).call(t)},undo:function(){t.opacity=i,_classPrivateMethodGet(t,M,$).call(t)},mustExec:!0,type:a.AnnotationEditorParamsType.INK_OPACITY,overwriteIfSameType:!0,keepUndo:!0})}function Q(){var e=this.parent.viewport,t=e.width,i=e.height;switch(e.rotation){case 90:return[0,t,t,i];case 180:return[t,i,t,i];case 270:return[i,0,t,i];default:return[0,0,t,i]}}function W(){this.ctx.lineWidth=this.thickness*this.parent.scaleFactor/this.scaleFactor,this.ctx.lineCap="round",this.ctx.lineJoin="round",this.ctx.miterLimit=10,this.ctx.strokeStyle="".concat(this.color).concat((0,o.opacityToHex)(this.opacity))}function Z(e,t){var i,a=this;this.isEditing=!0,_classPrivateFieldGet(this,y)||(_classPrivateFieldSet(this,y,!0),_classPrivateMethodGet(this,B,ae).call(this),this.thickness||(this.thickness=U._defaultThickness),this.color||(this.color=U._defaultColor||n.AnnotationEditor._defaultLineColor),null!==(i=this.opacity)&&void 0!==i||(this.opacity=U._defaultOpacity)),this.currentPath.push([e,t]),_classPrivateFieldSet(this,b,null),_classPrivateMethodGet(this,k,W).call(this),this.ctx.beginPath(),this.ctx.moveTo(e,t),_classPrivateFieldSet(this,A,(function(){var e;_classPrivateFieldGet(a,A)&&(_classPrivateFieldGet(a,b)&&(a.isEmpty()?(a.ctx.setTransform(1,0,0,1,0,0),a.ctx.clearRect(0,0,a.canvas.width,a.canvas.height)):_classPrivateMethodGet(a,M,$).call(a),(e=a.ctx).lineTo.apply(e,_toConsumableArray(_classPrivateFieldGet(a,b))),_classPrivateFieldSet(a,b,null),a.ctx.stroke()),window.requestAnimationFrame(_classPrivateFieldGet(a,A)))})),window.requestAnimationFrame(_classPrivateFieldGet(this,A))}function J(e,t){var i=this.currentPath.at(-1),a=_slicedToArray(i,2),n=a[0],r=a[1];e===n&&t===r||(this.currentPath.push([e,t]),_classPrivateFieldSet(this,b,[e,t]))}function K(e,t){var i=this;this.ctx.closePath(),_classPrivateFieldSet(this,A,null),e=Math.min(Math.max(e,0),this.canvas.width),t=Math.min(Math.max(t,0),this.canvas.height);var a,n=this.currentPath.at(-1),o=_slicedToArray(n,2),s=o[0],l=o[1];if(e===s&&t===l||this.currentPath.push([e,t]),1!==this.currentPath.length)a=(0,r.fitCurve)(this.currentPath,30,null);else{var c=[e,t];a=[[c,c.slice(),c.slice(),c]]}var d=_classStaticPrivateMethodGet(U,U,oe).call(U,a);this.currentPath.length=0,this.parent.addCommands({cmd:function(){i.paths.push(a),i.bezierPath2D.push(d),i.rebuild()},undo:function(){i.paths.pop(),i.bezierPath2D.pop(),0===i.paths.length?i.remove():(i.canvas||(_classPrivateMethodGet(i,P,te).call(i),_classPrivateMethodGet(i,z,ie).call(i)),_classPrivateMethodGet(i,q,pe).call(i))},mustExec:!0})}function $(){if(this.isEmpty())_classPrivateMethodGet(this,E,re).call(this);else{_classPrivateMethodGet(this,k,W).call(this);var e=this.canvas,t=this.ctx;t.setTransform(1,0,0,1,0,0),t.clearRect(0,0,e.width,e.height),_classPrivateMethodGet(this,E,re).call(this);var i,a=_createForOfIteratorHelper(this.bezierPath2D);try{for(a.s();!(i=a.n()).done;){var n=i.value;t.stroke(n)}}catch(r){a.e(r)}finally{a.f()}}}function ee(e){_classPrivateMethodGet(this,I,K).call(this,e.offsetX,e.offsetY),this.canvas.removeEventListener("pointerleave",_classPrivateFieldGet(this,p)),this.canvas.removeEventListener("pointermove",_classPrivateFieldGet(this,u)),this.parent.addToAnnotationStorage(this)}function te(){var e=this;this.canvas=document.createElement("canvas"),this.canvas.width=this.canvas.height=0,this.canvas.className="inkEditorCanvas",U._l10nPromise.get("editor_ink_canvas_aria_label").then((function(t){var i;return null===(i=e.canvas)||void 0===i?void 0:i.setAttribute("aria-label",t)})),this.div.append(this.canvas),this.ctx=this.canvas.getContext("2d")}function ie(){var e=this;_classPrivateFieldSet(this,g,new ResizeObserver((function(t){var i=t[0].contentRect;i.width&&i.height&&e.setDimensions(i.width,i.height)}))),_classPrivateFieldGet(this,g).observe(this.div)}function ae(){if(_classPrivateFieldGet(this,y)){var e=_slicedToArray(this.parent.viewportBaseDimensions,2),t=e[0],i=e[1];this.canvas.width=Math.ceil(this.width*t),this.canvas.height=Math.ceil(this.height*i),_classPrivateMethodGet(this,E,re).call(this)}}function ne(e,t){var i=_classPrivateMethodGet(this,j,ue).call(this),a=(e-i)/_classPrivateFieldGet(this,d),n=(t-i)/_classPrivateFieldGet(this,c);this.scaleFactor=Math.min(a,n)}function re(){var e=_classPrivateMethodGet(this,j,ue).call(this)/2;this.ctx.setTransform(this.scaleFactor,0,0,this.scaleFactor,this.translationX*this.scaleFactor+e,this.translationY*this.scaleFactor+e)}function oe(e){for(var t=new Path2D,i=0,a=e.length;i<a;i++){var n=_slicedToArray(e[i],4),r=n[0],o=n[1],s=n[2],l=n[3];0===i&&t.moveTo.apply(t,_toConsumableArray(r)),t.bezierCurveTo(o[0],o[1],s[0],s[1],l[0],l[1])}return t}function se(e,t,i,a){var n,r,o,s=[],l=this.thickness/2,c=_createForOfIteratorHelper(this.paths);try{for(c.s();!(o=c.n()).done;){var d=o.value;n=[],r=[];for(var u=0,p=d.length;u<p;u++){var m=_slicedToArray(d[u],4),h=m[0],f=m[1],y=m[2],b=m[3],g=e*(h[0]+t)+l,v=a-e*(h[1]+i)-l,_=e*(f[0]+t)+l,A=a-e*(f[1]+i)-l,x=e*(y[0]+t)+l,w=a-e*(y[1]+i)-l,S=e*(b[0]+t)+l,C=a-e*(b[1]+i)-l;0===u&&(n.push(g,v),r.push(g,v)),n.push(_,A,x,w,S,C),_classPrivateMethodGet(this,O,le).call(this,g,v,_,A,x,w,S,C,4,r)}s.push({bezier:n,points:r})}}catch(k){c.e(k)}finally{c.f()}return s}function le(e,t,i,a,n,r,o,s,l,c){if(_classPrivateMethodGet(this,G,ce).call(this,e,t,i,a,n,r,o,s))c.push(o,s);else{for(var d=1;d<l-1;d++){var u=d/l,p=1-u,m=u*e+p*i,h=u*t+p*a,f=u*i+p*n,y=u*a+p*r;m=u*(m=u*m+p*f)+p*(f=u*f+p*(u*n+p*o)),h=u*(h=u*h+p*y)+p*(y=u*y+p*(u*r+p*s)),c.push(m,h)}c.push(o,s)}}function ce(e,t,i,a,n,r,o,s){var l=Math.pow(3*i-2*e-o,2),c=Math.pow(3*a-2*t-s,2),d=Math.pow(3*n-e-2*o,2),u=Math.pow(3*r-t-2*s,2);return Math.max(l,d)+Math.max(c,u)<=10}function de(){var e,t=1/0,i=-1/0,n=1/0,r=-1/0,o=_createForOfIteratorHelper(this.paths);try{for(o.s();!(e=o.n()).done;){var s,l=e.value,c=_createForOfIteratorHelper(l);try{for(c.s();!(s=c.n()).done;){var d,u=_slicedToArray(s.value,4),p=u[0],m=u[1],h=u[2],f=u[3],y=(d=a.Util).bezierBoundingBox.apply(d,_toConsumableArray(p).concat(_toConsumableArray(m),_toConsumableArray(h),_toConsumableArray(f)));t=Math.min(t,y[0]),n=Math.min(n,y[1]),i=Math.max(i,y[2]),r=Math.max(r,y[3])}}catch(b){c.e(b)}finally{c.f()}}}catch(b){o.e(b)}finally{o.f()}return[t,n,i,r]}function ue(){return _classPrivateFieldGet(this,f)?Math.ceil(this.thickness*this.parent.scaleFactor):0}function pe(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0];if(!this.isEmpty())if(_classPrivateFieldGet(this,f)){var t=_classPrivateMethodGet(this,L,de).call(this),i=_classPrivateMethodGet(this,j,ue).call(this);_classPrivateFieldSet(this,d,Math.max(s,t[2]-t[0])),_classPrivateFieldSet(this,c,Math.max(s,t[3]-t[1]));var a=Math.ceil(i+_classPrivateFieldGet(this,d)*this.scaleFactor),n=Math.ceil(i+_classPrivateFieldGet(this,c)*this.scaleFactor),r=_slicedToArray(this.parent.viewportBaseDimensions,2),o=r[0],u=r[1];this.width=a/o,this.height=n/u,_classPrivateFieldSet(this,l,a/n),_classPrivateMethodGet(this,H,me).call(this);var p=this.translationX,m=this.translationY;this.translationX=-t[0],this.translationY=-t[1],_classPrivateMethodGet(this,B,ae).call(this),_classPrivateMethodGet(this,M,$).call(this),_classPrivateFieldSet(this,v,a),_classPrivateFieldSet(this,_,n),this.setDims(a,n);var h=e?i/this.scaleFactor/2:0;this.translate(p-this.translationX-h,m-this.translationY-h)}else _classPrivateMethodGet(this,M,$).call(this)}function me(){var e=this.div.style;_classPrivateFieldGet(this,l)>=1?(e.minHeight="".concat(s,"px"),e.minWidth="".concat(Math.round(_classPrivateFieldGet(this,l)*s),"px")):(e.minWidth="".concat(s,"px"),e.minHeight="".concat(Math.round(s/_classPrivateFieldGet(this,l)),"px"))}_defineProperty(U,"_defaultColor",null),_defineProperty(U,"_defaultOpacity",1),_defineProperty(U,"_defaultThickness",1),_defineProperty(U,"_l10nPromise",void 0),_defineProperty(U,"_type","ink"),t.InkEditor=U},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.fitCurve=void 0;var a=i(26);t.fitCurve=a},function(e){function t(e,n,r,o,s){var c,d,u,p,m,h,f,y,b,g,v,_,A;if(2===e.length)return _=l.vectorLen(l.subtract(e[0],e[1]))/3,[c=[e[0],l.addArrays(e[0],l.mulItems(n,_)),l.addArrays(e[1],l.mulItems(r,_)),e[1]]];d=function(e){var t,i,a,n=[];return e.forEach((function(e,r){t=r?i+l.vectorLen(l.subtract(e,a)):0,n.push(t),i=t,a=e})),n=n.map((function(e){return e/i}))}(e);var x=i(e,d,d,n,r,s),w=_slicedToArray(x,3);if(c=w[0],p=w[1],h=w[2],0===p||p<o)return[c];if(p<o*o)for(u=d,m=p,f=h,A=0;A<20;A++){var S=i(e,d,u=a(c,e,u),n,r,s),C=_slicedToArray(S,3);if(c=C[0],p=C[1],h=C[2],p<o)return[c];if(h===f){var k=p/m;if(k>.9999&&k<1.0001)break}m=p,f=h}if(v=[],(y=l.subtract(e[h-1],e[h+1])).every((function(e){return 0===e}))){var D=[-(y=l.subtract(e[h-1],e[h]))[1],y[0]];y[0]=D[0],y[1]=D[1]}return b=l.normalize(y),g=l.mulItems(b,-1),v=(v=v.concat(t(e.slice(0,h+1),n,b,o,s))).concat(t(e.slice(h),g,r,o,s))}function i(e,t,i,a,n,s){var d,u,p;d=function(e,t,i,a){var n,r,o,s,d,u,p,m,h,f,y,b,g,v,_,A,x,w=e[0],S=e[e.length-1];for(n=[w,null,null,S],r=l.zeros_Xx2x2(t.length),g=0,v=t.length;g<v;g++)x=1-(A=t[g]),(o=r[g])[0]=l.mulItems(i,3*A*(x*x)),o[1]=l.mulItems(a,3*x*(A*A));for(s=[[0,0],[0,0]],d=[0,0],g=0,v=e.length;g<v;g++)A=t[g],o=r[g],s[0][0]+=l.dot(o[0],o[0]),s[0][1]+=l.dot(o[0],o[1]),s[1][0]+=l.dot(o[0],o[1]),s[1][1]+=l.dot(o[1],o[1]),_=l.subtract(e[g],c.q([w,w,S,S],A)),d[0]+=l.dot(o[0],_),d[1]+=l.dot(o[1],_);return u=s[0][0]*s[1][1]-s[1][0]*s[0][1],p=s[0][0]*d[1]-s[1][0]*d[0],m=d[0]*s[1][1]-d[1]*s[0][1],h=0===u?0:m/u,f=0===u?0:p/u,b=l.vectorLen(l.subtract(w,S)),h<(y=1e-6*b)||f<y?(n[1]=l.addArrays(w,l.mulItems(i,b/3)),n[2]=l.addArrays(S,l.mulItems(a,b/3))):(n[1]=l.addArrays(w,l.mulItems(i,h)),n[2]=l.addArrays(S,l.mulItems(a,f))),n}(e,i,a,n);var m=function(e,t,i){var a,n,s,d,u,p,m,h;n=0,s=Math.floor(e.length/2);var f=r(t,10);for(u=0,p=e.length;u<p;u++)m=e[u],h=o(0,i[u],f,10),(a=(d=l.subtract(c.q(t,h),m))[0]*d[0]+d[1]*d[1])>n&&(n=a,s=u);return[n,s]}(e,d,t),h=_slicedToArray(m,2);return u=h[0],p=h[1],s&&s({bez:d,points:e,params:t,maxErr:u,maxPoint:p}),[d,u,p]}function a(e,t,i){return i.map((function(i,a){return n(e,t[a],i)}))}function n(e,t,i){var a=l.subtract(c.q(e,i),t),n=c.qprime(e,i),r=l.mulMatrix(a,n),o=l.sum(l.squareItems(n))+2*l.mulMatrix(a,c.qprimeprime(e,i));return 0===o?i:i-r/o}var r=function(e,t){for(var i,a=[0],n=e[0],r=0,o=1;o<=t;o++)i=c.q(e,o/t),r+=l.vectorLen(l.subtract(i,n)),a.push(r),n=i;return a=a.map((function(e){return e/r}))};function o(e,t,i,a){if(t<0)return 0;if(t>1)return 1;for(var n,r,o,s,l=1;l<=a;l++)if(t<=i[l]){o=(l-1)/a,r=l/a,s=(t-(n=i[l-1]))/(i[l]-n)*(r-o)+o;break}return s}function s(e,t){return l.normalize(l.subtract(e,t))}var l=function(){function e(){_classCallCheck(this,e)}return _createClass(e,null,[{key:"zeros_Xx2x2",value:function(e){for(var t=[];e--;)t.push([0,0]);return t}},{key:"mulItems",value:function(e,t){return e.map((function(e){return e*t}))}},{key:"mulMatrix",value:function(e,t){return e.reduce((function(e,i,a){return e+i*t[a]}),0)}},{key:"subtract",value:function(e,t){return e.map((function(e,i){return e-t[i]}))}},{key:"addArrays",value:function(e,t){return e.map((function(e,i){return e+t[i]}))}},{key:"addItems",value:function(e,t){return e.map((function(e){return e+t}))}},{key:"sum",value:function(e){return e.reduce((function(e,t){return e+t}))}},{key:"dot",value:function(t,i){return e.mulMatrix(t,i)}},{key:"vectorLen",value:function(e){return Math.hypot.apply(Math,_toConsumableArray(e))}},{key:"divItems",value:function(e,t){return e.map((function(e){return e/t}))}},{key:"squareItems",value:function(e){return e.map((function(e){return e*e}))}},{key:"normalize",value:function(e){return this.divItems(e,this.vectorLen(e))}}]),e}(),c=function(){function e(){_classCallCheck(this,e)}return _createClass(e,null,[{key:"q",value:function(e,t){var i=1-t,a=l.mulItems(e[0],i*i*i),n=l.mulItems(e[1],3*i*i*t),r=l.mulItems(e[2],3*i*t*t),o=l.mulItems(e[3],t*t*t);return l.addArrays(l.addArrays(a,n),l.addArrays(r,o))}},{key:"qprime",value:function(e,t){var i=1-t,a=l.mulItems(l.subtract(e[1],e[0]),3*i*i),n=l.mulItems(l.subtract(e[2],e[1]),6*i*t),r=l.mulItems(l.subtract(e[3],e[2]),3*t*t);return l.addArrays(l.addArrays(a,n),r)}},{key:"qprimeprime",value:function(e,t){return l.addArrays(l.mulItems(l.addArrays(l.subtract(e[2],l.mulItems(e[1],2)),e[0]),6*(1-t)),l.mulItems(l.addArrays(l.subtract(e[3],l.mulItems(e[2],2)),e[1]),6*t))}}]),e}();e.exports=function(e,i,a){if(!Array.isArray(e))throw new TypeError("First argument should be an array");if(e.forEach((function(t){if(!Array.isArray(t)||t.some((function(e){return"number"!==typeof e}))||t.length!==e[0].length)throw Error("Each point should be an array of numbers. Each point should have the same amount of numbers.")})),(e=e.filter((function(t,i){return 0===i||!t.every((function(t,a){return t===e[i-1][a]}))}))).length<2)return[];var n=e.length,r=s(e[1],e[0]),o=s(e[n-2],e[n-1]);return t(e,r,o,i,a)},e.exports.fitCubic=t,e.exports.createTangent=s},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.AnnotationLayer=void 0;var a=i(1),n=i(8),r=i(5),o=i(28),s=i(29),l=1e3,c=new WeakSet;function d(e){return{width:e[2]-e[0],height:e[3]-e[1]}}var u=function(){function e(){_classCallCheck(this,e)}return _createClass(e,null,[{key:"create",value:function(e){switch(e.data.annotationType){case a.AnnotationType.LINK:return new m(e);case a.AnnotationType.TEXT:return new h(e);case a.AnnotationType.WIDGET:switch(e.data.fieldType){case"Tx":return new y(e);case"Btn":return e.data.radioButton?new g(e):e.data.checkBox?new b(e):new v(e);case"Ch":return new _(e)}return new f(e);case a.AnnotationType.POPUP:return new A(e);case a.AnnotationType.FREETEXT:return new w(e);case a.AnnotationType.LINE:return new S(e);case a.AnnotationType.SQUARE:return new C(e);case a.AnnotationType.CIRCLE:return new k(e);case a.AnnotationType.POLYLINE:return new D(e);case a.AnnotationType.CARET:return new I(e);case a.AnnotationType.INK:return new M(e);case a.AnnotationType.POLYGON:return new R(e);case a.AnnotationType.HIGHLIGHT:return new T(e);case a.AnnotationType.UNDERLINE:return new P(e);case a.AnnotationType.SQUIGGLY:return new z(e);case a.AnnotationType.STRIKEOUT:return new B(e);case a.AnnotationType.STAMP:return new F(e);case a.AnnotationType.FILEATTACHMENT:return new E(e);default:return new p(e)}}}]),e}(),p=function(){function e(t){var i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},a=i.isRenderable,n=void 0!==a&&a,r=i.ignoreBorder,o=void 0!==r&&r,s=i.createQuadrilaterals,l=void 0!==s&&s;_classCallCheck(this,e),this.isRenderable=n,this.data=t.data,this.layer=t.layer,this.page=t.page,this.viewport=t.viewport,this.linkService=t.linkService,this.downloadManager=t.downloadManager,this.imageResourcesPath=t.imageResourcesPath,this.renderForms=t.renderForms,this.svgFactory=t.svgFactory,this.annotationStorage=t.annotationStorage,this.enableScripting=t.enableScripting,this.hasJSActions=t.hasJSActions,this._fieldObjects=t.fieldObjects,this._mouseState=t.mouseState,n&&(this.container=this._createContainer(o)),l&&(this.quadrilaterals=this._createQuadrilaterals(o))}return _createClass(e,[{key:"_createContainer",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=this.data,i=this.page,n=this.viewport,r=document.createElement("section"),o=d(t.rect),s=o.width,l=o.height,c=_slicedToArray(n.viewBox,4),u=c[0],p=c[1],m=c[2]-u,h=c[3]-p;r.setAttribute("data-annotation-id",t.id);var f=a.Util.normalizeRect([t.rect[0],i.view[3]-t.rect[1]+i.view[1],t.rect[2],i.view[3]-t.rect[3]+i.view[1]]);if(!e&&t.borderStyle.width>0){r.style.borderWidth="".concat(t.borderStyle.width,"px");var y=t.borderStyle.horizontalCornerRadius,b=t.borderStyle.verticalCornerRadius;if(y>0||b>0){var v="calc(".concat(y,"px * var(--scale-factor)) / calc(").concat(b,"px * var(--scale-factor))");r.style.borderRadius=v}else if(this instanceof g){var _="calc(".concat(s,"px * var(--scale-factor)) / calc(").concat(l,"px * var(--scale-factor))");r.style.borderRadius=_}switch(t.borderStyle.style){case a.AnnotationBorderStyleType.SOLID:r.style.borderStyle="solid";break;case a.AnnotationBorderStyleType.DASHED:r.style.borderStyle="dashed";break;case a.AnnotationBorderStyleType.BEVELED:(0,a.warn)("Unimplemented border style: beveled");break;case a.AnnotationBorderStyleType.INSET:(0,a.warn)("Unimplemented border style: inset");break;case a.AnnotationBorderStyleType.UNDERLINE:r.style.borderBottomStyle="solid"}var A=t.borderColor||null;A?r.style.borderColor=a.Util.makeHexColor(0|A[0],0|A[1],0|A[2]):r.style.borderWidth=0}r.style.left="".concat(100*(f[0]-u)/m,"%"),r.style.top="".concat(100*(f[1]-p)/h,"%");var x=t.rotation;return t.hasOwnCanvas||0===x?(r.style.width="".concat(100*s/m,"%"),r.style.height="".concat(100*l/h,"%")):this.setRotation(x,r),r}},{key:"setRotation",value:function(e){var t,i,a=arguments.length>1&&void 0!==arguments[1]?arguments[1]:this.container,n=_slicedToArray(this.viewport.viewBox,4),r=n[0],o=n[1],s=n[2]-r,l=n[3]-o,c=d(this.data.rect),u=c.width,p=c.height;e%180===0?(t=100*u/s,i=100*p/l):(t=100*p/s,i=100*u/l),a.style.width="".concat(t,"%"),a.style.height="".concat(i,"%"),a.setAttribute("data-main-rotation",(360-e)%360)}},{key:"_commonActions",get:function(){var e=this,t=function(e,t,i){var a=i.detail[e];i.target.style[t]=o.ColorConverters["".concat(a[0],"_HTML")](a.slice(1))};return(0,a.shadow)(this,"_commonActions",{display:function(t){var i=t.detail.display%2===1;e.container.style.visibility=i?"hidden":"visible",e.annotationStorage.setValue(e.data.id,{hidden:i,print:0===t.detail.display||3===t.detail.display})},print:function(t){e.annotationStorage.setValue(e.data.id,{print:t.detail.print})},hidden:function(t){e.container.style.visibility=t.detail.hidden?"hidden":"visible",e.annotationStorage.setValue(e.data.id,{hidden:t.detail.hidden})},focus:function(e){setTimeout((function(){return e.target.focus({preventScroll:!1})}),0)},userName:function(e){e.target.title=e.detail.userName},readonly:function(e){e.detail.readonly?e.target.setAttribute("readonly",""):e.target.removeAttribute("readonly")},required:function(t){e._setRequired(t.target,t.detail.required)},bgColor:function(e){t("bgColor","backgroundColor",e)},fillColor:function(e){t("fillColor","backgroundColor",e)},fgColor:function(e){t("fgColor","color",e)},textColor:function(e){t("textColor","color",e)},borderColor:function(e){t("borderColor","borderColor",e)},strokeColor:function(e){t("strokeColor","borderColor",e)},rotation:function(t){var i=t.detail.rotation;e.setRotation(i),e.annotationStorage.setValue(e.data.id,{rotation:i})}})}},{key:"_dispatchEventFromSandbox",value:function(e,t){for(var i=this._commonActions,a=0,n=Object.keys(t.detail);a<n.length;a++){var r=n[a],o=e[r]||i[r];o&&o(t)}}},{key:"_setDefaultPropertiesFromJS",value:function(e){if(this.enableScripting){var t=this.annotationStorage.getRawValue(this.data.id);if(t)for(var i=this._commonActions,a=0,n=Object.entries(t);a<n.length;a++){var r=_slicedToArray(n[a],2),o=r[0],s=r[1],l=i[o];l&&(l({detail:_defineProperty({},o,s),target:e}),delete t[o])}}}},{key:"_createQuadrilaterals",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0];if(!this.data.quadPoints)return null;var t,i=[],a=this.data.rect,n=_createForOfIteratorHelper(this.data.quadPoints);try{for(n.s();!(t=n.n()).done;){var r=t.value;this.data.rect=[r[2].x,r[2].y,r[1].x,r[1].y],i.push(this._createContainer(e))}}catch(o){n.e(o)}finally{n.f()}return this.data.rect=a,i}},{key:"_createPopup",value:function(e,t){var i=this.container;this.quadrilaterals&&(e=e||this.quadrilaterals,i=this.quadrilaterals[0]),e||((e=document.createElement("div")).className="popupTriggerArea",i.append(e));var a=new x({container:i,trigger:e,color:t.color,titleObj:t.titleObj,modificationDate:t.modificationDate,contentsObj:t.contentsObj,richText:t.richText,hideWrapper:!0}).render();a.style.left="100%",i.append(a)}},{key:"_renderQuadrilaterals",value:function(e){var t,i=_createForOfIteratorHelper(this.quadrilaterals);try{for(i.s();!(t=i.n()).done;)t.value.className=e}catch(a){i.e(a)}finally{i.f()}return this.quadrilaterals}},{key:"render",value:function(){(0,a.unreachable)("Abstract method `AnnotationElement.render` called")}},{key:"_getElementsByName",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null,i=[];if(this._fieldObjects){var n=this._fieldObjects[e];if(n){var r,o=_createForOfIteratorHelper(n);try{for(o.s();!(r=o.n()).done;){var s=r.value,l=s.page,d=s.id,u=s.exportValues;if(-1!==l&&d!==t){var p="string"===typeof u?u:null,m=document.querySelector('[data-element-id="'.concat(d,'"]'));!m||c.has(m)?i.push({id:d,exportValue:p,domElement:m}):(0,a.warn)("_getElementsByName - element not allowed: ".concat(d))}}}catch(v){o.e(v)}finally{o.f()}}return i}var h,f=_createForOfIteratorHelper(document.getElementsByName(e));try{for(f.s();!(h=f.n()).done;){var y=h.value,b=y.id,g=y.exportValue;b!==t&&c.has(y)&&i.push({id:b,exportValue:g,domElement:y})}}catch(v){f.e(v)}finally{f.f()}return i}}],[{key:"platform",get:function(){var e="undefined"!==typeof navigator?navigator.platform:"";return(0,a.shadow)(this,"platform",{isWin:e.includes("Win"),isMac:e.includes("Mac")})}}]),e}(),m=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;return _classCallCheck(this,i),(a=t.call(this,e,{isRenderable:!0,ignoreBorder:!(null===n||void 0===n||!n.ignoreBorder),createQuadrilaterals:!0})).isTooltipOnly=e.data.isTooltipOnly,a}return _createClass(i,[{key:"render",value:function(){var e=this.data,t=this.linkService,i=document.createElement("a");i.setAttribute("data-element-id",e.id);var a=!1;return e.url?(t.addLinkAttributes(i,e.url,e.newWindow),a=!0):e.action?(this._bindNamedAction(i,e.action),a=!0):e.dest?(this._bindLink(i,e.dest),a=!0):(e.actions&&(e.actions.Action||e.actions["Mouse Up"]||e.actions["Mouse Down"])&&this.enableScripting&&this.hasJSActions&&(this._bindJSAction(i,e),a=!0),e.resetForm?(this._bindResetFormAction(i,e.resetForm),a=!0):this.isTooltipOnly&&!a&&(this._bindLink(i,""),a=!0)),this.quadrilaterals?this._renderQuadrilaterals("linkAnnotation").map((function(e,t){var a=0===t?i:i.cloneNode();return e.append(a),e})):(this.container.className="linkAnnotation",a&&this.container.append(i),this.container)}},{key:"_bindLink",value:function(e,t){var i=this;e.href=this.linkService.getDestinationHash(t),e.onclick=function(){return t&&i.linkService.goToDestination(t),!1},(t||""===t)&&(e.className="internalLink")}},{key:"_bindNamedAction",value:function(e,t){var i=this;e.href=this.linkService.getAnchorUrl(""),e.onclick=function(){return i.linkService.executeNamedAction(t),!1},e.className="internalLink"}},{key:"_bindJSAction",value:function(e,t){var i=this;e.href=this.linkService.getAnchorUrl("");for(var a=new Map([["Action","onclick"],["Mouse Up","onmouseup"],["Mouse Down","onmousedown"]]),n=function(){var n=o[r],s=a.get(n);if(!s)return"continue";e[s]=function(){var e;return null===(e=i.linkService.eventBus)||void 0===e||e.dispatch("dispatcheventinsandbox",{source:i,detail:{id:t.id,name:n}}),!1}},r=0,o=Object.keys(t.actions);r<o.length;r++)n();e.onclick||(e.onclick=function(){return!1}),e.className="internalLink"}},{key:"_bindResetFormAction",value:function(e,t){var i=this,n=e.onclick;if(n||(e.href=this.linkService.getAnchorUrl("")),e.className="internalLink",!this._fieldObjects)return(0,a.warn)('_bindResetFormAction - "resetForm" action not supported, ensure that the `fieldObjects` parameter is provided.'),void(n||(e.onclick=function(){return!1}));e.onclick=function(){n&&n();var e=t.fields,r=t.refs,o=t.include,s=[];if(0!==e.length||0!==r.length){var l,d=new Set(r),u=_createForOfIteratorHelper(e);try{for(u.s();!(l=u.n()).done;){var p,m=l.value,h=i._fieldObjects[m]||[],f=_createForOfIteratorHelper(h);try{for(f.s();!(p=f.n()).done;){var y=p.value.id;d.add(y)}}catch(N){f.e(N)}finally{f.f()}}}catch(N){u.e(N)}finally{u.f()}for(var b=0,g=Object.values(i._fieldObjects);b<g.length;b++){var v,_=g[b],A=_createForOfIteratorHelper(_);try{for(A.s();!(v=A.n()).done;){var x=v.value;d.has(x.id)===o&&s.push(x)}}catch(N){A.e(N)}finally{A.f()}}}else for(var w=0,S=Object.values(i._fieldObjects);w<S.length;w++){var C=S[w];s.push.apply(s,_toConsumableArray(C))}for(var k,D=i.annotationStorage,R=[],I=0,M=s;I<M.length;I++){var T=M[I],P=T.id;switch(R.push(P),T.type){case"text":var z=T.defaultValue||"";D.setValue(P,{value:z});break;case"checkbox":case"radiobutton":var B=T.defaultValue===T.exportValues;D.setValue(P,{value:B});break;case"combobox":case"listbox":var F=T.defaultValue||"";D.setValue(P,{value:F});break;default:continue}var E=document.querySelector('[data-element-id="'.concat(P,'"]'));E&&(c.has(E)?E.dispatchEvent(new Event("resetform")):(0,a.warn)("_bindResetFormAction - element not allowed: ".concat(P)))}return i.enableScripting&&(null===(k=i.linkService.eventBus)||void 0===k||k.dispatch("dispatcheventinsandbox",{source:i,detail:{id:"app",ids:R,name:"ResetForm"}})),!1}}}]),i}(p),h=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o})}return _createClass(i,[{key:"render",value:function(){this.container.className="textAnnotation";var e=document.createElement("img");return e.src=this.imageResourcesPath+"annotation-"+this.data.name.toLowerCase()+".svg",e.alt="[{{type}} Annotation]",e.dataset.l10nId="text_annotation_type",e.dataset.l10nArgs=JSON.stringify({type:this.data.name}),this.data.hasPopup||this._createPopup(e,this.data),this.container.append(e),this.container}}]),i}(p),f=function(e){_inherits(i,e);var t=_createSuper(i);function i(){return _classCallCheck(this,i),t.apply(this,arguments)}return _createClass(i,[{key:"render",value:function(){return this.data.alternativeText&&(this.container.title=this.data.alternativeText),this.container}},{key:"_getKeyModifier",value:function(e){var t=p.platform,i=t.isWin,a=t.isMac;return i&&e.ctrlKey||a&&e.metaKey}},{key:"_setEventListener",value:function(e,t,i,a){var n=this;t.includes("mouse")?e.addEventListener(t,(function(e){var t;null===(t=n.linkService.eventBus)||void 0===t||t.dispatch("dispatcheventinsandbox",{source:n,detail:{id:n.data.id,name:i,value:a(e),shift:e.shiftKey,modifier:n._getKeyModifier(e)}})})):e.addEventListener(t,(function(e){var t;null===(t=n.linkService.eventBus)||void 0===t||t.dispatch("dispatcheventinsandbox",{source:n,detail:{id:n.data.id,name:i,value:a(e)}})}))}},{key:"_setEventListeners",value:function(e,t,i){var a,n=_createForOfIteratorHelper(t);try{for(n.s();!(a=n.n()).done;){var r,o=_slicedToArray(a.value,2),s=o[0],l=o[1];("Action"===l||null!==(r=this.data.actions)&&void 0!==r&&r[l])&&this._setEventListener(e,s,l,i)}}catch(c){n.e(c)}finally{n.f()}}},{key:"_setBackgroundColor",value:function(e){var t=this.data.backgroundColor||null;e.style.backgroundColor=null===t?"transparent":a.Util.makeHexColor(t[0],t[1],t[2])}},{key:"_setTextStyle",value:function(e){var t,i=this.data.defaultAppearanceData.fontColor,n=this.data.defaultAppearanceData.fontSize||9,r=e.style;if(this.data.multiLine){var o=Math.abs(this.data.rect[3]-this.data.rect[1]),s=o/(Math.round(o/(a.LINE_FACTOR*n))||1);t=Math.min(n,Math.round(s/a.LINE_FACTOR))}else{var l=Math.abs(this.data.rect[3]-this.data.rect[1]);t=Math.min(n,Math.round(l/a.LINE_FACTOR))}r.fontSize="calc(".concat(t,"px * var(--scale-factor))"),r.color=a.Util.makeHexColor(i[0],i[1],i[2]),null!==this.data.textAlignment&&(r.textAlign=["left","center","right"][this.data.textAlignment])}},{key:"_setRequired",value:function(e,t){t?e.setAttribute("required",!0):e.removeAttribute("required"),e.setAttribute("aria-required",t)}}]),i}(p),y=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){_classCallCheck(this,i);var a=e.renderForms||!e.data.hasAppearance&&!!e.data.fieldValue;return t.call(this,e,{isRenderable:a})}return _createClass(i,[{key:"setPropertyOnSiblings",value:function(e,t,i,a){var n,r=this.annotationStorage,o=_createForOfIteratorHelper(this._getElementsByName(e.name,e.id));try{for(o.s();!(n=o.n()).done;){var s=n.value;s.domElement&&(s.domElement[t]=i),r.setValue(s.id,_defineProperty({},a,i))}}catch(l){o.e(l)}finally{o.f()}}},{key:"render",value:function(){var e=this,t=this.annotationStorage,i=this.data.id;this.container.className="textWidgetAnnotation";var a=null;if(this.renderForms){var n=t.getValue(i,{value:this.data.fieldValue}),r=n.formattedValue||n.value||"",o=t.getValue(i,{charLimit:this.data.maxLen}).charLimit;o&&r.length>o&&(r=r.slice(0,o));var s={userValue:r,formattedValue:null,valueOnFocus:""};this.data.multiLine?((a=document.createElement("textarea")).textContent=r,this.data.doNotScroll&&(a.style.overflowY="hidden")):((a=document.createElement("input")).type="text",a.setAttribute("value",r),this.data.doNotScroll&&(a.style.overflowX="hidden")),c.add(a),a.setAttribute("data-element-id",i),a.disabled=this.data.readOnly,a.name=this.data.fieldName,a.tabIndex=l,this._setRequired(a,this.data.required),o&&(a.maxLength=o),a.addEventListener("input",(function(n){t.setValue(i,{value:n.target.value}),e.setPropertyOnSiblings(a,"value",n.target.value,"value")})),a.addEventListener("resetform",(function(t){var i,n=null!==(i=e.data.defaultFieldValue)&&void 0!==i?i:"";a.value=s.userValue=n,s.formattedValue=null}));var d=function(e){var t=s.formattedValue;null!==t&&void 0!==t&&(e.target.value=t),e.target.scrollLeft=0};if(this.enableScripting&&this.hasJSActions){var u;a.addEventListener("focus",(function(e){s.userValue&&(e.target.value=s.userValue),s.valueOnFocus=e.target.value})),a.addEventListener("updatefromsandbox",(function(a){var n={value:function(e){var a;s.userValue=null!==(a=e.detail.value)&&void 0!==a?a:"",t.setValue(i,{value:s.userValue.toString()}),e.target.value=s.userValue},formattedValue:function(e){var a=e.detail.formattedValue;s.formattedValue=a,null!==a&&void 0!==a&&e.target!==document.activeElement&&(e.target.value=a),t.setValue(i,{formattedValue:a})},selRange:function(e){var t;(t=e.target).setSelectionRange.apply(t,_toConsumableArray(e.detail.selRange))},charLimit:function(a){var n,r=a.detail.charLimit,o=a.target;if(0!==r){o.setAttribute("maxLength",r);var l=s.userValue;!l||l.length<=r||(l=l.slice(0,r),o.value=s.userValue=l,t.setValue(i,{value:l}),null===(n=e.linkService.eventBus)||void 0===n||n.dispatch("dispatcheventinsandbox",{source:e,detail:{id:i,name:"Keystroke",value:l,willCommit:!0,commitKey:1,selStart:o.selectionStart,selEnd:o.selectionEnd}}))}else o.removeAttribute("maxLength")}};e._dispatchEventFromSandbox(n,a)})),a.addEventListener("keydown",(function(t){var a,n=-1;if("Escape"===t.key?n=0:"Enter"===t.key?n=2:"Tab"===t.key&&(n=3),-1!==n){var r=t.target.value;s.valueOnFocus!==r&&(s.userValue=r,null===(a=e.linkService.eventBus)||void 0===a||a.dispatch("dispatcheventinsandbox",{source:e,detail:{id:i,name:"Keystroke",value:r,willCommit:!0,commitKey:n,selStart:t.target.selectionStart,selEnd:t.target.selectionEnd}}))}}));var p=d;d=null,a.addEventListener("blur",(function(t){var a,n=t.target.value;s.userValue=n,e._mouseState.isDown&&s.valueOnFocus!==n&&(null===(a=e.linkService.eventBus)||void 0===a||a.dispatch("dispatcheventinsandbox",{source:e,detail:{id:i,name:"Keystroke",value:n,willCommit:!0,commitKey:1,selStart:t.target.selectionStart,selEnd:t.target.selectionEnd}})),p(t)})),null!==(u=this.data.actions)&&void 0!==u&&u.Keystroke&&a.addEventListener("beforeinput",(function(t){var a,n=t.data,r=t.target,o=r.value,s=r.selectionStart,l=r.selectionEnd,c=s,d=l;switch(t.inputType){case"deleteWordBackward":var u=o.substring(0,s).match(/\w*[^\w]*$/);u&&(c-=u[0].length);break;case"deleteWordForward":var p=o.substring(s).match(/^[^\w]*\w*/);p&&(d+=p[0].length);break;case"deleteContentBackward":s===l&&(c-=1);break;case"deleteContentForward":s===l&&(d+=1)}t.preventDefault(),null===(a=e.linkService.eventBus)||void 0===a||a.dispatch("dispatcheventinsandbox",{source:e,detail:{id:i,name:"Keystroke",value:o,change:n||"",willCommit:!1,selStart:c,selEnd:d}})})),this._setEventListeners(a,[["focus","Focus"],["blur","Blur"],["mousedown","Mouse Down"],["mouseenter","Mouse Enter"],["mouseleave","Mouse Exit"],["mouseup","Mouse Up"]],(function(e){return e.target.value}))}if(d&&a.addEventListener("blur",d),this.data.comb){var m=(this.data.rect[2]-this.data.rect[0])/o;a.classList.add("comb"),a.style.letterSpacing="calc(".concat(m,"px * var(--scale-factor) - 1ch)")}}else(a=document.createElement("div")).textContent=this.data.fieldValue,a.style.verticalAlign="middle",a.style.display="table-cell";return this._setTextStyle(a),this._setBackgroundColor(a),this._setDefaultPropertiesFromJS(a),this.container.append(a),this.container}}]),i}(f),b=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){return _classCallCheck(this,i),t.call(this,e,{isRenderable:e.renderForms})}return _createClass(i,[{key:"render",value:function(){var e=this,t=this.annotationStorage,i=this.data,a=i.id,n=t.getValue(a,{value:i.exportValue===i.fieldValue}).value;"string"===typeof n&&(n="Off"!==n,t.setValue(a,{value:n})),this.container.className="buttonWidgetAnnotation checkBox";var r=document.createElement("input");return c.add(r),r.setAttribute("data-element-id",a),r.disabled=i.readOnly,this._setRequired(r,this.data.required),r.type="checkbox",r.name=i.fieldName,n&&r.setAttribute("checked",!0),r.setAttribute("exportValue",i.exportValue),r.tabIndex=l,r.addEventListener("change",(function(n){var r,o=n.target,s=o.name,l=o.checked,c=_createForOfIteratorHelper(e._getElementsByName(s,a));try{for(c.s();!(r=c.n()).done;){var d=r.value,u=l&&d.exportValue===i.exportValue;d.domElement&&(d.domElement.checked=u),t.setValue(d.id,{value:u})}}catch(p){c.e(p)}finally{c.f()}t.setValue(a,{value:l})})),r.addEventListener("resetform",(function(e){var t=i.defaultFieldValue||"Off";e.target.checked=t===i.exportValue})),this.enableScripting&&this.hasJSActions&&(r.addEventListener("updatefromsandbox",(function(i){var n={value:function(e){e.target.checked="Off"!==e.detail.value,t.setValue(a,{value:e.target.checked})}};e._dispatchEventFromSandbox(n,i)})),this._setEventListeners(r,[["change","Validate"],["change","Action"],["focus","Focus"],["blur","Blur"],["mousedown","Mouse Down"],["mouseenter","Mouse Enter"],["mouseleave","Mouse Exit"],["mouseup","Mouse Up"]],(function(e){return e.target.checked}))),this._setBackgroundColor(r),this._setDefaultPropertiesFromJS(r),this.container.append(r),this.container}}]),i}(f),g=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){return _classCallCheck(this,i),t.call(this,e,{isRenderable:e.renderForms})}return _createClass(i,[{key:"render",value:function(){var e=this;this.container.className="buttonWidgetAnnotation radioButton";var t=this.annotationStorage,i=this.data,a=i.id,n=t.getValue(a,{value:i.fieldValue===i.buttonValue}).value;"string"===typeof n&&(n=n!==i.buttonValue,t.setValue(a,{value:n}));var r=document.createElement("input");if(c.add(r),r.setAttribute("data-element-id",a),r.disabled=i.readOnly,this._setRequired(r,this.data.required),r.type="radio",r.name=i.fieldName,n&&r.setAttribute("checked",!0),r.tabIndex=l,r.addEventListener("change",(function(i){var n,r=i.target,o=r.name,s=r.checked,l=_createForOfIteratorHelper(e._getElementsByName(o,a));try{for(l.s();!(n=l.n()).done;){var c=n.value;t.setValue(c.id,{value:!1})}}catch(d){l.e(d)}finally{l.f()}t.setValue(a,{value:s})})),r.addEventListener("resetform",(function(e){var t=i.defaultFieldValue;e.target.checked=null!==t&&void 0!==t&&t===i.buttonValue})),this.enableScripting&&this.hasJSActions){var o=i.buttonValue;r.addEventListener("updatefromsandbox",(function(i){var n={value:function(i){var n,r=o===i.detail.value,s=_createForOfIteratorHelper(e._getElementsByName(i.target.name));try{for(s.s();!(n=s.n()).done;){var l=n.value,c=r&&l.id===a;l.domElement&&(l.domElement.checked=c),t.setValue(l.id,{value:c})}}catch(d){s.e(d)}finally{s.f()}}};e._dispatchEventFromSandbox(n,i)})),this._setEventListeners(r,[["change","Validate"],["change","Action"],["focus","Focus"],["blur","Blur"],["mousedown","Mouse Down"],["mouseenter","Mouse Enter"],["mouseleave","Mouse Exit"],["mouseup","Mouse Up"]],(function(e){return e.target.checked}))}return this._setBackgroundColor(r),this._setDefaultPropertiesFromJS(r),this.container.append(r),this.container}}]),i}(f),v=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){return _classCallCheck(this,i),t.call(this,e,{ignoreBorder:e.data.hasAppearance})}return _createClass(i,[{key:"render",value:function(){var e=this,t=_get(_getPrototypeOf(i.prototype),"render",this).call(this);t.className="buttonWidgetAnnotation pushButton",this.data.alternativeText&&(t.title=this.data.alternativeText);var a=t.lastChild;return this.enableScripting&&this.hasJSActions&&a&&(this._setDefaultPropertiesFromJS(a),a.addEventListener("updatefromsandbox",(function(t){e._dispatchEventFromSandbox({},t)}))),t}}]),i}(m),_=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){return _classCallCheck(this,i),t.call(this,e,{isRenderable:e.renderForms})}return _createClass(i,[{key:"render",value:function(){var e=this;this.container.className="choiceWidgetAnnotation";var t=this.annotationStorage,i=this.data.id,a=t.getValue(i,{value:this.data.fieldValue}),n=document.createElement("select");c.add(n),n.setAttribute("data-element-id",i),n.disabled=this.data.readOnly,this._setRequired(n,this.data.required),n.name=this.data.fieldName,n.tabIndex=l;var r=this.data.combo&&this.data.options.length>0;this.data.combo||(n.size=this.data.options.length,this.data.multiSelect&&(n.multiple=!0)),n.addEventListener("resetform",(function(t){var i,a=e.data.defaultFieldValue,r=_createForOfIteratorHelper(n.options);try{for(r.s();!(i=r.n()).done;){var o=i.value;o.selected=o.value===a}}catch(s){r.e(s)}finally{r.f()}}));var o,s=_createForOfIteratorHelper(this.data.options);try{for(s.s();!(o=s.n()).done;){var d=o.value,u=document.createElement("option");u.textContent=d.displayValue,u.value=d.exportValue,a.value.includes(d.exportValue)&&(u.setAttribute("selected",!0),r=!1),n.append(u)}}catch(y){s.e(y)}finally{s.f()}var p=null;if(r){var m=document.createElement("option");m.value=" ",m.setAttribute("hidden",!0),m.setAttribute("selected",!0),n.prepend(m),p=function(){m.remove(),n.removeEventListener("input",p),p=null},n.addEventListener("input",p)}var h=function(e,t){var i=t?"value":"textContent",a=e.target.options;return e.target.multiple?Array.prototype.filter.call(a,(function(e){return e.selected})).map((function(e){return e[i]})):-1===a.selectedIndex?null:a[a.selectedIndex][i]},f=function(e){var t=e.target.options;return Array.prototype.map.call(t,(function(e){return{displayValue:e.textContent,exportValue:e.value}}))};return this.enableScripting&&this.hasJSActions?(n.addEventListener("updatefromsandbox",(function(a){var r={value:function(e){var a;null===(a=p)||void 0===a||a();var r,o=e.detail.value,s=new Set(Array.isArray(o)?o:[o]),l=_createForOfIteratorHelper(n.options);try{for(l.s();!(r=l.n()).done;){var c=r.value;c.selected=s.has(c.value)}}catch(y){l.e(y)}finally{l.f()}t.setValue(i,{value:h(e,!0)})},multipleSelection:function(e){n.multiple=!0},remove:function(e){var a=n.options,r=e.detail.remove;if(a[r].selected=!1,n.remove(r),a.length>0){var o=Array.prototype.findIndex.call(a,(function(e){return e.selected}));-1===o&&(a[0].selected=!0)}t.setValue(i,{value:h(e,!0),items:f(e)})},clear:function(e){for(;0!==n.length;)n.remove(0);t.setValue(i,{value:null,items:[]})},insert:function(e){var a=e.detail.insert,r=a.index,o=a.displayValue,s=a.exportValue,l=n.children[r],c=document.createElement("option");c.textContent=o,c.value=s,l?l.before(c):n.append(c),t.setValue(i,{value:h(e,!0),items:f(e)})},items:function(e){for(var a=e.detail.items;0!==n.length;)n.remove(0);var r,o=_createForOfIteratorHelper(a);try{for(o.s();!(r=o.n()).done;){var s=r.value,l=s.displayValue,c=s.exportValue,d=document.createElement("option");d.textContent=l,d.value=c,n.append(d)}}catch(y){o.e(y)}finally{o.f()}n.options.length>0&&(n.options[0].selected=!0),t.setValue(i,{value:h(e,!0),items:f(e)})},indices:function(e){var a,n=new Set(e.detail.indices),r=_createForOfIteratorHelper(e.target.options);try{for(r.s();!(a=r.n()).done;){var o=a.value;o.selected=n.has(o.index)}}catch(y){r.e(y)}finally{r.f()}t.setValue(i,{value:h(e,!0)})},editable:function(e){e.target.disabled=!e.detail.editable}};e._dispatchEventFromSandbox(r,a)})),n.addEventListener("input",(function(a){var n,r=h(a,!0),o=h(a,!1);t.setValue(i,{value:r}),null===(n=e.linkService.eventBus)||void 0===n||n.dispatch("dispatcheventinsandbox",{source:e,detail:{id:i,name:"Keystroke",value:o,changeEx:r,willCommit:!0,commitKey:1,keyDown:!1}})})),this._setEventListeners(n,[["focus","Focus"],["blur","Blur"],["mousedown","Mouse Down"],["mouseenter","Mouse Enter"],["mouseleave","Mouse Exit"],["mouseup","Mouse Up"],["input","Action"]],(function(e){return e.target.checked}))):n.addEventListener("input",(function(e){t.setValue(i,{value:h(e,!0)})})),this.data.combo&&this._setTextStyle(n),this._setBackgroundColor(n),this._setDefaultPropertiesFromJS(n),this.container.append(n),this.container}}]),i}(f),A=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o})}return _createClass(i,[{key:"render",value:function(){if(this.container.className="popupAnnotation",["Line","Square","Circle","PolyLine","Polygon","Ink"].includes(this.data.parentType))return this.container;var e='[data-annotation-id="'.concat(this.data.parentId,'"]'),t=this.layer.querySelectorAll(e);if(0===t.length)return this.container;var i=new x({container:this.container,trigger:Array.from(t),color:this.data.color,titleObj:this.data.titleObj,modificationDate:this.data.modificationDate,contentsObj:this.data.contentsObj,richText:this.data.richText}),n=this.page,r=a.Util.normalizeRect([this.data.parentRect[0],n.view[3]-this.data.parentRect[1]+n.view[1],this.data.parentRect[2],n.view[3]-this.data.parentRect[3]+n.view[1]]),o=r[0]+this.data.parentRect[2]-this.data.parentRect[0],s=r[1],l=_slicedToArray(this.viewport.viewBox,4),c=l[0],d=l[1],u=l[2]-c,p=l[3]-d;return this.container.style.left="".concat(100*(o-c)/u,"%"),this.container.style.top="".concat(100*(s-d)/p,"%"),this.container.append(i.render()),this.container}}]),i}(p),x=function(){function e(t){_classCallCheck(this,e),this.container=t.container,this.trigger=t.trigger,this.color=t.color,this.titleObj=t.titleObj,this.modificationDate=t.modificationDate,this.contentsObj=t.contentsObj,this.richText=t.richText,this.hideWrapper=t.hideWrapper||!1,this.pinned=!1}return _createClass(e,[{key:"render",value:function(){var e,t,i=document.createElement("div");i.className="popupWrapper",this.hideElement=this.hideWrapper?i:this.container,this.hideElement.hidden=!0;var r=document.createElement("div");r.className="popup";var o=this.color;if(o){var l=.7*(255-o[0])+o[0],c=.7*(255-o[1])+o[1],d=.7*(255-o[2])+o[2];r.style.backgroundColor=a.Util.makeHexColor(0|l,0|c,0|d)}var u=document.createElement("h1");u.dir=this.titleObj.dir,u.textContent=this.titleObj.str,r.append(u);var p=n.PDFDateString.toDateObject(this.modificationDate);if(p){var m=document.createElement("span");m.className="popupDate",m.textContent="{{date}}, {{time}}",m.dataset.l10nId="annotation_date_string",m.dataset.l10nArgs=JSON.stringify({date:p.toLocaleDateString(),time:p.toLocaleTimeString()}),r.append(m)}if(null===(e=this.richText)||void 0===e||!e.str||null!==(t=this.contentsObj)&&void 0!==t&&t.str&&this.contentsObj.str!==this.richText.str){var h=this._formatContents(this.contentsObj);r.append(h)}else s.XfaLayer.render({xfaHtml:this.richText.html,intent:"richText",div:r}),r.lastChild.className="richText popupContent";Array.isArray(this.trigger)||(this.trigger=[this.trigger]);var f,y=_createForOfIteratorHelper(this.trigger);try{for(y.s();!(f=y.n()).done;){var b=f.value;b.addEventListener("click",this._toggle.bind(this)),b.addEventListener("mouseover",this._show.bind(this,!1)),b.addEventListener("mouseout",this._hide.bind(this,!1))}}catch(g){y.e(g)}finally{y.f()}return r.addEventListener("click",this._hide.bind(this,!0)),i.append(r),i}},{key:"_formatContents",value:function(e){var t=e.str,i=e.dir,a=document.createElement("p");a.className="popupContent",a.dir=i;for(var n=t.split(/(?:\r\n?|\n)/),r=0,o=n.length;r<o;++r){var s=n[r];a.append(document.createTextNode(s)),r<o-1&&a.append(document.createElement("br"))}return a}},{key:"_toggle",value:function(){this.pinned?this._hide(!0):this._show(!0)}},{key:"_show",value:function(){arguments.length>0&&void 0!==arguments[0]&&arguments[0]&&(this.pinned=!0),this.hideElement.hidden&&(this.hideElement.hidden=!1,this.container.style.zIndex=parseInt(this.container.style.zIndex)+1e3)}},{key:"_hide",value:function(){(!(arguments.length>0&&void 0!==arguments[0])||arguments[0])&&(this.pinned=!1),this.hideElement.hidden||this.pinned||(this.hideElement.hidden=!0,this.container.style.zIndex=parseInt(this.container.style.zIndex)-1e3)}}]),e}(),w=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r,o;_classCallCheck(this,i);var s=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return(o=t.call(this,e,{isRenderable:s,ignoreBorder:!0})).textContent=e.data.textContent,o}return _createClass(i,[{key:"render",value:function(){if(this.container.className="freeTextAnnotation",this.textContent){var e=document.createElement("div");e.className="annotationTextContent",e.setAttribute("role","comment");var t,i=_createForOfIteratorHelper(this.textContent);try{for(i.s();!(t=i.n()).done;){var a=t.value,n=document.createElement("span");n.textContent=a,e.append(n)}}catch(r){i.e(r)}finally{i.f()}this.container.append(e)}return this.data.hasPopup||this._createPopup(null,this.data),this.container}}]),i}(p),S=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0})}return _createClass(i,[{key:"render",value:function(){this.container.className="lineAnnotation";var e=this.data,t=d(e.rect),i=t.width,a=t.height,n=this.svgFactory.create(i,a,!0),r=this.svgFactory.createElement("svg:line");return r.setAttribute("x1",e.rect[2]-e.lineCoordinates[0]),r.setAttribute("y1",e.rect[3]-e.lineCoordinates[1]),r.setAttribute("x2",e.rect[2]-e.lineCoordinates[2]),r.setAttribute("y2",e.rect[3]-e.lineCoordinates[3]),r.setAttribute("stroke-width",e.borderStyle.width||1),r.setAttribute("stroke","transparent"),r.setAttribute("fill","transparent"),n.append(r),this.container.append(n),this._createPopup(r,e),this.container}}]),i}(p),C=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0})}return _createClass(i,[{key:"render",value:function(){this.container.className="squareAnnotation";var e=this.data,t=d(e.rect),i=t.width,a=t.height,n=this.svgFactory.create(i,a,!0),r=e.borderStyle.width,o=this.svgFactory.createElement("svg:rect");return o.setAttribute("x",r/2),o.setAttribute("y",r/2),o.setAttribute("width",i-r),o.setAttribute("height",a-r),o.setAttribute("stroke-width",r||1),o.setAttribute("stroke","transparent"),o.setAttribute("fill","transparent"),n.append(o),this.container.append(n),this._createPopup(o,e),this.container}}]),i}(p),k=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0})}return _createClass(i,[{key:"render",value:function(){this.container.className="circleAnnotation";var e=this.data,t=d(e.rect),i=t.width,a=t.height,n=this.svgFactory.create(i,a,!0),r=e.borderStyle.width,o=this.svgFactory.createElement("svg:ellipse");return o.setAttribute("cx",i/2),o.setAttribute("cy",a/2),o.setAttribute("rx",i/2-r/2),o.setAttribute("ry",a/2-r/2),o.setAttribute("stroke-width",r||1),o.setAttribute("stroke","transparent"),o.setAttribute("fill","transparent"),n.append(o),this.container.append(n),this._createPopup(o,e),this.container}}]),i}(p),D=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r,o;_classCallCheck(this,i);var s=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return(o=t.call(this,e,{isRenderable:s,ignoreBorder:!0})).containerClassName="polylineAnnotation",o.svgElementName="svg:polyline",o}return _createClass(i,[{key:"render",value:function(){this.container.className=this.containerClassName;var e,t=this.data,i=d(t.rect),a=i.width,n=i.height,r=this.svgFactory.create(a,n,!0),o=[],s=_createForOfIteratorHelper(t.vertices);try{for(s.s();!(e=s.n()).done;){var l=e.value,c=l.x-t.rect[0],u=t.rect[3]-l.y;o.push(c+","+u)}}catch(m){s.e(m)}finally{s.f()}o=o.join(" ");var p=this.svgFactory.createElement(this.svgElementName);return p.setAttribute("points",o),p.setAttribute("stroke-width",t.borderStyle.width||1),p.setAttribute("stroke","transparent"),p.setAttribute("fill","transparent"),r.append(p),this.container.append(r),this._createPopup(p,t),this.container}}]),i}(p),R=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a;return _classCallCheck(this,i),(a=t.call(this,e)).containerClassName="polygonAnnotation",a.svgElementName="svg:polygon",a}return _createClass(i)}(D),I=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0})}return _createClass(i,[{key:"render",value:function(){return this.container.className="caretAnnotation",this.data.hasPopup||this._createPopup(null,this.data),this.container}}]),i}(p),M=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r,o;_classCallCheck(this,i);var s=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return(o=t.call(this,e,{isRenderable:s,ignoreBorder:!0})).containerClassName="inkAnnotation",o.svgElementName="svg:polyline",o}return _createClass(i,[{key:"render",value:function(){this.container.className=this.containerClassName;var e,t=this.data,i=d(t.rect),a=i.width,n=i.height,r=this.svgFactory.create(a,n,!0),o=_createForOfIteratorHelper(t.inkLists);try{for(o.s();!(e=o.n()).done;){var s,l=e.value,c=[],u=_createForOfIteratorHelper(l);try{for(u.s();!(s=u.n()).done;){var p=s.value,m=p.x-t.rect[0],h=t.rect[3]-p.y;c.push("".concat(m,",").concat(h))}}catch(y){u.e(y)}finally{u.f()}c=c.join(" ");var f=this.svgFactory.createElement(this.svgElementName);f.setAttribute("points",c),f.setAttribute("stroke-width",t.borderStyle.width||1),f.setAttribute("stroke","transparent"),f.setAttribute("fill","transparent"),this._createPopup(f,t),r.append(f)}}catch(y){o.e(y)}finally{o.f()}return this.container.append(r),this.container}}]),i}(p),T=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0,createQuadrilaterals:!0})}return _createClass(i,[{key:"render",value:function(){return this.data.hasPopup||this._createPopup(null,this.data),this.quadrilaterals?this._renderQuadrilaterals("highlightAnnotation"):(this.container.className="highlightAnnotation",this.container)}}]),i}(p),P=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0,createQuadrilaterals:!0})}return _createClass(i,[{key:"render",value:function(){return this.data.hasPopup||this._createPopup(null,this.data),this.quadrilaterals?this._renderQuadrilaterals("underlineAnnotation"):(this.container.className="underlineAnnotation",this.container)}}]),i}(p),z=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0,createQuadrilaterals:!0})}return _createClass(i,[{key:"render",value:function(){return this.data.hasPopup||this._createPopup(null,this.data),this.quadrilaterals?this._renderQuadrilaterals("squigglyAnnotation"):(this.container.className="squigglyAnnotation",this.container)}}]),i}(p),B=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0,createQuadrilaterals:!0})}return _createClass(i,[{key:"render",value:function(){return this.data.hasPopup||this._createPopup(null,this.data),this.quadrilaterals?this._renderQuadrilaterals("strikeoutAnnotation"):(this.container.className="strikeoutAnnotation",this.container)}}]),i}(p),F=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,n,r;_classCallCheck(this,i);var o=!!(e.data.hasPopup||null!==(a=e.data.titleObj)&&void 0!==a&&a.str||null!==(n=e.data.contentsObj)&&void 0!==n&&n.str||null!==(r=e.data.richText)&&void 0!==r&&r.str);return t.call(this,e,{isRenderable:o,ignoreBorder:!0})}return _createClass(i,[{key:"render",value:function(){return this.container.className="stampAnnotation",this.data.hasPopup||this._createPopup(null,this.data),this.container}}]),i}(p),E=function(e){_inherits(i,e);var t=_createSuper(i);function i(e){var a,r;_classCallCheck(this,i);var o=(r=t.call(this,e,{isRenderable:!0})).data.file,s=o.filename,l=o.content;return r.filename=(0,n.getFilenameFromUrl)(s),r.content=l,null===(a=r.linkService.eventBus)||void 0===a||a.dispatch("fileattachmentannotation",{source:_assertThisInitialized(r),filename:s,content:l}),r}return _createClass(i,[{key:"render",value:function(){var e,t;this.container.className="fileAttachmentAnnotation";var i=document.createElement("div");return i.className="popupTriggerArea",i.addEventListener("dblclick",this._download.bind(this)),!this.data.hasPopup&&(null!==(e=this.data.titleObj)&&void 0!==e&&e.str||null!==(t=this.data.contentsObj)&&void 0!==t&&t.str||this.data.richText)&&this._createPopup(i,this.data),this.container.append(i),this.container}},{key:"_download",value:function(){var e;null===(e=this.downloadManager)||void 0===e||e.openOrDownloadData(this.container,this.content,this.filename)}}]),i}(p),N=function(){function e(){_classCallCheck(this,e)}return _createClass(e,null,[{key:"render",value:function(t){var i=t.annotations,o=t.div,s=t.viewport,l=t.accessibilityManager;_classStaticPrivateMethodGet(this,e,G).call(this,o,s);var c,p=0,m=_createForOfIteratorHelper(i);try{for(m.s();!(c=m.n()).done;){var h=c.value;if(h.annotationType!==a.AnnotationType.POPUP){var f=d(h.rect),y=f.width,b=f.height;if(y<=0||b<=0)continue}var g=u.create({data:h,layer:o,page:t.page,viewport:s,linkService:t.linkService,downloadManager:t.downloadManager,imageResourcesPath:t.imageResourcesPath||"",renderForms:!1!==t.renderForms,svgFactory:new n.DOMSVGFactory,annotationStorage:t.annotationStorage||new r.AnnotationStorage,enableScripting:t.enableScripting,hasJSActions:t.hasJSActions,fieldObjects:t.fieldObjects,mouseState:t.mouseState||{isDown:!1}});if(g.isRenderable){var v=g.render();if(h.hidden&&(v.style.visibility="hidden"),Array.isArray(v)){var _,x=_createForOfIteratorHelper(v);try{for(x.s();!(_=x.n()).done;){var w=_.value;w.style.zIndex=p++,_classStaticPrivateMethodGet(e,e,O).call(e,w,h.id,o,l)}}catch(S){x.e(S)}finally{x.f()}}else v.style.zIndex=p++,g instanceof A?o.prepend(v):_classStaticPrivateMethodGet(e,e,O).call(e,v,h.id,o,l)}}}catch(S){m.e(S)}finally{m.f()}_classStaticPrivateMethodGet(this,e,L).call(this,o,t.annotationCanvasMap)}},{key:"update",value:function(t){var i=t.annotationCanvasMap,a=t.div,n=t.viewport;_classStaticPrivateMethodGet(this,e,G).call(this,a,n),_classStaticPrivateMethodGet(this,e,L).call(this,a,i),a.hidden=!1}}]),e}();function O(e,t,i,a){var r=e.firstChild||e;r.id="".concat(n.AnnotationPrefix).concat(t),i.append(e),null===a||void 0===a||a.moveElementInDOM(i,e,r,!1)}function G(e,t){var i=t.width,a=t.height,n=t.rotation,r=e.style,o=n%180!==0,s=Math.floor(i)+"px",l=Math.floor(a)+"px";r.width=o?l:s,r.height=o?s:l,e.setAttribute("data-main-rotation",n)}function L(e,t){if(t){var i,a=_createForOfIteratorHelper(t);try{for(a.s();!(i=a.n()).done;){var n=_slicedToArray(i.value,2),r=n[0],o=n[1],s=e.querySelector('[data-annotation-id="'.concat(r,'"]'));if(s){var l=s.firstChild;l?"CANVAS"===l.nodeName?l.replaceWith(o):l.before(o):s.append(o)}}}catch(c){a.e(c)}finally{a.f()}t.clear()}}t.AnnotationLayer=N},function(e,t){function i(e){return Math.floor(255*Math.max(0,Math.min(1,e))).toString(16).padStart(2,"0")}Object.defineProperty(t,"__esModule",{value:!0}),t.ColorConverters=void 0;var a=function(){function e(){_classCallCheck(this,e)}return _createClass(e,null,[{key:"CMYK_G",value:function(e){var t=_slicedToArray(e,4),i=t[0],a=t[1],n=t[2],r=t[3];return["G",1-Math.min(1,.3*i+.59*n+.11*a+r)]}},{key:"G_CMYK",value:function(e){return["CMYK",0,0,0,1-_slicedToArray(e,1)[0]]}},{key:"G_RGB",value:function(e){var t=_slicedToArray(e,1)[0];return["RGB",t,t,t]}},{key:"G_HTML",value:function(e){var t=i(_slicedToArray(e,1)[0]);return"#".concat(t).concat(t).concat(t)}},{key:"RGB_G",value:function(e){var t=_slicedToArray(e,3);return["G",.3*t[0]+.59*t[1]+.11*t[2]]}},{key:"RGB_HTML",value:function(e){var t=_slicedToArray(e,3),a=t[0],n=t[1],r=t[2],o=i(a),s=i(n),l=i(r);return"#".concat(o).concat(s).concat(l)}},{key:"T_HTML",value:function(){return"#00000000"}},{key:"CMYK_RGB",value:function(e){var t=_slicedToArray(e,4),i=t[0],a=t[1],n=t[2],r=t[3];return["RGB",1-Math.min(1,i+r),1-Math.min(1,n+r),1-Math.min(1,a+r)]}},{key:"CMYK_HTML",value:function(e){var t=this.CMYK_RGB(e).slice(1);return this.RGB_HTML(t)}},{key:"RGB_CMYK",value:function(e){var t=_slicedToArray(e,3),i=1-t[0],a=1-t[1],n=1-t[2];return["CMYK",i,a,n,Math.min(i,a,n)]}}]),e}();t.ColorConverters=a},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.XfaLayer=void 0;var a=i(20),n=function(){function e(){_classCallCheck(this,e)}return _createClass(e,null,[{key:"setupStorage",value:function(e,t,i,a,n){var r=a.getValue(t,{value:null});switch(i.name){case"textarea":if(null!==r.value&&(e.textContent=r.value),"print"===n)break;e.addEventListener("input",(function(e){a.setValue(t,{value:e.target.value})}));break;case"input":if("radio"===i.attributes.type||"checkbox"===i.attributes.type){if(r.value===i.attributes.xfaOn?e.setAttribute("checked",!0):r.value===i.attributes.xfaOff&&e.removeAttribute("checked"),"print"===n)break;e.addEventListener("change",(function(e){a.setValue(t,{value:e.target.checked?e.target.getAttribute("xfaOn"):e.target.getAttribute("xfaOff")})}))}else{if(null!==r.value&&e.setAttribute("value",r.value),"print"===n)break;e.addEventListener("input",(function(e){a.setValue(t,{value:e.target.value})}))}break;case"select":if(null!==r.value){var o,s=_createForOfIteratorHelper(i.children);try{for(s.s();!(o=s.n()).done;){var l=o.value;l.attributes.value===r.value&&(l.attributes.selected=!0)}}catch(c){s.e(c)}finally{s.f()}}e.addEventListener("input",(function(e){var i=e.target.options,n=-1===i.selectedIndex?"":i[i.selectedIndex].value;a.setValue(t,{value:n})}))}}},{key:"setAttributes",value:function(e){var t=e.html,i=e.element,a=e.storage,n=void 0===a?null:a,r=e.intent,o=e.linkService,s=i.attributes,l=t instanceof HTMLAnchorElement;"radio"===s.type&&(s.name="".concat(s.name,"-").concat(r));for(var c=0,d=Object.entries(s);c<d.length;c++){var u=_slicedToArray(d[c],2),p=u[0],m=u[1];if(null!==m&&void 0!==m)switch(p){case"class":m.length&&t.setAttribute(p,m.join(" "));break;case"dataId":break;case"id":t.setAttribute("data-element-id",m);break;case"style":Object.assign(t.style,m);break;case"textContent":t.textContent=m;break;default:(!l||"href"!==p&&"newWindow"!==p)&&t.setAttribute(p,m)}}l&&o.addLinkAttributes(t,s.href,s.newWindow),n&&s.dataId&&this.setupStorage(t,s.dataId,i,n)}},{key:"render",value:function(e){var t=e.annotationStorage,i=e.linkService,n=e.xfaHtml,r=e.intent||"display",o=document.createElement(n.name);n.attributes&&this.setAttributes({html:o,element:n,intent:r,linkService:i});var s=[[n,-1,o]],l=e.div;if(l.append(o),e.viewport){var c="matrix(".concat(e.viewport.transform.join(","),")");l.style.transform=c}"richText"!==r&&l.setAttribute("class","xfaLayer xfaFont");for(var d=[];s.length>0;){var u,p=s.at(-1),m=_slicedToArray(p,3),h=m[0],f=m[1],y=m[2];if(f+1!==h.children.length){var b=h.children[++s.at(-1)[1]];if(null!==b){var g=b.name;if("#text"!==g){var v=void 0;if(v=null!==b&&void 0!==b&&null!==(u=b.attributes)&&void 0!==u&&u.xmlns?document.createElementNS(b.attributes.xmlns,g):document.createElement(g),y.append(v),b.attributes&&this.setAttributes({html:v,element:b,storage:t,intent:r,linkService:i}),b.children&&b.children.length>0)s.push([b,-1,v]);else if(b.value){var _=document.createTextNode(b.value);a.XfaText.shouldBuildText(g)&&d.push(_),v.append(_)}}else{var A=document.createTextNode(b.value);d.push(A),y.append(A)}}}else s.pop()}var x,w=_createForOfIteratorHelper(l.querySelectorAll(".xfaNonInteractive input, .xfaNonInteractive textarea"));try{for(w.s();!(x=w.n()).done;)x.value.setAttribute("readOnly",!0)}catch(S){w.e(S)}finally{w.f()}return{textDivs:d}}},{key:"update",value:function(e){var t="matrix(".concat(e.viewport.transform.join(","),")");e.div.style.transform=t,e.div.hidden=!1}}]),e}();t.XfaLayer=n},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.TextLayerRenderTask=void 0,t.renderTextLayer=function(e){var t=new f({textContent:e.textContent,textContentStream:e.textContentStream,container:e.container,viewport:e.viewport,textDivs:e.textDivs,textContentItemsStr:e.textContentItemsStr,enhanceTextSelection:e.enhanceTextSelection});return t._render(e.timeout),t};var a=i(1),n=i(8),r=1e5,o=30,s=.8,l=new Map,c=/^\s+$/g;function d(e,t,i,n){var r=document.createElement("span"),d=e._enhanceTextSelection?{angle:0,canvasWidth:0,hasText:""!==t.str,hasEOL:t.hasEOL,originalTransform:null,paddingBottom:0,paddingLeft:0,paddingRight:0,paddingTop:0,scale:1,fontSize:0}:{angle:0,canvasWidth:0,hasText:""!==t.str,hasEOL:t.hasEOL,fontSize:0};e._textDivs.push(r);var u=a.Util.transform(e._viewport.transform,t.transform),p=Math.atan2(u[1],u[0]),m=i[t.fontName];m.vertical&&(p+=Math.PI/2);var h,f,y=Math.hypot(u[2],u[3]),b=y*function(e,t){var i=l.get(e);if(i)return i;t.save(),t.font="".concat(o,"px ").concat(e);var a=t.measureText(""),n=a.fontBoundingBoxAscent,r=Math.abs(a.fontBoundingBoxDescent);if(n){t.restore();var c=n/(n+r);return l.set(e,c),c}t.strokeStyle="red",t.clearRect(0,0,o,o),t.strokeText("g",0,0);var d=t.getImageData(0,0,o,o).data;r=0;for(var u=d.length-1-3;u>=0;u-=4)if(d[u]>0){r=Math.ceil(u/4/o);break}t.clearRect(0,0,o,o),t.strokeText("A",0,o),n=0;for(var p=0,m=(d=t.getImageData(0,0,o,o).data).length;p<m;p+=4)if(d[p]>0){n=o-Math.floor(p/4/o);break}if(t.restore(),n){var h=n/(n+r);return l.set(e,h),h}return l.set(e,s),s}(m.fontFamily,n);0===p?(h=u[4],f=u[5]-b):(h=u[4]+b*Math.sin(p),f=u[5]-b*Math.cos(p)),r.style.left="".concat(h,"px"),r.style.top="".concat(f,"px"),r.style.fontSize="".concat(y,"px"),r.style.fontFamily=m.fontFamily,d.fontSize=y,r.setAttribute("role","presentation"),r.textContent=t.str,r.dir=t.dir,e._fontInspectorEnabled&&(r.dataset.fontName=t.fontName),0!==p&&(d.angle=p*(180/Math.PI));var g=!1;if(t.str.length>1||e._enhanceTextSelection&&c.test(t.str))g=!0;else if(" "!==t.str&&t.transform[0]!==t.transform[3]){var v=Math.abs(t.transform[0]),_=Math.abs(t.transform[3]);v!==_&&Math.max(v,_)/Math.min(v,_)>1.5&&(g=!0)}if(g&&(m.vertical?d.canvasWidth=t.height*e._viewport.scale:d.canvasWidth=t.width*e._viewport.scale),e._textDivProperties.set(r,d),e._textContentStream&&e._layoutText(r),e._enhanceTextSelection&&d.hasText){var A=1,x=0;0!==p&&(A=Math.cos(p),x=Math.sin(p));var w,S,C=(m.vertical?t.height:t.width)*e._viewport.scale,k=y;0!==p?(w=[A,x,-x,A,h,f],S=a.Util.getAxialAlignedBoundingBox([0,0,C,k],w)):S=[h,f,h+C,f+k],e._bounds.push({left:S[0],top:S[1],right:S[2],bottom:S[3],div:r,size:[C,k],m:w})}}function u(e){if(!e._canceled){var t=e._textDivs,i=e._capability,a=t.length;if(a>r)return e._renderingDone=!0,void i.resolve();if(!e._textContentStream)for(var n=0;n<a;n++)e._layoutText(t[n]);e._renderingDone=!0,i.resolve()}}function p(e,t,i){for(var a=0,n=0;n<i;n++){var r=e[t++];r>0&&(a=a?Math.min(r,a):r)}return a}function m(e){for(var t=e._bounds,i=e._viewport,n=function(e,t,i){var a=i.map((function(e,t){return{x1:e.left,y1:e.top,x2:e.right,y2:e.bottom,index:t,x1New:void 0,x2New:void 0}}));h(e,a);var n,r=new Array(i.length),o=_createForOfIteratorHelper(a);try{for(o.s();!(n=o.n()).done;){var s=n.value,l=s.index;r[l]={left:s.x1New,top:0,right:s.x2New,bottom:0}}}catch(m){o.e(m)}finally{o.f()}i.map((function(t,i){var n=r[i],o=a[i];o.x1=t.top,o.y1=e-n.right,o.x2=t.bottom,o.y2=e-n.left,o.index=i,o.x1New=void 0,o.x2New=void 0})),h(t,a);var c,d=_createForOfIteratorHelper(a);try{for(d.s();!(c=d.n()).done;){var u=c.value,p=u.index;r[p].top=u.x1New,r[p].bottom=u.x2New}}catch(m){d.e(m)}finally{d.f()}return r}(i.width,i.height,t),r=0;r<n.length;r++){var o=t[r].div,s=e._textDivProperties.get(o);if(0!==s.angle){for(var l=n[r],c=t[r],d=c.m,u=d[0],m=d[1],f=[[0,0],[0,c.size[1]],[c.size[0],0],c.size],y=new Float64Array(64),b=0,g=f.length;b<g;b++){var v=a.Util.applyTransform(f[b],d);y[b+0]=u&&(l.left-v[0])/u,y[b+4]=m&&(l.top-v[1])/m,y[b+8]=u&&(l.right-v[0])/u,y[b+12]=m&&(l.bottom-v[1])/m,y[b+16]=m&&(l.left-v[0])/-m,y[b+20]=u&&(l.top-v[1])/u,y[b+24]=m&&(l.right-v[0])/-m,y[b+28]=u&&(l.bottom-v[1])/u,y[b+32]=u&&(l.left-v[0])/-u,y[b+36]=m&&(l.top-v[1])/-m,y[b+40]=u&&(l.right-v[0])/-u,y[b+44]=m&&(l.bottom-v[1])/-m,y[b+48]=m&&(l.left-v[0])/m,y[b+52]=u&&(l.top-v[1])/-u,y[b+56]=m&&(l.right-v[0])/m,y[b+60]=u&&(l.bottom-v[1])/-u}var _=1+Math.min(Math.abs(u),Math.abs(m));s.paddingLeft=p(y,32,16)/_,s.paddingTop=p(y,48,16)/_,s.paddingRight=p(y,0,16)/_,s.paddingBottom=p(y,16,16)/_,e._textDivProperties.set(o,s)}else s.paddingLeft=t[r].left-n[r].left,s.paddingTop=t[r].top-n[r].top,s.paddingRight=n[r].right-t[r].right,s.paddingBottom=n[r].bottom-t[r].bottom,e._textDivProperties.set(o,s)}}function h(e,t){t.sort((function(e,t){return e.x1-t.x1||e.index-t.index}));var i,a=[{start:-1/0,end:1/0,boundary:{x1:-1/0,y1:-1/0,x2:0,y2:1/0,index:-1,x1New:0,x2New:0}}],n=_createForOfIteratorHelper(t);try{for(n.s();!(i=n.n()).done;){for(var r=i.value,o=0;o<a.length&&a[o].end<=r.y1;)o++;for(var s=a.length-1;s>=0&&a[s].start>=r.y2;)s--;var l=void 0,c=void 0,d=void 0,u=void 0,p=-1/0;for(d=o;d<=s;d++){c=(l=a[d]).boundary;var m=void 0;(m=c.x2>r.x1?c.index>r.index?c.x1New:r.x1:void 0===c.x2New?(c.x2+r.x1)/2:c.x2New)>p&&(p=m)}for(r.x1New=p,d=o;d<=s;d++)void 0===(c=(l=a[d]).boundary).x2New?c.x2>r.x1?c.index>r.index&&(c.x2New=c.x2):c.x2New=p:c.x2New>p&&(c.x2New=Math.max(p,c.x2));var h=[],f=null;for(d=o;d<=s;d++){var y=(c=(l=a[d]).boundary).x2>r.x2?c:r;f===y?h.at(-1).end=l.end:(h.push({start:l.start,end:l.end,boundary:y}),f=y)}for(a[o].start<r.y1&&(h[0].start=r.y1,h.unshift({start:a[o].start,end:r.y1,boundary:a[o].boundary})),r.y2<a[s].end&&(h.at(-1).end=r.y2,h.push({start:r.y2,end:a[s].end,boundary:a[s].boundary})),d=o;d<=s;d++)if(void 0===(c=(l=a[d]).boundary).x2New){var b=!1;for(u=o-1;!b&&u>=0&&a[u].start>=c.y1;u--)b=a[u].boundary===c;for(u=s+1;!b&&u<a.length&&a[u].end<=c.y2;u++)b=a[u].boundary===c;for(u=0;!b&&u<h.length;u++)b=h[u].boundary===c;b||(c.x2New=p)}Array.prototype.splice.apply(a,[o,s-o+1].concat(h))}}catch(A){n.e(A)}finally{n.f()}for(var g=0,v=a;g<v.length;g++){var _=v[g].boundary;void 0===_.x2New&&(_.x2New=Math.max(e,_.x2))}}var f=function(){function e(t){var i,r=this,o=t.textContent,s=t.textContentStream,l=t.container,c=t.viewport,d=t.textDivs,u=t.textContentItemsStr,p=t.enhanceTextSelection;_classCallCheck(this,e),p&&(0,n.deprecated)("The `enhanceTextSelection` functionality will be removed in the future."),this._textContent=o,this._textContentStream=s,this._container=l,this._document=l.ownerDocument,this._viewport=c,this._textDivs=d||[],this._textContentItemsStr=u||[],this._enhanceTextSelection=!!p,this._fontInspectorEnabled=!(null===(i=globalThis.FontInspector)||void 0===i||!i.enabled),this._reader=null,this._layoutTextLastFontSize=null,this._layoutTextLastFontFamily=null,this._layoutTextCtx=null,this._textDivProperties=new WeakMap,this._renderingDone=!1,this._canceled=!1,this._capability=(0,a.createPromiseCapability)(),this._renderTimer=null,this._bounds=[],this._devicePixelRatio=globalThis.devicePixelRatio||1,this._capability.promise.finally((function(){r._enhanceTextSelection||(r._textDivProperties=null),r._layoutTextCtx&&(r._layoutTextCtx.canvas.width=0,r._layoutTextCtx.canvas.height=0,r._layoutTextCtx=null)})).catch((function(){}))}return _createClass(e,[{key:"promise",get:function(){return this._capability.promise}},{key:"cancel",value:function(){this._canceled=!0,this._reader&&(this._reader.cancel(new a.AbortException("TextLayer task cancelled.")).catch((function(){})),this._reader=null),null!==this._renderTimer&&(clearTimeout(this._renderTimer),this._renderTimer=null),this._capability.reject(new Error("TextLayer task cancelled."))}},{key:"_processItems",value:function(e,t){for(var i=0,a=e.length;i<a;i++)if(void 0!==e[i].str)this._textContentItemsStr.push(e[i].str),d(this,e[i],t,this._layoutTextCtx);else if("beginMarkedContentProps"===e[i].type||"beginMarkedContent"===e[i].type){var n=this._container;this._container=document.createElement("span"),this._container.classList.add("markedContent"),null!==e[i].id&&this._container.setAttribute("id","".concat(e[i].id)),n.append(this._container)}else"endMarkedContent"===e[i].type&&(this._container=this._container.parentNode)}},{key:"_layoutText",value:function(e){var t=this._textDivProperties.get(e),i="";if(0!==t.canvasWidth&&t.hasText){var a=e.style.fontFamily,n=t.fontSize;n===this._layoutTextLastFontSize&&a===this._layoutTextLastFontFamily||(this._layoutTextCtx.font="".concat(n*this._devicePixelRatio,"px ").concat(a),this._layoutTextLastFontSize=n,this._layoutTextLastFontFamily=a);var r=this._layoutTextCtx.measureText(e.textContent).width;if(r>0){var o=this._devicePixelRatio*t.canvasWidth/r;this._enhanceTextSelection&&(t.scale=o),i="scaleX(".concat(o,")")}}if(0!==t.angle&&(i="rotate(".concat(t.angle,"deg) ").concat(i)),i.length>0&&(this._enhanceTextSelection&&(t.originalTransform=i),e.style.transform=i),t.hasText&&this._container.append(e),t.hasEOL){var s=document.createElement("br");s.setAttribute("role","presentation"),this._container.append(s)}}},{key:"_render",value:function(){var e=this,t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:0,i=(0,a.createPromiseCapability)(),n=Object.create(null),r=this._document.createElement("canvas");if(r.height=r.width=o,this._layoutTextCtx=r.getContext("2d",{alpha:!1}),this._textContent){var s=this._textContent.items,l=this._textContent.styles;this._processItems(s,l),i.resolve()}else{if(!this._textContentStream)throw new Error('Neither "textContent" nor "textContentStream" parameters specified.');this._reader=this._textContentStream.getReader(),function t(){e._reader.read().then((function(a){var r=a.value;a.done?i.resolve():(Object.assign(n,r.styles),e._processItems(r.items,n),t())}),i.reject)}()}i.promise.then((function(){n=null,t?e._renderTimer=setTimeout((function(){u(e),e._renderTimer=null}),t):u(e)}),this._capability.reject)}},{key:"expandTextDivs",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0];if(this._enhanceTextSelection&&this._renderingDone){null!==this._bounds&&(m(this),this._bounds=null);for(var t=[],i=[],a=0,n=this._textDivs.length;a<n;a++){var r=this._textDivs[a],o=this._textDivProperties.get(r);o.hasText&&(e?(t.length=0,i.length=0,o.originalTransform&&t.push(o.originalTransform),o.paddingTop>0?(i.push("".concat(o.paddingTop,"px")),t.push("translateY(".concat(-o.paddingTop,"px)"))):i.push(0),o.paddingRight>0?i.push("".concat(o.paddingRight/o.scale,"px")):i.push(0),o.paddingBottom>0?i.push("".concat(o.paddingBottom,"px")):i.push(0),o.paddingLeft>0?(i.push("".concat(o.paddingLeft/o.scale,"px")),t.push("translateX(".concat(-o.paddingLeft/o.scale,"px)"))):i.push(0),r.style.padding=i.join(" "),t.length&&(r.style.transform=t.join(" "))):(r.style.padding=null,r.style.transform=o.originalTransform))}}}}]),e}();t.TextLayerRenderTask=f},function(e,t,i){Object.defineProperty(t,"__esModule",{value:!0}),t.SVGGraphics=void 0;var a=i(8),n=i(1),r=i(3),o=_createClass((function e(){_classCallCheck(this,e),(0,n.unreachable)("Not implemented: SVGGraphics")}));t.SVGGraphics=o;var s=function(e){if(Number.isInteger(e))return e.toString();var t=e.toFixed(10),i=t.length-1;if("0"!==t[i])return t;do{i--}while("0"===t[i]);return t.substring(0,"."===t[i]?i:i+1)},l=function(e){if(0===e[4]&&0===e[5]){if(0===e[1]&&0===e[2])return 1===e[0]&&1===e[3]?"":"scale(".concat(s(e[0])," ").concat(s(e[3]),")");if(e[0]===e[3]&&e[1]===-e[2]){var t=180*Math.acos(e[0])/Math.PI;return"rotate(".concat(s(t),")")}}else if(1===e[0]&&0===e[1]&&0===e[2]&&1===e[3])return"translate(".concat(s(e[4])," ").concat(s(e[5]),")");return"matrix(".concat(s(e[0])," ").concat(s(e[1])," ").concat(s(e[2])," ").concat(s(e[3])," ").concat(s(e[4])," ")+"".concat(s(e[5]),")")},c={fontStyle:"normal",fontWeight:"normal",fillColor:"#000000"},d=["butt","round","square"],u=["miter","round","bevel"],p=function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"",i=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if(URL.createObjectURL&&"undefined"!==typeof Blob&&!i)return URL.createObjectURL(new Blob([e],{type:t}));for(var a="ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyz0123456789+/=",n="data:".concat(t,";base64,"),r=0,o=e.length;r<o;r+=3){var s=255&e[r],l=255&e[r+1],c=255&e[r+2];n+=a[s>>2]+a[(3&s)<<4|l>>4]+a[r+1<o?(15&l)<<2|c>>6:64]+a[r+2<o?63&c:64]}return n},m=function(){for(var e=new Uint8Array([137,80,78,71,13,10,26,10]),t=12,i=new Int32Array(256),a=0;a<256;a++){for(var o=a,s=0;s<8;s++)o=1&o?3988292384^o>>1&2147483647:o>>1&2147483647;i[a]=o}function l(e,t,a,n){var r=n,o=t.length;a[r]=o>>24&255,a[r+1]=o>>16&255,a[r+2]=o>>8&255,a[r+3]=255&o,a[r+=4]=255&e.charCodeAt(0),a[r+1]=255&e.charCodeAt(1),a[r+2]=255&e.charCodeAt(2),a[r+3]=255&e.charCodeAt(3),r+=4,a.set(t,r);var s=function(e,t,a){for(var n=-1,r=t;r<a;r++){var o=255&(n^e[r]);n=n>>>8^i[o]}return-1^n}(a,n+4,r+=t.length);a[r]=s>>24&255,a[r+1]=s>>16&255,a[r+2]=s>>8&255,a[r+3]=255&s}function c(e){var t=e.length,i=65535,a=Math.ceil(t/i),n=new Uint8Array(2+t+5*a+4),r=0;n[r++]=120,n[r++]=156;for(var o=0;t>i;)n[r++]=0,n[r++]=255,n[r++]=255,n[r++]=0,n[r++]=0,n.set(e.subarray(o,o+i),r),r+=i,o+=i,t-=i;n[r++]=1,n[r++]=255&t,n[r++]=t>>8&255,n[r++]=255&~t,n[r++]=(65535&~t)>>8&255,n.set(e.subarray(o),r),r+=e.length-o;var s=function(e,t,i){for(var a=1,n=0,r=t;r<i;++r)n=(n+(a=(a+(255&e[r]))%65521))%65521;return n<<16|a}(e,0,e.length);return n[r++]=s>>24&255,n[r++]=s>>16&255,n[r++]=s>>8&255,n[r++]=255&s,n}function d(i,a,o,s){var d,u,m,h=i.width,f=i.height,y=i.data;switch(a){case n.ImageKind.GRAYSCALE_1BPP:u=0,d=1,m=h+7>>3;break;case n.ImageKind.RGB_24BPP:u=2,d=8,m=3*h;break;case n.ImageKind.RGBA_32BPP:u=6,d=8,m=4*h;break;default:throw new Error("invalid format")}for(var b=new Uint8Array((1+m)*f),g=0,v=0,_=0;_<f;++_)b[g++]=0,b.set(y.subarray(v,v+m),g),v+=m,g+=m;if(a===n.ImageKind.GRAYSCALE_1BPP&&s){g=0;for(var A=0;A<f;A++){g++;for(var x=0;x<m;x++)b[g++]^=255}}var w=new Uint8Array([h>>24&255,h>>16&255,h>>8&255,255&h,f>>24&255,f>>16&255,f>>8&255,255&f,d,u,0,0,0]),S=function(e){if(!r.isNodeJS)return c(e);try{var t;t=parseInt(process.versions.node)>=8?e:Buffer.from(e);var i=__webpack_require__(5232).deflateSync(t,{level:9});return i instanceof Uint8Array?i:new Uint8Array(i)}catch(a){(0,n.warn)("Not compressing PNG because zlib.deflateSync is unavailable: "+a)}return c(e)}(b),C=e.length+3*t+w.length+S.length,k=new Uint8Array(C),D=0;return k.set(e,D),l("IHDR",w,k,D+=e.length),l("IDATA",S,k,D+=t+w.length),D+=t+S.length,l("IEND",new Uint8Array(0),k,D),p(k,"image/png",o)}return function(e,t,i){return d(e,void 0===e.kind?n.ImageKind.GRAYSCALE_1BPP:e.kind,t,i)}}(),h=function(){function e(){_classCallCheck(this,e),this.fontSizeScale=1,this.fontWeight=c.fontWeight,this.fontSize=0,this.textMatrix=n.IDENTITY_MATRIX,this.fontMatrix=n.FONT_IDENTITY_MATRIX,this.leading=0,this.textRenderingMode=n.TextRenderingMode.FILL,this.textMatrixScale=1,this.x=0,this.y=0,this.lineX=0,this.lineY=0,this.charSpacing=0,this.wordSpacing=0,this.textHScale=1,this.textRise=0,this.fillColor=c.fillColor,this.strokeColor="#000000",this.fillAlpha=1,this.strokeAlpha=1,this.lineWidth=1,this.lineJoin="",this.lineCap="",this.miterLimit=0,this.dashArray=[],this.dashPhase=0,this.dependencies=[],this.activeClipUrl=null,this.clipGroup=null,this.maskId=""}return _createClass(e,[{key:"clone",value:function(){return Object.create(this)}},{key:"setCurrentPoint",value:function(e,t){this.x=e,this.y=t}}]),e}(),f=0,y=0,b=0;t.SVGGraphics=o=function(){function e(t,i){var r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];for(var o in _classCallCheck(this,e),(0,a.deprecated)("The SVG back-end is no longer maintained and *may* be removed in the future."),this.svgFactory=new a.DOMSVGFactory,this.current=new h,this.transformMatrix=n.IDENTITY_MATRIX,this.transformStack=[],this.extraStack=[],this.commonObjs=t,this.objs=i,this.pendingClip=null,this.pendingEOFill=!1,this.embedFonts=!1,this.embeddedFonts=Object.create(null),this.cssStyle=null,this.forceDataSchema=!!r,this._operatorIdMapping=[],n.OPS)this._operatorIdMapping[n.OPS[o]]=o}return _createClass(e,[{key:"save",value:function(){this.transformStack.push(this.transformMatrix);var e=this.current;this.extraStack.push(e),this.current=e.clone()}},{key:"restore",value:function(){this.transformMatrix=this.transformStack.pop(),this.current=this.extraStack.pop(),this.pendingClip=null,this.tgrp=null}},{key:"group",value:function(e){this.save(),this.executeOpTree(e),this.restore()}},{key:"loadDependencies",value:function(e){for(var t=this,i=e.fnArray,a=e.argsArray,r=0,o=i.length;r<o;r++)if(i[r]===n.OPS.dependency){var s,l=_createForOfIteratorHelper(a[r]);try{var c=function(){var e=s.value,i=e.startsWith("g_")?t.commonObjs:t.objs,a=new Promise((function(t){i.get(e,t)}));t.current.dependencies.push(a)};for(l.s();!(s=l.n()).done;)c()}catch(d){l.e(d)}finally{l.f()}}return Promise.all(this.current.dependencies)}},{key:"transform",value:function(e,t,i,a,r,o){var s=[e,t,i,a,r,o];this.transformMatrix=n.Util.transform(this.transformMatrix,s),this.tgrp=null}},{key:"getSVG",value:function(e,t){var i=this;this.viewport=t;var a=this._initialize(t);return this.loadDependencies(e).then((function(){return i.transformMatrix=n.IDENTITY_MATRIX,i.executeOpTree(i.convertOpList(e)),a}))}},{key:"convertOpList",value:function(e){for(var t=this._operatorIdMapping,i=e.argsArray,a=e.fnArray,n=[],r=0,o=a.length;r<o;r++){var s=a[r];n.push({fnId:s,fn:t[s],args:i[r]})}return function(e){var t,i=[],a=[],n=_createForOfIteratorHelper(e);try{for(n.s();!(t=n.n()).done;){var r=t.value;"save"!==r.fn?"restore"===r.fn?i=a.pop():i.push(r):(i.push({fnId:92,fn:"group",items:[]}),a.push(i),i=i.at(-1).items)}}catch(o){n.e(o)}finally{n.f()}return i}(n)}},{key:"executeOpTree",value:function(e){var t,i=_createForOfIteratorHelper(e);try{for(i.s();!(t=i.n()).done;){var a=t.value,r=a.fn,o=a.fnId,s=a.args;switch(0|o){case n.OPS.beginText:this.beginText();break;case n.OPS.dependency:break;case n.OPS.setLeading:this.setLeading(s);break;case n.OPS.setLeadingMoveText:this.setLeadingMoveText(s[0],s[1]);break;case n.OPS.setFont:this.setFont(s);break;case n.OPS.showText:case n.OPS.showSpacedText:this.showText(s[0]);break;case n.OPS.endText:this.endText();break;case n.OPS.moveText:this.moveText(s[0],s[1]);break;case n.OPS.setCharSpacing:this.setCharSpacing(s[0]);break;case n.OPS.setWordSpacing:this.setWordSpacing(s[0]);break;case n.OPS.setHScale:this.setHScale(s[0]);break;case n.OPS.setTextMatrix:this.setTextMatrix(s[0],s[1],s[2],s[3],s[4],s[5]);break;case n.OPS.setTextRise:this.setTextRise(s[0]);break;case n.OPS.setTextRenderingMode:this.setTextRenderingMode(s[0]);break;case n.OPS.setLineWidth:this.setLineWidth(s[0]);break;case n.OPS.setLineJoin:this.setLineJoin(s[0]);break;case n.OPS.setLineCap:this.setLineCap(s[0]);break;case n.OPS.setMiterLimit:this.setMiterLimit(s[0]);break;case n.OPS.setFillRGBColor:this.setFillRGBColor(s[0],s[1],s[2]);break;case n.OPS.setStrokeRGBColor:this.setStrokeRGBColor(s[0],s[1],s[2]);break;case n.OPS.setStrokeColorN:this.setStrokeColorN(s);break;case n.OPS.setFillColorN:this.setFillColorN(s);break;case n.OPS.shadingFill:this.shadingFill(s[0]);break;case n.OPS.setDash:this.setDash(s[0],s[1]);break;case n.OPS.setRenderingIntent:this.setRenderingIntent(s[0]);break;case n.OPS.setFlatness:this.setFlatness(s[0]);break;case n.OPS.setGState:this.setGState(s[0]);break;case n.OPS.fill:this.fill();break;case n.OPS.eoFill:this.eoFill();break;case n.OPS.stroke:this.stroke();break;case n.OPS.fillStroke:this.fillStroke();break;case n.OPS.eoFillStroke:this.eoFillStroke();break;case n.OPS.clip:this.clip("nonzero");break;case n.OPS.eoClip:this.clip("evenodd");break;case n.OPS.paintSolidColorImageMask:this.paintSolidColorImageMask();break;case n.OPS.paintImageXObject:this.paintImageXObject(s[0]);break;case n.OPS.paintInlineImageXObject:this.paintInlineImageXObject(s[0]);break;case n.OPS.paintImageMaskXObject:this.paintImageMaskXObject(s[0]);break;case n.OPS.paintFormXObjectBegin:this.paintFormXObjectBegin(s[0],s[1]);break;case n.OPS.paintFormXObjectEnd:this.paintFormXObjectEnd();break;case n.OPS.closePath:this.closePath();break;case n.OPS.closeStroke:this.closeStroke();break;case n.OPS.closeFillStroke:this.closeFillStroke();break;case n.OPS.closeEOFillStroke:this.closeEOFillStroke();break;case n.OPS.nextLine:this.nextLine();break;case n.OPS.transform:this.transform(s[0],s[1],s[2],s[3],s[4],s[5]);break;case n.OPS.constructPath:this.constructPath(s[0],s[1]);break;case n.OPS.endPath:this.endPath();break;case 92:this.group(a.items);break;default:(0,n.warn)("Unimplemented operator ".concat(r))}}}catch(l){i.e(l)}finally{i.f()}}},{key:"setWordSpacing",value:function(e){this.current.wordSpacing=e}},{key:"setCharSpacing",value:function(e){this.current.charSpacing=e}},{key:"nextLine",value:function(){this.moveText(0,this.current.leading)}},{key:"setTextMatrix",value:function(e,t,i,a,n,r){var o=this.current;o.textMatrix=o.lineMatrix=[e,t,i,a,n,r],o.textMatrixScale=Math.hypot(e,t),o.x=o.lineX=0,o.y=o.lineY=0,o.xcoords=[],o.ycoords=[],o.tspan=this.svgFactory.createElement("svg:tspan"),o.tspan.setAttributeNS(null,"font-family",o.fontFamily),o.tspan.setAttributeNS(null,"font-size","".concat(s(o.fontSize),"px")),o.tspan.setAttributeNS(null,"y",s(-o.y)),o.txtElement=this.svgFactory.createElement("svg:text"),o.txtElement.append(o.tspan)}},{key:"beginText",value:function(){var e=this.current;e.x=e.lineX=0,e.y=e.lineY=0,e.textMatrix=n.IDENTITY_MATRIX,e.lineMatrix=n.IDENTITY_MATRIX,e.textMatrixScale=1,e.tspan=this.svgFactory.createElement("svg:tspan"),e.txtElement=this.svgFactory.createElement("svg:text"),e.txtgrp=this.svgFactory.createElement("svg:g"),e.xcoords=[],e.ycoords=[]}},{key:"moveText",value:function(e,t){var i=this.current;i.x=i.lineX+=e,i.y=i.lineY+=t,i.xcoords=[],i.ycoords=[],i.tspan=this.svgFactory.createElement("svg:tspan"),i.tspan.setAttributeNS(null,"font-family",i.fontFamily),i.tspan.setAttributeNS(null,"font-size","".concat(s(i.fontSize),"px")),i.tspan.setAttributeNS(null,"y",s(-i.y))}},{key:"showText",value:function(e){var t=this.current,i=t.font,a=t.fontSize;if(0!==a){var r,o=t.fontSizeScale,d=t.charSpacing,u=t.wordSpacing,p=t.fontDirection,m=t.textHScale*p,h=i.vertical,f=h?1:-1,y=i.defaultVMetrics,b=a*t.fontMatrix[0],g=0,v=_createForOfIteratorHelper(e);try{for(v.s();!(r=v.n()).done;){var _=r.value;if(null!==_)if("number"!==typeof _){var A=(_.isSpace?u:0)+d,x=_.fontChar,w=void 0,S=void 0,C=_.width;if(h){var k=void 0,D=_.vmetric||y;k=-(k=_.vmetric?D[1]:.5*C)*b;var R=D[2]*b;C=D?-D[0]:C,w=k/o,S=(g+R)/o}else w=g/o,S=0;(_.isInFont||i.missingFile)&&(t.xcoords.push(t.x+w),h&&t.ycoords.push(-t.y+S),t.tspan.textContent+=x),g+=h?C*b-A*p:C*b+A*p}else g+=f*_*a/1e3;else g+=p*u}}catch(P){v.e(P)}finally{v.f()}t.tspan.setAttributeNS(null,"x",t.xcoords.map(s).join(" ")),h?t.tspan.setAttributeNS(null,"y",t.ycoords.map(s).join(" ")):t.tspan.setAttributeNS(null,"y",s(-t.y)),h?t.y-=g:t.x+=g*m,t.tspan.setAttributeNS(null,"font-family",t.fontFamily),t.tspan.setAttributeNS(null,"font-size","".concat(s(t.fontSize),"px")),t.fontStyle!==c.fontStyle&&t.tspan.setAttributeNS(null,"font-style",t.fontStyle),t.fontWeight!==c.fontWeight&&t.tspan.setAttributeNS(null,"font-weight",t.fontWeight);var I=t.textRenderingMode&n.TextRenderingMode.FILL_STROKE_MASK;if(I===n.TextRenderingMode.FILL||I===n.TextRenderingMode.FILL_STROKE?(t.fillColor!==c.fillColor&&t.tspan.setAttributeNS(null,"fill",t.fillColor),t.fillAlpha<1&&t.tspan.setAttributeNS(null,"fill-opacity",t.fillAlpha)):t.textRenderingMode===n.TextRenderingMode.ADD_TO_PATH?t.tspan.setAttributeNS(null,"fill","transparent"):t.tspan.setAttributeNS(null,"fill","none"),I===n.TextRenderingMode.STROKE||I===n.TextRenderingMode.FILL_STROKE){var M=1/(t.textMatrixScale||1);this._setStrokeAttributes(t.tspan,M)}var T=t.textMatrix;0!==t.textRise&&((T=T.slice())[5]+=t.textRise),t.txtElement.setAttributeNS(null,"transform","".concat(l(T)," scale(").concat(s(m),", -1)")),t.txtElement.setAttributeNS("http://www.w3.org/XML/1998/namespace","xml:space","preserve"),t.txtElement.append(t.tspan),t.txtgrp.append(t.txtElement),this._ensureTransformGroup().append(t.txtElement)}}},{key:"setLeadingMoveText",value:function(e,t){this.setLeading(-t),this.moveText(e,t)}},{key:"addFontStyle",value:function(e){if(!e.data)throw new Error('addFontStyle: No font data available, ensure that the "fontExtraProperties" API parameter is set.');this.cssStyle||(this.cssStyle=this.svgFactory.createElement("svg:style"),this.cssStyle.setAttributeNS(null,"type","text/css"),this.defs.append(this.cssStyle));var t=p(e.data,e.mimetype,this.forceDataSchema);this.cssStyle.textContent+='@font-face { font-family: "'.concat(e.loadedName,'";')+" src: url(".concat(t,"); }\n")}},{key:"setFont",value:function(e){var t=this.current,i=this.commonObjs.get(e[0]),a=e[1];t.font=i,!this.embedFonts||i.missingFile||this.embeddedFonts[i.loadedName]||(this.addFontStyle(i),this.embeddedFonts[i.loadedName]=i),t.fontMatrix=i.fontMatrix||n.FONT_IDENTITY_MATRIX;var r="normal";i.black?r="900":i.bold&&(r="bold");var o=i.italic?"italic":"normal";a<0?(a=-a,t.fontDirection=-1):t.fontDirection=1,t.fontSize=a,t.fontFamily=i.loadedName,t.fontWeight=r,t.fontStyle=o,t.tspan=this.svgFactory.createElement("svg:tspan"),t.tspan.setAttributeNS(null,"y",s(-t.y)),t.xcoords=[],t.ycoords=[]}},{key:"endText",value:function(){var e,t=this.current;t.textRenderingMode&n.TextRenderingMode.ADD_TO_PATH_FLAG&&null!==(e=t.txtElement)&&void 0!==e&&e.hasChildNodes()&&(t.element=t.txtElement,this.clip("nonzero"),this.endPath())}},{key:"setLineWidth",value:function(e){e>0&&(this.current.lineWidth=e)}},{key:"setLineCap",value:function(e){this.current.lineCap=d[e]}},{key:"setLineJoin",value:function(e){this.current.lineJoin=u[e]}},{key:"setMiterLimit",value:function(e){this.current.miterLimit=e}},{key:"setStrokeAlpha",value:function(e){this.current.strokeAlpha=e}},{key:"setStrokeRGBColor",value:function(e,t,i){this.current.strokeColor=n.Util.makeHexColor(e,t,i)}},{key:"setFillAlpha",value:function(e){this.current.fillAlpha=e}},{key:"setFillRGBColor",value:function(e,t,i){this.current.fillColor=n.Util.makeHexColor(e,t,i),this.current.tspan=this.svgFactory.createElement("svg:tspan"),this.current.xcoords=[],this.current.ycoords=[]}},{key:"setStrokeColorN",value:function(e){this.current.strokeColor=this._makeColorN_Pattern(e)}},{key:"setFillColorN",value:function(e){this.current.fillColor=this._makeColorN_Pattern(e)}},{key:"shadingFill",value:function(e){var t=this.viewport.width,i=this.viewport.height,a=n.Util.inverseTransform(this.transformMatrix),r=n.Util.applyTransform([0,0],a),o=n.Util.applyTransform([0,i],a),s=n.Util.applyTransform([t,0],a),l=n.Util.applyTransform([t,i],a),c=Math.min(r[0],o[0],s[0],l[0]),d=Math.min(r[1],o[1],s[1],l[1]),u=Math.max(r[0],o[0],s[0],l[0]),p=Math.max(r[1],o[1],s[1],l[1]),m=this.svgFactory.createElement("svg:rect");m.setAttributeNS(null,"x",c),m.setAttributeNS(null,"y",d),m.setAttributeNS(null,"width",u-c),m.setAttributeNS(null,"height",p-d),m.setAttributeNS(null,"fill",this._makeShadingPattern(e)),this.current.fillAlpha<1&&m.setAttributeNS(null,"fill-opacity",this.current.fillAlpha),this._ensureTransformGroup().append(m)}},{key:"_makeColorN_Pattern",value:function(e){return"TilingPattern"===e[0]?this._makeTilingPattern(e):this._makeShadingPattern(e)}},{key:"_makeTilingPattern",value:function(e){var t=e[1],i=e[2],a=e[3]||n.IDENTITY_MATRIX,r=_slicedToArray(e[4],4),o=r[0],s=r[1],l=r[2],c=r[3],d=e[5],u=e[6],p=e[7],m="shading".concat(b++),h=n.Util.normalizeRect([].concat(_toConsumableArray(n.Util.applyTransform([o,s],a)),_toConsumableArray(n.Util.applyTransform([l,c],a)))),f=_slicedToArray(h,4),y=f[0],g=f[1],v=f[2],_=f[3],A=n.Util.singularValueDecompose2dScale(a),x=_slicedToArray(A,2),w=d*x[0],S=u*x[1],C=this.svgFactory.createElement("svg:pattern");C.setAttributeNS(null,"id",m),C.setAttributeNS(null,"patternUnits","userSpaceOnUse"),C.setAttributeNS(null,"width",w),C.setAttributeNS(null,"height",S),C.setAttributeNS(null,"x","".concat(y)),C.setAttributeNS(null,"y","".concat(g));var k=this.svg,D=this.transformMatrix,R=this.current.fillColor,I=this.current.strokeColor,M=this.svgFactory.create(v-y,_-g);if(this.svg=M,this.transformMatrix=a,2===p){var T,P=(T=n.Util).makeHexColor.apply(T,_toConsumableArray(t));this.current.fillColor=P,this.current.strokeColor=P}return this.executeOpTree(this.convertOpList(i)),this.svg=k,this.transformMatrix=D,this.current.fillColor=R,this.current.strokeColor=I,C.append(M.childNodes[0]),this.defs.append(C),"url(#".concat(m,")")}},{key:"_makeShadingPattern",value:function(e){switch("string"===typeof e&&(e=this.objs.get(e)),e[0]){case"RadialAxial":var t,i="shading".concat(b++),a=e[3];switch(e[1]){case"axial":var r=e[4],o=e[5];(t=this.svgFactory.createElement("svg:linearGradient")).setAttributeNS(null,"id",i),t.setAttributeNS(null,"gradientUnits","userSpaceOnUse"),t.setAttributeNS(null,"x1",r[0]),t.setAttributeNS(null,"y1",r[1]),t.setAttributeNS(null,"x2",o[0]),t.setAttributeNS(null,"y2",o[1]);break;case"radial":var s=e[4],l=e[5],c=e[6],d=e[7];(t=this.svgFactory.createElement("svg:radialGradient")).setAttributeNS(null,"id",i),t.setAttributeNS(null,"gradientUnits","userSpaceOnUse"),t.setAttributeNS(null,"cx",l[0]),t.setAttributeNS(null,"cy",l[1]),t.setAttributeNS(null,"r",d),t.setAttributeNS(null,"fx",s[0]),t.setAttributeNS(null,"fy",s[1]),t.setAttributeNS(null,"fr",c);break;default:throw new Error("Unknown RadialAxial type: ".concat(e[1]))}var u,p=_createForOfIteratorHelper(a);try{for(p.s();!(u=p.n()).done;){var m=u.value,h=this.svgFactory.createElement("svg:stop");h.setAttributeNS(null,"offset",m[0]),h.setAttributeNS(null,"stop-color",m[1]),t.append(h)}}catch(f){p.e(f)}finally{p.f()}return this.defs.append(t),"url(#".concat(i,")");case"Mesh":return(0,n.warn)("Unimplemented pattern Mesh"),null;case"Dummy":return"hotpink";default:throw new Error("Unknown IR type: 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e=__webpack_exports__;Object.defineProperty(e,"__esModule",{value:!0}),Object.defineProperty(e,"AnnotationEditorLayer",{enumerable:!0,get:function(){return n.AnnotationEditorLayer}}),Object.defineProperty(e,"AnnotationEditorParamsType",{enumerable:!0,get:function(){return t.AnnotationEditorParamsType}}),Object.defineProperty(e,"AnnotationEditorType",{enumerable:!0,get:function(){return t.AnnotationEditorType}}),Object.defineProperty(e,"AnnotationEditorUIManager",{enumerable:!0,get:function(){return r.AnnotationEditorUIManager}}),Object.defineProperty(e,"AnnotationLayer",{enumerable:!0,get:function(){return o.AnnotationLayer}}),Object.defineProperty(e,"AnnotationMode",{enumerable:!0,get:function(){return t.AnnotationMode}}),Object.defineProperty(e,"CMapCompressionType",{enumerable:!0,get:function(){return t.CMapCompressionType}}),Object.defineProperty(e,"GlobalWorkerOptions",{enumerable:!0,get:function(){return s.GlobalWorkerOptions}}),Object.defineProperty(e,"InvalidPDFException",{enumerable:!0,get:function(){return t.InvalidPDFException}}),Object.defineProperty(e,"LoopbackPort",{enumerable:!0,get:function(){return i.LoopbackPort}}),Object.defineProperty(e,"MissingPDFException",{enumerable:!0,get:function(){return t.MissingPDFException}}),Object.defineProperty(e,"OPS",{enumerable:!0,get:function(){return t.OPS}}),Object.defineProperty(e,"PDFDataRangeTransport",{enumerable:!0,get:function(){return i.PDFDataRangeTransport}}),Object.defineProperty(e,"PDFDateString",{enumerable:!0,get:function(){return a.PDFDateString}}),Object.defineProperty(e,"PDFWorker",{enumerable:!0,get:function(){return i.PDFWorker}}),Object.defineProperty(e,"PasswordResponses",{enumerable:!0,get:function(){return t.PasswordResponses}}),Object.defineProperty(e,"PermissionFlag",{enumerable:!0,get:function(){return t.PermissionFlag}}),Object.defineProperty(e,"PixelsPerInch",{enumerable:!0,get:function(){return a.PixelsPerInch}}),Object.defineProperty(e,"RenderingCancelledException",{enumerable:!0,get:function(){return a.RenderingCancelledException}}),Object.defineProperty(e,"SVGGraphics",{enumerable:!0,get:function(){return d.SVGGraphics}}),Object.defineProperty(e,"UNSUPPORTED_FEATURES",{enumerable:!0,get:function(){return t.UNSUPPORTED_FEATURES}}),Object.defineProperty(e,"UnexpectedResponseException",{enumerable:!0,get:function(){return t.UnexpectedResponseException}}),Object.defineProperty(e,"Util",{enumerable:!0,get:function(){return t.Util}}),Object.defineProperty(e,"VerbosityLevel",{enumerable:!0,get:function(){return t.VerbosityLevel}}),Object.defineProperty(e,"XfaLayer",{enumerable:!0,get:function(){return u.XfaLayer}}),Object.defineProperty(e,"build",{enumerable:!0,get:function(){return i.build}}),Object.defineProperty(e,"createPromiseCapability",{enumerable:!0,get:function(){return 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called")}},{key:"getBaseStreams",value:function(){return null}}]),e}();t.BaseStream=n},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.NetworkPdfManager=t.LocalPdfManager=void 0;var a=i(2),n=i(134),r=i(131),o=i(136),s=i(135);function c(e){if(e){var t=(0,a.createValidAbsoluteUrl)(e);if(t)return t.href;(0,a.warn)('Invalid absolute docBaseUrl: "'.concat(e,'".'))}return null}var m=function(){function e(){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize BasePdfManager.")}return g(e,[{key:"docId",get:function(){return this._docId}},{key:"password",get:function(){return this._password}},{key:"docBaseUrl",get:function(){var e=this.pdfDocument.catalog;return(0,a.shadow)(this,"docBaseUrl",e.baseUrl||this._docBaseUrl)}},{key:"onLoadedStream",value:function(){(0,a.unreachable)("Abstract method `onLoadedStream` called")}},{key:"ensureDoc",value:function(e,t){return this.ensure(this.pdfDocument,e,t)}},{key:"ensureXRef",value:function(e,t){return this.ensure(this.pdfDocument.xref,e,t)}},{key:"ensureCatalog",value:function(e,t){return this.ensure(this.pdfDocument.catalog,e,t)}},{key:"getPage",value:function(e){return this.pdfDocument.getPage(e)}},{key:"fontFallback",value:function(e,t){return this.pdfDocument.fontFallback(e,t)}},{key:"loadXfaFonts",value:function(e,t){return this.pdfDocument.loadXfaFonts(e,t)}},{key:"loadXfaImages",value:function(){return this.pdfDocument.loadXfaImages()}},{key:"serializeXfaData",value:function(e){return this.pdfDocument.serializeXfaData(e)}},{key:"cleanup",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0];return this.pdfDocument.cleanup(e)}},{key:"ensure",value:function(){var e=y(p().mark((function e(t,i,n){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:(0,a.unreachable)("Abstract method `ensure` called");case 1:case"end":return e.stop()}}),e)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"requestRange",value:function(e,t){(0,a.unreachable)("Abstract method `requestRange` called")}},{key:"requestLoadedStream",value:function(){(0,a.unreachable)("Abstract method `requestLoadedStream` called")}},{key:"sendProgressiveData",value:function(e){(0,a.unreachable)("Abstract method `sendProgressiveData` called")}},{key:"updatePassword",value:function(e){this._password=e}},{key:"terminate",value:function(e){(0,a.unreachable)("Abstract method `terminate` called")}}]),e}(),h=function(e){d(i,e);var t=u(i);function i(e,a,n,r,d,u,p){var m;b(this,i),(m=t.call(this))._docId=e,m._password=n,m._docBaseUrl=c(p),m.msgHandler=r,m.evaluatorOptions=d,m.enableXfa=u;var h=new s.Stream(a);return m.pdfDocument=new o.PDFDocument(l(m),h),m._loadedStreamPromise=Promise.resolve(h),m}return g(i,[{key:"ensure",value:function(){var e=y(p().mark((function e(t,i,a){var n;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if("function"!==typeof(n=t[i])){e.next=3;break}return e.abrupt("return",n.apply(t,a));case 3:return e.abrupt("return",n);case 4:case"end":return e.stop()}}),e)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"requestRange",value:function(e,t){return Promise.resolve()}},{key:"requestLoadedStream",value:function(){}},{key:"onLoadedStream",value:function(){return this._loadedStreamPromise}},{key:"terminate",value:function(e){}}]),i}(m);t.LocalPdfManager=h;var f=function(e){d(i,e);var t=u(i);function i(e,a,r,s,d,u){var p;return b(this,i),(p=t.call(this))._docId=e,p._password=r.password,p._docBaseUrl=c(u),p.msgHandler=r.msgHandler,p.evaluatorOptions=s,p.enableXfa=d,p.streamManager=new n.ChunkedStreamManager(a,{msgHandler:r.msgHandler,length:r.length,disableAutoFetch:r.disableAutoFetch,rangeChunkSize:r.rangeChunkSize}),p.pdfDocument=new o.PDFDocument(l(p),p.streamManager.getStream()),p}return g(i,[{key:"ensure",value:function(){var e=y(p().mark((function e(t,i,a){var n;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(e.prev=0,"function"!==typeof(n=t[i])){e.next=4;break}return e.abrupt("return",n.apply(t,a));case 4:return e.abrupt("return",n);case 7:if(e.prev=7,e.t0=e.catch(0),e.t0 instanceof r.MissingDataException){e.next=11;break}throw e.t0;case 11:return e.next=13,this.requestRange(e.t0.begin,e.t0.end);case 13:return e.abrupt("return",this.ensure(t,i,a));case 14:case"end":return e.stop()}}),e,this,[[0,7]])})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"requestRange",value:function(e,t){return this.streamManager.requestRange(e,t)}},{key:"requestLoadedStream",value:function(){this.streamManager.requestAllChunks()}},{key:"sendProgressiveData",value:function(e){this.streamManager.onReceiveData({chunk:e})}},{key:"onLoadedStream",value:function(){return this.streamManager.onLoadedStream()}},{key:"terminate",value:function(e){this.streamManager.abort(e)}}]),i}(m);t.NetworkPdfManager=f},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.ChunkedStreamManager=t.ChunkedStream=void 0;var a=i(2),n=i(131),r=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,new Uint8Array(e),0,e,null)).chunkSize=a,r._loadedChunks=new Set,r.numChunks=Math.ceil(e/a),r.manager=n,r.progressiveDataLength=0,r.lastSuccessfulEnsureByteChunk=-1,r}return g(i,[{key:"getMissingChunks",value:function(){for(var e=[],t=0,i=this.numChunks;t<i;++t)this._loadedChunks.has(t)||e.push(t);return e}},{key:"numChunksLoaded",get:function(){return this._loadedChunks.size}},{key:"isDataLoaded",get:function(){return this.numChunksLoaded===this.numChunks}},{key:"onReceiveData",value:function(e,t){var i=this.chunkSize;if(e%i!==0)throw new Error("Bad begin offset: ".concat(e));var a=e+t.byteLength;if(a%i!==0&&a!==this.bytes.length)throw new Error("Bad end offset: ".concat(a));this.bytes.set(new Uint8Array(t),e);for(var n=Math.floor(e/i),r=Math.floor((a-1)/i)+1,o=n;o<r;++o)this._loadedChunks.add(o)}},{key:"onReceiveProgressiveData",value:function(e){var t=this.progressiveDataLength,i=Math.floor(t/this.chunkSize);this.bytes.set(new Uint8Array(e),t),t+=e.byteLength,this.progressiveDataLength=t;for(var a=t>=this.end?this.numChunks:Math.floor(t/this.chunkSize),n=i;n<a;++n)this._loadedChunks.add(n)}},{key:"ensureByte",value:function(e){if(!(e<this.progressiveDataLength)){var t=Math.floor(e/this.chunkSize);if(!(t>this.numChunks)&&t!==this.lastSuccessfulEnsureByteChunk){if(!this._loadedChunks.has(t))throw new n.MissingDataException(e,e+1);this.lastSuccessfulEnsureByteChunk=t}}}},{key:"ensureRange",value:function(e,t){if(!(e>=t)&&!(t<=this.progressiveDataLength)){var i=Math.floor(e/this.chunkSize);if(!(i>this.numChunks))for(var a=Math.min(Math.floor((t-1)/this.chunkSize)+1,this.numChunks),r=i;r<a;++r)if(!this._loadedChunks.has(r))throw new n.MissingDataException(e,t)}}},{key:"nextEmptyChunk",value:function(e){for(var t=this.numChunks,i=0;i<t;++i){var a=(e+i)%t;if(!this._loadedChunks.has(a))return a}return null}},{key:"hasChunk",value:function(e){return this._loadedChunks.has(e)}},{key:"getByte",value:function(){var e=this.pos;return e>=this.end?-1:(e>=this.progressiveDataLength&&this.ensureByte(e),this.bytes[this.pos++])}},{key:"getBytes",value:function(e){var t=this.bytes,i=this.pos,a=this.end;if(!e)return a>this.progressiveDataLength&&this.ensureRange(i,a),t.subarray(i,a);var n=i+e;return n>a&&(n=a),n>this.progressiveDataLength&&this.ensureRange(i,n),this.pos=n,t.subarray(i,n)}},{key:"getByteRange",value:function(e,t){return e<0&&(e=0),t>this.end&&(t=this.end),t>this.progressiveDataLength&&this.ensureRange(e,t),this.bytes.subarray(e,t)}},{key:"makeSubStream",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null;function a(){}t?e+t>this.progressiveDataLength&&this.ensureRange(e,e+t):e>=this.progressiveDataLength&&this.ensureByte(e),a.prototype=Object.create(this),a.prototype.getMissingChunks=function(){for(var e=this.chunkSize,t=Math.floor(this.start/e),i=Math.floor((this.end-1)/e)+1,a=[],n=t;n<i;++n)this._loadedChunks.has(n)||a.push(n);return a},Object.defineProperty(a.prototype,"isDataLoaded",{get:function(){return this.numChunksLoaded===this.numChunks||0===this.getMissingChunks().length},configurable:!0});var n=new a;return n.pos=n.start=e,n.end=e+t||this.end,n.dict=i,n}},{key:"getBaseStreams",value:function(){return[this]}}]),i}(i(135).Stream);t.ChunkedStream=r;var o=function(){function e(t,i){b(this,e),this.length=i.length,this.chunkSize=i.rangeChunkSize,this.stream=new r(this.length,this.chunkSize,this),this.pdfNetworkStream=t,this.disableAutoFetch=i.disableAutoFetch,this.msgHandler=i.msgHandler,this.currRequestId=0,this._chunksNeededByRequest=new Map,this._requestsByChunk=new Map,this._promisesByRequest=new Map,this.progressiveDataLength=0,this.aborted=!1,this._loadedStreamCapability=(0,a.createPromiseCapability)()}return g(e,[{key:"onLoadedStream",value:function(){return this._loadedStreamCapability.promise}},{key:"sendRequest",value:function(e,t){var i=this,n=this.pdfNetworkStream.getRangeReader(e,t);n.isStreamingSupported||(n.onProgress=this.onProgress.bind(this));var r=[],o=0;return new Promise((function(e,t){n.read().then((function s(l){try{if(!l.done){var c=l.value;return r.push(c),o+=(0,a.arrayByteLength)(c),n.isStreamingSupported&&i.onProgress({loaded:o}),void n.read().then(s,t)}var d=(0,a.arraysToBytes)(r);r=null,e(d)}catch(u){t(u)}}),t)})).then((function(t){i.aborted||i.onReceiveData({chunk:t,begin:e})}))}},{key:"requestAllChunks",value:function(){var e=this.stream.getMissingChunks();return this._requestChunks(e),this._loadedStreamCapability.promise}},{key:"_requestChunks",value:function(e){var t=this,i=this.currRequestId++,n=new Set;this._chunksNeededByRequest.set(i,n);var r,o=h(e);try{for(o.s();!(r=o.n()).done;){var s=r.value;this.stream.hasChunk(s)||n.add(s)}}catch(A){o.e(A)}finally{o.f()}if(0===n.size)return Promise.resolve();var l=(0,a.createPromiseCapability)();this._promisesByRequest.set(i,l);var c,d=[],u=h(n);try{for(u.s();!(c=u.n()).done;){var p=c.value,m=this._requestsByChunk.get(p);m||(m=[],this._requestsByChunk.set(p,m),d.push(p)),m.push(i)}}catch(A){u.e(A)}finally{u.f()}if(d.length>0){var f,y=this.groupChunks(d),b=h(y);try{for(b.s();!(f=b.n()).done;){var g=f.value,v=g.beginChunk*this.chunkSize,_=Math.min(g.endChunk*this.chunkSize,this.length);this.sendRequest(v,_).catch(l.reject)}}catch(A){b.e(A)}finally{b.f()}}return l.promise.catch((function(e){if(!t.aborted)throw e}))}},{key:"getStream",value:function(){return this.stream}},{key:"requestRange",value:function(e,t){t=Math.min(t,this.length);for(var i=this.getBeginChunk(e),a=this.getEndChunk(t),n=[],r=i;r<a;++r)n.push(r);return this._requestChunks(n)}},{key:"requestRanges",value:function(){var e,t=[],i=h(arguments.length>0&&void 0!==arguments[0]?arguments[0]:[]);try{for(i.s();!(e=i.n()).done;)for(var a=e.value,n=this.getBeginChunk(a.begin),r=this.getEndChunk(a.end),o=n;o<r;++o)t.includes(o)||t.push(o)}catch(s){i.e(s)}finally{i.f()}return t.sort((function(e,t){return e-t})),this._requestChunks(t)}},{key:"groupChunks",value:function(e){for(var t=[],i=-1,a=-1,n=0,r=e.length;n<r;++n){var o=e[n];i<0&&(i=o),a>=0&&a+1!==o&&(t.push({beginChunk:i,endChunk:a+1}),i=o),n+1===e.length&&t.push({beginChunk:i,endChunk:o+1}),a=o}return t}},{key:"onProgress",value:function(e){this.msgHandler.send("DocProgress",{loaded:this.stream.numChunksLoaded*this.chunkSize+e.loaded,total:this.length})}},{key:"onReceiveData",value:function(e){var t=e.chunk,i=void 0===e.begin,a=i?this.progressiveDataLength:e.begin,n=a+t.byteLength,r=Math.floor(a/this.chunkSize),o=n<this.length?Math.floor(n/this.chunkSize):Math.ceil(n/this.chunkSize);i?(this.stream.onReceiveProgressiveData(t),this.progressiveDataLength=n):this.stream.onReceiveData(a,t),this.stream.isDataLoaded&&this._loadedStreamCapability.resolve(this.stream);for(var s=[],l=r;l<o;++l){var c=this._requestsByChunk.get(l);if(c){this._requestsByChunk.delete(l);var d,u=h(c);try{for(u.s();!(d=u.n()).done;){var p=d.value,m=this._chunksNeededByRequest.get(p);m.has(l)&&m.delete(l),m.size>0||s.push(p)}}catch(A){u.e(A)}finally{u.f()}}}if(!this.disableAutoFetch&&0===this._requestsByChunk.size){var f;if(1===this.stream.numChunksLoaded){var y=this.stream.numChunks-1;this.stream.hasChunk(y)||(f=y)}else f=this.stream.nextEmptyChunk(o);Number.isInteger(f)&&this._requestChunks([f])}for(var b=0,g=s;b<g.length;b++){var v=g[b],_=this._promisesByRequest.get(v);this._promisesByRequest.delete(v),_.resolve()}this.msgHandler.send("DocProgress",{loaded:this.stream.numChunksLoaded*this.chunkSize,total:this.length})}},{key:"onError",value:function(e){this._loadedStreamCapability.reject(e)}},{key:"getBeginChunk",value:function(e){return Math.floor(e/this.chunkSize)}},{key:"getEndChunk",value:function(e){return Math.floor((e-1)/this.chunkSize)+1}},{key:"abort",value:function(e){this.aborted=!0,this.pdfNetworkStream&&this.pdfNetworkStream.cancelAllRequests(e);var t,i=h(this._promisesByRequest.values());try{for(i.s();!(t=i.n()).done;)t.value.reject(e)}catch(a){i.e(a)}finally{i.f()}}}]),e}();t.ChunkedStreamManager=o},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.StringStream=t.Stream=t.NullStream=void 0;var a=i(132),n=i(2),r=function(e){d(i,e);var t=u(i);function i(e,a,n,r){var o;return b(this,i),(o=t.call(this)).bytes=e instanceof Uint8Array?e:new Uint8Array(e),o.start=a||0,o.pos=o.start,o.end=a+n||o.bytes.length,o.dict=r,o}return g(i,[{key:"length",get:function(){return this.end-this.start}},{key:"isEmpty",get:function(){return 0===this.length}},{key:"getByte",value:function(){return this.pos>=this.end?-1:this.bytes[this.pos++]}},{key:"getBytes",value:function(e){var t=this.bytes,i=this.pos,a=this.end;if(!e)return t.subarray(i,a);var n=i+e;return n>a&&(n=a),this.pos=n,t.subarray(i,n)}},{key:"getByteRange",value:function(e,t){return e<0&&(e=0),t>this.end&&(t=this.end),this.bytes.subarray(e,t)}},{key:"reset",value:function(){this.pos=this.start}},{key:"moveStart",value:function(){this.start=this.pos}},{key:"makeSubStream",value:function(e,t){var a=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null;return new i(this.bytes.buffer,e,t,a)}}]),i}(a.BaseStream);t.Stream=r;var o=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,(0,n.stringToBytes)(e))}return g(i)}(r);t.StringStream=o;var s=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.call(this,new Uint8Array(0))}return g(i)}(r);t.NullStream=s},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Page=t.PDFDocument=void 0;var a=i(137),n=i(2),r=i(131),o=i(130),l=i(176),m=i(132),v=i(192),_=i(194),A=i(196),x=i(225),w=i(142),S=i(135),C=i(200),k=i(187),D=i(140),R=i(144),I=i(199),M=i(190),T=i(201),P=i(226),z=[0,0,612,792],B=function(){function e(t){b(this,e);var i=t.pdfManager,a=t.xref,n=t.pageIndex,r=t.pageDict,o=t.ref,s=t.globalIdFactory,l=t.fontCache,c=t.builtInCMapCache,p=t.standardFontDataCache,m=t.globalImageCache,h=t.nonBlendModesSet,f=t.xfaFactory;this.pdfManager=i,this.pageIndex=n,this.pageDict=r,this.xref=a,this.ref=o,this.fontCache=l,this.builtInCMapCache=c,this.standardFontDataCache=p,this.globalImageCache=m,this.nonBlendModesSet=h,this.evaluatorOptions=i.evaluatorOptions,this.resourcesPromise=null,this.xfaFactory=f;var y={obj:0};this._localIdFactory=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.apply(this,arguments)}return g(i,null,[{key:"createObjId",value:function(){return"p".concat(n,"_").concat(++y.obj)}},{key:"getPageObjId",value:function(){return"page".concat(o.toString())}}]),i}(s)}return g(e,[{key:"_getInheritableProperty",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],i=(0,r.getInheritableProperty)({dict:this.pageDict,key:e,getArray:t,stopWhenFound:!1});return Array.isArray(i)?1!==i.length&&i[0]instanceof o.Dict?o.Dict.merge({xref:this.xref,dictArray:i}):i[0]:i}},{key:"content",get:function(){return this.pageDict.getArray("Contents")}},{key:"resources",get:function(){var e=this._getInheritableProperty("Resources");return(0,n.shadow)(this,"resources",e instanceof o.Dict?e:o.Dict.empty)}},{key:"_getBoundingBox",value:function(e){if(this.xfaData)return this.xfaData.bbox;var t=this._getInheritableProperty(e,!0);if(Array.isArray(t)&&4===t.length){if(t[2]-t[0]!==0&&t[3]-t[1]!==0)return t;(0,n.warn)("Empty /".concat(e," entry."))}return null}},{key:"mediaBox",get:function(){return(0,n.shadow)(this,"mediaBox",this._getBoundingBox("MediaBox")||z)}},{key:"cropBox",get:function(){return(0,n.shadow)(this,"cropBox",this._getBoundingBox("CropBox")||this.mediaBox)}},{key:"userUnit",get:function(){var e=this.pageDict.get("UserUnit");return("number"!==typeof e||e<=0)&&(e=1),(0,n.shadow)(this,"userUnit",e)}},{key:"view",get:function(){var e,t=this.cropBox,i=this.mediaBox;if(t===i||(0,n.isArrayEqual)(t,i))e=i;else{var a=n.Util.intersect(t,i);a&&a[2]-a[0]!==0&&a[3]-a[1]!==0?e=a:(0,n.warn)("Empty /CropBox and /MediaBox intersection.")}return(0,n.shadow)(this,"view",e||i)}},{key:"rotate",get:function(){var e=this._getInheritableProperty("Rotate")||0;return e%90!==0?e=0:e>=360?e%=360:e<0&&(e=(e%360+360)%360),(0,n.shadow)(this,"rotate",e)}},{key:"_onSubStreamError",value:function(e,t,i){if(this.evaluatorOptions.ignoreErrors)return e.send("UnsupportedFeature",{featureId:n.UNSUPPORTED_FEATURES.errorContentSubStream}),void(0,n.warn)("getContentStream - ignoring sub-stream (".concat(i,'): "').concat(t,'".'));throw t}},{key:"getContentStream",value:function(e){var t=this;return this.pdfManager.ensure(this,"content").then((function(i){return i instanceof m.BaseStream?i:Array.isArray(i)?new R.StreamsSequenceStream(i,t._onSubStreamError.bind(t,e)):new S.NullStream}))}},{key:"xfaData",get:function(){return(0,n.shadow)(this,"xfaData",this.xfaFactory?{bbox:this.xfaFactory.getBoundingBox(this.pageIndex)}:null)}},{key:"saveNewAnnotations",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,d,u,m,f,y,b,g;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.xfaFactory){e.next=2;break}throw new Error("XFA: Cannot save new annotations.");case 2:return r=new D.PartialEvaluator({xref:this.xref,handler:t,pageIndex:this.pageIndex,idFactory:this._localIdFactory,fontCache:this.fontCache,builtInCMapCache:this.builtInCMapCache,standardFontDataCache:this.standardFontDataCache,globalImageCache:this.globalImageCache,options:this.evaluatorOptions}),o=this.pageDict,s=this.annotations.slice(),e.next=7,a.AnnotationFactory.saveNewAnnotations(r,i,n);case 7:l=e.sent,d=h(l.annotations);try{for(d.s();!(u=d.n()).done;)m=u.value.ref,s.push(m)}catch(p){d.e(p)}finally{d.f()}return f=o.get("Annots"),o.set("Annots",s),y=[],b=null,this.xref.encrypt&&(b=this.xref.encrypt.createCipherTransform(this.ref.num,this.ref.gen)),(0,M.writeObject)(this.ref,o,y,b),f&&o.set("Annots",f),(g=l.dependencies).push.apply(g,[{ref:this.ref,data:y.join("")}].concat(c(l.annotations))),e.abrupt("return",g);case 20:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"save",value:function(e,t,i){var a=new D.PartialEvaluator({xref:this.xref,handler:e,pageIndex:this.pageIndex,idFactory:this._localIdFactory,fontCache:this.fontCache,builtInCMapCache:this.builtInCMapCache,standardFontDataCache:this.standardFontDataCache,globalImageCache:this.globalImageCache,options:this.evaluatorOptions});return this._parsedAnnotations.then((function(e){var r,o=[],s=h(e);try{for(s.s();!(r=s.n()).done;){var l=r.value;l.mustBePrinted(i)&&o.push(l.save(a,t,i).catch((function(e){return(0,n.warn)("save - ignoring annotation data during "+'"'.concat(t.name,'" task: "').concat(e,'".')),null})))}}catch(c){s.e(c)}finally{s.f()}return Promise.all(o).then((function(e){return e.filter((function(e){return!!e}))}))}))}},{key:"loadResources",value:function(e){var t=this;return this.resourcesPromise||(this.resourcesPromise=this.pdfManager.ensure(this,"resources")),this.resourcesPromise.then((function(){return new C.ObjectLoader(t.resources,e,t.xref).load()}))}},{key:"getOperatorList",value:function(e){var t=this,i=e.handler,o=e.sink,s=e.task,l=e.intent,c=e.cacheKey,d=e.annotationStorage,u=void 0===d?null:d,p=this.getContentStream(i),m=this.loadResources(["ColorSpace","ExtGState","Font","Pattern","Properties","Shading","XObject"]),y=new D.PartialEvaluator({xref:this.xref,handler:i,pageIndex:this.pageIndex,idFactory:this._localIdFactory,fontCache:this.fontCache,builtInCMapCache:this.builtInCMapCache,standardFontDataCache:this.standardFontDataCache,globalImageCache:this.globalImageCache,options:this.evaluatorOptions}),b=this.xfaFactory?null:(0,r.getNewAnnotationsMap)(u),g=Promise.resolve(null);if(b){var v=b.get(this.pageIndex);v&&(g=a.AnnotationFactory.printNewAnnotations(y,s,v))}var _=Promise.all([p,m]).then((function(e){var a=f(e,1)[0],n=new k.OperatorList(l,o);return i.send("StartRenderPage",{transparency:y.hasBlendModes(t.resources,t.nonBlendModesSet),pageIndex:t.pageIndex,cacheKey:c}),y.getOperatorList({stream:a,task:s,resources:t.resources,operatorList:n}).then((function(){return n}))}));return Promise.all([_,this._parsedAnnotations,g]).then((function(e){var t=f(e,3),i=t[0],a=t[1],r=t[2];if(r&&(a=a.concat(r)),0===a.length||l&n.RenderingIntentFlag.ANNOTATIONS_DISABLE)return i.flush(!0),{length:i.totalLength};var o,c=!!(l&n.RenderingIntentFlag.ANNOTATIONS_FORMS),d=!!(l&n.RenderingIntentFlag.ANY),p=!!(l&n.RenderingIntentFlag.DISPLAY),m=!!(l&n.RenderingIntentFlag.PRINT),b=[],g=h(a);try{for(g.s();!(o=g.n()).done;){var v=o.value;(d||p&&v.mustBeViewed(u)||m&&v.mustBePrinted(u))&&b.push(v.getOperatorList(y,s,l,c,u).catch((function(e){return(0,n.warn)("getOperatorList - ignoring annotation data during "+'"'.concat(s.name,'" task: "').concat(e,'".')),null})))}}catch(_){g.e(_)}finally{g.f()}return Promise.all(b).then((function(e){var t,a=!1,n=!1,r=h(e);try{for(r.s();!(t=r.n()).done;){var o=t.value,s=o.opList,l=o.separateForm,c=o.separateCanvas;i.addOpList(s),l&&(a=l),c&&(n=c)}}catch(_){r.e(_)}finally{r.f()}return i.flush(!0,{form:a,canvas:n}),{length:i.totalLength}}))}))}},{key:"extractTextContent",value:function(e){var t=this,i=e.handler,a=e.task,n=e.includeMarkedContent,r=e.sink,o=e.combineTextItems,s=this.getContentStream(i),l=this.loadResources(["ExtGState","Font","Properties","XObject"]);return Promise.all([s,l]).then((function(e){var s=f(e,1)[0];return new D.PartialEvaluator({xref:t.xref,handler:i,pageIndex:t.pageIndex,idFactory:t._localIdFactory,fontCache:t.fontCache,builtInCMapCache:t.builtInCMapCache,standardFontDataCache:t.standardFontDataCache,globalImageCache:t.globalImageCache,options:t.evaluatorOptions}).getTextContent({stream:s,task:a,resources:t.resources,includeMarkedContent:n,combineTextItems:o,sink:r,viewBox:t.view})}))}},{key:"getStructTree",value:function(){var e=y(p().mark((function e(){var t,i;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this.pdfManager.ensureCatalog("structTreeRoot");case 2:if(t=e.sent){e.next=5;break}return e.abrupt("return",null);case 5:return e.next=7,this.pdfManager.ensure(this,"_parseStructTree",[t]);case 7:return i=e.sent,e.abrupt("return",i.serializable);case 9:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"_parseStructTree",value:function(e){var t=new I.StructTreePage(e,this.pageDict);return t.parse(),t}},{key:"getAnnotationsData",value:function(){var e=y(p().mark((function e(t,i,a){var r,o,s,l,c,d,u,m,f,y,b;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this._parsedAnnotations;case 2:if(0!==(r=e.sent).length){e.next=5;break}return e.abrupt("return",[]);case 5:o=[],s=[],c=!!(a&n.RenderingIntentFlag.ANY),d=!!(a&n.RenderingIntentFlag.DISPLAY),u=!!(a&n.RenderingIntentFlag.PRINT),m=h(r);try{for(m.s();!(f=m.n()).done;)y=f.value,((b=c||d&&y.viewable)||u&&y.printable)&&s.push(y.data),y.hasTextContent&&b&&(l||(l=new D.PartialEvaluator({xref:this.xref,handler:t,pageIndex:this.pageIndex,idFactory:this._localIdFactory,fontCache:this.fontCache,builtInCMapCache:this.builtInCMapCache,standardFontDataCache:this.standardFontDataCache,globalImageCache:this.globalImageCache,options:this.evaluatorOptions})),o.push(y.extractTextContent(l,i,this.view).catch((function(e){(0,n.warn)('getAnnotationsData - ignoring textContent during "'.concat(i.name,'" task: "').concat(e,'".'))}))))}catch(p){m.e(p)}finally{m.f()}return e.next=12,Promise.all(o);case 12:return e.abrupt("return",s);case 13:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"annotations",get:function(){var e=this._getInheritableProperty("Annots");return(0,n.shadow)(this,"annotations",Array.isArray(e)?e:[])}},{key:"_parsedAnnotations",get:function(){var e=this,t=this.pdfManager.ensure(this,"annotations").then((function(){var t,i=[],r=h(e.annotations);try{for(r.s();!(t=r.n()).done;){var o=t.value;i.push(a.AnnotationFactory.create(e.xref,o,e.pdfManager,e._localIdFactory,!1).catch((function(e){return(0,n.warn)('_parsedAnnotations: "'.concat(e,'".')),null})))}}catch(s){r.e(s)}finally{r.f()}return Promise.all(i).then((function(e){if(0===e.length)return e;var t,i,n=[],r=h(e);try{for(r.s();!(i=r.n()).done;){var o=i.value;o&&(o instanceof a.PopupAnnotation?(t||(t=[]),t.push(o)):n.push(o))}}catch(s){r.e(s)}finally{r.f()}return t&&n.push.apply(n,c(t)),n}))}));return(0,n.shadow)(this,"_parsedAnnotations",t)}},{key:"jsActions",get:function(){var e=(0,r.collectActions)(this.xref,this.pageDict,n.PageActionEventType);return(0,n.shadow)(this,"jsActions",e)}}]),e}();t.Page=B;var F=new Uint8Array([37,80,68,70,45]),E=new Uint8Array([115,116,97,114,116,120,114,101,102]),N=new Uint8Array([101,110,100,111,98,106]),O="\0\0\0\0\0\0\0\0\0\0\0\0\0\0\0\0",G=/^[1-9]\.\d$/;function L(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:1024,a=arguments.length>3&&void 0!==arguments[3]&&arguments[3],n=t.length,r=e.peekBytes(i),o=r.length-n;if(o<=0)return!1;if(a)for(var s=n-1,l=r.length-1;l>=s;){for(var c=0;c<n&&r[l-c]===t[s-c];)c++;if(c>=n)return e.pos+=l-s,!0;l--}else for(var d=0;d<=o;){for(var u=0;u<n&&r[d+u]===t[u];)u++;if(u>=n)return e.pos+=d,!0;d++}return!1}var j=function(){function e(t,i){if(b(this,e),i.length<=0)throw new n.InvalidPDFException("The PDF file is empty, i.e. its size is zero bytes.");this.pdfManager=t,this.stream=i,this.xref=new P.XRef(i,t),this._pagePromises=new Map,this._version=null;var a={font:0};this._globalIdFactory=function(){function e(){b(this,e)}return g(e,null,[{key:"getDocId",value:function(){return"g_".concat(t.docId)}},{key:"createFontId",value:function(){return"f".concat(++a.font)}},{key:"createObjId",value:function(){(0,n.unreachable)("Abstract method `createObjId` called.")}},{key:"getPageObjId",value:function(){(0,n.unreachable)("Abstract method `getPageObjId` called.")}}]),e}()}return g(e,[{key:"parse",value:function(e){this.xref.parse(e),this.catalog=new _.Catalog(this.pdfManager,this.xref),this.catalog.version&&(this._version=this.catalog.version)}},{key:"linearization",get:function(){var e=null;try{e=w.Linearization.create(this.stream)}catch(t){if(t instanceof r.MissingDataException)throw t;(0,n.info)(t)}return(0,n.shadow)(this,"linearization",e)}},{key:"startXRef",get:function(){var e=this.stream,t=0;if(this.linearization)e.reset(),L(e,N)&&(t=e.pos+6-e.start);else{for(var i=E.length,a=!1,o=e.end;!a&&o>0;)(o-=1024-i)<0&&(o=0),e.pos=o,a=L(e,E,1024,!0);if(a){var s;e.skip(9);do{s=e.getByte()}while((0,r.isWhiteSpace)(s));for(var l="";s>=32&&s<=57;)l+=String.fromCharCode(s),s=e.getByte();t=parseInt(l,10),isNaN(t)&&(t=0)}}return(0,n.shadow)(this,"startXRef",t)}},{key:"checkHeader",value:function(){var e=this.stream;if(e.reset(),L(e,F)){e.moveStart();for(var t,i="";(t=e.getByte())>32&&!(i.length>=12);)i+=String.fromCharCode(t);this._version||(this._version=i.substring(5))}}},{key:"parseStartXRef",value:function(){this.xref.setStartXRef(this.startXRef)}},{key:"numPages",get:function(){var e=0;return e=this.catalog.hasActualNumPages?this.catalog.numPages:this.xfaFactory?this.xfaFactory.getNumPages():this.linearization?this.linearization.numPages:this.catalog.numPages,(0,n.shadow)(this,"numPages",e)}},{key:"_hasOnlyDocumentSignatures",value:function(e){var t=this,i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:0;return!!Array.isArray(e)&&e.every((function(e){if(!((e=t.xref.fetchIfRef(e))instanceof o.Dict))return!1;if(e.has("Kids"))return++i>10?((0,n.warn)("_hasOnlyDocumentSignatures: maximum recursion depth reached"),!1):t._hasOnlyDocumentSignatures(e.get("Kids"),i);var a=(0,o.isName)(e.get("FT"),"Sig"),r=e.get("Rect"),s=Array.isArray(r)&&r.every((function(e){return 0===e}));return a&&s}))}},{key:"_xfaStreams",get:function(){var e=this.catalog.acroForm;if(!e)return null;var t=e.get("XFA"),i={"xdp:xdp":"",template:"",datasets:"",config:"",connectionSet:"",localeSet:"",stylesheet:"","/xdp:xdp":""};if(t instanceof m.BaseStream&&!t.isEmpty)return i["xdp:xdp"]=t,i;if(!Array.isArray(t)||0===t.length)return null;for(var a=0,n=t.length;a<n;a+=2){var r=void 0;if(r=0===a?"xdp:xdp":a===n-2?"/xdp:xdp":t[a],i.hasOwnProperty(r)){var o=this.xref.fetchIfRef(t[a+1]);o instanceof m.BaseStream&&!o.isEmpty&&(i[r]=o)}}return i}},{key:"xfaDatasets",get:function(){var e=this._xfaStreams;if(!e)return(0,n.shadow)(this,"xfaDatasets",null);for(var t=0,i=["datasets","xdp:xdp"];t<i.length;t++){var a=i[t],r=e[a];if(r)try{var o=(0,n.stringToUTF8String)(r.getString()),l=s({},a,o);return(0,n.shadow)(this,"xfaDatasets",new x.DatasetReader(l))}catch(c){(0,n.warn)("XFA - Invalid utf-8 string.");break}}return(0,n.shadow)(this,"xfaDatasets",null)}},{key:"xfaData",get:function(){var e=this._xfaStreams;if(!e)return null;for(var t=Object.create(null),i=0,a=Object.entries(e);i<a.length;i++){var r=f(a[i],2),o=r[0],s=r[1];if(s)try{t[o]=(0,n.stringToUTF8String)(s.getString())}catch(l){return(0,n.warn)("XFA - Invalid utf-8 string."),null}}return t}},{key:"xfaFactory",get:function(){var e;return this.pdfManager.enableXfa&&this.catalog.needsRendering&&this.formInfo.hasXfa&&!this.formInfo.hasAcroForm&&(e=this.xfaData),(0,n.shadow)(this,"xfaFactory",e?new T.XFAFactory(e):null)}},{key:"isPureXfa",get:function(){return!!this.xfaFactory&&this.xfaFactory.isValid()}},{key:"htmlForXfa",get:function(){return this.xfaFactory?this.xfaFactory.getPages():null}},{key:"loadXfaImages",value:function(){var e=y(p().mark((function e(){var t,i,a,n,r,o,s,l;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this.pdfManager.ensureCatalog("xfaImages");case 2:if(t=e.sent){e.next=5;break}return e.abrupt("return");case 5:return i=t.getKeys(),a=new C.ObjectLoader(t,i,this.xref),e.next=9,a.load();case 9:n=new Map,r=h(i);try{for(r.s();!(o=r.n()).done;)s=o.value,(l=t.get(s))instanceof m.BaseStream&&n.set(s,l.getBytes())}catch(c){r.e(c)}finally{r.f()}this.xfaFactory.setImages(n);case 13:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"loadXfaFonts",value:function(){var e=y(p().mark((function e(t,i){var a,s,c,d,u,m,y,b,g,v,_,A,x,w,S,R,I,M,T,P,z,B,F,E,N,O,G,L,j,q,H,U,Y,X;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this.pdfManager.ensureCatalog("acroForm");case 2:if(a=e.sent){e.next=5;break}return e.abrupt("return");case 5:return e.next=7,a.getAsync("DR");case 7:if((s=e.sent)instanceof o.Dict){e.next=10;break}return e.abrupt("return");case 10:return c=new C.ObjectLoader(s,["Font"],this.xref),e.next=13,c.load();case 13:if((d=s.get("Font"))instanceof o.Dict){e.next=16;break}return e.abrupt("return");case 16:(u=Object.assign(Object.create(null),this.pdfManager.evaluatorOptions)).useSystemFonts=!1,m=new D.PartialEvaluator({xref:this.xref,handler:t,pageIndex:-1,idFactory:this._globalIdFactory,fontCache:this.catalog.fontCache,builtInCMapCache:this.catalog.builtInCMapCache,standardFontDataCache:this.catalog.standardFontDataCache,options:u}),y=new k.OperatorList,b=[],e.t0=function(){return this},g={get font(){return b.at(-1)},set font(e){b.push(e)},clone:e.t0},v=new Map,d.forEach((function(e,t){v.set(e,t)})),_=[],A=h(v),e.prev=27,A.s();case 29:if((x=A.n()).done){e.next=44;break}if(w=f(x.value,2),S=w[0],R=w[1],(I=R.get("FontDescriptor"))instanceof o.Dict){e.next=34;break}return e.abrupt("continue",42);case 34:if(M=(M=I.get("FontFamily")).replace(/[ ]+(\d)/g,"$1"),T=I.get("FontWeight"),P=-I.get("ItalicAngle"),z={fontFamily:M,fontWeight:T,italicAngle:P},(0,r.validateCSSFont)(z)){e.next=41;break}return e.abrupt("continue",42);case 41:_.push(m.handleSetFont(s,[o.Name.get(S),1],null,y,i,g,null,z).catch((function(e){return(0,n.warn)('loadXfaFonts: "'.concat(e,'".')),null})));case 42:e.next=29;break;case 44:e.next=49;break;case 46:e.prev=46,e.t1=e.catch(27),A.e(e.t1);case 49:return e.prev=49,A.f(),e.finish(49);case 52:return e.next=54,Promise.all(_);case 54:if(B=this.xfaFactory.setFonts(b)){e.next=57;break}return e.abrupt("return");case 57:u.ignoreErrors=!0,_.length=0,b.length=0,F=new Set,E=h(B);try{for(E.s();!(N=E.n()).done;)O=N.value,(0,l.getXfaFontName)("".concat(O,"-Regular"))||F.add(O)}catch(p){E.e(p)}finally{E.f()}F.size&&B.push("PdfJS-Fallback"),G=h(B),e.prev=65,G.s();case 67:if((L=G.n()).done){e.next=74;break}if(j=L.value,!F.has(j)){e.next=71;break}return e.abrupt("continue",72);case 71:for(q=0,H=[{name:"Regular",fontWeight:400,italicAngle:0},{name:"Bold",fontWeight:700,italicAngle:0},{name:"Italic",fontWeight:400,italicAngle:12},{name:"BoldItalic",fontWeight:700,italicAngle:12}];q<H.length;q++)U=H[q],Y="".concat(j,"-").concat(U.name),X=(0,l.getXfaFontDict)(Y),_.push(m.handleSetFont(s,[o.Name.get(Y),1],null,y,i,g,X,{fontFamily:j,fontWeight:U.fontWeight,italicAngle:U.italicAngle}).catch((function(e){return(0,n.warn)('loadXfaFonts: "'.concat(e,'".')),null})));case 72:e.next=67;break;case 74:e.next=79;break;case 76:e.prev=76,e.t2=e.catch(65),G.e(e.t2);case 79:return e.prev=79,G.f(),e.finish(79);case 82:return e.next=84,Promise.all(_);case 84:this.xfaFactory.appendFonts(b,F);case 85:case"end":return e.stop()}}),e,this,[[27,46,49,52],[65,76,79,82]])})));return function(t,i){return e.apply(this,arguments)}}()},{key:"serializeXfaData",value:function(){var e=y(p().mark((function e(t){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.abrupt("return",this.xfaFactory?this.xfaFactory.serializeData(t):null);case 1:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"formInfo",get:function(){var e={hasFields:!1,hasAcroForm:!1,hasXfa:!1,hasSignatures:!1},t=this.catalog.acroForm;if(!t)return(0,n.shadow)(this,"formInfo",e);try{var i=t.get("Fields"),a=Array.isArray(i)&&i.length>0;e.hasFields=a;var o=t.get("XFA");e.hasXfa=Array.isArray(o)&&o.length>0||o instanceof m.BaseStream&&!o.isEmpty;var s=!!(1&t.get("SigFlags")),l=s&&this._hasOnlyDocumentSignatures(i);e.hasAcroForm=a&&!l,e.hasSignatures=s}catch(c){if(c instanceof r.MissingDataException)throw c;(0,n.warn)('Cannot fetch form information: "'.concat(c,'".'))}return(0,n.shadow)(this,"formInfo",e)}},{key:"documentInfo",get:function(){var e=this._version;"string"===typeof e&&G.test(e)||((0,n.warn)("Invalid PDF header version number: ".concat(e)),e=null);var t,i={PDFFormatVersion:e,Language:this.catalog.lang,EncryptFilterName:this.xref.encrypt?this.xref.encrypt.filterName:null,IsLinearized:!!this.linearization,IsAcroFormPresent:this.formInfo.hasAcroForm,IsXFAPresent:this.formInfo.hasXfa,IsCollectionPresent:!!this.catalog.collection,IsSignaturesPresent:this.formInfo.hasSignatures};try{t=this.xref.trailer.get("Info")}catch(u){if(u instanceof r.MissingDataException)throw u;(0,n.info)("The document information dictionary is invalid.")}if(!(t instanceof o.Dict))return(0,n.shadow)(this,"documentInfo",i);var a,s=h(t.getKeys());try{for(s.s();!(a=s.n()).done;){var l=a.value,c=t.get(l);switch(l){case"Title":case"Author":case"Subject":case"Keywords":case"Creator":case"Producer":case"CreationDate":case"ModDate":if("string"===typeof c){i[l]=(0,n.stringToPDFString)(c);continue}break;case"Trapped":if(c instanceof o.Name){i[l]=c;continue}break;default:var d=void 0;switch(typeof c){case"string":d=(0,n.stringToPDFString)(c);break;case"number":case"boolean":d=c;break;default:c instanceof o.Name&&(d=c)}if(void 0===d){(0,n.warn)('Bad value, for custom key "'.concat(l,'", in Info: ').concat(c,"."));continue}i.Custom||(i.Custom=Object.create(null)),i.Custom[l]=d;continue}(0,n.warn)('Bad value, for key "'.concat(l,'", in Info: ').concat(c,"."))}}catch(u){s.e(u)}finally{s.f()}return(0,n.shadow)(this,"documentInfo",i)}},{key:"fingerprints",get:function(){function e(e){return"string"===typeof e&&e.length>0&&e!==O}function t(e){for(var t=[],i=0,a=e.length;i<a;i++){var n=e[i].toString(16);t.push(n.padStart(2,"0"))}return t.join("")}var i,a,r=this.xref.trailer.get("ID");return Array.isArray(r)&&e(r[0])?(i=(0,n.stringToBytes)(r[0]),r[1]!==r[0]&&e(r[1])&&(a=(0,n.stringToBytes)(r[1]))):i=(0,v.calculateMD5)(this.stream.getByteRange(0,1024),0,1024),(0,n.shadow)(this,"fingerprints",[t(i),a?t(a):null])}},{key:"_getLinearizationPage",value:function(){var e=y(p().mark((function e(t){var i,a,r,s,l,c;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return i=this.catalog,a=this.linearization,r=this.xref,s=o.Ref.get(a.objectNumberFirst,0),e.prev=2,e.next=5,r.fetchAsync(s);case 5:if(!((l=e.sent)instanceof o.Dict)){e.next=16;break}if(!((c=l.getRaw("Type"))instanceof o.Ref)){e.next=12;break}return e.next=11,r.fetchAsync(c);case 11:c=e.sent;case 12:if(!(0,o.isName)(c,"Page")&&(l.has("Type")||l.has("Kids"))){e.next=16;break}return i.pageKidsCountCache.has(s)||i.pageKidsCountCache.put(s,1),i.pageIndexCache.has(s)||i.pageIndexCache.put(s,0),e.abrupt("return",[l,s]);case 16:throw new n.FormatError("The Linearization dictionary doesn't point to a valid Page dictionary.");case 19:return e.prev=19,e.t0=e.catch(2),(0,n.warn)('_getLinearizationPage: "'.concat(e.t0.message,'".')),e.abrupt("return",i.getPageDict(t));case 23:case"end":return e.stop()}}),e,this,[[2,19]])})));return function(t){return e.apply(this,arguments)}}()},{key:"getPage",value:function(e){var t=this,i=this._pagePromises.get(e);if(i)return i;var a,n=this.catalog,r=this.linearization,s=this.xfaFactory;return a=(a=s?Promise.resolve([o.Dict.empty,null]):r&&r.pageFirst===e?this._getLinearizationPage(e):n.getPageDict(e)).then((function(i){var a=f(i,2),r=a[0],o=a[1];return new B({pdfManager:t.pdfManager,xref:t.xref,pageIndex:e,pageDict:r,ref:o,globalIdFactory:t._globalIdFactory,fontCache:n.fontCache,builtInCMapCache:n.builtInCMapCache,standardFontDataCache:n.standardFontDataCache,globalImageCache:n.globalImageCache,nonBlendModesSet:n.nonBlendModesSet,xfaFactory:s})})),this._pagePromises.set(e,a),a}},{key:"checkFirstPage",value:function(){var e=y(p().mark((function e(){var t=arguments;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(t.length>0&&void 0!==t[0]&&t[0])){e.next=3;break}return e.abrupt("return");case 3:return e.prev=3,e.next=6,this.getPage(0);case 6:e.next=15;break;case 8:if(e.prev=8,e.t0=e.catch(3),!(e.t0 instanceof r.XRefEntryException)){e.next=15;break}return this._pagePromises.delete(0),e.next=14,this.cleanup();case 14:throw new r.XRefParseException;case 15:case"end":return e.stop()}}),e,this,[[3,8]])})));return function(){return e.apply(this,arguments)}}()},{key:"checkLastPage",value:function(){var e=y(p().mark((function e(){var t,i,a,o,s,l,c,d,u,m,y,b,g,v=arguments;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return t=v.length>0&&void 0!==v[0]&&v[0],i=this.catalog,a=this.pdfManager,i.setActualNumPages(),e.prev=3,e.next=6,Promise.all([a.ensureDoc("xfaFactory"),a.ensureDoc("linearization"),a.ensureCatalog("numPages")]);case 6:if(!this.xfaFactory){e.next=10;break}return e.abrupt("return");case 10:o=this.linearization?this.linearization.numPages:i.numPages;case 11:if(Number.isInteger(o)){e.next=15;break}throw new n.FormatError("Page count is not an integer.");case 15:if(!(o<=1)){e.next=17;break}return e.abrupt("return");case 17:return e.next=19,this.getPage(o-1);case 19:e.next=44;break;case 21:return e.prev=21,e.t0=e.catch(3),this._pagePromises.delete(o-1),e.next=26,this.cleanup();case 26:if(!(e.t0 instanceof r.XRefEntryException)||t){e.next=28;break}throw new r.XRefParseException;case 28:return(0,n.warn)("checkLastPage - invalid /Pages tree /Count: ".concat(o,".")),e.prev=29,e.next=32,i.getAllPageDicts(t);case 32:s=e.sent,e.next=41;break;case 35:if(e.prev=35,e.t1=e.catch(29),!(e.t1 instanceof r.XRefEntryException)||t){e.next=39;break}throw new r.XRefParseException;case 39:return i.setActualNumPages(1),e.abrupt("return");case 41:l=h(s);try{for(l.s();!(c=l.n()).done;)d=f(c.value,2),u=d[0],m=f(d[1],2),y=m[0],b=m[1],g=void 0,y instanceof Error?(g=Promise.reject(y)).catch((function(){})):g=Promise.resolve(new B({pdfManager:a,xref:this.xref,pageIndex:u,pageDict:y,ref:b,globalIdFactory:this._globalIdFactory,fontCache:i.fontCache,builtInCMapCache:i.builtInCMapCache,standardFontDataCache:i.standardFontDataCache,globalImageCache:i.globalImageCache,nonBlendModesSet:i.nonBlendModesSet,xfaFactory:null})),this._pagePromises.set(u,g)}catch(p){l.e(p)}finally{l.f()}i.setActualNumPages(s.size);case 44:case"end":return e.stop()}}),e,this,[[3,21],[29,35]])})));return function(){return e.apply(this,arguments)}}()},{key:"fontFallback",value:function(e,t){return this.catalog.fontFallback(e,t)}},{key:"cleanup",value:function(){var e=y(p().mark((function e(){var t,i=arguments;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return t=i.length>0&&void 0!==i[0]&&i[0],e.abrupt("return",this.catalog?this.catalog.cleanup(t):(0,A.clearGlobalCaches)());case 2:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"_collectFieldObjects",value:function(e,t,i){var r=this.xref.fetchIfRef(t);if(r.has("T")){var o=(0,n.stringToPDFString)(r.get("T"));e=""===e?o:"".concat(e,".").concat(o)}if(i.has(e)||i.set(e,[]),i.get(e).push(a.AnnotationFactory.create(this.xref,t,this.pdfManager,this._localIdFactory,!0).then((function(e){return e&&e.getFieldObject()})).catch((function(e){return(0,n.warn)('_collectFieldObjects: "'.concat(e,'".')),null}))),r.has("Kids")){var s,l=r.get("Kids"),c=h(l);try{for(c.s();!(s=c.n()).done;){var d=s.value;this._collectFieldObjects(e,d,i)}}catch(u){c.e(u)}finally{c.f()}}}},{key:"fieldObjects",get:function(){if(!this.formInfo.hasFields)return(0,n.shadow)(this,"fieldObjects",Promise.resolve(null));var e,t=Object.create(null),i=new Map,a=h(this.catalog.acroForm.get("Fields"));try{for(a.s();!(e=a.n()).done;){var r=e.value;this._collectFieldObjects("",r,i)}}catch(d){a.e(d)}finally{a.f()}var o,s=[],l=h(i);try{var c=function(){var e=f(o.value,2),i=e[0],a=e[1];s.push(Promise.all(a).then((function(e){(e=e.filter((function(e){return!!e}))).length>0&&(t[i]=e)})))};for(l.s();!(o=l.n()).done;)c()}catch(d){l.e(d)}finally{l.f()}return(0,n.shadow)(this,"fieldObjects",Promise.all(s).then((function(){return t})))}},{key:"hasJSActions",get:function(){var e=this.pdfManager.ensureDoc("_parseHasJSActions");return(0,n.shadow)(this,"hasJSActions",e)}},{key:"_parseHasJSActions",value:function(){var e=y(p().mark((function e(){var t,i,a,n;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,Promise.all([this.pdfManager.ensureCatalog("jsActions"),this.pdfManager.ensureDoc("fieldObjects")]);case 2:if(t=e.sent,i=f(t,2),a=i[0],n=i[1],!a){e.next=8;break}return e.abrupt("return",!0);case 8:if(!n){e.next=10;break}return e.abrupt("return",Object.values(n).some((function(e){return e.some((function(e){return null!==e.actions}))})));case 10:return e.abrupt("return",!1);case 11:case"end":return e.stop()}}),e,this)})));return function(){return e.apply(this,arguments)}}()},{key:"calculationOrderIds",get:function(){var e=this.catalog.acroForm;if(!e||!e.has("CO"))return(0,n.shadow)(this,"calculationOrderIds",null);var t=e.get("CO");if(!Array.isArray(t)||0===t.length)return(0,n.shadow)(this,"calculationOrderIds",null);var i,a=[],r=h(t);try{for(r.s();!(i=r.n()).done;){var s=i.value;s instanceof o.Ref&&a.push(s.toString())}}catch(l){r.e(l)}finally{r.f()}return 0===a.length?(0,n.shadow)(this,"calculationOrderIds",null):(0,n.shadow)(this,"calculationOrderIds",a)}}]),e}();t.PDFDocument=j},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.PopupAnnotation=t.MarkupAnnotation=t.AnnotationFactory=t.AnnotationBorderStyle=t.Annotation=void 0,t.getQuadPoints=T;var a=i(2),s=i(131),c=i(138),m=i(130),v=i(190),_=i(132),A=i(185),x=i(194),w=i(139),S=i(197),C=i(200),k=i(187),D=i(135),R=i(201),I=function(){function e(){b(this,e)}return g(e,null,[{key:"create",value:function(e,t,i,a,n){var r=this;return Promise.all([i.ensureCatalog("acroForm"),i.ensureCatalog("baseUrl"),i.ensureDoc("xfaDatasets"),n?this._getPageIndex(e,t,i):-1]).then((function(o){var s=f(o,4),l=s[0],c=(s[1],s[2]),d=s[3];return i.ensure(r,"_create",[e,t,i,a,l,c,n,d])}))}},{key:"_create",value:function(e,t,i,n,r,o,l){var c=arguments.length>7&&void 0!==arguments[7]?arguments[7]:-1,d=e.fetchIfRef(t);if(d instanceof m.Dict){var u=t instanceof m.Ref?t.toString():"annot_".concat(n.createObjId()),p=d.get("Subtype"),h={xref:e,ref:t,dict:d,subtype:p=p instanceof m.Name?p.name:null,id:u,pdfManager:i,acroForm:r instanceof m.Dict?r:m.Dict.empty,xfaDatasets:o,collectFields:l,pageIndex:c};switch(p){case"Link":return new q(h);case"Text":return new j(h);case"Widget":var f=(0,s.getInheritableProperty)({dict:d,key:"FT"});switch(f=f instanceof m.Name?f.name:null){case"Tx":return new N(h);case"Btn":return new O(h);case"Ch":return new G(h);case"Sig":return new L(h)}return(0,a.warn)('Unimplemented widget field type "'.concat(f,'", ')+"falling back to base field type."),new E(h);case"Popup":return new H(h);case"FreeText":return new U(h);case"Line":return new Y(h);case"Square":return new X(h);case"Circle":return new V(h);case"PolyLine":return new Q(h);case"Polygon":return new W(h);case"Caret":return new Z(h);case"Ink":return new J(h);case"Highlight":return new K(h);case"Underline":return new $(h);case"Squiggly":return new ee(h);case"StrikeOut":return new te(h);case"Stamp":return new ie(h);case"FileAttachment":return new ae(h);default:return l||(p?(0,a.warn)('Unimplemented annotation type "'.concat(p,'", ')+"falling back to base annotation."):(0,a.warn)("Annotation is missing the required /Subtype.")),new z(h)}}}},{key:"_getPageIndex",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.prev=0,e.next=3,t.fetchIfRefAsync(i);case 3:if((r=e.sent)instanceof m.Dict){e.next=6;break}return e.abrupt("return",-1);case 6:if((o=r.getRaw("P"))instanceof m.Ref){e.next=9;break}return e.abrupt("return",-1);case 9:return e.next=11,n.ensureCatalog("getPageIndex",[o]);case 11:return s=e.sent,e.abrupt("return",s);case 15:return e.prev=15,e.t0=e.catch(0),(0,a.warn)('_getPageIndex: "'.concat(e.t0,'".')),e.abrupt("return",-1);case 19:case"end":return e.stop()}}),e,null,[[0,15]])})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"saveNewAnnotations",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c,d,u,f,y;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:r=t.xref,s=[],l=[],c=h(n),e.prev=4,c.s();case 6:if((d=c.n()).done){e.next=17;break}u=d.value,e.t0=u.annotationType,e.next=e.t0===a.AnnotationEditorType.FREETEXT?11:e.t0===a.AnnotationEditorType.INK?14:15;break;case 11:return o||((f=new m.Dict(r)).set("BaseFont",m.Name.get("Helvetica")),f.set("Type",m.Name.get("Font")),f.set("Subtype",m.Name.get("Type1")),f.set("Encoding",m.Name.get("WinAnsiEncoding")),y=[],o=r.getNewRef(),(0,v.writeObject)(o,f,y,null),s.push({ref:o,data:y.join("")})),l.push(U.createNewAnnotation(r,u,s,{evaluator:t,task:i,baseFontRef:o})),e.abrupt("break",15);case 14:l.push(J.createNewAnnotation(r,u,s));case 15:e.next=6;break;case 17:e.next=22;break;case 19:e.prev=19,e.t1=e.catch(4),c.e(e.t1);case 22:return e.prev=22,c.f(),e.finish(22);case 25:return e.next=27,Promise.all(l);case 27:return e.t2=e.sent,e.t3=s,e.abrupt("return",{annotations:e.t2,dependencies:e.t3});case 30:case"end":return e.stop()}}),e,null,[[4,19,22,25]])})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"printNewAnnotations",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(n){e.next=2;break}return e.abrupt("return",null);case 2:r=t.xref,o=[],s=h(n),e.prev=5,s.s();case 7:if((l=s.n()).done){e.next=18;break}c=l.value,e.t0=c.annotationType,e.next=e.t0===a.AnnotationEditorType.FREETEXT?12:e.t0===a.AnnotationEditorType.INK?14:16;break;case 12:return o.push(U.createNewPrintAnnotation(r,c,{evaluator:t,task:i})),e.abrupt("break",16);case 14:return o.push(J.createNewPrintAnnotation(r,c)),e.abrupt("break",16);case 16:e.next=7;break;case 18:e.next=23;break;case 20:e.prev=20,e.t1=e.catch(5),s.e(e.t1);case 23:return e.prev=23,s.f(),e.finish(23);case 26:return e.abrupt("return",Promise.all(o));case 27:case"end":return e.stop()}}),e,null,[[5,20,23,26]])})));return function(t,i,a){return e.apply(this,arguments)}}()}]),e}();function M(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:new Uint8ClampedArray(3);if(!Array.isArray(e))return t;var i=t||new Uint8ClampedArray(3);switch(e.length){case 0:return null;case 1:return w.ColorSpace.singletons.gray.getRgbItem(e,0,i,0),i;case 3:return w.ColorSpace.singletons.rgb.getRgbItem(e,0,i,0),i;case 4:return w.ColorSpace.singletons.cmyk.getRgbItem(e,0,i,0),i;default:return t}}function T(e,t){if(!e.has("QuadPoints"))return null;var i=e.getArray("QuadPoints");if(!Array.isArray(i)||0===i.length||i.length%8>0)return null;for(var a=[],n=0,r=i.length/8;n<r;n++){a.push([]);for(var o=8*n,s=8*n+8;o<s;o+=2){var l=i[o],c=i[o+1];if(null!==t&&(l<t[0]||l>t[2]||c<t[1]||c>t[3]))return null;a[n].push({x:l,y:c})}}return a.map((function(e){var t=e.reduce((function(e,t){var i=f(e,4),a=i[0],n=i[1],r=i[2],o=i[3];return[Math.min(a,t.x),Math.max(n,t.x),Math.min(r,t.y),Math.max(o,t.y)]}),[Number.MAX_VALUE,Number.MIN_VALUE,Number.MAX_VALUE,Number.MIN_VALUE]),i=f(t,4),a=i[0],n=i[1],r=i[2],o=i[3];return[{x:a,y:o},{x:n,y:o},{x:a,y:r},{x:n,y:r}]}))}function P(e,t,i){var n=a.Util.getAxialAlignedBoundingBox(t,i),r=f(n,4),o=r[0],s=r[1],l=r[2],c=r[3];if(o===l||s===c)return[1,0,0,1,e[0],e[1]];var d=(e[2]-e[0])/(l-o),u=(e[3]-e[1])/(c-s);return[d,0,0,u,e[0]-o*d,e[1]-s*u]}t.AnnotationFactory=I;var z=function(){function e(t){b(this,e);var i=t.dict;this.setTitle(i.get("T")),this.setContents(i.get("Contents")),this.setModificationDate(i.get("M")),this.setFlags(i.get("F")),this.setRectangle(i.getArray("Rect")),this.setColor(i.getArray("C")),this.setBorderStyle(i),this.setAppearance(i),this.setOptionalContent(i);var n=i.get("MK");if(this.setBorderAndBackgroundColors(n),this.setRotation(n),this._streams=[],this.appearance&&this._streams.push(this.appearance),this.data={annotationFlags:this.flags,borderStyle:this.borderStyle,color:this.color,backgroundColor:this.backgroundColor,borderColor:this.borderColor,rotation:this.rotation,contentsObj:this._contents,hasAppearance:!!this.appearance,id:t.id,modificationDate:this.modificationDate,rect:this.rectangle,subtype:t.subtype,hasOwnCanvas:!1},t.collectFields){var r=i.get("Kids");if(Array.isArray(r)){var o,l=[],c=h(r);try{for(c.s();!(o=c.n()).done;){var d=o.value;d instanceof m.Ref&&l.push(d.toString())}}catch(u){c.e(u)}finally{c.f()}0!==l.length&&(this.data.kidIds=l)}this.data.actions=(0,s.collectActions)(t.xref,i,a.AnnotationActionEventType),this.data.fieldName=this._constructFieldName(i),this.data.pageIndex=t.pageIndex}this._fallbackFontDict=null}return g(e,[{key:"_hasFlag",value:function(e,t){return!!(e&t)}},{key:"_isViewable",value:function(e){return!this._hasFlag(e,a.AnnotationFlag.INVISIBLE)&&!this._hasFlag(e,a.AnnotationFlag.NOVIEW)}},{key:"_isPrintable",value:function(e){return this._hasFlag(e,a.AnnotationFlag.PRINT)&&!this._hasFlag(e,a.AnnotationFlag.INVISIBLE)}},{key:"mustBeViewed",value:function(e){var t=e&&e.get(this.data.id);return t&&void 0!==t.hidden?!t.hidden:this.viewable&&!this._hasFlag(this.flags,a.AnnotationFlag.HIDDEN)}},{key:"mustBePrinted",value:function(e){var t=e&&e.get(this.data.id);return t&&void 0!==t.print?t.print:this.printable}},{key:"viewable",get:function(){return null!==this.data.quadPoints&&(0===this.flags||this._isViewable(this.flags))}},{key:"printable",get:function(){return null!==this.data.quadPoints&&0!==this.flags&&this._isPrintable(this.flags)}},{key:"_parseStringHelper",value:function(e){var t="string"===typeof e?(0,a.stringToPDFString)(e):"";return{str:t,dir:t&&"rtl"===(0,A.bidi)(t).dir?"rtl":"ltr"}}},{key:"setTitle",value:function(e){this._title=this._parseStringHelper(e)}},{key:"setContents",value:function(e){this._contents=this._parseStringHelper(e)}},{key:"setModificationDate",value:function(e){this.modificationDate="string"===typeof e?e:null}},{key:"setFlags",value:function(e){this.flags=Number.isInteger(e)&&e>0?e:0}},{key:"hasFlag",value:function(e){return this._hasFlag(this.flags,e)}},{key:"setRectangle",value:function(e){Array.isArray(e)&&4===e.length?this.rectangle=a.Util.normalizeRect(e):this.rectangle=[0,0,0,0]}},{key:"setColor",value:function(e){this.color=M(e)}},{key:"setLineEndings",value:function(e){if(this.lineEndings=["None","None"],Array.isArray(e)&&2===e.length)for(var t=0;t<2;t++){var i=e[t];if(i instanceof m.Name)switch(i.name){case"None":continue;case"Square":case"Circle":case"Diamond":case"OpenArrow":case"ClosedArrow":case"Butt":case"ROpenArrow":case"RClosedArrow":case"Slash":this.lineEndings[t]=i.name;continue}(0,a.warn)("Ignoring invalid lineEnding: ".concat(i))}}},{key:"setRotation",value:function(e){if(this.rotation=0,e instanceof m.Dict){var t=e.get("R")||0;Number.isInteger(t)&&0!==t&&((t%=360)<0&&(t+=360),t%90===0&&(this.rotation=t))}}},{key:"setBorderAndBackgroundColors",value:function(e){e instanceof m.Dict?(this.borderColor=M(e.getArray("BC"),null),this.backgroundColor=M(e.getArray("BG"),null)):this.borderColor=this.backgroundColor=null}},{key:"setBorderStyle",value:function(e){if(this.borderStyle=new B,e instanceof m.Dict)if(e.has("BS")){var t=e.get("BS"),i=t.get("Type");i&&!(0,m.isName)(i,"Border")||(this.borderStyle.setWidth(t.get("W"),this.rectangle),this.borderStyle.setStyle(t.get("S")),this.borderStyle.setDashArray(t.getArray("D")))}else if(e.has("Border")){var a=e.getArray("Border");Array.isArray(a)&&a.length>=3&&(this.borderStyle.setHorizontalCornerRadius(a[0]),this.borderStyle.setVerticalCornerRadius(a[1]),this.borderStyle.setWidth(a[2],this.rectangle),4===a.length&&this.borderStyle.setDashArray(a[3],!0))}else this.borderStyle.setWidth(0)}},{key:"setAppearance",value:function(e){this.appearance=null;var t=e.get("AP");if(t instanceof m.Dict){var i=t.get("N");if(i instanceof _.BaseStream)this.appearance=i;else if(i instanceof m.Dict){var a=e.get("AS");a instanceof m.Name&&i.has(a.name)&&(this.appearance=i.get(a.name))}}}},{key:"setOptionalContent",value:function(e){this.oc=null;var t=e.get("OC");t instanceof m.Name?(0,a.warn)("setOptionalContent: Support for /Name-entry is not implemented."):t instanceof m.Dict&&(this.oc=t)}},{key:"loadResources",value:function(e,t){return t.dict.getAsync("Resources").then((function(t){if(t)return new C.ObjectLoader(t,e,t.xref).load().then((function(){return t}))}))}},{key:"getOperatorList",value:function(){var e=y(p().mark((function e(t,i,n,r,o){var s,l,c,d,u,h,f,y,b,g;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(s=this.data,l=this.appearance,c=!!(this.data.hasOwnCanvas&&n&a.RenderingIntentFlag.DISPLAY),l){e.next=8;break}if(c){e.next=6;break}return e.abrupt("return",{opList:new k.OperatorList,separateForm:!1,separateCanvas:!1});case 6:(l=new D.StringStream("")).dict=new m.Dict;case 8:return d=l.dict,e.next=11,this.loadResources(["ExtGState","ColorSpace","Pattern","Shading","XObject","Font"],l);case 11:if(u=e.sent,h=d.getArray("BBox")||[0,0,1,1],f=d.getArray("Matrix")||[1,0,0,1,0,0],y=P(s.rect,h,f),b=new k.OperatorList,!this.oc){e.next=20;break}return e.next=19,t.parseMarkedContentProps(this.oc,null);case 19:g=e.sent;case 20:return void 0!==g&&b.addOp(a.OPS.beginMarkedContentProps,["OC",g]),b.addOp(a.OPS.beginAnnotation,[s.id,s.rect,y,f,c]),e.next=24,t.getOperatorList({stream:l,task:i,resources:u,operatorList:b,fallbackFontDict:this._fallbackFontDict});case 24:return b.addOp(a.OPS.endAnnotation,[]),void 0!==g&&b.addOp(a.OPS.endMarkedContent,[]),this.reset(),e.abrupt("return",{opList:b,separateForm:!1,separateCanvas:c});case 28:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n,r){return e.apply(this,arguments)}}()},{key:"save",value:function(){var e=y(p().mark((function e(t,i,a){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.abrupt("return",null);case 1:case"end":return e.stop()}}),e)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"hasTextContent",get:function(){return!1}},{key:"extractTextContent",value:function(){var e=y(p().mark((function e(t,i,a){var n,r,o,s;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(this.appearance){e.next=2;break}return e.abrupt("return");case 2:return e.next=4,this.loadResources(["ExtGState","Font","Properties","XObject"],this.appearance);case 4:return n=e.sent,r=[],o=[],s={desiredSize:Math.Infinity,ready:!0,enqueue:function(e,t){var i,a=h(e.items);try{for(a.s();!(i=a.n()).done;){var n=i.value;o.push(n.str),n.hasEOL&&(r.push(o.join("")),o.length=0)}}catch(s){a.e(s)}finally{a.f()}}},e.next=10,t.getTextContent({stream:this.appearance,task:i,resources:n,includeMarkedContent:!0,combineTextItems:!0,sink:s,viewBox:a});case 10:this.reset(),o.length&&r.push(o.join("")),r.length>0&&(this.data.textContent=r);case 13:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"getFieldObject",value:function(){return this.data.kidIds?{id:this.data.id,actions:this.data.actions,name:this.data.fieldName,strokeColor:this.data.borderColor,fillColor:this.data.backgroundColor,type:"",kidIds:this.data.kidIds,page:this.data.pageIndex,rotation:this.rotation}:null}},{key:"reset",value:function(){var e,t=h(this._streams);try{for(t.s();!(e=t.n()).done;)e.value.reset()}catch(i){t.e(i)}finally{t.f()}}},{key:"_constructFieldName",value:function(e){if(!e.has("T")&&!e.has("Parent"))return(0,a.warn)("Unknown field name, falling back to empty field name."),"";if(!e.has("Parent"))return(0,a.stringToPDFString)(e.get("T"));var t=[];e.has("T")&&t.unshift((0,a.stringToPDFString)(e.get("T")));var i=e,n=new m.RefSet;for(e.objId&&n.put(e.objId);i.has("Parent")&&(i=i.get("Parent"))instanceof m.Dict&&(!i.objId||!n.has(i.objId));)i.objId&&n.put(i.objId),i.has("T")&&t.unshift((0,a.stringToPDFString)(i.get("T")));return t.join(".")}}]),e}();t.Annotation=z;var B=function(){function e(){b(this,e),this.width=1,this.style=a.AnnotationBorderStyleType.SOLID,this.dashArray=[3],this.horizontalCornerRadius=0,this.verticalCornerRadius=0}return g(e,[{key:"setWidth",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:[0,0,0,0];if(e instanceof m.Name)this.width=0;else if("number"===typeof e){if(e>0){var i=(t[2]-t[0])/2,n=(t[3]-t[1])/2;i>0&&n>0&&(e>i||e>n)&&((0,a.warn)("AnnotationBorderStyle.setWidth - ignoring width: ".concat(e)),e=1)}this.width=e}}},{key:"setStyle",value:function(e){if(e instanceof m.Name)switch(e.name){case"S":this.style=a.AnnotationBorderStyleType.SOLID;break;case"D":this.style=a.AnnotationBorderStyleType.DASHED;break;case"B":this.style=a.AnnotationBorderStyleType.BEVELED;break;case"I":this.style=a.AnnotationBorderStyleType.INSET;break;case"U":this.style=a.AnnotationBorderStyleType.UNDERLINE}}},{key:"setDashArray",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];if(Array.isArray(e)&&e.length>0){var i,a=!0,n=!0,r=h(e);try{for(r.s();!(i=r.n()).done;){var o=i.value;if(!(+o>=0)){a=!1;break}o>0&&(n=!1)}}catch(s){r.e(s)}finally{r.f()}a&&!n?(this.dashArray=e,t&&this.setStyle(m.Name.get("D"))):this.width=0}else e&&(this.width=0)}},{key:"setHorizontalCornerRadius",value:function(e){Number.isInteger(e)&&(this.horizontalCornerRadius=e)}},{key:"setVerticalCornerRadius",value:function(e){Number.isInteger(e)&&(this.verticalCornerRadius=e)}}]),e}();t.AnnotationBorderStyle=B;var F=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict;if(r.has("IRT")){var o=r.getRaw("IRT");n.data.inReplyTo=o instanceof m.Ref?o.toString():null;var s=r.get("RT");n.data.replyType=s instanceof m.Name?s.name:a.AnnotationReplyType.REPLY}if(n.data.replyType===a.AnnotationReplyType.GROUP){var l=r.get("IRT");n.setTitle(l.get("T")),n.data.titleObj=n._title,n.setContents(l.get("Contents")),n.data.contentsObj=n._contents,l.has("CreationDate")?(n.setCreationDate(l.get("CreationDate")),n.data.creationDate=n.creationDate):n.data.creationDate=null,l.has("M")?(n.setModificationDate(l.get("M")),n.data.modificationDate=n.modificationDate):n.data.modificationDate=null,n.data.hasPopup=l.has("Popup"),l.has("C")?(n.setColor(l.getArray("C")),n.data.color=n.color):n.data.color=null}else n.data.titleObj=n._title,n.setCreationDate(r.get("CreationDate")),n.data.creationDate=n.creationDate,n.data.hasPopup=r.has("Popup"),r.has("C")||(n.data.color=null);return r.has("RC")&&(n.data.richText=R.XFAFactory.getRichTextAsHtml(r.get("RC"))),n}return g(i,[{key:"setCreationDate",value:function(e){this.creationDate="string"===typeof e?e:null}},{key:"_setDefaultAppearance",value:function(e){var t=e.xref,i=e.extra,a=e.strokeColor,n=e.fillColor,r=e.blendMode,o=e.strokeAlpha,s=e.fillAlpha,l=e.pointsCallback,c=Number.MAX_VALUE,d=Number.MAX_VALUE,u=Number.MIN_VALUE,p=Number.MIN_VALUE,y=["q"];i&&y.push(i),a&&y.push("".concat(a[0]," ").concat(a[1]," ").concat(a[2]," RG")),n&&y.push("".concat(n[0]," ").concat(n[1]," ").concat(n[2]," rg"));var b=this.data.quadPoints;b||(b=[[{x:this.rectangle[0],y:this.rectangle[3]},{x:this.rectangle[2],y:this.rectangle[3]},{x:this.rectangle[0],y:this.rectangle[1]},{x:this.rectangle[2],y:this.rectangle[1]}]]);var g,v=h(b);try{for(v.s();!(g=v.n()).done;){var _=l(y,g.value),A=f(_,4),x=A[0],w=A[1],S=A[2],C=A[3];c=Math.min(c,x),u=Math.max(u,w),d=Math.min(d,S),p=Math.max(p,C)}}catch(F){v.e(F)}finally{v.f()}y.push("Q");var k=new m.Dict(t),R=new m.Dict(t);R.set("Subtype",m.Name.get("Form"));var I=new D.StringStream(y.join(" "));I.dict=R,k.set("Fm0",I);var M=new m.Dict(t);r&&M.set("BM",m.Name.get(r)),"number"===typeof o&&M.set("CA",o),"number"===typeof s&&M.set("ca",s);var T=new m.Dict(t);T.set("GS0",M);var P=new m.Dict(t);P.set("ExtGState",T),P.set("XObject",k);var z=new m.Dict(t);z.set("Resources",P);var B=this.data.rect=[c,d,u,p];z.set("BBox",B),this.appearance=new D.StringStream("/GS0 gs /Fm0 Do"),this.appearance.dict=z,this._streams.push(this.appearance,I)}}],[{key:"createNewAnnotation",value:function(){var e=y(p().mark((function e(t,i,a,n){var r,o,s,l,c,d;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return r=t.getNewRef(),o=t.getNewRef(),s=this.createNewDict(i,t,{apRef:o}),e.next=5,this.createNewAppearanceStream(i,t,n);case 5:return l=e.sent,c=[],d=t.encrypt?t.encrypt.createCipherTransform(o.num,o.gen):null,(0,v.writeObject)(o,l,c,d),a.push({ref:o,data:c.join("")}),c.length=0,d=t.encrypt?t.encrypt.createCipherTransform(r.num,r.gen):null,(0,v.writeObject)(r,s,c,d),e.abrupt("return",{ref:r,data:c.join("")});case 14:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n){return e.apply(this,arguments)}}()},{key:"createNewPrintAnnotation",value:function(){var e=y(p().mark((function e(t,i,a){var n,r;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,this.createNewAppearanceStream(i,t,a);case 2:return n=e.sent,r=this.createNewDict(i,t,{ap:n}),e.abrupt("return",new this.prototype.constructor({dict:r,xref:t}));case 5:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()}]),i}(z);t.MarkupAnnotation=F;var E=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict,o=n.data;n.ref=e.ref,o.annotationType=a.AnnotationType.WIDGET,void 0===o.fieldName&&(o.fieldName=n._constructFieldName(r)),void 0===o.actions&&(o.actions=(0,s.collectActions)(e.xref,r,a.AnnotationActionEventType));var l=(0,s.getInheritableProperty)({dict:r,key:"V",getArray:!0});o.fieldValue=n._decodeFormValue(l);var d=(0,s.getInheritableProperty)({dict:r,key:"DV",getArray:!0});if(o.defaultFieldValue=n._decodeFormValue(d),void 0===l&&e.xfaDatasets){var u=n._title.str;u&&(n._hasValueFromXFA=!0,o.fieldValue=l=e.xfaDatasets.getValue(u))}void 0===l&&null!==o.defaultFieldValue&&(o.fieldValue=o.defaultFieldValue),o.alternativeText=(0,a.stringToPDFString)(r.get("TU")||"");var p=(0,s.getInheritableProperty)({dict:r,key:"DA"})||e.acroForm.get("DA");n._defaultAppearance="string"===typeof p?p:"",o.defaultAppearanceData=(0,c.parseDefaultAppearance)(n._defaultAppearance);var h=(0,s.getInheritableProperty)({dict:r,key:"FT"});o.fieldType=h instanceof m.Name?h.name:null;var f=(0,s.getInheritableProperty)({dict:r,key:"DR"}),y=e.acroForm.get("DR"),g=n.appearance&&n.appearance.dict.get("Resources");return n._fieldResources={localResources:f,acroFormResources:y,appearanceResources:g,mergedResources:m.Dict.merge({xref:e.xref,dictArray:[f,g,y],mergeSubDicts:!0})},o.fieldFlags=(0,s.getInheritableProperty)({dict:r,key:"Ff"}),(!Number.isInteger(o.fieldFlags)||o.fieldFlags<0)&&(o.fieldFlags=0),o.readOnly=n.hasFieldFlag(a.AnnotationFieldFlag.READONLY),o.required=n.hasFieldFlag(a.AnnotationFieldFlag.REQUIRED),o.hidden=n._hasFlag(o.annotationFlags,a.AnnotationFlag.HIDDEN),n}return g(i,[{key:"_decodeFormValue",value:function(e){return Array.isArray(e)?e.filter((function(e){return"string"===typeof e})).map((function(e){return(0,a.stringToPDFString)(e)})):e instanceof m.Name?(0,a.stringToPDFString)(e.name):"string"===typeof e?(0,a.stringToPDFString)(e):null}},{key:"hasFieldFlag",value:function(e){return!!(this.data.fieldFlags&e)}},{key:"getRotationMatrix",value:function(e){var t=e?e.get(this.data.id):void 0,n=t&&t.rotation;if(void 0===n&&(n=this.rotation),0===n)return a.IDENTITY_MATRIX;var r=this.data.rect[2]-this.data.rect[0],o=this.data.rect[3]-this.data.rect[1];return i._getRotationMatrix(n,r,o)}},{key:"getBorderAndBackgroundAppearances",value:function(e){var t=e?e.get(this.data.id):void 0,i=t&&t.rotation;if(void 0===i&&(i=this.rotation),!this.backgroundColor&&!this.borderColor)return"";var a=this.data.rect[2]-this.data.rect[0],n=this.data.rect[3]-this.data.rect[1],r=0===i||180===i?"0 0 ".concat(a," ").concat(n," re"):"0 0 ".concat(n," ").concat(a," re"),o="";if(this.backgroundColor&&(o="".concat((0,c.getPdfColor)(this.backgroundColor,!0)," ").concat(r," f ")),this.borderColor){var s=this.borderStyle.width||1;o+="".concat(s," w ").concat((0,c.getPdfColor)(this.borderColor,!1)," ").concat(r," S ")}return o}},{key:"getOperatorList",value:function(){var e=y(p().mark((function e(t,n,s,l,c){var d,u,m,h,f,y,b;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!l||this instanceof L){e.next=2;break}return e.abrupt("return",{opList:new k.OperatorList,separateForm:!0,separateCanvas:!1});case 2:if(this._hasText){e.next=4;break}return e.abrupt("return",r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,l,c));case 4:return e.next=6,this._getAppearance(t,n,c);case 6:if(d=e.sent,!this.appearance||null!==d){e.next=9;break}return e.abrupt("return",r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,l,c));case 9:if(u=new k.OperatorList,this._defaultAppearance&&null!==d){e.next=12;break}return e.abrupt("return",{opList:u,separateForm:!1,separateCanvas:!1});case 12:if(m=[1,0,0,1,0,0],h=[0,0,this.data.rect[2]-this.data.rect[0],this.data.rect[3]-this.data.rect[1]],f=P(this.data.rect,h,m),!this.oc){e.next=19;break}return e.next=18,t.parseMarkedContentProps(this.oc,null);case 18:y=e.sent;case 19:return void 0!==y&&u.addOp(a.OPS.beginMarkedContentProps,["OC",y]),u.addOp(a.OPS.beginAnnotation,[this.data.id,this.data.rect,f,this.getRotationMatrix(c),!1]),b=new D.StringStream(d),e.next=24,t.getOperatorList({stream:b,task:n,resources:this._fieldResources.mergedResources,operatorList:u});case 24:return u.addOp(a.OPS.endAnnotation,[]),void 0!==y&&u.addOp(a.OPS.endMarkedContent,[]),e.abrupt("return",{opList:u,separateForm:!1,separateCanvas:!1});case 27:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n,r){return e.apply(this,arguments)}}()},{key:"_getMKDict",value:function(e){var t=new m.Dict(null);return e&&t.set("R",e),this.borderColor&&t.set("BC",Array.from(this.borderColor).map((function(e){return e/255}))),this.backgroundColor&&t.set("BG",Array.from(this.backgroundColor).map((function(e){return e/255}))),t.size>0?t:null}},{key:"save",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c,d,u,h,f,y,b,g,_,A,x,w,S,C,k,D=this;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(r=n?n.get(this.data.id):void 0,o=r&&r.value,s=r&&r.rotation,o!==this.data.fieldValue&&void 0!==o){e.next=7;break}if(this._hasValueFromXFA||void 0!==s){e.next=6;break}return e.abrupt("return",null);case 6:o=o||this.data.fieldValue;case 7:if(void 0!==s||this._hasValueFromXFA||!Array.isArray(o)||!Array.isArray(this.data.fieldValue)||o.length!==this.data.fieldValue.length||!o.every((function(e,t){return e===D.data.fieldValue[t]}))){e.next=9;break}return e.abrupt("return",null);case 9:return void 0===s&&(s=this.rotation),e.next=12,this._getAppearance(t,i,n);case 12:if(null!==(l=e.sent)){e.next=15;break}return e.abrupt("return",null);case 15:if(c=t.xref,(d=c.fetchIfRef(this.ref))instanceof m.Dict){e.next=19;break}return e.abrupt("return",null);case 19:return u=[0,0,this.data.rect[2]-this.data.rect[0],this.data.rect[3]-this.data.rect[1]],h={path:(0,a.stringToPDFString)(d.get("T")||""),value:o},f=c.getNewRef(),(y=new m.Dict(c)).set("N",f),b=c.encrypt,g=null,_=null,b&&(g=b.createCipherTransform(this.ref.num,this.ref.gen),_=b.createCipherTransform(f.num,f.gen),l=_.encryptString(l)),A=function(e){return(0,a.isAscii)(e)?e:(0,a.stringToUTF16BEString)(e)},d.set("V",Array.isArray(o)?o.map(A):A(o)),d.set("AP",y),d.set("M","D:".concat((0,a.getModificationDate)())),(x=this._getMKDict(s))&&d.set("MK",x),(w=new m.Dict(c)).set("Length",l.length),w.set("Subtype",m.Name.get("Form")),w.set("Resources",this._getSaveFieldResources(c)),w.set("BBox",u),(S=this.getRotationMatrix(n))!==a.IDENTITY_MATRIX&&w.set("Matrix",S),C=["".concat(this.ref.num," ").concat(this.ref.gen," obj\n")],(0,v.writeDict)(d,C,g),C.push("\nendobj\n"),k=["".concat(f.num," ").concat(f.gen," obj\n")],(0,v.writeDict)(w,k,_),k.push(" stream\n",l,"\nendstream\nendobj\n"),e.abrupt("return",[{ref:this.ref,data:C.join(""),xfa:h},{ref:f,data:k.join(""),xfa:null}]);case 48:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_getAppearance",value:function(){var e=y(p().mark((function e(t,n,r){var o,s,l,d,u,m,h,y,b,g,v,_,A,x,w,S,C,k,D,R,I;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.hasFieldFlag(a.AnnotationFieldFlag.PASSWORD)){e.next=3;break}return e.abrupt("return",null);case 3:if((o=r?r.get(this.data.id):void 0)&&(s=o.formattedValue||o.value,l=o.rotation),void 0!==l||void 0!==s){e.next=8;break}if(this._hasValueFromXFA&&!this.appearance){e.next=8;break}return e.abrupt("return",null);case 8:if(void 0!==s){e.next=12;break}if(s=this.data.fieldValue){e.next=12;break}return e.abrupt("return","");case 12:if(Array.isArray(s)&&1===s.length&&(s=s[0]),(0,a.assert)("string"===typeof s,"Expected `value` to be a string."),""!==(s=s.trim())){e.next=17;break}return e.abrupt("return","");case 17:return void 0===l&&(l=this.rotation),d=-1,this.data.multiLine&&(d=s.split(/\r\n|\r|\n/).length),m=u=2,h=this.data.rect[3]-this.data.rect[1],y=this.data.rect[2]-this.data.rect[0],90!==l&&270!==l||(y=(b=[h,y])[0],h=b[1]),this._defaultAppearance||(this.data.defaultAppearanceData=(0,c.parseDefaultAppearance)(this._defaultAppearance="/Helvetica 0 Tf 0 g")),e.next=28,i._getFontData(t,n,this.data.defaultAppearanceData,this._fieldResources.mergedResources);case 28:if(g=e.sent,v=this._computeFontSize(h-u,y-2*m,s,g,d),_=f(v,2),A=_[0],x=_[1],w=g.descent,isNaN(w)&&(w=0),S=Math.min(Math.floor((h-x)/2),u),C=S+Math.abs(w)*x,k=this.data.textAlignment,!this.data.multiLine){e.next=37;break}return e.abrupt("return",this._getMultilineAppearance(A,s,g,x,y,h,k,m,C,r));case 37:if(D=g.encodeString(s).join(""),!this.data.comb){e.next=40;break}return e.abrupt("return",this._getCombAppearance(A,g,D,y,m,C,r));case 40:if(R=this.getBorderAndBackgroundAppearances(r),!(0===k||k>2)){e.next=43;break}return e.abrupt("return","/Tx BMC q ".concat(R,"BT ")+A+" 1 0 0 1 ".concat(m," ").concat(C," Tm (").concat((0,a.escapeString)(D),") Tj")+" ET Q EMC");case 43:return I=this._renderText(D,g,x,y,k,m,C),e.abrupt("return","/Tx BMC q ".concat(R,"BT ")+A+" 1 0 0 1 0 0 Tm ".concat(I)+" ET Q EMC");case 45:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_getTextWidth",value:function(e,t){return t.charsToGlyphs(e).reduce((function(e,t){return e+t.width}),0)/1e3}},{key:"_computeFontSize",value:function(e,t,i,n,r){var o=this,s=this.data.defaultAppearanceData.fontSize;if(!s){var l=function(e){return Math.floor(100*e)/100};if(-1===r){var d=this._getTextWidth(i,n);s=l(Math.min(e/a.LINE_FACTOR,t/d))}else{var u,p=i.split(/\r\n?|\n/),m=[],f=h(p);try{for(f.s();!(u=f.n()).done;){var y=u.value,b=n.encodeString(y).join(""),g=n.charsToGlyphs(b),v=n.getCharPositions(b);m.push({line:b,glyphs:g,positions:v})}}catch(k){f.e(k)}finally{f.f()}var _=function(i){for(var a=0,r=0,s=m;r<s.length;r++){var l=s[r];if((a+=o._splitLine(null,n,i,t,l).length*i)>e)return!0}return!1},A=(s=12)*a.LINE_FACTOR,x=Math.round(e/A);for(x=Math.max(x,r);_(s=l((A=e/x)/a.LINE_FACTOR));)x++}var w=this.data.defaultAppearanceData,S=w.fontName,C=w.fontColor;this._defaultAppearance=(0,c.createDefaultAppearance)({fontSize:s,fontName:S,fontColor:C})}return[this._defaultAppearance,s]}},{key:"_renderText",value:function(e,t,i,n,r,o,l){var c;return c=1===r?(n-this._getTextWidth(e,t)*i)/2:2===r?n-this._getTextWidth(e,t)*i-o:o,c=(0,s.numberToString)(c),l=(0,s.numberToString)(l),"".concat(c," ").concat(l," Td (").concat((0,a.escapeString)(e),") Tj")}},{key:"_getSaveFieldResources",value:function(e){var t=this._fieldResources,i=t.localResources,a=t.appearanceResources,n=t.acroFormResources,r=this.data.defaultAppearanceData&&this.data.defaultAppearanceData.fontName;if(!r)return i||m.Dict.empty;for(var o=0,s=[i,a];o<s.length;o++){var l=s[o];if(l instanceof m.Dict){var c=l.get("Font");if(c instanceof m.Dict&&c.has(r))return l}}if(n instanceof m.Dict){var d=n.get("Font");if(d instanceof m.Dict&&d.has(r)){var u=new m.Dict(e);u.set(r,d.getRaw(r));var p=new m.Dict(e);return p.set("Font",u),m.Dict.merge({xref:e,dictArray:[p,i],mergeSubDicts:!0})}}return i||m.Dict.empty}},{key:"getFieldObject",value:function(){return null}}],[{key:"_getRotationMatrix",value:function(e,t,i){switch(e){case 90:return[0,1,-1,0,t,0];case 180:return[-1,0,0,-1,t,i];case 270:return[0,-1,1,0,0,i];default:throw new Error("Invalid rotation")}}},{key:"_getFontData",value:function(){var e=y(p().mark((function e(t,i,a,n){var r,o,s,l;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return r=new k.OperatorList,o={font:null,clone:function(){return this}},s=a.fontName,l=a.fontSize,e.next=5,t.handleSetFont(n,[s&&m.Name.get(s),l],null,r,i,o,null);case 5:return e.abrupt("return",o.font);case 6:case"end":return e.stop()}}),e)})));return function(t,i,a,n){return e.apply(this,arguments)}}()}]),i}(z),N=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),(n=t.call(this,e))._hasText=!0;var r=e.dict;"string"!==typeof n.data.fieldValue&&(n.data.fieldValue="");var o=(0,s.getInheritableProperty)({dict:r,key:"Q"});(!Number.isInteger(o)||o<0||o>2)&&(o=null),n.data.textAlignment=o;var l=(0,s.getInheritableProperty)({dict:r,key:"MaxLen"});return(!Number.isInteger(l)||l<0)&&(l=0),n.data.maxLen=l,n.data.multiLine=n.hasFieldFlag(a.AnnotationFieldFlag.MULTILINE),n.data.comb=n.hasFieldFlag(a.AnnotationFieldFlag.COMB)&&!n.hasFieldFlag(a.AnnotationFieldFlag.MULTILINE)&&!n.hasFieldFlag(a.AnnotationFieldFlag.PASSWORD)&&!n.hasFieldFlag(a.AnnotationFieldFlag.FILESELECT)&&0!==n.data.maxLen,n.data.doNotScroll=n.hasFieldFlag(a.AnnotationFieldFlag.DONOTSCROLL),n}return g(i,[{key:"_getCombAppearance",value:function(e,t,i,n,r,o,l){var c,d=(0,s.numberToString)(n/this.data.maxLen),u=[],p=t.getCharPositions(i),m=h(p);try{for(m.s();!(c=m.n()).done;){var y=f(c.value,2),b=y[0],g=y[1];u.push("(".concat((0,a.escapeString)(i.substring(b,g)),") Tj"))}}catch(A){m.e(A)}finally{m.f()}var v=this.getBorderAndBackgroundAppearances(l),_=u.join(" ".concat(d," 0 Td "));return"/Tx BMC q ".concat(v,"BT ")+e+" 1 0 0 1 ".concat(r," ").concat(o," Tm ").concat(_)+" ET Q EMC"}},{key:"_getMultilineAppearance",value:function(e,t,i,a,n,r,o,s,l,c){var d,u=t.split(/\r\n?|\n/),p=[],m=n-2*s,f=h(u);try{for(f.s();!(d=f.n()).done;){var y,b=d.value,g=this._splitLine(b,i,a,m),v=h(g);try{for(v.s();!(y=v.n()).done;){var _=y.value,A=0===p.length?s:0;p.push(this._renderText(_,i,a,n,o,A,-a))}}catch(S){v.e(S)}finally{v.f()}}}catch(S){f.e(S)}finally{f.f()}var x=p.join("\n"),w=this.getBorderAndBackgroundAppearances(c);return"/Tx BMC q ".concat(w,"BT ")+e+" 1 0 0 1 0 ".concat(r," Tm ").concat(x)+" ET Q EMC"}},{key:"_splitLine",value:function(e,t,i,a){var n=arguments.length>4&&void 0!==arguments[4]?arguments[4]:{};e=n.line||t.encodeString(e).join("");var r=n.glyphs||t.charsToGlyphs(e);if(r.length<=1)return[e];for(var o=n.positions||t.getCharPositions(e),s=i/1e3,l=[],c=-1,d=-1,u=-1,p=0,m=0,h=0,y=r.length;h<y;h++){var b=f(o[h],2),g=b[0],v=b[1],_=r[h],A=_.width*s;" "===_.unicode?m+A>a?(l.push(e.substring(p,g)),p=g,m=A,c=-1,u=-1):(m+=A,c=g,d=v,u=h):m+A>a?-1!==c?(l.push(e.substring(p,d)),p=d,h=u+1,c=-1,m=0):(l.push(e.substring(p,g)),p=g,m=A):m+=A}return p<e.length&&l.push(e.substring(p,e.length)),l}},{key:"getFieldObject",value:function(){return{id:this.data.id,value:this.data.fieldValue,defaultValue:this.data.defaultFieldValue||"",multiline:this.data.multiLine,password:this.hasFieldFlag(a.AnnotationFieldFlag.PASSWORD),charLimit:this.data.maxLen,comb:this.data.comb,editable:!this.data.readOnly,hidden:this.data.hidden,name:this.data.fieldName,rect:this.data.rect,actions:this.data.actions,page:this.data.pageIndex,strokeColor:this.data.borderColor,fillColor:this.data.backgroundColor,rotation:this.rotation,type:"text"}}}]),i}(E),O=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).checkedAppearance=null,n.uncheckedAppearance=null,n.data.checkBox=!n.hasFieldFlag(a.AnnotationFieldFlag.RADIO)&&!n.hasFieldFlag(a.AnnotationFieldFlag.PUSHBUTTON),n.data.radioButton=n.hasFieldFlag(a.AnnotationFieldFlag.RADIO)&&!n.hasFieldFlag(a.AnnotationFieldFlag.PUSHBUTTON),n.data.pushButton=n.hasFieldFlag(a.AnnotationFieldFlag.PUSHBUTTON),n.data.isTooltipOnly=!1,n.data.checkBox?n._processCheckBox(e):n.data.radioButton?n._processRadioButton(e):n.data.pushButton?(n.data.hasOwnCanvas=!0,n._processPushButton(e)):(0,a.warn)("Invalid field flags for button widget annotation"),n}return g(i,[{key:"getOperatorList",value:function(){var e=y(p().mark((function e(t,n,s,l,c){var d,u,m,h,f,y,b;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.data.pushButton){e.next=2;break}return e.abrupt("return",r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,!1,c));case 2:if(d=null,u=null,c&&(m=c.get(this.data.id),d=m?m.value:null,u=m?m.rotation:null),null!==d||!this.appearance){e.next=7;break}return e.abrupt("return",r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,l,c));case 7:if(null!==d&&void 0!==d||(d=this.data.checkBox?this.data.fieldValue===this.data.exportValue:this.data.fieldValue===this.data.buttonValue),!(h=d?this.checkedAppearance:this.uncheckedAppearance)){e.next=18;break}return f=this.appearance,y=h.dict.getArray("Matrix")||a.IDENTITY_MATRIX,u&&h.dict.set("Matrix",this.getRotationMatrix(c)),this.appearance=h,b=r(o(i.prototype),"getOperatorList",this).call(this,t,n,s,l,c),this.appearance=f,h.dict.set("Matrix",y),e.abrupt("return",b);case 18:return e.abrupt("return",{opList:new k.OperatorList,separateForm:!1,separateCanvas:!1});case 19:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n,r){return e.apply(this,arguments)}}()},{key:"save",value:function(){var e=y(p().mark((function e(t,i,a){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.data.checkBox){e.next=2;break}return e.abrupt("return",this._saveCheckbox(t,i,a));case 2:if(!this.data.radioButton){e.next=4;break}return e.abrupt("return",this._saveRadioButton(t,i,a));case 4:return e.abrupt("return",null);case 5:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_saveCheckbox",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c,d,u,h,f,y;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(n){e.next=2;break}return e.abrupt("return",null);case 2:if(r=n.get(this.data.id),o=r&&r.rotation,s=r&&r.value,void 0!==o){e.next=11;break}if(void 0!==s){e.next=8;break}return e.abrupt("return",null);case 8:if(this.data.fieldValue===this.data.exportValue!==s){e.next=11;break}return e.abrupt("return",null);case 11:if((l=t.xref.fetchIfRef(this.ref))instanceof m.Dict){e.next=14;break}return e.abrupt("return",null);case 14:return void 0===o&&(o=this.rotation),void 0===s&&(s=this.data.fieldValue===this.data.exportValue),c={path:(0,a.stringToPDFString)(l.get("T")||""),value:s?this.data.exportValue:""},d=m.Name.get(s?this.data.exportValue:"Off"),l.set("V",d),l.set("AS",d),l.set("M","D:".concat((0,a.getModificationDate)())),(u=this._getMKDict(o))&&l.set("MK",u),h=t.xref.encrypt,f=null,h&&(f=h.createCipherTransform(this.ref.num,this.ref.gen)),y=["".concat(this.ref.num," ").concat(this.ref.gen," obj\n")],(0,v.writeDict)(l,y,f),y.push("\nendobj\n"),e.abrupt("return",[{ref:this.ref,data:y.join(""),xfa:c}]);case 30:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_saveRadioButton",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,s,l,c,d,u,h,f,y,b,g,_,A;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(n){e.next=2;break}return e.abrupt("return",null);case 2:if(r=n.get(this.data.id),o=r&&r.rotation,s=r&&r.value,void 0!==o){e.next=11;break}if(void 0!==s){e.next=8;break}return e.abrupt("return",null);case 8:if(this.data.fieldValue===this.data.buttonValue!==s){e.next=11;break}return e.abrupt("return",null);case 11:if((l=t.xref.fetchIfRef(this.ref))instanceof m.Dict){e.next=14;break}return e.abrupt("return",null);case 14:return void 0===s&&(s=this.data.fieldValue===this.data.buttonValue),void 0===o&&(o=this.rotation),c={path:(0,a.stringToPDFString)(l.get("T")||""),value:s?this.data.buttonValue:""},d=m.Name.get(s?this.data.buttonValue:"Off"),u=null,h=t.xref.encrypt,s&&(this.parent instanceof m.Ref?(f=t.xref.fetch(this.parent),y=null,h&&(y=h.createCipherTransform(this.parent.num,this.parent.gen)),f.set("V",d),u=["".concat(this.parent.num," ").concat(this.parent.gen," obj\n")],(0,v.writeDict)(f,u,y),u.push("\nendobj\n")):this.parent instanceof m.Dict&&this.parent.set("V",d)),l.set("AS",d),l.set("M","D:".concat((0,a.getModificationDate)())),(b=this._getMKDict(o))&&l.set("MK",b),g=null,h&&(g=h.createCipherTransform(this.ref.num,this.ref.gen)),_=["".concat(this.ref.num," ").concat(this.ref.gen," obj\n")],(0,v.writeDict)(l,_,g),_.push("\nendobj\n"),A=[{ref:this.ref,data:_.join(""),xfa:c}],null!==u&&A.push({ref:this.parent,data:u.join(""),xfa:null}),e.abrupt("return",A);case 33:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()},{key:"_getDefaultCheckedAppearance",value:function(e,t){var i,n,r=this.data.rect[2]-this.data.rect[0],o=this.data.rect[3]-this.data.rect[1],l=[0,0,r,o],c=.8*Math.min(r,o);"check"===t?(i={width:.755*c,height:.705*c},n="3"):"disc"===t?(i={width:.791*c,height:.705*c},n="l"):(0,a.unreachable)("_getDefaultCheckedAppearance - unsupported type: ".concat(t));var d=(0,s.numberToString)((r-i.width)/2),u=(0,s.numberToString)((o-i.height)/2),p="q BT /PdfJsZaDb ".concat(c," Tf 0 g ").concat(d," ").concat(u," Td (").concat(n,") Tj ET Q"),h=new m.Dict(e.xref);h.set("FormType",1),h.set("Subtype",m.Name.get("Form")),h.set("Type",m.Name.get("XObject")),h.set("BBox",l),h.set("Matrix",[1,0,0,1,0,0]),h.set("Length",p.length);var f=new m.Dict(e.xref),y=new m.Dict(e.xref);y.set("PdfJsZaDb",this.fallbackFontDict),f.set("Font",y),h.set("Resources",f),this.checkedAppearance=new D.StringStream(p),this.checkedAppearance.dict=h,this._streams.push(this.checkedAppearance)}},{key:"_processCheckBox",value:function(e){var t=e.dict.get("AP");if(t instanceof m.Dict){var i=t.get("N");if(i instanceof m.Dict){var a=this._decodeFormValue(e.dict.get("AS"));"string"===typeof a&&(this.data.fieldValue=a);var n=null!==this.data.fieldValue&&"Off"!==this.data.fieldValue?this.data.fieldValue:"Yes",r=i.getKeys();if(0===r.length)r.push("Off",n);else if(1===r.length)"Off"===r[0]?r.push(n):r.unshift("Off");else if(r.includes(n))r.length=0,r.push("Off",n);else{var o=r.find((function(e){return"Off"!==e}));r.length=0,r.push("Off",o)}r.includes(this.data.fieldValue)||(this.data.fieldValue="Off"),this.data.exportValue=r[1],this.checkedAppearance=i.get(this.data.exportValue)||null,this.uncheckedAppearance=i.get("Off")||null,this.checkedAppearance?this._streams.push(this.checkedAppearance):this._getDefaultCheckedAppearance(e,"check"),this.uncheckedAppearance&&this._streams.push(this.uncheckedAppearance),this._fallbackFontDict=this.fallbackFontDict}}}},{key:"_processRadioButton",value:function(e){this.data.fieldValue=this.data.buttonValue=null;var t=e.dict.get("Parent");if(t instanceof m.Dict){this.parent=e.dict.getRaw("Parent");var i=t.get("V");i instanceof m.Name&&(this.data.fieldValue=this._decodeFormValue(i))}var a=e.dict.get("AP");if(a instanceof m.Dict){var n=a.get("N");if(n instanceof m.Dict){var r,o=h(n.getKeys());try{for(o.s();!(r=o.n()).done;){var s=r.value;if("Off"!==s){this.data.buttonValue=this._decodeFormValue(s);break}}}catch(l){o.e(l)}finally{o.f()}this.checkedAppearance=n.get(this.data.buttonValue)||null,this.uncheckedAppearance=n.get("Off")||null,this.checkedAppearance?this._streams.push(this.checkedAppearance):this._getDefaultCheckedAppearance(e,"disc"),this.uncheckedAppearance&&this._streams.push(this.uncheckedAppearance),this._fallbackFontDict=this.fallbackFontDict}}}},{key:"_processPushButton",value:function(e){e.dict.has("A")||e.dict.has("AA")||this.data.alternativeText?(this.data.isTooltipOnly=!e.dict.has("A")&&!e.dict.has("AA"),x.Catalog.parseDestDictionary({destDict:e.dict,resultObj:this.data,docBaseUrl:e.pdfManager.docBaseUrl})):(0,a.warn)("Push buttons without action dictionaries are not supported")}},{key:"getFieldObject",value:function(){var e,t="button";return this.data.checkBox?(t="checkbox",e=this.data.exportValue):this.data.radioButton&&(t="radiobutton",e=this.data.buttonValue),{id:this.data.id,value:this.data.fieldValue||"Off",defaultValue:this.data.defaultFieldValue,exportValues:e,editable:!this.data.readOnly,name:this.data.fieldName,rect:this.data.rect,hidden:this.data.hidden,actions:this.data.actions,page:this.data.pageIndex,strokeColor:this.data.borderColor,fillColor:this.data.backgroundColor,rotation:this.rotation,type:t}}},{key:"fallbackFontDict",get:function(){var e=new m.Dict;return e.set("BaseFont",m.Name.get("ZapfDingbats")),e.set("Type",m.Name.get("FallbackType")),e.set("Subtype",m.Name.get("FallbackType")),e.set("Encoding",m.Name.get("ZapfDingbatsEncoding")),(0,a.shadow)(this,"fallbackFontDict",e)}}]),i}(E),G=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),(n=t.call(this,e)).data.options=[];var r=(0,s.getInheritableProperty)({dict:e.dict,key:"Opt"});if(Array.isArray(r))for(var o=e.xref,l=0,c=r.length;l<c;l++){var d=o.fetchIfRef(r[l]),u=Array.isArray(d);n.data.options[l]={exportValue:n._decodeFormValue(u?o.fetchIfRef(d[0]):d),displayValue:n._decodeFormValue(u?o.fetchIfRef(d[1]):d)}}return"string"===typeof n.data.fieldValue?n.data.fieldValue=[n.data.fieldValue]:n.data.fieldValue||(n.data.fieldValue=[]),n.data.combo=n.hasFieldFlag(a.AnnotationFieldFlag.COMBO),n.data.multiSelect=n.hasFieldFlag(a.AnnotationFieldFlag.MULTISELECT),n._hasText=!0,n}return g(i,[{key:"getFieldObject",value:function(){var e=this.data.combo?"combobox":"listbox",t=this.data.fieldValue.length>0?this.data.fieldValue[0]:null;return{id:this.data.id,value:t,defaultValue:this.data.defaultFieldValue,editable:!this.data.readOnly,name:this.data.fieldName,rect:this.data.rect,numItems:this.data.fieldValue.length,multipleSelection:this.data.multiSelect,hidden:this.data.hidden,actions:this.data.actions,items:this.data.options,page:this.data.pageIndex,strokeColor:this.data.borderColor,fillColor:this.data.backgroundColor,rotation:this.rotation,type:e}}},{key:"_getAppearance",value:function(){var e=y(p().mark((function e(t,n,s){var l,d,u,m,y,b,g,v,_,A,x,w,S,C,k,D,R,I,M,T,P,z,B,F,N,O,G,L,j,q,H,U,Y,X,V,Q,W,Z;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!this.data.combo){e.next=2;break}return e.abrupt("return",r(o(i.prototype),"_getAppearance",this).call(this,t,n,s));case 2:if(s){e.next=4;break}return e.abrupt("return",null);case 4:if(l=s.get(this.data.id)){e.next=7;break}return e.abrupt("return",null);case 7:if(d=l.rotation,u=l.value,void 0!==d||void 0!==u){e.next=11;break}return e.abrupt("return",null);case 11:for(void 0===u?u=this.data.fieldValue:Array.isArray(u)||(u=[u]),y=m=2,b=this.data.rect[3]-this.data.rect[1],g=this.data.rect[2]-this.data.rect[0],90!==d&&270!==d||(g=(v=[b,g])[0],b=v[1]),_=this.data.options.length,A=[],x=0;x<_;x++)w=this.data.options[x].exportValue,u.includes(w)&&A.push(x);return this._defaultAppearance||(this.data.defaultAppearanceData=(0,c.parseDefaultAppearance)(this._defaultAppearance="/Helvetica 0 Tf 0 g")),e.next=23,E._getFontData(t,n,this.data.defaultAppearanceData,this._fieldResources.mergedResources);case 23:if(S=e.sent,k=this.data.defaultAppearanceData.fontSize)C=this._defaultAppearance;else{D=(b-m)/_,R=-1,M=h(this.data.options);try{for(M.s();!(T=M.n()).done;)P=T.value.displayValue,(z=this._getTextWidth(P,S))>R&&(R=z,I=P)}catch(p){M.e(p)}finally{M.f()}B=this._computeFontSize(D,g-2*y,I,S,-1),F=f(B,2),C=F[0],k=F[1]}if(N=k*a.LINE_FACTOR,O=(N-k)/2,G=Math.floor(b/N),1===A.length?(j=A[0],L=j-j%G):L=A.length?A[0]:0,q=Math.min(L+G+1,_),H=["/Tx BMC q","1 1 ".concat(g," ").concat(b," re W n")],A.length){H.push("0.600006 0.756866 0.854904 rg"),U=h(A);try{for(U.s();!(Y=U.n()).done;)X=Y.value,L<=X&&X<q&&H.push("1 ".concat(b-(X-L+1)*N," ").concat(g," ").concat(N," re f"))}catch(p){U.e(p)}finally{U.f()}}for(H.push("BT",C,"1 0 0 1 0 ".concat(b," Tm")),V=L;V<q;V++)Q=this.data.options[V].displayValue,W=V===L?y:0,Z=V===L?O:0,H.push(this._renderText(Q,S,k,g,0,W,-N+Z));return H.push("ET Q EMC"),e.abrupt("return",H.join("\n"));case 37:case"end":return e.stop()}}),e,this)})));return function(t,i,a){return e.apply(this,arguments)}}()}]),i}(E),L=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this,e)).data.fieldValue=null,a}return g(i,[{key:"getFieldObject",value:function(){return{id:this.data.id,value:null,page:this.data.pageIndex,type:"signature"}}}]),i}(E),j=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict;return n.data.annotationType=a.AnnotationType.TEXT,n.data.hasAppearance?n.data.name="NoIcon":(n.data.rect[1]=n.data.rect[3]-22,n.data.rect[2]=n.data.rect[0]+22,n.data.name=r.has("Name")?r.get("Name").name:"Note"),r.has("State")?(n.data.state=r.get("State")||null,n.data.stateModel=r.get("StateModel")||null):(n.data.state=null,n.data.stateModel=null),n}return g(i)}(F),q=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.LINK;var r=T(e.dict,n.rectangle);return r&&(n.data.quadPoints=r),n.data.borderColor=n.data.borderColor||n.data.color,x.Catalog.parseDestDictionary({destDict:e.dict,resultObj:n.data,docBaseUrl:e.pdfManager.docBaseUrl}),n}return g(i)}(z),H=function(e){d(i,e);var t=u(i);function i(e){var r;b(this,i),(r=t.call(this,e)).data.annotationType=a.AnnotationType.POPUP;var o=e.dict.get("Parent");if(!o)return(0,a.warn)("Popup annotation has a missing or invalid parent annotation."),n(r);var s=o.get("Subtype");r.data.parentType=s instanceof m.Name?s.name:null;var l=e.dict.getRaw("Parent");r.data.parentId=l instanceof m.Ref?l.toString():null;var c=o.getArray("Rect");Array.isArray(c)&&4===c.length?r.data.parentRect=a.Util.normalizeRect(c):r.data.parentRect=[0,0,0,0];var d=o.get("RT");if((0,m.isName)(d,a.AnnotationReplyType.GROUP)&&(o=o.get("IRT")),o.has("M")?(r.setModificationDate(o.get("M")),r.data.modificationDate=r.modificationDate):r.data.modificationDate=null,o.has("C")?(r.setColor(o.getArray("C")),r.data.color=r.color):r.data.color=null,!r.viewable){var u=o.get("F");r._isViewable(u)&&r.setFlags(u)}return r.setTitle(o.get("T")),r.data.titleObj=r._title,r.setContents(o.get("Contents")),r.data.contentsObj=r._contents,o.has("RC")&&(r.data.richText=R.XFAFactory.getRichTextAsHtml(o.get("RC"))),r}return g(i)}(z);t.PopupAnnotation=H;var U=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.FREETEXT,n}return g(i,[{key:"hasTextContent",get:function(){return!!this.appearance}}],[{key:"createNewDict",value:function(e,t,i){var n=i.apRef,r=i.ap,o=e.color,s=e.fontSize,l=e.rect,d=e.rotation,u=e.user,p=e.value,h=new m.Dict(t);h.set("Type",m.Name.get("Annot")),h.set("Subtype",m.Name.get("FreeText")),h.set("CreationDate","D:".concat((0,a.getModificationDate)())),h.set("Rect",l);var f="/Helv ".concat(s," Tf ").concat((0,c.getPdfColor)(o,!0));h.set("DA",f),h.set("Contents",p),h.set("F",4),h.set("Border",[0,0,0]),h.set("Rotate",d),u&&h.set("T",(0,a.stringToUTF8String)(u));var y=new m.Dict(t);return h.set("AP",y),n?y.set("N",n):y.set("N",r),h}},{key:"createNewAppearanceStream",value:function(){var e=y(p().mark((function e(t,i,n){var r,o,l,d,u,y,b,g,v,_,A,x,w,S,C,k,R,I,M,T,P,z,B,F,N,O,G,L,j,q,H,U,Y,X,V,Q,W,Z,J,K,$,ee,te,ie,ae,ne,re,oe;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return r=n.baseFontRef,o=n.evaluator,l=n.task,d=t.color,u=t.fontSize,y=t.rect,b=t.rotation,g=t.value,v=new m.Dict(i),_=new m.Dict(i),r?_.set("Helv",r):((A=new m.Dict(i)).set("BaseFont",m.Name.get("Helvetica")),A.set("Type",m.Name.get("Font")),A.set("Subtype",m.Name.get("Type1")),A.set("Encoding",m.Name.get("WinAnsiEncoding")),_.set("Helv",A)),v.set("Font",_),e.next=8,E._getFontData(o,l,{fontName:"Helvetica",fontSize:u},v);case 8:x=e.sent,w=f(y,4),S=w[0],C=w[1],k=w[2],R=w[3],I=k-S,M=R-C,b%180!==0&&(I=(T=[M,I])[0],M=T[1]),P=g.split("\n"),z=u/1e3,B=-1/0,F=[],N=h(P);try{for(N.s();!(O=N.n()).done;){G=O.value,G=x.encodeString(G).join(""),F.push(G),L=0,j=x.charsToGlyphs(G),q=h(j);try{for(q.s();!(H=q.n()).done;)U=H.value,L+=U.width*z}catch(p){q.e(p)}finally{q.f()}B=Math.max(B,L)}}catch(p){N.e(p)}finally{N.f()}for(Y=1,B>I&&(Y=I/B),X=1,V=a.LINE_FACTOR*u,Q=a.LINE_DESCENT_FACTOR*u,(W=V*P.length)>M&&(X=M/W),Z=Math.min(Y,X),J=u*Z,K=["q","0 0 ".concat((0,s.numberToString)(I)," ").concat((0,s.numberToString)(M)," re W n"),"BT","1 0 0 1 0 ".concat((0,s.numberToString)(M+Q)," Tm 0 Tc ").concat((0,c.getPdfColor)(d,!0)),"/Helv ".concat((0,s.numberToString)(J)," Tf")],$=(0,s.numberToString)(V),ee=0,te=F;ee<te.length;ee++)ie=te[ee],K.push("0 -".concat($," Td (").concat((0,a.escapeString)(ie),") Tj"));return K.push("ET","Q"),ae=K.join("\n"),(ne=new m.Dict(i)).set("FormType",1),ne.set("Subtype",m.Name.get("Form")),ne.set("Type",m.Name.get("XObject")),ne.set("BBox",[0,0,I,M]),ne.set("Length",ae.length),ne.set("Resources",v),b&&(re=E._getRotationMatrix(b,I,M),ne.set("Matrix",re)),(oe=new D.StringStream(ae)).dict=ne,e.abrupt("return",oe);case 44:case"end":return e.stop()}}),e)})));return function(t,i,a){return e.apply(this,arguments)}}()}]),i}(F),Y=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=e.dict;n.data.annotationType=a.AnnotationType.LINE;var o=r.getArray("L");if(n.data.lineCoordinates=a.Util.normalizeRect(o),n.setLineEndings(r.getArray("LE")),n.data.lineEndings=n.lineEndings,!n.appearance){var s=n.color?Array.from(n.color).map((function(e){return e/255})):[0,0,0],l=r.get("CA"),c=null,d=r.getArray("IC");d&&(c=(d=M(d,null))?Array.from(d).map((function(e){return e/255})):null);var u=c?l:null,p=n.borderStyle.width||1,m=2*p,h=[n.data.lineCoordinates[0]-m,n.data.lineCoordinates[1]-m,n.data.lineCoordinates[2]+m,n.data.lineCoordinates[3]+m];a.Util.intersect(n.rectangle,h)||(n.rectangle=h),n._setDefaultAppearance({xref:e.xref,extra:"".concat(p," w"),strokeColor:s,fillColor:c,strokeAlpha:l,fillAlpha:u,pointsCallback:function(e,t){return e.push("".concat(o[0]," ").concat(o[1]," m"),"".concat(o[2]," ").concat(o[3]," l"),"S"),[t[0].x-p,t[1].x+p,t[3].y-p,t[1].y+p]}})}return n}return g(i)}(F),X=function(e){d(i,e);var t=u(i);function i(e){var r;if(b(this,i),(r=t.call(this,e)).data.annotationType=a.AnnotationType.SQUARE,!r.appearance){var o=r.color?Array.from(r.color).map((function(e){return e/255})):[0,0,0],s=e.dict.get("CA"),l=null,c=e.dict.getArray("IC");c&&(c=M(c,null),l=c?Array.from(c).map((function(e){return e/255})):null);var d=l?s:null;if(0===r.borderStyle.width&&!l)return n(r);r._setDefaultAppearance({xref:e.xref,extra:"".concat(r.borderStyle.width," w"),strokeColor:o,fillColor:l,strokeAlpha:s,fillAlpha:d,pointsCallback:function(e,t){var i=t[2].x+r.borderStyle.width/2,a=t[2].y+r.borderStyle.width/2,n=t[3].x-t[2].x-r.borderStyle.width,o=t[1].y-t[3].y-r.borderStyle.width;return e.push("".concat(i," ").concat(a," ").concat(n," ").concat(o," re")),l?e.push("B"):e.push("S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}return r}return g(i)}(F),V=function(e){d(i,e);var t=u(i);function i(e){var r;if(b(this,i),(r=t.call(this,e)).data.annotationType=a.AnnotationType.CIRCLE,!r.appearance){var o=r.color?Array.from(r.color).map((function(e){return e/255})):[0,0,0],s=e.dict.get("CA"),l=null,c=e.dict.getArray("IC");c&&(c=M(c,null),l=c?Array.from(c).map((function(e){return e/255})):null);var d=l?s:null;if(0===r.borderStyle.width&&!l)return n(r);var u=4/3*Math.tan(Math.PI/8);r._setDefaultAppearance({xref:e.xref,extra:"".concat(r.borderStyle.width," w"),strokeColor:o,fillColor:l,strokeAlpha:s,fillAlpha:d,pointsCallback:function(e,t){var i=t[0].x+r.borderStyle.width/2,a=t[0].y-r.borderStyle.width/2,n=t[3].x-r.borderStyle.width/2,o=t[3].y+r.borderStyle.width/2,s=i+(n-i)/2,c=a+(o-a)/2,d=(n-i)/2*u,p=(o-a)/2*u;return e.push("".concat(s," ").concat(o," m"),"".concat(s+d," ").concat(o," ").concat(n," ").concat(c+p," ").concat(n," ").concat(c," c"),"".concat(n," ").concat(c-p," ").concat(s+d," ").concat(a," ").concat(s," ").concat(a," c"),"".concat(s-d," ").concat(a," ").concat(i," ").concat(c-p," ").concat(i," ").concat(c," c"),"".concat(i," ").concat(c+p," ").concat(s-d," ").concat(o," ").concat(s," ").concat(o," c"),"h"),l?e.push("B"):e.push("S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}return r}return g(i)}(F),Q=function(e){d(i,e);var t=u(i);function i(e){var r;b(this,i),r=t.call(this,e);var o=e.dict;r.data.annotationType=a.AnnotationType.POLYLINE,r.data.vertices=[],l(r)instanceof W||(r.setLineEndings(o.getArray("LE")),r.data.lineEndings=r.lineEndings);var s=o.getArray("Vertices");if(!Array.isArray(s))return n(r);for(var c=0,d=s.length;c<d;c+=2)r.data.vertices.push({x:s[c],y:s[c+1]});if(!r.appearance){var u,p=r.color?Array.from(r.color).map((function(e){return e/255})):[0,0,0],m=o.get("CA"),f=r.borderStyle.width||1,y=2*f,g=[1/0,1/0,-1/0,-1/0],v=h(r.data.vertices);try{for(v.s();!(u=v.n()).done;){var _=u.value;g[0]=Math.min(g[0],_.x-y),g[1]=Math.min(g[1],_.y-y),g[2]=Math.max(g[2],_.x+y),g[3]=Math.max(g[3],_.y+y)}}catch(A){v.e(A)}finally{v.f()}a.Util.intersect(r.rectangle,g)||(r.rectangle=g),r._setDefaultAppearance({xref:e.xref,extra:"".concat(f," w"),strokeColor:p,strokeAlpha:m,pointsCallback:function(e,t){for(var i=r.data.vertices,a=0,n=i.length;a<n;a++)e.push("".concat(i[a].x," ").concat(i[a].y," ").concat(0===a?"m":"l"));return e.push("S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}return r}return g(i)}(F),W=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.POLYGON,n}return g(i)}(Q),Z=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.CARET,n}return g(i)}(F),J=function(e){d(i,e);var t=u(i);function i(e){var r;b(this,i),(r=t.call(this,e)).data.annotationType=a.AnnotationType.INK,r.data.inkLists=[];var o=e.dict.getArray("InkList");if(!Array.isArray(o))return n(r);for(var s=e.xref,l=0,c=o.length;l<c;++l){r.data.inkLists.push([]);for(var d=0,u=o[l].length;d<u;d+=2)r.data.inkLists[l].push({x:s.fetchIfRef(o[l][d]),y:s.fetchIfRef(o[l][d+1])})}if(!r.appearance){var p,m=r.color?Array.from(r.color).map((function(e){return e/255})):[0,0,0],f=e.dict.get("CA"),y=r.borderStyle.width||1,g=2*y,v=[1/0,1/0,-1/0,-1/0],_=h(r.data.inkLists);try{for(_.s();!(p=_.n()).done;){var A,x=p.value,w=h(x);try{for(w.s();!(A=w.n()).done;){var S=A.value;v[0]=Math.min(v[0],S.x-g),v[1]=Math.min(v[1],S.y-g),v[2]=Math.max(v[2],S.x+g),v[3]=Math.max(v[3],S.y+g)}}catch(C){w.e(C)}finally{w.f()}}}catch(C){_.e(C)}finally{_.f()}a.Util.intersect(r.rectangle,v)||(r.rectangle=v),r._setDefaultAppearance({xref:e.xref,extra:"".concat(y," w"),strokeColor:m,strokeAlpha:f,pointsCallback:function(e,t){var i,a=h(r.data.inkLists);try{for(a.s();!(i=a.n()).done;){for(var n=i.value,o=0,s=n.length;o<s;o++)e.push("".concat(n[o].x," ").concat(n[o].y," ").concat(0===o?"m":"l"));e.push("S")}}catch(C){a.e(C)}finally{a.f()}return[t[0].x,t[1].x,t[3].y,t[1].y]}})}return r}return g(i,null,[{key:"createNewDict",value:function(e,t,i){var n=i.apRef,r=i.ap,o=e.paths,s=e.rect,l=e.rotation,c=new m.Dict(t);c.set("Type",m.Name.get("Annot")),c.set("Subtype",m.Name.get("Ink")),c.set("CreationDate","D:".concat((0,a.getModificationDate)())),c.set("Rect",s),c.set("InkList",o.map((function(e){return e.points}))),c.set("F",4),c.set("Border",[0,0,0]),c.set("Rotate",l);var d=new m.Dict(t);return c.set("AP",d),n?d.set("N",n):d.set("N",r),c}},{key:"createNewAppearanceStream",value:function(){var e=y(p().mark((function e(t,i,a){var n,r,o,l,d,u,y,b,g,v,_,A,x,w,S,C,k,R,I,M,T,P,z,B,F,N,O,G,L;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:n=t.color,r=t.rect,o=t.rotation,l=t.paths,d=t.thickness,u=t.opacity,y=f(r,4),b=y[0],g=y[1],v=y[2],_=y[3],A=v-b,x=_-g,o%180!==0&&(A=(w=[x,A])[0],x=w[1]),S=["".concat(d," w 1 J 1 j"),"".concat((0,c.getPdfColor)(n,!1))],1!==u&&S.push("/R0 gs"),C=[],k=h(l);try{for(k.s();!(R=k.n()).done;){for(I=R.value.bezier,C.length=0,C.push("".concat((0,s.numberToString)(I[0])," ").concat((0,s.numberToString)(I[1])," m")),M=2,T=I.length;M<T;M+=6)P=I.slice(M,M+6).map(s.numberToString).join(" "),C.push("".concat(P," c"));C.push("S"),S.push(C.join("\n"))}}catch(a){k.e(a)}finally{k.f()}return z=S.join("\n"),(B=new m.Dict(i)).set("FormType",1),B.set("Subtype",m.Name.get("Form")),B.set("Type",m.Name.get("XObject")),B.set("BBox",[0,0,A,x]),B.set("Length",z.length),o&&(F=E._getRotationMatrix(o,A,x),B.set("Matrix",F)),1!==u&&(N=new m.Dict(i),O=new m.Dict(i),(G=new m.Dict(i)).set("CA",u),G.set("Type",m.Name.get("ExtGState")),O.set("R0",G),N.set("ExtGState",O),B.set("Resources",N)),(L=new D.StringStream(z)).dict=B,e.abrupt("return",L);case 22:case"end":return e.stop()}}),e)})));return function(t,i,a){return e.apply(this,arguments)}}()}]),i}(F),K=function(e){d(i,e);var t=u(i);function i(e){var n;if(b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.HIGHLIGHT,n.data.quadPoints=T(e.dict,null)){var r=n.appearance&&n.appearance.dict.get("Resources");if(!n.appearance||!r||!r.has("ExtGState")){n.appearance&&(0,a.warn)("HighlightAnnotation - ignoring built-in appearance stream.");var o=n.color?Array.from(n.color).map((function(e){return e/255})):[1,1,0],s=e.dict.get("CA");n._setDefaultAppearance({xref:e.xref,fillColor:o,blendMode:"Multiply",fillAlpha:s,pointsCallback:function(e,t){return e.push("".concat(t[0].x," ").concat(t[0].y," m"),"".concat(t[1].x," ").concat(t[1].y," l"),"".concat(t[3].x," ").concat(t[3].y," l"),"".concat(t[2].x," ").concat(t[2].y," l"),"f"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}}else n.data.hasPopup=!1;return n}return g(i)}(F),$=function(e){d(i,e);var t=u(i);function i(e){var n;if(b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.UNDERLINE,n.data.quadPoints=T(e.dict,null)){if(!n.appearance){var r=n.color?Array.from(n.color).map((function(e){return e/255})):[0,0,0],o=e.dict.get("CA");n._setDefaultAppearance({xref:e.xref,extra:"[] 0 d 1 w",strokeColor:r,strokeAlpha:o,pointsCallback:function(e,t){return e.push("".concat(t[2].x," ").concat(t[2].y," m"),"".concat(t[3].x," ").concat(t[3].y," l"),"S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}}else n.data.hasPopup=!1;return n}return g(i)}(F),ee=function(e){d(i,e);var t=u(i);function i(e){var n;if(b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.SQUIGGLY,n.data.quadPoints=T(e.dict,null)){if(!n.appearance){var r=n.color?Array.from(n.color).map((function(e){return e/255})):[0,0,0],o=e.dict.get("CA");n._setDefaultAppearance({xref:e.xref,extra:"[] 0 d 1 w",strokeColor:r,strokeAlpha:o,pointsCallback:function(e,t){var i=(t[0].y-t[2].y)/6,a=i,n=t[2].x,r=t[2].y,o=t[3].x;e.push("".concat(n," ").concat(r+a," m"));do{n+=2,a=0===a?i:0,e.push("".concat(n," ").concat(r+a," l"))}while(n<o);return e.push("S"),[t[2].x,o,r-2*i,r+2*i]}})}}else n.data.hasPopup=!1;return n}return g(i)}(F),te=function(e){d(i,e);var t=u(i);function i(e){var n;if(b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.STRIKEOUT,n.data.quadPoints=T(e.dict,null)){if(!n.appearance){var r=n.color?Array.from(n.color).map((function(e){return e/255})):[0,0,0],o=e.dict.get("CA");n._setDefaultAppearance({xref:e.xref,extra:"[] 0 d 1 w",strokeColor:r,strokeAlpha:o,pointsCallback:function(e,t){return e.push("".concat((t[0].x+t[2].x)/2," ")+"".concat((t[0].y+t[2].y)/2," m"),"".concat((t[1].x+t[3].x)/2," ")+"".concat((t[1].y+t[3].y)/2," l"),"S"),[t[0].x,t[1].x,t[3].y,t[1].y]}})}}else n.data.hasPopup=!1;return n}return g(i)}(F),ie=function(e){d(i,e);var t=u(i);function i(e){var n;return b(this,i),(n=t.call(this,e)).data.annotationType=a.AnnotationType.STAMP,n}return g(i)}(F),ae=function(e){d(i,e);var t=u(i);function i(e){var n;b(this,i),n=t.call(this,e);var r=new S.FileSpec(e.dict.get("FS"),e.xref);return n.data.annotationType=a.AnnotationType.FILEATTACHMENT,n.data.file=r.serializable,n}return g(i)}(F)},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.createDefaultAppearance=function(e){var t=e.fontSize,i=e.fontName,n=e.fontColor;return"/".concat((0,a.escapePDFName)(i)," ").concat(t," Tf ").concat(p(n,!0))},t.getPdfColor=p,t.parseDefaultAppearance=function(e){return new c(e).parse()};var a=i(131),n=i(2),r=i(139),o=i(140),s=i(130),l=i(135),c=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,new l.StringStream(e))}return g(i,[{key:"parse",value:function(){var e={fn:0,args:[]},t={fontSize:0,fontName:"",fontColor:new Uint8ClampedArray(3)};try{for(;e.args.length=0,this.read(e);)if(0===this.savedStatesDepth){var i=e.fn,a=e.args;switch(0|i){case n.OPS.setFont:var o=f(a,2),l=o[0],c=o[1];l instanceof s.Name&&(t.fontName=l.name),"number"===typeof c&&c>0&&(t.fontSize=c);break;case n.OPS.setFillRGBColor:r.ColorSpace.singletons.rgb.getRgbItem(a,0,t.fontColor,0);break;case n.OPS.setFillGray:r.ColorSpace.singletons.gray.getRgbItem(a,0,t.fontColor,0);break;case n.OPS.setFillColorSpace:r.ColorSpace.singletons.cmyk.getRgbItem(a,0,t.fontColor,0)}}}catch(d){(0,n.warn)('parseDefaultAppearance - ignoring errors: "'.concat(d,'".'))}return t}}]),i}(o.EvaluatorPreprocessor);function p(e,t){if(e[0]===e[1]&&e[1]===e[2]){var i=e[0]/255;return"".concat((0,a.numberToString)(i)," ").concat(t?"g":"G")}return Array.from(e).map((function(e){return(0,a.numberToString)(e/255)})).join(" ")+" ".concat(t?"rg":"RG")}},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.ColorSpace=void 0;var a=i(2),n=i(130),r=i(132),o=i(131),s=function(){function e(t,i){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize ColorSpace."),this.name=t,this.numComps=i}return g(e,[{key:"getRgb",value:function(e,t){var i=new Uint8ClampedArray(3);return this.getRgbItem(e,t,i,0),i}},{key:"getRgbItem",value:function(e,t,i,n){(0,a.unreachable)("Should not call ColorSpace.getRgbItem")}},{key:"getRgbBuffer",value:function(e,t,i,n,r,o,s){(0,a.unreachable)("Should not call ColorSpace.getRgbBuffer")}},{key:"getOutputLength",value:function(e,t){(0,a.unreachable)("Should not call ColorSpace.getOutputLength")}},{key:"isPassthrough",value:function(e){return!1}},{key:"isDefaultDecode",value:function(t,i){return e.isDefaultDecode(t,this.numComps)}},{key:"fillRgb",value:function(e,t,i,a,n,r,o,s,l){var c=t*i,d=null,u=1<<o,p=i!==n||t!==a;if(this.isPassthrough(o))d=s;else if(1===this.numComps&&c>u&&"DeviceGray"!==this.name&&"DeviceRGB"!==this.name){for(var m=o<=8?new Uint8Array(u):new Uint16Array(u),h=0;h<u;h++)m[h]=h;var f=new Uint8ClampedArray(3*u);if(this.getRgbBuffer(m,0,u,f,0,o,0),p){d=new Uint8Array(3*c);for(var y=0,b=0;b<c;++b){var g=3*s[b];d[y++]=f[g],d[y++]=f[g+1],d[y++]=f[g+2]}}else for(var v=0,_=0;_<c;++_){var A=3*s[_];e[v++]=f[A],e[v++]=f[A+1],e[v++]=f[A+2],v+=l}}else p?(d=new Uint8ClampedArray(3*c),this.getRgbBuffer(s,0,c,d,0,o,0)):this.getRgbBuffer(s,0,a*r,e,0,o,l);if(d)if(p)!function(e,t,i,a,n,r,o){o=1!==o?0:o;for(var s,l=i/n,c=a/r,d=0,u=new Uint16Array(n),p=3*i,m=0;m<n;m++)u[m]=3*Math.floor(m*l);for(var h=0;h<r;h++)for(var f=Math.floor(h*c)*p,y=0;y<n;y++)s=f+u[y],t[d++]=e[s++],t[d++]=e[s++],t[d++]=e[s++],d+=o}(d,e,t,i,a,n,l);else for(var x=0,w=0,S=0,C=a*r;S<C;S++)e[x++]=d[w++],e[x++]=d[w++],e[x++]=d[w++],x+=l}},{key:"usesZeroToOneRange",get:function(){return(0,a.shadow)(this,"usesZeroToOneRange",!0)}}],[{key:"_cache",value:function(e,t,i,a){if(!i)throw new Error('ColorSpace._cache - expected "localColorSpaceCache" argument.');if(!a)throw new Error('ColorSpace._cache - expected "parsedColorSpace" argument.');var r,o;e instanceof n.Ref&&(o=e,e=t.fetch(e)),e instanceof n.Name&&(r=e.name),(r||o)&&i.set(r,o,a)}},{key:"getCached",value:function(e,t,i){if(!i)throw new Error('ColorSpace.getCached - expected "localColorSpaceCache" argument.');if(e instanceof n.Ref){var a=i.getByRef(e);if(a)return a;try{e=t.fetch(e)}catch(s){if(s instanceof o.MissingDataException)throw s}}if(e instanceof n.Name){var r=i.getByName(e.name);if(r)return r}return null}},{key:"parseAsync",value:function(){var e=y(p().mark((function e(t){var i,a,n,r,o,s,l;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return i=t.cs,a=t.xref,n=t.resources,r=void 0===n?null:n,o=t.pdfFunctionFactory,s=t.localColorSpaceCache,l=this._parse(i,a,r,o),this._cache(i,a,s,l),e.abrupt("return",l);case 4:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"parse",value:function(e){var t=e.cs,i=e.xref,a=e.resources,n=void 0===a?null:a,r=e.pdfFunctionFactory,o=e.localColorSpaceCache,s=this.getCached(t,i,o);if(s)return s;var l=this._parse(t,i,n,r);return this._cache(t,i,o,l),l}},{key:"_parse",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null,r=arguments.length>3?arguments[3]:void 0;if((e=t.fetchIfRef(e))instanceof n.Name)switch(e.name){case"G":case"DeviceGray":return this.singletons.gray;case"RGB":case"DeviceRGB":return this.singletons.rgb;case"CMYK":case"DeviceCMYK":return this.singletons.cmyk;case"Pattern":return new c(null);default:if(i instanceof n.Dict){var o=i.get("ColorSpace");if(o instanceof n.Dict){var s=o.get(e.name);if(s){if(s instanceof n.Name)return this._parse(s,t,i,r);e=s;break}}}throw new a.FormatError("Unrecognized ColorSpace: ".concat(e.name))}if(Array.isArray(e)){var d,u,p,h,f,y,b=t.fetchIfRef(e[0]).name;switch(b){case"G":case"DeviceGray":return this.singletons.gray;case"RGB":case"DeviceRGB":return this.singletons.rgb;case"CMYK":case"DeviceCMYK":return this.singletons.cmyk;case"CalGray":return h=(d=t.fetchIfRef(e[1])).getArray("WhitePoint"),f=d.getArray("BlackPoint"),y=d.get("Gamma"),new _(h,f,y);case"CalRGB":h=(d=t.fetchIfRef(e[1])).getArray("WhitePoint"),f=d.getArray("BlackPoint"),y=d.getArray("Gamma");var g=d.getArray("Matrix");return new A(h,f,y,g);case"ICCBased":var v=t.fetchIfRef(e[1]).dict;u=v.get("N");var w=v.get("Alternate");if(w){var S=this._parse(w,t,i,r);if(S.numComps===u)return S;(0,a.warn)("ICCBased color space: Ignoring incorrect /Alternate entry.")}if(1===u)return this.singletons.gray;if(3===u)return this.singletons.rgb;if(4===u)return this.singletons.cmyk;break;case"Pattern":return(p=e[1]||null)&&(p=this._parse(p,t,i,r)),new c(p);case"I":case"Indexed":p=this._parse(e[1],t,i,r);var C=t.fetchIfRef(e[2])+1,k=t.fetchIfRef(e[3]);return new m(p,C,k);case"Separation":case"DeviceN":var D=t.fetchIfRef(e[1]);u=Array.isArray(D)?D.length:1,p=this._parse(e[2],t,i,r);var R=r.create(e[3]);return new l(u,p,R);case"Lab":h=(d=t.fetchIfRef(e[1])).getArray("WhitePoint"),f=d.getArray("BlackPoint");var I=d.getArray("Range");return new x(h,f,I);default:throw new a.FormatError("Unimplemented ColorSpace object: ".concat(b))}}throw new a.FormatError("Unrecognized ColorSpace object: ".concat(e))}},{key:"isDefaultDecode",value:function(e,t){if(!Array.isArray(e))return!0;if(2*t!==e.length)return(0,a.warn)("The decode map is not the correct length"),!0;for(var i=0,n=e.length;i<n;i+=2)if(0!==e[i]||1!==e[i+1])return!1;return!0}},{key:"singletons",get:function(){return(0,a.shadow)(this,"singletons",{get gray(){return(0,a.shadow)(this,"gray",new h)},get rgb(){return(0,a.shadow)(this,"rgb",new f)},get cmyk(){return(0,a.shadow)(this,"cmyk",new v)}})}}]),e}();t.ColorSpace=s;var l=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,"Alternate",e)).base=a,r.tintFn=n,r.tmpBuf=new Float32Array(a.numComps),r}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){var n=this.tmpBuf;this.tintFn(e,t,n,0),this.base.getRgbItem(n,0,i,a)}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){var s,l,c=this.tintFn,d=this.base,u=1/((1<<r)-1),p=d.numComps,m=d.usesZeroToOneRange,h=(d.isPassthrough(8)||!m)&&0===o,f=h?n:0,y=h?a:new Uint8ClampedArray(p*i),b=this.numComps,g=new Float32Array(b),v=new Float32Array(p);for(s=0;s<i;s++){for(l=0;l<b;l++)g[l]=e[t++]*u;if(c(g,0,v,0),m)for(l=0;l<p;l++)y[f++]=255*v[l];else d.getRgbItem(v,0,y,f),f+=p}h||d.getRgbBuffer(y,0,i,a,n,8,o)}},{key:"getOutputLength",value:function(e,t){return this.base.getOutputLength(e*this.base.numComps/this.numComps,t)}}]),i}(s),c=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this,"Pattern",null)).base=e,a}return g(i,[{key:"isDefaultDecode",value:function(e,t){(0,a.unreachable)("Should not call PatternCS.isDefaultDecode")}}]),i}(s),m=function(e){d(i,e);var t=u(i);function i(e,n,o){var s;b(this,i),(s=t.call(this,"Indexed",1)).base=e,s.highVal=n;var l=e.numComps*n;if(s.lookup=new Uint8Array(l),o instanceof r.BaseStream){var c=o.getBytes(l);s.lookup.set(c)}else{if("string"!==typeof o)throw new a.FormatError("IndexedCS - unrecognized lookup table: ".concat(o));for(var d=0;d<l;++d)s.lookup[d]=255&o.charCodeAt(d)}return s}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){var n=this.base.numComps,r=e[t]*n;this.base.getRgbBuffer(this.lookup,r,1,i,a,8,0)}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){for(var s=this.base,l=s.numComps,c=s.getOutputLength(l,o),d=this.lookup,u=0;u<i;++u){var p=e[t++]*l;s.getRgbBuffer(d,p,1,a,n,8,o),n+=c}}},{key:"getOutputLength",value:function(e,t){return this.base.getOutputLength(e*this.base.numComps,t)}},{key:"isDefaultDecode",value:function(e,t){return!Array.isArray(e)||(2!==e.length?((0,a.warn)("Decode map length is not correct"),!0):!Number.isInteger(t)||t<1?((0,a.warn)("Bits per component is not correct"),!0):0===e[0]&&e[1]===(1<<t)-1)}}]),i}(s),h=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.call(this,"DeviceGray",1)}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){var n=255*e[t];i[a]=i[a+1]=i[a+2]=n}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){for(var s=255/((1<<r)-1),l=t,c=n,d=0;d<i;++d){var u=s*e[l++];a[c++]=u,a[c++]=u,a[c++]=u,c+=o}}},{key:"getOutputLength",value:function(e,t){return e*(3+t)}}]),i}(s),f=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.call(this,"DeviceRGB",3)}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){i[a]=255*e[t],i[a+1]=255*e[t+1],i[a+2]=255*e[t+2]}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){if(8!==r||0!==o)for(var s=255/((1<<r)-1),l=t,c=n,d=0;d<i;++d)a[c++]=s*e[l++],a[c++]=s*e[l++],a[c++]=s*e[l++],c+=o;else a.set(e.subarray(t,t+3*i),n)}},{key:"getOutputLength",value:function(e,t){return e*(3+t)/3|0}},{key:"isPassthrough",value:function(e){return 8===e}}]),i}(s),v=function(){function e(e,t,i,a,n){var r=e[t]*i,o=e[t+1]*i,s=e[t+2]*i,l=e[t+3]*i;a[n]=255+r*(-4.387332384609988*r+54.48615194189176*o+18.82290502165302*s+212.25662451639585*l-285.2331026137004)+o*(1.7149763477362134*o-5.6096736904047315*s+-17.873870861415444*l-5.497006427196366)+s*(-2.5217340131683033*s-21.248923337353073*l+17.5119270841813)+l*(-21.86122147463605*l-189.48180835922747),a[n+1]=255+r*(8.841041422036149*r+60.118027045597366*o+6.871425592049007*s+31.159100130055922*l-79.2970844816548)+o*(-15.310361306967817*o+17.575251261109482*s+131.35250912493976*l-190.9453302588951)+s*(4.444339102852739*s+9.8632861493405*l-24.86741582555878)+l*(-20.737325471181034*l-187.80453709719578),a[n+2]=255+r*(.8842522430003296*r+8.078677503112928*o+30.89978309703729*s-.23883238689178934*l-14.183576799673286)+o*(10.49593273432072*o+63.02378494754052*s+50.606957656360734*l-112.23884253719248)+s*(.03296041114873217*s+115.60384449646641*l-193.58209356861505)+l*(-22.33816807309886*l-180.12613974708367)}return function(t){d(a,t);var i=u(a);function a(){return b(this,a),i.call(this,"DeviceCMYK",4)}return g(a,[{key:"getRgbItem",value:function(t,i,a,n){e(t,i,1,a,n)}},{key:"getRgbBuffer",value:function(t,i,a,n,r,o,s){for(var l=1/((1<<o)-1),c=0;c<a;c++)e(t,i,l,n,r),i+=4,r+=3+s}},{key:"getOutputLength",value:function(e,t){return e/4*(3+t)|0}}]),a}(s)}(),_=function(){function e(e,t,i,a,n,r){var o=t[i]*r,s=Math.pow(o,e.G),l=e.YW*s,c=Math.max(295.8*Math.pow(l,.3333333333333333)-40.8,0);a[n]=c,a[n+1]=c,a[n+2]=c}return function(t){d(n,t);var i=u(n);function n(e,t,r){var o;if(b(this,n),o=i.call(this,"CalGray",1),!e)throw new a.FormatError("WhitePoint missing - required for color space CalGray");if(t=t||[0,0,0],r=r||1,o.XW=e[0],o.YW=e[1],o.ZW=e[2],o.XB=t[0],o.YB=t[1],o.ZB=t[2],o.G=r,o.XW<0||o.ZW<0||1!==o.YW)throw new a.FormatError("Invalid WhitePoint components for ".concat(o.name)+", no fallback available");return(o.XB<0||o.YB<0||o.ZB<0)&&((0,a.info)("Invalid BlackPoint for ".concat(o.name,", falling back to default.")),o.XB=o.YB=o.ZB=0),0===o.XB&&0===o.YB&&0===o.ZB||(0,a.warn)("".concat(o.name,", BlackPoint: XB: ").concat(o.XB,", YB: ").concat(o.YB,", ")+"ZB: ".concat(o.ZB,", only default values are supported.")),o.G<1&&((0,a.info)("Invalid Gamma: ".concat(o.G," for ").concat(o.name,", ")+"falling back to default."),o.G=1),o}return g(n,[{key:"getRgbItem",value:function(t,i,a,n){e(this,t,i,a,n,1)}},{key:"getRgbBuffer",value:function(t,i,a,n,r,o,s){for(var l=1/((1<<o)-1),c=0;c<a;++c)e(this,t,i,n,r,l),i+=1,r+=3+s}},{key:"getOutputLength",value:function(e,t){return e*(3+t)}}]),n}(s)}(),A=function(){var e=new Float32Array([.8951,.2664,-.1614,-.7502,1.7135,.0367,.0389,-.0685,1.0296]),t=new Float32Array([.9869929,-.1470543,.1599627,.4323053,.5183603,.0492912,-.0085287,.0400428,.9684867]),i=new Float32Array([3.2404542,-1.5371385,-.4985314,-.969266,1.8760108,.041556,.0556434,-.2040259,1.0572252]),n=new Float32Array([1,1,1]),r=new Float32Array(3),o=new Float32Array(3),l=new Float32Array(3),c=Math.pow(24/116,3)/8;function p(e,t,i){i[0]=e[0]*t[0]+e[1]*t[1]+e[2]*t[2],i[1]=e[3]*t[0]+e[4]*t[1]+e[5]*t[2],i[2]=e[6]*t[0]+e[7]*t[1]+e[8]*t[2]}function m(e){return e<=.0031308?h(0,1,12.92*e):e>=.99554525?1:h(0,1,1.055*Math.pow(e,1/2.4)-.055)}function h(e,t,i){return Math.max(e,Math.min(t,i))}function f(e){return e<0?-f(-e):e>8?Math.pow((e+16)/116,3):e*c}function y(a,s,c,d,u,y){var b=h(0,1,s[c]*y),g=h(0,1,s[c+1]*y),v=h(0,1,s[c+2]*y),_=1===b?1:Math.pow(b,a.GR),A=1===g?1:Math.pow(g,a.GG),x=1===v?1:Math.pow(v,a.GB),w=a.MXA*_+a.MXB*A+a.MXC*x,S=a.MYA*_+a.MYB*A+a.MYC*x,C=a.MZA*_+a.MZB*A+a.MZC*x,k=o;k[0]=w,k[1]=S,k[2]=C;var D=l;!function(i,a,n){if(1===i[0]&&1===i[2])return n[0]=a[0],n[1]=a[1],void(n[2]=a[2]);var o=n;p(e,a,o);var s=r;!function(e,t,i){i[0]=1*t[0]/e[0],i[1]=1*t[1]/e[1],i[2]=1*t[2]/e[2]}(i,o,s),p(t,s,n)}(a.whitePoint,k,D);var R=o;!function(e,t,i){if(0===e[0]&&0===e[1]&&0===e[2])return i[0]=t[0],i[1]=t[1],void(i[2]=t[2]);var a=f(0),n=(1-a)/(1-f(e[0])),r=1-n,o=(1-a)/(1-f(e[1])),s=1-o,l=(1-a)/(1-f(e[2])),c=1-l;i[0]=t[0]*n+r,i[1]=t[1]*o+s,i[2]=t[2]*l+c}(a.blackPoint,D,R);var I=l;!function(i,a,n){var o=n;p(e,a,o);var s=r;!function(e,t,i){i[0]=.95047*t[0]/e[0],i[1]=1*t[1]/e[1],i[2]=1.08883*t[2]/e[2]}(i,o,s),p(t,s,n)}(n,R,I);var M=o;p(i,I,M),d[u]=255*m(M[0]),d[u+1]=255*m(M[1]),d[u+2]=255*m(M[2])}return function(e){d(i,e);var t=u(i);function i(e,n,r,o){var s;if(b(this,i),s=t.call(this,"CalRGB",3),!e)throw new a.FormatError("WhitePoint missing - required for color space CalRGB");n=n||new Float32Array(3),r=r||new Float32Array([1,1,1]),o=o||new Float32Array([1,0,0,0,1,0,0,0,1]);var l=e[0],c=e[1],d=e[2];s.whitePoint=e;var u=n[0],p=n[1],m=n[2];if(s.blackPoint=n,s.GR=r[0],s.GG=r[1],s.GB=r[2],s.MXA=o[0],s.MYA=o[1],s.MZA=o[2],s.MXB=o[3],s.MYB=o[4],s.MZB=o[5],s.MXC=o[6],s.MYC=o[7],s.MZC=o[8],l<0||d<0||1!==c)throw new a.FormatError("Invalid WhitePoint components for ".concat(s.name)+", no fallback available");return(u<0||p<0||m<0)&&((0,a.info)("Invalid BlackPoint for ".concat(s.name," [").concat(u,", ").concat(p,", ").concat(m,"], ")+"falling back to default."),s.blackPoint=new Float32Array(3)),(s.GR<0||s.GG<0||s.GB<0)&&((0,a.info)("Invalid Gamma [".concat(s.GR,", ").concat(s.GG,", ").concat(s.GB,"] for ")+"".concat(s.name,", falling back to default.")),s.GR=s.GG=s.GB=1),s}return g(i,[{key:"getRgbItem",value:function(e,t,i,a){y(this,e,t,i,a,1)}},{key:"getRgbBuffer",value:function(e,t,i,a,n,r,o){for(var s=1/((1<<r)-1),l=0;l<i;++l)y(this,e,t,a,n,s),t+=3,n+=3+o}},{key:"getOutputLength",value:function(e,t){return e*(3+t)/3|0}}]),i}(s)}(),x=function(){function e(e){return e>=6/29?Math.pow(e,3):108/841*(e-4/29)}function t(e,t,i,a){return i+e*(a-i)/t}function i(i,a,n,r,o,s){var l=a[n],c=a[n+1],d=a[n+2];!1!==r&&(l=t(l,r,0,100),c=t(c,r,i.amin,i.amax),d=t(d,r,i.bmin,i.bmax)),c>i.amax?c=i.amax:c<i.amin&&(c=i.amin),d>i.bmax?d=i.bmax:d<i.bmin&&(d=i.bmin);var u,p,m,h=(l+16)/116,f=h+c/500,y=h-d/200,b=i.XW*e(f),g=i.YW*e(h),v=i.ZW*e(y);i.ZW<1?(u=3.1339*b+-1.617*g+-.4906*v,p=-.9785*b+1.916*g+.0333*v,m=.072*b+-.229*g+1.4057*v):(u=3.2406*b+-1.5372*g+-.4986*v,p=-.9689*b+1.8758*g+.0415*v,m=.0557*b+-.204*g+1.057*v),o[s]=255*Math.sqrt(u),o[s+1]=255*Math.sqrt(p),o[s+2]=255*Math.sqrt(m)}return function(e){d(n,e);var t=u(n);function n(e,i,r){var o;if(b(this,n),o=t.call(this,"Lab",3),!e)throw new a.FormatError("WhitePoint missing - required for color space Lab");if(i=i||[0,0,0],r=r||[-100,100,-100,100],o.XW=e[0],o.YW=e[1],o.ZW=e[2],o.amin=r[0],o.amax=r[1],o.bmin=r[2],o.bmax=r[3],o.XB=i[0],o.YB=i[1],o.ZB=i[2],o.XW<0||o.ZW<0||1!==o.YW)throw new a.FormatError("Invalid WhitePoint components, no fallback available");return(o.XB<0||o.YB<0||o.ZB<0)&&((0,a.info)("Invalid BlackPoint, falling back to default"),o.XB=o.YB=o.ZB=0),(o.amin>o.amax||o.bmin>o.bmax)&&((0,a.info)("Invalid Range, falling back to defaults"),o.amin=-100,o.amax=100,o.bmin=-100,o.bmax=100),o}return g(n,[{key:"getRgbItem",value:function(e,t,a,n){i(this,e,t,!1,a,n)}},{key:"getRgbBuffer",value:function(e,t,a,n,r,o,s){for(var l=(1<<o)-1,c=0;c<a;c++)i(this,e,t,l,n,r),t+=3,r+=3+s}},{key:"getOutputLength",value:function(e,t){return e*(3+t)/3|0}},{key:"isDefaultDecode",value:function(e,t){return!0}},{key:"usesZeroToOneRange",get:function(){return(0,a.shadow)(this,"usesZeroToOneRange",!1)}}]),n}(s)}()},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.PartialEvaluator=t.EvaluatorPreprocessor=void 0;var a=i(2),n=i(141),r=i(130),o=i(159),s=i(163),l=i(162),c=i(166),d=i(165),u=i(175),m=i(176),v=i(167),_=i(182),A=i(142),x=i(184),w=i(135),S=i(132),C=i(185),k=i(139),D=i(144),R=i(164),I=i(131),M=i(170),T=i(186),P=i(187),z=i(188),B=Object.freeze({maxImageSize:-1,disableFontFace:!1,ignoreErrors:!1,isEvalSupported:!0,fontExtraProperties:!1,useSystemFonts:!0,cMapUrl:null,standardFontDataUrl:null}),F=1,E=2,N=10,O=Promise.resolve();function G(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];if(Array.isArray(e)){for(var i=0,n=e.length;i<n;i++){var o=G(e[i],!0);if(o)return o}return(0,a.warn)("Unsupported blend mode Array: ".concat(e)),"source-over"}if(!(e instanceof r.Name))return t?null:"source-over";switch(e.name){case"Normal":case"Compatible":return"source-over";case"Multiply":return"multiply";case"Screen":return"screen";case"Overlay":return"overlay";case"Darken":return"darken";case"Lighten":return"lighten";case"ColorDodge":return"color-dodge";case"ColorBurn":return"color-burn";case"HardLight":return"hard-light";case"SoftLight":return"soft-light";case"Difference":return"difference";case"Exclusion":return"exclusion";case"Hue":return"hue";case"Saturation":return"saturation";case"Color":return"color";case"Luminosity":return"luminosity"}return t?null:((0,a.warn)("Unsupported blend mode: ".concat(e.name)),"source-over")}function L(e){e.fn===a.OPS.paintImageMaskXObject&&e.args[0]&&e.args[0].count>0&&e.args[0].count++}var j=function(){function e(){b(this,e),this.reset()}return g(e,[{key:"check",value:function(){return!(++this.checked<e.CHECK_TIME_EVERY)&&(this.checked=0,this.endTime<=Date.now())}},{key:"reset",value:function(){this.endTime=Date.now()+e.TIME_SLOT_DURATION_MS,this.checked=0}}],[{key:"TIME_SLOT_DURATION_MS",get:function(){return(0,a.shadow)(this,"TIME_SLOT_DURATION_MS",20)}},{key:"CHECK_TIME_EVERY",get:function(){return(0,a.shadow)(this,"CHECK_TIME_EVERY",100)}}]),e}(),q=function(){function e(t){b(this,e);var i=t.xref,a=t.handler,n=t.pageIndex,r=t.idFactory,o=t.fontCache,s=t.builtInCMapCache,l=t.standardFontDataCache,c=t.globalImageCache,d=t.options,u=void 0===d?null:d;this.xref=i,this.handler=a,this.pageIndex=n,this.idFactory=r,this.fontCache=o,this.builtInCMapCache=s,this.standardFontDataCache=l,this.globalImageCache=c,this.options=u||B,this.parsingType3Font=!1,this._fetchBuiltInCMapBound=this.fetchBuiltInCMap.bind(this)}return g(e,[{key:"_pdfFunctionFactory",get:function(){var e=new _.PDFFunctionFactory({xref:this.xref,isEvalSupported:this.options.isEvalSupported});return(0,a.shadow)(this,"_pdfFunctionFactory",e)}},{key:"clone",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:null,t=Object.create(this);return t.options=Object.assign(Object.create(null),this.options,e),t}},{key:"hasBlendModes",value:function(e,t){if(!(e instanceof r.Dict))return!1;if(e.objId&&t.has(e.objId))return!1;var i=new r.RefSet(t);e.objId&&i.put(e.objId);for(var n=[e],o=this.xref;n.length;){var s=n.shift(),l=s.get("ExtGState");if(l instanceof r.Dict){var c,d=h(l.getRawValues());try{for(d.s();!(c=d.n()).done;){var u=c.value;if(u instanceof r.Ref){if(i.has(u))continue;try{u=o.fetch(u)}catch(k){i.put(u),(0,a.info)('hasBlendModes - ignoring ExtGState: "'.concat(k,'".'));continue}}if(u instanceof r.Dict){u.objId&&i.put(u.objId);var p=u.get("BM");if(p instanceof r.Name){if("Normal"!==p.name)return!0}else if(void 0!==p&&Array.isArray(p)){var m,f=h(p);try{for(f.s();!(m=f.n()).done;){var y=m.value;if(y instanceof r.Name&&"Normal"!==y.name)return!0}}catch(D){f.e(D)}finally{f.f()}}}}}catch(D){d.e(D)}finally{d.f()}}var b=s.get("XObject");if(b instanceof r.Dict){var g,v=h(b.getRawValues());try{for(v.s();!(g=v.n()).done;){var _=g.value;if(_ instanceof r.Ref){if(i.has(_))continue;try{_=o.fetch(_)}catch(k){i.put(_),(0,a.info)('hasBlendModes - ignoring XObject: "'.concat(k,'".'));continue}}if(_ instanceof S.BaseStream){_.dict.objId&&i.put(_.dict.objId);var A=_.dict.get("Resources");A instanceof r.Dict&&(A.objId&&i.has(A.objId)||(n.push(A),A.objId&&i.put(A.objId)))}}}catch(D){v.e(D)}finally{v.f()}}}var x,w=h(i);try{for(w.s();!(x=w.n()).done;){var C=x.value;t.put(C)}}catch(D){w.e(D)}finally{w.f()}return!1}},{key:"fetchBuiltInCMap",value:function(){var e=y(p().mark((function e(t){var i,n,r,o;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(i=this.builtInCMapCache.get(t))){e.next=3;break}return e.abrupt("return",i);case 3:if(null===this.options.cMapUrl){e.next=19;break}return r="".concat(this.options.cMapUrl).concat(t,".bcmap"),e.next=7,fetch(r);case 7:if((o=e.sent).ok){e.next=10;break}throw new Error('fetchBuiltInCMap: failed to fetch file "'.concat(r,'" with "').concat(o.statusText,'".'));case 10:return e.t0=Uint8Array,e.next=13,o.arrayBuffer();case 13:e.t1=e.sent,e.t2=new e.t0(e.t1),e.t3=a.CMapCompressionType.BINARY,n={cMapData:e.t2,compressionType:e.t3},e.next=22;break;case 19:return e.next=21,this.handler.sendWithPromise("FetchBuiltInCMap",{name:t});case 21:n=e.sent;case 22:return n.compressionType!==a.CMapCompressionType.NONE&&this.builtInCMapCache.set(t,n),e.abrupt("return",n);case 24:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"fetchStandardFontData",value:function(){var e=y(p().mark((function e(t){var i,n,r,o,s,l;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(i=this.standardFontDataCache.get(t))){e.next=3;break}return e.abrupt("return",new w.Stream(i));case 3:if(!this.options.useSystemFonts||"Symbol"===t||"ZapfDingbats"===t){e.next=5;break}return e.abrupt("return",null);case 5:if(n=(0,c.getFontNameToFileMap)(),r=n[t],null===this.options.standardFontDataUrl){e.next=20;break}return s="".concat(this.options.standardFontDataUrl).concat(r),e.next=10,fetch(s);case 10:if((l=e.sent).ok){e.next=15;break}(0,a.warn)('fetchStandardFontData: failed to fetch file "'.concat(s,'" with "').concat(l.statusText,'".')),e.next=18;break;case 15:return e.next=17,l.arrayBuffer();case 17:o=e.sent;case 18:e.next=29;break;case 20:return e.prev=20,e.next=23,this.handler.sendWithPromise("FetchStandardFontData",{filename:r});case 23:o=e.sent,e.next=29;break;case 26:e.prev=26,e.t0=e.catch(20),(0,a.warn)('fetchStandardFontData: failed to fetch file "'.concat(r,'" with "').concat(e.t0,'".'));case 29:if(o){e.next=31;break}return e.abrupt("return",null);case 31:return this.standardFontDataCache.set(t,o),e.abrupt("return",new w.Stream(o));case 33:case"end":return e.stop()}}),e,this,[[20,26]])})));return function(t){return e.apply(this,arguments)}}()},{key:"buildFormXObject",value:function(){var e=y(p().mark((function e(t,i,n,o,s,l,c){var d,u,m,h,f,y,b,g,v,_,A;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(d=i.dict,u=d.getArray("Matrix"),m=d.getArray("BBox"),m=Array.isArray(m)&&4===m.length?a.Util.normalizeRect(m):null,!d.has("OC")){e.next=8;break}return e.next=7,this.parseMarkedContentProps(d.get("OC"),t);case 7:h=e.sent;case 8:if(void 0!==h&&o.addOp(a.OPS.beginMarkedContentProps,["OC",h]),!(y=d.get("Group"))){e.next=29;break}if(f={matrix:u,bbox:m,smask:n,isolated:!1,knockout:!1},b=y.get("S"),g=null,!(0,r.isName)(b,"Transparency")){e.next=27;break}if(f.isolated=y.get("I")||!1,f.knockout=y.get("K")||!1,!y.has("CS")){e.next=27;break}if(v=y.getRaw("CS"),!(_=k.ColorSpace.getCached(v,this.xref,c))){e.next=24;break}g=_,e.next=27;break;case 24:return e.next=26,this.parseColorSpace({cs:v,resources:t,localColorSpaceCache:c});case 26:g=e.sent;case 27:n&&n.backdrop&&(g=g||k.ColorSpace.singletons.rgb,n.backdrop=g.getRgb(n.backdrop,0)),o.addOp(a.OPS.beginGroup,[f]);case 29:return A=y?[u,null]:[u,m],o.addOp(a.OPS.paintFormXObjectBegin,A),e.abrupt("return",this.getOperatorList({stream:i,task:s,resources:d.get("Resources")||t,operatorList:o,initialState:l}).then((function(){o.addOp(a.OPS.paintFormXObjectEnd,[]),y&&o.addOp(a.OPS.endGroup,[f]),void 0!==h&&o.addOp(a.OPS.endMarkedContent,[])})));case 32:case"end":return e.stop()}}),e,this)})));return function(t,i,a,n,r,o,s){return e.apply(this,arguments)}}()},{key:"_sendImgData",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]&&arguments[2],a=t?[t.bitmap||t.data.buffer]:null;return this.parsingType3Font||i?this.handler.send("commonobj",[e,"Image",t],a):this.handler.send("obj",[e,this.pageIndex,"Image",t],a)}},{key:"buildPaintImageXObject",value:function(){var e=y(p().mark((function e(t){var i,n,r,o,s,l,c,d,u,m,h,f,y,b,g,v,_,A,x,w,S,C,k,R,I,M,T,P=this;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(i=t.resources,n=t.image,r=t.isInline,o=void 0!==r&&r,s=t.operatorList,l=t.cacheKey,c=t.localImageCache,d=t.localColorSpaceCache,u=n.dict,m=u.objId,h=u.get("W","Width"),f=u.get("H","Height"),h&&"number"===typeof h&&f&&"number"===typeof f){e.next=8;break}return(0,a.warn)("Image dimensions are missing, or not numbers."),e.abrupt("return");case 8:if(!(-1!==(y=this.options.maxImageSize)&&h*f>y)){e.next=15;break}if(b="Image exceeded maximum allowed size and was removed.",!this.options.ignoreErrors){e.next=14;break}return(0,a.warn)(b),e.abrupt("return");case 14:throw new Error(b);case 15:if(!u.has("OC")){e.next=19;break}return e.next=18,this.parseMarkedContentProps(u.get("OC"),i);case 18:g=e.sent;case 19:if(!u.get("IM","ImageMask")){e.next=44;break}if(A=u.get("I","Interpolate"),x=h+7>>3,w=n.getBytes(x*f),S=u.getArray("D","Decode"),!this.parsingType3Font){e.next=32;break}return(v=z.PDFImage.createRawMask({imgArray:w,width:h,height:f,imageIsFromDecodeStream:n instanceof D.DecodeStream,inverseDecode:!!S&&S[0]>0,interpolate:A})).cached=!!l,_=[v],s.addImageOps(a.OPS.paintImageMaskXObject,_,g),l&&c.set(l,m,{fn:a.OPS.paintImageMaskXObject,args:_,optionalContent:g}),e.abrupt("return");case 32:if(!(v=z.PDFImage.createMask({imgArray:w,width:h,height:f,imageIsFromDecodeStream:n instanceof D.DecodeStream,inverseDecode:!!S&&S[0]>0,interpolate:A})).isSingleOpaquePixel){e.next=37;break}return s.addImageOps(a.OPS.paintSolidColorImageMask,[],g),l&&c.set(l,m,{fn:a.OPS.paintSolidColorImageMask,args:[],optionalContent:g}),e.abrupt("return");case 37:return C="mask_".concat(this.idFactory.createObjId()),s.addDependency(C),this._sendImgData(C,v),_=[{data:C,width:v.width,height:v.height,interpolate:v.interpolate,count:1}],s.addImageOps(a.OPS.paintImageMaskXObject,_,g),l&&c.set(l,m,{fn:a.OPS.paintImageMaskXObject,args:_,optionalContent:g}),e.abrupt("return");case 44:if(k=u.get("SM","SMask")||!1,R=u.get("Mask")||!1,!o||k||R||!(h+f<200)){e.next=52;break}return I=new z.PDFImage({xref:this.xref,res:i,image:n,isInline:o,pdfFunctionFactory:this._pdfFunctionFactory,localColorSpaceCache:d}),v=I.createImageData(!0),s.addImageOps(a.OPS.paintInlineImageXObject,[v],g),e.abrupt("return");case 52:M="img_".concat(this.idFactory.createObjId()),T=!1,this.parsingType3Font?M="".concat(this.idFactory.getDocId(),"_type3_").concat(M):m&&(T=this.globalImageCache.shouldCache(m,this.pageIndex))&&(M="".concat(this.idFactory.getDocId(),"_").concat(M)),s.addDependency(M),_=[M,h,f],z.PDFImage.buildImage({xref:this.xref,res:i,image:n,isInline:o,pdfFunctionFactory:this._pdfFunctionFactory,localColorSpaceCache:d}).then((function(e){return v=e.createImageData(!1),l&&m&&T&&P.globalImageCache.addByteSize(m,v.data.length),P._sendImgData(M,v,T)})).catch((function(e){return(0,a.warn)('Unable to decode image "'.concat(M,'": "').concat(e,'".')),P._sendImgData(M,null,T)})),s.addImageOps(a.OPS.paintImageXObject,_,g),l&&(c.set(l,m,{fn:a.OPS.paintImageXObject,args:_,optionalContent:g}),m&&((0,a.assert)(!o,"Cannot cache an inline image globally."),this.globalImageCache.addPageIndex(m,this.pageIndex),T&&this.globalImageCache.setData(m,{objId:M,fn:a.OPS.paintImageXObject,args:_,optionalContent:g,byteSize:0})));case 59:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"handleSMask",value:function(e,t,i,a,n,r){var o=e.get("G"),s={subtype:e.get("S").name,backdrop:e.get("BC")},l=e.get("TR");if((0,_.isPDFFunction)(l)){for(var c=this._pdfFunctionFactory.create(l),d=new Uint8Array(256),u=new Float32Array(1),p=0;p<256;p++)u[0]=p/255,c(u,0,u,0),d[p]=255*u[0]|0;s.transferMap=d}return this.buildFormXObject(t,o,s,i,a,n.state.clone(),r)}},{key:"handleTransferFunction",value:function(e){var t;if(Array.isArray(e))t=e;else{if(!(0,_.isPDFFunction)(e))return null;t=[e]}var i,a=[],n=0,o=0,s=h(t);try{for(s.s();!(i=s.n()).done;){var l=i.value,c=this.xref.fetchIfRef(l);if(n++,(0,r.isName)(c,"Identity"))a.push(null);else{if(!(0,_.isPDFFunction)(c))return null;for(var d=this._pdfFunctionFactory.create(c),u=new Uint8Array(256),p=new Float32Array(1),m=0;m<256;m++)p[0]=m/255,d(p,0,p,0),u[m]=255*p[0]|0;a.push(u),o++}}}catch(f){s.e(f)}finally{s.f()}return 1!==n&&4!==n||0===o?null:a}},{key:"handleTilingType",value:function(e,t,i,n,o,s,l,c){var d=this,p=new P.OperatorList,m=r.Dict.merge({xref:this.xref,dictArray:[o.get("Resources"),i]});return this.getOperatorList({stream:n,task:l,resources:m,operatorList:p}).then((function(){var i=p.getIR(),a=(0,u.getTilingPatternIR)(i,o,t);s.addDependencies(p.dependencies),s.addOp(e,a),o.objId&&c.set(null,o.objId,{operatorListIR:i,dict:o})})).catch((function(e){if(!(e instanceof a.AbortException)){if(d.options.ignoreErrors)return d.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorTilingPattern}),void(0,a.warn)('handleTilingType - ignoring pattern: "'.concat(e,'".'));throw e}}))}},{key:"handleSetFont",value:function(e,t,i,n,s,l){var c=this,d=arguments.length>6&&void 0!==arguments[6]?arguments[6]:null,u=arguments.length>7&&void 0!==arguments[7]?arguments[7]:null,p=t&&t[0]instanceof r.Name?t[0].name:null;return this.loadFont(p,i,e,d,u).then((function(t){return t.font.isType3Font?t.loadType3Data(c,e,s).then((function(){return n.addDependencies(t.type3Dependencies),t})).catch((function(e){return c.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontLoadType3}),new H({loadedName:"g_font_error",font:new o.ErrorFont("Type3 font load error: ".concat(e)),dict:t.font,evaluatorOptions:c.options})})):t})).then((function(e){return l.font=e.font,e.send(c.handler),e.loadedName}))}},{key:"handleText",value:function(t,i){var n=i.font,r=n.charsToGlyphs(t);return n.data&&(i.textRenderingMode&a.TextRenderingMode.ADD_TO_PATH_FLAG||"Pattern"===i.fillColorSpace.name||n.disableFontFace||this.options.disableFontFace)&&e.buildFontPaths(n,r,this.handler,this.options),r}},{key:"ensureStateFont",value:function(e){if(!e.font){var t=new a.FormatError("Missing setFont (Tf) operator before text rendering operator.");if(this.options.ignoreErrors)return this.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontState}),void(0,a.warn)('ensureStateFont: "'.concat(t,'".'));throw t}}},{key:"setGState",value:function(){var e=y(p().mark((function e(t){var i,n,o,s,l,c,d,u,m,h,f,y,b,g,v,_,A=this;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:i=t.resources,n=t.gState,o=t.operatorList,s=t.cacheKey,l=t.task,c=t.stateManager,d=t.localGStateCache,u=t.localColorSpaceCache,m=n.objId,h=!0,f=[],y=n.getKeys(),b=Promise.resolve(),g=p().mark((function e(){var t,s,d;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:t=y[v],s=n.get(t),e.t0=t,e.next="Type"===e.t0?5:"LW"===e.t0||"LC"===e.t0||"LJ"===e.t0||"ML"===e.t0||"D"===e.t0||"RI"===e.t0||"FL"===e.t0||"CA"===e.t0||"ca"===e.t0?6:"Font"===e.t0?8:"BM"===e.t0?11:"SMask"===e.t0?13:"TR"===e.t0?18:"OP"===e.t0||"op"===e.t0||"OPM"===e.t0||"BG"===e.t0||"BG2"===e.t0||"UCR"===e.t0||"UCR2"===e.t0||"TR2"===e.t0||"HT"===e.t0||"SM"===e.t0||"SA"===e.t0||"AIS"===e.t0||"TK"===e.t0?21:23;break;case 5:return e.abrupt("break",25);case 6:return f.push([t,s]),e.abrupt("break",25);case 8:return h=!1,b=b.then((function(){return A.handleSetFont(i,null,s[0],o,l,c.state).then((function(e){o.addDependency(e),f.push([t,[e,s[1]]])}))})),e.abrupt("break",25);case 11:return f.push([t,G(s)]),e.abrupt("break",25);case 13:if(!(0,r.isName)(s,"None")){e.next=16;break}return f.push([t,!1]),e.abrupt("break",25);case 16:return s instanceof r.Dict?(h=!1,b=b.then((function(){return A.handleSMask(s,i,o,l,c,u)})),f.push([t,!0])):(0,a.warn)("Unsupported SMask type"),e.abrupt("break",25);case 18:return d=A.handleTransferFunction(s),f.push([t,d]),e.abrupt("break",25);case 21:return(0,a.info)("graphic state operator "+t),e.abrupt("break",25);case 23:return(0,a.info)("Unknown graphic state operator "+t),e.abrupt("break",25);case 25:case"end":return e.stop()}}),e)})),v=0,_=y.length;case 8:if(!(v<_)){e.next=13;break}return e.delegateYield(g(),"t0",10);case 10:v++,e.next=8;break;case 13:return e.abrupt("return",b.then((function(){f.length>0&&o.addOp(a.OPS.setGState,[f]),h&&d.set(s,m,f)})));case 14:case"end":return e.stop()}}),e)})));return function(t){return e.apply(this,arguments)}}()},{key:"loadFont",value:function(t,i,n){var l,c=this,d=arguments.length>3&&void 0!==arguments[3]?arguments[3]:null,u=arguments.length>4&&void 0!==arguments[4]?arguments[4]:null,m=function(){var e=y(p().mark((function e(){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.abrupt("return",new H({loadedName:"g_font_error",font:new o.ErrorFont('Font "'.concat(t,'" is not available.')),dict:i,evaluatorOptions:c.options}));case 1:case"end":return e.stop()}}),e)})));return function(){return e.apply(this,arguments)}}(),h=this.xref;if(i)i instanceof r.Ref&&(l=i);else{var f=n.get("Font");f&&(l=f.getRaw(t))}if(!l){var b='Font "'.concat(t||i&&i.toString(),'" is not available');if(!this.options.ignoreErrors&&!this.parsingType3Font)return(0,a.warn)("".concat(b,".")),m();this.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontMissing}),(0,a.warn)("".concat(b," -- attempting to fallback to a default font.")),l=d||e.fallbackFontDict}if(this.parsingType3Font&&this.type3FontRefs.has(l))return m();if(this.fontCache.has(l))return this.fontCache.get(l);if(!((i=h.fetchIfRef(l))instanceof r.Dict))return m();if(i.cacheKey&&this.fontCache.has(i.cacheKey))return this.fontCache.get(i.cacheKey);var g,v=(0,a.createPromiseCapability)();try{(g=this.preEvaluateFont(i)).cssFontInfo=u}catch(D){return(0,a.warn)('loadFont - preEvaluateFont failed: "'.concat(D,'".')),m()}var _,A=g,x=A.descriptor,w=A.hash,S=l instanceof r.Ref;if(S&&(_="f".concat(l.toString())),w&&x instanceof r.Dict){x.fontAliases||(x.fontAliases=Object.create(null));var C=x.fontAliases;if(C[w]){var k=C[w].aliasRef;if(S&&k&&this.fontCache.has(k))return this.fontCache.putAlias(l,k),this.fontCache.get(l)}else C[w]={fontID:this.idFactory.createFontId()};S&&(C[w].aliasRef=l),_=C[w].fontID}return S?this.fontCache.put(l,v.promise):(_||(_=this.idFactory.createFontId()),i.cacheKey="cacheKey_".concat(_),this.fontCache.put(i.cacheKey,v.promise)),(0,a.assert)(_&&_.startsWith("f"),'The "fontID" must be (correctly) defined.'),i.loadedName="".concat(this.idFactory.getDocId(),"_").concat(_),this.translateFont(g).then((function(e){void 0!==e.fontType&&h.stats.addFontType(e.fontType),v.resolve(new H({loadedName:i.loadedName,font:e,dict:i,evaluatorOptions:c.options}))})).catch((function(e){c.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontTranslate}),(0,a.warn)('loadFont - translateFont failed: "'.concat(e,'".'));try{var t=x&&x.get("FontFile3"),n=t&&t.get("Subtype"),r=(0,s.getFontType)(g.type,n&&n.name);void 0!==r&&h.stats.addFontType(r)}catch(l){}v.resolve(new H({loadedName:i.loadedName,font:new o.ErrorFont(e instanceof Error?e.message:e),dict:i,evaluatorOptions:c.options}))})),v.promise}},{key:"buildPath",value:function(e,t,i){var n,r=arguments.length>3&&void 0!==arguments[3]&&arguments[3],o=e.length-1;if(i||(i=[]),o<0||e.fnArray[o]!==a.OPS.constructPath)r&&((0,a.warn)('Encountered path operator "'.concat(t,'" inside of a text object.')),e.addOp(a.OPS.save,null)),n=[1/0,-1/0,1/0,-1/0],e.addOp(a.OPS.constructPath,[[t],i,n]),r&&e.addOp(a.OPS.restore,null);else{var s=e.argsArray[o];s[0].push(t),Array.prototype.push.apply(s[1],i),n=s[2]}switch(t){case a.OPS.rectangle:n[0]=Math.min(n[0],i[0],i[0]+i[2]),n[1]=Math.max(n[1],i[0],i[0]+i[2]),n[2]=Math.min(n[2],i[1],i[1]+i[3]),n[3]=Math.max(n[3],i[1],i[1]+i[3]);break;case a.OPS.moveTo:case a.OPS.lineTo:n[0]=Math.min(n[0],i[0]),n[1]=Math.max(n[1],i[0]),n[2]=Math.min(n[2],i[1]),n[3]=Math.max(n[3],i[1])}}},{key:"parseColorSpace",value:function(e){var t=this,i=e.cs,n=e.resources,r=e.localColorSpaceCache;return k.ColorSpace.parseAsync({cs:i,xref:this.xref,resources:n,pdfFunctionFactory:this._pdfFunctionFactory,localColorSpaceCache:r}).catch((function(e){if(e instanceof a.AbortException)return null;if(t.options.ignoreErrors)return t.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorColorSpace}),(0,a.warn)('parseColorSpace - ignoring ColorSpace: "'.concat(e,'".')),null;throw e}))}},{key:"parseShading",value:function(e){var t=e.shading,i=e.resources,a=e.localColorSpaceCache,n=e.localShadingPatternCache,r=n.get(t);if(!r){var o=u.Pattern.parseShading(t,this.xref,i,this.handler,this._pdfFunctionFactory,a).getIR();r="pattern_".concat(this.idFactory.createObjId()),n.set(t,r),this.handler.send("obj",[r,this.pageIndex,"Pattern",o])}return r}},{key:"handleColorN",value:function(e,t,i,n,o,s,l,c,d,p){var m=i.pop();if(m instanceof r.Name){var h=o.getRaw(m.name),f=h instanceof r.Ref&&d.getByRef(h);if(f)try{var y=n.base?n.base.getRgb(i,0):null,b=(0,u.getTilingPatternIR)(f.operatorListIR,f.dict,y);return void e.addOp(t,b)}catch(k){}var g=this.xref.fetchIfRef(h);if(g){var v=g instanceof S.BaseStream?g.dict:g,_=v.get("PatternType");if(_===F){var A=n.base?n.base.getRgb(i,0):null;return this.handleTilingType(t,A,s,g,v,e,l,d)}if(_===E){var x=v.get("Shading"),w=v.getArray("Matrix"),C=this.parseShading({shading:x,resources:s,localColorSpaceCache:c,localShadingPatternCache:p});return void e.addOp(t,["Shading",C,w])}throw new a.FormatError("Unknown PatternType: ".concat(_))}}throw new a.FormatError("Unknown PatternName: ".concat(m))}},{key:"_parseVisibilityExpression",value:function(e,t,i){if(++t>10)(0,a.warn)("Visibility expression is too deeply nested");else{var n=e.length,o=this.xref.fetchIfRef(e[0]);if(!(n<2)&&o instanceof r.Name){switch(o.name){case"And":case"Or":case"Not":i.push(o.name);break;default:return void(0,a.warn)("Invalid operator ".concat(o.name," in visibility expression"))}for(var s=1;s<n;s++){var l=e[s],c=this.xref.fetchIfRef(l);if(Array.isArray(c)){var d=[];i.push(d),this._parseVisibilityExpression(c,t,d)}else l instanceof r.Ref&&i.push(l.toString())}}else(0,a.warn)("Invalid visibility expression")}}},{key:"parseMarkedContentProps",value:function(){var e=y(p().mark((function e(t,i){var n,o,s,l,c,d,u,m,f,y;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(t instanceof r.Name)){e.next=5;break}o=i.get("Properties"),n=o.get(t.name),e.next=10;break;case 5:if(!(t instanceof r.Dict)){e.next=9;break}n=t,e.next=10;break;case 9:throw new a.FormatError("Optional content properties malformed.");case 10:if("OCG"!==(s=n.get("Type").name)){e.next=15;break}return e.abrupt("return",{type:s,id:n.objId});case 15:if("OCMD"!==s){e.next=31;break}if(l=n.get("VE"),!Array.isArray(l)){e.next=22;break}if(c=[],this._parseVisibilityExpression(l,0,c),!(c.length>0)){e.next=22;break}return e.abrupt("return",{type:"OCMD",expression:c});case 22:if(d=n.get("OCGs"),!(Array.isArray(d)||d instanceof r.Dict)){e.next=29;break}if(u=[],Array.isArray(d)){m=h(d);try{for(m.s();!(f=m.n()).done;)y=f.value,u.push(y.toString())}catch(p){m.e(p)}finally{m.f()}}else u.push(d.objId);return e.abrupt("return",{type:s,ids:u,policy:n.get("P")instanceof r.Name?n.get("P").name:null,expression:null});case 29:if(!(d instanceof r.Ref)){e.next=31;break}return e.abrupt("return",{type:s,id:d.toString()});case 31:return e.abrupt("return",null);case 32:case"end":return e.stop()}}),e,this)})));return function(t,i){return e.apply(this,arguments)}}()},{key:"getOperatorList",value:function(e){var t=this,i=e.stream,n=e.task,o=e.resources,s=e.operatorList,l=e.initialState,c=void 0===l?null:l,d=e.fallbackFontDict,u=void 0===d?null:d;if(o=o||r.Dict.empty,c=c||new X,!s)throw new Error('getOperatorList: missing "operatorList" parameter');var p=this,m=this.xref,h=!1,f=new x.LocalImageCache,y=new x.LocalColorSpaceCache,b=new x.LocalGStateCache,g=new x.LocalTilingPatternCache,v=new Map,_=o.get("XObject")||r.Dict.empty,A=o.get("Pattern")||r.Dict.empty,w=new U(c),C=new V(i,m,w),D=new j;function R(e){for(var t=0,i=C.savedStatesDepth;t<i;t++)s.addOp(a.OPS.restore,[])}return new Promise((function e(t,i){var l=function(a){Promise.all([a,s.ready]).then((function(){try{e(t,i)}catch(a){i(a)}}),i)};n.ensureNotTerminated(),D.reset();for(var c,d,x,I,M,T,P={};!(c=D.check())&&(P.args=null,C.read(P));){var z=P.args,B=P.fn;switch(0|B){case a.OPS.paintXObject:if(T=z[0]instanceof r.Name,M=z[0].name,T){var F=f.getByName(M);if(F){s.addImageOps(F.fn,F.args,F.optionalContent),L(F),z=null;continue}}return void l(new Promise((function(e,t){if(!T)throw new a.FormatError("XObject must be referred to by name.");var i=_.getRaw(M);if(i instanceof r.Ref){var l=f.getByRef(i);if(l)return s.addImageOps(l.fn,l.args,l.optionalContent),L(l),void e();var c=p.globalImageCache.getData(i,p.pageIndex);if(c)return s.addDependency(c.objId),s.addImageOps(c.fn,c.args,c.optionalContent),void e();i=m.fetch(i)}if(!(i instanceof S.BaseStream))throw new a.FormatError("XObject should be a stream");var d=i.dict.get("Subtype");if(!(d instanceof r.Name))throw new a.FormatError("XObject should have a Name subtype");if("Form"===d.name)return w.save(),void p.buildFormXObject(o,i,null,s,n,w.state.clone(),y).then((function(){w.restore(),e()}),t);if("Image"!==d.name){if("PS"!==d.name)throw new a.FormatError("Unhandled XObject subtype ".concat(d.name));(0,a.info)("Ignored XObject subtype PS"),e()}else p.buildPaintImageXObject({resources:o,image:i,operatorList:s,cacheKey:M,localImageCache:f,localColorSpaceCache:y}).then(e,t)})).catch((function(e){if(!(e instanceof a.AbortException)){if(p.options.ignoreErrors)return p.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorXObject}),void(0,a.warn)('getOperatorList - ignoring XObject: "'.concat(e,'".'));throw e}})));case a.OPS.setFont:var E=z[1];return void l(p.handleSetFont(o,z,null,s,n,w.state,u).then((function(e){s.addDependency(e),s.addOp(a.OPS.setFont,[e,E])})));case a.OPS.beginText:h=!0;break;case a.OPS.endText:h=!1;break;case a.OPS.endInlineImage:var N=z[0].cacheKey;if(N){var G=f.getByName(N);if(G){s.addImageOps(G.fn,G.args,G.optionalContent),L(G),z=null;continue}}return void l(p.buildPaintImageXObject({resources:o,image:z[0],isInline:!0,operatorList:s,cacheKey:N,localImageCache:f,localColorSpaceCache:y}));case a.OPS.showText:if(!w.state.font){p.ensureStateFont(w.state);continue}z[0]=p.handleText(z[0],w.state);break;case a.OPS.showSpacedText:if(!w.state.font){p.ensureStateFont(w.state);continue}var j=z[0],q=[],H=j.length,U=w.state;for(d=0;d<H;++d){var Y=j[d];"string"===typeof Y?Array.prototype.push.apply(q,p.handleText(Y,U)):"number"===typeof Y&&q.push(Y)}z[0]=q,B=a.OPS.showText;break;case a.OPS.nextLineShowText:if(!w.state.font){p.ensureStateFont(w.state);continue}s.addOp(a.OPS.nextLine),z[0]=p.handleText(z[0],w.state),B=a.OPS.showText;break;case a.OPS.nextLineSetSpacingShowText:if(!w.state.font){p.ensureStateFont(w.state);continue}s.addOp(a.OPS.nextLine),s.addOp(a.OPS.setWordSpacing,[z.shift()]),s.addOp(a.OPS.setCharSpacing,[z.shift()]),z[0]=p.handleText(z[0],w.state),B=a.OPS.showText;break;case a.OPS.setTextRenderingMode:w.state.textRenderingMode=z[0];break;case a.OPS.setFillColorSpace:var X=k.ColorSpace.getCached(z[0],m,y);if(X){w.state.fillColorSpace=X;continue}return void l(p.parseColorSpace({cs:z[0],resources:o,localColorSpaceCache:y}).then((function(e){e&&(w.state.fillColorSpace=e)})));case a.OPS.setStrokeColorSpace:var V=k.ColorSpace.getCached(z[0],m,y);if(V){w.state.strokeColorSpace=V;continue}return void l(p.parseColorSpace({cs:z[0],resources:o,localColorSpaceCache:y}).then((function(e){e&&(w.state.strokeColorSpace=e)})));case a.OPS.setFillColor:z=(I=w.state.fillColorSpace).getRgb(z,0),B=a.OPS.setFillRGBColor;break;case a.OPS.setStrokeColor:z=(I=w.state.strokeColorSpace).getRgb(z,0),B=a.OPS.setStrokeRGBColor;break;case a.OPS.setFillGray:w.state.fillColorSpace=k.ColorSpace.singletons.gray,z=k.ColorSpace.singletons.gray.getRgb(z,0),B=a.OPS.setFillRGBColor;break;case a.OPS.setStrokeGray:w.state.strokeColorSpace=k.ColorSpace.singletons.gray,z=k.ColorSpace.singletons.gray.getRgb(z,0),B=a.OPS.setStrokeRGBColor;break;case a.OPS.setFillCMYKColor:w.state.fillColorSpace=k.ColorSpace.singletons.cmyk,z=k.ColorSpace.singletons.cmyk.getRgb(z,0),B=a.OPS.setFillRGBColor;break;case a.OPS.setStrokeCMYKColor:w.state.strokeColorSpace=k.ColorSpace.singletons.cmyk,z=k.ColorSpace.singletons.cmyk.getRgb(z,0),B=a.OPS.setStrokeRGBColor;break;case a.OPS.setFillRGBColor:w.state.fillColorSpace=k.ColorSpace.singletons.rgb,z=k.ColorSpace.singletons.rgb.getRgb(z,0);break;case a.OPS.setStrokeRGBColor:w.state.strokeColorSpace=k.ColorSpace.singletons.rgb,z=k.ColorSpace.singletons.rgb.getRgb(z,0);break;case a.OPS.setFillColorN:if("Pattern"===(I=w.state.fillColorSpace).name)return void l(p.handleColorN(s,a.OPS.setFillColorN,z,I,A,o,n,y,g,v));z=I.getRgb(z,0),B=a.OPS.setFillRGBColor;break;case a.OPS.setStrokeColorN:if("Pattern"===(I=w.state.strokeColorSpace).name)return void l(p.handleColorN(s,a.OPS.setStrokeColorN,z,I,A,o,n,y,g,v));z=I.getRgb(z,0),B=a.OPS.setStrokeRGBColor;break;case a.OPS.shadingFill:var Q=o.get("Shading");if(!Q)throw new a.FormatError("No shading resource found");var W=Q.get(z[0].name);if(!W)throw new a.FormatError("No shading object found");z=[p.parseShading({shading:W,resources:o,localColorSpaceCache:y,localShadingPatternCache:v})],B=a.OPS.shadingFill;break;case a.OPS.setGState:if(T=z[0]instanceof r.Name,M=z[0].name,T){var Z=b.getByName(M);if(Z){Z.length>0&&s.addOp(a.OPS.setGState,[Z]),z=null;continue}}return void l(new Promise((function(e,t){if(!T)throw new a.FormatError("GState must be referred to by name.");var i=o.get("ExtGState");if(!(i instanceof r.Dict))throw new a.FormatError("ExtGState should be a dictionary.");var l=i.get(M);if(!(l instanceof r.Dict))throw new a.FormatError("GState should be a dictionary.");p.setGState({resources:o,gState:l,operatorList:s,cacheKey:M,task:n,stateManager:w,localGStateCache:b,localColorSpaceCache:y}).then(e,t)})).catch((function(e){if(!(e instanceof a.AbortException)){if(p.options.ignoreErrors)return p.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorExtGState}),void(0,a.warn)('getOperatorList - ignoring ExtGState: "'.concat(e,'".'));throw e}})));case a.OPS.moveTo:case a.OPS.lineTo:case a.OPS.curveTo:case a.OPS.curveTo2:case a.OPS.curveTo3:case a.OPS.closePath:case a.OPS.rectangle:p.buildPath(s,B,z,h);continue;case a.OPS.markPoint:case a.OPS.markPointProps:case a.OPS.beginCompat:case a.OPS.endCompat:continue;case a.OPS.beginMarkedContentProps:if(!(z[0]instanceof r.Name)){(0,a.warn)("Expected name for beginMarkedContentProps arg0=".concat(z[0]));continue}if("OC"===z[0].name)return void l(p.parseMarkedContentProps(z[1],o).then((function(e){s.addOp(a.OPS.beginMarkedContentProps,["OC",e])})).catch((function(e){if(!(e instanceof a.AbortException)){if(p.options.ignoreErrors)return p.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorMarkedContent}),void(0,a.warn)('getOperatorList - ignoring beginMarkedContentProps: "'.concat(e,'".'));throw e}})));z=[z[0].name,z[1]instanceof r.Dict?z[1].get("MCID"):null];break;case a.OPS.beginMarkedContent:case a.OPS.endMarkedContent:default:if(null!==z){for(d=0,x=z.length;d<x&&!(z[d]instanceof r.Dict);d++);if(d<x){(0,a.warn)("getOperatorList - ignoring operator: "+B);continue}}}s.addOp(B,z)}c?l(O):(R(),t())})).catch((function(e){if(!(e instanceof a.AbortException)){if(t.options.ignoreErrors)return t.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorOperatorList}),(0,a.warn)('getOperatorList - ignoring errors during "'.concat(n.name,'" ')+'task: "'.concat(e,'".')),void R();throw e}}))}},{key:"getTextContent",value:function(e){var t=this,i=e.stream,n=e.task,o=e.resources,s=e.stateManager,l=void 0===s?null:s,c=e.combineTextItems,u=void 0!==c&&c,p=e.includeMarkedContent,m=void 0!==p&&p,h=e.sink,y=e.seenStyles,b=void 0===y?new Set:y,g=e.viewBox;o=o||r.Dict.empty,l=l||new U(new Y);var v=(0,d.getNormalizedUnicodes)(),_={items:[],styles:Object.create(null)},A={initialized:!1,str:[],totalWidth:0,totalHeight:0,width:0,height:0,vertical:!1,prevTransform:null,textAdvanceScale:0,spaceInFlowMin:0,spaceInFlowMax:0,trackingSpaceMin:1/0,negativeSpaceMax:-1/0,notASpace:-1/0,transform:null,fontName:null,hasEOL:!1},w=[" "," "],k=0;function D(e){var t=(k+1)%2,i=" "!==w[k]&&" "===w[t];return w[k]=e,k=t,i}function R(){w[0]=w[1]=" ",k=0}var I,M=.1,T=.03,P=-.2,z=.1,B=.6,F=this,E=this.xref,G=[],L=null,q=new x.LocalImageCache,H=new x.LocalGStateCache,X=new V(i,E,l);function Q(){var e=I.font,t=[I.fontSize*I.textHScale,0,0,I.fontSize,0,I.textRise];if(e.isType3Font&&(I.fontSize<=1||e.isCharBBox)&&!(0,a.isArrayEqual)(I.fontMatrix,a.FONT_IDENTITY_MATRIX)){var i=e.bbox[3]-e.bbox[1];i>0&&(t[3]*=i*I.fontMatrix[3])}return a.Util.transform(I.ctm,a.Util.transform(I.textMatrix,t))}function W(){if(A.initialized)return A;var e=I.font,t=e.loadedName;b.has(t)||(b.add(t),_.styles[t]={fontFamily:e.fallbackName,ascent:e.ascent,descent:e.descent,vertical:e.vertical}),A.fontName=t;var i=A.transform=Q();e.vertical?(A.width=A.totalWidth=Math.hypot(i[0],i[1]),A.height=A.totalHeight=0,A.vertical=!0):(A.width=A.totalWidth=0,A.height=A.totalHeight=Math.hypot(i[2],i[3]),A.vertical=!1);var a=Math.hypot(I.textLineMatrix[0],I.textLineMatrix[1]),n=Math.hypot(I.ctm[0],I.ctm[1]);return A.textAdvanceScale=n*a,A.trackingSpaceMin=I.fontSize*M,A.notASpace=I.fontSize*T,A.negativeSpaceMax=I.fontSize*P,A.spaceInFlowMin=I.fontSize*z,A.spaceInFlowMax=I.fontSize*B,A.hasEOL=!1,A.initialized=!0,A}function Z(){if(A.initialized){var e=Math.hypot(I.textLineMatrix[0],I.textLineMatrix[1]),t=Math.hypot(I.ctm[0],I.ctm[1])*e;t!==A.textAdvanceScale&&(A.vertical?(A.totalHeight+=A.height*A.textAdvanceScale,A.height=0):(A.totalWidth+=A.width*A.textAdvanceScale,A.width=0),A.textAdvanceScale=t)}}function J(e,t){return F.loadFont(e,t,o).then((function(e){return e.font.isType3Font?e.loadType3Data(F,o,n).catch((function(){})).then((function(){return e})):e})).then((function(e){I.font=e.font,I.fontMatrix=e.font.fontMatrix||a.FONT_IDENTITY_MATRIX}))}function K(e,t,i){var a=Math.hypot(i[0],i[1]);return[(i[0]*e+i[1]*t)/a,(i[2]*e+i[3]*t)/a]}function $(){var e=Q(),t=e[4],i=e[5],a=t-g[0],n=i-g[1];if(a<0||a>g[2]||n<0||n>g[3])return!1;if(!u||!I.font||!A.prevTransform)return!0;var r=A.prevTransform[4],o=A.prevTransform[5];if(r===t&&o===i)return!0;var s=-1;switch(e[0]&&0===e[1]&&0===e[2]?s=e[0]>0?0:180:e[1]&&0===e[0]&&0===e[3]&&(s=e[1]>0?90:270),s){case 0:break;case 90:var l=[i,t];t=l[0],i=l[1];var c=[o,r];r=c[0],o=c[1];break;case 180:var d=[-t,-i,-r,-o];t=d[0],i=d[1],r=d[2],o=d[3];break;case 270:var p=[-i,-t];t=p[0],i=p[1];var m=[-o,-r];r=m[0],o=m[1];break;default:var h=K(t,i,e),y=f(h,2);t=y[0],i=y[1];var b=K(r,o,A.prevTransform),v=f(b,2);r=v[0],o=v[1]}if(I.font.vertical){var x=(o-i)/A.textAdvanceScale,w=t-r,S=Math.sign(A.height);return x<S*A.negativeSpaceMax?Math.abs(w)>.5*A.width?(te(),!0):(R(),ae(),!0):Math.abs(w)>A.width?(te(),!0):(x<=S*A.notASpace&&R(),x<=S*A.trackingSpaceMin?A.height+=x:ie(x,A.prevTransform,S)||(0===A.str.length?(R(),_.items.push({str:" ",dir:"ltr",width:0,height:Math.abs(x),transform:A.prevTransform,fontName:A.fontName,hasEOL:!1})):A.height+=x),!0)}var C=(t-r)/A.textAdvanceScale,k=i-o,D=Math.sign(A.width);return C<D*A.negativeSpaceMax?Math.abs(k)>.5*A.height?(te(),!0):(R(),ae(),!0):Math.abs(k)>A.height?(te(),!0):(C<=D*A.notASpace&&R(),C<=D*A.trackingSpaceMin?A.width+=C:ie(C,A.prevTransform,D)||(0===A.str.length?(R(),_.items.push({str:" ",dir:"ltr",width:Math.abs(C),height:0,transform:A.prevTransform,fontName:A.fontName,hasEOL:!1})):A.width+=C),!0)}function ee(e){var t=e.chars,i=e.extraSpacing,a=I.font;if(t)for(var n=a.charsToGlyphs(t),r=I.fontMatrix[0]*I.fontSize,o=0,s=n.length;o<s;o++){var l=n[o];if(!l.isInvisibleFormatMark){var c=I.charSpacing+(o+1===s?i:0),u=l.width;a.vertical&&(u=l.vmetric?l.vmetric[0]:-u);var p=u*r;if(l.isWhitespace)a.vertical?(c+=-p+I.wordSpacing,I.translateTextMatrix(0,-c)):(c+=p+I.wordSpacing,I.translateTextMatrix(c*I.textHScale,0)),D(" ");else if($()){var m=W();l.isZeroWidthDiacritic&&(p=0),a.vertical?(I.translateTextMatrix(0,p),p=Math.abs(p),m.height+=p):(p*=I.textHScale,I.translateTextMatrix(p,0),m.width+=p),p&&(m.prevTransform=Q());var h=l.unicode;h=v[h]||h,D(h=(0,d.reverseIfRtl)(h))&&m.str.push(" "),m.str.push(h),c&&(a.vertical?I.translateTextMatrix(0,-c):I.translateTextMatrix(c*I.textHScale,0))}}}else{var f=I.charSpacing+i;f&&(a.vertical?I.translateTextMatrix(0,-f):I.translateTextMatrix(f*I.textHScale,0))}}function te(){R(),A.initialized?(A.hasEOL=!0,ae()):_.items.push({str:"",dir:"ltr",width:0,height:0,transform:Q(),fontName:I.font.loadedName,hasEOL:!0})}function ie(e,t,i){if(i*A.spaceInFlowMin<=e&&e<=i*A.spaceInFlowMax)return A.initialized&&(R(),A.str.push(" ")),!1;var a=A.fontName,n=0;return A.vertical&&(n=e,e=0),ae(),R(),_.items.push({str:" ",dir:"ltr",width:Math.abs(e),height:Math.abs(n),transform:t||Q(),fontName:a,hasEOL:!1}),!0}function ae(){A.initialized&&A.str&&(A.vertical?A.totalHeight+=A.height*A.textAdvanceScale:A.totalWidth+=A.width*A.textAdvanceScale,_.items.push(function(e){var t=e.str.join(""),i=(0,C.bidi)(t,-1,e.vertical);return{str:i.str,dir:i.dir,width:Math.abs(e.totalWidth),height:Math.abs(e.totalHeight),transform:e.transform,fontName:e.fontName,hasEOL:e.hasEOL}}(A)),A.initialized=!1,A.str.length=0)}function ne(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=_.items.length;0!==t&&(e&&t<N||(h.enqueue(_,t),_.items=[],_.styles=Object.create(null)))}var re=new j;return new Promise((function e(t,i){var s=function(a){ne(!0),Promise.all([a,h.ready]).then((function(){try{e(t,i)}catch(a){i(a)}}),i)};n.ensureNotTerminated(),re.reset();for(var c,d={},p=[];!(c=re.check())&&(p.length=0,d.args=p,X.read(d));){I=l.state;var f=d.fn;switch(p=d.args,0|f){case a.OPS.setFont:var y=p[0].name,v=p[1];if(I.font&&y===I.fontName&&v===I.fontSize)break;return ae(),I.fontName=y,I.fontSize=v,void s(J(y,null));case a.OPS.setTextRise:I.textRise=p[0];break;case a.OPS.setHScale:I.textHScale=p[0]/100;break;case a.OPS.setLeading:I.leading=p[0];break;case a.OPS.moveText:I.translateTextLineMatrix(p[0],p[1]),I.textMatrix=I.textLineMatrix.slice();break;case a.OPS.setLeadingMoveText:I.leading=-p[1],I.translateTextLineMatrix(p[0],p[1]),I.textMatrix=I.textLineMatrix.slice();break;case a.OPS.nextLine:I.carriageReturn();break;case a.OPS.setTextMatrix:I.setTextMatrix(p[0],p[1],p[2],p[3],p[4],p[5]),I.setTextLineMatrix(p[0],p[1],p[2],p[3],p[4],p[5]),Z();break;case a.OPS.setCharSpacing:I.charSpacing=p[0];break;case a.OPS.setWordSpacing:I.wordSpacing=p[0];break;case a.OPS.beginText:I.textMatrix=a.IDENTITY_MATRIX.slice(),I.textLineMatrix=a.IDENTITY_MATRIX.slice();break;case a.OPS.showSpacedText:if(!l.state.font){F.ensureStateFont(l.state);continue}for(var A=(I.font.vertical?1:-1)*I.fontSize/1e3,x=p[0],w=0,C=x.length;w<C-1;w++){var k=x[w];if("string"===typeof k)G.push(k);else if("number"===typeof k&&0!==k){var D=G.join("");G.length=0,ee({chars:D,extraSpacing:k*A})}}var R=x.at(-1);if("string"===typeof R&&G.push(R),G.length>0){var M=G.join("");G.length=0,ee({chars:M,extraSpacing:0})}break;case a.OPS.showText:if(!l.state.font){F.ensureStateFont(l.state);continue}ee({chars:p[0],extraSpacing:0});break;case a.OPS.nextLineShowText:if(!l.state.font){F.ensureStateFont(l.state);continue}I.carriageReturn(),ee({chars:p[0],extraSpacing:0});break;case a.OPS.nextLineSetSpacingShowText:if(!l.state.font){F.ensureStateFont(l.state);continue}I.wordSpacing=p[0],I.charSpacing=p[1],I.carriageReturn(),ee({chars:p[2],extraSpacing:0});break;case a.OPS.paintXObject:ae(),L||(L=o.get("XObject")||r.Dict.empty);var T=p[0]instanceof r.Name,P=p[0].name;if(T&&q.getByName(P))break;return void s(new Promise((function(e,t){if(!T)throw new a.FormatError("XObject must be referred to by name.");var i=L.getRaw(P);if(i instanceof r.Ref){if(q.getByRef(i))return void e();if(F.globalImageCache.getData(i,F.pageIndex))return void e();i=E.fetch(i)}if(!(i instanceof S.BaseStream))throw new a.FormatError("XObject should be a stream");var s=i.dict.get("Subtype");if(!(s instanceof r.Name))throw new a.FormatError("XObject should have a Name subtype");if("Form"!==s.name)return q.set(P,i.dict.objId,!0),void e();var c=l.state.clone(),d=new U(c),p=i.dict.getArray("Matrix");Array.isArray(p)&&6===p.length&&d.transform(p),ne();var f={enqueueInvoked:!1,enqueue:function(e,t){this.enqueueInvoked=!0,h.enqueue(e,t)},get desiredSize(){return h.desiredSize},get ready(){return h.ready}};F.getTextContent({stream:i,task:n,resources:i.dict.get("Resources")||o,stateManager:d,combineTextItems:u,includeMarkedContent:m,sink:f,seenStyles:b,viewBox:g}).then((function(){f.enqueueInvoked||q.set(P,i.dict.objId,!0),e()}),t)})).catch((function(e){if(!(e instanceof a.AbortException)){if(!F.options.ignoreErrors)throw e;(0,a.warn)('getTextContent - ignoring XObject: "'.concat(e,'".'))}})));case a.OPS.setGState:if(T=p[0]instanceof r.Name,P=p[0].name,T&&H.getByName(P))break;return void s(new Promise((function(e,t){if(!T)throw new a.FormatError("GState must be referred to by name.");var i=o.get("ExtGState");if(!(i instanceof r.Dict))throw new a.FormatError("ExtGState should be a dictionary.");var n=i.get(P);if(!(n instanceof r.Dict))throw new a.FormatError("GState should be a dictionary.");var s=n.get("Font");if(!s)return H.set(P,n.objId,!0),void e();ae(),I.fontName=null,I.fontSize=s[1],J(null,s[0]).then(e,t)})).catch((function(e){if(!(e instanceof a.AbortException)){if(!F.options.ignoreErrors)throw e;(0,a.warn)('getTextContent - ignoring ExtGState: "'.concat(e,'".'))}})));case a.OPS.beginMarkedContent:ae(),m&&_.items.push({type:"beginMarkedContent",tag:p[0]instanceof r.Name?p[0].name:null});break;case a.OPS.beginMarkedContentProps:if(ae(),m){var z=null;p[1]instanceof r.Dict&&(z=p[1].get("MCID")),_.items.push({type:"beginMarkedContentProps",id:Number.isInteger(z)?"".concat(F.idFactory.getPageObjId(),"_mcid").concat(z):null,tag:p[0]instanceof r.Name?p[0].name:null})}break;case a.OPS.endMarkedContent:ae(),m&&_.items.push({type:"endMarkedContent"})}if(_.items.length>=h.desiredSize){c=!0;break}}c?s(O):(ae(),ne(),t())})).catch((function(e){if(!(e instanceof a.AbortException)){if(t.options.ignoreErrors)return(0,a.warn)('getTextContent - ignoring errors during "'.concat(n.name,'" ')+'task: "'.concat(e,'".')),ae(),void ne();throw e}}))}},{key:"extractDataStructures",value:function(e,t,i){var n,o=this,c=this.xref,d=this.readToUnicode(i.toUnicode||e.get("ToUnicode")||t.get("ToUnicode"));if(i.composite){var u=e.get("CIDSystemInfo");u instanceof r.Dict&&(i.cidSystemInfo={registry:(0,a.stringToPDFString)(u.get("Registry")),ordering:(0,a.stringToPDFString)(u.get("Ordering")),supplement:u.get("Supplement")});try{var p=e.get("CIDToGIDMap");p instanceof S.BaseStream&&(n=p.getBytes())}catch(C){if(!this.options.ignoreErrors)throw C;(0,a.warn)('extractDataStructures - ignoring CIDToGIDMap data: "'.concat(C,'".'))}}var m,h=[],f=null;if(e.has("Encoding")){if((m=e.get("Encoding"))instanceof r.Dict){if(f=(f=m.get("BaseEncoding"))instanceof r.Name?f.name:null,m.has("Differences"))for(var y=m.get("Differences"),b=0,g=0,v=y.length;g<v;g++){var _=c.fetchIfRef(y[g]);if("number"===typeof _)b=_;else{if(!(_ instanceof r.Name))throw new a.FormatError("Invalid entry in 'Differences' array: ".concat(_));h[b++]=_.name}}}else if(m instanceof r.Name)f=m.name;else{var A="Encoding is not a Name nor a Dict";if(!this.options.ignoreErrors)throw new a.FormatError(A);(0,a.warn)(A)}"MacRomanEncoding"!==f&&"MacExpertEncoding"!==f&&"WinAnsiEncoding"!==f&&(f=null)}if(f)i.defaultEncoding=(0,l.getEncoding)(f);else{var x=!!(i.flags&s.FontFlags.Symbolic),w=!!(i.flags&s.FontFlags.Nonsymbolic);m=l.StandardEncoding,"TrueType"!==i.type||w||(m=l.WinAnsiEncoding),x&&(m=l.MacRomanEncoding,i.file&&!i.isInternalFont||(/Symbol/i.test(i.name)?m=l.SymbolSetEncoding:/Dingbats|Wingdings/i.test(i.name)&&(m=l.ZapfDingbatsEncoding))),i.defaultEncoding=m}return i.differences=h,i.baseEncodingName=f,i.hasEncoding=!!f||h.length>0,i.dict=e,d.then((function(e){return i.toUnicode=e,o.buildToUnicode(i)})).then((function(e){return i.toUnicode=e,n&&(i.cidToGidMap=o.readCidToGidMap(n,e)),i}))}},{key:"_simpleFontToUnicode",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];(0,a.assert)(!e.composite,"Must be a simple font.");var i=[],n=e.defaultEncoding.slice(),r=e.baseEncodingName,o=e.differences;for(var s in o){var c=o[s];".notdef"!==c&&(n[s]=c)}var u=(0,R.getGlyphsUnicode)();for(var p in n){var m=n[p];if(""!==m)if(void 0!==u[m])i[p]=String.fromCharCode(u[m]);else{var h=0;switch(m[0]){case"G":3===m.length&&(h=parseInt(m.substring(1),16));break;case"g":5===m.length&&(h=parseInt(m.substring(1),16));break;case"C":case"c":if(m.length>=3&&m.length<=4){var f=m.substring(1);if(t){h=parseInt(f,16);break}if(h=+f,Number.isNaN(h)&&Number.isInteger(parseInt(f,16)))return this._simpleFontToUnicode(e,!0)}break;default:var y=(0,d.getUnicodeForGlyph)(m,u);-1!==y&&(h=y)}if(h>0&&h<=1114111&&Number.isInteger(h)){if(r&&h===+p){var b=(0,l.getEncoding)(r);if(b&&(m=b[p])){i[p]=String.fromCharCode(u[m]);continue}}i[p]=String.fromCodePoint(h)}}}return i}},{key:"buildToUnicode",value:function(){var e=y(p().mark((function e(t){var i,o,s,l,c,d;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(t.hasIncludedToUnicodeMap=!!t.toUnicode&&t.toUnicode.length>0,!t.hasIncludedToUnicodeMap){e.next=4;break}return!t.composite&&t.hasEncoding&&(t.fallbackToUnicode=this._simpleFontToUnicode(t)),e.abrupt("return",t.toUnicode);case 4:if(t.composite){e.next=6;break}return e.abrupt("return",new v.ToUnicodeMap(this._simpleFontToUnicode(t)));case 6:if(!t.composite||(!t.cMap.builtInCMap||t.cMap instanceof n.IdentityCMap)&&("Adobe"!==t.cidSystemInfo.registry||"GB1"!==t.cidSystemInfo.ordering&&"CNS1"!==t.cidSystemInfo.ordering&&"Japan1"!==t.cidSystemInfo.ordering&&"Korea1"!==t.cidSystemInfo.ordering)){e.next=15;break}return i=t.cidSystemInfo,o=i.registry,s=i.ordering,l=r.Name.get("".concat(o,"-").concat(s,"-UCS2")),e.next=11,n.CMapFactory.create({encoding:l,fetchBuiltInCMap:this._fetchBuiltInCMapBound,useCMap:null});case 11:return c=e.sent,d=[],t.cMap.forEach((function(e,t){if(t>65535)throw new a.FormatError("Max size of CID is 65,535");var i=c.lookup(t);i&&(d[e]=String.fromCharCode((i.charCodeAt(0)<<8)+i.charCodeAt(1)))})),e.abrupt("return",new v.ToUnicodeMap(d));case 15:return e.abrupt("return",new v.IdentityToUnicodeMap(t.firstChar,t.lastChar));case 16:case"end":return e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"readToUnicode",value:function(e){var t=this;return e?e instanceof r.Name?n.CMapFactory.create({encoding:e,fetchBuiltInCMap:this._fetchBuiltInCMapBound,useCMap:null}).then((function(e){return e instanceof n.IdentityCMap?new v.IdentityToUnicodeMap(0,65535):new v.ToUnicodeMap(e.getMap())})):e instanceof S.BaseStream?n.CMapFactory.create({encoding:e,fetchBuiltInCMap:this._fetchBuiltInCMapBound,useCMap:null}).then((function(e){if(e instanceof n.IdentityCMap)return new v.IdentityToUnicodeMap(0,65535);var t=new Array(e.length);return e.forEach((function(e,i){if("number"!==typeof i){for(var a=[],n=0;n<i.length;n+=2){var r=i.charCodeAt(n)<<8|i.charCodeAt(n+1);if(55296===(63488&r)){n+=2;var o=i.charCodeAt(n)<<8|i.charCodeAt(n+1);a.push(((1023&r)<<10)+(1023&o)+65536)}else a.push(r)}t[e]=String.fromCodePoint.apply(String,a)}else t[e]=String.fromCodePoint(i)})),new v.ToUnicodeMap(t)}),(function(e){if(e instanceof a.AbortException)return null;if(t.options.ignoreErrors)return t.handler.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontToUnicode}),(0,a.warn)('readToUnicode - ignoring ToUnicode data: "'.concat(e,'".')),null;throw e})):Promise.resolve(null):Promise.resolve(null)}},{key:"readCidToGidMap",value:function(e,t){for(var i=[],a=0,n=e.length;a<n;a++){var r=e[a++]<<8|e[a],o=a>>1;(0!==r||t.has(o))&&(i[o]=r)}return i}},{key:"extractWidths",value:function(e,t,i){var a,n,o,l,c,d,u,p,m=this.xref,h=[],f=0,y=[];if(i.composite){if(f=e.has("DW")?e.get("DW"):1e3,p=e.get("W"))for(n=0,o=p.length;n<o;n++)if(d=m.fetchIfRef(p[n++]),u=m.fetchIfRef(p[n]),Array.isArray(u))for(l=0,c=u.length;l<c;l++)h[d++]=m.fetchIfRef(u[l]);else{var b=m.fetchIfRef(p[++n]);for(l=d;l<=u;l++)h[l]=b}if(i.vertical){var g=e.getArray("DW2")||[880,-1e3];if(a=[g[1],.5*f,g[0]],g=e.get("W2"))for(n=0,o=g.length;n<o;n++)if(d=m.fetchIfRef(g[n++]),u=m.fetchIfRef(g[n]),Array.isArray(u))for(l=0,c=u.length;l<c;l++)y[d++]=[m.fetchIfRef(u[l++]),m.fetchIfRef(u[l++]),m.fetchIfRef(u[l])];else{var v=[m.fetchIfRef(g[++n]),m.fetchIfRef(g[++n]),m.fetchIfRef(g[++n])];for(l=d;l<=u;l++)y[l]=v}}}else{var _=i.firstChar;if(p=e.get("Widths")){for(l=_,n=0,o=p.length;n<o;n++)h[l++]=m.fetchIfRef(p[n]);f=parseFloat(t.get("MissingWidth"))||0}else{var A=e.get("BaseFont");if(A instanceof r.Name){var x=this.getBaseFontMetrics(A.name);h=this.buildCharCodeToWidth(x.widths,i),f=x.defaultWidth}}}var w=!0,S=f;for(var C in h){var k=h[C];if(k)if(S){if(S!==k){w=!1;break}}else S=k}w&&(i.flags|=s.FontFlags.FixedPitch),i.defaultWidth=f,i.widths=h,i.defaultVMetrics=a,i.vmetrics=y}},{key:"isSerifFont",value:function(e){var t=e.split("-")[0];return t in(0,c.getSerifFonts)()||-1!==t.search(/serif/gi)}},{key:"getBaseFontMetrics",value:function(e){var t=0,i=Object.create(null),a=!1,n=(0,c.getStdFontMap)()[e]||e,r=(0,M.getMetrics)();n in r||(n=this.isSerifFont(e)?"Times-Roman":"Helvetica");var o=r[n];return"number"===typeof o?(t=o,a=!0):i=o(),{defaultWidth:t,monospace:a,widths:i}}},{key:"buildCharCodeToWidth",value:function(e,t){for(var i=Object.create(null),a=t.differences,n=t.defaultEncoding,r=0;r<256;r++)r in a&&e[a[r]]?i[r]=e[a[r]]:r in n&&e[n[r]]&&(i[r]=e[n[r]]);return i}},{key:"preEvaluateFont",value:function(e){var t=e,i=e.get("Subtype");if(!(i instanceof r.Name))throw new a.FormatError("invalid font Subtype");var n,o,s=!1;if("Type0"===i.name){var l=e.get("DescendantFonts");if(!l)throw new a.FormatError("Descendant fonts are not specified");if(!((e=Array.isArray(l)?this.xref.fetchIfRef(l[0]):l)instanceof r.Dict))throw new a.FormatError("Descendant font is not a dictionary.");if(!((i=e.get("Subtype"))instanceof r.Name))throw new a.FormatError("invalid font Subtype");s=!0}var c=e.get("FirstChar")||0,d=e.get("LastChar")||(s?65535:255),u=e.get("FontDescriptor");if(u){n=new T.MurmurHash3_64;var p=t.getRaw("Encoding");if(p instanceof r.Name)n.update(p.name);else if(p instanceof r.Ref)n.update(p.toString());else if(p instanceof r.Dict){var m,f=h(p.getRawValues());try{for(f.s();!(m=f.n()).done;){var y=m.value;if(y instanceof r.Name)n.update(y.name);else if(y instanceof r.Ref)n.update(y.toString());else if(Array.isArray(y)){for(var b=y.length,g=new Array(b),v=0;v<b;v++){var _=y[v];_ instanceof r.Name?g[v]=_.name:("number"===typeof _||_ instanceof r.Ref)&&(g[v]=_.toString())}n.update(g.join())}}}catch(L){f.e(L)}finally{f.f()}}if(n.update("".concat(c,"-").concat(d)),(o=e.get("ToUnicode")||t.get("ToUnicode"))instanceof S.BaseStream){var A=o.str||o,x=A.buffer?new Uint8Array(A.buffer.buffer,0,A.bufferLength):new Uint8Array(A.bytes.buffer,A.start,A.end-A.start);n.update(x)}else o instanceof r.Name&&n.update(o.name);var w=e.get("Widths")||t.get("Widths");if(Array.isArray(w)){var C,k=[],D=h(w);try{for(D.s();!(C=D.n()).done;){var R=C.value;("number"===typeof R||R instanceof r.Ref)&&k.push(R.toString())}}catch(L){D.e(L)}finally{D.f()}n.update(k.join())}if(s){n.update("compositeFont");var I=e.get("W")||t.get("W");if(Array.isArray(I)){var M,P=[],z=h(I);try{for(z.s();!(M=z.n()).done;){var B=M.value;if("number"===typeof B||B instanceof r.Ref)P.push(B.toString());else if(Array.isArray(B)){var F,E=[],N=h(B);try{for(N.s();!(F=N.n()).done;){var O=F.value;("number"===typeof O||O instanceof r.Ref)&&E.push(O.toString())}}catch(L){N.e(L)}finally{N.f()}P.push("[".concat(E.join(),"]"))}}}catch(L){z.e(L)}finally{z.f()}n.update(P.join())}var G=e.getRaw("CIDToGIDMap")||t.getRaw("CIDToGIDMap");G instanceof r.Name?n.update(G.name):G instanceof r.Ref?n.update(G.toString()):G instanceof S.BaseStream&&n.update(G.peekBytes())}}return{descriptor:u,dict:e,baseDict:t,composite:s,type:i.name,firstChar:c,lastChar:d,toUnicode:o,hash:n?n.hexdigest():""}}},{key:"translateFont",value:function(){var e=y(p().mark((function e(t){var i,l,d,u,h,f,y,b,g,v,_,A,x,S,C,k,D,R,I,M,T,P,z,B,F,E,N,O,G,L,j,q,H,U,Y,X=this;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(i=t.descriptor,l=t.dict,d=t.baseDict,u=t.composite,h=t.type,f=t.firstChar,y=t.lastChar,b=t.toUnicode,g=t.cssFontInfo,v="Type3"===h,i){e.next=27;break}if(!v){e.next=9;break}(i=new r.Dict(null)).set("FontName",r.Name.get(h)),i.set("FontBBox",l.getArray("FontBBox")||[0,0,0,0]),e.next=27;break;case 9:if((A=l.get("BaseFont"))instanceof r.Name){e.next=12;break}throw new a.FormatError("Base font is not specified");case 12:if(A=A.name.replace(/[,_]/g,"-"),x=this.getBaseFontMetrics(A),S=A.split("-")[0],C=(this.isSerifFont(S)?s.FontFlags.Serif:0)|(x.monospace?s.FontFlags.FixedPitch:0)|((0,c.getSymbolsFonts)()[S]?s.FontFlags.Symbolic:s.FontFlags.Nonsymbolic),_={type:h,name:A,loadedName:d.loadedName,widths:x.widths,defaultWidth:x.defaultWidth,isSimulatedFlags:!0,flags:C,firstChar:f,lastChar:y,toUnicode:b,xHeight:0,capHeight:0,italicAngle:0,isType3Font:v},k=l.get("Widths"),D=(0,c.getStandardFontName)(A),R=null,!D){e.next=26;break}return _.isStandardFont=!0,e.next=24,this.fetchStandardFontData(D);case 24:R=e.sent,_.isInternalFont=!!R;case 26:return e.abrupt("return",this.extractDataStructures(l,l,_).then((function(e){if(k){for(var t=[],i=f,a=0,n=k.length;a<n;a++)t[i++]=X.xref.fetchIfRef(k[a]);e.widths=t}else e.widths=X.buildCharCodeToWidth(x.widths,e);return new o.Font(A,R,e)})));case 27:if(I=i.get("FontName"),M=l.get("BaseFont"),"string"===typeof I&&(I=r.Name.get(I)),"string"===typeof M&&(M=r.Name.get(M)),v||(T=I&&I.name,P=M&&M.name,T!==P&&((0,a.info)("The FontDescriptor's FontName is \"".concat(T,'" but ')+"should be the same as the Font's BaseFont \"".concat(P,'".')),T&&P&&P.startsWith(T)&&(I=M))),(I=I||M)instanceof r.Name){e.next=35;break}throw new a.FormatError("invalid font name");case 35:e.prev=35,z=i.get("FontFile","FontFile2","FontFile3"),e.next=45;break;case 39:if(e.prev=39,e.t0=e.catch(35),this.options.ignoreErrors){e.next=43;break}throw e.t0;case 43:(0,a.warn)('translateFont - fetching "'.concat(I.name,'" font file: "').concat(e.t0,'".')),z=new w.NullStream;case 45:if(O=!1,G=!1,L=null,!z){e.next=52;break}z.dict&&((j=z.dict.get("Subtype"))instanceof r.Name&&(B=j.name),F=z.dict.get("Length1"),E=z.dict.get("Length2"),N=z.dict.get("Length3")),e.next=74;break;case 52:if(!g){e.next=66;break}if(!(q=(0,m.getXfaFontName)(I.name))){e.next=64;break}return g.fontFamily="".concat(g.fontFamily,"-PdfJS-XFA"),g.metrics=q.metrics||null,L=q.factors||null,e.next=60,this.fetchStandardFontData(q.name);case 60:z=e.sent,G=!!z,d=l=(0,m.getXfaFontDict)(I.name),u=!0;case 64:e.next=74;break;case 66:if(v){e.next=74;break}if(!(H=(0,c.getStandardFontName)(I.name))){e.next=74;break}return O=!0,e.next=72,this.fetchStandardFontData(H);case 72:z=e.sent,G=!!z;case 74:if(_={type:h,name:I.name,subtype:B,file:z,length1:F,length2:E,length3:N,isStandardFont:O,isInternalFont:G,loadedName:d.loadedName,composite:u,fixedPitch:!1,fontMatrix:l.getArray("FontMatrix")||a.FONT_IDENTITY_MATRIX,firstChar:f,lastChar:y,toUnicode:b,bbox:i.getArray("FontBBox")||l.getArray("FontBBox"),ascent:i.get("Ascent"),descent:i.get("Descent"),xHeight:i.get("XHeight")||0,capHeight:i.get("CapHeight")||0,flags:i.get("Flags"),italicAngle:i.get("ItalicAngle")||0,isType3Font:v,cssFontInfo:g,scaleFactors:L},!u){e.next=83;break}return(U=d.get("Encoding"))instanceof r.Name&&(_.cidEncoding=U.name),e.next=80,n.CMapFactory.create({encoding:U,fetchBuiltInCMap:this._fetchBuiltInCMapBound,useCMap:null});case 80:Y=e.sent,_.cMap=Y,_.vertical=_.cMap.vertical;case 83:return e.abrupt("return",this.extractDataStructures(l,d,_).then((function(e){return X.extractWidths(l,i,e),new o.Font(I.name,z,e)})));case 84:case"end":return e.stop()}}),e,this,[[35,39]])})));return function(t){return e.apply(this,arguments)}}()}],[{key:"buildFontPaths",value:function(e,t,i,n){function r(t){var r="".concat(e.loadedName,"_path_").concat(t);try{if(e.renderer.hasBuiltPath(t))return;i.send("commonobj",[r,"FontPath",e.renderer.getPathJs(t)])}catch(o){if(n.ignoreErrors)return i.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.errorFontBuildPath}),void(0,a.warn)("buildFontPaths - ignoring ".concat(r,' glyph: "').concat(o,'".'));throw o}}var o,s=h(t);try{for(s.s();!(o=s.n()).done;){var l=o.value;r(l.fontChar);var c=l.accent;c&&c.fontChar&&r(c.fontChar)}}catch(d){s.e(d)}finally{s.f()}}},{key:"fallbackFontDict",get:function(){var e=new r.Dict;return e.set("BaseFont",r.Name.get("PDFJS-FallbackFont")),e.set("Type",r.Name.get("FallbackType")),e.set("Subtype",r.Name.get("FallbackType")),e.set("Encoding",r.Name.get("WinAnsiEncoding")),(0,a.shadow)(this,"fallbackFontDict",e)}}]),e}();t.PartialEvaluator=q;var H=function(){function e(t){b(this,e);var i=t.loadedName,a=t.font,n=t.dict,r=t.evaluatorOptions;this.loadedName=i,this.font=a,this.dict=n,this._evaluatorOptions=r||B,this.type3Loaded=null,this.type3Dependencies=a.isType3Font?new Set:null,this.sent=!1}return g(e,[{key:"send",value:function(e){this.sent||(this.sent=!0,e.send("commonobj",[this.loadedName,"Font",this.font.exportData(this._evaluatorOptions.fontExtraProperties)]))}},{key:"fallback",value:function(e){this.font.data&&(this.font.disableFontFace=!0,q.buildFontPaths(this.font,this.font.glyphCacheValues,e,this._evaluatorOptions))}},{key:"loadType3Data",value:function(e,t,i){var n=this;if(this.type3Loaded)return this.type3Loaded;if(!this.font.isType3Font)throw new Error("Must be a Type3 font.");var o=e.clone({ignoreErrors:!1});o.parsingType3Font=!0;var s=new r.RefSet(e.type3FontRefs);this.dict.objId&&!s.has(this.dict.objId)&&s.put(this.dict.objId),o.type3FontRefs=s;var l,c=this.font,d=this.type3Dependencies,u=Promise.resolve(),p=this.dict.get("CharProcs"),m=this.dict.get("Resources")||t,f=Object.create(null),y=a.Util.normalizeRect(c.bbox||[0,0,0,0]),b=y[2]-y[0],g=y[3]-y[1],v=Math.hypot(b,g),_=h(p.getKeys());try{var A=function(){var e=l.value;u=u.then((function(){var t=p.get(e),r=new P.OperatorList;return o.getOperatorList({stream:t,task:i,resources:m,operatorList:r}).then((function(){r.fnArray[0]===a.OPS.setCharWidthAndBounds&&n._removeType3ColorOperators(r,v),f[e]=r.getIR();var t,i=h(r.dependencies);try{for(i.s();!(t=i.n()).done;){var o=t.value;d.add(o)}}catch(s){i.e(s)}finally{i.f()}})).catch((function(t){(0,a.warn)('Type3 font resource "'.concat(e,'" is not available.'));var i=new P.OperatorList;f[e]=i.getIR()}))}))};for(_.s();!(l=_.n()).done;)A()}catch(x){_.e(x)}finally{_.f()}return this.type3Loaded=u.then((function(){c.charProcOperatorList=f,n._bbox&&(c.isCharBBox=!0,c.bbox=n._bbox)})),this.type3Loaded}},{key:"_removeType3ColorOperators",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:NaN,i=a.Util.normalizeRect(e.argsArray[0].slice(2)),n=i[2]-i[0],r=i[3]-i[1],o=Math.hypot(n,r);0===n||0===r?(e.fnArray.splice(0,1),e.argsArray.splice(0,1)):(0===t||Math.round(o/t)>=10)&&(this._bbox||(this._bbox=[1/0,1/0,-1/0,-1/0]),this._bbox[0]=Math.min(this._bbox[0],i[0]),this._bbox[1]=Math.min(this._bbox[1],i[1]),this._bbox[2]=Math.max(this._bbox[2],i[2]),this._bbox[3]=Math.max(this._bbox[3],i[3]));for(var s=0,l=e.length;s<l;){switch(e.fnArray[s]){case a.OPS.setCharWidthAndBounds:break;case a.OPS.setStrokeColorSpace:case a.OPS.setFillColorSpace:case a.OPS.setStrokeColor:case a.OPS.setStrokeColorN:case a.OPS.setFillColor:case a.OPS.setFillColorN:case a.OPS.setStrokeGray:case a.OPS.setFillGray:case a.OPS.setStrokeRGBColor:case a.OPS.setFillRGBColor:case a.OPS.setStrokeCMYKColor:case a.OPS.setFillCMYKColor:case a.OPS.shadingFill:case a.OPS.setRenderingIntent:e.fnArray.splice(s,1),e.argsArray.splice(s,1),l--;continue;case a.OPS.setGState:for(var c=f(e.argsArray[s],1)[0],d=0,u=c.length;d<u;){switch(f(c[d],1)[0]){case"TR":case"TR2":case"HT":case"BG":case"BG2":case"UCR":case"UCR2":c.splice(d,1),u--;continue}d++}}s++}}}]),e}(),U=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:new X;this.state=t,this.stateStack=[]}return g(e,[{key:"save",value:function(){var e=this.state;this.stateStack.push(this.state),this.state=e.clone()}},{key:"restore",value:function(){var e=this.stateStack.pop();e&&(this.state=e)}},{key:"transform",value:function(e){this.state.ctm=a.Util.transform(this.state.ctm,e)}}]),e}(),Y=function(){function e(){b(this,e),this.ctm=new Float32Array(a.IDENTITY_MATRIX),this.fontName=null,this.fontSize=0,this.font=null,this.fontMatrix=a.FONT_IDENTITY_MATRIX,this.textMatrix=a.IDENTITY_MATRIX.slice(),this.textLineMatrix=a.IDENTITY_MATRIX.slice(),this.charSpacing=0,this.wordSpacing=0,this.leading=0,this.textHScale=1,this.textRise=0}return g(e,[{key:"setTextMatrix",value:function(e,t,i,a,n,r){var o=this.textMatrix;o[0]=e,o[1]=t,o[2]=i,o[3]=a,o[4]=n,o[5]=r}},{key:"setTextLineMatrix",value:function(e,t,i,a,n,r){var o=this.textLineMatrix;o[0]=e,o[1]=t,o[2]=i,o[3]=a,o[4]=n,o[5]=r}},{key:"translateTextMatrix",value:function(e,t){var i=this.textMatrix;i[4]=i[0]*e+i[2]*t+i[4],i[5]=i[1]*e+i[3]*t+i[5]}},{key:"translateTextLineMatrix",value:function(e,t){var i=this.textLineMatrix;i[4]=i[0]*e+i[2]*t+i[4],i[5]=i[1]*e+i[3]*t+i[5]}},{key:"carriageReturn",value:function(){this.translateTextLineMatrix(0,-this.leading),this.textMatrix=this.textLineMatrix.slice()}},{key:"clone",value:function(){var e=Object.create(this);return e.textMatrix=this.textMatrix.slice(),e.textLineMatrix=this.textLineMatrix.slice(),e.fontMatrix=this.fontMatrix.slice(),e}}]),e}(),X=function(){function e(){b(this,e),this.ctm=new Float32Array(a.IDENTITY_MATRIX),this.font=null,this.textRenderingMode=a.TextRenderingMode.FILL,this.fillColorSpace=k.ColorSpace.singletons.gray,this.strokeColorSpace=k.ColorSpace.singletons.gray}return g(e,[{key:"clone",value:function(){return Object.create(this)}}]),e}(),V=function(){function e(t,i){b(this,e);var a=arguments.length>2&&void 0!==arguments[2]?arguments[2]:new U;this.parser=new A.Parser({lexer:new A.Lexer(t,e.opMap),xref:i}),this.stateManager=a,this.nonProcessedArgs=[],this._isPathOp=!1,this._numInvalidPathOPS=0}return g(e,[{key:"savedStatesDepth",get:function(){return this.stateManager.stateStack.length}},{key:"read",value:function(t){for(var i=t.args;;){var n=this.parser.getObj();if(n instanceof r.Cmd){var o=n.cmd,s=e.opMap[o];if(!s){(0,a.warn)('Unknown command "'.concat(o,'".'));continue}var l=s.id,c=s.numArgs,d=null!==i?i.length:0;if(this._isPathOp||(this._numInvalidPathOPS=0),this._isPathOp=l>=a.OPS.moveTo&&l<=a.OPS.endPath,s.variableArgs)d>c&&(0,a.info)("Command ".concat(o,": expected [0, ").concat(c,"] args, ")+"but received ".concat(d," args."));else{if(d!==c){for(var u=this.nonProcessedArgs;d>c;)u.push(i.shift()),d--;for(;d<c&&0!==u.length;)null===i&&(i=[]),i.unshift(u.pop()),d++}if(d<c){var p="command ".concat(o,": expected ").concat(c," args, ")+"but received ".concat(d," args.");if(this._isPathOp&&++this._numInvalidPathOPS>e.MAX_INVALID_PATH_OPS)throw new a.FormatError("Invalid ".concat(p));(0,a.warn)("Skipping ".concat(p)),null!==i&&(i.length=0);continue}}return this.preprocessCommand(l,i),t.fn=l,t.args=i,!0}if(n===r.EOF)return!1;if(null!==n&&(null===i&&(i=[]),i.push(n),i.length>33))throw new a.FormatError("Too many arguments")}}},{key:"preprocessCommand",value:function(e,t){switch(0|e){case a.OPS.save:this.stateManager.save();break;case a.OPS.restore:this.stateManager.restore();break;case a.OPS.transform:this.stateManager.transform(t)}}}],[{key:"opMap",get:function(){var e=(0,I.getLookupTableFactory)((function(e){e.w={id:a.OPS.setLineWidth,numArgs:1,variableArgs:!1},e.J={id:a.OPS.setLineCap,numArgs:1,variableArgs:!1},e.j={id:a.OPS.setLineJoin,numArgs:1,variableArgs:!1},e.M={id:a.OPS.setMiterLimit,numArgs:1,variableArgs:!1},e.d={id:a.OPS.setDash,numArgs:2,variableArgs:!1},e.ri={id:a.OPS.setRenderingIntent,numArgs:1,variableArgs:!1},e.i={id:a.OPS.setFlatness,numArgs:1,variableArgs:!1},e.gs={id:a.OPS.setGState,numArgs:1,variableArgs:!1},e.q={id:a.OPS.save,numArgs:0,variableArgs:!1},e.Q={id:a.OPS.restore,numArgs:0,variableArgs:!1},e.cm={id:a.OPS.transform,numArgs:6,variableArgs:!1},e.m={id:a.OPS.moveTo,numArgs:2,variableArgs:!1},e.l={id:a.OPS.lineTo,numArgs:2,variableArgs:!1},e.c={id:a.OPS.curveTo,numArgs:6,variableArgs:!1},e.v={id:a.OPS.curveTo2,numArgs:4,variableArgs:!1},e.y={id:a.OPS.curveTo3,numArgs:4,variableArgs:!1},e.h={id:a.OPS.closePath,numArgs:0,variableArgs:!1},e.re={id:a.OPS.rectangle,numArgs:4,variableArgs:!1},e.S={id:a.OPS.stroke,numArgs:0,variableArgs:!1},e.s={id:a.OPS.closeStroke,numArgs:0,variableArgs:!1},e.f={id:a.OPS.fill,numArgs:0,variableArgs:!1},e.F={id:a.OPS.fill,numArgs:0,variableArgs:!1},e["f*"]={id:a.OPS.eoFill,numArgs:0,variableArgs:!1},e.B={id:a.OPS.fillStroke,numArgs:0,variableArgs:!1},e["B*"]={id:a.OPS.eoFillStroke,numArgs:0,variableArgs:!1},e.b={id:a.OPS.closeFillStroke,numArgs:0,variableArgs:!1},e["b*"]={id:a.OPS.closeEOFillStroke,numArgs:0,variableArgs:!1},e.n={id:a.OPS.endPath,numArgs:0,variableArgs:!1},e.W={id:a.OPS.clip,numArgs:0,variableArgs:!1},e["W*"]={id:a.OPS.eoClip,numArgs:0,variableArgs:!1},e.BT={id:a.OPS.beginText,numArgs:0,variableArgs:!1},e.ET={id:a.OPS.endText,numArgs:0,variableArgs:!1},e.Tc={id:a.OPS.setCharSpacing,numArgs:1,variableArgs:!1},e.Tw={id:a.OPS.setWordSpacing,numArgs:1,variableArgs:!1},e.Tz={id:a.OPS.setHScale,numArgs:1,variableArgs:!1},e.TL={id:a.OPS.setLeading,numArgs:1,variableArgs:!1},e.Tf={id:a.OPS.setFont,numArgs:2,variableArgs:!1},e.Tr={id:a.OPS.setTextRenderingMode,numArgs:1,variableArgs:!1},e.Ts={id:a.OPS.setTextRise,numArgs:1,variableArgs:!1},e.Td={id:a.OPS.moveText,numArgs:2,variableArgs:!1},e.TD={id:a.OPS.setLeadingMoveText,numArgs:2,variableArgs:!1},e.Tm={id:a.OPS.setTextMatrix,numArgs:6,variableArgs:!1},e["T*"]={id:a.OPS.nextLine,numArgs:0,variableArgs:!1},e.Tj={id:a.OPS.showText,numArgs:1,variableArgs:!1},e.TJ={id:a.OPS.showSpacedText,numArgs:1,variableArgs:!1},e["'"]={id:a.OPS.nextLineShowText,numArgs:1,variableArgs:!1},e['"']={id:a.OPS.nextLineSetSpacingShowText,numArgs:3,variableArgs:!1},e.d0={id:a.OPS.setCharWidth,numArgs:2,variableArgs:!1},e.d1={id:a.OPS.setCharWidthAndBounds,numArgs:6,variableArgs:!1},e.CS={id:a.OPS.setStrokeColorSpace,numArgs:1,variableArgs:!1},e.cs={id:a.OPS.setFillColorSpace,numArgs:1,variableArgs:!1},e.SC={id:a.OPS.setStrokeColor,numArgs:4,variableArgs:!0},e.SCN={id:a.OPS.setStrokeColorN,numArgs:33,variableArgs:!0},e.sc={id:a.OPS.setFillColor,numArgs:4,variableArgs:!0},e.scn={id:a.OPS.setFillColorN,numArgs:33,variableArgs:!0},e.G={id:a.OPS.setStrokeGray,numArgs:1,variableArgs:!1},e.g={id:a.OPS.setFillGray,numArgs:1,variableArgs:!1},e.RG={id:a.OPS.setStrokeRGBColor,numArgs:3,variableArgs:!1},e.rg={id:a.OPS.setFillRGBColor,numArgs:3,variableArgs:!1},e.K={id:a.OPS.setStrokeCMYKColor,numArgs:4,variableArgs:!1},e.k={id:a.OPS.setFillCMYKColor,numArgs:4,variableArgs:!1},e.sh={id:a.OPS.shadingFill,numArgs:1,variableArgs:!1},e.BI={id:a.OPS.beginInlineImage,numArgs:0,variableArgs:!1},e.ID={id:a.OPS.beginImageData,numArgs:0,variableArgs:!1},e.EI={id:a.OPS.endInlineImage,numArgs:1,variableArgs:!1},e.Do={id:a.OPS.paintXObject,numArgs:1,variableArgs:!1},e.MP={id:a.OPS.markPoint,numArgs:1,variableArgs:!1},e.DP={id:a.OPS.markPointProps,numArgs:2,variableArgs:!1},e.BMC={id:a.OPS.beginMarkedContent,numArgs:1,variableArgs:!1},e.BDC={id:a.OPS.beginMarkedContentProps,numArgs:2,variableArgs:!1},e.EMC={id:a.OPS.endMarkedContent,numArgs:0,variableArgs:!1},e.BX={id:a.OPS.beginCompat,numArgs:0,variableArgs:!1},e.EX={id:a.OPS.endCompat,numArgs:0,variableArgs:!1},e.BM=null,e.BD=null,e.true=null,e.fa=null,e.fal=null,e.fals=null,e.false=null,e.nu=null,e.nul=null,e.null=null}));return(0,a.shadow)(this,"opMap",e())}},{key:"MAX_INVALID_PATH_OPS",get:function(){return(0,a.shadow)(this,"MAX_INVALID_PATH_OPS",10)}}]),e}();t.EvaluatorPreprocessor=V},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.IdentityCMap=t.CMapFactory=t.CMap=void 0;var a=i(2),n=i(130),r=i(132),o=i(142),s=i(131),l=i(135),c=["Adobe-GB1-UCS2","Adobe-CNS1-UCS2","Adobe-Japan1-UCS2","Adobe-Korea1-UCS2","78-EUC-H","78-EUC-V","78-H","78-RKSJ-H","78-RKSJ-V","78-V","78ms-RKSJ-H","78ms-RKSJ-V","83pv-RKSJ-H","90ms-RKSJ-H","90ms-RKSJ-V","90msp-RKSJ-H","90msp-RKSJ-V","90pv-RKSJ-H","90pv-RKSJ-V","Add-H","Add-RKSJ-H","Add-RKSJ-V","Add-V","Adobe-CNS1-0","Adobe-CNS1-1","Adobe-CNS1-2","Adobe-CNS1-3","Adobe-CNS1-4","Adobe-CNS1-5","Adobe-CNS1-6","Adobe-GB1-0","Adobe-GB1-1","Adobe-GB1-2","Adobe-GB1-3","Adobe-GB1-4","Adobe-GB1-5","Adobe-Japan1-0","Adobe-Japan1-1","Adobe-Japan1-2","Adobe-Japan1-3","Adobe-Japan1-4","Adobe-Japan1-5","Adobe-Japan1-6","Adobe-Korea1-0","Adobe-Korea1-1","Adobe-Korea1-2","B5-H","B5-V","B5pc-H","B5pc-V","CNS-EUC-H","CNS-EUC-V","CNS1-H","CNS1-V","CNS2-H","CNS2-V","ETHK-B5-H","ETHK-B5-V","ETen-B5-H","ETen-B5-V","ETenms-B5-H","ETenms-B5-V","EUC-H","EUC-V","Ext-H","Ext-RKSJ-H","Ext-RKSJ-V","Ext-V","GB-EUC-H","GB-EUC-V","GB-H","GB-V","GBK-EUC-H","GBK-EUC-V","GBK2K-H","GBK2K-V","GBKp-EUC-H","GBKp-EUC-V","GBT-EUC-H","GBT-EUC-V","GBT-H","GBT-V","GBTpc-EUC-H","GBTpc-EUC-V","GBpc-EUC-H","GBpc-EUC-V","H","HKdla-B5-H","HKdla-B5-V","HKdlb-B5-H","HKdlb-B5-V","HKgccs-B5-H","HKgccs-B5-V","HKm314-B5-H","HKm314-B5-V","HKm471-B5-H","HKm471-B5-V","HKscs-B5-H","HKscs-B5-V","Hankaku","Hiragana","KSC-EUC-H","KSC-EUC-V","KSC-H","KSC-Johab-H","KSC-Johab-V","KSC-V","KSCms-UHC-H","KSCms-UHC-HW-H","KSCms-UHC-HW-V","KSCms-UHC-V","KSCpc-EUC-H","KSCpc-EUC-V","Katakana","NWP-H","NWP-V","RKSJ-H","RKSJ-V","Roman","UniCNS-UCS2-H","UniCNS-UCS2-V","UniCNS-UTF16-H","UniCNS-UTF16-V","UniCNS-UTF32-H","UniCNS-UTF32-V","UniCNS-UTF8-H","UniCNS-UTF8-V","UniGB-UCS2-H","UniGB-UCS2-V","UniGB-UTF16-H","UniGB-UTF16-V","UniGB-UTF32-H","UniGB-UTF32-V","UniGB-UTF8-H","UniGB-UTF8-V","UniJIS-UCS2-H","UniJIS-UCS2-HW-H","UniJIS-UCS2-HW-V","UniJIS-UCS2-V","UniJIS-UTF16-H","UniJIS-UTF16-V","UniJIS-UTF32-H","UniJIS-UTF32-V","UniJIS-UTF8-H","UniJIS-UTF8-V","UniJIS2004-UTF16-H","UniJIS2004-UTF16-V","UniJIS2004-UTF32-H","UniJIS2004-UTF32-V","UniJIS2004-UTF8-H","UniJIS2004-UTF8-V","UniJISPro-UCS2-HW-V","UniJISPro-UCS2-V","UniJISPro-UTF8-V","UniJISX0213-UTF32-H","UniJISX0213-UTF32-V","UniJISX02132004-UTF32-H","UniJISX02132004-UTF32-V","UniKS-UCS2-H","UniKS-UCS2-V","UniKS-UTF16-H","UniKS-UTF16-V","UniKS-UTF32-H","UniKS-UTF32-V","UniKS-UTF8-H","UniKS-UTF8-V","V","WP-Symbol"],m=Math.pow(2,24)-1,h=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]&&arguments[0];this.codespaceRanges=[[],[],[],[]],this.numCodespaceRanges=0,this._map=[],this.name="",this.vertical=!1,this.useCMap=null,this.builtInCMap=t}return g(e,[{key:"addCodespaceRange",value:function(e,t,i){this.codespaceRanges[e-1].push(t,i),this.numCodespaceRanges++}},{key:"mapCidRange",value:function(e,t,i){if(t-e>m)throw new Error("mapCidRange - ignoring data above MAX_MAP_RANGE.");for(;e<=t;)this._map[e++]=i++}},{key:"mapBfRange",value:function(e,t,i){if(t-e>m)throw new Error("mapBfRange - ignoring data above MAX_MAP_RANGE.");for(var a=i.length-1;e<=t;){this._map[e++]=i;var n=i.charCodeAt(a)+1;i=n>255?i.substring(0,a-1)+String.fromCharCode(i.charCodeAt(a-1)+1)+"\0":i.substring(0,a)+String.fromCharCode(n)}}},{key:"mapBfRangeToArray",value:function(e,t,i){if(t-e>m)throw new Error("mapBfRangeToArray - ignoring data above MAX_MAP_RANGE.");for(var a=i.length,n=0;e<=t&&n<a;)this._map[e]=i[n++],++e}},{key:"mapOne",value:function(e,t){this._map[e]=t}},{key:"lookup",value:function(e){return this._map[e]}},{key:"contains",value:function(e){return void 0!==this._map[e]}},{key:"forEach",value:function(e){var t=this._map,i=t.length;if(i<=65536)for(var a=0;a<i;a++)void 0!==t[a]&&e(a,t[a]);else for(var n in t)e(n,t[n])}},{key:"charCodeOf",value:function(e){var t=this._map;if(t.length<=65536)return t.indexOf(e);for(var i in t)if(t[i]===e)return 0|i;return-1}},{key:"getMap",value:function(){return this._map}},{key:"readCharCode",value:function(e,t,i){for(var a=0,n=this.codespaceRanges,r=0,o=n.length;r<o;r++){a=(a<<8|e.charCodeAt(t+r))>>>0;for(var s=n[r],l=0,c=s.length;l<c;){var d=s[l++],u=s[l++];if(a>=d&&a<=u)return i.charcode=a,void(i.length=r+1)}}i.charcode=0,i.length=1}},{key:"getCharCodeLength",value:function(e){for(var t=this.codespaceRanges,i=0,a=t.length;i<a;i++)for(var n=t[i],r=0,o=n.length;r<o;){var s=n[r++],l=n[r++];if(e>=s&&e<=l)return i+1}return 1}},{key:"length",get:function(){return this._map.length}},{key:"isIdentityCMap",get:function(){if("Identity-H"!==this.name&&"Identity-V"!==this.name)return!1;if(65536!==this._map.length)return!1;for(var e=0;e<65536;e++)if(this._map[e]!==e)return!1;return!0}}]),e}();t.CMap=h;var f=function(e){d(i,e);var t=u(i);function i(e,a){var n;return b(this,i),(n=t.call(this)).vertical=e,n.addCodespaceRange(a,0,65535),n}return g(i,[{key:"mapCidRange",value:function(e,t,i){(0,a.unreachable)("should not call mapCidRange")}},{key:"mapBfRange",value:function(e,t,i){(0,a.unreachable)("should not call mapBfRange")}},{key:"mapBfRangeToArray",value:function(e,t,i){(0,a.unreachable)("should not call mapBfRangeToArray")}},{key:"mapOne",value:function(e,t){(0,a.unreachable)("should not call mapCidOne")}},{key:"lookup",value:function(e){return Number.isInteger(e)&&e<=65535?e:void 0}},{key:"contains",value:function(e){return Number.isInteger(e)&&e<=65535}},{key:"forEach",value:function(e){for(var t=0;t<=65535;t++)e(t,t)}},{key:"charCodeOf",value:function(e){return Number.isInteger(e)&&e<=65535?e:-1}},{key:"getMap",value:function(){for(var e=new Array(65536),t=0;t<=65535;t++)e[t]=t;return e}},{key:"length",get:function(){return 65536}},{key:"isIdentityCMap",get:function(){(0,a.unreachable)("should not access .isIdentityCMap")}}]),i}(h);t.IdentityCMap=f;var v=function(){function e(e,t){for(var i=0,a=0;a<=t;a++)i=i<<8|e[a];return i>>>0}function t(e,t){return 1===t?String.fromCharCode(e[0],e[1]):3===t?String.fromCharCode(e[0],e[1],e[2],e[3]):String.fromCharCode.apply(null,e.subarray(0,t+1))}function i(e,t,i){for(var a=0,n=i;n>=0;n--)a+=e[n]+t[n],e[n]=255&a,a>>=8}function n(e,t){for(var i=1,a=t;a>=0&&i>0;a--)i+=e[a],e[a]=255&i,i>>=8}var r=16,o=19,s=function(){function e(t){b(this,e),this.buffer=t,this.pos=0,this.end=t.length,this.tmpBuf=new Uint8Array(o)}return g(e,[{key:"readByte",value:function(){return this.pos>=this.end?-1:this.buffer[this.pos++]}},{key:"readNumber",value:function(){var e,t=0;do{var i=this.readByte();if(i<0)throw new a.FormatError("unexpected EOF in bcmap");e=!(128&i),t=t<<7|127&i}while(!e);return t}},{key:"readSigned",value:function(){var e=this.readNumber();return 1&e?~(e>>>1):e>>>1}},{key:"readHex",value:function(e,t){e.set(this.buffer.subarray(this.pos,this.pos+t+1)),this.pos+=t+1}},{key:"readHexNumber",value:function(e,t){var i,n=this.tmpBuf,r=0;do{var o=this.readByte();if(o<0)throw new a.FormatError("unexpected EOF in bcmap");i=!(128&o),n[r++]=127&o}while(!i);for(var s=t,l=0,c=0;s>=0;){for(;c<8&&n.length>0;)l|=n[--r]<<c,c+=7;e[s]=255&l,s--,l>>=8,c-=8}}},{key:"readHexSigned",value:function(e,t){this.readHexNumber(e,t);for(var i=1&e[t]?255:0,a=0,n=0;n<=t;n++)a=(1&a)<<8|e[n],e[n]=a>>1^i}},{key:"readString",value:function(){for(var e=this.readNumber(),t="",i=0;i<e;i++)t+=String.fromCharCode(this.readNumber());return t}}]),e}(),l=function(){function a(){b(this,a)}return g(a,[{key:"process",value:function(){var a=y(p().mark((function a(o,l,c){var d,u,m,h,f,y,b,g,v,_,A,x,w,S,C,k,D,R,I,M,T;return p().wrap((function(a){for(;;)switch(a.prev=a.next){case 0:d=new s(o),u=d.readByte(),l.vertical=!!(1&u),m=null,h=new Uint8Array(r),f=new Uint8Array(r),y=new Uint8Array(r),b=new Uint8Array(r),g=new Uint8Array(r);case 9:if(!((_=d.readByte())>=0)){a.next=68;break}if(7!==(A=_>>5)){a.next=20;break}a.t0=31&_,a.next=0===a.t0?15:1===a.t0?17:19;break;case 15:return d.readString(),a.abrupt("break",19);case 17:return m=d.readString(),a.abrupt("break",19);case 19:return a.abrupt("continue",9);case 20:if(x=!!(16&_),!(1+(w=15&_)>r)){a.next=24;break}throw new Error("BinaryCMapReader.process: Invalid dataSize.");case 24:S=1,C=d.readNumber(),a.t1=A,a.next=0===a.t1?29:1===a.t1?35:2===a.t1?41:3===a.t1?46:4===a.t1?53:5===a.t1?58:65;break;case 29:for(d.readHex(h,w),d.readHexNumber(f,w),i(f,h,w),l.addCodespaceRange(w+1,e(h,w),e(f,w)),k=1;k<C;k++)n(f,w),d.readHexNumber(h,w),i(h,f,w),d.readHexNumber(f,w),i(f,h,w),l.addCodespaceRange(w+1,e(h,w),e(f,w));return a.abrupt("break",66);case 35:for(d.readHex(h,w),d.readHexNumber(f,w),i(f,h,w),d.readNumber(),D=1;D<C;D++)n(f,w),d.readHexNumber(h,w),i(h,f,w),d.readHexNumber(f,w),i(f,h,w),d.readNumber();return a.abrupt("break",66);case 41:for(d.readHex(y,w),v=d.readNumber(),l.mapOne(e(y,w),v),R=1;R<C;R++)n(y,w),x||(d.readHexNumber(g,w),i(y,g,w)),v=d.readSigned()+(v+1),l.mapOne(e(y,w),v);return a.abrupt("break",66);case 46:for(d.readHex(h,w),d.readHexNumber(f,w),i(f,h,w),v=d.readNumber(),l.mapCidRange(e(h,w),e(f,w),v),I=1;I<C;I++)n(f,w),x?h.set(f):(d.readHexNumber(h,w),i(h,f,w)),d.readHexNumber(f,w),i(f,h,w),v=d.readNumber(),l.mapCidRange(e(h,w),e(f,w),v);return a.abrupt("break",66);case 53:for(d.readHex(y,S),d.readHex(b,w),l.mapOne(e(y,S),t(b,w)),M=1;M<C;M++)n(y,S),x||(d.readHexNumber(g,S),i(y,g,S)),n(b,w),d.readHexSigned(g,w),i(b,g,w),l.mapOne(e(y,S),t(b,w));return a.abrupt("break",66);case 58:for(d.readHex(h,S),d.readHexNumber(f,S),i(f,h,S),d.readHex(b,w),l.mapBfRange(e(h,S),e(f,S),t(b,w)),T=1;T<C;T++)n(f,S),x?h.set(f):(d.readHexNumber(h,S),i(h,f,S)),d.readHexNumber(f,S),i(f,h,S),d.readHex(b,w),l.mapBfRange(e(h,S),e(f,S),t(b,w));return a.abrupt("break",66);case 65:throw new Error("BinaryCMapReader.process - unknown type: ".concat(A));case 66:a.next=9;break;case 68:if(!m){a.next=70;break}return a.abrupt("return",c(m));case 70:return a.abrupt("return",l);case 71:case"end":return a.stop()}}),a)})));return function(e,t,i){return a.apply(this,arguments)}}()}]),a}();return l}(),_=function(){function e(e){for(var t=0,i=0;i<e.length;i++)t=t<<8|e.charCodeAt(i);return t>>>0}function t(e){if("string"!==typeof e)throw new a.FormatError("Malformed CMap: expected string.")}function i(e){if(!Number.isInteger(e))throw new a.FormatError("Malformed CMap: expected int.")}function d(i,a){for(;;){var r=a.getObj();if(r===n.EOF)break;if((0,n.isCmd)(r,"endbfchar"))return;t(r);var o=e(r);t(r=a.getObj());var s=r;i.mapOne(o,s)}}function u(i,r){for(;;){var o=r.getObj();if(o===n.EOF)break;if((0,n.isCmd)(o,"endbfrange"))return;t(o);var s=e(o);t(o=r.getObj());var l=e(o);if(o=r.getObj(),Number.isInteger(o)||"string"===typeof o){var c=Number.isInteger(o)?String.fromCharCode(o):o;i.mapBfRange(s,l,c)}else{if(!(0,n.isCmd)(o,"["))break;o=r.getObj();for(var d=[];!(0,n.isCmd)(o,"]")&&o!==n.EOF;)d.push(o),o=r.getObj();i.mapBfRangeToArray(s,l,d)}}throw new a.FormatError("Invalid bf range.")}function m(a,r){for(;;){var o=r.getObj();if(o===n.EOF)break;if((0,n.isCmd)(o,"endcidchar"))return;t(o);var s=e(o);i(o=r.getObj());var l=o;a.mapOne(s,l)}}function b(a,r){for(;;){var o=r.getObj();if(o===n.EOF)break;if((0,n.isCmd)(o,"endcidrange"))return;t(o);var s=e(o);t(o=r.getObj());var l=e(o);i(o=r.getObj());var c=o;a.mapCidRange(s,l,c)}}function g(t,i){for(;;){var r=i.getObj();if(r===n.EOF)break;if((0,n.isCmd)(r,"endcodespacerange"))return;if("string"!==typeof r)break;var o=e(r);if("string"!==typeof(r=i.getObj()))break;var s=e(r);t.addCodespaceRange(r.length,o,s)}throw new a.FormatError("Invalid codespace range.")}function _(e,t){var i=t.getObj();Number.isInteger(i)&&(e.vertical=!!i)}function A(e,t){var i=t.getObj();i instanceof n.Name&&(e.name=i.name)}function x(e,t,i,a){return w.apply(this,arguments)}function w(){return(w=y(p().mark((function e(t,i,r,o){var l,c,h;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(e.prev=1,(h=i.getObj())!==n.EOF){e.next=7;break}return e.abrupt("break",39);case 7:if(!(h instanceof n.Name)){e.next=12;break}"WMode"===h.name?_(t,i):"CMapName"===h.name&&A(t,i),l=h,e.next=29;break;case 12:if(!(h instanceof n.Cmd)){e.next=29;break}e.t0=h.cmd,e.next="endcmap"===e.t0?16:"usecmap"===e.t0?17:"begincodespacerange"===e.t0?19:"beginbfchar"===e.t0?21:"begincidchar"===e.t0?23:"beginbfrange"===e.t0?25:"begincidrange"===e.t0?27:29;break;case 16:return e.abrupt("break",39);case 17:return l instanceof n.Name&&(c=l.name),e.abrupt("break",29);case 19:return g(t,i),e.abrupt("break",29);case 21:return d(t,i),e.abrupt("break",29);case 23:return m(t,i),e.abrupt("break",29);case 25:return u(t,i),e.abrupt("break",29);case 27:return b(t,i),e.abrupt("break",29);case 29:e.next=37;break;case 31:if(e.prev=31,e.t1=e.catch(1),!(e.t1 instanceof s.MissingDataException)){e.next=35;break}throw e.t1;case 35:return(0,a.warn)("Invalid cMap data: "+e.t1),e.abrupt("continue",0);case 37:e.next=0;break;case 39:if(!o&&c&&(o=c),!o){e.next=42;break}return e.abrupt("return",S(t,r,o));case 42:return e.abrupt("return",t);case 43:case"end":return e.stop()}}),e,null,[[1,31]])})))).apply(this,arguments)}function S(e,t,i){return C.apply(this,arguments)}function C(){return(C=y(p().mark((function e(t,i,a){var n,r;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.next=2,k(a,i);case 2:if(t.useCMap=e.sent,0===t.numCodespaceRanges){for(n=t.useCMap.codespaceRanges,r=0;r<n.length;r++)t.codespaceRanges[r]=n[r].slice();t.numCodespaceRanges=t.useCMap.numCodespaceRanges}return t.useCMap.forEach((function(e,i){t.contains(e)||t.mapOne(e,t.useCMap.lookup(e))})),e.abrupt("return",t);case 6:case"end":return e.stop()}}),e)})))).apply(this,arguments)}function k(e,t){return D.apply(this,arguments)}function D(){return(D=y(p().mark((function e(t,i){var n,r,s,d,u;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if("Identity-H"!==t){e.next=4;break}return e.abrupt("return",new f(!1,2));case 4:if("Identity-V"!==t){e.next=6;break}return e.abrupt("return",new f(!0,2));case 6:if(c.includes(t)){e.next=8;break}throw new Error("Unknown CMap name: "+t);case 8:if(i){e.next=10;break}throw new Error("Built-in CMap parameters are not provided.");case 10:return e.next=12,i(t);case 12:if(n=e.sent,r=n.cMapData,s=n.compressionType,d=new h(!0),s!==a.CMapCompressionType.BINARY){e.next=18;break}return e.abrupt("return",(new v).process(r,d,(function(e){return S(d,i,e)})));case 18:if(s!==a.CMapCompressionType.NONE){e.next=21;break}return u=new o.Lexer(new l.Stream(r)),e.abrupt("return",x(d,u,i,null));case 21:throw new Error("TODO: Only BINARY/NONE CMap compression is currently supported.");case 22:case"end":return e.stop()}}),e)})))).apply(this,arguments)}return{create:function(e){return y(p().mark((function t(){var i,a,s,l;return p().wrap((function(t){for(;;)switch(t.prev=t.next){case 0:if(i=e.encoding,a=e.fetchBuiltInCMap,s=e.useCMap,!(i instanceof n.Name)){t.next=7;break}return t.abrupt("return",k(i.name,a));case 7:if(!(i instanceof r.BaseStream)){t.next=14;break}return t.next=10,x(new h,new o.Lexer(i),a,s);case 10:if(!(l=t.sent).isIdentityCMap){t.next=13;break}return t.abrupt("return",k(l.name,a));case 13:return t.abrupt("return",l);case 14:throw new Error("Encoding required.");case 15:case"end":return t.stop()}}),t)})))()}}}();t.CMapFactory=_},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Parser=t.Linearization=t.Lexer=void 0;var a=i(2),n=i(130),r=i(131),o=i(143),s=i(145),l=i(146),c=i(148),d=i(149),u=i(152),p=i(154),m=i(156),h=i(135),f=i(157),y=i(158);function v(e){for(var t=e.length,i=1,a=0,n=0;n<t;++n)a+=i+=255&e[n];return a%65521<<16|i%65521}var _=function(){function e(t){b(this,e);var i=t.lexer,a=t.xref,n=t.allowStreams,r=void 0!==n&&n,o=t.recoveryMode,s=void 0!==o&&o;this.lexer=i,this.xref=a,this.allowStreams=r,this.recoveryMode=s,this.imageCache=Object.create(null),this.refill()}return g(e,[{key:"refill",value:function(){this.buf1=this.lexer.getObj(),this.buf2=this.lexer.getObj()}},{key:"shift",value:function(){this.buf2 instanceof n.Cmd&&"ID"===this.buf2.cmd?(this.buf1=this.buf2,this.buf2=null):(this.buf1=this.buf2,this.buf2=this.lexer.getObj())}},{key:"tryShift",value:function(){try{return this.shift(),!0}catch(e){if(e instanceof r.MissingDataException)throw e;return!1}}},{key:"getObj",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:null,t=this.buf1;if(this.shift(),t instanceof n.Cmd)switch(t.cmd){case"BI":return this.makeInlineImage(e);case"[":for(var i=[];!(0,n.isCmd)(this.buf1,"]")&&this.buf1!==n.EOF;)i.push(this.getObj(e));if(this.buf1===n.EOF){if(this.recoveryMode)return i;throw new r.ParserEOFException("End of file inside array.")}return this.shift(),i;case"<<":for(var o=new n.Dict(this.xref);!(0,n.isCmd)(this.buf1,">>")&&this.buf1!==n.EOF;)if(this.buf1 instanceof n.Name){var s=this.buf1.name;if(this.shift(),this.buf1===n.EOF)break;o.set(s,this.getObj(e))}else(0,a.info)("Malformed dictionary: key must be a name object"),this.shift();if(this.buf1===n.EOF){if(this.recoveryMode)return o;throw new r.ParserEOFException("End of file inside dictionary.")}return(0,n.isCmd)(this.buf2,"stream")?this.allowStreams?this.makeStream(o,e):o:(this.shift(),o);default:return t}if(Number.isInteger(t)){if(Number.isInteger(this.buf1)&&(0,n.isCmd)(this.buf2,"R")){var l=n.Ref.get(t,this.buf1);return this.shift(),this.shift(),l}return t}return"string"===typeof t&&e?e.decryptString(t):t}},{key:"findDefaultInlineStreamEnd",value:function(e){for(var t,i,o=this.lexer,s=e.pos,l=0;-1!==(t=e.getByte());)if(0===l)l=69===t?1:0;else if(1===l)l=73===t?2:0;else if((0,a.assert)(2===l,"findDefaultInlineStreamEnd - invalid state."),32===t||10===t||13===t){i=e.pos;for(var c=e.peekBytes(10),d=0,u=c.length;d<u;d++)if((0!==(t=c[d])||0===c[d+1])&&10!==t&&13!==t&&(t<32||t>127)){l=0;break}if(2!==l)continue;if(o.knownCommands){var p=o.peekObj();p instanceof n.Cmd&&!o.knownCommands[p.cmd]&&(l=0)}else(0,a.warn)("findDefaultInlineStreamEnd - `lexer.knownCommands` is undefined.");if(2===l)break}else l=0;-1===t&&((0,a.warn)("findDefaultInlineStreamEnd: Reached the end of the stream without finding a valid EI marker"),i&&((0,a.warn)('... trying to recover by using the last "EI" occurrence.'),e.skip(-(e.pos-i))));var m=4;return e.skip(-m),t=e.peekByte(),e.skip(m),(0,r.isWhiteSpace)(t)||m--,e.pos-m-s}},{key:"findDCTDecodeInlineStreamEnd",value:function(e){for(var t,i,n=e.pos,r=!1;-1!==(t=e.getByte());)if(255===t){switch(e.getByte()){case 0:break;case 255:e.skip(-1);break;case 217:r=!0;break;case 192:case 193:case 194:case 195:case 197:case 198:case 199:case 201:case 202:case 203:case 205:case 206:case 207:case 196:case 204:case 218:case 219:case 220:case 221:case 222:case 223:case 224:case 225:case 226:case 227:case 228:case 229:case 230:case 231:case 232:case 233:case 234:case 235:case 236:case 237:case 238:case 239:case 254:(i=e.getUint16())>2?e.skip(i-2):e.skip(-2)}if(r)break}var o=e.pos-n;return-1===t?((0,a.warn)("Inline DCTDecode image stream: EOI marker not found, searching for /EI/ instead."),e.skip(-o),this.findDefaultInlineStreamEnd(e)):(this.inlineStreamSkipEI(e),o)}},{key:"findASCII85DecodeInlineStreamEnd",value:function(e){for(var t,i=e.pos;-1!==(t=e.getByte());)if(126===t){var n=e.pos;for(t=e.peekByte();(0,r.isWhiteSpace)(t);)e.skip(),t=e.peekByte();if(62===t){e.skip();break}if(e.pos>n){var o=e.peekBytes(2);if(69===o[0]&&73===o[1])break}}var s=e.pos-i;return-1===t?((0,a.warn)("Inline ASCII85Decode image stream: EOD marker not found, searching for /EI/ instead."),e.skip(-s),this.findDefaultInlineStreamEnd(e)):(this.inlineStreamSkipEI(e),s)}},{key:"findASCIIHexDecodeInlineStreamEnd",value:function(e){for(var t,i=e.pos;-1!==(t=e.getByte())&&62!==t;);var n=e.pos-i;return-1===t?((0,a.warn)("Inline ASCIIHexDecode image stream: EOD marker not found, searching for /EI/ instead."),e.skip(-n),this.findDefaultInlineStreamEnd(e)):(this.inlineStreamSkipEI(e),n)}},{key:"inlineStreamSkipEI",value:function(e){for(var t,i=0;-1!==(t=e.getByte());)if(0===i)i=69===t?1:0;else if(1===i)i=73===t?2:0;else if(2===i)break}},{key:"makeInlineImage",value:function(e){for(var t,i=this.lexer,r=i.stream,o=new n.Dict(this.xref);!(0,n.isCmd)(this.buf1,"ID")&&this.buf1!==n.EOF;){if(!(this.buf1 instanceof n.Name))throw new a.FormatError("Dictionary key must be a name object");var s=this.buf1.name;if(this.shift(),this.buf1===n.EOF)break;o.set(s,this.getObj(e))}-1!==i.beginInlineImagePos&&(t=r.pos-i.beginInlineImagePos);var l,c=o.get("F","Filter");if(c instanceof n.Name)l=c.name;else if(Array.isArray(c)){var d=this.xref.fetchIfRef(c[0]);d instanceof n.Name&&(l=d.name)}var u,p=r.pos;switch(l){case"DCT":case"DCTDecode":u=this.findDCTDecodeInlineStreamEnd(r);break;case"A85":case"ASCII85Decode":u=this.findASCII85DecodeInlineStreamEnd(r);break;case"AHx":case"ASCIIHexDecode":u=this.findASCIIHexDecodeInlineStreamEnd(r);break;default:u=this.findDefaultInlineStreamEnd(r)}var m,h=r.makeSubStream(p,u,o);if(u<1e3&&t<5552){var f=h.getBytes();h.reset();var y=r.pos;r.pos=i.beginInlineImagePos;var b=r.getBytes(t);r.pos=y,m=v(f)+"_"+v(b);var g=this.imageCache[m];if(void 0!==g)return this.buf2=n.Cmd.get("EI"),this.shift(),g.reset(),g}return e&&(h=e.createStream(h,u)),(h=this.filter(h,o,u)).dict=o,void 0!==m&&(h.cacheKey="inline_".concat(u,"_").concat(m),this.imageCache[m]=h),this.buf2=n.Cmd.get("EI"),this.shift(),h}},{key:"_findStreamLength",value:function(e,t){var i=this.lexer.stream;i.pos=e;for(var a=t.length;i.pos<i.end;){var n=i.peekBytes(2048),r=n.length-a;if(r<=0)break;for(var o=0;o<r;){for(var s=0;s<a&&n[o+s]===t[s];)s++;if(s>=a)return i.pos+=o,i.pos-e;o++}i.pos+=r}return-1}},{key:"makeStream",value:function(e,t){var i=this.lexer,o=i.stream;i.skipToNextLine();var s=o.pos-1,l=e.get("Length");if(Number.isInteger(l)||((0,a.info)('Bad length "'.concat(l&&l.toString(),'" in stream.')),l=0),o.pos=s+l,i.nextChar(),this.tryShift()&&(0,n.isCmd)(this.buf2,"endstream"))this.shift();else{var c=new Uint8Array([101,110,100,115,116,114,101,97,109]),d=this._findStreamLength(s,c);if(d<0){for(var u=1;u<=1;u++){var p=c.length-u,m=c.slice(0,p),h=this._findStreamLength(s,m);if(h>=0){var f=o.peekBytes(p+1)[p];if(!(0,r.isWhiteSpace)(f))break;(0,a.info)('Found "'.concat((0,a.bytesToString)(m),'" when ')+"searching for endstream command."),d=h;break}}if(d<0)throw new a.FormatError("Missing endstream command.")}l=d,i.nextChar(),this.shift(),this.shift()}return this.shift(),o=o.makeSubStream(s,l,e),t&&(o=t.createStream(o,l)),(o=this.filter(o,e,l)).dict=e,o}},{key:"filter",value:function(e,t,i){var r=t.get("F","Filter"),o=t.get("DP","DecodeParms");if(r instanceof n.Name)return Array.isArray(o)&&(0,a.warn)("/DecodeParms should not be an Array, when /Filter is a Name."),this.makeFilter(e,r.name,i,o);var s=i;if(Array.isArray(r))for(var l=r,c=o,d=0,u=l.length;d<u;++d){if(r=this.xref.fetchIfRef(l[d]),!(r instanceof n.Name))throw new a.FormatError('Bad filter name "'.concat(r,'"'));o=null,Array.isArray(c)&&d in c&&(o=this.xref.fetchIfRef(c[d])),e=this.makeFilter(e,r.name,s,o),s=null}return e}},{key:"makeFilter",value:function(e,t,i,n){if(0===i)return(0,a.warn)('Empty "'.concat(t,'" stream.')),new h.NullStream;var b=this.xref.stats;try{switch(t){case"Fl":case"FlateDecode":return b.addStreamType(a.StreamType.FLATE),n?new f.PredictorStream(new c.FlateStream(e,i),i,n):new c.FlateStream(e,i);case"LZW":case"LZWDecode":b.addStreamType(a.StreamType.LZW);var g=1;return n?(n.has("EarlyChange")&&(g=n.get("EarlyChange")),new f.PredictorStream(new m.LZWStream(e,i,g),i,n)):new m.LZWStream(e,i,g);case"DCT":case"DCTDecode":return b.addStreamType(a.StreamType.DCT),new u.JpegStream(e,i,n);case"JPX":case"JPXDecode":return b.addStreamType(a.StreamType.JPX),new p.JpxStream(e,i,n);case"A85":case"ASCII85Decode":return b.addStreamType(a.StreamType.A85),new o.Ascii85Stream(e,i);case"AHx":case"ASCIIHexDecode":return b.addStreamType(a.StreamType.AHX),new s.AsciiHexStream(e,i);case"CCF":case"CCITTFaxDecode":return b.addStreamType(a.StreamType.CCF),new l.CCITTFaxStream(e,i,n);case"RL":case"RunLengthDecode":return b.addStreamType(a.StreamType.RLX),new y.RunLengthStream(e,i);case"JBIG2Decode":return b.addStreamType(a.StreamType.JBIG),new d.Jbig2Stream(e,i,n)}return(0,a.warn)('Filter "'.concat(t,'" is not supported.')),e}catch(v){if(v instanceof r.MissingDataException)throw v;return(0,a.warn)('Invalid stream: "'.concat(v,'"')),new h.NullStream}}}]),e}();t.Parser=_;var A=[1,0,0,0,0,0,0,0,0,1,1,0,1,1,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,1,0,0,0,0,2,0,0,2,2,0,0,0,0,0,2,0,0,0,0,0,0,0,0,0,0,0,0,2,0,2,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,2,0,2,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,2,0,2,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0];function x(e){return e>=48&&e<=57?15&e:e>=65&&e<=70||e>=97&&e<=102?9+(15&e):-1}var w=function(){function e(t){b(this,e);var i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;this.stream=t,this.nextChar(),this.strBuf=[],this.knownCommands=i,this._hexStringNumWarn=0,this.beginInlineImagePos=-1}return g(e,[{key:"nextChar",value:function(){return this.currentChar=this.stream.getByte()}},{key:"peekChar",value:function(){return this.stream.peekByte()}},{key:"getNumber",value:function(){var e=this.currentChar,t=!1,i=0,n=0;if(45===e?(n=-1,45===(e=this.nextChar())&&(e=this.nextChar())):43===e&&(n=1,e=this.nextChar()),10===e||13===e)do{e=this.nextChar()}while(10===e||13===e);if(46===e&&(i=10,e=this.nextChar()),e<48||e>57){if((0,r.isWhiteSpace)(e)||-1===e){if(10===i&&0===n)return(0,a.warn)("Lexer.getNumber - treating a single decimal point as zero."),0;if(0===i&&-1===n)return(0,a.warn)("Lexer.getNumber - treating a single minus sign as zero."),0}throw new a.FormatError("Invalid number: ".concat(String.fromCharCode(e)," (charCode ").concat(e,")"))}n=n||1;for(var o=e-48,s=0,l=1;(e=this.nextChar())>=0;)if(e>=48&&e<=57){var c=e-48;t?s=10*s+c:(0!==i&&(i*=10),o=10*o+c)}else if(46===e){if(0!==i)break;i=1}else if(45===e)(0,a.warn)("Badly formatted number: minus sign in the middle");else{if(69!==e&&101!==e)break;if(43===(e=this.peekChar())||45===e)l=45===e?-1:1,this.nextChar();else if(e<48||e>57)break;t=!0}return 0!==i&&(o/=i),t&&(o*=Math.pow(10,l*s)),n*o}},{key:"getString",value:function(){var e=1,t=!1,i=this.strBuf;i.length=0;for(var n=this.nextChar();;){var r=!1;switch(0|n){case-1:(0,a.warn)("Unterminated string"),t=!0;break;case 40:++e,i.push("(");break;case 41:0===--e?(this.nextChar(),t=!0):i.push(")");break;case 92:switch(n=this.nextChar()){case-1:(0,a.warn)("Unterminated string"),t=!0;break;case 110:i.push("\n");break;case 114:i.push("\r");break;case 116:i.push("\t");break;case 98:i.push("\b");break;case 102:i.push("\f");break;case 92:case 40:case 41:i.push(String.fromCharCode(n));break;case 48:case 49:case 50:case 51:case 52:case 53:case 54:case 55:var o=15&n;r=!0,(n=this.nextChar())>=48&&n<=55&&(o=(o<<3)+(15&n),(n=this.nextChar())>=48&&n<=55&&(r=!1,o=(o<<3)+(15&n))),i.push(String.fromCharCode(o));break;case 13:10===this.peekChar()&&this.nextChar();break;case 10:break;default:i.push(String.fromCharCode(n))}break;default:i.push(String.fromCharCode(n))}if(t)break;r||(n=this.nextChar())}return i.join("")}},{key:"getName",value:function(){var e,t,i=this.strBuf;for(i.length=0;(e=this.nextChar())>=0&&!A[e];)if(35===e){if(e=this.nextChar(),A[e]){(0,a.warn)("Lexer_getName: NUMBER SIGN (#) should be followed by a hexadecimal number."),i.push("#");break}var r=x(e);if(-1!==r){t=e;var o=x(e=this.nextChar());if(-1===o){if((0,a.warn)("Lexer_getName: Illegal digit (".concat(String.fromCharCode(e),") ")+"in hexadecimal number."),i.push("#",String.fromCharCode(t)),A[e])break;i.push(String.fromCharCode(e));continue}i.push(String.fromCharCode(r<<4|o))}else i.push("#",String.fromCharCode(e))}else i.push(String.fromCharCode(e));return i.length>127&&(0,a.warn)("Name token is longer than allowed by the spec: 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e(t){b(this,e);var i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{};if(!t||"function"!==typeof t.next)throw new Error('CCITTFaxDecoder - invalid "source" parameter.');this.source=t,this.eof=!1,this.encoding=i.K||0,this.eoline=i.EndOfLine||!1,this.byteAlign=i.EncodedByteAlign||!1,this.columns=i.Columns||1728,this.rows=i.Rows||0;var a,n=i.EndOfBlock;for(null!==n&&void 0!==n||(n=!0),this.eoblock=n,this.black=i.BlackIs1||!1,this.codingLine=new Uint32Array(this.columns+1),this.refLine=new Uint32Array(this.columns+2),this.codingLine[0]=this.columns,this.codingPos=0,this.row=0,this.nextLine2D=this.encoding<0,this.inputBits=0,this.inputBuf=0,this.outputBits=0,this.rowsDone=!1;0===(a=this._lookBits(12));)this._eatBits(1);1===a&&this._eatBits(12),this.encoding>0&&(this.nextLine2D=!this._lookBits(1),this._eatBits(1))}return g(e,[{key:"readNextChar",value:function(){if(this.eof)return-1;var e,t,i,r,o,s=this.refLine,l=this.codingLine,c=this.columns;if(0===this.outputBits){if(this.rowsDone&&(this.eof=!0),this.eof)return-1;var d,u,p;if(this.err=!1,this.nextLine2D){for(r=0;l[r]<c;++r)s[r]=l[r];for(s[r++]=c,s[r]=c,l[0]=0,this.codingPos=0,e=0,t=0;l[this.codingPos]<c;)switch(d=this._getTwoDimCode()){case 0:this._addPixels(s[e+1],t),s[e+1]<c&&(e+=2);break;case 1:if(d=u=0,t){do{d+=p=this._getBlackCode()}while(p>=64);do{u+=p=this._getWhiteCode()}while(p>=64)}else{do{d+=p=this._getWhiteCode()}while(p>=64);do{u+=p=this._getBlackCode()}while(p>=64)}for(this._addPixels(l[this.codingPos]+d,t),l[this.codingPos]<c&&this._addPixels(l[this.codingPos]+u,1^t);s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 7:if(this._addPixels(s[e]+3,t),t^=1,l[this.codingPos]<c)for(++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 5:if(this._addPixels(s[e]+2,t),t^=1,l[this.codingPos]<c)for(++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 3:if(this._addPixels(s[e]+1,t),t^=1,l[this.codingPos]<c)for(++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 2:if(this._addPixels(s[e],t),t^=1,l[this.codingPos]<c)for(++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 8:if(this._addPixelsNeg(s[e]-3,t),t^=1,l[this.codingPos]<c)for(e>0?--e:++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 6:if(this._addPixelsNeg(s[e]-2,t),t^=1,l[this.codingPos]<c)for(e>0?--e:++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case 4:if(this._addPixelsNeg(s[e]-1,t),t^=1,l[this.codingPos]<c)for(e>0?--e:++e;s[e]<=l[this.codingPos]&&s[e]<c;)e+=2;break;case n:this._addPixels(c,0),this.eof=!0;break;default:(0,a.info)("bad 2d code"),this._addPixels(c,0),this.err=!0}}else for(l[0]=0,this.codingPos=0,t=0;l[this.codingPos]<c;){if(d=0,t)do{d+=p=this._getBlackCode()}while(p>=64);else do{d+=p=this._getWhiteCode()}while(p>=64);this._addPixels(l[this.codingPos]+d,t),t^=1}var m=!1;if(this.byteAlign&&(this.inputBits&=-8),this.eoblock||this.row!==this.rows-1){if(d=this._lookBits(12),this.eoline)for(;d!==n&&1!==d;)this._eatBits(1),d=this._lookBits(12);else for(;0===d;)this._eatBits(1),d=this._lookBits(12);1===d?(this._eatBits(12),m=!0):d===n&&(this.eof=!0)}else this.rowsDone=!0;if(!this.eof&&this.encoding>0&&!this.rowsDone&&(this.nextLine2D=!this._lookBits(1),this._eatBits(1)),this.eoblock&&m&&this.byteAlign){if(1===(d=this._lookBits(12))){if(this._eatBits(12),this.encoding>0&&(this._lookBits(1),this._eatBits(1)),this.encoding>=0)for(r=0;r<4;++r)1!==(d=this._lookBits(12))&&(0,a.info)("bad rtc code: "+d),this._eatBits(12),this.encoding>0&&(this._lookBits(1),this._eatBits(1));this.eof=!0}}else if(this.err&&this.eoline){for(;;){if((d=this._lookBits(13))===n)return this.eof=!0,-1;if(d>>1===1)break;this._eatBits(1)}this._eatBits(12),this.encoding>0&&(this._eatBits(1),this.nextLine2D=!(1&d))}l[0]>0?this.outputBits=l[this.codingPos=0]:this.outputBits=l[this.codingPos=1],this.row++}if(this.outputBits>=8)o=1&this.codingPos?0:255,this.outputBits-=8,0===this.outputBits&&l[this.codingPos]<c&&(this.codingPos++,this.outputBits=l[this.codingPos]-l[this.codingPos-1]);else{i=8,o=0;do{if("number"!==typeof this.outputBits)throw new a.FormatError('Invalid /CCITTFaxDecode data, "outputBits" must be a number.');this.outputBits>i?(o<<=i,1&this.codingPos||(o|=255>>8-i),this.outputBits-=i,i=0):(o<<=this.outputBits,1&this.codingPos||(o|=255>>8-this.outputBits),i-=this.outputBits,this.outputBits=0,l[this.codingPos]<c?(this.codingPos++,this.outputBits=l[this.codingPos]-l[this.codingPos-1]):i>0&&(o<<=i,i=0))}while(i)}return this.black&&(o^=255),o}},{key:"_addPixels",value:function(e,t){var i=this.codingLine,n=this.codingPos;e>i[n]&&(e>this.columns&&((0,a.info)("row is wrong length"),this.err=!0,e=this.columns),1&n^t&&++n,i[n]=e),this.codingPos=n}},{key:"_addPixelsNeg",value:function(e,t){var i=this.codingLine,n=this.codingPos;if(e>i[n])e>this.columns&&((0,a.info)("row is wrong length"),this.err=!0,e=this.columns),1&n^t&&++n,i[n]=e;else if(e<i[n]){for(e<0&&((0,a.info)("invalid code"),this.err=!0,e=0);n>0&&e<i[n-1];)--n;i[n]=e}this.codingPos=n}},{key:"_findTableCode",value:function(e,t,i,a){for(var r=a||0,o=e;o<=t;++o){var s=this._lookBits(o);if(s===n)return[!0,1,!1];if(o<t&&(s<<=t-o),!r||s>=r){var l=i[s-r];if(l[0]===o)return this._eatBits(o),[!0,l[1],!0]}}return[!1,0,!1]}},{key:"_getTwoDimCode",value:function(){var e,t=0;if(this.eoblock){if(t=this._lookBits(7),(e=r[t])&&e[0]>0)return this._eatBits(e[0]),e[1]}else{var i=this._findTableCode(1,7,r);if(i[0]&&i[2])return i[1]}return(0,a.info)("Bad two dim code"),n}},{key:"_getWhiteCode",value:function(){var e,t=0;if(this.eoblock){if((t=this._lookBits(12))===n)return 1;if((e=t>>5===0?o[t]:s[t>>3])[0]>0)return this._eatBits(e[0]),e[1]}else{var i=this._findTableCode(1,9,s);if(i[0])return i[1];if((i=this._findTableCode(11,12,o))[0])return i[1]}return(0,a.info)("bad white code"),this._eatBits(1),1}},{key:"_getBlackCode",value:function(){var e,t;if(this.eoblock){if((e=this._lookBits(13))===n)return 1;if((t=e>>7===0?l[e]:e>>9===0&&e>>7!==0?c[(e>>1)-64]:d[e>>7])[0]>0)return this._eatBits(t[0]),t[1]}else{var i=this._findTableCode(2,6,d);if(i[0])return i[1];if((i=this._findTableCode(7,12,c,64))[0])return i[1];if((i=this._findTableCode(10,13,l))[0])return i[1]}return(0,a.info)("bad black code"),this._eatBits(1),1}},{key:"_lookBits",value:function(e){for(var t;this.inputBits<e;){if(-1===(t=this.source.next()))return 0===this.inputBits?n:this.inputBuf<<e-this.inputBits&65535>>16-e;this.inputBuf=this.inputBuf<<8|t,this.inputBits+=8}return this.inputBuf>>this.inputBits-e&65535>>16-e}},{key:"_eatBits",value:function(e){(this.inputBits-=e)<0&&(this.inputBits=0)}}]),e}();t.CCITTFaxDecoder=u},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.FlateStream=void 0;var a=i(144),n=i(2),r=new Int32Array([16,17,18,0,8,7,9,6,10,5,11,4,12,3,13,2,14,1,15]),o=new Int32Array([3,4,5,6,7,8,9,10,65547,65549,65551,65553,131091,131095,131099,131103,196643,196651,196659,196667,262211,262227,262243,262259,327811,327843,327875,327907,258,258,258]),s=new Int32Array([1,2,3,4,65541,65543,131081,131085,196625,196633,262177,262193,327745,327777,393345,393409,459009,459137,524801,525057,590849,591361,657409,658433,724993,727041,794625,798721,868353,876545]),l=[new Int32Array([459008,524368,524304,524568,459024,524400,524336,590016,459016,524384,524320,589984,524288,524416,524352,590048,459012,524376,524312,589968,459028,524408,524344,590032,459020,524392,524328,59e4,524296,524424,524360,590064,459010,524372,524308,524572,459026,524404,524340,590024,459018,524388,524324,589992,524292,524420,524356,590056,459014,524380,524316,589976,459030,524412,524348,590040,459022,524396,524332,590008,524300,524428,524364,590072,459009,524370,524306,524570,459025,524402,524338,590020,459017,524386,524322,589988,524290,524418,524354,590052,459013,524378,524314,589972,459029,524410,524346,590036,459021,524394,524330,590004,524298,524426,524362,590068,459011,524374,524310,524574,459027,524406,524342,590028,459019,524390,524326,589996,524294,524422,524358,590060,459015,524382,524318,589980,459031,524414,524350,590044,459023,524398,524334,590012,524302,524430,524366,590076,459008,524369,524305,524569,459024,524401,524337,590018,459016,524385,524321,589986,524289,524417,524353,590050,459012,524377,524313,589970,459028,524409,524345,590034,459020,524393,524329,590002,524297,524425,524361,590066,459010,524373,524309,524573,459026,524405,524341,590026,459018,524389,524325,589994,524293,524421,524357,590058,459014,524381,524317,589978,459030,524413,524349,590042,459022,524397,524333,590010,524301,524429,524365,590074,459009,524371,524307,524571,459025,524403,524339,590022,459017,524387,524323,589990,524291,524419,524355,590054,459013,524379,524315,589974,459029,524411,524347,590038,459021,524395,524331,590006,524299,524427,524363,590070,459011,524375,524311,524575,459027,524407,524343,590030,459019,524391,524327,589998,524295,524423,524359,590062,459015,524383,524319,589982,459031,524415,524351,590046,459023,524399,524335,590014,524303,524431,524367,590078,459008,524368,524304,524568,459024,524400,524336,590017,459016,524384,524320,589985,524288,524416,524352,590049,459012,524376,524312,589969,459028,524408,524344,590033,459020,524392,524328,590001,524296,524424,524360,590065,459010,524372,524308,524572,459026,524404,524340,590025,459018,524388,524324,589993,524292,524420,524356,590057,459014,524380,524316,589977,459030,524412,524348,590041,459022,524396,524332,590009,524300,524428,524364,590073,459009,524370,524306,524570,459025,524402,524338,590021,459017,524386,524322,589989,524290,524418,524354,590053,459013,524378,524314,589973,459029,524410,524346,590037,459021,524394,524330,590005,524298,524426,524362,590069,459011,524374,524310,524574,459027,524406,524342,590029,459019,524390,524326,589997,524294,524422,524358,590061,459015,524382,524318,589981,459031,524414,524350,590045,459023,524398,524334,590013,524302,524430,524366,590077,459008,524369,524305,524569,459024,524401,524337,590019,459016,524385,524321,589987,524289,524417,524353,590051,459012,524377,524313,589971,459028,524409,524345,590035,459020,524393,524329,590003,524297,524425,524361,590067,459010,524373,524309,524573,459026,524405,524341,590027,459018,524389,524325,589995,524293,524421,524357,590059,459014,524381,524317,589979,459030,524413,524349,590043,459022,524397,524333,590011,524301,524429,524365,590075,459009,524371,524307,524571,459025,524403,524339,590023,459017,524387,524323,589991,524291,524419,524355,590055,459013,524379,524315,589975,459029,524411,524347,590039,459021,524395,524331,590007,524299,524427,524363,590071,459011,524375,524311,524575,459027,524407,524343,590031,459019,524391,524327,589999,524295,524423,524359,590063,459015,524383,524319,589983,459031,524415,524351,590047,459023,524399,524335,590015,524303,524431,524367,590079]),9],c=[new Int32Array([327680,327696,327688,327704,327684,327700,327692,327708,327682,327698,327690,327706,327686,327702,327694,0,327681,327697,327689,327705,327685,327701,327693,327709,327683,327699,327691,327707,327687,327703,327695,0]),5],p=function(e){d(i,e);var t=u(i);function i(e,a){var r;b(this,i),(r=t.call(this,a)).str=e,r.dict=e.dict;var o=e.getByte(),s=e.getByte();if(-1===o||-1===s)throw new n.FormatError("Invalid header in flate stream: ".concat(o,", ").concat(s));if(8!==(15&o))throw new n.FormatError("Unknown compression method in flate stream: ".concat(o,", ").concat(s));if(((o<<8)+s)%31!==0)throw new n.FormatError("Bad FCHECK in flate stream: ".concat(o,", ").concat(s));if(32&s)throw new n.FormatError("FDICT bit set in flate stream: ".concat(o,", ").concat(s));return r.codeSize=0,r.codeBuf=0,r}return g(i,[{key:"getBits",value:function(e){for(var t,i=this.str,a=this.codeSize,r=this.codeBuf;a<e;){if(-1===(t=i.getByte()))throw new n.FormatError("Bad encoding in flate stream");r|=t<<a,a+=8}return t=r&(1<<e)-1,this.codeBuf=r>>e,this.codeSize=a-=e,t}},{key:"getCode",value:function(e){for(var t,i=this.str,a=e[0],r=e[1],o=this.codeSize,s=this.codeBuf;o<r&&-1!==(t=i.getByte());)s|=t<<o,o+=8;var l=a[s&(1<<r)-1],c=l>>16,d=65535&l;if(c<1||o<c)throw new n.FormatError("Bad encoding in flate stream");return this.codeBuf=s>>c,this.codeSize=o-c,d}},{key:"generateHuffmanTable",value:function(e){var t,i=e.length,a=0;for(t=0;t<i;++t)e[t]>a&&(a=e[t]);for(var n=1<<a,r=new Int32Array(n),o=1,s=0,l=2;o<=a;++o,s<<=1,l<<=1)for(var c=0;c<i;++c)if(e[c]===o){var d=0,u=s;for(t=0;t<o;++t)d=d<<1|1&u,u>>=1;for(t=d;t<n;t+=l)r[t]=o<<16|c;++s}return[r,a]}},{key:"readBlock",value:function(){var e,t,i=this.str,a=this.getBits(3);if(1&a&&(this.eof=!0),0!==(a>>=1)){var d,u;if(1===a)d=l,u=c;else{if(2!==a)throw new n.FormatError("Unknown block type in flate stream");var p,m=this.getBits(5)+257,h=this.getBits(5)+1,f=this.getBits(4)+4,y=new Uint8Array(r.length);for(p=0;p<f;++p)y[r[p]]=this.getBits(3);var b=this.generateHuffmanTable(y);t=0,p=0;for(var g,v,_,A=m+h,x=new Uint8Array(A);p<A;){var w=this.getCode(b);if(16===w)g=2,v=3,_=t;else if(17===w)g=3,v=3,_=t=0;else{if(18!==w){x[p++]=t=w;continue}g=7,v=11,_=t=0}for(var S=this.getBits(g)+v;S-- >0;)x[p++]=_}d=this.generateHuffmanTable(x.subarray(0,m)),u=this.generateHuffmanTable(x.subarray(m,A))}for(var C=(e=this.buffer)?e.length:0,k=this.bufferLength;;){var D=this.getCode(d);if(D<256)k+1>=C&&(C=(e=this.ensureBuffer(k+1)).length),e[k++]=D;else{if(256===D)return void(this.bufferLength=k);var R=(D=o[D-=257])>>16;R>0&&(R=this.getBits(R)),t=(65535&D)+R,D=this.getCode(u),(R=(D=s[D])>>16)>0&&(R=this.getBits(R));var I=(65535&D)+R;k+t>=C&&(C=(e=this.ensureBuffer(k+t)).length);for(var M=0;M<t;++M,++k)e[k]=e[k-I]}}}else{var T;if(-1===(T=i.getByte()))throw new n.FormatError("Bad block header in flate stream");var P=T;if(-1===(T=i.getByte()))throw new n.FormatError("Bad block header in flate stream");if(P|=T<<8,-1===(T=i.getByte()))throw new n.FormatError("Bad block header in flate stream");var z=T;if(-1===(T=i.getByte()))throw new n.FormatError("Bad block header in flate stream");if((z|=T<<8)!==(65535&~P)&&(0!==P||0!==z))throw new n.FormatError("Bad uncompressed block length in flate stream");this.codeBuf=0,this.codeSize=0;var B=this.bufferLength,F=B+P;if(e=this.ensureBuffer(F),this.bufferLength=F,0===P)-1===i.peekByte()&&(this.eof=!0);else{var E=i.getBytes(P);e.set(E,B),E.length<P&&(this.eof=!0)}}}}]),i}(a.DecodeStream);t.FlateStream=p},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Jbig2Stream=void 0;var a=i(132),n=i(144),r=i(130),o=i(150),s=i(2),l=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,a)).stream=e,r.dict=e.dict,r.maybeLength=a,r.params=n,r}return g(i,[{key:"bytes",get:function(){return(0,s.shadow)(this,"bytes",this.stream.getBytes(this.maybeLength))}},{key:"ensureBuffer",value:function(e){}},{key:"readBlock",value:function(){if(!this.eof){var e=new o.Jbig2Image,t=[];if(this.params instanceof r.Dict){var i=this.params.get("JBIG2Globals");if(i instanceof a.BaseStream){var n=i.getBytes();t.push({data:n,start:0,end:n.length})}}t.push({data:this.bytes,start:0,end:this.bytes.length});for(var s=e.parseChunks(t),l=s.length,c=0;c<l;c++)s[c]^=255;this.buffer=s,this.bufferLength=l,this.eof=!0}}}]),i}(n.DecodeStream);t.Jbig2Stream=l},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Jbig2Image=void 0;var a=i(2),n=i(131),r=i(151),o=i(147),s=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,"JBIG2 error: ".concat(e),"Jbig2Error")}return g(i)}(a.BaseException),l=function(){function e(){b(this,e)}return g(e,[{key:"getContexts",value:function(e){return e in this?this[e]:this[e]=new 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y=["SymbolDictionary",null,null,null,"IntermediateTextRegion",null,"ImmediateTextRegion","ImmediateLosslessTextRegion",null,null,null,null,null,null,null,null,"PatternDictionary",null,null,null,"IntermediateHalftoneRegion",null,"ImmediateHalftoneRegion","ImmediateLosslessHalftoneRegion",null,null,null,null,null,null,null,null,null,null,null,null,"IntermediateGenericRegion",null,"ImmediateGenericRegion","ImmediateLosslessGenericRegion","IntermediateGenericRefinementRegion",null,"ImmediateGenericRefinementRegion","ImmediateLosslessGenericRefinementRegion",null,null,null,null,"PageInformation","EndOfPage","EndOfStripe","EndOfFile","Profiles","Tables",null,null,null,null,null,null,null,null,"Extension"],v=[[{x:-1,y:-2},{x:0,y:-2},{x:1,y:-2},{x:-2,y:-1},{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:2,y:-1},{x:-4,y:0},{x:-3,y:0},{x:-2,y:0},{x:-1,y:0}],[{x:-1,y:-2},{x:0,y:-2},{x:1,y:-2},{x:2,y:-2},{x:-2,y:-1},{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:2,y:-1},{x:-3,y:0},{x:-2,y:0},{x:-1,y:0}],[{x:-1,y:-2},{x:0,y:-2},{x:1,y:-2},{x:-2,y:-1},{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:-2,y:0},{x:-1,y:0}],[{x:-3,y:-1},{x:-2,y:-1},{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:-4,y:0},{x:-3,y:0},{x:-2,y:0},{x:-1,y:0}]],_=[{coding:[{x:0,y:-1},{x:1,y:-1},{x:-1,y:0}],reference:[{x:0,y:-1},{x:1,y:-1},{x:-1,y:0},{x:0,y:0},{x:1,y:0},{x:-1,y:1},{x:0,y:1},{x:1,y:1}]},{coding:[{x:-1,y:-1},{x:0,y:-1},{x:1,y:-1},{x:-1,y:0}],reference:[{x:0,y:-1},{x:-1,y:0},{x:0,y:0},{x:1,y:0},{x:0,y:1},{x:1,y:1}]}],A=[39717,1941,229,405],x=[32,8];function w(e,t,i,a,n,r,o,s){if(e)return j(new O(s.data,s.start,s.end),t,i,!1);if(0===a&&!r&&!n&&4===o.length&&3===o[0].x&&-1===o[0].y&&-3===o[1].x&&-1===o[1].y&&2===o[2].x&&-2===o[2].y&&-2===o[3].x&&-2===o[3].y)return function(e,t,i){var a,n,r,o,s,l,c,d=i.decoder,u=i.contextCache.getContexts("GB"),p=[];for(n=0;n<t;n++)for(s=p[n]=new Uint8Array(e),l=n<1?s:p[n-1],a=(c=n<2?s:p[n-2])[0]<<13|c[1]<<12|c[2]<<11|l[0]<<7|l[1]<<6|l[2]<<5|l[3]<<4,r=0;r<e;r++)s[r]=o=d.readBit(u,a),a=(31735&a)<<1|(r+3<e?c[r+3]<<11:0)|(r+4<e?l[r+4]<<4:0)|o;return p}(t,i,s);var l=!!r,c=v[a].concat(o);c.sort((function(e,t){return e.y-t.y||e.x-t.x}));var d,u,p=c.length,m=new Int8Array(p),h=new Int8Array(p),f=[],y=0,b=0,g=0,_=0;for(u=0;u<p;u++)m[u]=c[u].x,h[u]=c[u].y,b=Math.min(b,c[u].x),g=Math.max(g,c[u].x),_=Math.min(_,c[u].y),u<p-1&&c[u].y===c[u+1].y&&c[u].x===c[u+1].x-1?y|=1<<p-1-u:f.push(u);var x=f.length,w=new Int8Array(x),S=new Int8Array(x),C=new Uint16Array(x);for(d=0;d<x;d++)u=f[d],w[d]=c[u].x,S[d]=c[u].y,C[d]=1<<p-1-u;for(var k,D,R,I,M,T=-b,P=-_,z=t-g,B=A[a],F=new Uint8Array(t),E=[],N=s.decoder,G=s.contextCache.getContexts("GB"),L=0,q=0,H=0;H<i;H++)if(n&&(L^=N.readBit(G,B)))E.push(F);else for(F=new Uint8Array(F),E.push(F),k=0;k<t;k++)if(l&&r[H][k])F[k]=0;else{if(k>=T&&k<z&&H>=P)for(q=q<<1&y,u=0;u<x;u++)D=H+S[u],R=k+w[u],(I=E[D][R])&&(q|=I=C[u]);else for(q=0,M=p-1,u=0;u<p;u++,M--)(R=k+m[u])>=0&&R<t&&(D=H+h[u])>=0&&(I=E[D][R])&&(q|=I<<M);var U=N.readBit(G,q);F[k]=U}return E}function S(e,t,i,a,n,r,o,l,c){var d=_[i].coding;0===i&&(d=d.concat([l[0]]));var u,p=d.length,m=new Int32Array(p),h=new Int32Array(p);for(u=0;u<p;u++)m[u]=d[u].x,h[u]=d[u].y;var f=_[i].reference;0===i&&(f=f.concat([l[1]]));var y=f.length,b=new Int32Array(y),g=new Int32Array(y);for(u=0;u<y;u++)b[u]=f[u].x,g[u]=f[u].y;for(var v=a[0].length,A=a.length,w=x[i],S=[],C=c.decoder,k=c.contextCache.getContexts("GR"),D=0,R=0;R<t;R++){if(o&&(D^=C.readBit(k,w)))throw new s("prediction is not supported");var I=new Uint8Array(e);S.push(I);for(var M=0;M<e;M++){var T=void 0,P=void 0,z=0;for(u=0;u<p;u++)T=R+h[u],P=M+m[u],T<0||P<0||P>=e?z<<=1:z=z<<1|S[T][P];for(u=0;u<y;u++)T=R+g[u]-r,P=M+b[u]-n,T<0||T>=A||P<0||P>=v?z<<=1:z=z<<1|a[T][P];var B=C.readBit(k,z);I[M]=B}}return S}function C(e,t,i,a,n,r,o,l,c,d,u,p,h,y,b,g,v,_,A){if(e&&t)throw new s("refinement with Huffman is not supported");var x,w,C=[];for(x=0;x<a;x++){if(w=new Uint8Array(i),n)for(var k=0;k<i;k++)w[k]=n;C.push(w)}var D=v.decoder,R=v.contextCache,I=e?-y.tableDeltaT.decode(A):-m(R,"IADT",D),M=0;for(x=0;x<r;){I+=e?y.tableDeltaT.decode(A):m(R,"IADT",D);for(var T=M+=e?y.tableFirstS.decode(A):m(R,"IAFS",D);;){var P=0;o>1&&(P=e?A.readBits(_):m(R,"IAIT",D));var z=o*I+P,B=e?y.symbolIDTable.decode(A):f(R,D,c),F=t&&(e?A.readBit():m(R,"IARI",D)),E=l[B],N=E[0].length,O=E.length;if(F){var G=m(R,"IARDW",D),L=m(R,"IARDH",D);E=S(N+=G,O+=L,b,E,(G>>1)+m(R,"IARDX",D),(L>>1)+m(R,"IARDY",D),!1,g,v)}var j=z-(1&p?0:O-1),q=T-(2&p?N-1:0),H=void 0,U=void 0,Y=void 0;if(d){for(H=0;H<O;H++)if(w=C[q+H]){Y=E[H];var X=Math.min(i-j,N);switch(h){case 0:for(U=0;U<X;U++)w[j+U]|=Y[U];break;case 2:for(U=0;U<X;U++)w[j+U]^=Y[U];break;default:throw new s("operator ".concat(h," is not supported"))}}T+=O-1}else{for(U=0;U<O;U++)if(w=C[j+U])switch(Y=E[U],h){case 0:for(H=0;H<N;H++)w[q+H]|=Y[H];break;case 2:for(H=0;H<N;H++)w[q+H]^=Y[H];break;default:throw new s("operator ".concat(h," is not supported"))}T+=N-1}x++;var V=e?y.tableDeltaS.decode(A):m(R,"IADS",D);if(null===V)break;T+=V+u}}return C}function k(e,t){var i={};i.number=(0,n.readUint32)(e,t);var a=e[t+4],r=63&a;if(!y[r])throw new s("invalid segment type: "+r);i.type=r,i.typeName=y[r],i.deferredNonRetain=!!(128&a);var o=!!(64&a),l=e[t+5],c=l>>5&7,d=[31&l],u=t+6;if(7===l){c=536870911&(0,n.readUint32)(e,u-1),u+=3;var p=c+7>>3;for(d[0]=e[u++];--p>0;)d.push(e[u++])}else if(5===l||6===l)throw new s("invalid referred-to flags");i.retainBits=d;var m=4;i.number<=256?m=1:i.number<=65536&&(m=2);var h,f,b=[];for(h=0;h<c;h++){var g=void 0;g=1===m?e[u]:2===m?(0,n.readUint16)(e,u):(0,n.readUint32)(e,u),b.push(g),u+=m}if(i.referredTo=b,o?(i.pageAssociation=(0,n.readUint32)(e,u),u+=4):i.pageAssociation=e[u++],i.length=(0,n.readUint32)(e,u),u+=4,4294967295===i.length){if(38!==r)throw new s("invalid unknown segment length");var v=R(e,u),_=!!(1&e[u+I]),A=new Uint8Array(6);for(_||(A[0]=255,A[1]=172),A[2]=v.height>>>24&255,A[3]=v.height>>16&255,A[4]=v.height>>8&255,A[5]=255&v.height,h=u,f=e.length;h<f;h++){for(var x=0;x<6&&A[x]===e[h+x];)x++;if(6===x){i.length=h+6;break}}if(4294967295===i.length)throw new s("segment end was not found")}return i.headerEnd=u,i}function D(e,t,i,a){for(var n=[],r=i;r<a;){var o=k(t,r);r=o.headerEnd;var s={header:o,data:t};if(e.randomAccess||(s.start=r,r+=o.length,s.end=r),n.push(s),51===o.type)break}if(e.randomAccess)for(var l=0,c=n.length;l<c;l++)n[l].start=r,r+=n[l].header.length,n[l].end=r;return n}function R(e,t){return{width:(0,n.readUint32)(e,t),height:(0,n.readUint32)(e,t+4),x:(0,n.readUint32)(e,t+8),y:(0,n.readUint32)(e,t+12),combinationOperator:7&e[t+16]}}var I=17;function M(e,t){var i,a,r,o,l=e.header,c=e.data,d=e.end,u=e.start;switch(l.type){case 0:var p={},m=(0,n.readUint16)(c,u);if(p.huffman=!!(1&m),p.refinement=!!(2&m),p.huffmanDHSelector=m>>2&3,p.huffmanDWSelector=m>>4&3,p.bitmapSizeSelector=m>>6&1,p.aggregationInstancesSelector=m>>7&1,p.bitmapCodingContextUsed=!!(256&m),p.bitmapCodingContextRetained=!!(512&m),p.template=m>>10&3,p.refinementTemplate=m>>12&1,u+=2,!p.huffman){for(o=0===p.template?4:1,a=[],r=0;r<o;r++)a.push({x:(0,n.readInt8)(c,u),y:(0,n.readInt8)(c,u+1)}),u+=2;p.at=a}if(p.refinement&&!p.refinementTemplate){for(a=[],r=0;r<2;r++)a.push({x:(0,n.readInt8)(c,u),y:(0,n.readInt8)(c,u+1)}),u+=2;p.refinementAt=a}p.numberOfExportedSymbols=(0,n.readUint32)(c,u),u+=4,p.numberOfNewSymbols=(0,n.readUint32)(c,u),u+=4,i=[p,l.number,l.referredTo,c,u,d];break;case 6:case 7:var h={};h.info=R(c,u),u+=I;var f=(0,n.readUint16)(c,u);if(u+=2,h.huffman=!!(1&f),h.refinement=!!(2&f),h.logStripSize=f>>2&3,h.stripSize=1<<h.logStripSize,h.referenceCorner=f>>4&3,h.transposed=!!(64&f),h.combinationOperator=f>>7&3,h.defaultPixelValue=f>>9&1,h.dsOffset=f<<17>>27,h.refinementTemplate=f>>15&1,h.huffman){var y=(0,n.readUint16)(c,u);u+=2,h.huffmanFS=3&y,h.huffmanDS=y>>2&3,h.huffmanDT=y>>4&3,h.huffmanRefinementDW=y>>6&3,h.huffmanRefinementDH=y>>8&3,h.huffmanRefinementDX=y>>10&3,h.huffmanRefinementDY=y>>12&3,h.huffmanRefinementSizeSelector=!!(16384&y)}if(h.refinement&&!h.refinementTemplate){for(a=[],r=0;r<2;r++)a.push({x:(0,n.readInt8)(c,u),y:(0,n.readInt8)(c,u+1)}),u+=2;h.refinementAt=a}h.numberOfSymbolInstances=(0,n.readUint32)(c,u),u+=4,i=[h,l.referredTo,c,u,d];break;case 16:var b={},g=c[u++];b.mmr=!!(1&g),b.template=g>>1&3,b.patternWidth=c[u++],b.patternHeight=c[u++],b.maxPatternIndex=(0,n.readUint32)(c,u),u+=4,i=[b,l.number,c,u,d];break;case 22:case 23:var v={};v.info=R(c,u),u+=I;var _=c[u++];v.mmr=!!(1&_),v.template=_>>1&3,v.enableSkip=!!(8&_),v.combinationOperator=_>>4&7,v.defaultPixelValue=_>>7&1,v.gridWidth=(0,n.readUint32)(c,u),u+=4,v.gridHeight=(0,n.readUint32)(c,u),u+=4,v.gridOffsetX=4294967295&(0,n.readUint32)(c,u),u+=4,v.gridOffsetY=4294967295&(0,n.readUint32)(c,u),u+=4,v.gridVectorX=(0,n.readUint16)(c,u),u+=2,v.gridVectorY=(0,n.readUint16)(c,u),u+=2,i=[v,l.referredTo,c,u,d];break;case 38:case 39:var A={};A.info=R(c,u),u+=I;var x=c[u++];if(A.mmr=!!(1&x),A.template=x>>1&3,A.prediction=!!(8&x),!A.mmr){for(o=0===A.template?4:1,a=[],r=0;r<o;r++)a.push({x:(0,n.readInt8)(c,u),y:(0,n.readInt8)(c,u+1)}),u+=2;A.at=a}i=[A,c,u,d];break;case 48:var w={width:(0,n.readUint32)(c,u),height:(0,n.readUint32)(c,u+4),resolutionX:(0,n.readUint32)(c,u+8),resolutionY:(0,n.readUint32)(c,u+12)};4294967295===w.height&&delete w.height;var S=c[u+16];(0,n.readUint16)(c,u+17),w.lossless=!!(1&S),w.refinement=!!(2&S),w.defaultPixelValue=S>>2&1,w.combinationOperator=S>>3&3,w.requiresBuffer=!!(32&S),w.combinationOperatorOverride=!!(64&S),i=[w];break;case 49:case 50:case 51:case 62:break;case 53:i=[l.number,c,u,d];break;default:throw new s("segment type ".concat(l.typeName,"(").concat(l.type,") is not implemented"))}var C="on"+l.typeName;C in t&&t[C].apply(t,i)}function T(e,t){for(var i=0,a=e.length;i<a;i++)M(e[i],t)}var P=function(){function e(){b(this,e)}return g(e,[{key:"onPageInformation",value:function(e){this.currentPageInfo=e;var t=e.width+7>>3,i=new Uint8ClampedArray(t*e.height);e.defaultPixelValue&&i.fill(255),this.buffer=i}},{key:"drawBitmap",value:function(e,t){var i,a,n,r,o=this.currentPageInfo,l=e.width,c=e.height,d=o.width+7>>3,u=o.combinationOperatorOverride?e.combinationOperator:o.combinationOperator,p=this.buffer,m=128>>(7&e.x),h=e.y*d+(e.x>>3);switch(u){case 0:for(i=0;i<c;i++){for(n=m,r=h,a=0;a<l;a++)t[i][a]&&(p[r]|=n),(n>>=1)||(n=128,r++);h+=d}break;case 2:for(i=0;i<c;i++){for(n=m,r=h,a=0;a<l;a++)t[i][a]&&(p[r]^=n),(n>>=1)||(n=128,r++);h+=d}break;default:throw new s("operator ".concat(u," is not supported"))}}},{key:"onImmediateGenericRegion",value:function(e,t,i,a){var n=e.info,r=new p(t,i,a),o=w(e.mmr,n.width,n.height,e.template,e.prediction,null,e.at,r);this.drawBitmap(n,o)}},{key:"onImmediateLosslessGenericRegion",value:function(){this.onImmediateGenericRegion.apply(this,arguments)}},{key:"onSymbolDictionary",value:function(e,t,i,a,r,o){var l,d;e.huffman&&(l=function(e,t,i){var a,n,r,o,l=0;switch(e.huffmanDHSelector){case 0:case 1:a=N(e.huffmanDHSelector+4);break;case 3:a=G(l,t,i),l++;break;default:throw new s("invalid Huffman DH selector")}switch(e.huffmanDWSelector){case 0:case 1:n=N(e.huffmanDWSelector+2);break;case 3:n=G(l,t,i),l++;break;default:throw new s("invalid Huffman DW selector")}return e.bitmapSizeSelector?(r=G(l,t,i),l++):r=N(1),o=e.aggregationInstancesSelector?G(l,t,i):N(1),{tableDeltaHeight:a,tableDeltaWidth:n,tableBitmapSize:r,tableAggregateInstances:o}}(e,i,this.customTables),d=new O(a,r,o));var u=this.symbols;u||(this.symbols=u={});var y,b=[],g=h(i);try{for(g.s();!(y=g.n()).done;){var v=u[y.value];v&&b.push.apply(b,c(v))}}catch(A){g.e(A)}finally{g.f()}var _=new p(a,r,o);u[t]=function(e,t,i,a,r,o,l,c,d,u,p,h){if(e&&t)throw new s("symbol refinement with Huffman is not supported");var y,b,g=[],v=0,_=(0,n.log2)(i.length+a),A=p.decoder,x=p.contextCache;for(e&&(y=N(1),b=[],_=Math.max(_,1));g.length<a;){v+=e?o.tableDeltaHeight.decode(h):m(x,"IADH",A);for(var k=0,D=0,R=e?b.length:0;;){var I=e?o.tableDeltaWidth.decode(h):m(x,"IADW",A);if(null===I)break;D+=k+=I;var M=void 0;if(t){var T=m(x,"IAAI",A);if(T>1)M=C(e,t,k,v,0,T,1,i.concat(g),_,0,0,1,0,o,d,u,p,0,h);else{var P=f(x,A,_),z=m(x,"IARDX",A),B=m(x,"IARDY",A);M=S(k,v,d,P<i.length?i[P]:g[P-i.length],z,B,!1,u,p)}g.push(M)}else e?b.push(k):(M=w(!1,k,v,l,!1,null,c,p),g.push(M))}if(e&&!t){var F=o.tableBitmapSize.decode(h);h.byteAlign();var E=void 0;if(0===F)E=L(h,D,v);else{var O=h.end,G=h.position+F;h.end=G,E=j(h,D,v,!1),h.end=O,h.position=G}var q=b.length;if(R===q-1)g.push(E);else{var H=void 0,U=void 0,Y=0,X=void 0,V=void 0;for(H=R;H<q;H++){for(X=Y+b[H],V=[],U=0;U<v;U++)V.push(E[U].subarray(Y,X));g.push(V),Y=X}}}}for(var Q,W,Z=[],J=[],K=!1,$=i.length+a;J.length<$;){for(var ee=e?y.decode(h):m(x,"IAEX",A);ee--;)J.push(K);K=!K}for(Q=0,W=i.length;Q<W;Q++)J[Q]&&Z.push(i[Q]);for(var te=0;te<a;Q++,te++)J[Q]&&Z.push(g[te]);return Z}(e.huffman,e.refinement,b,e.numberOfNewSymbols,e.numberOfExportedSymbols,l,e.template,e.at,e.refinementTemplate,e.refinementAt,_,d)}},{key:"onImmediateTextRegion",value:function(e,t,i,a,r){var o,l,d,u=e.info,m=this.symbols,f=[],y=h(t);try{for(y.s();!(d=y.n()).done;){var b=m[d.value];b&&f.push.apply(f,c(b))}}catch(A){y.e(A)}finally{y.f()}var g=(0,n.log2)(f.length);e.huffman&&(l=new O(i,a,r),o=function(e,t,i,a,n){for(var r=[],o=0;o<=34;o++){var l=n.readBits(4);r.push(new z([o,l,0,0]))}var c=new F(r,!1);r.length=0;for(var d=0;d<a;){var u=c.decode(n);if(u>=32){var p=void 0,m=void 0,h=void 0;switch(u){case 32:if(0===d)throw new s("no previous value in symbol ID table");m=n.readBits(2)+3,p=r[d-1].prefixLength;break;case 33:m=n.readBits(3)+3,p=0;break;case 34:m=n.readBits(7)+11,p=0;break;default:throw new s("invalid code length in symbol ID table")}for(h=0;h<m;h++)r.push(new z([d,p,0,0])),d++}else r.push(new z([d,u,0,0])),d++}n.byteAlign();var f,y,b,g=new F(r,!1),v=0;switch(e.huffmanFS){case 0:case 1:f=N(e.huffmanFS+6);break;case 3:f=G(v,t,i),v++;break;default:throw new s("invalid Huffman FS selector")}switch(e.huffmanDS){case 0:case 1:case 2:y=N(e.huffmanDS+8);break;case 3:y=G(v,t,i),v++;break;default:throw new s("invalid Huffman DS selector")}switch(e.huffmanDT){case 0:case 1:case 2:b=N(e.huffmanDT+11);break;case 3:b=G(v,t,i),v++;break;default:throw new s("invalid Huffman DT selector")}if(e.refinement)throw new s("refinement with Huffman is not supported");return{symbolIDTable:g,tableFirstS:f,tableDeltaS:y,tableDeltaT:b}}(e,t,this.customTables,f.length,l));var v=new p(i,a,r),_=C(e.huffman,e.refinement,u.width,u.height,e.defaultPixelValue,e.numberOfSymbolInstances,e.stripSize,f,g,e.transposed,e.dsOffset,e.referenceCorner,e.combinationOperator,o,e.refinementTemplate,e.refinementAt,v,e.logStripSize,l);this.drawBitmap(u,_)}},{key:"onImmediateLosslessTextRegion",value:function(){this.onImmediateTextRegion.apply(this,arguments)}},{key:"onPatternDictionary",value:function(e,t,i,a,n){var r=this.patterns;r||(this.patterns=r={});var o=new p(i,a,n);r[t]=function(e,t,i,a,n,r){var o=[];e||(o.push({x:-t,y:0}),0===n&&o.push({x:-3,y:-1},{x:2,y:-2},{x:-2,y:-2}));for(var s=w(e,(a+1)*t,i,n,!1,null,o,r),l=[],c=0;c<=a;c++){for(var d=[],u=t*c,p=u+t,m=0;m<i;m++)d.push(s[m].subarray(u,p));l.push(d)}return l}(e.mmr,e.patternWidth,e.patternHeight,e.maxPatternIndex,e.template,o)}},{key:"onImmediateHalftoneRegion",value:function(e,t,i,a,r){var o=this.patterns[t[0]],l=e.info,c=new p(i,a,r),d=function(e,t,i,a,r,o,l,c,d,u,p,m,h,f,y){if(l)throw new s("skip is not supported");if(0!==c)throw new s('operator "'.concat(c,'" is not supported in halftone region'));var b,g,v,_=[];for(b=0;b<r;b++){if(v=new Uint8Array(a),o)for(g=0;g<a;g++)v[g]=o;_.push(v)}var A=t.length,x=t[0],S=x[0].length,C=x.length,k=(0,n.log2)(A),D=[];e||(D.push({x:i<=1?3:2,y:-1}),0===i&&D.push({x:-3,y:-1},{x:2,y:-2},{x:-2,y:-2}));var R,I,M,T,P,z,B,F,E,N,G,L=[];for(e&&(R=new O(y.data,y.start,y.end)),b=k-1;b>=0;b--)I=e?j(R,d,u,!0):w(!1,d,u,i,!1,null,D,y),L[b]=I;for(M=0;M<u;M++)for(T=0;T<d;T++){for(P=0,z=0,g=k-1;g>=0;g--)z|=(P^=L[g][M][T])<<g;if(B=t[z],E=m+M*h-T*f>>8,(F=p+M*f+T*h>>8)>=0&&F+S<=a&&E>=0&&E+C<=r)for(b=0;b<C;b++)for(G=_[E+b],N=B[b],g=0;g<S;g++)G[F+g]|=N[g];else{var q=void 0,H=void 0;for(b=0;b<C;b++)if(!((H=E+b)<0||H>=r))for(G=_[H],N=B[b],g=0;g<S;g++)(q=F+g)>=0&&q<a&&(G[q]|=N[g])}}return _}(e.mmr,o,e.template,l.width,l.height,e.defaultPixelValue,e.enableSkip,e.combinationOperator,e.gridWidth,e.gridHeight,e.gridOffsetX,e.gridOffsetY,e.gridVectorX,e.gridVectorY,c);this.drawBitmap(l,d)}},{key:"onImmediateLosslessHalftoneRegion",value:function(){this.onImmediateHalftoneRegion.apply(this,arguments)}},{key:"onTables",value:function(e,t,i,a){var r=this.customTables;r||(this.customTables=r={}),r[e]=function(e,t,i){var a,r,o=e[t],s=4294967295&(0,n.readUint32)(e,t+1),l=4294967295&(0,n.readUint32)(e,t+5),c=new O(e,t+9,i),d=1+(o>>1&7),u=1+(o>>4&7),p=[],m=s;do{a=c.readBits(d),r=c.readBits(u),p.push(new z([m,a,r,0])),m+=1<<r}while(m<l);return a=c.readBits(d),p.push(new z([s-1,a,32,0,"lower"])),a=c.readBits(d),p.push(new z([l,a,32,0])),1&o&&(a=c.readBits(d),p.push(new z([a,0]))),new F(p,!1)}(t,i,a)}}]),e}(),z=g((function e(t){b(this,e),2===t.length?(this.isOOB=!0,this.rangeLow=0,this.prefixLength=t[0],this.rangeLength=0,this.prefixCode=t[1],this.isLowerRange=!1):(this.isOOB=!1,this.rangeLow=t[0],this.prefixLength=t[1],this.rangeLength=t[2],this.prefixCode=t[3],this.isLowerRange="lower"===t[4])})),B=function(){function e(t){b(this,e),this.children=[],t?(this.isLeaf=!0,this.rangeLength=t.rangeLength,this.rangeLow=t.rangeLow,this.isLowerRange=t.isLowerRange,this.isOOB=t.isOOB):this.isLeaf=!1}return g(e,[{key:"buildTree",value:function(t,i){var a=t.prefixCode>>i&1;if(i<=0)this.children[a]=new e(t);else{var n=this.children[a];n||(this.children[a]=n=new e(null)),n.buildTree(t,i-1)}}},{key:"decodeNode",value:function(e){if(this.isLeaf){if(this.isOOB)return null;var t=e.readBits(this.rangeLength);return this.rangeLow+(this.isLowerRange?-t:t)}var i=this.children[e.readBit()];if(!i)throw new s("invalid Huffman data");return i.decodeNode(e)}}]),e}(),F=function(){function e(t,i){b(this,e),i||this.assignPrefixCodes(t),this.rootNode=new B(null);for(var a=0,n=t.length;a<n;a++){var r=t[a];r.prefixLength>0&&this.rootNode.buildTree(r,r.prefixLength-1)}}return g(e,[{key:"decode",value:function(e){return this.rootNode.decodeNode(e)}},{key:"assignPrefixCodes",value:function(e){for(var t=e.length,i=0,a=0;a<t;a++)i=Math.max(i,e[a].prefixLength);for(var n=new Uint32Array(i+1),r=0;r<t;r++)n[e[r].prefixLength]++;var o,s,l,c=1,d=0;for(n[0]=0;c<=i;){for(o=d=d+n[c-1]<<1,s=0;s<t;)(l=e[s]).prefixLength===c&&(l.prefixCode=o,o++),s++;c++}}}]),e}(),E={};function N(e){var t,i=E[e];if(i)return i;switch(e){case 1:t=[[0,1,4,0],[16,2,8,2],[272,3,16,6],[65808,3,32,7]];break;case 2:t=[[0,1,0,0],[1,2,0,2],[2,3,0,6],[3,4,3,14],[11,5,6,30],[75,6,32,62],[6,63]];break;case 3:t=[[-256,8,8,254],[0,1,0,0],[1,2,0,2],[2,3,0,6],[3,4,3,14],[11,5,6,30],[-257,8,32,255,"lower"],[75,7,32,126],[6,62]];break;case 4:t=[[1,1,0,0],[2,2,0,2],[3,3,0,6],[4,4,3,14],[12,5,6,30],[76,5,32,31]];break;case 5:t=[[-255,7,8,126],[1,1,0,0],[2,2,0,2],[3,3,0,6],[4,4,3,14],[12,5,6,30],[-256,7,32,127,"lower"],[76,6,32,62]];break;case 6:t=[[-2048,5,10,28],[-1024,4,9,8],[-512,4,8,9],[-256,4,7,10],[-128,5,6,29],[-64,5,5,30],[-32,4,5,11],[0,2,7,0],[128,3,7,2],[256,3,8,3],[512,4,9,12],[1024,4,10,13],[-2049,6,32,62,"lower"],[2048,6,32,63]];break;case 7:t=[[-1024,4,9,8],[-512,3,8,0],[-256,4,7,9],[-128,5,6,26],[-64,5,5,27],[-32,4,5,10],[0,4,5,11],[32,5,5,28],[64,5,6,29],[128,4,7,12],[256,3,8,1],[512,3,9,2],[1024,3,10,3],[-1025,5,32,30,"lower"],[2048,5,32,31]];break;case 8:t=[[-15,8,3,252],[-7,9,1,508],[-5,8,1,253],[-3,9,0,509],[-2,7,0,124],[-1,4,0,10],[0,2,1,0],[2,5,0,26],[3,6,0,58],[4,3,4,4],[20,6,1,59],[22,4,4,11],[38,4,5,12],[70,5,6,27],[134,5,7,28],[262,6,7,60],[390,7,8,125],[646,6,10,61],[-16,9,32,510,"lower"],[1670,9,32,511],[2,1]];break;case 9:t=[[-31,8,4,252],[-15,9,2,508],[-11,8,2,253],[-7,9,1,509],[-5,7,1,124],[-3,4,1,10],[-1,3,1,2],[1,3,1,3],[3,5,1,26],[5,6,1,58],[7,3,5,4],[39,6,2,59],[43,4,5,11],[75,4,6,12],[139,5,7,27],[267,5,8,28],[523,6,8,60],[779,7,9,125],[1291,6,11,61],[-32,9,32,510,"lower"],[3339,9,32,511],[2,0]];break;case 10:t=[[-21,7,4,122],[-5,8,0,252],[-4,7,0,123],[-3,5,0,24],[-2,2,2,0],[2,5,0,25],[3,6,0,54],[4,7,0,124],[5,8,0,253],[6,2,6,1],[70,5,5,26],[102,6,5,55],[134,6,6,56],[198,6,7,57],[326,6,8,58],[582,6,9,59],[1094,6,10,60],[2118,7,11,125],[-22,8,32,254,"lower"],[4166,8,32,255],[2,2]];break;case 11:t=[[1,1,0,0],[2,2,1,2],[4,4,0,12],[5,4,1,13],[7,5,1,28],[9,5,2,29],[13,6,2,60],[17,7,2,122],[21,7,3,123],[29,7,4,124],[45,7,5,125],[77,7,6,126],[141,7,32,127]];break;case 12:t=[[1,1,0,0],[2,2,0,2],[3,3,1,6],[5,5,0,28],[6,5,1,29],[8,6,1,60],[10,7,0,122],[11,7,1,123],[13,7,2,124],[17,7,3,125],[25,7,4,126],[41,8,5,254],[73,8,32,255]];break;case 13:t=[[1,1,0,0],[2,3,0,4],[3,4,0,12],[4,5,0,28],[5,4,1,13],[7,3,3,5],[15,6,1,58],[17,6,2,59],[21,6,3,60],[29,6,4,61],[45,6,5,62],[77,7,6,126],[141,7,32,127]];break;case 14:t=[[-2,3,0,4],[-1,3,0,5],[0,1,0,0],[1,3,0,6],[2,3,0,7]];break;case 15:t=[[-24,7,4,124],[-8,6,2,60],[-4,5,1,28],[-2,4,0,12],[-1,3,0,4],[0,1,0,0],[1,3,0,5],[2,4,0,13],[3,5,1,29],[5,6,2,61],[9,7,4,125],[-25,7,32,126,"lower"],[25,7,32,127]];break;default:throw new s("standard table B.".concat(e," does not exist"))}for(var a=0,n=t.length;a<n;a++)t[a]=new z(t[a]);return i=new F(t,!0),E[e]=i,i}var O=function(){function e(t,i,a){b(this,e),this.data=t,this.start=i,this.end=a,this.position=i,this.shift=-1,this.currentByte=0}return g(e,[{key:"readBit",value:function(){if(this.shift<0){if(this.position>=this.end)throw new s("end of data while reading bit");this.currentByte=this.data[this.position++],this.shift=7}var e=this.currentByte>>this.shift&1;return this.shift--,e}},{key:"readBits",value:function(e){var t,i=0;for(t=e-1;t>=0;t--)i|=this.readBit()<<t;return i}},{key:"byteAlign",value:function(){this.shift=-1}},{key:"next",value:function(){return this.position>=this.end?-1:this.data[this.position++]}}]),e}();function G(e,t,i){for(var a=0,n=0,r=t.length;n<r;n++){var o=i[t[n]];if(o){if(e===a)return o;a++}}throw new s("can't find custom Huffman table")}function L(e,t,i){for(var a=[],n=0;n<i;n++){var r=new Uint8Array(t);a.push(r);for(var o=0;o<t;o++)r[o]=e.readBit();e.byteAlign()}return a}function j(e,t,i,a){for(var n,r={K:-1,Columns:t,Rows:i,BlackIs1:!0,EndOfBlock:a},s=new o.CCITTFaxDecoder(e,r),l=[],c=!1,d=0;d<i;d++){var u=new Uint8Array(t);l.push(u);for(var p=-1,m=0;m<t;m++)p<0&&(-1===(n=s.readNextChar())&&(n=0,c=!0),p=7),u[m]=n>>p&1,p--}if(a&&!c)for(var h=0;h<5&&-1!==s.readNextChar();h++);return l}var q=function(){function e(){b(this,e)}return g(e,[{key:"parseChunks",value:function(e){return function(e){for(var t=new P,i=0,a=e.length;i<a;i++){var n=e[i];T(D({},n.data,n.start,n.end),t)}return t.buffer}(e)}},{key:"parse",value:function(e){throw new Error("Not implemented: Jbig2Image.parse")}}]),e}();t.Jbig2Image=q},function(e,t){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.ArithmeticDecoder=void 0;var i=[{qe:22017,nmps:1,nlps:1,switchFlag:1},{qe:13313,nmps:2,nlps:6,switchFlag:0},{qe:6145,nmps:3,nlps:9,switchFlag:0},{qe:2753,nmps:4,nlps:12,switchFlag:0},{qe:1313,nmps:5,nlps:29,switchFlag:0},{qe:545,nmps:38,nlps:33,switchFlag:0},{qe:22017,nmps:7,nlps:6,switchFlag:1},{qe:21505,nmps:8,nlps:14,switchFlag:0},{qe:18433,nmps:9,nlps:14,switchFlag:0},{qe:14337,nmps:10,nlps:14,switchFlag:0},{qe:12289,nmps:11,nlps:17,switchFlag:0},{qe:9217,nmps:12,nlps:18,switchFlag:0},{qe:7169,nmps:13,nlps:20,switchFlag:0},{qe:5633,nmps:29,nlps:21,switchFlag:0},{qe:22017,nmps:15,nlps:14,switchFlag:1},{qe:21505,nmps:16,nlps:14,switchFlag:0},{qe:20737,nmps:17,nlps:15,switchFlag:0},{qe:18433,nmps:18,nlps:16,switchFlag:0},{qe:14337,nmps:19,nlps:17,switchFlag:0},{qe:13313,nmps:20,nlps:18,switchFlag:0},{qe:12289,nmps:21,nlps:19,switchFlag:0},{qe:10241,nmps:22,nlps:19,switchFlag:0},{qe:9217,nmps:23,nlps:20,switchFlag:0},{qe:8705,nmps:24,nlps:21,switchFlag:0},{qe:7169,nmps:25,nlps:22,switchFlag:0},{qe:6145,nmps:26,nlps:23,switchFlag:0},{qe:5633,nmps:27,nlps:24,switchFlag:0},{qe:5121,nmps:28,nlps:25,switchFlag:0},{qe:4609,nmps:29,nlps:26,switchFlag:0},{qe:4353,nmps:30,nlps:27,switchFlag:0},{qe:2753,nmps:31,nlps:28,switchFlag:0},{qe:2497,nmps:32,nlps:29,switchFlag:0},{qe:2209,nmps:33,nlps:30,switchFlag:0},{qe:1313,nmps:34,nlps:31,switchFlag:0},{qe:1089,nmps:35,nlps:32,switchFlag:0},{qe:673,nmps:36,nlps:33,switchFlag:0},{qe:545,nmps:37,nlps:34,switchFlag:0},{qe:321,nmps:38,nlps:35,switchFlag:0},{qe:273,nmps:39,nlps:36,switchFlag:0},{qe:133,nmps:40,nlps:37,switchFlag:0},{qe:73,nmps:41,nlps:38,switchFlag:0},{qe:37,nmps:42,nlps:39,switchFlag:0},{qe:21,nmps:43,nlps:40,switchFlag:0},{qe:9,nmps:44,nlps:41,switchFlag:0},{qe:5,nmps:45,nlps:42,switchFlag:0},{qe:1,nmps:45,nlps:43,switchFlag:0},{qe:22017,nmps:46,nlps:46,switchFlag:0}],a=function(){function e(t,i,a){b(this,e),this.data=t,this.bp=i,this.dataEnd=a,this.chigh=t[i],this.clow=0,this.byteIn(),this.chigh=this.chigh<<7&65535|this.clow>>9&127,this.clow=this.clow<<7&65535,this.ct-=7,this.a=32768}return g(e,[{key:"byteIn",value:function(){var e=this.data,t=this.bp;255===e[t]?e[t+1]>143?(this.clow+=65280,this.ct=8):(t++,this.clow+=e[t]<<9,this.ct=7,this.bp=t):(t++,this.clow+=t<this.dataEnd?e[t]<<8:65280,this.ct=8,this.bp=t),this.clow>65535&&(this.chigh+=this.clow>>16,this.clow&=65535)}},{key:"readBit",value:function(e,t){var a,n=e[t]>>1,r=1&e[t],o=i[n],s=o.qe,l=this.a-s;if(this.chigh<s)l<s?(l=s,a=r,n=o.nmps):(l=s,a=1^r,1===o.switchFlag&&(r=a),n=o.nlps);else{if(this.chigh-=s,0!==(32768&l))return this.a=l,r;l<s?(a=1^r,1===o.switchFlag&&(r=a),n=o.nlps):(a=r,n=o.nmps)}do{0===this.ct&&this.byteIn(),l<<=1,this.chigh=this.chigh<<1&65535|this.clow>>15&1,this.clow=this.clow<<1&65535,this.ct--}while(0===(32768&l));return this.a=l,e[t]=n<<1|r,a}}]),e}();t.ArithmeticDecoder=a},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.JpegStream=void 0;var a=i(144),n=i(130),r=i(153),o=i(2),s=function(e){d(i,e);var t=u(i);function i(e,a,n){var r,o;for(b(this,i);-1!==(o=e.getByte());)if(255===o){e.skip(-1);break}return(r=t.call(this,a)).stream=e,r.dict=e.dict,r.maybeLength=a,r.params=n,r}return g(i,[{key:"bytes",get:function(){return(0,o.shadow)(this,"bytes",this.stream.getBytes(this.maybeLength))}},{key:"ensureBuffer",value:function(e){}},{key:"readBlock",value:function(){if(!this.eof){var e={decodeTransform:void 0,colorTransform:void 0},t=this.dict.getArray("D","Decode");if(this.forceRGB&&Array.isArray(t)){for(var i=this.dict.get("BPC","BitsPerComponent")||8,a=t.length,o=new Int32Array(a),s=!1,l=(1<<i)-1,c=0;c<a;c+=2)o[c]=256*(t[c+1]-t[c])|0,o[c+1]=t[c]*l|0,256===o[c]&&0===o[c+1]||(s=!0);s&&(e.decodeTransform=o)}if(this.params instanceof n.Dict){var d=this.params.get("ColorTransform");Number.isInteger(d)&&(e.colorTransform=d)}var u=new r.JpegImage(e);u.parse(this.bytes);var p=u.getData({width:this.drawWidth,height:this.drawHeight,forceRGB:this.forceRGB,isSourcePDF:!0});this.buffer=p,this.bufferLength=p.length,this.eof=!0}}}]),i}(a.DecodeStream);t.JpegStream=s},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.JpegImage=void 0;var a=i(2),n=i(131),r=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,"JPEG error: ".concat(e),"JpegError")}return g(i)}(a.BaseException),o=function(e){d(i,e);var t=u(i);function i(e,a){var n;return b(this,i),(n=t.call(this,e,"DNLMarkerError")).scanLines=a,n}return g(i)}(a.BaseException),s=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"EOIMarkerError")}return g(i)}(a.BaseException),l=new 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new o("Found DNL marker (0xFFDC) while parsing scan data",l)}else if(217===a){if(f){var c=M*(8===i.precision?8:0);if(c>0&&Math.round(i.scanLines/c)>=10)throw new o("Found EOI marker (0xFFD9) while parsing scan data, possibly caused by incorrect `scanLines` parameter",c)}throw new s("Found EOI marker (0xFFD9) while parsing scan data")}throw new r("unexpected marker ".concat((v<<8|a).toString(16)))}}return _=7,v>>>7}function w(e){for(var t=e;;){switch(typeof(t=t[A()])){case"number":return t;case"object":continue}throw new r("invalid huffman sequence")}}function S(e){for(var t=0;e>0;)t=t<<1|A(),e--;return t}function C(e){if(1===e)return 1===A()?1:-1;var t=S(e);return t>=1<<e-1?t:t+(-1<<e)+1}var D,R=0,I=0,M=0;function T(e,t,i,a,n){var r=i%y;M=(i/y|0)*e.v+a;var o=r*e.h+n;t(e,x(e,M,o))}function P(e,t,i){M=i/e.blocksPerLine|0;var a=i%e.blocksPerLine;t(e,x(e,M,a))}var z,B,F,E,N,O,G=c.length;O=b?0===u?0===m?function(e,t){var i=w(e.huffmanTableDC),a=0===i?0:C(i)<<h;e.blockData[t]=e.pred+=a}:function(e,t){e.blockData[t]|=A()<<h}:0===m?function(e,t){if(R>0)R--;else for(var i=u,a=p;i<=a;){var n=w(e.huffmanTableAC),r=15&n,o=n>>4;if(0!==r){var s=l[i+=o];e.blockData[t+s]=C(r)*(1<<h),i++}else{if(o<15){R=S(o)+(1<<o)-1;break}i+=16}}}:function(e,t){for(var i,a,n=u,o=p,s=0;n<=o;){var c=t+l[n],d=e.blockData[c]<0?-1:1;switch(I){case 0:if(s=(a=w(e.huffmanTableAC))>>4,0===(i=15&a))s<15?(R=S(s)+(1<<s),I=4):(s=16,I=1);else{if(1!==i)throw new r("invalid ACn encoding");D=C(i),I=s?2:3}continue;case 1:case 2:e.blockData[c]?e.blockData[c]+=d*(A()<<h):0===--s&&(I=2===I?3:0);break;case 3:e.blockData[c]?e.blockData[c]+=d*(A()<<h):(e.blockData[c]=D<<h,I=0);break;case 4:e.blockData[c]&&(e.blockData[c]+=d*(A()<<h))}n++}4===I&&0===--R&&(I=0)}:function(e,t){var i=w(e.huffmanTableDC),a=0===i?0:C(i);e.blockData[t]=e.pred+=a;for(var n=1;n<64;){var r=w(e.huffmanTableAC),o=15&r,s=r>>4;if(0!==o){var c=l[n+=s];e.blockData[t+c]=C(o),n++}else{if(s<15)break;n+=16}}};var L,j,q,H,U=0;for(j=1===G?c[0].blocksPerLine*c[0].blocksPerColumn:y*i.mcusPerColumn;U<=j;){var Y=d?Math.min(j-U,d):j;if(Y>0){for(B=0;B<G;B++)c[B].pred=0;if(R=0,1===G)for(z=c[0],N=0;N<Y;N++)P(z,O,U),U++;else for(N=0;N<Y;N++){for(B=0;B<G;B++)for(q=(z=c[B]).h,H=z.v,F=0;F<H;F++)for(E=0;E<q;E++)T(z,O,U,F,E);U++}}if(_=0,!(L=k(e,t)))break;if(L.invalid){var X=Y>0?"unexpected":"excessive";(0,a.warn)("decodeScan - ".concat(X," MCU data, current marker is: ").concat(L.invalid)),t=L.offset}if(!(L.marker>=65488&&L.marker<=65495))break;t+=2}return t-g}function S(e,t,i){var a,n,o,s,l,d,u,b,g,A,x,w,S,C,k,D,R,I=e.quantizationTable,M=e.blockData;if(!I)throw new r("missing required Quantization Table.");for(var T=0;T<64;T+=8)g=M[t+T],A=M[t+T+1],x=M[t+T+2],w=M[t+T+3],S=M[t+T+4],C=M[t+T+5],k=M[t+T+6],D=M[t+T+7],g*=I[T],0!==(A|x|w|S|C|k|D)?(A*=I[T+1],x*=I[T+2],w*=I[T+3],S*=I[T+4],C*=I[T+5],k*=I[T+6],D*=I[T+7],n=(a=(a=v*g+128>>8)+(n=v*S+128>>8)+1>>1)-n,R=(o=x)*y+(s=k)*f+128>>8,o=o*f-s*y+128>>8,u=(l=(l=_*(A-D)+128>>8)+(u=C<<4)+1>>1)-u,d=(b=(b=_*(A+D)+128>>8)+(d=w<<4)+1>>1)-d,s=(a=a+(s=R)+1>>1)-s,o=(n=n+o+1>>1)-o,R=l*h+b*m+2048>>12,l=l*m-b*h+2048>>12,b=R,R=d*p+u*c+2048>>12,d=d*c-u*p+2048>>12,u=R,i[T]=a+b,i[T+7]=a-b,i[T+1]=n+u,i[T+6]=n-u,i[T+2]=o+d,i[T+5]=o-d,i[T+3]=s+l,i[T+4]=s-l):(R=v*g+512>>10,i[T]=R,i[T+1]=R,i[T+2]=R,i[T+3]=R,i[T+4]=R,i[T+5]=R,i[T+6]=R,i[T+7]=R);for(var P=0;P<8;++P)g=i[P],0!==((A=i[P+8])|(x=i[P+16])|(w=i[P+24])|(S=i[P+32])|(C=i[P+40])|(k=i[P+48])|(D=i[P+56]))?(n=(a=4112+((a=v*g+2048>>12)+(n=v*S+2048>>12)+1>>1))-n,R=(o=x)*y+(s=k)*f+2048>>12,o=o*f-s*y+2048>>12,s=R,u=(l=(l=_*(A-D)+2048>>12)+(u=C)+1>>1)-u,d=(b=(b=_*(A+D)+2048>>12)+(d=w)+1>>1)-d,R=l*h+b*m+2048>>12,l=l*m-b*h+2048>>12,b=R,R=d*p+u*c+2048>>12,d=d*c-u*p+2048>>12,(g=(a=a+s+1>>1)+b)<16?g=0:g>=4080?g=255:g>>=4,(A=(n=n+o+1>>1)+(u=R))<16?A=0:A>=4080?A=255:A>>=4,(x=(o=n-o)+d)<16?x=0:x>=4080?x=255:x>>=4,(w=(s=a-s)+l)<16?w=0:w>=4080?w=255:w>>=4,(S=s-l)<16?S=0:S>=4080?S=255:S>>=4,(C=o-d)<16?C=0:C>=4080?C=255:C>>=4,(k=n-u)<16?k=0:k>=4080?k=255:k>>=4,(D=a-b)<16?D=0:D>=4080?D=255:D>>=4,M[t+P]=g,M[t+P+8]=A,M[t+P+16]=x,M[t+P+24]=w,M[t+P+32]=S,M[t+P+40]=C,M[t+P+48]=k,M[t+P+56]=D):(R=(R=v*g+8192>>14)<-2040?0:R>=2024?255:R+2056>>4,M[t+P]=R,M[t+P+8]=R,M[t+P+16]=R,M[t+P+24]=R,M[t+P+32]=R,M[t+P+40]=R,M[t+P+48]=R,M[t+P+56]=R)}function C(e,t){for(var i=t.blocksPerLine,a=t.blocksPerColumn,n=new Int16Array(64),r=0;r<a;r++)for(var o=0;o<i;o++)S(t,x(t,r,o),n);return t.blockData}function k(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:t,a=e.length-1,r=i<t?i:t;if(t>=a)return null;var o=(0,n.readUint16)(e,t);if(o>=65472&&o<=65534)return{invalid:null,marker:o,offset:t};for(var s=(0,n.readUint16)(e,r);!(s>=65472&&s<=65534);){if(++r>=a)return null;s=(0,n.readUint16)(e,r)}return{invalid:o.toString(16),marker:s,offset:r}}var D=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{},i=t.decodeTransform,a=void 0===i?null:i,n=t.colorTransform,r=void 0===n?-1:n;this._decodeTransform=a,this._colorTransform=r}return g(e,[{key:"parse",value:function(e){var t=(arguments.length>1&&void 0!==arguments[1]?arguments[1]:{}).dnlScanLines,i=void 0===t?null:t;function c(){var t=(0,n.readUint16)(e,m),i=(m+=2)+t-2,r=k(e,i,m);r&&r.invalid&&((0,a.warn)("readDataBlock - incorrect length, current marker is: "+r.invalid),i=r.offset);var o=e.subarray(m,i);return m+=o.length,o}function d(e){for(var t=Math.ceil(e.samplesPerLine/8/e.maxH),i=Math.ceil(e.scanLines/8/e.maxV),a=0,n=e.components.length;a<n;a++){var r=e.components[a],o=Math.ceil(Math.ceil(e.samplesPerLine/8)*r.h/e.maxH),s=Math.ceil(Math.ceil(e.scanLines/8)*r.v/e.maxV),l=t*r.h,c=i*r.v*64*(l+1);r.blockData=new Int16Array(c),r.blocksPerLine=o,r.blocksPerColumn=s}e.mcusPerLine=t,e.mcusPerColumn=i}var u,p,m=0,h=null,f=null,y=0,b=[],g=[],v=[],_=(0,n.readUint16)(e,m);if(m+=2,65496!==_)throw new r("SOI not found");_=(0,n.readUint16)(e,m),m+=2;e:for(;65497!==_;){var x=void 0,S=void 0,D=void 0;switch(_){case 65504:case 65505:case 65506:case 65507:case 65508:case 65509:case 65510:case 65511:case 65512:case 65513:case 65514:case 65515:case 65516:case 65517:case 65518:case 65519:case 65534:var R=c();65504===_&&74===R[0]&&70===R[1]&&73===R[2]&&70===R[3]&&0===R[4]&&(h={version:{major:R[5],minor:R[6]},densityUnits:R[7],xDensity:R[8]<<8|R[9],yDensity:R[10]<<8|R[11],thumbWidth:R[12],thumbHeight:R[13],thumbData:R.subarray(14,14+3*R[12]*R[13])}),65518===_&&65===R[0]&&100===R[1]&&111===R[2]&&98===R[3]&&101===R[4]&&(f={version:R[5]<<8|R[6],flags0:R[7]<<8|R[8],flags1:R[9]<<8|R[10],transformCode:R[11]});break;case 65499:for(var I=(0,n.readUint16)(e,m)+(m+=2)-2;m<I;){var M=e[m++],T=new Uint16Array(64);if(M>>4===0)for(S=0;S<64;S++)T[l[S]]=e[m++];else{if(M>>4!==1)throw new r("DQT - invalid table spec");for(S=0;S<64;S++)T[l[S]]=(0,n.readUint16)(e,m),m+=2}b[15&M]=T}break;case 65472:case 65473:case 65474:if(u)throw new r("Only single frame JPEGs supported");m+=2,(u={}).extended=65473===_,u.progressive=65474===_,u.precision=e[m++];var P=(0,n.readUint16)(e,m);m+=2,u.scanLines=i||P,u.samplesPerLine=(0,n.readUint16)(e,m),m+=2,u.components=[],u.componentIds={};var z=e[m++],B=0,F=0;for(x=0;x<z;x++){var E=e[m],N=e[m+1]>>4,O=15&e[m+1];B<N&&(B=N),F<O&&(F=O);var G=e[m+2];D=u.components.push({h:N,v:O,quantizationId:G,quantizationTable:null}),u.componentIds[E]=D-1,m+=3}u.maxH=B,u.maxV=F,d(u);break;case 65476:var L=(0,n.readUint16)(e,m);for(m+=2,x=2;x<L;){var j=e[m++],q=new Uint8Array(16),H=0;for(S=0;S<16;S++,m++)H+=q[S]=e[m];var U=new Uint8Array(H);for(S=0;S<H;S++,m++)U[S]=e[m];x+=17+H,(j>>4===0?v:g)[15&j]=A(q,U)}break;case 65501:m+=2,p=(0,n.readUint16)(e,m),m+=2;break;case 65498:var Y=1===++y&&!i;m+=2;var X=e[m++],V=[];for(x=0;x<X;x++){var Q=e[m++],W=u.componentIds[Q],Z=u.components[W];Z.index=Q;var J=e[m++];Z.huffmanTableDC=v[J>>4],Z.huffmanTableAC=g[15&J],V.push(Z)}var K=e[m++],$=e[m++],ee=e[m++];try{var te=w(e,m,u,V,p,K,$,ee>>4,15&ee,Y);m+=te}catch(se){if(se instanceof o)return(0,a.warn)("".concat(se.message," -- attempting to re-parse the JPEG image.")),this.parse(e,{dnlScanLines:se.scanLines});if(se instanceof s){(0,a.warn)("".concat(se.message," -- ignoring the rest of the image data."));break e}throw se}break;case 65500:m+=4;break;case 65535:255!==e[m]&&m--;break;default:var ie=k(e,m-2,m-3);if(ie&&ie.invalid){(0,a.warn)("JpegImage.parse - unexpected data, current marker is: "+ie.invalid),m=ie.offset;break}if(!ie||m>=e.length-1){(0,a.warn)("JpegImage.parse - reached the end of the image data without finding an EOI marker (0xFFD9).");break e}throw new r("JpegImage.parse - unknown marker: "+_.toString(16))}_=(0,n.readUint16)(e,m),m+=2}this.width=u.samplesPerLine,this.height=u.scanLines,this.jfif=h,this.adobe=f,this.components=[];for(var ae=0,ne=u.components.length;ae<ne;ae++){var re=u.components[ae],oe=b[re.quantizationId];oe&&(re.quantizationTable=oe),this.components.push({index:re.index,output:C(0,re),scaleX:re.h/u.maxH,scaleY:re.v/u.maxV,blocksPerLine:re.blocksPerLine,blocksPerColumn:re.blocksPerColumn})}this.numComponents=this.components.length}},{key:"_getLinearizedBlockData",value:function(e,t){var i,a,n,r,o,s,l,c,d,u,p,m,h=arguments.length>2&&void 0!==arguments[2]&&arguments[2],f=this.width/e,y=this.height/t,b=0,g=this.components.length,v=e*t*g,_=new Uint8ClampedArray(v),A=new Uint32Array(e),x=4294967288;for(l=0;l<g;l++){if(a=(i=this.components[l]).scaleX*f,n=i.scaleY*y,b=l,p=i.output,r=i.blocksPerLine+1<<3,a!==m){for(o=0;o<e;o++)c=0|o*a,A[o]=(c&x)<<3|7&c;m=a}for(s=0;s<t;s++)for(u=r*((c=0|s*n)&x)|(7&c)<<3,o=0;o<e;o++)_[b]=p[u+A[o]],b+=g}var w=this._decodeTransform;if(h||4!==g||w||(w=new Int32Array([-256,255,-256,255,-256,255,-256,255])),w)for(l=0;l<v;)for(c=0,d=0;c<g;c++,l++,d+=2)_[l]=(_[l]*w[d]>>8)+w[d+1];return _}},{key:"_isColorConversionNeeded",get:function(){return this.adobe?!!this.adobe.transformCode:3===this.numComponents?0!==this._colorTransform&&(82!==this.components[0].index||71!==this.components[1].index||66!==this.components[2].index):1===this._colorTransform}},{key:"_convertYccToRgb",value:function(e){for(var t,i,a,n=0,r=e.length;n<r;n+=3)t=e[n],i=e[n+1],a=e[n+2],e[n]=t-179.456+1.402*a,e[n+1]=t+135.459-.344*i-.714*a,e[n+2]=t-226.816+1.772*i;return e}},{key:"_convertYcckToRgb",value:function(e){for(var t,i,a,n,r=0,o=0,s=e.length;o<s;o+=4)t=e[o],i=e[o+1],a=e[o+2],n=e[o+3],e[r++]=i*(-660635669420364e-19*i+.000437130475926232*a-54080610064599e-18*t+.00048449797120281*n-.154362151871126)-122.67195406894+a*(-.000957964378445773*a+.000817076911346625*t-.00477271405408747*n+1.53380253221734)+t*(.000961250184130688*t-.00266257332283933*n+.48357088451265)+n*(-.000336197177618394*n+.484791561490776),e[r++]=107.268039397724+i*(219927104525741e-19*i-.000640992018297945*a+.000659397001245577*t+.000426105652938837*n-.176491792462875)+a*(-.000778269941513683*a+.00130872261408275*t+.000770482631801132*n-.151051492775562)+t*(.00126935368114843*t-.00265090189010898*n+.25802910206845)+n*(-.000318913117588328*n-.213742400323665),e[r++]=i*(-.000570115196973677*i-263409051004589e-19*a+.0020741088115012*t-.00288260236853442*n+.814272968359295)-20.810012546947+a*(-153496057440975e-19*a-.000132689043961446*t+.000560833691242812*n-.195152027534049)+t*(.00174418132927582*t-.00255243321439347*n+.116935020465145)+n*(-.000343531996510555*n+.24165260232407);return e.subarray(0,r)}},{key:"_convertYcckToCmyk",value:function(e){for(var t,i,a,n=0,r=e.length;n<r;n+=4)t=e[n],i=e[n+1],a=e[n+2],e[n]=434.456-t-1.402*a,e[n+1]=119.541-t+.344*i+.714*a,e[n+2]=481.816-t-1.772*i;return e}},{key:"_convertCmykToRgb",value:function(e){for(var t,i,a,n,r=0,o=0,s=e.length;o<s;o+=4)t=e[o],i=e[o+1],a=e[o+2],n=e[o+3],e[r++]=255+t*(-6747147073602441e-20*t+.0008379262121013727*i+.0002894718188643294*a+.003264231057537806*n-1.1185611867203937)+i*(26374107616089405e-21*i-8626949158638572e-20*a-.0002748769067499491*n-.02155688794978967)+a*(-3878099212869363e-20*a-.0003267808279485286*n+.0686742238595345)-n*(.0003361971776183937*n+.7430659151342254),e[r++]=255+t*(.00013596372813588848*t+.000924537132573585*i+.00010567359618683593*a+.0004791864687436512*n-.3109689587515875)+i*(-.00023545346108370344*i+.0002702845253534714*a+.0020200308977307156*n-.7488052167015494)+a*(6834815998235662e-20*a+.00015168452363460973*n-.09751927774728933)-n*(.0003189131175883281*n+.7364883807733168),e[r++]=255+t*(13598650411385307e-21*t+.00012423956175490851*i+.0004751985097583589*a-36729317476630422e-22*n-.05562186980264034)+i*(.00016141380598724676*i+.0009692239130725186*a+.0007782692450036253*n-.44015232367526463)+a*(5.068882914068769e-7*a+.0017778369011375071*n-.7591454649749609)-n*(.0003435319965105553*n+.7063770186160144);return e.subarray(0,r)}},{key:"getData",value:function(e){var t=e.width,i=e.height,a=e.forceRGB,n=void 0!==a&&a,o=e.isSourcePDF,s=void 0!==o&&o;if(this.numComponents>4)throw new r("Unsupported color mode");var l=this._getLinearizedBlockData(t,i,s);if(1===this.numComponents&&n){for(var c=l.length,d=new Uint8ClampedArray(3*c),u=0,p=0;p<c;p++){var m=l[p];d[u++]=m,d[u++]=m,d[u++]=m}return d}if(3===this.numComponents&&this._isColorConversionNeeded)return this._convertYccToRgb(l);if(4===this.numComponents){if(this._isColorConversionNeeded)return n?this._convertYcckToRgb(l):this._convertYcckToCmyk(l);if(n)return this._convertCmykToRgb(l)}return l}}]),e}();t.JpegImage=D},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.JpxStream=void 0;var a=i(144),n=i(155),r=i(2),o=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,a)).stream=e,r.dict=e.dict,r.maybeLength=a,r.params=n,r}return g(i,[{key:"bytes",get:function(){return(0,r.shadow)(this,"bytes",this.stream.getBytes(this.maybeLength))}},{key:"ensureBuffer",value:function(e){}},{key:"readBlock",value:function(){if(!this.eof){var e=new n.JpxImage;e.parse(this.bytes);var t=e.width,i=e.height,a=e.componentsCount,r=e.tiles.length;if(1===r)this.buffer=e.tiles[0].items;else{for(var o=new Uint8ClampedArray(t*i*a),s=0;s<r;s++)for(var l=e.tiles[s],c=l.width,d=l.height,u=l.left,p=l.top,m=l.items,h=0,f=(t*p+u)*a,y=t*a,b=c*a,g=0;g<d;g++){var v=m.subarray(h,h+b);o.set(v,f),h+=b,f+=y}this.buffer=o}this.bufferLength=this.buffer.length,this.eof=!0}}}]),i}(a.DecodeStream);t.JpxStream=o},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.JpxImage=void 0;var a=i(2),n=i(131),r=i(151),o=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,"JPX error: ".concat(e),"JpxError")}return g(i)}(a.BaseException),s={LL:0,LH:1,HL:1,HH:2},l=function(){function e(){b(this,e),this.failOnCorruptedImage=!1}return g(e,[{key:"parse",value:function(e){if(65359!==(0,n.readUint16)(e,0))for(var t=e.length,i=0;i<t;){var r=8,s=(0,n.readUint32)(e,i),l=(0,n.readUint32)(e,i+4);if(i+=r,1===s&&(s=4294967296*(0,n.readUint32)(e,i)+(0,n.readUint32)(e,i+4),i+=8,r+=8),0===s&&(s=t-i+r),s<r)throw new o("Invalid box field size");var c=s-r,d=!0;switch(l){case 1785737832:d=!1;break;case 1668246642:var u=e[i];if(1===u){var p=(0,n.readUint32)(e,i+3);switch(p){case 16:case 17:case 18:break;default:(0,a.warn)("Unknown colorspace "+p)}}else 2===u&&(0,a.info)("ICC profile not supported");break;case 1785737827:this.parseCodestream(e,i,i+c);break;case 1783636e3:218793738!==(0,n.readUint32)(e,i)&&(0,a.warn)("Invalid JP2 signature");break;case 1783634458:case 1718909296:case 1920099697:case 1919251232:case 1768449138:break;default:var m=String.fromCharCode(l>>24&255,l>>16&255,l>>8&255,255&l);(0,a.warn)("Unsupported header type ".concat(l," (").concat(m,")."))}d&&(i+=c)}else this.parseCodestream(e,0,e.length)}},{key:"parseImageProperties",value:function(e){for(var t=e.getByte();t>=0;)if(65361===(t<<8|(t=e.getByte()))){e.skip(4);var i=e.getInt32()>>>0,a=e.getInt32()>>>0,n=e.getInt32()>>>0,r=e.getInt32()>>>0;e.skip(16);var s=e.getUint16();return this.width=i-n,this.height=a-r,this.componentsCount=s,void(this.bitsPerComponent=8)}throw new o("No size marker found in JPX stream")}},{key:"parseCodestream",value:function(e,t,i){var r={},s=!1;try{for(var l=t;l+1<i;){var d=(0,n.readUint16)(e,l);l+=2;var u=0,m=void 0,h=void 0,f=void 0,y=void 0,b=void 0,g=void 0;switch(d){case 65359:r.mainHeader=!0;break;case 65497:break;case 65361:u=(0,n.readUint16)(e,l);var v={};v.Xsiz=(0,n.readUint32)(e,l+4),v.Ysiz=(0,n.readUint32)(e,l+8),v.XOsiz=(0,n.readUint32)(e,l+12),v.YOsiz=(0,n.readUint32)(e,l+16),v.XTsiz=(0,n.readUint32)(e,l+20),v.YTsiz=(0,n.readUint32)(e,l+24),v.XTOsiz=(0,n.readUint32)(e,l+28),v.YTOsiz=(0,n.readUint32)(e,l+32);var _=(0,n.readUint16)(e,l+36);v.Csiz=_;var A=[];m=l+38;for(var x=0;x<_;x++){var w={precision:1+(127&e[m]),isSigned:!!(128&e[m]),XRsiz:e[m+1],YRsiz:e[m+2]};m+=3,c(w,v),A.push(w)}r.SIZ=v,r.components=A,p(r,A),r.QCC=[],r.COC=[];break;case 65372:u=(0,n.readUint16)(e,l);var S={};switch(m=l+2,31&(h=e[m++])){case 0:y=8,b=!0;break;case 1:y=16,b=!1;break;case 2:y=16,b=!0;break;default:throw new Error("Invalid SQcd value "+h)}for(S.noQuantization=8===y,S.scalarExpounded=b,S.guardBits=h>>5,f=[];m<u+l;){var C={};8===y?(C.epsilon=e[m++]>>3,C.mu=0):(C.epsilon=e[m]>>3,C.mu=(7&e[m])<<8|e[m+1],m+=2),f.push(C)}S.SPqcds=f,r.mainHeader?r.QCD=S:(r.currentTile.QCD=S,r.currentTile.QCC=[]);break;case 65373:u=(0,n.readUint16)(e,l);var R={};m=l+2;var T=void 0;switch(r.SIZ.Csiz<257?T=e[m++]:(T=(0,n.readUint16)(e,m),m+=2),31&(h=e[m++])){case 0:y=8,b=!0;break;case 1:y=16,b=!1;break;case 2:y=16,b=!0;break;default:throw new Error("Invalid SQcd value "+h)}for(R.noQuantization=8===y,R.scalarExpounded=b,R.guardBits=h>>5,f=[];m<u+l;){var P={};8===y?(P.epsilon=e[m++]>>3,P.mu=0):(P.epsilon=e[m]>>3,P.mu=(7&e[m])<<8|e[m+1],m+=2),f.push(P)}R.SPqcds=f,r.mainHeader?r.QCC[T]=R:r.currentTile.QCC[T]=R;break;case 65362:u=(0,n.readUint16)(e,l);var z={};m=l+2;var B=e[m++];z.entropyCoderWithCustomPrecincts=!!(1&B),z.sopMarkerUsed=!!(2&B),z.ephMarkerUsed=!!(4&B),z.progressionOrder=e[m++],z.layersCount=(0,n.readUint16)(e,m),m+=2,z.multipleComponentTransform=e[m++],z.decompositionLevelsCount=e[m++],z.xcb=2+(15&e[m++]),z.ycb=2+(15&e[m++]);var F=e[m++];if(z.selectiveArithmeticCodingBypass=!!(1&F),z.resetContextProbabilities=!!(2&F),z.terminationOnEachCodingPass=!!(4&F),z.verticallyStripe=!!(8&F),z.predictableTermination=!!(16&F),z.segmentationSymbolUsed=!!(32&F),z.reversibleTransformation=e[m++],z.entropyCoderWithCustomPrecincts){for(var E=[];m<u+l;){var N=e[m++];E.push({PPx:15&N,PPy:N>>4})}z.precinctsSizes=E}var O=[];z.selectiveArithmeticCodingBypass&&O.push("selectiveArithmeticCodingBypass"),z.terminationOnEachCodingPass&&O.push("terminationOnEachCodingPass"),z.verticallyStripe&&O.push("verticallyStripe"),z.predictableTermination&&O.push("predictableTermination"),O.length>0&&(s=!0,(0,a.warn)("JPX: Unsupported COD options (".concat(O.join(", "),")."))),r.mainHeader?r.COD=z:(r.currentTile.COD=z,r.currentTile.COC=[]);break;case 65424:u=(0,n.readUint16)(e,l),(g={}).index=(0,n.readUint16)(e,l+2),g.length=(0,n.readUint32)(e,l+4),g.dataEnd=g.length+l-2,g.partIndex=e[l+8],g.partsCount=e[l+9],r.mainHeader=!1,0===g.partIndex&&(g.COD=r.COD,g.COC=r.COC.slice(0),g.QCD=r.QCD,g.QCC=r.QCC.slice(0)),r.currentTile=g;break;case 65427:0===(g=r.currentTile).partIndex&&(M(r,g.index),k(r)),D(r,e,l,u=g.dataEnd-l);break;case 65363:(0,a.warn)("JPX: Codestream code 0xFF53 (COC) is not implemented.");case 65365:case 65367:case 65368:case 65380:u=(0,n.readUint16)(e,l);break;default:throw new Error("Unknown codestream code: "+d.toString(16))}l+=u}}catch(G){if(s||this.failOnCorruptedImage)throw new o(G.message);(0,a.warn)('JPX: Trying to recover from: "'.concat(G.message,'".'))}this.tiles=function(e){for(var t=e.SIZ,i=e.components,a=t.Csiz,n=[],r=0,o=e.tiles.length;r<o;r++){for(var s=e.tiles[r],l=[],c=0;c<a;c++)l[c]=I(e,s,c);var d=l[0],u=new Uint8ClampedArray(d.items.length*a),p={left:d.left,top:d.top,width:d.width,height:d.height,items:u},m=void 0,h=void 0,f=0,y=void 0,b=void 0,g=void 0,v=void 0,_=void 0;if(s.codingStyleDefaultParameters.multipleComponentTransform){var A=4===a,x=l[0].items,w=l[1].items,S=l[2].items,C=A?l[3].items:null;h=.5+(128<<(m=i[0].precision-8));var k=s.components[0],D=a-3;if(b=x.length,k.codingStyleParameters.reversibleTransformation)for(y=0;y<b;y++,f+=D){g=x[y]+h,v=w[y];var R=g-((_=S[y])+v>>2);u[f++]=R+_>>m,u[f++]=R>>m,u[f++]=R+v>>m}else for(y=0;y<b;y++,f+=D)g=x[y]+h,v=w[y],_=S[y],u[f++]=g+1.402*_>>m,u[f++]=g-.34413*v-.71414*_>>m,u[f++]=g+1.772*v>>m;if(A)for(y=0,f=3;y<b;y++,f+=4)u[f]=C[y]+h>>m}else for(var M=0;M<a;M++){var T=l[M].items;for(h=.5+(128<<(m=i[M].precision-8)),f=M,y=0,b=T.length;y<b;y++)u[f]=T[y]+h>>m,f+=a}n.push(p)}return n}(r),this.width=r.SIZ.Xsiz-r.SIZ.XOsiz,this.height=r.SIZ.Ysiz-r.SIZ.YOsiz,this.componentsCount=r.SIZ.Csiz}}]),e}();function c(e,t){e.x0=Math.ceil(t.XOsiz/e.XRsiz),e.x1=Math.ceil(t.Xsiz/e.XRsiz),e.y0=Math.ceil(t.YOsiz/e.YRsiz),e.y1=Math.ceil(t.Ysiz/e.YRsiz),e.width=e.x1-e.x0,e.height=e.y1-e.y0}function p(e,t){for(var i,a=e.SIZ,n=[],r=Math.ceil((a.Xsiz-a.XTOsiz)/a.XTsiz),o=Math.ceil((a.Ysiz-a.YTOsiz)/a.YTsiz),s=0;s<o;s++)for(var l=0;l<r;l++)(i={}).tx0=Math.max(a.XTOsiz+l*a.XTsiz,a.XOsiz),i.ty0=Math.max(a.YTOsiz+s*a.YTsiz,a.YOsiz),i.tx1=Math.min(a.XTOsiz+(l+1)*a.XTsiz,a.Xsiz),i.ty1=Math.min(a.YTOsiz+(s+1)*a.YTsiz,a.Ysiz),i.width=i.tx1-i.tx0,i.height=i.ty1-i.ty0,i.components=[],n.push(i);e.tiles=n;for(var c=0,d=a.Csiz;c<d;c++)for(var u=t[c],p=0,m=n.length;p<m;p++){var h={};i=n[p],h.tcx0=Math.ceil(i.tx0/u.XRsiz),h.tcy0=Math.ceil(i.ty0/u.YRsiz),h.tcx1=Math.ceil(i.tx1/u.XRsiz),h.tcy1=Math.ceil(i.ty1/u.YRsiz),h.width=h.tcx1-h.tcx0,h.height=h.tcy1-h.tcy0,i.components[c]=h}}function m(e,t,i){var a=t.codingStyleParameters,n={};return a.entropyCoderWithCustomPrecincts?(n.PPx=a.precinctsSizes[i].PPx,n.PPy=a.precinctsSizes[i].PPy):(n.PPx=15,n.PPy=15),n.xcb_=i>0?Math.min(a.xcb,n.PPx-1):Math.min(a.xcb,n.PPx),n.ycb_=i>0?Math.min(a.ycb,n.PPy-1):Math.min(a.ycb,n.PPy),n}function h(e,t,i){var a=1<<i.PPx,n=1<<i.PPy,r=0===t.resLevel,o=1<<i.PPx+(r?0:-1),s=1<<i.PPy+(r?0:-1),l=t.trx1>t.trx0?Math.ceil(t.trx1/a)-Math.floor(t.trx0/a):0,c=t.try1>t.try0?Math.ceil(t.try1/n)-Math.floor(t.try0/n):0,d=l*c;t.precinctParameters={precinctWidth:a,precinctHeight:n,numprecinctswide:l,numprecinctshigh:c,numprecincts:d,precinctWidthInSubband:o,precinctHeightInSubband:s}}function f(e,t,i){var a,n,r,o,s=i.xcb_,l=i.ycb_,c=1<<s,d=1<<l,u=t.tbx0>>s,p=t.tby0>>l,m=t.tbx1+c-1>>s,h=t.tby1+d-1>>l,f=t.resolution.precinctParameters,y=[],b=[];for(n=p;n<h;n++)for(a=u;a<m;a++)if((r={cbx:a,cby:n,tbx0:c*a,tby0:d*n,tbx1:c*(a+1),tby1:d*(n+1)}).tbx0_=Math.max(t.tbx0,r.tbx0),r.tby0_=Math.max(t.tby0,r.tby0),r.tbx1_=Math.min(t.tbx1,r.tbx1),r.tby1_=Math.min(t.tby1,r.tby1),o=Math.floor((r.tbx0_-t.tbx0)/f.precinctWidthInSubband)+Math.floor((r.tby0_-t.tby0)/f.precinctHeightInSubband)*f.numprecinctswide,r.precinctNumber=o,r.subbandType=t.type,r.Lblock=3,!(r.tbx1_<=r.tbx0_||r.tby1_<=r.tby0_)){y.push(r);var g=b[o];void 0!==g?(a<g.cbxMin?g.cbxMin=a:a>g.cbxMax&&(g.cbxMax=a),n<g.cbyMin?g.cbxMin=n:n>g.cbyMax&&(g.cbyMax=n)):b[o]=g={cbxMin:a,cbyMin:n,cbxMax:a,cbyMax:n},r.precinct=g}t.codeblockParameters={codeblockWidth:s,codeblockHeight:l,numcodeblockwide:m-u+1,numcodeblockhigh:h-p+1},t.codeblocks=y,t.precincts=b}function y(e,t,i){for(var a=[],n=e.subbands,r=0,o=n.length;r<o;r++)for(var s=n[r].codeblocks,l=0,c=s.length;l<c;l++){var d=s[l];d.precinctNumber===t&&a.push(d)}return{layerNumber:i,codeblocks:a}}function v(e){for(var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=a.codingStyleDefaultParameters.layersCount,r=t.Csiz,s=0,l=0;l<r;l++)s=Math.max(s,a.components[l].codingStyleParameters.decompositionLevelsCount);var c=0,d=0,u=0,p=0;this.nextPacket=function(){for(;c<n;c++){for(;d<=s;d++){for(;u<r;u++){var e=a.components[u];if(!(d>e.codingStyleParameters.decompositionLevelsCount)){for(var t=e.resolutions[d],i=t.precinctParameters.numprecincts;p<i;){var l=y(t,p,c);return p++,l}p=0}}u=0}d=0}throw new o("Out of packets")}}function _(e){for(var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=a.codingStyleDefaultParameters.layersCount,r=t.Csiz,s=0,l=0;l<r;l++)s=Math.max(s,a.components[l].codingStyleParameters.decompositionLevelsCount);var c=0,d=0,u=0,p=0;this.nextPacket=function(){for(;c<=s;c++){for(;d<n;d++){for(;u<r;u++){var e=a.components[u];if(!(c>e.codingStyleParameters.decompositionLevelsCount)){for(var t=e.resolutions[c],i=t.precinctParameters.numprecincts;p<i;){var l=y(t,p,d);return p++,l}p=0}}u=0}d=0}throw new o("Out of packets")}}function A(e){var t,i,a,n,r=e.SIZ,s=e.currentTile.index,l=e.tiles[s],c=l.codingStyleDefaultParameters.layersCount,d=r.Csiz,u=0;for(a=0;a<d;a++){var p=l.components[a];u=Math.max(u,p.codingStyleParameters.decompositionLevelsCount)}var m=new Int32Array(u+1);for(i=0;i<=u;++i){var h=0;for(a=0;a<d;++a){var f=l.components[a].resolutions;i<f.length&&(h=Math.max(h,f[i].precinctParameters.numprecincts))}m[i]=h}t=0,i=0,a=0,n=0,this.nextPacket=function(){for(;i<=u;i++){for(;n<m[i];n++){for(;a<d;a++){var e=l.components[a];if(!(i>e.codingStyleParameters.decompositionLevelsCount)){var r=e.resolutions[i],s=r.precinctParameters.numprecincts;if(!(n>=s)){for(;t<c;){var p=y(r,n,t);return t++,p}t=0}}}a=0}n=0}throw new o("Out of packets")}}function x(e){var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=a.codingStyleDefaultParameters.layersCount,r=t.Csiz,s=C(a),l=s,c=0,d=0,u=0,p=0,m=0;this.nextPacket=function(){for(;m<l.maxNumHigh;m++){for(;p<l.maxNumWide;p++){for(;u<r;u++){for(var e=a.components[u],t=e.codingStyleParameters.decompositionLevelsCount;d<=t;d++){var i=e.resolutions[d],h=s.components[u].resolutions[d],f=S(p,m,h,l,i);if(null!==f){for(;c<n;){var b=y(i,f,c);return c++,b}c=0}}d=0}u=0}p=0}throw new o("Out of packets")}}function w(e){var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=a.codingStyleDefaultParameters.layersCount,r=t.Csiz,s=C(a),l=0,c=0,d=0,u=0,p=0;this.nextPacket=function(){for(;d<r;++d){for(var e=a.components[d],t=s.components[d],i=e.codingStyleParameters.decompositionLevelsCount;p<t.maxNumHigh;p++){for(;u<t.maxNumWide;u++){for(;c<=i;c++){var m=e.resolutions[c],h=t.resolutions[c],f=S(u,p,h,t,m);if(null!==f){for(;l<n;){var b=y(m,f,l);return l++,b}l=0}}c=0}u=0}p=0}throw new o("Out of packets")}}function S(e,t,i,a,n){var r=e*a.minWidth,o=t*a.minHeight;if(r%i.width!==0||o%i.height!==0)return null;var s=o/i.width*n.precinctParameters.numprecinctswide;return r/i.height+s}function C(e){for(var t=e.components.length,i=Number.MAX_VALUE,a=Number.MAX_VALUE,n=0,r=0,o=new Array(t),s=0;s<t;s++){for(var l=e.components[s],c=l.codingStyleParameters.decompositionLevelsCount,d=new Array(c+1),u=Number.MAX_VALUE,p=Number.MAX_VALUE,m=0,h=0,f=1,y=c;y>=0;--y){var b=l.resolutions[y],g=f*b.precinctParameters.precinctWidth,v=f*b.precinctParameters.precinctHeight;u=Math.min(u,g),p=Math.min(p,v),m=Math.max(m,b.precinctParameters.numprecinctswide),h=Math.max(h,b.precinctParameters.numprecinctshigh),d[y]={width:g,height:v},f<<=1}i=Math.min(i,u),a=Math.min(a,p),n=Math.max(n,m),r=Math.max(r,h),o[s]={resolutions:d,minWidth:u,minHeight:p,maxNumWide:m,maxNumHigh:h}}return{components:o,minWidth:i,minHeight:a,maxNumWide:n,maxNumHigh:r}}function k(e){for(var t=e.SIZ,i=e.currentTile.index,a=e.tiles[i],n=t.Csiz,r=0;r<n;r++){for(var s=a.components[r],l=s.codingStyleParameters.decompositionLevelsCount,c=[],d=[],u=0;u<=l;u++){var p=m(0,s,u),y={},b=1<<l-u;y.trx0=Math.ceil(s.tcx0/b),y.try0=Math.ceil(s.tcy0/b),y.trx1=Math.ceil(s.tcx1/b),y.try1=Math.ceil(s.tcy1/b),y.resLevel=u,h(0,y,p),c.push(y);var g=void 0;if(0===u)(g={}).type="LL",g.tbx0=Math.ceil(s.tcx0/b),g.tby0=Math.ceil(s.tcy0/b),g.tbx1=Math.ceil(s.tcx1/b),g.tby1=Math.ceil(s.tcy1/b),g.resolution=y,f(0,g,p),d.push(g),y.subbands=[g];else{var S=1<<l-u+1,C=[];(g={}).type="HL",g.tbx0=Math.ceil(s.tcx0/S-.5),g.tby0=Math.ceil(s.tcy0/S),g.tbx1=Math.ceil(s.tcx1/S-.5),g.tby1=Math.ceil(s.tcy1/S),g.resolution=y,f(0,g,p),d.push(g),C.push(g),(g={}).type="LH",g.tbx0=Math.ceil(s.tcx0/S),g.tby0=Math.ceil(s.tcy0/S-.5),g.tbx1=Math.ceil(s.tcx1/S),g.tby1=Math.ceil(s.tcy1/S-.5),g.resolution=y,f(0,g,p),d.push(g),C.push(g),(g={}).type="HH",g.tbx0=Math.ceil(s.tcx0/S-.5),g.tby0=Math.ceil(s.tcy0/S-.5),g.tbx1=Math.ceil(s.tcx1/S-.5),g.tby1=Math.ceil(s.tcy1/S-.5),g.resolution=y,f(0,g,p),d.push(g),C.push(g),y.subbands=C}}s.resolutions=c,s.subbands=d}var k=a.codingStyleDefaultParameters.progressionOrder;switch(k){case 0:a.packetsIterator=new v(e);break;case 1:a.packetsIterator=new _(e);break;case 2:a.packetsIterator=new A(e);break;case 3:a.packetsIterator=new x(e);break;case 4:a.packetsIterator=new w(e);break;default:throw new o("Unsupported progression order ".concat(k))}}function D(e,t,i,a){var r,s=0,l=0,c=!1;function d(e){for(;l<e;){var a=t[i+s];s++,c?(r=r<<7|a,l+=7,c=!1):(r=r<<8|a,l+=8),255===a&&(c=!0)}return r>>>(l-=e)&(1<<e)-1}function u(e){return 255===t[i+s-1]&&t[i+s]===e?(p(1),!0):255===t[i+s]&&t[i+s+1]===e&&(p(2),!0)}function p(e){s+=e}function m(){l=0,c&&(s++,c=!1)}function h(){if(0===d(1))return 1;if(0===d(1))return 2;var e=d(2);return e<3?e+3:(e=d(5))<31?e+6:(e=d(7))+37}for(var f=e.currentTile.index,y=e.tiles[f],b=e.COD.sopMarkerUsed,g=e.COD.ephMarkerUsed,v=y.packetsIterator;s<a;){m(),b&&u(145)&&p(4);var _=v.nextPacket();if(d(1)){for(var A=_.layerNumber,x=[],w=void 0,S=0,C=_.codeblocks.length;S<C;S++){var k=(w=_.codeblocks[S]).precinct,D=w.cbx-k.cbxMin,R=w.cby-k.cbyMin,I=!1,M=!1,z=void 0;if(void 0!==w.included)I=!!d(1);else{var B=void 0;if(void 0!==(k=w.precinct).inclusionTree)B=k.inclusionTree;else{var F=k.cbxMax-k.cbxMin+1,E=k.cbyMax-k.cbyMin+1;B=new P(F,E,A),z=new T(F,E),k.inclusionTree=B,k.zeroBitPlanesTree=z;for(var N=0;N<A;N++)if(0!==d(1))throw new o("Invalid tag tree")}if(B.reset(D,R,A))for(;;){if(!d(1)){B.incrementValue(A);break}if(!B.nextLevel()){w.included=!0,I=M=!0;break}}}if(I){if(M){for((z=k.zeroBitPlanesTree).reset(D,R);;)if(d(1)){if(!z.nextLevel())break}else z.incrementValue();w.zeroBitPlanes=z.value}for(var O=h();d(1);)w.Lblock++;var G=(0,n.log2)(O),L=d((O<1<<G?G-1:G)+w.Lblock);x.push({codeblock:w,codingpasses:O,dataLength:L})}}for(m(),g&&u(146);x.length>0;){var j=x.shift();void 0===(w=j.codeblock).data&&(w.data=[]),w.data.push({data:t,start:i+s,end:i+s+j.dataLength,codingpasses:j.codingpasses}),s+=j.dataLength}}}return s}function R(e,t,i,a,n,o,s,l,c){for(var d=a.tbx0,u=a.tby0,p=a.tbx1-a.tbx0,m=a.codeblocks,h="H"===a.type.charAt(0)?1:0,f="H"===a.type.charAt(1)?t:0,y=0,b=m.length;y<b;++y){var g=m[y],v=g.tbx1_-g.tbx0_,_=g.tby1_-g.tby0_;if(0!==v&&0!==_&&void 0!==g.data){var A=new z(v,_,g.subbandType,g.zeroBitPlanes,o),x=2,w=g.data,S=0,C=0,k=void 0,D=void 0,R=void 0;for(k=0,D=w.length;k<D;k++)S+=(R=w[k]).end-R.start,C+=R.codingpasses;var I=new Uint8Array(S),M=0;for(k=0,D=w.length;k<D;k++){var T=(R=w[k]).data.subarray(R.start,R.end);I.set(T,M),M+=T.length}var P=new r.ArithmeticDecoder(I,0,S);for(A.setDecoder(P),k=0;k<C;k++){switch(x){case 0:A.runSignificancePropagationPass();break;case 1:A.runMagnitudeRefinementPass();break;case 2:A.runCleanupPass(),l&&A.checkSegmentationSymbol()}c&&A.reset(),x=(x+1)%3}var B=g.tbx0_-d+(g.tby0_-u)*p,F=A.coefficentsSign,E=A.coefficentsMagnitude,N=A.bitsDecoded,O=s?0:.5,G=void 0,L=void 0,j=void 0;M=0;var q="LL"!==a.type;for(k=0;k<_;k++){var H=2*(B/p|0)*(t-p)+h+f;for(G=0;G<v;G++){if(0!==(L=E[M])){L=(L+O)*n,0!==F[M]&&(L=-L),j=N[M];var U=q?H+(B<<1):B;e[U]=s&&j>=o?L:L*(1<<o-j)}B++,M++}B+=p-v}}}}function I(e,t,i){for(var a=t.components[i],n=a.codingStyleParameters,r=a.quantizationParameters,o=n.decompositionLevelsCount,l=r.SPqcds,c=r.scalarExpounded,d=r.guardBits,u=n.segmentationSymbolUsed,p=n.resetContextProbabilities,m=e.components[i].precision,h=n.reversibleTransformation,f=h?new E:new F,y=[],b=0,g=0;g<=o;g++){for(var v=a.resolutions[g],_=v.trx1-v.trx0,A=v.try1-v.try0,x=new Float32Array(_*A),w=0,S=v.subbands.length;w<S;w++){var C=void 0,k=void 0;c?(C=l[b].mu,k=l[b].epsilon,b++):(C=l[0].mu,k=l[0].epsilon+(g>0?1-g:0));var D=v.subbands[w],I=s[D.type];R(x,_,0,D,h?1:Math.pow(2,m+I-k)*(1+C/2048),d+k-1,h,u,p)}y.push({width:_,height:A,items:x})}var M=f.calculate(y,a.tcx0,a.tcy0);return{left:a.tcx0,top:a.tcy0,width:M.width,height:M.height,items:M.items}}function M(e,t){for(var i=e.SIZ.Csiz,a=e.tiles[t],n=0;n<i;n++){var r=a.components[n],o=void 0!==e.currentTile.QCC[n]?e.currentTile.QCC[n]:e.currentTile.QCD;r.quantizationParameters=o;var s=void 0!==e.currentTile.COC[n]?e.currentTile.COC[n]:e.currentTile.COD;r.codingStyleParameters=s}a.codingStyleDefaultParameters=e.currentTile.COD}t.JpxImage=l;var T=function(){function e(t,i){b(this,e);var a=(0,n.log2)(Math.max(t,i))+1;this.levels=[];for(var r=0;r<a;r++){var o={width:t,height:i,items:[]};this.levels.push(o),t=Math.ceil(t/2),i=Math.ceil(i/2)}}return g(e,[{key:"reset",value:function(e,t){for(var i,a=0,n=0;a<this.levels.length;){var r=e+t*(i=this.levels[a]).width;if(void 0!==i.items[r]){n=i.items[r];break}i.index=r,e>>=1,t>>=1,a++}a--,(i=this.levels[a]).items[i.index]=n,this.currentLevel=a,delete this.value}},{key:"incrementValue",value:function(){var e=this.levels[this.currentLevel];e.items[e.index]++}},{key:"nextLevel",value:function(){var e=this.currentLevel,t=this.levels[e],i=t.items[t.index];return--e<0?(this.value=i,!1):(this.currentLevel=e,(t=this.levels[e]).items[t.index]=i,!0)}}]),e}(),P=function(){function e(t,i,a){b(this,e);var r=(0,n.log2)(Math.max(t,i))+1;this.levels=[];for(var o=0;o<r;o++){for(var s=new Uint8Array(t*i),l=0,c=s.length;l<c;l++)s[l]=a;var d={width:t,height:i,items:s};this.levels.push(d),t=Math.ceil(t/2),i=Math.ceil(i/2)}}return g(e,[{key:"reset",value:function(e,t,i){for(var a=0;a<this.levels.length;){var n=this.levels[a],r=e+t*n.width;n.index=r;var o=n.items[r];if(255===o)break;if(o>i)return this.currentLevel=a,this.propagateValues(),!1;e>>=1,t>>=1,a++}return this.currentLevel=a-1,!0}},{key:"incrementValue",value:function(e){var t=this.levels[this.currentLevel];t.items[t.index]=e+1,this.propagateValues()}},{key:"propagateValues",value:function(){for(var e=this.currentLevel,t=this.levels[e],i=t.items[t.index];--e>=0;)(t=this.levels[e]).items[t.index]=i}},{key:"nextLevel",value:function(){var e=this.currentLevel,t=this.levels[e],i=t.items[t.index];return t.items[t.index]=255,!(--e<0)&&(this.currentLevel=e,(t=this.levels[e]).items[t.index]=i,!0)}}]),e}(),z=function(){var e=17,t=new Uint8Array([0,5,8,0,3,7,8,0,4,7,8,0,0,0,0,0,1,6,8,0,3,7,8,0,4,7,8,0,0,0,0,0,2,6,8,0,3,7,8,0,4,7,8,0,0,0,0,0,2,6,8,0,3,7,8,0,4,7,8,0,0,0,0,0,2,6,8,0,3,7,8,0,4,7,8]),i=new Uint8Array([0,3,4,0,5,7,7,0,8,8,8,0,0,0,0,0,1,3,4,0,6,7,7,0,8,8,8,0,0,0,0,0,2,3,4,0,6,7,7,0,8,8,8,0,0,0,0,0,2,3,4,0,6,7,7,0,8,8,8,0,0,0,0,0,2,3,4,0,6,7,7,0,8,8,8]),a=new Uint8Array([0,1,2,0,1,2,2,0,2,2,2,0,0,0,0,0,3,4,5,0,4,5,5,0,5,5,5,0,0,0,0,0,6,7,7,0,7,7,7,0,7,7,7,0,0,0,0,0,8,8,8,0,8,8,8,0,8,8,8,0,0,0,0,0,8,8,8,0,8,8,8,0,8,8,8]);return function(){function n(e,r,o,s,l){var c;b(this,n),this.width=e,this.height=r,c="HH"===o?a:"HL"===o?i:t,this.contextLabelTable=c;var d,u=e*r;this.neighborsSignificance=new Uint8Array(u),this.coefficentsSign=new Uint8Array(u),d=l>14?new Uint32Array(u):l>6?new Uint16Array(u):new Uint8Array(u),this.coefficentsMagnitude=d,this.processingFlags=new Uint8Array(u);var p=new Uint8Array(u);if(0!==s)for(var m=0;m<u;m++)p[m]=s;this.bitsDecoded=p,this.reset()}return g(n,[{key:"setDecoder",value:function(e){this.decoder=e}},{key:"reset",value:function(){this.contexts=new Int8Array(19),this.contexts[0]=8,this.contexts[17]=92,this.contexts[18]=6}},{key:"setNeighborsSignificance",value:function(e,t,i){var a,n=this.neighborsSignificance,r=this.width,o=this.height,s=t>0,l=t+1<r;e>0&&(a=i-r,s&&(n[a-1]+=16),l&&(n[a+1]+=16),n[a]+=4),e+1<o&&(a=i+r,s&&(n[a-1]+=16),l&&(n[a+1]+=16),n[a]+=4),s&&(n[i-1]+=1),l&&(n[i+1]+=1),n[i]|=128}},{key:"runSignificancePropagationPass",value:function(){for(var e=this.decoder,t=this.width,i=this.height,a=this.coefficentsMagnitude,n=this.coefficentsSign,r=this.neighborsSignificance,o=this.processingFlags,s=this.contexts,l=this.contextLabelTable,c=this.bitsDecoded,d=0;d<i;d+=4)for(var u=0;u<t;u++)for(var p=d*t+u,m=0;m<4;m++,p+=t){var h=d+m;if(h>=i)break;if(o[p]&=-2,!a[p]&&r[p]){var f=l[r[p]];if(e.readBit(s,f)){var y=this.decodeSignBit(h,u,p);n[p]=y,a[p]=1,this.setNeighborsSignificance(h,u,p),o[p]|=2}c[p]++,o[p]|=1}}}},{key:"decodeSignBit",value:function(e,t,i){var a,n,r,o,s,l,c=this.width,d=this.height,u=this.coefficentsMagnitude,p=this.coefficentsSign;o=t>0&&0!==u[i-1],t+1<c&&0!==u[i+1]?(r=p[i+1],a=o?1-r-(n=p[i-1]):1-r-r):a=o?1-(n=p[i-1])-n:0;var m=3*a;return o=e>0&&0!==u[i-c],e+1<d&&0!==u[i+c]?(r=p[i+c],a=o?1-r-(n=p[i-c])+m:1-r-r+m):a=o?1-(n=p[i-c])-n+m:m,a>=0?(s=9+a,l=this.decoder.readBit(this.contexts,s)):(s=9-a,l=1^this.decoder.readBit(this.contexts,s)),l}},{key:"runMagnitudeRefinementPass",value:function(){for(var e,t=this.decoder,i=this.width,a=this.height,n=this.coefficentsMagnitude,r=this.neighborsSignificance,o=this.contexts,s=this.bitsDecoded,l=this.processingFlags,c=i*a,d=4*i,u=0;u<c;u=e){e=Math.min(c,u+d);for(var p=0;p<i;p++)for(var m=u+p;m<e;m+=i)if(n[m]&&0===(1&l[m])){var h=16;0!==(2&l[m])&&(l[m]^=2,h=0===(127&r[m])?15:14);var f=t.readBit(o,h);n[m]=n[m]<<1|f,s[m]++,l[m]|=1}}}},{key:"runCleanupPass",value:function(){for(var t,i=this.decoder,a=this.width,n=this.height,r=this.neighborsSignificance,o=this.coefficentsMagnitude,s=this.coefficentsSign,l=this.contexts,c=this.contextLabelTable,d=this.bitsDecoded,u=this.processingFlags,p=a,m=2*a,h=3*a,f=0;f<n;f=t){t=Math.min(f+4,n);for(var y=f*a,b=f+3<n,g=0;g<a;g++){var v=y+g,_=0,A=v,x=f,w=void 0;if(b&&0===u[v]&&0===u[v+p]&&0===u[v+m]&&0===u[v+h]&&0===r[v]&&0===r[v+p]&&0===r[v+m]&&0===r[v+h]){if(!i.readBit(l,18)){d[v]++,d[v+p]++,d[v+m]++,d[v+h]++;continue}0!==(_=i.readBit(l,e)<<1|i.readBit(l,e))&&(x=f+_,A+=_*a),w=this.decodeSignBit(x,g,A),s[A]=w,o[A]=1,this.setNeighborsSignificance(x,g,A),u[A]|=2,A=v;for(var S=f;S<=x;S++,A+=a)d[A]++;_++}for(x=f+_;x<t;x++,A+=a)if(!o[A]&&0===(1&u[A])){var C=c[r[A]];1===i.readBit(l,C)&&(w=this.decodeSignBit(x,g,A),s[A]=w,o[A]=1,this.setNeighborsSignificance(x,g,A),u[A]|=2),d[A]++}}}}},{key:"checkSegmentationSymbol",value:function(){var t=this.decoder,i=this.contexts;if(10!==(t.readBit(i,e)<<3|t.readBit(i,e)<<2|t.readBit(i,e)<<1|t.readBit(i,e)))throw new o("Invalid segmentation symbol")}}]),n}()}(),B=function(){function e(){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize Transform.")}return g(e,[{key:"calculate",value:function(e,t,i){for(var a=e[0],n=1,r=e.length;n<r;n++)a=this.iterate(a,e[n],t,i);return a}},{key:"extend",value:function(e,t,i){var a=t-1,n=t+1,r=t+i-2,o=t+i;e[a--]=e[n++],e[o++]=e[r--],e[a--]=e[n++],e[o++]=e[r--],e[a--]=e[n++],e[o++]=e[r--],e[a]=e[n],e[o]=e[r]}},{key:"filter",value:function(e,t,i){(0,a.unreachable)("Abstract method `filter` called")}},{key:"iterate",value:function(e,t,i,a){var n,r,o,s,l,c,d=e.width,u=e.height,p=e.items,m=t.width,h=t.height,f=t.items;for(o=0,n=0;n<u;n++)for(s=2*n*m,r=0;r<d;r++,o++,s+=2)f[s]=p[o];p=e.items=null;var y=new Float32Array(m+8);if(1===m){if(0!==(1&i))for(c=0,o=0;c<h;c++,o+=m)f[o]*=.5}else for(c=0,o=0;c<h;c++,o+=m)y.set(f.subarray(o,o+m),4),this.extend(y,4,m),this.filter(y,4,m),f.set(y.subarray(4,4+m),o);var b=16,g=[];for(n=0;n<b;n++)g.push(new Float32Array(h+8));var v,_=0;if(e=4+h,1===h){if(0!==(1&a))for(l=0;l<m;l++)f[l]*=.5}else for(l=0;l<m;l++){if(0===_){for(b=Math.min(m-l,b),o=l,s=4;s<e;o+=m,s++)for(v=0;v<b;v++)g[v][s]=f[o+v];_=b}var A=g[--_];if(this.extend(A,4,h),this.filter(A,4,h),0===_)for(o=l-b+1,s=4;s<e;o+=m,s++)for(v=0;v<b;v++)f[o+v]=g[v][s]}return{width:m,height:h,items:f}}}]),e}(),F=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.apply(this,arguments)}return g(i,[{key:"filter",value:function(e,t,i){var a,n,r,o,s=i>>1,l=-1.586134342059924,c=-.052980118572961,d=.882911075530934,u=.443506852043971,p=1.230174104914001;for(a=(t|=0)-3,n=s+4;n--;a+=2)e[a]*=.8128930661159609;for(r=u*e[(a=t-2)-1],n=s+3;n--&&(o=u*e[a+1],e[a]=p*e[a]-r-o,n--);a+=2)r=u*e[(a+=2)+1],e[a]=p*e[a]-r-o;for(r=d*e[(a=t-1)-1],n=s+2;n--&&(o=d*e[a+1],e[a]-=r+o,n--);a+=2)r=d*e[(a+=2)+1],e[a]-=r+o;for(r=c*e[(a=t)-1],n=s+1;n--&&(o=c*e[a+1],e[a]-=r+o,n--);a+=2)r=c*e[(a+=2)+1],e[a]-=r+o;if(0!==s)for(r=l*e[(a=t+1)-1],n=s;n--&&(o=l*e[a+1],e[a]-=r+o,n--);a+=2)r=l*e[(a+=2)+1],e[a]-=r+o}}]),i}(B),E=function(e){d(i,e);var t=u(i);function i(){return b(this,i),t.apply(this,arguments)}return g(i,[{key:"filter",value:function(e,t,i){var a,n,r=i>>1;for(a=t|=0,n=r+1;n--;a+=2)e[a]-=e[a-1]+e[a+1]+2>>2;for(a=t+1,n=r;n--;a+=2)e[a]+=e[a-1]+e[a+1]>>1}}]),i}(B)},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.LZWStream=void 0;var a=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;b(this,i),(r=t.call(this,a)).str=e,r.dict=e.dict,r.cachedData=0,r.bitsCached=0;for(var o=4096,s={earlyChange:n,codeLength:9,nextCode:258,dictionaryValues:new Uint8Array(o),dictionaryLengths:new Uint16Array(o),dictionaryPrevCodes:new Uint16Array(o),currentSequence:new Uint8Array(o),currentSequenceLength:0},l=0;l<256;++l)s.dictionaryValues[l]=l,s.dictionaryLengths[l]=1;return r.lzwState=s,r}return g(i,[{key:"readBits",value:function(e){for(var t=this.bitsCached,i=this.cachedData;t<e;){var a=this.str.getByte();if(-1===a)return this.eof=!0,null;i=i<<8|a,t+=8}return this.bitsCached=t-=e,this.cachedData=i,this.lastCode=null,i>>>t&(1<<e)-1}},{key:"readBlock",value:function(){var e,t,i,a=1024,n=this.lzwState;if(n){var r=n.earlyChange,o=n.nextCode,s=n.dictionaryValues,l=n.dictionaryLengths,c=n.dictionaryPrevCodes,d=n.codeLength,u=n.prevCode,p=n.currentSequence,m=n.currentSequenceLength,h=0,f=this.bufferLength,y=this.ensureBuffer(this.bufferLength+a);for(e=0;e<512;e++){var b=this.readBits(d),g=m>0;if(b<256)p[0]=b,m=1;else{if(!(b>=258)){if(256===b){d=9,o=258,m=0;continue}this.eof=!0,delete this.lzwState;break}if(b<o)for(t=(m=l[b])-1,i=b;t>=0;t--)p[t]=s[i],i=c[i];else p[m++]=p[0]}if(g&&(c[o]=u,l[o]=l[u]+1,s[o]=p[0],d=++o+r&o+r-1?d:0|Math.min(Math.log(o+r)/.6931471805599453+1,12)),u=b,a<(h+=m)){do{a+=512}while(a<h);y=this.ensureBuffer(this.bufferLength+a)}for(t=0;t<m;t++)y[f++]=p[t]}n.nextCode=o,n.codeLength=d,n.prevCode=u,n.currentSequenceLength=m,this.bufferLength=f}}}]),i}(i(144).DecodeStream);t.LZWStream=a},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.PredictorStream=void 0;var a=i(144),r=i(130),o=i(2),s=function(e){d(i,e);var t=u(i);function i(e,a,s){var c;if(b(this,i),c=t.call(this,a),!(s instanceof r.Dict))return n(c,e);var d=c.predictor=s.get("Predictor")||1;if(d<=1)return n(c,e);if(2!==d&&(d<10||d>15))throw new o.FormatError("Unsupported predictor: 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_=0;_<n;++_)c<a&&(s=s<<8|255&r[b++],c+=8),f[_]=f[_]+(s>>c-a)&y,c-=a,l=l<<a|f[_],(d+=a)>=8&&(i[g++]=l>>d-8&255,d-=8);d>0&&(i[g++]=(l<<8-d)+(s&(1<<8-d)-1))}this.bufferLength+=e}}},{key:"readBlockPng",value:function(){var e=this.rowBytes,t=this.pixBytes,i=this.str.getByte(),a=this.str.getBytes(e);if(this.eof=!a.length,!this.eof){var n=this.bufferLength,r=this.ensureBuffer(n+e),s=r.subarray(n-e,n);0===s.length&&(s=new Uint8Array(e));var l,c,d,u=n;switch(i){case 0:for(l=0;l<e;++l)r[u++]=a[l];break;case 1:for(l=0;l<t;++l)r[u++]=a[l];for(;l<e;++l)r[u]=r[u-t]+a[l]&255,u++;break;case 2:for(l=0;l<e;++l)r[u++]=s[l]+a[l]&255;break;case 3:for(l=0;l<t;++l)r[u++]=(s[l]>>1)+a[l];for(;l<e;++l)r[u]=(s[l]+r[u-t]>>1)+a[l]&255,u++;break;case 4:for(l=0;l<t;++l)c=s[l],d=a[l],r[u++]=c+d;for(;l<e;++l){c=s[l];var p=s[l-t],m=r[u-t],h=m+c-p,f=h-m;f<0&&(f=-f);var y=h-c;y<0&&(y=-y);var b=h-p;b<0&&(b=-b),d=a[l],r[u++]=f<=y&&f<=b?m+d:y<=b?c+d:p+d}break;default:throw new o.FormatError("Unsupported predictor: ".concat(i))}this.bufferLength+=e}}}]),i}(a.DecodeStream);t.PredictorStream=s},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.RunLengthStream=void 0;var a=function(e){d(i,e);var t=u(i);function i(e,a){var n;return b(this,i),(n=t.call(this,a)).str=e,n.dict=e.dict,n}return g(i,[{key:"readBlock",value:function(){var e=this.str.getBytes(2);if(!e||e.length<2||128===e[0])this.eof=!0;else{var t,i=this.bufferLength,a=e[0];if(a<128){if((t=this.ensureBuffer(i+a+1))[i++]=e[1],a>0){var n=this.str.getBytes(a);t.set(n,i),i+=a}}else{a=257-a;var r=e[1];t=this.ensureBuffer(i+a+1);for(var o=0;o<a;o++)t[i++]=r}this.bufferLength=i}}}]),i}(i(144).DecodeStream);t.RunLengthStream=a},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Font=t.ErrorFont=void 0;var a=i(2),n=i(160),r=i(163),o=i(165),s=i(164),l=i(162),c=i(166),d=i(167),u=i(168),p=i(169),m=i(170),y=i(171),v=i(141),_=i(172),A=i(131),x=i(135),w=i(173),S=[[57344,63743],[1048576,1114109]],C=1e3,k=["ascent","bbox","black","bold","charProcOperatorList","composite","cssFontInfo","data","defaultVMetrics","defaultWidth","descent","fallbackName","fontMatrix","fontType","isType3Font","italic","loadedName","mimetype","missingFile","name","remeasure","subtype","type","vertical"],D=["cMap","defaultEncoding","differences","isMonospace","isSerifFont","isSymbolicFont","seacMap","toFontChar","toUnicode","vmetrics","widths"];function R(e){if(e.fontMatrix&&e.fontMatrix[0]!==a.FONT_IDENTITY_MATRIX[0]){var t=.001/e.fontMatrix[0],i=e.widths;for(var n in i)i[n]*=t;e.defaultWidth*=t}}function I(e){if(e.fallbackToUnicode&&!(e.toUnicode instanceof d.IdentityToUnicodeMap)){var t=[];for(var i in e.fallbackToUnicode)e.toUnicode.has(i)||(t[i]=e.fallbackToUnicode[i]);t.length>0&&e.toUnicode.amend(t)}}var M=function(){function e(t,i,a,n,r,s,l,c,d){b(this,e),this.originalCharCode=t,this.fontChar=i,this.unicode=a,this.accent=n,this.width=r,this.vmetric=s,this.operatorListId=l,this.isSpace=c,this.isInFont=d;var u=(0,o.getCharUnicodeCategory)(a);this.isWhitespace=u.isWhitespace,this.isZeroWidthDiacritic=u.isZeroWidthDiacritic,this.isInvisibleFormatMark=u.isInvisibleFormatMark}return g(e,[{key:"matchesForCache",value:function(e,t,i,a,n,r,o,s,l){return this.originalCharCode===e&&this.fontChar===t&&this.unicode===i&&this.accent===a&&this.width===n&&this.vmetric===r&&this.operatorListId===o&&this.isSpace===s&&this.isInFont===l}}]),e}();function T(e,t){return(e<<8)+t}function P(e,t,i){e[t+1]=i,e[t]=i>>>8}function z(e,t){var i=(e<<8)+t;return 32768&i?i-65536:i}function B(e){return String.fromCharCode(e>>8&255,255&e)}function F(e){return e>32767?e=32767:e<-32768&&(e=-32768),String.fromCharCode(e>>8&255,255&e)}function E(e){var t=e.peekBytes(4);return"ttcf"===(0,a.bytesToString)(t)}function N(e,t){var i,n,r=t.type,o=t.subtype,s=t.composite;return function(e){var t=e.peekBytes(4);return 65536===(0,A.readUint32)(t,0)||"true"===(0,a.bytesToString)(t)}(e)||E(e)?i=s?"CIDFontType2":"TrueType":function(e){var t=e.peekBytes(4);return"OTTO"===(0,a.bytesToString)(t)}(e)?i=s?"CIDFontType2":"OpenType":function(e){var t=e.peekBytes(2);return 37===t[0]&&33===t[1]||128===t[0]&&1===t[1]}(e)?i=s?"CIDFontType0":"MMType1"===r?"MMType1":"Type1":function(e){var t=e.peekBytes(4);return t[0]>=1&&t[3]>=1&&t[3]<=4}(e)?s?(i="CIDFontType0",n="CIDFontType0C"):(i="MMType1"===r?"MMType1":"Type1",n="Type1C"):((0,a.warn)("getFontFileType: Unable to detect correct font file Type/Subtype."),i=r,n=o),[i,n]}function O(e,t){for(var i in t)e[+i]=t[i]}function G(e,t,i){for(var a,n=[],r=0,s=e.length;r<s;r++)-1!==(a=(0,o.getUnicodeForGlyph)(e[r],t))&&(n[r]=a);for(var l in i)-1!==(a=(0,o.getUnicodeForGlyph)(i[l],t))&&(n[+l]=a);return n}function L(e,t){var i=arguments.length>2&&void 0!==arguments[2]&&arguments[2];switch(t.length){case 1:return t.charCodeAt(0);case 2:return t.charCodeAt(0)<<8|t.charCodeAt(1)}var n="Unsupported CID string (charCode ".concat(e,'): "').concat(t,'".');if(i)throw new a.FormatError(n);return(0,a.warn)(n),t}function j(e,t,i,n){var r=Object.create(null),o=new Map,s=[],l=new Set,c=0,d=S[c][0],u=d,p=S[c][1];for(var m in e){var h=e[m|=0];if(t(h)){if(u>p){if(++c>=S.length){(0,a.warn)("Ran out of space in font private use area.");break}u=S[c][0],p=S[c][1]}var f=u++;0===h&&(h=i);var y=n.get(m);"string"===typeof y&&(y=y.codePointAt(0)),y&&y<d&&!l.has(h)&&(o.set(y,h),l.add(h)),r[f]=h,s[m]=f}}return{toFontChar:s,charCodeToGlyphId:r,toUnicodeExtraMap:o,nextAvailableFontCharCode:u}}function q(e,t,i){var n,r,o,s,l=function(e,t,i){var a=[];for(var n in e)e[n]>=i||a.push({fontCharCode:0|n,glyphId:e[n]});if(t){var r,o=h(t);try{for(o.s();!(r=o.n()).done;){var s=f(r.value,2),l=s[0],c=s[1];c>=i||a.push({fontCharCode:l,glyphId:c})}}catch(g){o.e(g)}finally{o.f()}}0===a.length&&a.push({fontCharCode:0,glyphId:0}),a.sort((function(e,t){return e.fontCharCode-t.fontCharCode}));for(var d=[],u=a.length,p=0;p<u;){var m=a[p].fontCharCode,y=[a[p].glyphId];++p;for(var b=m;p<u&&b+1===a[p].fontCharCode&&(y.push(a[p].glyphId),++p,65535!==++b););d.push([m,b,y])}return d}(e,t,i),c=l.at(-1)[1]>65535?2:1,d="\0\0"+B(c)+"\0\x03\0\x01"+(0,a.string32)(4+8*c);for(n=l.length-1;n>=0&&!(l[n][0]<=65535);--n);var u=n+1;l[n][0]<65535&&65535===l[n][1]&&(l[n][1]=65534);var p,m,y,b,g=l[n][1]<65535?1:0,v=u+g,A=_.OpenTypeFileBuilder.getSearchParams(v,2),x="",w="",S="",C="",k="",D=0;for(n=0,r=u;n<r;n++){m=(p=l[n])[0],y=p[1],x+=B(m),w+=B(y);var R=!0;for(o=1,s=(b=p[2]).length;o<s;++o)if(b[o]!==b[o-1]+1){R=!1;break}if(R)S+=B(b[0]-m&65535),C+=B(0);else{var I=2*(v-n)+2*D;for(D+=y-m+1,S+=B(0),C+=B(I),o=0,s=b.length;o<s;++o)k+=B(b[o])}}g>0&&(w+="\xff\xff",x+="\xff\xff",S+="\0\x01",C+="\0\0");var M="\0\0"+B(2*v)+B(A.range)+B(A.entry)+B(A.rangeShift)+w+"\0\0"+x+S+C+k,T="",P="";if(c>1){for(d+="\0\x03\0\n"+(0,a.string32)(4+8*c+4+M.length),T="",n=0,r=l.length;n<r;n++){m=(p=l[n])[0];var z=(b=p[2])[0];for(o=1,s=b.length;o<s;++o)b[o]!==b[o-1]+1&&(y=p[0]+o-1,T+=(0,a.string32)(m)+(0,a.string32)(y)+(0,a.string32)(z),m=y+1,z=b[o]);T+=(0,a.string32)(m)+(0,a.string32)(p[1])+(0,a.string32)(z)}P="\0\f\0\0"+(0,a.string32)(T.length+16)+"\0\0\0\0"+(0,a.string32)(T.length/12)}return d+"\0\x04"+B(M.length+4)+M+P+T}function H(e,t,i){i=i||{unitsPerEm:0,yMax:0,yMin:0,ascent:0,descent:0};var n=0,r=0,s=0,l=0,c=null,d=0;if(t){for(var u in t){(c>(u|=0)||!c)&&(c=u),d<u&&(d=u);var p=(0,o.getUnicodeRangeFor)(u);if(p<32)n|=1<<p;else if(p<64)r|=1<<p-32;else if(p<96)s|=1<<p-64;else{if(!(p<123))throw new a.FormatError("Unicode ranges Bits > 123 are reserved for internal usage");l|=1<<p-96}}d>65535&&(d=65535)}else c=0,d=255;var m=e.bbox||[0,0,0,0],h=i.unitsPerEm||1/(e.fontMatrix||a.FONT_IDENTITY_MATRIX)[0],f=e.ascentScaled?1:h/C,y=i.ascent||Math.round(f*(e.ascent||m[3])),b=i.descent||Math.round(f*(e.descent||m[1]));b>0&&e.descent>0&&m[1]<0&&(b=-b);var g=i.yMax||y,v=-i.yMin||-b;return"\0\x03\x02$\x01\xf4\0\x05\0\0\x02\x8a\x02\xbb\0\0\0\x8c\x02\x8a\x02\xbb\0\0\x01\xdf\x001\x01\x02\0\0\0\0\x06"+String.fromCharCode(e.fixedPitch?9:0)+"\0\0\0\0\0\0"+(0,a.string32)(n)+(0,a.string32)(r)+(0,a.string32)(s)+(0,a.string32)(l)+"*21*"+B(e.italicAngle?1:0)+B(c||e.firstChar)+B(d||e.lastChar)+B(y)+B(b)+"\0d"+B(g)+B(v)+"\0\0\0\0\0\0\0\0"+B(e.xHeight)+B(e.capHeight)+B(0)+B(c||e.firstChar)+"\0\x03"}function U(e){var t=Math.floor(e.italicAngle*Math.pow(2,16));return"\0\x03\0\0"+(0,a.string32)(t)+"\0\0\0\0"+(0,a.string32)(e.fixedPitch?1:0)+"\0\0\0\0\0\0\0\0\0\0\0\0\0\0\0\0"}function Y(e){return e.replace(/[^\x21-\x7E]|[[\](){}<>/%]/g,"").slice(0,63)}function X(e,t){t||(t=[[],[]]);var i,a,n,r,o,s=[t[0][0]||"Original licence",t[0][1]||e,t[0][2]||"Unknown",t[0][3]||"uniqueID",t[0][4]||e,t[0][5]||"Version 0.11",t[0][6]||Y(e),t[0][7]||"Unknown",t[0][8]||"Unknown",t[0][9]||"Unknown"],l=[];for(i=0,a=s.length;i<a;i++){var c=[];for(n=0,r=(o=t[1][i]||s[i]).length;n<r;n++)c.push(B(o.charCodeAt(n)));l.push(c.join(""))}var d=[s,l],u=["\0\x01","\0\x03"],p=["\0\0","\0\x01"],m=["\0\0","\x04\t"],h=s.length*u.length,f="\0\0"+B(h)+B(12*h+6),y=0;for(i=0,a=u.length;i<a;i++){var b=d[i];for(n=0,r=b.length;n<r;n++)o=b[n],f+=u[i]+p[i]+m[i]+B(n)+B(o.length)+B(y),y+=o.length}return f+=s.join("")+l.join("")}var V=function(){function e(t,i,n){b(this,e),this.name=t,this.psName=null,this.mimetype=null,this.disableFontFace=!1,this.loadedName=n.loadedName,this.isType3Font=n.isType3Font,this.missingFile=!1,this.cssFontInfo=n.cssFontInfo,this._charsCache=Object.create(null),this._glyphCache=Object.create(null);var o=!!(n.flags&r.FontFlags.Serif);if(!o&&!n.isSimulatedFlags){var s,l=t.replace(/[,_]/g,"-").split("-")[0],d=(0,c.getSerifFonts)(),p=h(l.split("+"));try{for(p.s();!(s=p.n()).done;)if(d[s.value]){o=!0;break}}catch(k){p.e(k)}finally{p.f()}}this.isSerifFont=o,this.isSymbolicFont=!!(n.flags&r.FontFlags.Symbolic),this.isMonospace=!!(n.flags&r.FontFlags.FixedPitch);var m=n.type,y=n.subtype;this.type=m,this.subtype=y;var g="sans-serif";if(this.isMonospace?g="monospace":this.isSerifFont&&(g="serif"),this.fallbackName=g,this.differences=n.differences,this.widths=n.widths,this.defaultWidth=n.defaultWidth,this.composite=n.composite,this.cMap=n.cMap,this.capHeight=n.capHeight/C,this.ascent=n.ascent/C,this.descent=n.descent/C,this.lineHeight=this.ascent-this.descent,this.fontMatrix=n.fontMatrix,this.bbox=n.bbox,this.defaultEncoding=n.defaultEncoding,this.toUnicode=n.toUnicode,this.toFontChar=[],"Type3"!==n.type){if(this.cidEncoding=n.cidEncoding||"",this.vertical=!!n.vertical,this.vertical&&(this.vmetrics=n.vmetrics,this.defaultVMetrics=n.defaultVMetrics),!i||i.isEmpty)return i&&(0,a.warn)('Font file is empty in "'+t+'" ('+this.loadedName+")"),void this.fallbackToSystemFont(n);var v,_=N(i,n),A=f(_,2);m=A[0],y=A[1],m===this.type&&y===this.subtype||(0,a.info)("Inconsistent font file Type/SubType, expected: "+"".concat(this.type,"/").concat(this.subtype," but found: ").concat(m,"/").concat(y,"."));try{switch(m){case"MMType1":(0,a.info)("MMType1 font ("+t+"), falling back to Type1.");case"Type1":case"CIDFontType0":this.mimetype="font/opentype";var x="Type1C"===y||"CIDFontType0C"===y?new u.CFFFont(i,n):new w.Type1Font(t,i,n);R(n),v=this.convert(t,x,n);break;case"OpenType":case"TrueType":case"CIDFontType2":this.mimetype="font/opentype",v=this.checkAndRepair(t,i,n),this.isOpenType&&(R(n),m="OpenType");break;default:throw new a.FormatError("Font ".concat(m," is not supported"))}}catch(D){return(0,a.warn)(D),void this.fallbackToSystemFont(n)}I(n),this.data=v,this.fontType=(0,r.getFontType)(m,y,n.isStandardFont),this.fontMatrix=n.fontMatrix,this.widths=n.widths,this.defaultWidth=n.defaultWidth,this.toUnicode=n.toUnicode,this.seacMap=n.seacMap}else{for(var S=0;S<256;S++)this.toFontChar[S]=this.differences[S]||n.defaultEncoding[S];this.fontType=a.FontType.TYPE3}}return g(e,[{key:"renderer",get:function(){var e=p.FontRendererFactory.create(this,r.SEAC_ANALYSIS_ENABLED);return(0,a.shadow)(this,"renderer",e)}},{key:"exportData",value:function(){var e,t,i,a=arguments.length>0&&void 0!==arguments[0]&&arguments[0]?[].concat(k,D):k,n=Object.create(null),r=h(a);try{for(r.s();!(i=r.n()).done;)void 0!==(t=this[e=i.value])&&(n[e]=t)}catch(o){r.e(o)}finally{r.f()}return n}},{key:"fallbackToSystemFont",value:function(e){var t=this;this.missingFile=!0;var i=this.name,n=this.type,u=this.subtype,p=(0,r.normalizeFontName)(i),h=(0,c.getStdFontMap)(),f=(0,c.getNonStdFontMap)(),y=!!h[p],b=!(!f[p]||!h[f[p]]);p=h[p]||f[p]||p;var g=(0,m.getFontBasicMetrics)()[p];g&&(isNaN(this.ascent)&&(this.ascent=g.ascent/C),isNaN(this.descent)&&(this.descent=g.descent/C),isNaN(this.capHeight)&&(this.capHeight=g.capHeight/C)),this.bold=-1!==p.search(/bold/gi),this.italic=-1!==p.search(/oblique/gi)||-1!==p.search(/italic/gi),this.black=-1!==i.search(/Black/g);var v=-1!==i.search(/Narrow/g);if(this.remeasure=(!y||v)&&Object.keys(this.widths).length>0,(y||b)&&"CIDFontType2"===n&&this.cidEncoding.startsWith("Identity-")){var _=e.cidToGidMap,A=[];if(O(A,(0,c.getGlyphMapForStandardFonts)()),/Arial-?Black/i.test(i)?O(A,(0,c.getSupplementalGlyphMapForArialBlack)()):/Calibri/i.test(i)&&O(A,(0,c.getSupplementalGlyphMapForCalibri)()),_){for(var x in A){var w=A[x];void 0!==_[w]&&(A[+x]=_[w])}_.length!==this.toUnicode.length&&e.hasIncludedToUnicodeMap&&this.toUnicode instanceof d.IdentityToUnicodeMap&&this.toUnicode.forEach((function(e,t){var i=A[e];void 0===_[i]&&(A[+e]=t)}))}this.toUnicode instanceof d.IdentityToUnicodeMap||this.toUnicode.forEach((function(e,t){A[+e]=t})),this.toFontChar=A,this.toUnicode=new d.ToUnicodeMap(A)}else if(/Symbol/i.test(p))this.toFontChar=G(l.SymbolSetEncoding,(0,s.getGlyphsUnicode)(),this.differences);else if(/Dingbats/i.test(p))/Wingdings/i.test(i)&&(0,a.warn)("Non-embedded Wingdings font, falling back to ZapfDingbats."),this.toFontChar=G(l.ZapfDingbatsEncoding,(0,s.getDingbatsGlyphsUnicode)(),this.differences);else if(y){var S=G(this.defaultEncoding,(0,s.getGlyphsUnicode)(),this.differences);"CIDFontType2"!==n||this.cidEncoding.startsWith("Identity-")||this.toUnicode instanceof d.IdentityToUnicodeMap||this.toUnicode.forEach((function(e,t){S[+e]=t})),this.toFontChar=S}else{var k=(0,s.getGlyphsUnicode)(),D=[];this.toUnicode.forEach((function(e,i){if(!t.composite){var a=t.differences[e]||t.defaultEncoding[e],n=(0,o.getUnicodeForGlyph)(a,k);-1!==n&&(i=n)}D[+e]=i})),this.composite&&this.toUnicode instanceof d.IdentityToUnicodeMap&&/Verdana/i.test(i)&&O(D,(0,c.getGlyphMapForStandardFonts)()),this.toFontChar=D}I(e),this.loadedName=p.split("-")[0],this.fontType=(0,r.getFontType)(n,u,e.isStandardFont)}},{key:"checkAndRepair",value:function(e,t,i){var o=["OS/2","cmap","head","hhea","hmtx","maxp","name","post","loca","glyf","fpgm","prep","cvt ","CFF "];function c(e,t){var i=Object.create(null);i["OS/2"]=null,i.cmap=null,i.head=null,i.hhea=null,i.hmtx=null,i.maxp=null,i.name=null,i.post=null;for(var a=0;a<t;a++){var n=p(e);o.includes(n.tag)&&0!==n.length&&(i[n.tag]=n)}return i}function p(e){var t=e.getString(4),i=e.getInt32()>>>0,a=e.getInt32()>>>0,n=e.getInt32()>>>0,r=e.pos;e.pos=e.start||0,e.skip(a);var o=e.getBytes(n);return e.pos=r,"head"===t&&(o[8]=o[9]=o[10]=o[11]=0,o[17]|=32),{tag:t,checksum:i,length:n,offset:a,data:o}}function m(e){return{version:e.getString(4),numTables:e.getUint16(),searchRange:e.getUint16(),entrySelector:e.getUint16(),rangeShift:e.getUint16()}}function f(e,t,i,a,n,r){var o={length:0,sizeOfInstructions:0};if(i-t<=12)return o;var s=e.subarray(t,i),l=z(s[0],s[1]);if(l<0)return P(s,0,l=-1),a.set(s,n),o.length=s.length,o;var c,d=10,u=0;for(c=0;c<l;c++)u=1+(s[d]<<8|s[d+1]),d+=2;var p=d,m=s[d]<<8|s[d+1];o.sizeOfInstructions=m;var h=d+=2+m,f=0;for(c=0;c<u;c++){var y=s[d++];192&y&&(s[d-1]=63&y);var b=2;2&y?b=1:16&y&&(b=0);var g=2;4&y?g=1:32&y&&(g=0);var v=b+g;if(f+=v,8&y){var _=s[d++];c+=_,f+=_*v}}if(0===f)return o;var A=d+f;return A>s.length?o:!r&&m>0?(a.set(s.subarray(0,p),n),a.set([0,0],n+p),a.set(s.subarray(h,A),n+p+2),A-=m,s.length-A>3&&(A=A+3&-4),o.length=A,o):s.length-A>3?(A=A+3&-4,a.set(s.subarray(0,A),n),o.length=A,o):(a.set(s,n),o.length=s.length,o)}function b(e){var i=(t.start||0)+e.offset;t.pos=i;var a=[[],[]],n=e.length,r=i+n;if(0!==t.getUint16()||n<6)return a;var o,s,l=t.getUint16(),c=t.getUint16(),d=[];for(o=0;o<l&&t.pos+12<=r;o++){var u={platform:t.getUint16(),encoding:t.getUint16(),language:t.getUint16(),name:t.getUint16(),length:t.getUint16(),offset:t.getUint16()};(1===u.platform&&0===u.encoding&&0===u.language||3===u.platform&&1===u.encoding&&1033===u.language)&&d.push(u)}for(o=0,s=d.length;o<s;o++){var p=d[o];if(!(p.length<=0)){var m=i+c+p.offset;if(!(m+p.length>r)){t.pos=m;var h=p.name;if(p.encoding){for(var f="",y=0,b=p.length;y<b;y+=2)f+=String.fromCharCode(t.getUint16());a[1][h]=f}else a[0][h]=t.getString(p.length)}}}return a}var g,A,w,S,C=[0,0,0,0,0,0,0,0,-2,-2,-2,-2,0,0,-2,-5,-1,-1,-1,-1,-1,-1,-1,-1,0,0,-1,0,-1,-1,-1,-1,1,-1,-999,0,1,0,-1,-2,0,-1,-2,-1,-1,0,-1,-1,0,0,-999,-999,-1,-1,-1,-1,-2,-999,-2,-2,-999,0,-2,-2,0,0,-2,0,-2,0,0,0,-2,-1,-1,1,1,0,0,-1,-1,-1,-1,-1,-1,-1,0,0,-1,0,-1,-1,0,-999,-1,-1,-1,-1,-1,-1,0,0,0,0,0,0,0,0,0,0,0,0,-2,-999,-999,-999,-999,-999,-1,-1,-2,-2,0,0,0,0,-1,-1,-999,-2,-2,0,0,-1,-2,-2,0,0,0,-1,-1,-1,-2];function k(e,t){for(var i,n,r,o,s,l=e.data,c=0,d=0,u=0,p=[],m=[],h=[],f=t.tooComplexToFollowFunctions,y=!1,b=0,g=0,v=l.length;c<v;){var _=l[c++];if(64===_)if(n=l[c++],y||g)c+=n;else for(i=0;i<n;i++)p.push(l[c++]);else if(65===_)if(n=l[c++],y||g)c+=2*n;else for(i=0;i<n;i++)r=l[c++],p.push(r<<8|l[c++]);else if(176===(248&_))if(n=_-176+1,y||g)c+=n;else for(i=0;i<n;i++)p.push(l[c++]);else if(184===(248&_))if(n=_-184+1,y||g)c+=2*n;else for(i=0;i<n;i++)r=l[c++],p.push(r<<8|l[c++]);else if(43!==_||f)if(44!==_||f){if(45===_)if(y)y=!1,d=c;else{if(!(s=m.pop()))return(0,a.warn)("TT: ENDF bad stack"),void(t.hintsValid=!1);o=h.pop(),l=s.data,c=s.i,t.functionsStackDeltas[o]=p.length-s.stackTop}else if(137===_)(y||g)&&((0,a.warn)("TT: nested IDEFs not allowed"),f=!0),y=!0,u=c;else if(88===_)++b;else if(27===_)g=b;else if(89===_)g===b&&(g=0),--b;else if(28===_&&!y&&!g){var A=p.at(-1);A>0&&(c+=A-1)}}else(y||g)&&((0,a.warn)("TT: nested FDEFs not allowed"),f=!0),y=!0,u=c,o=p.pop(),t.functionsDefined[o]={data:l,i:c};else if(!y&&!g)if(o=p.at(-1),isNaN(o))(0,a.info)("TT: CALL empty stack (or invalid entry).");else if(t.functionsUsed[o]=!0,o in t.functionsStackDeltas){var x=p.length+t.functionsStackDeltas[o];if(x<0)return(0,a.warn)("TT: CALL invalid functions stack delta."),void(t.hintsValid=!1);p.length=x}else if(o in t.functionsDefined&&!h.includes(o)){if(m.push({data:l,i:c,stackTop:p.length-1}),h.push(o),!(s=t.functionsDefined[o]))return(0,a.warn)("TT: CALL non-existent function"),void(t.hintsValid=!1);l=s.data,c=s.i}if(!y&&!g){var w=0;for(_<=142?w=C[_]:_>=192&&_<=223?w=-1:_>=224&&(w=-2),_>=113&&_<=117&&(n=p.pop(),isNaN(n)||(w=2*-n));w<0&&p.length>0;)p.pop(),w++;for(;w>0;)p.push(NaN),w--}}t.tooComplexToFollowFunctions=f;var S=[l];c>l.length&&S.push(new Uint8Array(c-l.length)),u>d&&((0,a.warn)("TT: complementing a missing function tail"),S.push(new Uint8Array([34,45]))),function(e,t){if(t.length>1){var i,a,n=0;for(i=0,a=t.length;i<a;i++)n+=t[i].length;n=n+3&-4;var r=new Uint8Array(n),o=0;for(i=0,a=t.length;i<a;i++)r.set(t[i],o),o+=t[i].length;e.data=r,e.length=n}}(e,S)}if(E(t=new x.Stream(new Uint8Array(t.getBytes())))){var D=function(e,t){for(var i,n=function(e){var t=e.getString(4);(0,a.assert)("ttcf"===t,"Must be a TrueType Collection font.");for(var i=e.getUint16(),n=e.getUint16(),r=e.getInt32()>>>0,o=[],s=0;s<r;s++)o.push(e.getInt32()>>>0);var l={ttcTag:t,majorVersion:i,minorVersion:n,numFonts:r,offsetTable:o};switch(i){case 1:return l;case 2:return l.dsigTag=e.getInt32()>>>0,l.dsigLength=e.getInt32()>>>0,l.dsigOffset=e.getInt32()>>>0,l}throw new a.FormatError("Invalid TrueType Collection majorVersion: ".concat(i,"."))}(e),r=n.numFonts,o=n.offsetTable,s=t.split("+"),l=0;l<r;l++){e.pos=(e.start||0)+o[l];var d=m(e),u=c(e,d.numTables);if(!u.name)throw new a.FormatError('TrueType Collection font must contain a "name" table.');for(var p=b(u.name),f=0,y=p.length;f<y;f++)for(var g=0,v=p[f].length;g<v;g++){var _=p[f][g]&&p[f][g].replace(/\s/g,"");if(_){if(_===t)return{header:d,tables:u};if(!(s.length<2)){var A,x=h(s);try{for(x.s();!(A=x.n()).done;){var w=A.value;_===w&&(i={name:w,header:d,tables:u})}}catch(S){x.e(S)}finally{x.f()}}}}}if(i)return(0,a.warn)('TrueType Collection does not contain "'.concat(t,'" font, ')+'falling back to "'.concat(i.name,'" font instead.')),{header:i.header,tables:i.tables};throw new a.FormatError('TrueType Collection does not contain "'.concat(t,'" font.'))}(t,this.name);g=D.header,A=D.tables}else g=m(t),A=c(t,g.numTables);var I=!A["CFF "];if(I){if(!A.loca)throw new a.FormatError('Required "loca" table is not found');A.glyf||((0,a.warn)('Required "glyf" table is not found -- trying to recover.'),A.glyf={tag:"glyf",data:new Uint8Array(0)}),this.isOpenType=!1}else{var M=i.composite&&((i.cidToGidMap||[]).length>0||!(i.cMap instanceof v.IdentityCMap));if("OTTO"===g.version&&!M||!A.head||!A.hhea||!A.maxp||!A.post)return S=new x.Stream(A["CFF "].data),w=new u.CFFFont(S,i),R(i),this.convert(e,w,i);delete A.glyf,delete A.loca,delete A.fpgm,delete A.prep,delete A["cvt "],this.isOpenType=!0}if(!A.maxp)throw new a.FormatError('Required "maxp" table is not found');t.pos=(t.start||0)+A.maxp.offset;var B=t.getInt32(),F=t.getUint16();if(i.scaleFactors&&i.scaleFactors.length===F&&I){var N=i.scaleFactors,O=T(A.head.data[50],A.head.data[51]),G=new y.GlyfTable({glyfTable:A.glyf.data,isGlyphLocationsLong:O,locaTable:A.loca.data,numGlyphs:F});G.scale(N);var Y=G.write(),V=Y.glyf,Q=Y.loca,W=Y.isLocationLong;A.glyf.data=V,A.loca.data=Q,W!==!!O&&(A.head.data[50]=0,A.head.data[51]=W?1:0);for(var Z=A.hmtx.data,J=0;J<F;J++){var K=4*J,$=Math.round(N[J]*T(Z[K],Z[K+1]));Z[K]=$>>8&255,Z[K+1]=255&$,P(Z,K+2,Math.round(N[J]*z(Z[K+2],Z[K+3])))}}var ee=F+1,te=!0;ee>65535&&(te=!1,ee=F,(0,a.warn)("Not enough space in glyfs to duplicate first glyph."));var ie=0,ae=0;B>=65536&&A.maxp.length>=22&&(t.pos+=8,t.getUint16()>2&&(A.maxp.data[14]=0,A.maxp.data[15]=2),t.pos+=4,ie=t.getUint16(),t.pos+=4,ae=t.getUint16()),A.maxp.data[4]=ee>>8,A.maxp.data[5]=255&ee;var ne=function(e,t,i,n){var r={functionsDefined:[],functionsUsed:[],functionsStackDeltas:[],tooComplexToFollowFunctions:!1,hintsValid:!0};if(e&&k(e,r),t&&k(t,r),e&&function(e,t){if(!e.tooComplexToFollowFunctions){if(e.functionsDefined.length>t)return(0,a.warn)("TT: more functions defined than expected"),void(e.hintsValid=!1);for(var i=0,n=e.functionsUsed.length;i<n;i++){if(i>t)return(0,a.warn)("TT: invalid function id: "+i),void(e.hintsValid=!1);if(e.functionsUsed[i]&&!e.functionsDefined[i])return(0,a.warn)("TT: undefined function: "+i),void(e.hintsValid=!1)}}}(r,n),i&&1&i.length){var o=new Uint8Array(i.length+1);o.set(i.data),i.data=o}return r.hintsValid}(A.fpgm,A.prep,A["cvt "],ie);if(ne||(delete A.fpgm,delete A.prep,delete A["cvt "]),function(e,t,i,n,r,o){if(t){e.pos=(e.start||0)+t.offset,e.pos+=4,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2,e.pos+=2;var s=e.getUint16();e.pos+=8,e.pos+=2;var l=e.getUint16();0!==s&&(2&T(n.data[44],n.data[45])||(t.data[22]=0,t.data[23]=0)),l>r&&((0,a.info)("The numOfMetrics (".concat(l,") should not be ")+"greater than the numGlyphs (".concat(r,").")),l=r,t.data[34]=(65280&l)>>8,t.data[35]=255&l);var c=r-l-(i.length-4*l>>1);if(c>0){var d=new Uint8Array(i.length+2*c);d.set(i.data),o&&(d[i.length]=i.data[2],d[i.length+1]=i.data[3]),i.data=d}}else i&&(i.data=null)}(t,A.hhea,A.hmtx,A.head,ee,te),!A.head)throw new a.FormatError('Required "head" table is not found');!function(e,t,i){var n,r,o,s,l=e.data,c=(n=l[0],r=l[1],o=l[2],s=l[3],(n<<24)+(r<<16)+(o<<8)+s);c>>16!==1&&((0,a.info)("Attempting to fix invalid version in head table: "+c),l[0]=0,l[1]=1,l[2]=0,l[3]=0);var d=T(l[50],l[51]);if(d<0||d>1){(0,a.info)("Attempting to fix invalid indexToLocFormat in head table: "+d);var u=t+1;if(i===u<<1)l[50]=0,l[51]=0;else{if(i!==u<<2)throw new a.FormatError("Could not fix indexToLocFormat: "+d);l[50]=0,l[51]=1}}}(A.head,F,I?A.loca.length:0);var re=Object.create(null);if(I){var oe=T(A.head.data[50],A.head.data[51]),se=function(e,t,i,a,n,r,o){var s,l,c;a?(s=4,l=function(e,t){return e[t]<<24|e[t+1]<<16|e[t+2]<<8|e[t+3]},c=function(e,t,i){e[t]=i>>>24&255,e[t+1]=i>>16&255,e[t+2]=i>>8&255,e[t+3]=255&i}):(s=2,l=function(e,t){return e[t]<<9|e[t+1]<<1},c=function(e,t,i){e[t]=i>>9&255,e[t+1]=i>>1&255});var d=r?i+1:i,u=s*(1+d),p=new Uint8Array(u);p.set(e.data.subarray(0,u)),e.data=p;var m,h,y=t.data,b=y.length,g=new Uint8Array(b),v=[];for(m=0,h=0;m<i+1;m++,h+=s){var _=l(p,h);_>b&&(_=b),v.push({index:m,offset:_,endOffset:0})}for(v.sort((function(e,t){return e.offset-t.offset})),m=0;m<i;m++)v[m].endOffset=v[m+1].offset;for(v.sort((function(e,t){return e.index-t.index})),m=0;m<i;m++){var A=v[m],x=A.offset,w=A.endOffset;if(0!==x||0!==w)break;var S=v[m+1].offset;if(0!==S){v[m].endOffset=S;break}}var C=Object.create(null),k=0;for(c(p,0,k),m=0,h=s;m<i;m++,h+=s){var D=f(y,v[m].offset,v[m].endOffset,g,k,n),R=D.length;0===R&&(C[m]=!0),D.sizeOfInstructions>o&&(o=D.sizeOfInstructions),c(p,h,k+=R)}if(0===k){var I=new Uint8Array([0,1,0,0,0,0,0,0,0,0,0,0,0,0,49,0]);for(m=0,h=s;m<d;m++,h+=s)c(p,h,I.length);t.data=I}else if(r){var M=l(p,s);g.length>M+k?t.data=g.subarray(0,M+k):(t.data=new Uint8Array(M+k),t.data.set(g.subarray(0,k))),t.data.set(g.subarray(0,M),k),c(e.data,p.length-s,k+M)}else t.data=g.subarray(0,k);return{missingGlyphs:C,maxSizeOfInstructions:o}}(A.loca,A.glyf,F,oe,ne,te,ae);re=se.missingGlyphs,B>=65536&&A.maxp.length>=22&&(A.maxp.data[26]=se.maxSizeOfInstructions>>8,A.maxp.data[27]=255&se.maxSizeOfInstructions)}if(!A.hhea)throw new a.FormatError('Required "hhea" table is not found');0===A.hhea.data[10]&&0===A.hhea.data[11]&&(A.hhea.data[10]=255,A.hhea.data[11]=255);var le={unitsPerEm:T(A.head.data[18],A.head.data[19]),yMax:T(A.head.data[42],A.head.data[43]),yMin:z(A.head.data[38],A.head.data[39]),ascent:z(A.hhea.data[4],A.hhea.data[5]),descent:z(A.hhea.data[6],A.hhea.data[7]),lineGap:z(A.hhea.data[8],A.hhea.data[9])};this.ascent=le.ascent/le.unitsPerEm,this.descent=le.descent/le.unitsPerEm,this.lineGap=le.lineGap/le.unitsPerEm,this.cssFontInfo&&this.cssFontInfo.lineHeight?(this.lineHeight=this.cssFontInfo.metrics.lineHeight,this.lineGap=this.cssFontInfo.metrics.lineGap):this.lineHeight=this.ascent-this.descent+this.lineGap,A.post&&function(e,i,n){var o=(t.start||0)+e.offset;t.pos=o;var s,l=o+e.length,c=t.getInt32();t.skip(28);var d,u=!0;switch(c){case 65536:s=r.MacStandardGlyphOrdering;break;case 131072:var p=t.getUint16();if(p!==n){u=!1;break}var m=[];for(d=0;d<p;++d){var h=t.getUint16();if(h>=32768){u=!1;break}m.push(h)}if(!u)break;for(var f=[],y=[];t.pos<l;){var b=t.getByte();for(y.length=b,d=0;d<b;++d)y[d]=String.fromCharCode(t.getByte());f.push(y.join(""))}for(s=[],d=0;d<p;++d){var g=m[d];g<258?s.push(r.MacStandardGlyphOrdering[g]):s.push(f[g-258])}break;case 196608:break;default:(0,a.warn)("Unknown/unsupported post table version "+c),u=!1,i.defaultEncoding&&(s=i.defaultEncoding)}i.glyphNames=s}(A.post,i,F),A.post={tag:"post",data:U(i)};var ce=[];function de(e){return!re[e]}if(i.composite){var ue=i.cidToGidMap||[],pe=0===ue.length;i.cMap.forEach((function(e,t){if("string"===typeof t&&(t=L(e,t,!0)),t>65535)throw new a.FormatError("Max size of CID is 65,535");var i=-1;pe?i=t:void 0!==ue[t]&&(i=ue[t]),i>=0&&i<F&&de(i)&&(ce[e]=i)}))}else{var me=function(e,t,i,n){if(!e)return(0,a.warn)("No cmap table available."),{platformId:-1,encodingId:-1,mappings:[],hasShortCmap:!1};var r,o=(t.start||0)+e.offset;t.pos=o,t.skip(2);for(var s,l=t.getUint16(),c=!1,d=0;d<l;d++){var u=t.getUint16(),p=t.getUint16(),m=t.getInt32()>>>0,h=!1;if(!s||s.platformId!==u||s.encodingId!==p){if(0!==u||0!==p&&1!==p&&3!==p)if(1===u&&0===p)h=!0;else if(3!==u||1!==p||!n&&s){if(i&&3===u&&0===p){h=!0;var f=!0;if(d<l-1){var y=t.peekBytes(2);T(y[0],y[1])<u&&(f=!1)}f&&(c=!0)}}else h=!0,i||(c=!0);else h=!0;if(h&&(s={platformId:u,encodingId:p,offset:m}),c)break}}if(s&&(t.pos=o+s.offset),!s||-1===t.peekByte())return(0,a.warn)("Could not find a preferred cmap table."),{platformId:-1,encodingId:-1,mappings:[],hasShortCmap:!1};var b,g,v=t.getUint16(),_=!1,A=[];if(0===v){for(t.skip(4),b=0;b<256;b++){var x=t.getByte();x&&A.push({charCode:b,glyphId:x})}_=!0}else if(2===v){t.skip(4);for(var w=[],S=0,C=0;C<256;C++){var k=t.getUint16()>>3;w.push(k),S=Math.max(k,S)}for(var D=[],R=0;R<=S;R++)D.push({firstCode:t.getUint16(),entryCount:t.getUint16(),idDelta:z(t.getByte(),t.getByte()),idRangePos:t.pos+t.getUint16()});for(var I=0;I<256;I++)if(0===w[I])t.pos=D[0].idRangePos+2*I,g=t.getUint16(),A.push({charCode:I,glyphId:g});else{var M=D[w[I]];for(b=0;b<M.entryCount;b++){var P=(I<<8)+b+M.firstCode;t.pos=M.idRangePos+2*b,0!==(g=t.getUint16())&&(g=(g+M.idDelta)%65536),A.push({charCode:P,glyphId:g})}}}else if(4===v){t.skip(4);var B=t.getUint16()>>1;t.skip(6);var F,E=[];for(F=0;F<B;F++)E.push({end:t.getUint16()});for(t.skip(2),F=0;F<B;F++)E[F].start=t.getUint16();for(F=0;F<B;F++)E[F].delta=t.getUint16();var N,O=0;for(F=0;F<B;F++){r=E[F];var G=t.getUint16();G?(N=(G>>1)-(B-F),r.offsetIndex=N,O=Math.max(O,N+r.end-r.start+1)):r.offsetIndex=-1}var L=[];for(b=0;b<O;b++)L.push(t.getUint16());for(F=0;F<B;F++){o=(r=E[F]).start;var j=r.end,q=r.delta;for(N=r.offsetIndex,b=o;b<=j;b++)65535!==b&&(g=(g=N<0?b:L[N+b-o])+q&65535,A.push({charCode:b,glyphId:g}))}}else if(6===v){t.skip(4);var H=t.getUint16(),U=t.getUint16();for(b=0;b<U;b++){g=t.getUint16();var Y=H+b;A.push({charCode:Y,glyphId:g})}}else{if(12!==v)return(0,a.warn)("cmap table has unsupported format: "+v),{platformId:-1,encodingId:-1,mappings:[],hasShortCmap:!1};t.skip(10);var X=t.getInt32()>>>0;for(b=0;b<X;b++)for(var V=t.getInt32()>>>0,Q=t.getInt32()>>>0,W=t.getInt32()>>>0,Z=V;Z<=Q;Z++)A.push({charCode:Z,glyphId:W++})}A.sort((function(e,t){return e.charCode-t.charCode}));for(var J=1;J<A.length;J++)A[J-1].charCode===A[J].charCode&&(A.splice(J,1),J--);return{platformId:s.platformId,encodingId:s.encodingId,mappings:A,hasShortCmap:_}}(A.cmap,t,this.isSymbolicFont,i.hasEncoding),he=me.platformId,fe=me.encodingId,ye=me.mappings,be=ye.length,ge=[],ve=!1;if(!i.hasEncoding||"MacRomanEncoding"!==i.baseEncodingName&&"WinAnsiEncoding"!==i.baseEncodingName||(ge=(0,l.getEncoding)(i.baseEncodingName)),i.hasEncoding&&!this.isSymbolicFont&&(3===he&&1===fe||1===he&&0===fe))for(var _e=(0,s.getGlyphsUnicode)(),Ae=0;Ae<256;Ae++){var xe=void 0;if(xe=void 0!==this.differences[Ae]?this.differences[Ae]:ge.length&&""!==ge[Ae]?ge[Ae]:l.StandardEncoding[Ae]){var we=(0,r.recoverGlyphName)(xe,_e),Se=void 0;if(3===he&&1===fe?Se=_e[we]:1===he&&0===fe&&(Se=l.MacRomanEncoding.indexOf(we)),void 0===Se){if(!i.glyphNames&&i.hasIncludedToUnicodeMap&&!(this.toUnicode instanceof d.IdentityToUnicodeMap)){var Ce=this.toUnicode.get(Ae);Ce&&(Se=Ce.codePointAt(0))}if(void 0===Se)continue}for(var ke=0;ke<be;++ke)if(ye[ke].charCode===Se){ce[Ae]=ye[ke].glyphId;break}}}else if(0===he){for(var De=0;De<be;++De)ce[ye[De].charCode]=ye[De].glyphId;ve=!0}else for(var Re=0;Re<be;++Re){var Ie=ye[Re].charCode;3===he&&Ie>=61440&&Ie<=61695&&(Ie&=255),ce[Ie]=ye[Re].glyphId}if(i.glyphNames&&(ge.length||this.differences.length))for(var Me=0;Me<256;++Me)if(ve||void 0===ce[Me]){var Te=this.differences[Me]||ge[Me];if(Te){var Pe=i.glyphNames.indexOf(Te);Pe>0&&de(Pe)&&(ce[Me]=Pe)}}}0===ce.length&&(ce[0]=0);var ze=ee-1;if(te||(ze=0),!i.cssFontInfo){var Be=j(ce,de,ze,this.toUnicode);this.toFontChar=Be.toFontChar,A.cmap={tag:"cmap",data:q(Be.charCodeToGlyphId,Be.toUnicodeExtraMap,ee)},A["OS/2"]&&function(e,t){t.pos=(t.start||0)+e.offset;var i=t.getUint16();t.skip(60);var a=t.getUint16();return!(i<4&&768&a)&&!(t.getUint16()>t.getUint16())&&(t.skip(6),0!==t.getUint16()&&(e.data[8]=e.data[9]=0,!0))}(A["OS/2"],t)||(A["OS/2"]={tag:"OS/2",data:H(i,Be.charCodeToGlyphId,le)})}if(!I)try{S=new x.Stream(A["CFF "].data),(w=new n.CFFParser(S,i,r.SEAC_ANALYSIS_ENABLED).parse()).duplicateFirstGlyph();var Fe=new n.CFFCompiler(w);A["CFF "].data=Fe.compile()}catch(Ge){(0,a.warn)("Failed to compile font "+i.loadedName)}if(A.name){var Ee=b(A.name);A.name.data=X(e,Ee),this.psName=Ee[0][6]||null}else A.name={tag:"name",data:X(this.name)};var Ne=new _.OpenTypeFileBuilder(g.version);for(var Oe in A)Ne.addTable(Oe,A[Oe].data);return Ne.toArray()}},{key:"convert",value:function(e,t,i){i.fixedPitch=!1,i.builtInEncoding&&function(e,t){if(!e.isInternalFont&&t!==e.defaultEncoding&&!(e.toUnicode instanceof d.IdentityToUnicodeMap)){var i=[],a=(0,s.getGlyphsUnicode)();for(var n in t){if(e.hasIncludedToUnicodeMap){if(e.toUnicode.has(n))continue}else if(e.hasEncoding&&(0===e.differences.length||void 0!==e.differences[n]))continue;var r=t[n],l=(0,o.getUnicodeForGlyph)(r,a);-1!==l&&(i[n]=String.fromCharCode(l))}i.length>0&&e.toUnicode.amend(i)}}(i,i.builtInEncoding);var n=1;t instanceof u.CFFFont&&(n=t.numGlyphs-1);var c=t.getGlyphMapping(i),p=null,m=c,h=null;i.cssFontInfo||(p=j(c,t.hasGlyphId.bind(t),n,this.toUnicode),this.toFontChar=p.toFontChar,m=p.charCodeToGlyphId,h=p.toUnicodeExtraMap);var f=t.numGlyphs;function y(e,t){var i=null;for(var a in e)t===e[a]&&(i||(i=[]),i.push(0|a));return i}function b(e,t){for(var i in e)if(t===e[i])return 0|i;return p.charCodeToGlyphId[p.nextAvailableFontCharCode]=t,p.nextAvailableFontCharCode++}var g=t.seacs;if(p&&r.SEAC_ANALYSIS_ENABLED&&g&&g.length){var v=i.fontMatrix||a.FONT_IDENTITY_MATRIX,A=t.getCharset(),x=Object.create(null);for(var w in g){var S=g[w|=0],C=l.StandardEncoding[S[2]],k=l.StandardEncoding[S[3]],D=A.indexOf(C),R=A.indexOf(k);if(!(D<0||R<0)){var I={x:S[0]*v[0]+S[1]*v[2]+v[4],y:S[0]*v[1]+S[1]*v[3]+v[5]},M=y(c,w);if(M)for(var T=0,P=M.length;T<P;T++){var z=M[T],E=p.charCodeToGlyphId,N=b(E,D),O=b(E,R);x[z]={baseFontCharCode:N,accentFontCharCode:O,accentOffset:I}}}}i.seacMap=x}var G=1/(i.fontMatrix||a.FONT_IDENTITY_MATRIX)[0],L=new _.OpenTypeFileBuilder("OTTO");return L.addTable("CFF ",t.data),L.addTable("OS/2",H(i,m)),L.addTable("cmap",q(m,h,f)),L.addTable("head","\0\x01\0\0\0\0\x10\0\0\0\0\0_\x0f<\xf5\0\0"+F(G)+"\0\0\0\0\x9e\v~'\0\0\0\0\x9e\v~'\0\0"+F(i.descent)+"\x0f\xff"+F(i.ascent)+B(i.italicAngle?2:0)+"\0\x11\0\0\0\0\0\0"),L.addTable("hhea","\0\x01\0\0"+F(i.ascent)+F(i.descent)+"\0\0\xff\xff\0\0\0\0\0\0"+F(i.capHeight)+F(Math.tan(i.italicAngle)*i.xHeight)+"\0\0\0\0\0\0\0\0\0\0\0\0"+B(f)),L.addTable("hmtx",function(){for(var e=t.charstrings,i=t.cff?t.cff.widths:null,a="\0\0\0\0",n=1,r=f;n<r;n++){var o=0;if(e){var s=e[n-1];o="width"in s?s.width:0}else i&&(o=Math.ceil(i[n]||0));a+=B(o)+B(0)}return a}()),L.addTable("maxp","\0\0P\0"+B(f)),L.addTable("name",X(e)),L.addTable("post",U(i)),L.toArray()}},{key:"spaceWidth",get:function(){for(var e,t=["space","minus","one","i","I"],i=0,n=t.length;i<n;i++){var r=t[i];if(r in this.widths){e=this.widths[r];break}var o=(0,s.getGlyphsUnicode)()[r],l=0;if(this.composite&&this.cMap.contains(o)&&"string"===typeof(l=this.cMap.lookup(o))&&(l=L(o,l)),!l&&this.toUnicode&&(l=this.toUnicode.charCodeOf(o)),l<=0&&(l=o),e=this.widths[l])break}return e=e||this.defaultWidth,(0,a.shadow)(this,"spaceWidth",e)}},{key:"_charToGlyph",value:function(e){var t,i,n,r=arguments.length>1&&void 0!==arguments[1]&&arguments[1],s=e;this.cMap&&this.cMap.contains(e)&&"string"===typeof(s=this.cMap.lookup(e))&&(s=L(e,s)),"number"!==typeof(i=this.widths[s])&&(i=this.defaultWidth);var l=this.vmetrics&&this.vmetrics[s],c=this.toUnicode.get(e)||e;"number"===typeof c&&(c=String.fromCharCode(c));var d=void 0!==this.toFontChar[e];if(t=this.toFontChar[e]||e,this.missingFile){var u=this.differences[e]||this.defaultEncoding[e];".notdef"!==u&&""!==u||"Type1"!==this.type||(t=32),t=(0,o.mapSpecialUnicodeValues)(t)}this.isType3Font&&(n=t);var p=null;if(this.seacMap&&this.seacMap[e]){d=!0;var m=this.seacMap[e];t=m.baseFontCharCode,p={fontChar:String.fromCodePoint(m.accentFontCharCode),offset:m.accentOffset}}var h="";"number"===typeof t&&(t<=1114111?h=String.fromCodePoint(t):(0,a.warn)("charToGlyph - invalid fontCharCode: ".concat(t)));var f=this._glyphCache[e];return f&&f.matchesForCache(e,h,c,p,i,l,n,r,d)||(f=new M(e,h,c,p,i,l,n,r,d),this._glyphCache[e]=f),f}},{key:"charsToGlyphs",value:function(e){var t=this._charsCache[e];if(t)return t;if(t=[],this.cMap)for(var i=Object.create(null),a=e.length,n=0;n<a;){this.cMap.readCharCode(e,n,i);var r=i.charcode,o=i.length;n+=o;var s=this._charToGlyph(r,1===o&&32===e.charCodeAt(n-1));t.push(s)}else for(var l=0,c=e.length;l<c;++l){var d=e.charCodeAt(l),u=this._charToGlyph(d,32===d);t.push(u)}return this._charsCache[e]=t}},{key:"getCharPositions",value:function(e){var t=[];if(this.cMap)for(var i=Object.create(null),a=0;a<e.length;){this.cMap.readCharCode(e,a,i);var n=i.length;t.push([a,a+n]),a+=n}else for(var r=0,o=e.length;r<o;++r)t.push([r,r+1]);return t}},{key:"glyphCacheValues",get:function(){return Object.values(this._glyphCache)}},{key:"encodeString",value:function(e){for(var t=this,i=[],a=[],n=function(){return i.length%2===1},r=this.toUnicode instanceof d.IdentityToUnicodeMap?function(e){return t.toUnicode.charCodeOf(e)}:function(e){return t.toUnicode.charCodeOf(String.fromCodePoint(e))},o=0,s=e.length;o<s;o++){var l=e.codePointAt(o);if(l>55295&&(l<57344||l>65533)&&o++,this.toUnicode){var c=r(l);if(-1!==c){n()&&(i.push(a.join("")),a.length=0);for(var u=(this.cMap?this.cMap.getCharCodeLength(c):1)-1;u>=0;u--)a.push(String.fromCharCode(c>>8*u&255));continue}}n()||(i.push(a.join("")),a.length=0),a.push(String.fromCodePoint(l))}return i.push(a.join("")),i}}]),e}();t.Font=V;var Q=function(){function e(t){b(this,e),this.error=t,this.loadedName="g_font_error",this.missingFile=!0}return g(e,[{key:"charsToGlyphs",value:function(){return[]}},{key:"encodeString",value:function(e){return[e]}},{key:"exportData",value:function(){return{error:this.error}}}]),e}();t.ErrorFont=Q},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.CFFTopDict=t.CFFStrings=t.CFFStandardStrings=t.CFFPrivateDict=t.CFFParser=t.CFFIndex=t.CFFHeader=t.CFFFDSelect=t.CFFCompiler=t.CFFCharset=t.CFF=void 0;var a=i(2),n=i(161),r=i(162),o=[".notdef","space","exclam","quotedbl","numbersign","dollar","percent","ampersand","quoteright","parenleft","parenright","asterisk","plus","comma","hyphen","period","slash","zero","one","two","three","four","five","six","seven","eight","nine","colon","semicolon","less","equal","greater","question","at","A","B","C","D","E","F","G","H","I","J","K","L","M","N","O","P","Q","R","S","T","U","V","W","X","Y","Z","bracketleft","backslash","bracketright","asciicircum","underscore","quoteleft","a","b","c","d","e","f","g","h","i","j","k","l","m","n","o","p","q","r","s","t","u","v","w","x","y","z","braceleft","bar","braceright","asciitilde","exclamdown","cent","sterling","fraction","yen","florin","section","currency","quotesingle","quotedblleft","guillemotleft","guilsinglleft","guilsinglright","fi","fl","endash","dagger","daggerdbl","periodcentered","paragraph","bullet","quotesinglbase","quotedblbase","quotedblright","guillemotright","ellipsis","perthousand","questiondown","grave","acute","circumflex","tilde","macron","breve","dotaccent","dieresis","ring","cedilla","hungarumlaut","ogonek","caron","emdash","AE","ordfeminine","Lslash","Oslash","OE","ordmasculine","ae","dotlessi","lslash","oslash","oe","germandbls","onesuperior","logicalnot","mu","trademark","Eth","onehalf","plusminus","Thorn","onequarter","divide","brokenbar","degree","thorn","threequarters","twosuperior","registered","minus","eth","multiply","threesuperior","copyright","Aacute","Acircumflex","Adieresis","Agrave","Aring","Atilde","Ccedilla","Eacute","Ecircumflex","Edieresis","Egrave","Iacute","Icircumflex","Idieresis","Igrave","Ntilde","Oacute","Ocircumflex","Odieresis","Ograve","Otilde","Scaron","Uacute","Ucircumflex","Udieresis","Ugrave","Yacute","Ydieresis","Zcaron","aacute","acircumflex","adieresis","agrave","aring","atilde","ccedilla","eacute","ecircumflex","edieresis","egrave","iacute","icircumflex","idieresis","igrave","ntilde","oacute","ocircumflex","odieresis","ograve","otilde","scaron","uacute","ucircumflex","udieresis","ugrave","yacute","ydieresis","zcaron","exclamsmall","Hungarumlautsmall","dollaroldstyle","dollarsuperior","ampersandsmall","Acutesmall","parenleftsuperior","parenrightsuperior","twodotenleader","onedotenleader","zerooldstyle","oneoldstyle","twooldstyle","threeoldstyle","fouroldstyle","fiveoldstyle","sixoldstyle","sevenoldstyle","eightoldstyle","nineoldstyle","commasuperior","threequartersemdash","periodsuperior","questionsmall","asuperior","bsuperior","centsuperior","dsuperior","esuperior","isuperior","lsuperior","msuperior","nsuperior","osuperior","rsuperior","ssuperior","tsuperior","ff","ffi","ffl","parenleftinferior","parenrightinferior","Circumflexsmall","hyphensuperior","Gravesmall","Asmall","Bsmall","Csmall","Dsmall","Esmall","Fsmall","Gsmall","Hsmall","Ismall","Jsmall","Ksmall","Lsmall","Msmall","Nsmall","Osmall","Psmall","Qsmall","Rsmall","Ssmall","Tsmall","Usmall","Vsmall","Wsmall","Xsmall","Ysmall","Zsmall","colonmonetary","onefitted","rupiah","Tildesmall","exclamdownsmall","centoldstyle","Lslashsmall","Scaronsmall","Zcaronsmall","Dieresissmall","Brevesmall","Caronsmall","Dotaccentsmall","Macronsmall","figuredash","hypheninferior","Ogoneksmall","Ringsmall","Cedillasmall","questiondownsmall","oneeighth","threeeighths","fiveeighths","seveneighths","onethird","twothirds","zerosuperior","foursuperior","fivesuperior","sixsuperior","sevensuperior","eightsuperior","ninesuperior","zeroinferior","oneinferior","twoinferior","threeinferior","fourinferior","fiveinferior","sixinferior","seveninferior","eightinferior","nineinferior","centinferior","dollarinferior","periodinferior","commainferior","Agravesmall","Aacutesmall","Acircumflexsmall","Atildesmall","Adieresissmall","Aringsmall","AEsmall","Ccedillasmall","Egravesmall","Eacutesmall","Ecircumflexsmall","Edieresissmall","Igravesmall","Iacutesmall","Icircumflexsmall","Idieresissmall","Ethsmall","Ntildesmall","Ogravesmall","Oacutesmall","Ocircumflexsmall","Otildesmall","Odieresissmall","OEsmall","Oslashsmall","Ugravesmall","Uacutesmall","Ucircumflexsmall","Udieresissmall","Yacutesmall","Thornsmall","Ydieresissmall","001.000","001.001","001.002","001.003","Black","Bold","Book","Light","Medium","Regular","Roman","Semibold"];t.CFFStandardStrings=o;var s=391,l=[null,{id:"hstem",min:2,stackClearing:!0,stem:!0},null,{id:"vstem",min:2,stackClearing:!0,stem:!0},{id:"vmoveto",min:1,stackClearing:!0},{id:"rlineto",min:2,resetStack:!0},{id:"hlineto",min:1,resetStack:!0},{id:"vlineto",min:1,resetStack:!0},{id:"rrcurveto",min:6,resetStack:!0},null,{id:"callsubr",min:1,undefStack:!0},{id:"return",min:0,undefStack:!0},null,null,{id:"endchar",min:0,stackClearing:!0},null,null,null,{id:"hstemhm",min:2,stackClearing:!0,stem:!0},{id:"hintmask",min:0,stackClearing:!0},{id:"cntrmask",min:0,stackClearing:!0},{id:"rmoveto",min:2,stackClearing:!0},{id:"hmoveto",min:1,stackClearing:!0},{id:"vstemhm",min:2,stackClearing:!0,stem:!0},{id:"rcurveline",min:8,resetStack:!0},{id:"rlinecurve",min:8,resetStack:!0},{id:"vvcurveto",min:4,resetStack:!0},{id:"hhcurveto",min:4,resetStack:!0},null,{id:"callgsubr",min:1,undefStack:!0},{id:"vhcurveto",min:4,resetStack:!0},{id:"hvcurveto",min:4,resetStack:!0}],p=[null,null,null,{id:"and",min:2,stackDelta:-1},{id:"or",min:2,stackDelta:-1},{id:"not",min:1,stackDelta:0},null,null,null,{id:"abs",min:1,stackDelta:0},{id:"add",min:2,stackDelta:-1,stackFn:function(e,t){e[t-2]=e[t-2]+e[t-1]}},{id:"sub",min:2,stackDelta:-1,stackFn:function(e,t){e[t-2]=e[t-2]-e[t-1]}},{id:"div",min:2,stackDelta:-1,stackFn:function(e,t){e[t-2]=e[t-2]/e[t-1]}},null,{id:"neg",min:1,stackDelta:0,stackFn:function(e,t){e[t-1]=-e[t-1]}},{id:"eq",min:2,stackDelta:-1},null,null,{id:"drop",min:1,stackDelta:-1},null,{id:"put",min:2,stackDelta:-2},{id:"get",min:1,stackDelta:0},{id:"ifelse",min:4,stackDelta:-3},{id:"random",min:0,stackDelta:1},{id:"mul",min:2,stackDelta:-1,stackFn:function(e,t){e[t-2]=e[t-2]*e[t-1]}},null,{id:"sqrt",min:1,stackDelta:0},{id:"dup",min:1,stackDelta:1},{id:"exch",min:2,stackDelta:0},{id:"index",min:2,stackDelta:0},{id:"roll",min:3,stackDelta:-2},null,null,null,{id:"hflex",min:7,resetStack:!0},{id:"flex",min:13,resetStack:!0},{id:"hflex1",min:9,resetStack:!0},{id:"flex1",min:11,resetStack:!0}],m=function(){function e(t,i,a){b(this,e),this.bytes=t.getBytes(),this.properties=i,this.seacAnalysisEnabled=!!a}return g(e,[{key:"parse",value:function(){var e=this.properties,t=new f;this.cff=t;var i=this.parseHeader(),a=this.parseIndex(i.endPos),n=this.parseIndex(a.endPos),r=this.parseIndex(n.endPos),o=this.parseIndex(r.endPos),s=this.parseDict(n.obj.get(0)),l=this.createDict(w,s,t.strings);t.header=i.obj,t.names=this.parseNameIndex(a.obj),t.strings=this.parseStringIndex(r.obj),t.topDict=l,t.globalSubrIndex=o.obj,this.parsePrivateDict(t.topDict),t.isCIDFont=l.hasName("ROS");var c=l.getByName("CharStrings"),d=this.parseIndex(c).obj,u=l.getByName("FontMatrix");u&&(e.fontMatrix=u);var p,m,h=l.getByName("FontBBox");if(h&&(e.ascent=Math.max(h[3],h[1]),e.descent=Math.min(h[1],h[3]),e.ascentScaled=!0),t.isCIDFont){for(var y=this.parseIndex(l.getByName("FDArray")).obj,b=0,g=y.count;b<g;++b){var v=y.get(b),_=this.createDict(w,this.parseDict(v),t.strings);this.parsePrivateDict(_),t.fdArray.push(_)}m=null,p=this.parseCharsets(l.getByName("charset"),d.count,t.strings,!0),t.fdSelect=this.parseFDSelect(l.getByName("FDSelect"),d.count)}else p=this.parseCharsets(l.getByName("charset"),d.count,t.strings,!1),m=this.parseEncoding(l.getByName("Encoding"),e,t.strings,p.charset);t.charset=p,t.encoding=m;var A=this.parseCharStrings({charStrings:d,localSubrIndex:l.privateDict.subrsIndex,globalSubrIndex:o.obj,fdSelect:t.fdSelect,fdArray:t.fdArray,privateDict:l.privateDict});return t.charStrings=A.charStrings,t.seacs=A.seacs,t.widths=A.widths,t}},{key:"parseHeader",value:function(){for(var e=this.bytes,t=e.length,i=0;i<t&&1!==e[i];)++i;if(i>=t)throw new a.FormatError("Invalid CFF header");0!==i&&((0,a.info)("cff data is shifted"),e=e.subarray(i),this.bytes=e);var n=e[0],r=e[1],o=e[2],s=e[3];return{obj:new y(n,r,o,s),endPos:o}}},{key:"parseDict",value:function(e){var t=0;function i(){var i=e[t++];return 30===i?function(){for(var i="",a=15,n=["0","1","2","3","4","5","6","7","8","9",".","E","E-",null,"-"],r=e.length;t<r;){var o=e[t++],s=o>>4,l=15&o;if(s===a)break;if(i+=n[s],l===a)break;i+=n[l]}return parseFloat(i)}():28===i?i=((i=e[t++])<<24|e[t++]<<16)>>16:29===i?i=(i=(i=(i=e[t++])<<8|e[t++])<<8|e[t++])<<8|e[t++]:i>=32&&i<=246?i-139:i>=247&&i<=250?256*(i-247)+e[t++]+108:i>=251&&i<=254?-256*(i-251)-e[t++]-108:((0,a.warn)('CFFParser_parseDict: "'+i+'" is a reserved command.'),NaN)}var n=[],r=[];t=0;for(var o=e.length;t<o;){var s=e[t];s<=21?(12===s&&(s=s<<8|e[++t]),r.push([s,n]),n=[],++t):n.push(i())}return r}},{key:"parseIndex",value:function(e){var t,i,a=new _,n=this.bytes,r=n[e++]<<8|n[e++],o=[],s=e;if(0!==r){var l=n[e++],c=e+(r+1)*l-1;for(t=0,i=r+1;t<i;++t){for(var d=0,u=0;u<l;++u)d<<=8,d+=n[e++];o.push(c+d)}s=o[r]}for(t=0,i=o.length-1;t<i;++t){var p=o[t],m=o[t+1];a.add(n.subarray(p,m))}return{obj:a,endPos:s}}},{key:"parseNameIndex",value:function(e){for(var t=[],i=0,n=e.count;i<n;++i){var r=e.get(i);t.push((0,a.bytesToString)(r))}return t}},{key:"parseStringIndex",value:function(e){for(var t=new v,i=0,n=e.count;i<n;++i){var r=e.get(i);t.add((0,a.bytesToString)(r))}return t}},{key:"createDict",value:function(e,t,i){for(var a=new e(i),n=0,r=t.length;n<r;++n){var o=t[n],s=o[0],l=o[1];a.setByKey(s,l)}return a}},{key:"parseCharString",value:function(e,t,i,n){if(!t||e.callDepth>10)return!1;for(var r=e.stackSize,o=e.stack,s=t.length,c=0;c<s;){var d=t[c++],u=null;if(12===d){var m=t[c++];0===m?(t[c-2]=139,t[c-1]=22,r=0):u=p[m]}else if(28===d)o[r]=(t[c]<<24|t[c+1]<<16)>>16,c+=2,r++;else if(14===d){if(r>=4&&(r-=4,this.seacAnalysisEnabled))return e.seac=o.slice(r,r+4),!1;u=l[d]}else if(d>=32&&d<=246)o[r]=d-139,r++;else if(d>=247&&d<=254)o[r]=d<251?(d-247<<8)+t[c]+108:-(d-251<<8)-t[c]-108,c++,r++;else if(255===d)o[r]=(t[c]<<24|t[c+1]<<16|t[c+2]<<8|t[c+3])/65536,c+=4,r++;else if(19===d||20===d)e.hints+=r>>1,c+=e.hints+7>>3,r%=2,u=l[d];else{if(10===d||29===d){var h=void 0;if(!(h=10===d?i:n))return u=l[d],(0,a.warn)("Missing subrsIndex for "+u.id),!1;var f=32768;h.count<1240?f=107:h.count<33900&&(f=1131);var y=o[--r]+f;if(y<0||y>=h.count||isNaN(y))return u=l[d],(0,a.warn)("Out of bounds subrIndex for "+u.id),!1;if(e.stackSize=r,e.callDepth++,!this.parseCharString(e,h.get(y),i,n))return!1;e.callDepth--,r=e.stackSize;continue}if(11===d)return e.stackSize=r,!0;0===d&&c===t.length?(t[c-1]=14,u=l[14]):u=l[d]}if(u){if(u.stem&&(e.hints+=r>>1,3===d||23===d?e.hasVStems=!0:!e.hasVStems||1!==d&&18!==d||((0,a.warn)("CFF stem hints are in wrong order"),t[c-1]=1===d?3:23)),"min"in u&&!e.undefStack&&r<u.min)return(0,a.warn)("Not enough parameters for "+u.id+"; actual: "+r+", expected: "+u.min),0===r&&(t[c-1]=14,!0);e.firstStackClearing&&u.stackClearing&&(e.firstStackClearing=!1,(r-=u.min)>=2&&u.stem?r%=2:r>1&&(0,a.warn)("Found too many parameters for stack-clearing command"),r>0&&(e.width=o[r-1])),"stackDelta"in u?("stackFn"in u&&u.stackFn(o,r),r+=u.stackDelta):u.stackClearing?r=0:u.resetStack?(r=0,e.undefStack=!1):u.undefStack&&(r=0,e.undefStack=!0,e.firstStackClearing=!1)}}return e.stackSize=r,!0}},{key:"parseCharStrings",value:function(e){for(var t=e.charStrings,i=e.localSubrIndex,n=e.globalSubrIndex,r=e.fdSelect,o=e.fdArray,s=e.privateDict,l=[],c=[],d=t.count,u=0;u<d;u++){var p=t.get(u),m={callDepth:0,stackSize:0,stack:[],undefStack:!0,hints:0,firstStackClearing:!0,seac:null,width:null,hasVStems:!1},h=!0,f=null,y=s;if(r&&o.length){var b=r.getFDIndex(u);-1===b&&((0,a.warn)("Glyph index is not in fd select."),h=!1),b>=o.length&&((0,a.warn)("Invalid fd index for glyph index."),h=!1),h&&(f=(y=o[b].privateDict).subrsIndex)}else i&&(f=i);if(h&&(h=this.parseCharString(m,p,f,n)),null!==m.width){var g=y.getByName("nominalWidthX");c[u]=g+m.width}else{var v=y.getByName("defaultWidthX");c[u]=v}null!==m.seac&&(l[u]=m.seac),h||t.set(u,new Uint8Array([14]))}return{charStrings:t,seacs:l,widths:c}}},{key:"emptyPrivateDictionary",value:function(e){var t=this.createDict(C,[],e.strings);e.setByKey(18,[0,0]),e.privateDict=t}},{key:"parsePrivateDict",value:function(e){if(e.hasName("Private")){var t=e.getByName("Private");if(Array.isArray(t)&&2===t.length){var i=t[0],a=t[1];if(0===i||a>=this.bytes.length)this.emptyPrivateDictionary(e);else{var n=a+i,r=this.bytes.subarray(a,n),o=this.parseDict(r),s=this.createDict(C,o,e.strings);if(e.privateDict=s,s.getByName("Subrs")){var l=s.getByName("Subrs"),c=a+l;if(0===l||c>=this.bytes.length)this.emptyPrivateDictionary(e);else{var d=this.parseIndex(c);s.subrsIndex=d.obj}}}}else e.removeByName("Private")}else this.emptyPrivateDictionary(e)}},{key:"parseCharsets",value:function(e,t,i,r){if(0===e)return new D(!0,k.ISO_ADOBE,n.ISOAdobeCharset);if(1===e)return new D(!0,k.EXPERT,n.ExpertCharset);if(2===e)return new D(!0,k.EXPERT_SUBSET,n.ExpertSubsetCharset);var o,s,l,c=this.bytes,d=e,u=c[e++],p=[r?0:".notdef"];switch(t-=1,u){case 0:for(l=0;l<t;l++)o=c[e++]<<8|c[e++],p.push(r?o:i.get(o));break;case 1:for(;p.length<=t;)for(o=c[e++]<<8|c[e++],s=c[e++],l=0;l<=s;l++)p.push(r?o++:i.get(o++));break;case 2:for(;p.length<=t;)for(o=c[e++]<<8|c[e++],s=c[e++]<<8|c[e++],l=0;l<=s;l++)p.push(r?o++:i.get(o++));break;default:throw new a.FormatError("Unknown charset format")}var m=e,h=c.subarray(d,m);return new D(!1,u,p,h)}},{key:"parseEncoding",value:function(e,t,i,n){var o,s,l,c=Object.create(null),d=this.bytes,u=!1,p=null;if(0===e||1===e){u=!0,o=e;var m=e?r.ExpertEncoding:r.StandardEncoding;for(s=0,l=n.length;s<l;s++){var h=m.indexOf(n[s]);-1!==h&&(c[h]=s)}}else{var f=e;switch(127&(o=d[e++])){case 0:var y=d[e++];for(s=1;s<=y;s++)c[d[e++]]=s;break;case 1:var b=d[e++],g=1;for(s=0;s<b;s++)for(var v=d[e++],_=d[e++],A=v;A<=v+_;A++)c[A]=g++;break;default:throw new a.FormatError("Unknown encoding format: ".concat(o," in CFF"))}var x=e;128&o&&(d[f]&=127,function(){var t=d[e++];for(s=0;s<t;s++){var a=d[e++],r=(d[e++]<<8)+(255&d[e++]);c[a]=n.indexOf(i.get(r))}}()),p=d.subarray(f,x)}return new R(u,o&=127,c,p)}},{key:"parseFDSelect",value:function(e,t){var i,n=this.bytes,r=n[e++],o=[];switch(r){case 0:for(i=0;i<t;++i){var s=n[e++];o.push(s)}break;case 3:var l=n[e++]<<8|n[e++];for(i=0;i<l;++i){var c=n[e++]<<8|n[e++];0===i&&0!==c&&((0,a.warn)("parseFDSelect: The first range must have a first GID of 0 -- trying to recover."),c=0);for(var d=n[e++],u=n[e]<<8|n[e+1],p=c;p<u;++p)o.push(d)}e+=2;break;default:throw new a.FormatError('parseFDSelect: Unknown format "'.concat(r,'".'))}if(o.length!==t)throw new a.FormatError("parseFDSelect: Invalid font data.");return new I(r,o)}}]),e}();t.CFFParser=m;var f=function(){function e(){b(this,e),this.header=null,this.names=[],this.topDict=null,this.strings=new v,this.globalSubrIndex=null,this.encoding=null,this.charset=null,this.charStrings=null,this.fdArray=[],this.fdSelect=null,this.isCIDFont=!1}return g(e,[{key:"duplicateFirstGlyph",value:function(){if(this.charStrings.count>=65535)(0,a.warn)("Not enough space in charstrings to duplicate first glyph.");else{var e=this.charStrings.get(0);this.charStrings.add(e),this.isCIDFont&&this.fdSelect.fdSelect.push(this.fdSelect.fdSelect[0])}}},{key:"hasGlyphId",value:function(e){return!(e<0||e>=this.charStrings.count)&&this.charStrings.get(e).length>0}}]),e}();t.CFF=f;var y=g((function e(t,i,a,n){b(this,e),this.major=t,this.minor=i,this.hdrSize=a,this.offSize=n}));t.CFFHeader=y;var v=function(){function e(){b(this,e),this.strings=[]}return g(e,[{key:"get",value:function(e){return e>=0&&e<=390?o[e]:e-s<=this.strings.length?this.strings[e-s]:o[0]}},{key:"getSID",value:function(e){var t=o.indexOf(e);return-1!==t?t:-1!==(t=this.strings.indexOf(e))?t+s:-1}},{key:"add",value:function(e){this.strings.push(e)}},{key:"count",get:function(){return this.strings.length}}]),e}();t.CFFStrings=v;var _=function(){function e(){b(this,e),this.objects=[],this.length=0}return g(e,[{key:"add",value:function(e){this.length+=e.length,this.objects.push(e)}},{key:"set",value:function(e,t){this.length+=t.length-this.objects[e].length,this.objects[e]=t}},{key:"get",value:function(e){return this.objects[e]}},{key:"count",get:function(){return this.objects.length}}]),e}();t.CFFIndex=_;var A=function(){function e(t,i){b(this,e),this.keyToNameMap=t.keyToNameMap,this.nameToKeyMap=t.nameToKeyMap,this.defaults=t.defaults,this.types=t.types,this.opcodes=t.opcodes,this.order=t.order,this.strings=i,this.values=Object.create(null)}return g(e,[{key:"setByKey",value:function(e,t){if(!(e in this.keyToNameMap))return!1;var i=t.length;if(0===i)return!0;for(var 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p=(0,a.getLookupTableFactory)((function(e){e[1]=32,e[4]=65,e[6]=193,e[17]=66,e[18]=67,e[21]=268,e[24]=68,e[28]=69,e[30]=201,e[32]=282,e[38]=70,e[39]=71,e[44]=72,e[47]=73,e[49]=205,e[58]=74,e[60]=75,e[62]=76,e[68]=77,e[69]=78,e[75]=79,e[87]=80,e[89]=81,e[90]=82,e[92]=344,e[94]=83,e[97]=352,e[100]=84,e[104]=85,e[115]=86,e[116]=87,e[121]=88,e[122]=89,e[124]=221,e[127]=90,e[129]=381,e[258]=97,e[260]=225,e[268]=261,e[271]=98,e[272]=99,e[273]=263,e[275]=269,e[282]=100,e[286]=101,e[288]=233,e[290]=283,e[295]=281,e[296]=102,e[336]=103,e[346]=104,e[349]=105,e[351]=237,e[361]=106,e[364]=107,e[367]=108,e[371]=322,e[373]=109,e[374]=110,e[381]=111,e[383]=243,e[393]=112,e[395]=113,e[396]=114,e[398]=345,e[400]=115,e[401]=347,e[403]=353,e[410]=116,e[437]=117,e[448]=118,e[449]=119,e[454]=120,e[455]=121,e[457]=253,e[460]=122,e[462]=382,e[463]=380,e[853]=44,e[855]=58,e[856]=46,e[876]=47,e[878]=45,e[882]=45,e[894]=40,e[895]=41,e[896]=91,e[897]=93,e[923]=64,e[1004]=48,e[1005]=49,e[1006]=50,e[1007]=51,e[1008]=52,e[1009]=53,e[1010]=54,e[1011]=55,e[1012]=56,e[1013]=57,e[1081]=37,e[1085]=43,e[1086]=45}));t.getSupplementalGlyphMapForCalibri=p},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.ToUnicodeMap=t.IdentityToUnicodeMap=void 0;var a=i(2),n=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:[];this._map=t}return g(e,[{key:"length",get:function(){return this._map.length}},{key:"forEach",value:function(e){for(var t in this._map)e(t,this._map[t].charCodeAt(0))}},{key:"has",value:function(e){return void 0!==this._map[e]}},{key:"get",value:function(e){return this._map[e]}},{key:"charCodeOf",value:function(e){var t=this._map;if(t.length<=65536)return t.indexOf(e);for(var i in t)if(t[i]===e)return 0|i;return-1}},{key:"amend",value:function(e){for(var t in e)this._map[t]=e[t]}}]),e}();t.ToUnicodeMap=n;var r=function(){function e(t,i){b(this,e),this.firstChar=t,this.lastChar=i}return g(e,[{key:"length",get:function(){return this.lastChar+1-this.firstChar}},{key:"forEach",value:function(e){for(var t=this.firstChar,i=this.lastChar;t<=i;t++)e(t,t)}},{key:"has",value:function(e){return this.firstChar<=e&&e<=this.lastChar}},{key:"get",value:function(e){if(this.firstChar<=e&&e<=this.lastChar)return String.fromCharCode(e)}},{key:"charCodeOf",value:function(e){return Number.isInteger(e)&&e>=this.firstChar&&e<=this.lastChar?e:-1}},{key:"amend",value:function(e){(0,a.unreachable)("Should not call amend()")}}]),e}();t.IdentityToUnicodeMap=r},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.CFFFont=void 0;var a=i(160),n=i(163),r=i(2),o=function(){function e(t,i){b(this,e),this.properties=i;var o=new a.CFFParser(t,i,n.SEAC_ANALYSIS_ENABLED);this.cff=o.parse(),this.cff.duplicateFirstGlyph();var s=new a.CFFCompiler(this.cff);this.seacs=this.cff.seacs;try{this.data=s.compile()}catch(l){(0,r.warn)("Failed to compile font "+i.loadedName),this.data=t}this._createBuiltInEncoding()}return g(e,[{key:"numGlyphs",get:function(){return this.cff.charStrings.count}},{key:"getCharset",value:function(){return this.cff.charset.charset}},{key:"getGlyphMapping",value:function(){var e,t,i=this.cff,a=this.properties,r=i.charset.charset;if(a.composite){if(e=Object.create(null),i.isCIDFont)for(t=0;t<r.length;t++){var o=r[t];e[a.cMap.charCodeOf(o)]=t}else for(t=0;t<i.charStrings.count;t++)e[a.cMap.charCodeOf(t)]=t;return e}var s=i.encoding?i.encoding.encoding:null;return a.isInternalFont&&(s=a.defaultEncoding),e=(0,n.type1FontGlyphMapping)(a,s,r)}},{key:"hasGlyphId",value:function(e){return this.cff.hasGlyphId(e)}},{key:"_createBuiltInEncoding",value:function(){var e=this.cff,t=e.charset,i=e.encoding;if(t&&i){var a=t.charset,n=i.encoding,r=[];for(var o in n){var s=n[o];if(s>=0){var l=a[s];l&&(r[o]=l)}}r.length>0&&(this.properties.builtInEncoding=r)}}}]),e}();t.CFFFont=o},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.FontRendererFactory=void 0;var a=i(2),n=i(160),r=i(164),o=i(162),s=i(135);function l(e,t){return(e[t]<<24|e[t+1]<<16|e[t+2]<<8|e[t+3])>>>0}function c(e,t){return e[t]<<8|e[t+1]}function p(e,t){return(e[t]<<24|e[t+1]<<16)>>16}function m(e,t){return e[t]<<24>>24}function h(e,t){return p(e,t)/16384}function f(e){var t=e.length,i=32768;return t<1240?i=107:t<33900&&(i=1131),i}function y(e,t,i){var n,r,o,s=1===c(e,t+2)?l(e,t+8):l(e,t+16),d=c(e,t+s);if(4===d){c(e,t+s+2);var u=c(e,t+s+6)>>1;for(r=t+s+14,n=[],o=0;o<u;o++,r+=2)n[o]={end:c(e,r)};for(r+=2,o=0;o<u;o++,r+=2)n[o].start=c(e,r);for(o=0;o<u;o++,r+=2)n[o].idDelta=c(e,r);for(o=0;o<u;o++,r+=2){var p=c(e,r);if(0!==p){n[o].ids=[];for(var m=0,h=n[o].end-n[o].start+1;m<h;m++)n[o].ids[m]=c(e,r+p),p+=2}}return n}if(12===d){var f=l(e,t+s+12);for(r=t+s+16,n=[],o=0;o<f;o++)t=l(e,r),n.push({start:t,end:l(e,r+4),idDelta:l(e,r+8)-t}),r+=12;return n}throw new a.FormatError("unsupported cmap: ".concat(d))}function v(e,t,i,a){var r=new n.CFFParser(new s.Stream(e,t,i-t),{},a).parse();return{glyphs:r.charStrings.objects,subrs:r.topDict.privateDict&&r.topDict.privateDict.subrsIndex&&r.topDict.privateDict.subrsIndex.objects,gsubrs:r.globalSubrIndex&&r.globalSubrIndex.objects,isCFFCIDFont:r.isCIDFont,fdSelect:r.fdSelect,fdArray:r.fdArray}}function _(e,t){for(var i=t.codePointAt(0),a=0,n=0,r=e.length-1;n<r;){var o=n+r+1>>1;i<e[o].start?r=o-1:n=o}return e[n].start<=i&&i<=e[n].end&&(a=e[n].idDelta+(e[n].ids?e[n].ids[i-e[n].start]:i)&65535),{charCode:i,glyphId:a}}function A(e,t,i){function a(e,i){t.push({cmd:"moveTo",args:[e,i]})}function n(e,i){t.push({cmd:"lineTo",args:[e,i]})}function r(e,i,a,n){t.push({cmd:"quadraticCurveTo",args:[e,i,a,n]})}var o,s=0,l=p(e,s),d=0,u=0;if(s+=10,l<0)do{o=c(e,s);var f=c(e,s+2);s+=4;var y=void 0,b=void 0;1&o?(2&o?(y=p(e,s),b=p(e,s+2)):(y=c(e,s),b=c(e,s+2)),s+=4):2&o?(y=m(e,s++),b=m(e,s++)):(y=e[s++],b=e[s++]),2&o?(d=y,u=b):(d=0,u=0);var g=1,v=1,_=0,x=0;8&o?(g=v=h(e,s),s+=2):64&o?(g=h(e,s),v=h(e,s+2),s+=4):128&o&&(g=h(e,s),_=h(e,s+2),x=h(e,s+4),v=h(e,s+6),s+=8);var w=i.glyphs[f];w&&(t.push({cmd:"save"},{cmd:"transform",args:[g,_,x,v,d,u]}),A(w,t,i),t.push({cmd:"restore"}))}while(32&o);else{var S,C,k=[];for(S=0;S<l;S++)k.push(c(e,s)),s+=2;s+=2+c(e,s);for(var D=k.at(-1)+1,R=[];R.length<D;){var I=1;for(8&(o=e[s++])&&(I+=e[s++]);I-- >0;)R.push({flags:o})}for(S=0;S<D;S++){switch(18&R[S].flags){case 0:d+=p(e,s),s+=2;break;case 2:d-=e[s++];break;case 18:d+=e[s++]}R[S].x=d}for(S=0;S<D;S++){switch(36&R[S].flags){case 0:u+=p(e,s),s+=2;break;case 4:u-=e[s++];break;case 36:u+=e[s++]}R[S].y=u}var M=0;for(s=0;s<l;s++){var T=k[s],P=R.slice(M,T+1);if(1&P[0].flags)P.push(P[0]);else if(1&P.at(-1).flags)P.unshift(P.at(-1));else{var z={flags:1,x:(P[0].x+P.at(-1).x)/2,y:(P[0].y+P.at(-1).y)/2};P.unshift(z),P.push(z)}for(a(P[0].x,P[0].y),S=1,C=P.length;S<C;S++)1&P[S].flags?n(P[S].x,P[S].y):1&P[S+1].flags?(r(P[S].x,P[S].y,P[S+1].x,P[S+1].y),S++):r(P[S].x,P[S].y,(P[S].x+P[S+1].x)/2,(P[S].y+P[S+1].y)/2);M=T+1}}}function x(e,t,i,n){function r(e,i){t.push({cmd:"moveTo",args:[e,i]})}function s(e,i){t.push({cmd:"lineTo",args:[e,i]})}function l(e,i,a,n,r,o){t.push({cmd:"bezierCurveTo",args:[e,i,a,n,r,o]})}var c=[],d=0,u=0,p=0;!function e(m){for(var h=0;h<m.length;){var y=!1,b=m[h++],g=void 0,v=void 0,A=void 0,w=void 0,S=void 0,C=void 0,k=void 0,D=void 0;switch(b){case 1:case 3:case 18:case 23:p+=c.length>>1,y=!0;break;case 4:u+=c.pop(),r(d,u),y=!0;break;case 5:for(;c.length>0;)d+=c.shift(),u+=c.shift(),s(d,u);break;case 6:for(;c.length>0&&(s(d+=c.shift(),u),0!==c.length);)u+=c.shift(),s(d,u);break;case 7:for(;c.length>0&&(u+=c.shift(),s(d,u),0!==c.length);)s(d+=c.shift(),u);break;case 8:for(;c.length>0;)g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u);break;case 10:if(k=c.pop(),D=null,i.isCFFCIDFont){var R=i.fdSelect.getFDIndex(n);if(R>=0&&R<i.fdArray.length){var I=i.fdArray[R],M=void 0;I.privateDict&&I.privateDict.subrsIndex&&(M=I.privateDict.subrsIndex.objects),M&&(D=M[k+=f(M)])}else(0,a.warn)("Invalid fd index for glyph index.")}else D=i.subrs[k+i.subrsBias];D&&e(D);break;case 11:return;case 12:switch(b=m[h++]){case 34:v=(g=d+c.shift())+c.shift(),S=u+c.shift(),d=v+c.shift(),l(g,u,v,S,d,S),v=(g=d+c.shift())+c.shift(),d=v+c.shift(),l(g,S,v,u,d,u);break;case 35:g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u),g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u),c.pop();break;case 36:l(g=d+c.shift(),S=u+c.shift(),v=g+c.shift(),C=S+c.shift(),d=v+c.shift(),C),l(g=d+c.shift(),C,v=g+c.shift(),C+c.shift(),d=v+c.shift(),u);break;case 37:var T=d,P=u;g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u),g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v,u=w,Math.abs(d-T)>Math.abs(u-P)?d+=c.shift():u+=c.shift(),l(g,A,v,w,d,u);break;default:throw new a.FormatError("unknown operator: 12 ".concat(b))}break;case 14:if(c.length>=4){var z=c.pop(),B=c.pop();u=c.pop(),d=c.pop(),t.push({cmd:"save"},{cmd:"translate",args:[d,u]});var F=_(i.cmap,String.fromCharCode(i.glyphNameMap[o.StandardEncoding[z]]));x(i.glyphs[F.glyphId],t,i,F.glyphId),t.push({cmd:"restore"}),F=_(i.cmap,String.fromCharCode(i.glyphNameMap[o.StandardEncoding[B]])),x(i.glyphs[F.glyphId],t,i,F.glyphId)}return;case 19:case 20:h+=(p+=c.length>>1)+7>>3,y=!0;break;case 21:u+=c.pop(),r(d+=c.pop(),u),y=!0;break;case 22:r(d+=c.pop(),u),y=!0;break;case 24:for(;c.length>2;)g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u);d+=c.shift(),u+=c.shift(),s(d,u);break;case 25:for(;c.length>6;)d+=c.shift(),u+=c.shift(),s(d,u);g=d+c.shift(),A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+c.shift(),l(g,A,v,w,d,u);break;case 26:for(c.length%2&&(d+=c.shift());c.length>0;)g=d,A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v,u=w+c.shift(),l(g,A,v,w,d,u);break;case 27:for(c.length%2&&(u+=c.shift());c.length>0;)l(g=d+c.shift(),A=u,v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w);break;case 28:c.push((m[h]<<24|m[h+1]<<16)>>16),h+=2;break;case 29:k=c.pop()+i.gsubrsBias,(D=i.gsubrs[k])&&e(D);break;case 30:for(;c.length>0&&(g=d,A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+(1===c.length?c.shift():0),l(g,A,v,w,d,u),0!==c.length);)g=d+c.shift(),A=u,v=g+c.shift(),w=A+c.shift(),u=w+c.shift(),l(g,A,v,w,d=v+(1===c.length?c.shift():0),u);break;case 31:for(;c.length>0&&(g=d+c.shift(),A=u,v=g+c.shift(),w=A+c.shift(),u=w+c.shift(),l(g,A,v,w,d=v+(1===c.length?c.shift():0),u),0!==c.length);)g=d,A=u+c.shift(),v=g+c.shift(),w=A+c.shift(),d=v+c.shift(),u=w+(1===c.length?c.shift():0),l(g,A,v,w,d,u);break;default:if(b<32)throw new a.FormatError("unknown operator: ".concat(b));b<247?c.push(b-139):b<251?c.push(256*(b-247)+m[h++]+108):b<255?c.push(256*-(b-251)-m[h++]-108):(c.push((m[h]<<24|m[h+1]<<16|m[h+2]<<8|m[h+3])/65536),h+=4)}y&&(c.length=0)}}(e)}var w=[],S=function(){function e(t){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize CompiledFont."),this.fontMatrix=t,this.compiledGlyphs=Object.create(null),this.compiledCharCodeToGlyphId=Object.create(null)}return g(e,[{key:"getPathJs",value:function(e){var t=_(this.cmap,e),i=t.charCode,a=t.glyphId,n=this.compiledGlyphs[a];if(!n)try{n=this.compileGlyph(this.glyphs[a],a),this.compiledGlyphs[a]=n}catch(r){throw this.compiledGlyphs[a]=w,void 0===this.compiledCharCodeToGlyphId[i]&&(this.compiledCharCodeToGlyphId[i]=a),r}return void 0===this.compiledCharCodeToGlyphId[i]&&(this.compiledCharCodeToGlyphId[i]=a),n}},{key:"compileGlyph",value:function(e,t){if(!e||0===e.length||14===e[0])return w;var i=this.fontMatrix;if(this.isCFFCIDFont){var n=this.fdSelect.getFDIndex(t);n>=0&&n<this.fdArray.length?i=this.fdArray[n].getByName("FontMatrix")||a.FONT_IDENTITY_MATRIX:(0,a.warn)("Invalid fd index for glyph index.")}var r=[{cmd:"save"},{cmd:"transform",args:i.slice()},{cmd:"scale",args:["size","-size"]}];return this.compileGlyphImpl(e,r,t),r.push({cmd:"restore"}),r}},{key:"compileGlyphImpl",value:function(){(0,a.unreachable)("Children classes should implement this.")}},{key:"hasBuiltPath",value:function(e){var t=_(this.cmap,e),i=t.charCode,a=t.glyphId;return void 0!==this.compiledGlyphs[a]&&void 0!==this.compiledCharCodeToGlyphId[i]}}]),e}(),C=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,n||[488e-6,0,0,488e-6,0,0])).glyphs=e,r.cmap=a,r}return g(i,[{key:"compileGlyphImpl",value:function(e,t){A(e,t,this)}}]),i}(S),k=function(e){d(i,e);var t=u(i);function i(e,a,n,o){var s;return b(this,i),(s=t.call(this,n||[.001,0,0,.001,0,0])).glyphs=e.glyphs,s.gsubrs=e.gsubrs||[],s.subrs=e.subrs||[],s.cmap=a,s.glyphNameMap=o||(0,r.getGlyphsUnicode)(),s.gsubrsBias=f(s.gsubrs),s.subrsBias=f(s.subrs),s.isCFFCIDFont=e.isCFFCIDFont,s.fdSelect=e.fdSelect,s.fdArray=e.fdArray,s}return g(i,[{key:"compileGlyphImpl",value:function(e,t,i){x(e,t,this,i)}}]),i}(S),D=function(){function e(){b(this,e)}return g(e,null,[{key:"create",value:function(e,t){for(var i,n,r,o,s,d,u=new Uint8Array(e.data),p=c(u,4),m=0,h=12;m<p;m++,h+=16){var f=(0,a.bytesToString)(u.subarray(h,h+4)),b=l(u,h+8),g=l(u,h+12);switch(f){case"cmap":i=y(u,b);break;case"glyf":n=u.subarray(b,b+g);break;case"loca":r=u.subarray(b,b+g);break;case"head":d=c(u,b+18),s=c(u,b+50);break;case"CFF 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a,n=h(this.composites);try{for(n.s();!(a=n.n()).done;)e+=a.value.write(e,t)}catch(r){n.e(r)}finally{n.f()}}return e-i}},{key:"scale",value:function(e){if(this.header){var t=(this.header.xMin+this.header.xMax)/2;if(this.header.scale(t,e),this.simple)this.simple.scale(t,e);else{var i,a=h(this.composites);try{for(a.s();!(i=a.n()).done;)i.value.scale(t,e)}catch(n){a.e(n)}finally{a.f()}}}}}],[{key:"parse",value:function(t,i){var a=n.parse(t,i),r=f(a,2),l=r[0],c=r[1];if(t+=l,c.numberOfContours<0){for(var d=[];;){var u=s.parse(t,i),p=f(u,2),m=p[0],h=p[1];if(t+=m,d.push(h),!(32&h.flags))break}return new e({header:c,composites:d})}return new e({header:c,simple:o.parse(t,i,c.numberOfContours)})}}]),e}(),n=function(){function e(t){b(this,e);var i=t.numberOfContours,a=t.xMin,n=t.yMin,r=t.xMax,o=t.yMax;this.numberOfContours=i,this.xMin=a,this.yMin=n,this.xMax=r,this.yMax=o}return g(e,[{key:"getSize",value:function(){return 10}},{key:"write",value:function(e,t){return t.setInt16(e,this.numberOfContours),t.setInt16(e+2,this.xMin),t.setInt16(e+4,this.yMin),t.setInt16(e+6,this.xMax),t.setInt16(e+8,this.yMax),10}},{key:"scale",value:function(e,t){this.xMin=Math.round(e+(this.xMin-e)*t),this.xMax=Math.round(e+(this.xMax-e)*t)}}],[{key:"parse",value:function(t,i){return[10,new e({numberOfContours:i.getInt16(t),xMin:i.getInt16(t+2),yMin:i.getInt16(t+4),xMax:i.getInt16(t+6),yMax:i.getInt16(t+8)})]}}]),e}(),r=g((function e(t){b(this,e);var i=t.flags,a=t.xCoordinates,n=t.yCoordinates;this.xCoordinates=a,this.yCoordinates=n,this.flags=i})),o=function(){function e(t){b(this,e);var i=t.contours,a=t.instructions;this.contours=i,this.instructions=a}return g(e,[{key:"getSize",value:function(){var e,t=2*this.contours.length+2+this.instructions.length,i=0,a=0,n=h(this.contours);try{for(n.s();!(e=n.n()).done;){var r=e.value;t+=r.flags.length;for(var o=0,s=r.xCoordinates.length;o<s;o++){var l=r.xCoordinates[o],c=r.yCoordinates[o],d=Math.abs(l-i);d>255?t+=2:d>0&&(t+=1),i=l,(d=Math.abs(c-a))>255?t+=2:d>0&&(t+=1),a=c}}}catch(u){n.e(u)}finally{n.f()}return t}},{key:"write",value:function(e,t){var i,a=e,n=[],r=[],o=[],s=0,l=0,c=h(this.contours);try{for(c.s();!(i=c.n()).done;){for(var d=i.value,u=0,p=d.xCoordinates.length;u<p;u++){var m=d.flags[u],f=d.xCoordinates[u],y=f-s;if(0===y)m|=16,n.push(0);else{var b=Math.abs(y);b<=255?(m|=y>=0?18:2,n.push(b)):n.push(y)}s=f;var g=d.yCoordinates[u];if(0===(y=g-l))m|=32,r.push(0);else{var v=Math.abs(y);v<=255?(m|=y>=0?36:4,r.push(v)):r.push(y)}l=g,o.push(m)}t.setUint16(e,n.length-1),e+=2}}catch(T){c.e(T)}finally{c.f()}t.setUint16(e,this.instructions.length),e+=2,this.instructions.length&&(new Uint8Array(t.buffer,0,t.buffer.byteLength).set(this.instructions,e),e+=this.instructions.length);for(var _=0,A=o;_<A.length;_++){var x=A[_];t.setUint8(e++,x)}for(var w=0,S=n.length;w<S;w++){var C=n[w],k=o[w];2&k?t.setUint8(e++,C):16&k||(t.setInt16(e,C),e+=2)}for(var D=0,R=r.length;D<R;D++){var I=r[D],M=o[D];4&M?t.setUint8(e++,I):32&M||(t.setInt16(e,I),e+=2)}return e-a}},{key:"scale",value:function(e,t){var i,a=h(this.contours);try{for(a.s();!(i=a.n()).done;){var n=i.value;if(0!==n.xCoordinates.length)for(var r=0,o=n.xCoordinates.length;r<o;r++)n.xCoordinates[r]=Math.round(e+(n.xCoordinates[r]-e)*t)}}catch(s){a.e(s)}finally{a.f()}}}],[{key:"parse",value:function(t,i,a){for(var n=[],o=0;o<a;o++){var s=i.getUint16(t);t+=2,n.push(s)}var l=n[a-1]+1,c=i.getUint16(t);t+=2;var d=new Uint8Array(i).slice(t,t+c);t+=c;for(var u=[],p=0;p<l;t++,p++){var m=i.getUint8(t);if(u.push(m),8&m){var h=i.getUint8(++t);m^=8;for(var f=0;f<h;f++)u.push(m);p+=h}}for(var y=[],b=[],g=[],v=[],_=[],A=0,x=0,w=0;w<l;w++){var S=u[w];if(2&S){var C=i.getUint8(t++);x+=16&S?C:-C,b.push(x)}else 16&S||(x+=i.getInt16(t),t+=2),b.push(x);n[A]===w&&(A++,y.push(b),b=[])}x=0,A=0;for(var k=0;k<l;k++){var D=u[k];if(4&D){var R=i.getUint8(t++);x+=32&D?R:-R,g.push(x)}else 32&D||(x+=i.getInt16(t),t+=2),g.push(x);v.push(1&D|64&D),n[A]===k&&(b=y[A],A++,_.push(new r({flags:v,xCoordinates:b,yCoordinates:g})),g=[],v=[])}return new e({contours:_,instructions:d})}}]),e}(),s=function(){function e(t){b(this,e);var i=t.flags,a=t.glyphIndex,n=t.argument1,r=t.argument2,o=t.transf,s=t.instructions;this.flags=i,this.glyphIndex=a,this.argument1=n,this.argument2=r,this.transf=o,this.instructions=s}return g(e,[{key:"getSize",value:function(){var e=4+2*this.transf.length;return 256&this.flags&&(e+=2+this.instructions.length),e+=2,2&this.flags?this.argument1>=-128&&this.argument1<=127&&this.argument2>=-128&&this.argument2<=127||(e+=2):this.argument1>=0&&this.argument1<=255&&this.argument2>=0&&this.argument2<=255||(e+=2),e}},{key:"write",value:function(e,t){var i=e;return 2&this.flags?this.argument1>=-128&&this.argument1<=127&&this.argument2>=-128&&this.argument2<=127||(this.flags|=1):this.argument1>=0&&this.argument1<=255&&this.argument2>=0&&this.argument2<=255||(this.flags|=1),t.setUint16(e,this.flags),t.setUint16(e+2,this.glyphIndex),e+=4,1&this.flags?(2&this.flags?(t.setInt16(e,this.argument1),t.setInt16(e+2,this.argument2)):(t.setUint16(e,this.argument1),t.setUint16(e+2,this.argument2)),e+=4):(t.setUint8(e,this.argument1),t.setUint8(e+1,this.argument2),e+=2),256&this.flags&&(t.setUint16(e,this.instructions.length),e+=2,this.instructions.length&&(new Uint8Array(t.buffer,0,t.buffer.byteLength).set(this.instructions,e),e+=this.instructions.length)),e-i}},{key:"scale",value:function(e,t){}}],[{key:"parse",value:function(t,i){var a,n,r=t,o=[],s=i.getUint16(t),l=i.getUint16(t+2);t+=4,1&s?(2&s?(a=i.getInt16(t),n=i.getInt16(t+2)):(a=i.getUint16(t),n=i.getUint16(t+2)),t+=4,s^=1):(2&s?(a=i.getInt8(t),n=i.getInt8(t+1)):(a=i.getUint8(t),n=i.getUint8(t+1)),t+=2),8&s?(o.push(i.getUint16(t)),t+=2):64&s?(o.push(i.getUint16(t),i.getUint16(t+2)),t+=4):128&s&&(o.push(i.getUint16(t),i.getUint16(t+2),i.getUint16(t+4),i.getUint16(t+6)),t+=8);var c=null;if(256&s){var d=i.getUint16(t);t+=2,c=new Uint8Array(i).slice(t,t+d),t+=d}return[t-r,new e({flags:s,glyphIndex:l,argument1:a,argument2:n,transf:o,instructions:c})]}}]),e}()},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.OpenTypeFileBuilder=void 0;var a=i(131),n=i(2);function r(e,t,i){e[t]=i>>8&255,e[t+1]=255&i}function o(e,t,i){e[t]=i>>24&255,e[t+1]=i>>16&255,e[t+2]=i>>8&255,e[t+3]=255&i}function s(e,t,i){if(i instanceof Uint8Array)e.set(i,t);else if("string"===typeof i)for(var a=0,n=i.length;a<n;a++)e[t++]=255&i.charCodeAt(a);else for(var r=0,o=i.length;r<o;r++)e[t++]=255&i[r]}var l=function(){function e(t){b(this,e),this.sfnt=t,this.tables=Object.create(null)}return g(e,[{key:"toArray",value:function(){var t=this.sfnt,i=this.tables,l=Object.keys(i);l.sort();var c,d,u,p,m,h=l.length,f=12+16*h,y=[f];for(c=0;c<h;c++)f+=((p=i[l[c]]).length+3&-4)>>>0,y.push(f);var b=new Uint8Array(f);for(c=0;c<h;c++)p=i[l[c]],s(b,y[c],p);"true"===t&&(t=(0,n.string32)(65536)),b[0]=255&t.charCodeAt(0),b[1]=255&t.charCodeAt(1),b[2]=255&t.charCodeAt(2),b[3]=255&t.charCodeAt(3),r(b,4,h);var g=e.getSearchParams(h,16);for(r(b,6,g.range),r(b,8,g.entry),r(b,10,g.rangeShift),f=12,c=0;c<h;c++){m=l[c],b[f]=255&m.charCodeAt(0),b[f+1]=255&m.charCodeAt(1),b[f+2]=255&m.charCodeAt(2),b[f+3]=255&m.charCodeAt(3);var v=0;for(d=y[c],u=y[c+1];d<u;d+=4)v=v+(0,a.readUint32)(b,d)>>>0;o(b,f+4,v),o(b,f+8,y[c]),o(b,f+12,i[m].length),f+=16}return b}},{key:"addTable",value:function(e,t){if(e in this.tables)throw new Error("Table "+e+" already exists");this.tables[e]=t}}],[{key:"getSearchParams",value:function(e,t){for(var i=1,a=0;(i^e)>i;)i<<=1,a++;var n=i*t;return{range:n,entry:a,rangeShift:t*e-n}}}]),e}();t.OpenTypeFileBuilder=l},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Type1Font=void 0;var a=i(160),n=i(163),r=i(131),o=i(135),s=i(174),l=i(2);function c(e,t,i){for(var a=e.length,n=t.length,o=a-n,s=i,l=!1;s<o;){for(var c=0;c<n&&e[s+c]===t[c];)c++;if(c>=n){for(s+=c;s<a&&(0,r.isWhiteSpace)(e[s]);)s++;l=!0;break}s++}return{found:l,length:s}}var d=function(){function e(t,i,a){b(this,e);var r=a.length1,d=(a.length2,i.peekBytes(6)),u=128===d[0]&&1===d[1];u&&(i.skip(6),r=d[5]<<24|d[4]<<16|d[3]<<8|d[2]);var p=function(e,t){var i,a,n,r,s=[101,101,120,101,99],d=e.pos;try{a=(i=e.getBytes(t)).length}catch(u){}if(a===t&&(n=c(i,s,t-2*s.length)).found&&n.length===t)return{stream:new o.Stream(i),length:t};for((0,l.warn)('Invalid "Length1" property in Type1 font -- trying to recover.'),e.pos=d;0!==(n=c(e.peekBytes(2048),s,0)).length;)if(e.pos+=n.length,n.found){r=e.pos-d;break}return e.pos=d,r?{stream:new o.Stream(e.getBytes(r)),length:r}:((0,l.warn)('Unable to recover "Length1" property in Type1 font -- using as is.'),{stream:new o.Stream(e.getBytes(t)),length:t})}(i,r);new s.Type1Parser(p.stream,!1,n.SEAC_ANALYSIS_ENABLED).extractFontHeader(a),u&&((d=i.getBytes(6))[5],d[4],d[3],d[2]);var m=function(e,t){var i=e.getBytes();return{stream:new o.Stream(i),length:i.length}}(i),h=new s.Type1Parser(m.stream,!0,n.SEAC_ANALYSIS_ENABLED).extractFontProgram(a);for(var f in h.properties)a[f]=h.properties[f];var y=h.charstrings,g=this.getType2Charstrings(y),v=this.getType2Subrs(h.subrs);this.charstrings=y,this.data=this.wrap(t,g,this.charstrings,v,a),this.seacs=this.getSeacs(h.charstrings)}return g(e,[{key:"numGlyphs",get:function(){return this.charstrings.length+1}},{key:"getCharset",value:function(){var e,t=[".notdef"],i=h(this.charstrings);try{for(i.s();!(e=i.n()).done;){var a=e.value.glyphName;t.push(a)}}catch(n){i.e(n)}finally{i.f()}return t}},{key:"getGlyphMapping",value:function(e){var t=this.charstrings;if(e.composite){for(var i=Object.create(null),a=0,r=t.length;a<r;a++)i[e.cMap.charCodeOf(a)]=a+1;return i}var o,s,l=[".notdef"];for(s=0;s<t.length;s++)l.push(t[s].glyphName);var c=e.builtInEncoding;if(c)for(var d in o=Object.create(null),c)(s=l.indexOf(c[d]))>=0&&(o[d]=s);return(0,n.type1FontGlyphMapping)(e,o,l)}},{key:"hasGlyphId",value:function(e){return!(e<0||e>=this.numGlyphs)&&(0===e||this.charstrings[e-1].charstring.length>0)}},{key:"getSeacs",value:function(e){for(var t=[],i=0,a=e.length;i<a;i++){var n=e[i];n.seac&&(t[i+1]=n.seac)}return t}},{key:"getType2Charstrings",value:function(e){for(var t=[],i=0,a=e.length;i<a;i++)t.push(e[i].charstring);return t}},{key:"getType2Subrs",value:function(e){var t=0,i=e.length;t=i<1133?107:i<33769?1131:32768;var a,n=[];for(a=0;a<t;a++)n.push([11]);for(a=0;a<i;a++)n.push(e[a]);return n}},{key:"wrap",value:function(e,t,i,n,r){var o=new a.CFF;o.header=new a.CFFHeader(1,0,4,4),o.names=[e];var s=new a.CFFTopDict;s.setByName("version",391),s.setByName("Notice",392),s.setByName("FullName",393),s.setByName("FamilyName",394),s.setByName("Weight",395),s.setByName("Encoding",null),s.setByName("FontMatrix",r.fontMatrix),s.setByName("FontBBox",r.bbox),s.setByName("charset",null),s.setByName("CharStrings",null),s.setByName("Private",null),o.topDict=s;var l=new a.CFFStrings;l.add("Version 0.11"),l.add("See original notice"),l.add(e),l.add(e),l.add("Medium"),o.strings=l,o.globalSubrIndex=new a.CFFIndex;var c,d,u=t.length,p=[".notdef"];for(c=0;c<u;c++){var m=i[c].glyphName;-1===a.CFFStandardStrings.indexOf(m)&&l.add(m),p.push(m)}o.charset=new a.CFFCharset(!1,0,p);var h=new a.CFFIndex;for(h.add([139,14]),c=0;c<u;c++)h.add(t[c]);o.charStrings=h;var f=new a.CFFPrivateDict;f.setByName("Subrs",null);var y=["BlueValues","OtherBlues","FamilyBlues","FamilyOtherBlues","StemSnapH","StemSnapV","BlueShift","BlueFuzz","BlueScale","LanguageGroup","ExpansionFactor","ForceBold","StdHW","StdVW"];for(c=0,d=y.length;c<d;c++){var b=y[c];if(b in r.privateData){var g=r.privateData[b];if(Array.isArray(g))for(var v=g.length-1;v>0;v--)g[v]-=g[v-1];f.setByName(b,g)}}o.topDict.privateDict=f;var _=new a.CFFIndex;for(c=0,d=n.length;c<d;c++)_.add(n[c]);return f.subrsIndex=_,new a.CFFCompiler(o).compile()}}]),e}();t.Type1Font=d},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Type1Parser=void 0;var a=i(162),n=i(131),r=i(135),o=i(2),s=[4],l=[5],d=[6],u=[7],p=[8],m=[12,35],h=[14],f=[21],y=[22],v=[30],_=[31],A=function(){function e(){b(this,e),this.width=0,this.lsb=0,this.flexing=!1,this.output=[],this.stack=[]}return g(e,[{key:"convert",value:function(e,t,i){for(var a,n,r,c=e.length,b=!1,g=0;g<c;g++){var A=e[g];if(A<32){switch(12===A&&(A=(A<<8)+e[++g]),A){case 1:case 3:case 9:case 3072:case 3073:case 3074:case 3105:this.stack=[];break;case 4:if(this.flexing){if(this.stack.length<1){b=!0;break}var x=this.stack.pop();this.stack.push(0,x);break}b=this.executeCommand(1,s);break;case 5:b=this.executeCommand(2,l);break;case 6:b=this.executeCommand(1,d);break;case 7:b=this.executeCommand(1,u);break;case 8:b=this.executeCommand(6,p);break;case 10:if(this.stack.length<1){b=!0;break}if(!t[r=this.stack.pop()]){b=!0;break}b=this.convert(t[r],t,i);break;case 11:return b;case 13:if(this.stack.length<2){b=!0;break}a=this.stack.pop(),n=this.stack.pop(),this.lsb=n,this.width=a,this.stack.push(a,n),b=this.executeCommand(2,y);break;case 14:this.output.push(h[0]);break;case 21:if(this.flexing)break;b=this.executeCommand(2,f);break;case 22:if(this.flexing){this.stack.push(0);break}b=this.executeCommand(1,y);break;case 30:b=this.executeCommand(4,v);break;case 31:b=this.executeCommand(4,_);break;case 3078:if(i){var w=this.stack.at(-5);this.seac=this.stack.splice(-4,4),this.seac[0]+=this.lsb-w,b=this.executeCommand(0,h)}else b=this.executeCommand(4,h);break;case 3079:if(this.stack.length<4){b=!0;break}this.stack.pop(),a=this.stack.pop();var S=this.stack.pop();n=this.stack.pop(),this.lsb=n,this.width=a,this.stack.push(a,n,S),b=this.executeCommand(3,f);break;case 3084:if(this.stack.length<2){b=!0;break}var C=this.stack.pop(),k=this.stack.pop();this.stack.push(k/C);break;case 3088:if(this.stack.length<2){b=!0;break}r=this.stack.pop();var D=this.stack.pop();if(0===r&&3===D){var R=this.stack.splice(this.stack.length-17,17);this.stack.push(R[2]+R[0],R[3]+R[1],R[4],R[5],R[6],R[7],R[8],R[9],R[10],R[11],R[12],R[13],R[14]),b=this.executeCommand(13,m,!0),this.flexing=!1,this.stack.push(R[15],R[16])}else 1===r&&0===D&&(this.flexing=!0);break;case 3089:break;default:(0,o.warn)('Unknown type 1 charstring command of "'+A+'"')}if(b)break}else A<=246?A-=139:A=A<=250?256*(A-247)+e[++g]+108:A<=254?-256*(A-251)-e[++g]-108:(255&e[++g])<<24|(255&e[++g])<<16|(255&e[++g])<<8|(255&e[++g])<<0,this.stack.push(A)}return b}},{key:"executeCommand",value:function(e,t,i){var a,n=this.stack.length;if(e>n)return!0;for(var r=n-e,o=r;o<n;o++){var s=this.stack[o];Number.isInteger(s)?this.output.push(28,s>>8&255,255&s):(s=65536*s|0,this.output.push(255,s>>24&255,s>>16&255,s>>8&255,255&s))}return(a=this.output).push.apply(a,c(t)),i?this.stack.splice(r,e):this.stack.length=0,!1}}]),e}(),x=55665;function w(e){return e>=48&&e<=57||e>=65&&e<=70||e>=97&&e<=102}function S(e,t,i){if(i>=e.length)return new Uint8Array(0);var a,n,r=0|t;for(a=0;a<i;a++)r=52845*(e[a]+r)+22719&65535;var o=e.length-i,s=new Uint8Array(o);for(a=i,n=0;n<o;a++,n++){var l=e[a];s[n]=l^r>>8,r=52845*(l+r)+22719&65535}return s}function C(e){return 47===e||91===e||93===e||123===e||125===e||40===e||41===e}var k=function(){function e(t,i,a){if(b(this,e),i){var o=t.getBytes(),s=!((w(o[0])||(0,n.isWhiteSpace)(o[0]))&&w(o[1])&&w(o[2])&&w(o[3])&&w(o[4])&&w(o[5])&&w(o[6])&&w(o[7]));t=new r.Stream(s?S(o,x,4):function(e,t,i){var a,n,r=0|t,o=e.length,s=new Uint8Array(o>>>1);for(a=0,n=0;a<o;a++){var l=e[a];if(w(l)){a++;for(var c=void 0;a<o&&!w(c=e[a]);)a++;if(a<o){var d=parseInt(String.fromCharCode(l,c),16);s[n++]=d^r>>8,r=52845*(d+r)+22719&65535}}}return s.slice(i,n)}(o,x,4))}this.seacAnalysisEnabled=!!a,this.stream=t,this.nextChar()}return g(e,[{key:"readNumberArray",value:function(){this.getToken();for(var e=[];;){var t=this.getToken();if(null===t||"]"===t||"}"===t)break;e.push(parseFloat(t||0))}return e}},{key:"readNumber",value:function(){var e=this.getToken();return parseFloat(e||0)}},{key:"readInt",value:function(){var e=this.getToken();return 0|parseInt(e||0,10)}},{key:"readBoolean",value:function(){return"true"===this.getToken()?1:0}},{key:"nextChar",value:function(){return this.currentChar=this.stream.getByte()}},{key:"prevChar",value:function(){return this.stream.skip(-2),this.currentChar=this.stream.getByte()}},{key:"getToken",value:function(){for(var e=!1,t=this.currentChar;;){if(-1===t)return null;if(e)10!==t&&13!==t||(e=!1);else if(37===t)e=!0;else if(!(0,n.isWhiteSpace)(t))break;t=this.nextChar()}if(C(t))return this.nextChar(),String.fromCharCode(t);var i="";do{i+=String.fromCharCode(t),t=this.nextChar()}while(t>=0&&!(0,n.isWhiteSpace)(t)&&!C(t));return i}},{key:"readCharStrings",value:function(e,t){return-1===t?e:S(e,4330,t)}},{key:"extractFontProgram",value:function(e){var t=this.stream,i=[],a=[],n=Object.create(null);n.lenIV=4;for(var r,o,s,l,c={subrs:[],charstrings:[],properties:{privateData:n}};null!==(r=this.getToken());)if("/"===r)switch(r=this.getToken()){case"CharStrings":for(this.getToken(),this.getToken(),this.getToken(),this.getToken();null!==(r=this.getToken())&&"end"!==r;)if("/"===r){var d=this.getToken();o=this.readInt(),this.getToken(),s=o>0?t.getBytes(o):new Uint8Array(0),l=c.properties.privateData.lenIV;var u=this.readCharStrings(s,l);this.nextChar(),"noaccess"===(r=this.getToken())?this.getToken():"/"===r&&this.prevChar(),a.push({glyph:d,encoded:u})}break;case"Subrs":for(this.readInt(),this.getToken();"dup"===this.getToken();){var p=this.readInt();o=this.readInt(),this.getToken(),s=o>0?t.getBytes(o):new Uint8Array(0),l=c.properties.privateData.lenIV;var m=this.readCharStrings(s,l);this.nextChar(),"noaccess"===(r=this.getToken())&&this.getToken(),i[p]=m}break;case"BlueValues":case"OtherBlues":case"FamilyBlues":case"FamilyOtherBlues":var h=this.readNumberArray();h.length>0&&h.length;break;case"StemSnapH":case"StemSnapV":c.properties.privateData[r]=this.readNumberArray();break;case"StdHW":case"StdVW":c.properties.privateData[r]=this.readNumberArray()[0];break;case"BlueShift":case"lenIV":case"BlueFuzz":case"BlueScale":case"LanguageGroup":case"ExpansionFactor":c.properties.privateData[r]=this.readNumber();break;case"ForceBold":c.properties.privateData[r]=this.readBoolean()}for(var f=0,y=a;f<y.length;f++){var b=y[f],g=b.encoded,v=b.glyph,_=new A,x=_.convert(g,i,this.seacAnalysisEnabled),w=_.output;x&&(w=[14]);var S={glyphName:v,charstring:w,width:_.width,lsb:_.lsb,seac:_.seac};if(".notdef"===v?c.charstrings.unshift(S):c.charstrings.push(S),e.builtInEncoding){var C=e.builtInEncoding.indexOf(v);C>-1&&void 0===e.widths[C]&&C>=e.firstChar&&C<=e.lastChar&&(e.widths[C]=_.width)}}return c}},{key:"extractFontHeader",value:function(e){for(var t;null!==(t=this.getToken());)if("/"===t)switch(t=this.getToken()){case"FontMatrix":var i=this.readNumberArray();e.fontMatrix=i;break;case"Encoding":var n=this.getToken(),r=void 0;if(/^\d+$/.test(n)){r=[];var o=0|parseInt(n,10);this.getToken();for(var s=0;s<o;s++){for(t=this.getToken();"dup"!==t&&"def"!==t;)if(null===(t=this.getToken()))return;if("def"===t)break;var l=this.readInt();this.getToken();var c=this.getToken();r[l]=c,this.getToken()}}else r=(0,a.getEncoding)(n);e.builtInEncoding=r;break;case"FontBBox":var d=this.readNumberArray();e.ascent=Math.max(d[3],d[1]),e.descent=Math.min(d[1],d[3]),e.ascentScaled=!0}}}]),e}();t.Type1Parser=k},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Pattern=void 0,t.getTilingPatternIR=function(e,t,i){var n=t.getArray("Matrix"),r=a.Util.normalizeRect(t.getArray("BBox")),o=t.get("XStep"),s=t.get("YStep"),l=t.get("PaintType"),c=t.get("TilingType");if(r[2]-r[0]===0||r[3]-r[1]===0)throw new a.FormatError("Invalid getTilingPatternIR /BBox array: [".concat(r,"]."));return["TilingPattern",i,e,n,r,o,s,l,c]};var a=i(2),r=i(132),o=i(139),s=i(131),l={FUNCTION_BASED:1,AXIAL:2,RADIAL:3,FREE_FORM_MESH:4,LATTICE_FORM_MESH:5,COONS_PATCH_MESH:6,TENSOR_PATCH_MESH:7},c=function(){function e(){b(this,e),(0,a.unreachable)("Cannot initialize Pattern.")}return g(e,null,[{key:"parseShading",value:function(e,t,i,n,o,c){var d=e instanceof r.BaseStream?e.dict:e,u=d.get("ShadingType");try{switch(u){case l.AXIAL:case l.RADIAL:return new m(d,t,i,o,c);case l.FREE_FORM_MESH:case l.LATTICE_FORM_MESH:case l.COONS_PATCH_MESH:case l.TENSOR_PATCH_MESH:return new v(e,t,i,o,c);default:throw new a.FormatError("Unsupported ShadingType: "+u)}}catch(p){if(p instanceof s.MissingDataException)throw p;return n.send("UnsupportedFeature",{featureId:a.UNSUPPORTED_FEATURES.shadingPattern}),(0,a.warn)(p),new _}}}]),e}();t.Pattern=c;var p=function(){function e(){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize BaseShading.")}return g(e,[{key:"getIR",value:function(){(0,a.unreachable)("Abstract method `getIR` called.")}}],[{key:"SMALL_NUMBER",get:function(){return(0,a.shadow)(this,"SMALL_NUMBER",1e-6)}}]),e}(),m=function(e){d(i,e);var t=u(i);function i(e,r,s,c,d){var u;b(this,i),(u=t.call(this)).coordsArr=e.getArray("Coords"),u.shadingType=e.get("ShadingType");var m=o.ColorSpace.parse({cs:e.getRaw("CS")||e.getRaw("ColorSpace"),xref:r,resources:s,pdfFunctionFactory:c,localColorSpaceCache:d}),h=e.getArray("BBox");Array.isArray(h)&&4===h.length?u.bbox=a.Util.normalizeRect(h):u.bbox=null;var y=0,g=1;if(e.has("Domain")){var v=e.getArray("Domain");y=v[0],g=v[1]}var _=!1,A=!1;if(e.has("Extend")){var x=e.getArray("Extend");_=x[0],A=x[1]}if(u.shadingType===l.RADIAL&&(!_||!A)){var w=f(u.coordsArr,6),S=w[0],C=w[1],k=w[2],D=w[3],R=w[4],I=w[5],M=Math.hypot(S-D,C-R);k<=I+M&&I<=k+M&&(0,a.warn)("Unsupported radial gradient.")}u.extendStart=_,u.extendEnd=A;var T=e.getRaw("Function"),P=c.createFromArray(T),z=(g-y)/10,B=u.colorStops=[];if(y>=g||z<=0)return(0,a.info)("Bad shading domain."),n(u);for(var F,E=new Float32Array(m.numComps),N=new Float32Array(1),O=0;O<=10;O++){N[0]=y+O*z,P(N,0,E,0),F=m.getRgb(E,0);var G=a.Util.makeHexColor(F[0],F[1],F[2]);B.push([O/10,G])}var L="transparent";return e.has("Background")&&(F=m.getRgb(e.get("Background"),0),L=a.Util.makeHexColor(F[0],F[1],F[2])),_||(B.unshift([0,L]),B[1][0]+=p.SMALL_NUMBER),A||(B.at(-1)[0]-=p.SMALL_NUMBER,B.push([1,L])),u.colorStops=B,u}return g(i,[{key:"getIR",value:function(){var e,t,i,n,r,o=this.coordsArr,s=this.shadingType;return s===l.AXIAL?(t=[o[0],o[1]],i=[o[2],o[3]],n=null,r=null,e="axial"):s===l.RADIAL?(t=[o[0],o[1]],i=[o[3],o[4]],n=o[2],r=o[5],e="radial"):(0,a.unreachable)("getPattern type unknown: ".concat(s)),["RadialAxial",e,this.bbox,this.colorStops,t,i,n,r]}}]),i}(p),h=function(){function e(t,i){b(this,e),this.stream=t,this.context=i,this.buffer=0,this.bufferLength=0;var a=i.numComps;this.tmpCompsBuf=new Float32Array(a);var n=i.colorSpace.numComps;this.tmpCsCompsBuf=i.colorFn?new Float32Array(n):this.tmpCompsBuf}return g(e,[{key:"hasData",get:function(){if(this.stream.end)return this.stream.pos<this.stream.end;if(this.bufferLength>0)return!0;var e=this.stream.getByte();return!(e<0)&&(this.buffer=e,this.bufferLength=8,!0)}},{key:"readBits",value:function(e){var t=this.buffer,i=this.bufferLength;if(32===e){if(0===i)return(this.stream.getByte()<<24|this.stream.getByte()<<16|this.stream.getByte()<<8|this.stream.getByte())>>>0;t=t<<24|this.stream.getByte()<<16|this.stream.getByte()<<8|this.stream.getByte();var a=this.stream.getByte();return this.buffer=a&(1<<i)-1,(t<<8-i|(255&a)>>i)>>>0}if(8===e&&0===i)return this.stream.getByte();for(;i<e;)t=t<<8|this.stream.getByte(),i+=8;return i-=e,this.bufferLength=i,this.buffer=t&(1<<i)-1,t>>i}},{key:"align",value:function(){this.buffer=0,this.bufferLength=0}},{key:"readFlag",value:function(){return this.readBits(this.context.bitsPerFlag)}},{key:"readCoordinate",value:function(){var e=this.context.bitsPerCoordinate,t=this.readBits(e),i=this.readBits(e),a=this.context.decode,n=e<32?1/((1<<e)-1):2.3283064365386963e-10;return[t*n*(a[1]-a[0])+a[0],i*n*(a[3]-a[2])+a[2]]}},{key:"readComponents",value:function(){for(var e=this.context.numComps,t=this.context.bitsPerComponent,i=t<32?1/((1<<t)-1):2.3283064365386963e-10,a=this.context.decode,n=this.tmpCompsBuf,r=0,o=4;r<e;r++,o+=2){var s=this.readBits(t);n[r]=s*i*(a[o+1]-a[o])+a[o]}var l=this.tmpCsCompsBuf;return this.context.colorFn&&this.context.colorFn(n,0,l,0),this.context.colorSpace.getRgb(l,0)}}]),e}(),y=function(){var e=[];return function(t){return e[t]||(e[t]=function(e){for(var t=[],i=0;i<=e;i++){var a=i/e,n=1-a;t.push(new Float32Array([n*n*n,3*a*n*n,3*a*a*n,a*a*a]))}return t}(t)),e[t]}}(),v=function(e){d(i,e);var t=u(i);function i(e,n,s,c,d){var u;if(b(this,i),u=t.call(this),!(e instanceof r.BaseStream))throw new a.FormatError("Mesh data is not a stream");var p=e.dict;u.shadingType=p.get("ShadingType");var m=p.getArray("BBox");Array.isArray(m)&&4===m.length?u.bbox=a.Util.normalizeRect(m):u.bbox=null;var f=o.ColorSpace.parse({cs:p.getRaw("CS")||p.getRaw("ColorSpace"),xref:n,resources:s,pdfFunctionFactory:c,localColorSpaceCache:d});u.background=p.has("Background")?f.getRgb(p.get("Background"),0):null;var y=p.getRaw("Function"),g=y?c.createFromArray(y):null;u.coords=[],u.colors=[],u.figures=[];var v={bitsPerCoordinate:p.get("BitsPerCoordinate"),bitsPerComponent:p.get("BitsPerComponent"),bitsPerFlag:p.get("BitsPerFlag"),decode:p.getArray("Decode"),colorFn:g,colorSpace:f,numComps:g?1:f.numComps},_=new h(e,v),A=!1;switch(u.shadingType){case l.FREE_FORM_MESH:u._decodeType4Shading(_);break;case l.LATTICE_FORM_MESH:var x=0|p.get("VerticesPerRow");if(x<2)throw new a.FormatError("Invalid VerticesPerRow");u._decodeType5Shading(_,x);break;case l.COONS_PATCH_MESH:u._decodeType6Shading(_),A=!0;break;case l.TENSOR_PATCH_MESH:u._decodeType7Shading(_),A=!0;break;default:(0,a.unreachable)("Unsupported mesh type.")}if(A){u._updateBounds();for(var w=0,S=u.figures.length;w<S;w++)u._buildFigureFromPatch(w)}return u._updateBounds(),u._packData(),u}return g(i,[{key:"_decodeType4Shading",value:function(e){for(var t=this.coords,i=this.colors,n=[],r=[],o=0;e.hasData;){var s=e.readFlag(),l=e.readCoordinate(),c=e.readComponents();if(0===o){if(!(0<=s&&s<=2))throw new a.FormatError("Unknown type4 flag");switch(s){case 0:o=3;break;case 1:r.push(r.at(-2),r.at(-1)),o=1;break;case 2:r.push(r.at(-3),r.at(-1)),o=1}n.push(s)}r.push(t.length),t.push(l),i.push(c),o--,e.align()}this.figures.push({type:"triangles",coords:new Int32Array(r),colors:new Int32Array(r)})}},{key:"_decodeType5Shading",value:function(e,t){for(var i=this.coords,a=this.colors,n=[];e.hasData;){var r=e.readCoordinate(),o=e.readComponents();n.push(i.length),i.push(r),a.push(o)}this.figures.push({type:"lattice",coords:new Int32Array(n),colors:new Int32Array(n),verticesPerRow:t})}},{key:"_decodeType6Shading",value:function(e){for(var t=this.coords,i=this.colors,n=new Int32Array(16),r=new Int32Array(4);e.hasData;){var o=e.readFlag();if(!(0<=o&&o<=3))throw new a.FormatError("Unknown type6 flag");for(var s=t.length,l=0,c=0!==o?8:12;l<c;l++)t.push(e.readCoordinate());for(var d=i.length,u=0,p=0!==o?2:4;u<p;u++)i.push(e.readComponents());var m=void 0,h=void 0,f=void 0,y=void 0;switch(o){case 0:n[12]=s+3,n[13]=s+4,n[14]=s+5,n[15]=s+6,n[8]=s+2,n[11]=s+7,n[4]=s+1,n[7]=s+8,n[0]=s,n[1]=s+11,n[2]=s+10,n[3]=s+9,r[2]=d+1,r[3]=d+2,r[0]=d,r[1]=d+3;break;case 1:m=n[12],h=n[13],f=n[14],y=n[15],n[12]=y,n[13]=s+0,n[14]=s+1,n[15]=s+2,n[8]=f,n[11]=s+3,n[4]=h,n[7]=s+4,n[0]=m,n[1]=s+7,n[2]=s+6,n[3]=s+5,m=r[2],h=r[3],r[2]=h,r[3]=d,r[0]=m,r[1]=d+1;break;case 2:m=n[15],h=n[11],n[12]=n[3],n[13]=s+0,n[14]=s+1,n[15]=s+2,n[8]=n[7],n[11]=s+3,n[4]=h,n[7]=s+4,n[0]=m,n[1]=s+7,n[2]=s+6,n[3]=s+5,m=r[3],r[2]=r[1],r[3]=d,r[0]=m,r[1]=d+1;break;case 3:n[12]=n[0],n[13]=s+0,n[14]=s+1,n[15]=s+2,n[8]=n[1],n[11]=s+3,n[4]=n[2],n[7]=s+4,n[0]=n[3],n[1]=s+7,n[2]=s+6,n[3]=s+5,r[2]=r[0],r[3]=d,r[0]=r[1],r[1]=d+1}n[5]=t.length,t.push([(-4*t[n[0]][0]-t[n[15]][0]+6*(t[n[4]][0]+t[n[1]][0])-2*(t[n[12]][0]+t[n[3]][0])+3*(t[n[13]][0]+t[n[7]][0]))/9,(-4*t[n[0]][1]-t[n[15]][1]+6*(t[n[4]][1]+t[n[1]][1])-2*(t[n[12]][1]+t[n[3]][1])+3*(t[n[13]][1]+t[n[7]][1]))/9]),n[6]=t.length,t.push([(-4*t[n[3]][0]-t[n[12]][0]+6*(t[n[2]][0]+t[n[7]][0])-2*(t[n[0]][0]+t[n[15]][0])+3*(t[n[4]][0]+t[n[14]][0]))/9,(-4*t[n[3]][1]-t[n[12]][1]+6*(t[n[2]][1]+t[n[7]][1])-2*(t[n[0]][1]+t[n[15]][1])+3*(t[n[4]][1]+t[n[14]][1]))/9]),n[9]=t.length,t.push([(-4*t[n[12]][0]-t[n[3]][0]+6*(t[n[8]][0]+t[n[13]][0])-2*(t[n[0]][0]+t[n[15]][0])+3*(t[n[11]][0]+t[n[1]][0]))/9,(-4*t[n[12]][1]-t[n[3]][1]+6*(t[n[8]][1]+t[n[13]][1])-2*(t[n[0]][1]+t[n[15]][1])+3*(t[n[11]][1]+t[n[1]][1]))/9]),n[10]=t.length,t.push([(-4*t[n[15]][0]-t[n[0]][0]+6*(t[n[11]][0]+t[n[14]][0])-2*(t[n[12]][0]+t[n[3]][0])+3*(t[n[2]][0]+t[n[8]][0]))/9,(-4*t[n[15]][1]-t[n[0]][1]+6*(t[n[11]][1]+t[n[14]][1])-2*(t[n[12]][1]+t[n[3]][1])+3*(t[n[2]][1]+t[n[8]][1]))/9]),this.figures.push({type:"patch",coords:new 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d,u,p=!1,m=n[l][0],h=n[s][0],f=n[s][1],y=n[s][2],b=n[s][3];if(f===y){p=!0,d=s+4;for(var g=l+4,v=1;v<c;v++,d+=4,g+=4)if(u=n[d],n[g][0]!==m||u[0]!==h||u[1]!==f||u[2]!==y||u[3]!==b){v<10?p=!1:c=v;break}}if(p){c=Math.min(c,1e3);var _=new Float32Array(2*c);d=s;for(var A=0;A<c;A++,d+=4)u=n[d],_[A<<1]=u[4],_[1+(A<<1)]=u[5];i.splice(o,4*c,a.OPS.paintImageMaskXObjectRepeat),n.splice(o,4*c,[m,h,f,y,b,_])}else{c=Math.min(c,100);for(var x=[],w=0;w<c;w++){u=n[s+(w<<2)];var S=n[l+(w<<2)][0];x.push({data:S.data,width:S.width,height:S.height,interpolate:S.interpolate,count:S.count,transform:u})}i.splice(o,4*c,a.OPS.paintImageMaskXObjectGroup),n.splice(o,4*c,[x])}return o+1})),n(r,[a.OPS.save,a.OPS.transform,a.OPS.paintImageXObject,a.OPS.restore],(function(e){var t=e.argsArray,i=e.iCurr-2;return 0===t[i][1]&&0===t[i][2]}),(function(e,t){var i=e.fnArray,n=e.argsArray,r=(t-(e.iCurr-3))%4;switch(r){case 0:return i[t]===a.OPS.save;case 1:if(i[t]!==a.OPS.transform)return!1;var o=e.iCurr-2,s=n[o][0],l=n[o][3];return n[t][0]===s&&0===n[t][1]&&0===n[t][2]&&n[t][3]===l;case 2:if(i[t]!==a.OPS.paintImageXObject)return!1;var c=n[e.iCurr-1][0];return n[t][0]===c;case 3:return i[t]===a.OPS.restore}throw new Error("iterateImageGroup - invalid pos: ".concat(r))}),(function(e,t){var i=e.fnArray,n=e.argsArray,r=e.iCurr,o=r-3,s=r-2,l=n[r-1][0],c=n[s][0],d=n[s][3],u=Math.min(Math.floor((t-o)/4),1e3);if(u<3)return t-(t-o)%4;for(var p=new Float32Array(2*u),m=s,h=0;h<u;h++,m+=4){var f=n[m];p[h<<1]=f[4],p[1+(h<<1)]=f[5]}var y=[l,c,d,p];return i.splice(o,4*u,a.OPS.paintImageXObjectRepeat),n.splice(o,4*u,y),o+1})),n(r,[a.OPS.beginText,a.OPS.setFont,a.OPS.setTextMatrix,a.OPS.showText,a.OPS.endText],null,(function(e,t){var i=e.fnArray,n=e.argsArray,r=(t-(e.iCurr-4))%5;switch(r){case 0:return i[t]===a.OPS.beginText;case 1:return i[t]===a.OPS.setFont;case 2:return i[t]===a.OPS.setTextMatrix;case 3:if(i[t]!==a.OPS.showText)return!1;var o=e.iCurr-3,s=n[o][0],l=n[o][1];return n[t][0]===s&&n[t][1]===l;case 4:return i[t]===a.OPS.endText}throw new Error("iterateShowTextGroup - invalid pos: ".concat(r))}),(function(e,t){var i=e.fnArray,a=e.argsArray,n=e.iCurr,r=n-4,o=n-3,s=n-2,l=n-1,c=n,d=a[o][0],u=a[o][1],p=Math.min(Math.floor((t-r)/5),1e3);if(p<3)return t-(t-r)%5;var m=r;r>=4&&i[r-4]===i[o]&&i[r-3]===i[s]&&i[r-2]===i[l]&&i[r-1]===i[c]&&a[r-4][0]===d&&a[r-4][1]===u&&(p++,m-=5);for(var h=m+4,f=1;f<p;f++)i.splice(h,3),a.splice(h,3),h+=2;return h+1}));var o=function(){function e(t){b(this,e),this.queue=t}return g(e,[{key:"_optimize",value:function(){}},{key:"push",value:function(e,t){this.queue.fnArray.push(e),this.queue.argsArray.push(t),this._optimize()}},{key:"flush",value:function(){}},{key:"reset",value:function(){}}]),e}(),s=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this,e)).state=null,a.context={iCurr:0,fnArray:e.fnArray,argsArray:e.argsArray},a.match=null,a.lastProcessed=0,a}return g(i,[{key:"_optimize",value:function(){var e=this.queue.fnArray,t=this.lastProcessed,i=e.length,a=this.state,n=this.match;if(a||n||t+1!==i||r[e[t]]){for(var o=this.context;t<i;){if(n){if((0,n.iterateFn)(o,t)){t++;continue}if(t=(0,n.processFn)(o,t+1),n=null,a=null,t>=(i=e.length))break}(a=(a||r)[e[t]])&&!Array.isArray(a)?(o.iCurr=t,t++,!a.checkFn||(0,a.checkFn)(o)?(n=a,a=null):a=null):t++}this.state=a,this.match=n,this.lastProcessed=t}else this.lastProcessed=i}},{key:"flush",value:function(){for(;this.match;){var e=this.queue.fnArray.length;this.lastProcessed=(0,this.match.processFn)(this.context,e),this.match=null,this.state=null,this._optimize()}}},{key:"reset",value:function(){this.state=null,this.match=null,this.lastProcessed=0}}]),i}(o),l=function(){function e(){b(this,e);var t=arguments.length>0&&void 0!==arguments[0]?arguments[0]:0,i=arguments.length>1?arguments[1]:void 0;this._streamSink=i,this.fnArray=[],this.argsArray=[],!i||t&a.RenderingIntentFlag.OPLIST?this.optimizer=new o(this):this.optimizer=new s(this),this.dependencies=new Set,this._totalLength=0,this.weight=0,this._resolved=i?null:Promise.resolve()}return g(e,[{key:"length",get:function(){return this.argsArray.length}},{key:"ready",get:function(){return this._resolved||this._streamSink.ready}},{key:"totalLength",get:function(){return this._totalLength+this.length}},{key:"addOp",value:function(t,i){this.optimizer.push(t,i),this.weight++,this._streamSink&&(this.weight>=e.CHUNK_SIZE||this.weight>=e.CHUNK_SIZE_ABOUT&&(t===a.OPS.restore||t===a.OPS.endText))&&this.flush()}},{key:"addImageOps",value:function(e,t,i){void 0!==i&&this.addOp(a.OPS.beginMarkedContentProps,["OC",i]),this.addOp(e,t),void 0!==i&&this.addOp(a.OPS.endMarkedContent,[])}},{key:"addDependency",value:function(e){this.dependencies.has(e)||(this.dependencies.add(e),this.addOp(a.OPS.dependency,[e]))}},{key:"addDependencies",value:function(e){var t,i=h(e);try{for(i.s();!(t=i.n()).done;){var a=t.value;this.addDependency(a)}}catch(n){i.e(n)}finally{i.f()}}},{key:"addOpList",value:function(t){if(t instanceof e){var i,n=h(t.dependencies);try{for(n.s();!(i=n.n()).done;){var r=i.value;this.dependencies.add(r)}}catch(l){n.e(l)}finally{n.f()}for(var o=0,s=t.length;o<s;o++)this.addOp(t.fnArray[o],t.argsArray[o])}else(0,a.warn)('addOpList - ignoring invalid "opList" parameter.')}},{key:"getIR",value:function(){return{fnArray:this.fnArray,argsArray:this.argsArray,length:this.length}}},{key:"_transfers",get:function(){for(var e=[],t=this.fnArray,i=this.argsArray,n=this.length,r=0;r<n;r++)switch(t[r]){case a.OPS.paintInlineImageXObject:case a.OPS.paintInlineImageXObjectGroup:case a.OPS.paintImageMaskXObject:var o=i[r][0];!o.cached&&o.data&&o.data.buffer instanceof ArrayBuffer&&e.push(o.data.buffer)}return e}},{key:"flush",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:null;this.optimizer.flush();var i=this.length;this._totalLength+=i,this._streamSink.enqueue({fnArray:this.fnArray,argsArray:this.argsArray,lastChunk:e,separateAnnots:t,length:i},1,this._transfers),this.dependencies.clear(),this.fnArray.length=0,this.argsArray.length=0,this.weight=0,this.optimizer.reset()}}],[{key:"CHUNK_SIZE",get:function(){return(0,a.shadow)(this,"CHUNK_SIZE",1e3)}},{key:"CHUNK_SIZE_ABOUT",get:function(){return(0,a.shadow)(this,"CHUNK_SIZE_ABOUT",this.CHUNK_SIZE-5)}}]),e}();t.OperatorList=l},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.PDFImage=void 0;var a=i(2),n=i(189),r=i(132),o=i(139),s=i(144),l=i(152),c=i(155),d=i(130);function u(e,t,i,a){return(e=t+e*i)<0?e=0:e>a&&(e=a),e}function m(e,t,i,a,n,r){var o,s=n*r;o=t<=8?new Uint8Array(s):t<=16?new Uint16Array(s):new Uint32Array(s);var l,c,d,u,p=i/n,m=a/r,h=0,f=new Uint16Array(n),y=i;for(l=0;l<n;l++)f[l]=Math.floor(l*p);for(l=0;l<r;l++)for(d=Math.floor(l*m)*y,c=0;c<n;c++)u=d+f[c],o[h++]=e[u];return o}var h=function(){function e(t){b(this,e);var i=t.xref,n=t.res,s=t.image,l=t.isInline,u=void 0!==l&&l,p=t.smask,m=void 0===p?null:p,h=t.mask,f=void 0===h?null:h,y=t.isMask,g=void 0!==y&&y,v=t.pdfFunctionFactory,_=t.localColorSpaceCache;this.image=s;var A,x=s.dict,w=x.get("F","Filter");if(w instanceof d.Name)A=w.name;else if(Array.isArray(w)){var S=i.fetchIfRef(w[0]);S instanceof d.Name&&(A=S.name)}switch(A){case"JPXDecode":var C=new c.JpxImage;C.parseImageProperties(s.stream),s.stream.reset(),s.width=C.width,s.height=C.height,s.bitsPerComponent=C.bitsPerComponent,s.numComps=C.componentsCount;break;case"JBIG2Decode":s.bitsPerComponent=1,s.numComps=1}var k=x.get("W","Width"),D=x.get("H","Height");if(Number.isInteger(s.width)&&s.width>0&&Number.isInteger(s.height)&&s.height>0&&(s.width!==k||s.height!==D)&&((0,a.warn)("PDFImage - using the Width/Height of the image data, rather than the image dictionary."),k=s.width,D=s.height),k<1||D<1)throw new a.FormatError("Invalid image width: ".concat(k," or height: ").concat(D));this.width=k,this.height=D,this.interpolate=x.get("I","Interpolate"),this.imageMask=x.get("IM","ImageMask")||!1,this.matte=x.get("Matte")||!1;var R=s.bitsPerComponent;if(!R&&!(R=x.get("BPC","BitsPerComponent"))){if(!this.imageMask)throw new a.FormatError("Bits per component missing in image: ".concat(this.imageMask));R=1}if(this.bpc=R,!this.imageMask){var I=x.getRaw("CS")||x.getRaw("ColorSpace");if(!I)switch((0,a.info)("JPX images (which do not require color spaces)"),s.numComps){case 1:I=d.Name.get("DeviceGray");break;case 3:I=d.Name.get("DeviceRGB");break;case 4:I=d.Name.get("DeviceCMYK");break;default:throw new Error("JPX images with ".concat(s.numComps," color components not supported."))}this.colorSpace=o.ColorSpace.parse({cs:I,xref:i,resources:u?n:null,pdfFunctionFactory:v,localColorSpaceCache:_}),this.numComps=this.colorSpace.numComps}if(this.decode=x.getArray("D","Decode"),this.needsDecode=!1,this.decode&&(this.colorSpace&&!this.colorSpace.isDefaultDecode(this.decode,R)||g&&!o.ColorSpace.isDefaultDecode(this.decode,1))){this.needsDecode=!0;var M=(1<<R)-1;this.decodeCoefficients=[],this.decodeAddends=[];for(var T=this.colorSpace&&"Indexed"===this.colorSpace.name,P=0,z=0;P<this.decode.length;P+=2,++z){var B=this.decode[P],F=this.decode[P+1];this.decodeCoefficients[z]=T?(F-B)/M:F-B,this.decodeAddends[z]=T?B:M*B}}m?this.smask=new e({xref:i,res:n,image:m,isInline:u,pdfFunctionFactory:v,localColorSpaceCache:_}):f&&(f instanceof r.BaseStream?f.dict.get("IM","ImageMask")?this.mask=new e({xref:i,res:n,image:f,isInline:u,isMask:!0,pdfFunctionFactory:v,localColorSpaceCache:_}):(0,a.warn)("Ignoring /Mask in image without /ImageMask."):this.mask=f)}return g(e,[{key:"drawWidth",get:function(){return Math.max(this.width,this.smask&&this.smask.width||0,this.mask&&this.mask.width||0)}},{key:"drawHeight",get:function(){return Math.max(this.height,this.smask&&this.smask.height||0,this.mask&&this.mask.height||0)}},{key:"decodeBuffer",value:function(e){var t,i,a=this.bpc,n=this.numComps,r=this.decodeAddends,o=this.decodeCoefficients,s=(1<<a)-1;if(1!==a){var l=0;for(t=0,i=this.width*this.height;t<i;t++)for(var c=0;c<n;c++)e[l]=u(e[l],r[c],o[c],s),l++}else for(t=0,i=e.length;t<i;t++)e[t]=+!e[t]}},{key:"getComponents",value:function(e){var t=this.bpc;if(8===t)return e;var i,a=this.width,n=this.height,r=this.numComps,o=a*n*r,s=0;i=t<=8?new Uint8Array(o):t<=16?new Uint16Array(o):new Uint32Array(o);var l,c,d=a*r,u=(1<<t)-1,p=0;if(1===t)for(var m,h,f,y=0;y<n;y++){for(h=p+(-8&d),f=p+d;p<h;)c=e[s++],i[p]=c>>7&1,i[p+1]=c>>6&1,i[p+2]=c>>5&1,i[p+3]=c>>4&1,i[p+4]=c>>3&1,i[p+5]=c>>2&1,i[p+6]=c>>1&1,i[p+7]=1&c,p+=8;if(p<f)for(c=e[s++],m=128;p<f;)i[p++]=+!!(c&m),m>>=1}else{var b=0;for(c=0,p=0,l=o;p<l;++p){for(p%d===0&&(c=0,b=0);b<t;)c=c<<8|e[s++],b+=8;var g=b-t,v=c>>g;v<0?v=0:v>u&&(v=u),i[p]=v,c&=(1<<g)-1,b=g}}return i}},{key:"fillOpacity",value:function(t,i,n,r,o){var s,l,c,d,u,p,h=this.smask,f=this.mask;if(h)l=h.width,c=h.height,s=new Uint8ClampedArray(l*c),h.fillGrayBuffer(s),l===i&&c===n||(s=m(s,h.bpc,l,c,i,n));else if(f)if(f instanceof e){for(l=f.width,c=f.height,s=new Uint8ClampedArray(l*c),f.numComps=1,f.fillGrayBuffer(s),d=0,u=l*c;d<u;++d)s[d]=255-s[d];l===i&&c===n||(s=m(s,f.bpc,l,c,i,n))}else{if(!Array.isArray(f))throw new a.FormatError("Unknown mask format.");s=new Uint8ClampedArray(i*n);var y=this.numComps;for(d=0,u=i*n;d<u;++d){var b=0,g=d*y;for(p=0;p<y;++p){var v=o[g+p],_=2*p;if(v<f[_]||v>f[_+1]){b=255;break}}s[d]=b}}if(s)for(d=0,p=3,u=i*r;d<u;++d,p+=4)t[p]=s[d];else for(d=0,p=3,u=i*r;d<u;++d,p+=4)t[p]=255}},{key:"undoPreblend",value:function(e,t,i){var a=this.smask&&this.smask.matte;if(a)for(var n=this.colorSpace.getRgb(a,0),r=n[0],o=n[1],s=n[2],l=t*i*4,c=0;c<l;c+=4){var d=e[c+3];if(0!==d){var u=255/d;e[c]=(e[c]-r)*u+r,e[c+1]=(e[c+1]-o)*u+o,e[c+2]=(e[c+2]-s)*u+s}else e[c]=255,e[c+1]=255,e[c+2]=255}}},{key:"createImageData",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=this.drawWidth,i=this.drawHeight,n={width:t,height:i,interpolate:this.interpolate,kind:0,data:null},r=this.numComps,o=this.width,s=this.height,c=this.bpc,d=o*r*c+7>>3;if(!e){var u;if("DeviceGray"===this.colorSpace.name&&1===c?u=a.ImageKind.GRAYSCALE_1BPP:"DeviceRGB"!==this.colorSpace.name||8!==c||this.needsDecode||(u=a.ImageKind.RGB_24BPP),u&&!this.smask&&!this.mask&&t===o&&i===s){if(n.kind=u,n.data=this.getImageBytes(s*d,{}),this.needsDecode){(0,a.assert)(u===a.ImageKind.GRAYSCALE_1BPP,"PDFImage.createImageData: The image must be grayscale.");for(var p=n.data,m=0,h=p.length;m<h;m++)p[m]^=255}return n}if(this.image instanceof l.JpegStream&&!this.smask&&!this.mask){var f=s*d;switch(this.colorSpace.name){case"DeviceGray":f*=3;case"DeviceRGB":case"DeviceCMYK":return n.kind=a.ImageKind.RGB_24BPP,n.data=this.getImageBytes(f,{drawWidth:t,drawHeight:i,forceRGB:!0}),n}}}var y,b,g=this.getImageBytes(s*d,{internal:!0}),v=0|g.length/d*i/s,_=this.getComponents(g);return e||this.smask||this.mask?(n.kind=a.ImageKind.RGBA_32BPP,n.data=new Uint8ClampedArray(t*i*4),y=1,b=!0,this.fillOpacity(n.data,t,i,v,_)):(n.kind=a.ImageKind.RGB_24BPP,n.data=new Uint8ClampedArray(t*i*3),y=0,b=!1),this.needsDecode&&this.decodeBuffer(_),this.colorSpace.fillRgb(n.data,o,s,t,i,v,c,_,y),b&&this.undoPreblend(n.data,t,v),n}},{key:"fillGrayBuffer",value:function(e){var t=this.numComps;if(1!==t)throw new a.FormatError("Reading gray scale from a color image: ".concat(t));var i,n,r=this.width,o=this.height,s=this.bpc,l=r*t*s+7>>3,c=this.getImageBytes(o*l,{internal:!0}),d=this.getComponents(c);if(1!==s){this.needsDecode&&this.decodeBuffer(d),n=r*o;var u=255/((1<<s)-1);for(i=0;i<n;++i)e[i]=u*d[i]}else if(n=r*o,this.needsDecode)for(i=0;i<n;++i)e[i]=d[i]-1&255;else for(i=0;i<n;++i)e[i]=255&-d[i]}},{key:"getImageBytes",value:function(e,t){var i=t.drawWidth,n=t.drawHeight,r=t.forceRGB,o=void 0!==r&&r,l=t.internal,c=void 0!==l&&l;this.image.reset(),this.image.drawWidth=i||this.width,this.image.drawHeight=n||this.height,this.image.forceRGB=!!o;var d=this.image.getBytes(e);return c||this.image instanceof s.DecodeStream?d:((0,a.assert)(d instanceof Uint8Array,'PDFImage.getImageBytes: Unsupported "imageBytes" type.'),new Uint8Array(d))}}],[{key:"buildImage",value:function(){var t=y(p().mark((function t(i){var n,o,s,l,c,d,u,m,h,f,y,b;return p().wrap((function(t){for(;;)switch(t.prev=t.next){case 0:return n=i.xref,o=i.res,s=i.image,l=i.isInline,c=void 0!==l&&l,d=i.pdfFunctionFactory,u=i.localColorSpaceCache,m=s,h=null,f=null,y=s.dict.get("SMask"),b=s.dict.get("Mask"),y?y instanceof r.BaseStream?h=y:(0,a.warn)("Unsupported /SMask format."):b&&(b instanceof r.BaseStream||Array.isArray(b)?f=b:(0,a.warn)("Unsupported /Mask format.")),t.abrupt("return",new e({xref:n,res:o,image:m,isInline:c,smask:h,mask:f,pdfFunctionFactory:d,localColorSpaceCache:u}));case 8:case"end":return t.stop()}}),t)})));return function(e){return t.apply(this,arguments)}}()},{key:"createRawMask",value:function(e){var t,i,a=e.imgArray,n=e.width,r=e.height,o=e.imageIsFromDecodeStream,s=e.inverseDecode,l=e.interpolate,c=(n+7>>3)*r,d=a.byteLength;if(!o||s&&c!==d?s?((t=new Uint8Array(c)).set(a),t.fill(255,d)):t=new Uint8Array(a):t=a,s)for(i=0;i<d;i++)t[i]^=255;return{data:t,width:n,height:r,interpolate:l}}},{key:"createMask",value:function(e){var t=e.imgArray,i=e.width,r=e.height,o=e.imageIsFromDecodeStream,s=e.inverseDecode,l=e.interpolate,c=1===i&&1===r&&s===(0===t.length||!!(128&t[0]));if(c)return{isSingleOpaquePixel:c};if(a.FeatureTest.isOffscreenCanvasSupported){var d=new OffscreenCanvas(i,r),u=d.getContext("2d"),p=u.createImageData(i,r);return(0,n.applyMaskImageData)({src:t,dest:p.data,width:i,height:r,inverseDecode:s}),u.putImageData(p,0,0),{data:null,width:i,height:r,interpolate:l,bitmap:d.transferToImageBitmap()}}return this.createRawMask({imgArray:t,width:i,height:r,inverseDecode:s,imageIsFromDecodeStream:o,interpolate:l})}}]),e}();t.PDFImage=h},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.applyMaskImageData=function(e){var t=e.src,i=e.srcPos,n=void 0===i?0:i,r=e.dest,o=e.destPos,s=void 0===o?0:o,l=e.width,c=e.height,d=e.inverseDecode,u=void 0!==d&&d,p=a.FeatureTest.isLittleEndian?4278190080:255,m=f(u?[0,p]:[p,0],2),h=m[0],y=m[1],b=l>>3,g=7&l,v=t.length;r=new Uint32Array(r.buffer);for(var _=0;_<c;_++){for(var A=n+b;n<A;n++){var x=n<v?t[n]:255;r[s++]=128&x?y:h,r[s++]=64&x?y:h,r[s++]=32&x?y:h,r[s++]=16&x?y:h,r[s++]=8&x?y:h,r[s++]=4&x?y:h,r[s++]=2&x?y:h,r[s++]=1&x?y:h}if(0!==g)for(var w=n<v?t[n++]:255,S=0;S<g;S++)r[s++]=w&1<<7-S?y:h}return{srcPos:n,destPos:s}};var a=i(2)},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.incrementalUpdate=function(e){var t=e.originalData,i=e.xrefInfo,s=e.newRefs,d=e.xref,u=void 0===d?null:d,y=e.hasXfa,b=void 0!==y&&y,g=e.xfaDatasetsRef,v=void 0===g?null:g,_=e.hasXfaDatasetsEntry,A=void 0!==_&&_,x=e.acroFormRef,w=void 0===x?null:x,S=e.acroForm,C=void 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m=u-8;r<m;)p[r++]=0;p[r++]=n<<3&255,p[r++]=n>>5&255,p[r++]=n>>13&255,p[r++]=n>>21&255,p[r++]=n>>>29&255,p[r++]=0,p[r++]=0,p[r++]=0;var h=new Int32Array(16);for(r=0;r<u;){for(o=0;o<16;++o,r+=4)h[o]=p[r]|p[r+1]<<8|p[r+2]<<16|p[r+3]<<24;var f=s,y=l,b=c,g=d,v=void 0,_=void 0;for(o=0;o<64;++o){o<16?(v=y&b|~y&g,_=o):o<32?(v=g&y|~g&b,_=5*o+1&15):o<48?(v=y^b^g,_=3*o+5&15):(v=b^(y|~g),_=7*o&15);var A=g,x=f+v+t[o]+h[_]|0,w=e[o];g=b,b=y,y=y+(x<<w|x>>>32-w)|0,f=A}s=s+f|0,l=l+y|0,c=c+b|0,d=d+g|0}return new Uint8Array([255&s,s>>8&255,s>>16&255,s>>>24&255,255&l,l>>8&255,l>>16&255,l>>>24&255,255&c,c>>8&255,c>>16&255,c>>>24&255,255&d,d>>8&255,d>>16&255,d>>>24&255])}}();t.calculateMD5=s;var l=function(){function e(t,i){b(this,e),this.high=0|t,this.low=0|i}return g(e,[{key:"and",value:function(e){this.high&=e.high,this.low&=e.low}},{key:"xor",value:function(e){this.high^=e.high,this.low^=e.low}},{key:"or",value:function(e){this.high|=e.high,this.low|=e.low}},{key:"shiftRight",value:function(e){e>=32?(this.low=this.high>>>e-32|0,this.high=0):(this.low=this.low>>>e|this.high<<32-e,this.high=this.high>>>e|0)}},{key:"shiftLeft",value:function(e){e>=32?(this.high=this.low<<e-32,this.low=0):(this.high=this.high<<e|this.low>>>32-e,this.low<<=e)}},{key:"rotateRight",value:function(e){var t,i;32&e?(i=this.low,t=this.high):(t=this.low,i=this.high),e&=31,this.low=t>>>e|i<<32-e,this.high=i>>>e|t<<32-e}},{key:"not",value:function(){this.high=~this.high,this.low=~this.low}},{key:"add",value:function(e){var t=(this.low>>>0)+(e.low>>>0),i=(this.high>>>0)+(e.high>>>0);t>4294967295&&(i+=1),this.low=0|t,this.high=0|i}},{key:"copyTo",value:function(e,t){e[t]=this.high>>>24&255,e[t+1]=this.high>>16&255,e[t+2]=this.high>>8&255,e[t+3]=255&this.high,e[t+4]=this.low>>>24&255,e[t+5]=this.low>>16&255,e[t+6]=this.low>>8&255,e[t+7]=255&this.low}},{key:"assign",value:function(e){this.high=e.high,this.low=e.low}}]),e}(),c=function(){function e(e,t){return e>>>t|e<<32-t}function t(e,t,i){return e&t^~e&i}function i(e,t,i){return e&t^e&i^t&i}function a(t){return e(t,2)^e(t,13)^e(t,22)}function n(t){return e(t,6)^e(t,11)^e(t,25)}function r(t){return e(t,7)^e(t,18)^t>>>3}var o=[1116352408,1899447441,3049323471,3921009573,961987163,1508970993,2453635748,2870763221,3624381080,310598401,607225278,1426881987,1925078388,2162078206,2614888103,3248222580,3835390401,4022224774,264347078,604807628,770255983,1249150122,1555081692,1996064986,2554220882,2821834349,2952996808,3210313671,3336571891,3584528711,113926993,338241895,666307205,773529912,1294757372,1396182291,1695183700,1986661051,2177026350,2456956037,2730485921,2820302411,3259730800,3345764771,3516065817,3600352804,4094571909,275423344,430227734,506948616,659060556,883997877,958139571,1322822218,1537002063,1747873779,1955562222,2024104815,2227730452,2361852424,2428436474,2756734187,3204031479,3329325298];return function(s,l,c){var d,u,p=1779033703,m=3144134277,h=1013904242,f=2773480762,y=1359893119,b=2600822924,g=528734635,v=1541459225,_=64*Math.ceil((c+9)/64),A=new Uint8Array(_);for(d=0;d<c;++d)A[d]=s[l++];A[d++]=128;for(var x=_-8;d<x;)A[d++]=0;A[d++]=0,A[d++]=0,A[d++]=0,A[d++]=c>>>29&255,A[d++]=c>>21&255,A[d++]=c>>13&255,A[d++]=c>>5&255,A[d++]=c<<3&255;var w,S=new Uint32Array(64);for(d=0;d<_;){for(u=0;u<16;++u)S[u]=A[d]<<24|A[d+1]<<16|A[d+2]<<8|A[d+3],d+=4;for(u=16;u<64;++u)S[u]=0|(e(w=S[u-2],17)^e(w,19)^w>>>10)+S[u-7]+r(S[u-15])+S[u-16];var C=p,k=m,D=h,R=f,I=y,M=b,T=g,P=v,z=void 0,B=void 0;for(u=0;u<64;++u)z=P+n(I)+t(I,M,T)+o[u]+S[u],B=a(C)+i(C,k,D),P=T,T=M,M=I,I=R+z|0,R=D,D=k,k=C,C=z+B|0;p=p+C|0,m=m+k|0,h=h+D|0,f=f+R|0,y=y+I|0,b=b+M|0,g=g+T|0,v=v+P|0}return new Uint8Array([p>>24&255,p>>16&255,p>>8&255,255&p,m>>24&255,m>>16&255,m>>8&255,255&m,h>>24&255,h>>16&255,h>>8&255,255&h,f>>24&255,f>>16&255,f>>8&255,255&f,y>>24&255,y>>16&255,y>>8&255,255&y,b>>24&255,b>>16&255,b>>8&255,255&b,g>>24&255,g>>16&255,g>>8&255,255&g,v>>24&255,v>>16&255,v>>8&255,255&v])}}();t.calculateSHA256=c;var p=function(){function e(e,t,i,a,n){e.assign(t),e.and(i),n.assign(t),n.not(),n.and(a),e.xor(n)}function t(e,t,i,a,n){e.assign(t),e.and(i),n.assign(t),n.and(a),e.xor(n),n.assign(i),n.and(a),e.xor(n)}function i(e,t,i){e.assign(t),e.rotateRight(28),i.assign(t),i.rotateRight(34),e.xor(i),i.assign(t),i.rotateRight(39),e.xor(i)}function a(e,t,i){e.assign(t),e.rotateRight(14),i.assign(t),i.rotateRight(18),e.xor(i),i.assign(t),i.rotateRight(41),e.xor(i)}function n(e,t,i){e.assign(t),e.rotateRight(1),i.assign(t),i.rotateRight(8),e.xor(i),i.assign(t),i.shiftRight(7),e.xor(i)}function r(e,t,i){e.assign(t),e.rotateRight(19),i.assign(t),i.rotateRight(61),e.xor(i),i.assign(t),i.shiftRight(6),e.xor(i)}var o=[new l(1116352408,3609767458),new l(1899447441,602891725),new l(3049323471,3964484399),new l(3921009573,2173295548),new l(961987163,4081628472),new l(1508970993,3053834265),new l(2453635748,2937671579),new l(2870763221,3664609560),new l(3624381080,2734883394),new l(310598401,1164996542),new l(607225278,1323610764),new l(1426881987,3590304994),new l(1925078388,4068182383),new l(2162078206,991336113),new l(2614888103,633803317),new l(3248222580,3479774868),new l(3835390401,2666613458),new l(4022224774,944711139),new l(264347078,2341262773),new l(604807628,2007800933),new l(770255983,1495990901),new l(1249150122,1856431235),new l(1555081692,3175218132),new l(1996064986,2198950837),new l(2554220882,3999719339),new l(2821834349,766784016),new l(2952996808,2566594879),new l(3210313671,3203337956),new l(3336571891,1034457026),new l(3584528711,2466948901),new l(113926993,3758326383),new l(338241895,168717936),new l(666307205,1188179964),new l(773529912,1546045734),new l(1294757372,1522805485),new l(1396182291,2643833823),new l(1695183700,2343527390),new l(1986661051,1014477480),new l(2177026350,1206759142),new l(2456956037,344077627),new l(2730485921,1290863460),new l(2820302411,3158454273),new l(3259730800,3505952657),new l(3345764771,106217008),new l(3516065817,3606008344),new l(3600352804,1432725776),new l(4094571909,1467031594),new l(275423344,851169720),new l(430227734,3100823752),new l(506948616,1363258195),new l(659060556,3750685593),new l(883997877,3785050280),new l(958139571,3318307427),new l(1322822218,3812723403),new l(1537002063,2003034995),new l(1747873779,3602036899),new l(1955562222,1575990012),new l(2024104815,1125592928),new l(2227730452,2716904306),new l(2361852424,442776044),new l(2428436474,593698344),new l(2756734187,3733110249),new l(3204031479,2999351573),new l(3329325298,3815920427),new l(3391569614,3928383900),new l(3515267271,566280711),new l(3940187606,3454069534),new l(4118630271,4000239992),new l(116418474,1914138554),new l(174292421,2731055270),new l(289380356,3203993006),new l(460393269,320620315),new l(685471733,587496836),new l(852142971,1086792851),new l(1017036298,365543100),new l(1126000580,2618297676),new l(1288033470,3409855158),new l(1501505948,4234509866),new l(1607167915,987167468),new l(1816402316,1246189591)];return function(s,c,d){var u,p,m,h,f,y,b,g,v=arguments.length>3&&void 0!==arguments[3]&&arguments[3];v?(u=new l(3418070365,3238371032),p=new l(1654270250,914150663),m=new l(2438529370,812702999),h=new l(355462360,4144912697),f=new l(1731405415,4290775857),y=new l(2394180231,1750603025),b=new l(3675008525,1694076839),g=new l(1203062813,3204075428)):(u=new l(1779033703,4089235720),p=new l(3144134277,2227873595),m=new l(1013904242,4271175723),h=new l(2773480762,1595750129),f=new l(1359893119,2917565137),y=new l(2600822924,725511199),b=new l(528734635,4215389547),g=new l(1541459225,327033209));var _,A,x=128*Math.ceil((d+17)/128),w=new Uint8Array(x);for(_=0;_<d;++_)w[_]=s[c++];w[_++]=128;for(var S=x-16;_<S;)w[_++]=0;w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=0,w[_++]=d>>>29&255,w[_++]=d>>21&255,w[_++]=d>>13&255,w[_++]=d>>5&255,w[_++]=d<<3&255;var C=new Array(80);for(_=0;_<80;_++)C[_]=new l(0,0);var k,D,R=new l(0,0),I=new l(0,0),M=new l(0,0),T=new l(0,0),P=new l(0,0),z=new l(0,0),B=new l(0,0),F=new l(0,0),E=new l(0,0),N=new l(0,0),O=new l(0,0),G=new l(0,0);for(_=0;_<x;){for(A=0;A<16;++A)C[A].high=w[_]<<24|w[_+1]<<16|w[_+2]<<8|w[_+3],C[A].low=w[_+4]<<24|w[_+5]<<16|w[_+6]<<8|w[_+7],_+=8;for(A=16;A<80;++A)r(k=C[A],C[A-2],G),k.add(C[A-7]),n(O,C[A-15],G),k.add(O),k.add(C[A-16]);for(R.assign(u),I.assign(p),M.assign(m),T.assign(h),P.assign(f),z.assign(y),B.assign(b),F.assign(g),A=0;A<80;++A)E.assign(F),a(O,P,G),E.add(O),e(O,P,z,B,G),E.add(O),E.add(o[A]),E.add(C[A]),i(N,R,G),t(O,R,I,M,G),N.add(O),k=F,F=B,B=z,z=P,T.add(E),P=T,T=M,M=I,I=R,k.assign(E),k.add(N),R=k;u.add(R),p.add(I),m.add(M),h.add(T),f.add(P),y.add(z),b.add(B),g.add(F)}return v?(D=new Uint8Array(48),u.copyTo(D,0),p.copyTo(D,8),m.copyTo(D,16),h.copyTo(D,24),f.copyTo(D,32),y.copyTo(D,40)):(D=new Uint8Array(64),u.copyTo(D,0),p.copyTo(D,8),m.copyTo(D,16),h.copyTo(D,24),f.copyTo(D,32),y.copyTo(D,40),b.copyTo(D,48),g.copyTo(D,56)),D}}();function m(e,t,i){return p(e,t,i,!0)}t.calculateSHA512=p;var h=function(){function e(){b(this,e)}return g(e,[{key:"decryptBlock",value:function(e){return e}},{key:"encrypt",value:function(e){return e}}]),e}(),f=function(){function e(){b(this,e),this.constructor===e&&(0,a.unreachable)("Cannot initialize AESBaseCipher."),this._s=new 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Uint8Array([82,9,106,213,48,54,165,56,191,64,163,158,129,243,215,251,124,227,57,130,155,47,255,135,52,142,67,68,196,222,233,203,84,123,148,50,166,194,35,61,238,76,149,11,66,250,195,78,8,46,161,102,40,217,36,178,118,91,162,73,109,139,209,37,114,248,246,100,134,104,152,22,212,164,92,204,93,101,182,146,108,112,72,80,253,237,185,218,94,21,70,87,167,141,157,132,144,216,171,0,140,188,211,10,247,228,88,5,184,179,69,6,208,44,30,143,202,63,15,2,193,175,189,3,1,19,138,107,58,145,17,65,79,103,220,234,151,242,207,206,240,180,230,115,150,172,116,34,231,173,53,133,226,249,55,232,28,117,223,110,71,241,26,113,29,41,197,137,111,183,98,14,170,24,190,27,252,86,62,75,198,210,121,32,154,219,192,254,120,205,90,244,31,221,168,51,136,7,199,49,177,18,16,89,39,128,236,95,96,81,127,169,25,181,74,13,45,229,122,159,147,201,156,239,160,224,59,77,174,42,245,176,200,235,187,60,131,83,153,97,23,43,4,126,186,119,214,38,225,105,20,99,85,33,12,125]),this._mix=new Uint32Array([0,235474187,470948374,303765277,941896748,908933415,607530554,708780849,1883793496,2118214995,1817866830,1649639237,1215061108,1181045119,1417561698,1517767529,3767586992,4003061179,4236429990,4069246893,3635733660,3602770327,3299278474,3400528769,2430122216,2664543715,2362090238,2193862645,2835123396,2801107407,3035535058,3135740889,3678124923,3576870512,3341394285,3374361702,3810496343,3977675356,4279080257,4043610186,2876494627,2776292904,3076639029,3110650942,2472011535,2640243204,2403728665,2169303058,1001089995,899835584,666464733,699432150,59727847,226906860,530400753,294930682,1273168787,1172967064,1475418501,1509430414,1942435775,2110667444,1876241833,1641816226,2910219766,2743034109,2976151520,3211623147,2505202138,2606453969,2302690252,2269728455,3711829422,3543599269,3240894392,3475313331,3843699074,3943906441,4178062228,4144047775,1306967366,1139781709,1374988112,1610459739,1975683434,2076935265,1775276924,1742315127,1034867998,866637845,566021896,800440835,92987698,193195065,429456164,395441711,1984812685,2017778566,1784663195,1683407248,1315562145,1080094634,1383856311,1551037884,101039829,135050206,437757123,337553864,1042385657,807962610,573804783,742039012,2531067453,2564033334,2328828971,2227573024,2935566865,2700099354,3001755655,3168937228,3868552805,3902563182,4203181171,4102977912,3736164937,3501741890,3265478751,3433712980,1106041591,1340463100,1576976609,1408749034,2043211483,2009195472,1708848333,1809054150,832877231,1068351396,766945465,599762354,159417987,126454664,361929877,463180190,2709260871,2943682380,3178106961,3009879386,2572697195,2538681184,2236228733,2336434550,3509871135,3745345300,3441850377,3274667266,3910161971,3877198648,4110568485,4211818798,2597806476,2497604743,2261089178,2295101073,2733856160,2902087851,3202437046,2968011453,3936291284,3835036895,4136440770,4169408201,3535486456,3702665459,3467192302,3231722213,2051518780,1951317047,1716890410,1750902305,1113818384,1282050075,1584504582,1350078989,168810852,67556463,371049330,404016761,841739592,1008918595,775550814,540080725,3969562369,3801332234,4035489047,4269907996,3569255213,3669462566,3366754619,3332740144,2631065433,2463879762,2160117071,2395588676,2767645557,2868897406,3102011747,3069049960,202008497,33778362,270040487,504459436,875451293,975658646,675039627,641025152,2084704233,1917518562,1615861247,1851332852,1147550661,1248802510,1484005843,1451044056,933301370,967311729,733156972,632953703,260388950,25965917,328671808,496906059,1206477858,1239443753,1543208500,1441952575,2144161806,1908694277,1675577880,1842759443,3610369226,3644379585,3408119516,3307916247,4011190502,3776767469,4077384432,4245618683,2809771154,2842737049,3144396420,3043140495,2673705150,2438237621,2203032232,2370213795]),this._mixCol=new Uint8Array(256);for(var t=0;t<256;t++)this._mixCol[t]=t<128?t<<1:t<<1^27;this.buffer=new Uint8Array(16),this.bufferPosition=0}return g(e,[{key:"_expandKey",value:function(e){(0,a.unreachable)("Cannot call `_expandKey` on the base class")}},{key:"_decrypt",value:function(e,t){var i,a,n,r=new Uint8Array(16);r.set(e);for(var o=0,s=this._keySize;o<16;++o,++s)r[o]^=t[s];for(var l=this._cyclesOfRepetition-1;l>=1;--l){i=r[13],r[13]=r[9],r[9]=r[5],r[5]=r[1],r[1]=i,i=r[14],a=r[10],r[14]=r[6],r[10]=r[2],r[6]=i,r[2]=a,i=r[15],a=r[11],n=r[7],r[15]=r[3],r[11]=i,r[7]=a,r[3]=n;for(var c=0;c<16;++c)r[c]=this._inv_s[r[c]];for(var d=0,u=16*l;d<16;++d,++u)r[d]^=t[u];for(var p=0;p<16;p+=4){var m=this._mix[r[p]],h=this._mix[r[p+1]],f=this._mix[r[p+2]],y=this._mix[r[p+3]];i=m^h>>>8^h<<24^f>>>16^f<<16^y>>>24^y<<8,r[p]=i>>>24&255,r[p+1]=i>>16&255,r[p+2]=i>>8&255,r[p+3]=255&i}}i=r[13],r[13]=r[9],r[9]=r[5],r[5]=r[1],r[1]=i,i=r[14],a=r[10],r[14]=r[6],r[10]=r[2],r[6]=i,r[2]=a,i=r[15],a=r[11],n=r[7],r[15]=r[3],r[11]=i,r[7]=a,r[3]=n;for(var b=0;b<16;++b)r[b]=this._inv_s[r[b]],r[b]^=t[b];return r}},{key:"_encrypt",value:function(e,t){var i,a,n,r=this._s,o=new Uint8Array(16);o.set(e);for(var s=0;s<16;++s)o[s]^=t[s];for(var l=1;l<this._cyclesOfRepetition;l++){for(var c=0;c<16;++c)o[c]=r[o[c]];n=o[1],o[1]=o[5],o[5]=o[9],o[9]=o[13],o[13]=n,n=o[2],a=o[6],o[2]=o[10],o[6]=o[14],o[10]=n,o[14]=a,n=o[3],a=o[7],i=o[11],o[3]=o[15],o[7]=n,o[11]=a,o[15]=i;for(var d=0;d<16;d+=4){var u=o[d+0],p=o[d+1],m=o[d+2],h=o[d+3];i=u^p^m^h,o[d+0]^=i^this._mixCol[u^p],o[d+1]^=i^this._mixCol[p^m],o[d+2]^=i^this._mixCol[m^h],o[d+3]^=i^this._mixCol[h^u]}for(var f=0,y=16*l;f<16;++f,++y)o[f]^=t[y]}for(var b=0;b<16;++b)o[b]=r[o[b]];n=o[1],o[1]=o[5],o[5]=o[9],o[9]=o[13],o[13]=n,n=o[2],a=o[6],o[2]=o[10],o[6]=o[14],o[10]=n,o[14]=a,n=o[3],a=o[7],i=o[11],o[3]=o[15],o[7]=n,o[11]=a,o[15]=i;for(var g=0,v=this._keySize;g<16;++g,++v)o[g]^=t[v];return o}},{key:"_decryptBlock2",value:function(e,t){for(var i=e.length,a=this.buffer,n=this.bufferPosition,r=[],o=this.iv,s=0;s<i;++s)if(a[n]=e[s],!(++n<16)){for(var l=this._decrypt(a,this._key),c=0;c<16;++c)l[c]^=o[c];o=a,r.push(l),a=new Uint8Array(16),n=0}if(this.buffer=a,this.bufferLength=n,this.iv=o,0===r.length)return new Uint8Array(0);var d=16*r.length;if(t){var u=r.at(-1),p=u[15];if(p<=16){for(var m=15,h=16-p;m>=h;--m)if(u[m]!==p){p=0;break}d-=p,r[r.length-1]=u.subarray(0,16-p)}}for(var f=new Uint8Array(d),y=0,b=0,g=r.length;y<g;++y,b+=16)f.set(r[y],b);return f}},{key:"decryptBlock",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]?arguments[2]:null,a=e.length,n=this.buffer,r=this.bufferPosition;if(i)this.iv=i;else{for(var o=0;r<16&&o<a;++o,++r)n[r]=e[o];if(r<16)return this.bufferLength=r,new Uint8Array(0);this.iv=n,e=e.subarray(16)}return this.buffer=new Uint8Array(16),this.bufferLength=0,this.decryptBlock=this._decryptBlock2,this.decryptBlock(e,t)}},{key:"encrypt",value:function(e,t){var i=e.length,a=this.buffer,n=this.bufferPosition,r=[];t||(t=new Uint8Array(16));for(var o=0;o<i;++o)if(a[n]=e[o],!(++n<16)){for(var s=0;s<16;++s)a[s]^=t[s];var l=this._encrypt(a,this._key);t=l,r.push(l),a=new Uint8Array(16),n=0}if(this.buffer=a,this.bufferLength=n,this.iv=t,0===r.length)return new Uint8Array(0);for(var c=16*r.length,d=new Uint8Array(c),u=0,p=0,m=r.length;u<m;++u,p+=16)d.set(r[u],p);return d}}]),e}(),y=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this))._cyclesOfRepetition=10,a._keySize=160,a._rcon=new Uint8Array([141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141,1,2,4,8,16,32,64,128,27,54,108,216,171,77,154,47,94,188,99,198,151,53,106,212,179,125,250,239,197,145,57,114,228,211,189,97,194,159,37,74,148,51,102,204,131,29,58,116,232,203,141]),a._key=a._expandKey(e),a}return g(i,[{key:"_expandKey",value:function(e){var t=this._s,i=this._rcon,a=new Uint8Array(176);a.set(e);for(var n=16,r=1;n<176;++r){var o=a[n-3],s=a[n-2],l=a[n-1],c=a[n-4];o=t[o],s=t[s],l=t[l],c=t[c],o^=i[r];for(var d=0;d<4;++d)a[n]=o^=a[n-16],a[++n]=s^=a[n-16],a[++n]=l^=a[n-16],a[++n]=c^=a[n-16],n++}return a}}]),i}(f);t.AES128Cipher=y;var v=function(e){d(i,e);var t=u(i);function i(e){var a;return b(this,i),(a=t.call(this))._cyclesOfRepetition=14,a._keySize=224,a._key=a._expandKey(e),a}return g(i,[{key:"_expandKey",value:function(e){var t=this._s,i=new Uint8Array(240);i.set(e);for(var a,n,r,o,s=1,l=32,c=1;l<240;++c){l%32===16?(a=t[a],n=t[n],r=t[r],o=t[o]):l%32===0&&(a=i[l-3],n=i[l-2],r=i[l-1],o=i[l-4],a=t[a],n=t[n],r=t[r],o=t[o],a^=s,(s<<=1)>=256&&(s=255&(27^s)));for(var d=0;d<4;++d)i[l]=a^=i[l-32],i[++l]=n^=i[l-32],i[++l]=r^=i[l-32],i[++l]=o^=i[l-32],l++}return i}}]),i}(f);t.AES256Cipher=v;var _=function(){function e(){b(this,e)}return g(e,[{key:"checkOwnerPassword",value:function(e,t,i,n){var r=new Uint8Array(e.length+56);r.set(e,0),r.set(t,e.length),r.set(i,e.length+t.length);var o=c(r,0,r.length);return(0,a.isArrayEqual)(o,n)}},{key:"checkUserPassword",value:function(e,t,i){var n=new Uint8Array(e.length+8);n.set(e,0),n.set(t,e.length);var r=c(n,0,n.length);return(0,a.isArrayEqual)(r,i)}},{key:"getOwnerKey",value:function(e,t,i,a){var n=new Uint8Array(e.length+56);n.set(e,0),n.set(t,e.length),n.set(i,e.length+t.length);var r=c(n,0,n.length);return new v(r).decryptBlock(a,!1,new Uint8Array(16))}},{key:"getUserKey",value:function(e,t,i){var a=new Uint8Array(e.length+8);a.set(e,0),a.set(t,e.length);var n=c(a,0,a.length);return new v(n).decryptBlock(i,!1,new Uint8Array(16))}}]),e}();t.PDF17=_;var A=function(){function e(e,t,i){for(var a=c(t,0,t.length).subarray(0,32),n=[0],r=0;r<64||n.at(-1)>r-32;){var o=e.length+a.length+i.length,s=new Uint8Array(o),l=0;s.set(e,l),l+=e.length,s.set(a,l),l+=a.length,s.set(i,l);for(var d=new Uint8Array(64*o),u=0,h=0;u<64;u++,h+=o)d.set(s,h);n=new y(a.subarray(0,16)).encrypt(d,a.subarray(16,32));for(var f=0,b=0;b<16;b++)f*=1,f%=3,f+=(n[b]>>>0)%3,f%=3;0===f?a=c(n,0,n.length):1===f?a=m(n,0,n.length):2===f&&(a=p(n,0,n.length)),r++}return a.subarray(0,32)}return function(){function t(){b(this,t)}return g(t,[{key:"hash",value:function(t,i,a){return e(t,i,a)}},{key:"checkOwnerPassword",value:function(t,i,n,r){var o=new Uint8Array(t.length+56);o.set(t,0),o.set(i,t.length),o.set(n,t.length+i.length);var s=e(t,o,n);return(0,a.isArrayEqual)(s,r)}},{key:"checkUserPassword",value:function(t,i,n){var r=new Uint8Array(t.length+8);r.set(t,0),r.set(i,t.length);var o=e(t,r,[]);return(0,a.isArrayEqual)(o,n)}},{key:"getOwnerKey",value:function(t,i,a,n){var r=new Uint8Array(t.length+56);r.set(t,0),r.set(i,t.length),r.set(a,t.length+i.length);var o=e(t,r,a);return new v(o).decryptBlock(n,!1,new Uint8Array(16))}},{key:"getUserKey",value:function(t,i,a){var n=new Uint8Array(t.length+8);n.set(t,0),n.set(i,t.length);var r=e(t,n,[]);return new v(r).decryptBlock(a,!1,new Uint8Array(16))}}]),t}()}();t.PDF20=A;var x=function(){function e(t,i){b(this,e),this.StringCipherConstructor=t,this.StreamCipherConstructor=i}return g(e,[{key:"createStream",value:function(e,t){var i=new this.StreamCipherConstructor;return new r.DecryptStream(e,t,(function(e,t){return i.decryptBlock(e,t)}))}},{key:"decryptString",value:function(e){var t=new this.StringCipherConstructor,i=(0,a.stringToBytes)(e);return i=t.decryptBlock(i,!0),(0,a.bytesToString)(i)}},{key:"encryptString",value:function(e){var t=new this.StringCipherConstructor;if(t instanceof f){var i=16-e.length%16;e+=String.fromCharCode(i).repeat(i);var n=new Uint8Array(16);if("undefined"!==typeof crypto)crypto.getRandomValues(n);else for(var r=0;r<16;r++)n[r]=Math.floor(256*Math.random());var o=(0,a.stringToBytes)(e);o=t.encrypt(o,n);var s=new Uint8Array(16+o.length);return s.set(n),s.set(o,16),(0,a.bytesToString)(s)}var l=(0,a.stringToBytes)(e);return l=t.encrypt(l),(0,a.bytesToString)(l)}}]),e}(),w=function(){var e=new Uint8Array([40,191,78,94,78,117,138,65,100,0,78,86,255,250,1,8,46,46,0,182,208,104,62,128,47,12,169,254,100,83,105,122]);function t(t,i,a,n,r,l,c,d){var u,p,m=40+a.length+t.length,h=new Uint8Array(m),f=0;if(i)for(p=Math.min(32,i.length);f<p;++f)h[f]=i[f];for(u=0;f<32;)h[f++]=e[u++];for(u=0,p=a.length;u<p;++u)h[f++]=a[u];for(h[f++]=255&r,h[f++]=r>>8&255,h[f++]=r>>16&255,h[f++]=r>>>24&255,u=0,p=t.length;u<p;++u)h[f++]=t[u];l>=4&&!d&&(h[f++]=255,h[f++]=255,h[f++]=255,h[f++]=255);var y=s(h,0,f),b=c>>3;if(l>=3)for(u=0;u<50;++u)y=s(y,0,b);var g,v=y.subarray(0,b);if(l>=3){for(f=0;f<32;++f)h[f]=e[f];for(u=0,p=t.length;u<p;++u)h[f++]=t[u];g=new o(v).encryptBlock(s(h,0,f)),p=v.length;var _=new Uint8Array(p);for(u=1;u<=19;++u){for(var A=0;A<p;++A)_[A]=v[A]^u;g=new o(_).encryptBlock(g)}for(u=0,p=g.length;u<p;++u)if(n[u]!==g[u])return null}else for(u=0,p=(g=new o(v).encryptBlock(e)).length;u<p;++u)if(n[u]!==g[u])return null;return v}var i=n.Name.get("Identity");function r(e,t,i){var a,n=arguments.length>3&&void 0!==arguments[3]&&arguments[3],r=new Uint8Array(i.length+9),o=i.length;for(a=0;a<o;++a)r[a]=i[a];return r[a++]=255&e,r[a++]=e>>8&255,r[a++]=e>>16&255,r[a++]=255&t,r[a++]=t>>8&255,n&&(r[a++]=115,r[a++]=65,r[a++]=108,r[a++]=84),s(r,0,a).subarray(0,Math.min(i.length+5,16))}function l(e,t,i,s,l){if(!(t instanceof n.Name))throw new a.FormatError("Invalid crypt filter name.");var c,d=e.get(t.name);if(null!==d&&void 0!==d&&(c=d.get("CFM")),!c||"None"===c.name)return function(){return new h};if("V2"===c.name)return function(){return new o(r(i,s,l,!1))};if("AESV2"===c.name)return function(){return new y(r(i,s,l,!0))};if("AESV3"===c.name)return function(){return new v(l)};throw new a.FormatError("Unknown crypto method")}return function(){function c(r,l,d){b(this,c);var u=r.get("Filter");if(!(0,n.isName)(u,"Standard"))throw new a.FormatError("unknown encryption method");this.filterName=u.name,this.dict=r;var p=r.get("V");if(!Number.isInteger(p)||1!==p&&2!==p&&4!==p&&5!==p)throw new a.FormatError("unsupported encryption algorithm");this.algorithm=p;var m=r.get("Length");if(!m)if(p<=3)m=40;else{var h=r.get("CF"),f=r.get("StmF");if(h instanceof n.Dict&&f instanceof n.Name){h.suppressEncryption=!0;var y=h.get(f.name);(m=y&&y.get("Length")||128)<40&&(m<<=3)}}if(!Number.isInteger(m)||m<40||m%8!==0)throw new a.FormatError("invalid key length");var g=(0,a.stringToBytes)(r.get("O")).subarray(0,32),v=(0,a.stringToBytes)(r.get("U")).subarray(0,32),x=r.get("P"),w=r.get("R"),S=(4===p||5===p)&&!1!==r.get("EncryptMetadata");this.encryptMetadata=S;var C,k,D=(0,a.stringToBytes)(l);if(d){if(6===w)try{d=(0,a.utf8StringToString)(d)}catch(N){(0,a.warn)("CipherTransformFactory: Unable to convert UTF8 encoded password.")}C=(0,a.stringToBytes)(d)}if(5!==p)k=t(D,C,g,v,x,w,m,S);else{var R=(0,a.stringToBytes)(r.get("O")).subarray(32,40),I=(0,a.stringToBytes)(r.get("O")).subarray(40,48),M=(0,a.stringToBytes)(r.get("U")).subarray(0,48),T=(0,a.stringToBytes)(r.get("U")).subarray(32,40),P=(0,a.stringToBytes)(r.get("U")).subarray(40,48),z=(0,a.stringToBytes)(r.get("OE")),B=(0,a.stringToBytes)(r.get("UE"));(0,a.stringToBytes)(r.get("Perms")),k=function(e,t,i,a,n,r,o,s,l,c,d,u){if(t){var p=Math.min(127,t.length);t=t.subarray(0,p)}else t=[];var m;return(m=6===e?new A:new _).checkUserPassword(t,s,o)?m.getUserKey(t,l,d):t.length&&m.checkOwnerPassword(t,a,r,i)?m.getOwnerKey(t,n,r,c):null}(w,C,g,R,I,M,v,T,P,z,B)}if(!k&&!d)throw new a.PasswordException("No password given",a.PasswordResponses.NEED_PASSWORD);if(!k&&d){var F=function(t,i,a,n){for(var r=new Uint8Array(32),l=0,c=Math.min(32,t.length);l<c;++l)r[l]=t[l];for(var d=0;l<32;)r[l++]=e[d++];var u,p=s(r,0,l),m=n>>3;if(a>=3)for(d=0;d<50;++d)p=s(p,0,p.length);if(a>=3){u=i;var h=new Uint8Array(m);for(d=19;d>=0;d--){for(var f=0;f<m;++f)h[f]=p[f]^d;u=new o(h).encryptBlock(u)}}else u=new o(p.subarray(0,m)).encryptBlock(i);return u}(C,g,w,m);k=t(D,F,g,v,x,w,m,S)}if(!k)throw new a.PasswordException("Incorrect Password",a.PasswordResponses.INCORRECT_PASSWORD);if(this.encryptionKey=k,p>=4){var E=r.get("CF");E instanceof n.Dict&&(E.suppressEncryption=!0),this.cf=E,this.stmf=r.get("StmF")||i,this.strf=r.get("StrF")||i,this.eff=r.get("EFF")||this.stmf}}return g(c,[{key:"createCipherTransform",value:function(e,t){if(4===this.algorithm||5===this.algorithm)return new x(l(this.cf,this.strf,e,t,this.encryptionKey),l(this.cf,this.stmf,e,t,this.encryptionKey));var i=r(e,t,this.encryptionKey,!1),a=function(){return new o(i)};return new x(a,a)}}]),c}()}();t.CipherTransformFactory=w},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.DecryptStream=void 0;var a=i(144),n=function(e){d(i,e);var t=u(i);function i(e,a,n){var r;return b(this,i),(r=t.call(this,a)).str=e,r.dict=e.dict,r.decrypt=n,r.nextChunk=null,r.initialized=!1,r}return g(i,[{key:"readBlock",value:function(){var e;if(this.initialized?e=this.nextChunk:(e=this.str.getBytes(512),this.initialized=!0),e&&0!==e.length){this.nextChunk=this.str.getBytes(512);var t=this.nextChunk&&this.nextChunk.length>0;e=(0,this.decrypt)(e,!t);for(var i=this.bufferLength,a=e.length,n=this.ensureBuffer(i+a),r=0;r<a;r++)n[i++]=e[r];this.bufferLength=i}else this.eof=!0}}]),i}(a.DecodeStream);t.DecryptStream=n},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.Catalog=void 0;var a=i(131),n=i(2),r=i(130),o=i(195),s=i(132),l=i(196),d=i(139),u=i(197),m=i(184),v=i(198),_=i(199);function A(e){return e instanceof r.Dict&&(e=e.get("D")),Array.isArray(e)?e:null}var x=function(){function e(t,i){if(b(this,e),this.pdfManager=t,this.xref=i,this._catDict=i.getCatalogObj(),!(this._catDict instanceof r.Dict))throw new n.FormatError("Catalog object is not a dictionary.");this.toplevelPagesDict,this._actualNumPages=null,this.fontCache=new r.RefSetCache,this.builtInCMapCache=new Map,this.standardFontDataCache=new Map,this.globalImageCache=new m.GlobalImageCache,this.pageKidsCountCache=new r.RefSetCache,this.pageIndexCache=new r.RefSetCache,this.nonBlendModesSet=new r.RefSet}return g(e,[{key:"version",get:function(){var e=this._catDict.get("Version");return(0,n.shadow)(this,"version",e instanceof r.Name?e.name:null)}},{key:"lang",get:function(){var e=this._catDict.get("Lang");return(0,n.shadow)(this,"lang","string"===typeof e?(0,n.stringToPDFString)(e):null)}},{key:"needsRendering",get:function(){var e=this._catDict.get("NeedsRendering");return(0,n.shadow)(this,"needsRendering","boolean"===typeof e&&e)}},{key:"collection",get:function(){var e=null;try{var t=this._catDict.get("Collection");t instanceof r.Dict&&t.size>0&&(e=t)}catch(i){if(i instanceof a.MissingDataException)throw i;(0,n.info)("Cannot fetch Collection entry; assuming no collection is present.")}return(0,n.shadow)(this,"collection",e)}},{key:"acroForm",get:function(){var e=null;try{var t=this._catDict.get("AcroForm");t instanceof r.Dict&&t.size>0&&(e=t)}catch(i){if(i instanceof a.MissingDataException)throw i;(0,n.info)("Cannot fetch AcroForm entry; assuming no forms are present.")}return(0,n.shadow)(this,"acroForm",e)}},{key:"acroFormRef",get:function(){var e=this._catDict.getRaw("AcroForm");return(0,n.shadow)(this,"acroFormRef",e instanceof r.Ref?e:null)}},{key:"metadata",get:function(){var e=this._catDict.getRaw("Metadata");if(!(e instanceof r.Ref))return(0,n.shadow)(this,"metadata",null);var t=null;try{var i=!(this.xref.encrypt&&this.xref.encrypt.encryptMetadata),o=this.xref.fetch(e,i);if(o instanceof s.BaseStream&&o.dict instanceof r.Dict){var l=o.dict.get("Type"),c=o.dict.get("Subtype");if((0,r.isName)(l,"Metadata")&&(0,r.isName)(c,"XML")){var d=(0,n.stringToUTF8String)(o.getString());d&&(t=new v.MetadataParser(d).serializable)}}}catch(u){if(u instanceof a.MissingDataException)throw u;(0,n.info)('Skipping invalid Metadata: "'.concat(u,'".'))}return(0,n.shadow)(this,"metadata",t)}},{key:"markInfo",get:function(){var e=null;try{e=this._readMarkInfo()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable to read mark info.")}return(0,n.shadow)(this,"markInfo",e)}},{key:"_readMarkInfo",value:function(){var e=this._catDict.get("MarkInfo");if(!(e instanceof r.Dict))return null;var t={Marked:!1,UserProperties:!1,Suspects:!1};for(var i in t){var a=e.get(i);"boolean"===typeof a&&(t[i]=a)}return t}},{key:"structTreeRoot",get:function(){var e=null;try{e=this._readStructTreeRoot()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable read to structTreeRoot info.")}return(0,n.shadow)(this,"structTreeRoot",e)}},{key:"_readStructTreeRoot",value:function(){var e=this._catDict.get("StructTreeRoot");if(!(e instanceof r.Dict))return null;var t=new _.StructTreeRoot(e);return t.init(),t}},{key:"toplevelPagesDict",get:function(){var e=this._catDict.get("Pages");if(!(e instanceof r.Dict))throw new n.FormatError("Invalid top-level pages dictionary.");return(0,n.shadow)(this,"toplevelPagesDict",e)}},{key:"documentOutline",get:function(){var e=null;try{e=this._readDocumentOutline()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable to read document outline.")}return(0,n.shadow)(this,"documentOutline",e)}},{key:"_readDocumentOutline",value:function(){var t=this._catDict.get("Outlines");if(!(t instanceof r.Dict))return null;if(!((t=t.getRaw("First"))instanceof r.Ref))return null;var i={items:[]},a=[{obj:t,parent:i}],o=new r.RefSet;o.put(t);for(var s=this.xref,l=new Uint8ClampedArray(3);a.length>0;){var c=a.shift(),u=s.fetchIfRef(c.obj);if(null!==u){if(!u.has("Title"))throw new n.FormatError("Invalid outline item encountered.");var p={url:null,dest:null};e.parseDestDictionary({destDict:u,resultObj:p,docBaseUrl:this.pdfManager.docBaseUrl});var m=u.get("Title"),h=u.get("F")||0,f=u.getArray("C"),y=u.get("Count"),b=l;!Array.isArray(f)||3!==f.length||0===f[0]&&0===f[1]&&0===f[2]||(b=d.ColorSpace.singletons.rgb.getRgb(f,0));var g={dest:p.dest,url:p.url,unsafeUrl:p.unsafeUrl,newWindow:p.newWindow,title:(0,n.stringToPDFString)(m),color:b,count:Number.isInteger(y)?y:void 0,bold:!!(2&h),italic:!!(1&h),items:[]};c.parent.items.push(g),(t=u.getRaw("First"))instanceof r.Ref&&!o.has(t)&&(a.push({obj:t,parent:g}),o.put(t)),(t=u.getRaw("Next"))instanceof r.Ref&&!o.has(t)&&(a.push({obj:t,parent:c.parent}),o.put(t))}}return i.items.length>0?i.items:null}},{key:"permissions",get:function(){var e=null;try{e=this._readPermissions()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable to read permissions.")}return(0,n.shadow)(this,"permissions",e)}},{key:"_readPermissions",value:function(){var e=this.xref.trailer.get("Encrypt");if(!(e instanceof r.Dict))return null;var t=e.get("P");if("number"!==typeof t)return null;t+=Math.pow(2,32);var i=[];for(var a in n.PermissionFlag){var o=n.PermissionFlag[a];t&o&&i.push(o)}return i}},{key:"optionalContentConfig",get:function(){var e=null;try{var t=this._catDict.get("OCProperties");if(!t)return(0,n.shadow)(this,"optionalContentConfig",null);var i=t.get("D");if(!i)return(0,n.shadow)(this,"optionalContentConfig",null);var o=t.get("OCGs");if(!Array.isArray(o))return(0,n.shadow)(this,"optionalContentConfig",null);var s,l=[],c=[],d=h(o);try{for(d.s();!(s=d.n()).done;){var u=s.value;if(u instanceof r.Ref){c.push(u);var p=this.xref.fetchIfRef(u);l.push({id:u.toString(),name:"string"===typeof p.get("Name")?(0,n.stringToPDFString)(p.get("Name")):null,intent:"string"===typeof p.get("Intent")?(0,n.stringToPDFString)(p.get("Intent")):null})}}}catch(m){d.e(m)}finally{d.f()}(e=this._readOptionalContentConfig(i,c)).groups=l}catch(f){if(f instanceof a.MissingDataException)throw f;(0,n.warn)("Unable to read optional content config: ".concat(f))}return(0,n.shadow)(this,"optionalContentConfig",e)}},{key:"_readOptionalContentConfig",value:function(e,t){function i(e){var i=[];if(Array.isArray(e)){var a,n=h(e);try{for(n.s();!(a=n.n()).done;){var o=a.value;o instanceof r.Ref&&t.includes(o)&&i.push(o.toString())}}catch(s){n.e(s)}finally{n.f()}}return i}function a(e){var i=arguments.length>1&&void 0!==arguments[1]?arguments[1]:0;if(!Array.isArray(e))return null;var a,n=[],s=h(e);try{for(s.s();!(a=s.n()).done;){var c=a.value;if(c instanceof r.Ref&&t.includes(c))l.put(c),n.push(c.toString());else{var d=o(c,i);d&&n.push(d)}}}catch(y){s.e(y)}finally{s.f()}if(i>0)return n;var u,p=[],m=h(t);try{for(m.s();!(u=m.n()).done;){var f=u.value;l.has(f)||p.push(f.toString())}}catch(y){m.e(y)}finally{m.f()}return p.length&&n.push({name:null,order:p}),n}function o(e,t){if(++t>c)return(0,n.warn)("parseNestedOrder - reached MAX_NESTED_LEVELS."),null;var i=s.fetchIfRef(e);if(!Array.isArray(i))return null;var r=s.fetchIfRef(i[0]);if("string"!==typeof r)return null;var o=a(i.slice(1),t);return o&&o.length?{name:(0,n.stringToPDFString)(r),order:o}:null}var s=this.xref,l=new r.RefSet,c=10;return{name:"string"===typeof e.get("Name")?(0,n.stringToPDFString)(e.get("Name")):null,creator:"string"===typeof e.get("Creator")?(0,n.stringToPDFString)(e.get("Creator")):null,baseState:e.get("BaseState")instanceof r.Name?e.get("BaseState").name:null,on:i(e.get("ON")),off:i(e.get("OFF")),order:a(e.get("Order")),groups:null}}},{key:"setActualNumPages",value:function(){var e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:null;this._actualNumPages=e}},{key:"hasActualNumPages",get:function(){return null!==this._actualNumPages}},{key:"_pagesCount",get:function(){var e=this.toplevelPagesDict.get("Count");if(!Number.isInteger(e))throw new n.FormatError("Page count in top-level pages dictionary is not an integer.");return(0,n.shadow)(this,"_pagesCount",e)}},{key:"numPages",get:function(){return this.hasActualNumPages?this._actualNumPages:this._pagesCount}},{key:"destinations",get:function(){var e=this._readDests(),t=Object.create(null);if(e instanceof o.NameTree){var i,a=h(e.getAll());try{for(a.s();!(i=a.n()).done;){var s=f(i.value,2),l=s[0],c=A(s[1]);c&&(t[(0,n.stringToPDFString)(l)]=c)}}catch(d){a.e(d)}finally{a.f()}}else e instanceof r.Dict&&e.forEach((function(e,i){var a=A(i);a&&(t[e]=a)}));return(0,n.shadow)(this,"destinations",t)}},{key:"getDestination",value:function(e){var t=this._readDests();if(t instanceof o.NameTree){var i=A(t.get(e));if(i)return i;var a=this.destinations[e];if(a)return(0,n.warn)('Found "'.concat(e,'" at an incorrect position in the NameTree.')),a}else if(t instanceof r.Dict){var s=A(t.get(e));if(s)return s}return null}},{key:"_readDests",value:function(){var e=this._catDict.get("Names");return e&&e.has("Dests")?new o.NameTree(e.getRaw("Dests"),this.xref):this._catDict.has("Dests")?this._catDict.get("Dests"):void 0}},{key:"pageLabels",get:function(){var e=null;try{e=this._readPageLabels()}catch(t){if(t instanceof a.MissingDataException)throw t;(0,n.warn)("Unable to read page labels.")}return(0,n.shadow)(this,"pageLabels",e)}},{key:"_readPageLabels",value:function(){var e=this._catDict.getRaw("PageLabels");if(!e)return null;for(var t=new Array(this.numPages),i=null,s="",l=new o.NumberTree(e,this.xref).getAll(),c="",d=1,u=0,p=this.numPages;u<p;u++){var m=l.get(u);if(void 0!==m){if(!(m instanceof r.Dict))throw new n.FormatError("PageLabel is not a dictionary.");if(m.has("Type")&&!(0,r.isName)(m.get("Type"),"PageLabel"))throw new n.FormatError("Invalid type in PageLabel dictionary.");if(m.has("S")){var h=m.get("S");if(!(h instanceof r.Name))throw new n.FormatError("Invalid style in PageLabel dictionary.");i=h.name}else i=null;if(m.has("P")){var f=m.get("P");if("string"!==typeof f)throw new n.FormatError("Invalid prefix in PageLabel dictionary.");s=(0,n.stringToPDFString)(f)}else s="";if(m.has("St")){var y=m.get("St");if(!(Number.isInteger(y)&&y>=1))throw new n.FormatError("Invalid start in PageLabel dictionary.");d=y}else d=1}switch(i){case"D":c=d;break;case"R":case"r":c=(0,a.toRomanNumerals)(d,"r"===i);break;case"A":case"a":var b="a"===i?97:65,g=d-1;c=String.fromCharCode(b+g%26).repeat(Math.floor(g/26)+1);break;default:if(i)throw new n.FormatError('Invalid style "'.concat(i,'" in PageLabel dictionary.'));c=""}t[u]=s+c,d++}return t}},{key:"pageLayout",get:function(){var e=this._catDict.get("PageLayout"),t="";if(e instanceof r.Name)switch(e.name){case"SinglePage":case"OneColumn":case"TwoColumnLeft":case"TwoColumnRight":case"TwoPageLeft":case"TwoPageRight":t=e.name}return(0,n.shadow)(this,"pageLayout",t)}},{key:"pageMode",get:function(){var e=this._catDict.get("PageMode"),t="UseNone";if(e instanceof r.Name)switch(e.name){case"UseNone":case"UseOutlines":case"UseThumbs":case"FullScreen":case"UseOC":case"UseAttachments":t=e.name}return(0,n.shadow)(this,"pageMode",t)}},{key:"viewerPreferences",get:function(){var e=this,t=this._catDict.get("ViewerPreferences");if(!(t instanceof r.Dict))return(0,n.shadow)(this,"viewerPreferences",null);var i,a=null,o=h(t.getKeys());try{for(o.s();!(i=o.n()).done;){var s=i.value,l=t.get(s),c=void 0;switch(s){case"HideToolbar":case"HideMenubar":case"HideWindowUI":case"FitWindow":case"CenterWindow":case"DisplayDocTitle":case"PickTrayByPDFSize":"boolean"===typeof l&&(c=l);break;case"NonFullScreenPageMode":if(l instanceof r.Name)switch(l.name){case"UseNone":case"UseOutlines":case"UseThumbs":case"UseOC":c=l.name;break;default:c="UseNone"}break;case"Direction":if(l instanceof r.Name)switch(l.name){case"L2R":case"R2L":c=l.name;break;default:c="L2R"}break;case"ViewArea":case"ViewClip":case"PrintArea":case"PrintClip":if(l instanceof r.Name)switch(l.name){case"MediaBox":case"CropBox":case"BleedBox":case"TrimBox":case"ArtBox":c=l.name;break;default:c="CropBox"}break;case"PrintScaling":if(l instanceof r.Name)switch(l.name){case"None":case"AppDefault":c=l.name;break;default:c="AppDefault"}break;case"Duplex":if(l instanceof r.Name)switch(l.name){case"Simplex":case"DuplexFlipShortEdge":case"DuplexFlipLongEdge":c=l.name;break;default:c="None"}break;case"PrintPageRange":Array.isArray(l)&&l.length%2===0&&l.every((function(t,i,a){return Number.isInteger(t)&&t>0&&(0===i||t>=a[i-1])&&t<=e.numPages}))&&(c=l);break;case"NumCopies":Number.isInteger(l)&&l>0&&(c=l);break;default:(0,n.warn)("Ignoring non-standard key in ViewerPreferences: ".concat(s,"."));continue}void 0!==c?(a||(a=Object.create(null)),a[s]=c):(0,n.warn)('Bad value, for key "'.concat(s,'", in ViewerPreferences: ').concat(l,"."))}}catch(d){o.e(d)}finally{o.f()}return(0,n.shadow)(this,"viewerPreferences",a)}},{key:"openAction",get:function(){var t=this._catDict.get("OpenAction"),i=Object.create(null);if(t instanceof r.Dict){var a=new r.Dict(this.xref);a.set("A",t);var o={url:null,dest:null,action:null};e.parseDestDictionary({destDict:a,resultObj:o}),Array.isArray(o.dest)?i.dest=o.dest:o.action&&(i.action=o.action)}else Array.isArray(t)&&(i.dest=t);return(0,n.shadow)(this,"openAction",(0,n.objectSize)(i)>0?i:null)}},{key:"attachments",get:function(){var e=this._catDict.get("Names"),t=null;if(e instanceof r.Dict&&e.has("EmbeddedFiles")){var i,a=new o.NameTree(e.getRaw("EmbeddedFiles"),this.xref),s=h(a.getAll());try{for(s.s();!(i=s.n()).done;){var l=f(i.value,2),c=l[0],d=l[1],p=new u.FileSpec(d,this.xref);t||(t=Object.create(null)),t[(0,n.stringToPDFString)(c)]=p.serializable}}catch(m){s.e(m)}finally{s.f()}}return(0,n.shadow)(this,"attachments",t)}},{key:"xfaImages",get:function(){var e=this._catDict.get("Names"),t=null;if(e instanceof r.Dict&&e.has("XFAImages")){var i,a=new o.NameTree(e.getRaw("XFAImages"),this.xref),s=h(a.getAll());try{for(s.s();!(i=s.n()).done;){var l=f(i.value,2),c=l[0],d=l[1];t||(t=new r.Dict(this.xref)),t.set((0,n.stringToPDFString)(c),d)}}catch(u){s.e(u)}finally{s.f()}}return(0,n.shadow)(this,"xfaImages",t)}},{key:"_collectJavaScript",value:function(){var e=this._catDict.get("Names"),t=null;function i(e,i){if(i instanceof r.Dict&&(0,r.isName)(i.get("S"),"JavaScript")){var a=i.get("JS");if(a instanceof s.BaseStream)a=a.getString();else if("string"!==typeof a)return;null===t&&(t=new Map),a=(0,n.stringToPDFString)(a).replace(/\u0000/g,""),t.set(e,a)}}if(e instanceof r.Dict&&e.has("JavaScript")){var a,l=new o.NameTree(e.getRaw("JavaScript"),this.xref),c=h(l.getAll());try{for(c.s();!(a=c.n()).done;){var d=f(a.value,2),u=d[0],p=d[1];i((0,n.stringToPDFString)(u),p)}}catch(y){c.e(y)}finally{c.f()}}var m=this._catDict.get("OpenAction");return m&&i("OpenAction",m),t}},{key:"javaScript",get:function(){var 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e.stop()}}),e,this)})));return function(t){return e.apply(this,arguments)}}()},{key:"getAllPageDicts",value:function(){var e=y(p().mark((function e(){var t,i,o,s,l,c,d,u,m,h,f,y,b,g,v,_,A,x=arguments;return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:h=function(e){if(e instanceof a.XRefEntryException&&!t)throw e;l.set(u++,[e,null])},m=function(e,t){t&&!d.has(t)&&d.put(t,u),l.set(u++,[e,t])},t=x.length>0&&void 0!==x[0]&&x[0],i=[{currentNode:this.toplevelPagesDict,posInKids:0}],o=new r.RefSet,(s=this._catDict.getRaw("Pages"))instanceof r.Ref&&o.put(s),l=new Map,c=this.xref,d=this.pageIndexCache,u=0;case 9:if(!(i.length>0)){e.next=69;break}if(f=i.at(-1),y=f.currentNode,b=f.posInKids,!((g=y.getRaw("Kids"))instanceof r.Ref)){e.next=24;break}return e.prev=14,e.next=17,c.fetchAsync(g);case 17:g=e.sent,e.next=24;break;case 20:return e.prev=20,e.t0=e.catch(14),h(e.t0),e.abrupt("break",69);case 24:if(Array.isArray(g)){e.next=27;break}return h(new n.FormatError("Page dictionary kids 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null;for(var s=[],l=!1,c=0,d=e.length;c<d;c++){var u=e[c];if(!(u instanceof r.Ref))throw new n.FormatError("Kid must be a reference.");if((0,r.isRefsEqual)(u,t)){l=!0;break}s.push(a.fetchAsync(u).then((function(e){if(!(e instanceof r.Dict))throw new n.FormatError("Kid node must be a dictionary.");e.has("Count")?o+=e.get("Count"):o++})))}if(!l)throw new n.FormatError("Kid reference not found in parent's kids.");return Promise.all(s).then((function(){return[o,i]}))}))}(s).then((function(a){if(!a)return t.pageIndexCache.put(e,o),o;var n=f(a,2),r=n[0],s=n[1];return o+=r,i(s)}))}(e)}},{key:"baseUrl",get:function(){var e=this._catDict.get("URI");if(e instanceof r.Dict){var t=e.get("Base");if("string"===typeof t){var i=(0,n.createValidAbsoluteUrl)(t,null,{tryConvertEncoding:!0});if(i)return(0,n.shadow)(this,"baseUrl",i.href)}}return(0,n.shadow)(this,"baseUrl",null)}}],[{key:"parseDestDictionary",value:function(e){var t=e.destDict;if(t instanceof r.Dict){var i=e.resultObj;if("object"===typeof 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w=o.split("#")[0];"string"===typeof x?o=w+"#"+x:Array.isArray(x)&&(o=w+"#"+JSON.stringify(x))}var S=d.get("NewWindow");"boolean"===typeof S&&(i.newWindow=S);break;case"Named":var C=d.get("N");C instanceof r.Name&&(i.action=C.name);break;case"JavaScript":var k,D=d.get("JS");D instanceof s.BaseStream?k=D.getString():"string"===typeof D&&(k=D);var R=k&&(0,a.recoverJsURL)((0,n.stringToPDFString)(k));if(R){o=R.url,i.newWindow=R.newWindow;break}default:if("JavaScript"===p||"SubmitForm"===p)break;(0,n.warn)('parseDestDictionary - unsupported action: "'.concat(p,'".'))}}else t.has("Dest")&&(l=t.get("Dest"));if("string"===typeof o){var I=(0,n.createValidAbsoluteUrl)(o,c,{addDefaultProtocol:!0,tryConvertEncoding:!0});I&&(i.url=I.href),i.unsafeUrl=o}l&&(l instanceof r.Name&&(l=l.name),"string"===typeof l?i.dest=(0,n.stringToPDFString)(l):Array.isArray(l)&&(i.dest=l))}else(0,n.warn)("parseDestDictionary: `resultObj` must be an object.")}else(0,n.warn)("parseDestDictionary: `destDict` must be a 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null;for(var t=this.xref,i=t.fetchIfRef(this.root),a=0;i.has("Kids");){if(++a>10)return(0,n.warn)('Search depth limit reached for "'.concat(this._type,'" tree.')),null;var r=i.get("Kids");if(!Array.isArray(r))return null;for(var o=0,s=r.length-1;o<=s;){var l=o+s>>1,c=t.fetchIfRef(r[l]),d=c.get("Limits");if(e<t.fetchIfRef(d[0]))s=l-1;else{if(!(e>t.fetchIfRef(d[1]))){i=c;break}o=l+1}}if(o>s)return null}var u=i.get(this._type);if(Array.isArray(u))for(var p=0,m=u.length-2;p<=m;){var h=p+m>>1,f=h+(1&h),y=t.fetchIfRef(u[f]);if(e<y)m=f-2;else{if(!(e>y))return t.fetchIfRef(u[f+1]);p=f+2}}return null}}]),e}(),o=function(e){d(i,e);var t=u(i);function i(e,a){return b(this,i),t.call(this,e,a,"Names")}return g(i)}(r);t.NameTree=o;var s=function(e){d(i,e);var t=u(i);function i(e,a){return b(this,i),t.call(this,e,a,"Nums")}return g(i)}(r);t.NumberTree=s},function(e,t,i){"use 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e=o(this.root)||"unnamed";this._filename=(0,a.stringToPDFString)(e).replace(/\\\\/g,"\\").replace(/\\\//g,"/").replace(/\\/g,"/")}return this._filename}},{key:"content",get:function(){if(!this.contentAvailable)return null;!this.contentRef&&this.root&&(this.contentRef=o(this.root.get("EF")));var e=null;if(this.contentRef){var t=this.xref.fetchIfRef(this.contentRef);t instanceof n.BaseStream?e=t.getBytes():(0,a.warn)("Embedded file specification points to non-existing/invalid content")}else(0,a.warn)("Embedded file specification does not have a content");return e}},{key:"serializable",get:function(){return{filename:this.filename,content:this.content}}}]),e}();t.FileSpec=s},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.MetadataParser=void 0;var a=i(191),n=function(){function e(t){b(this,e),t=this._repair(t);var i=new a.SimpleXMLParser({lowerCaseName:!0}).parseFromString(t);this._metadataMap=new Map,this._data=t,i&&this._parse(i)}return 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t=f(e.childNodes,1)[0],i=this._getSequence(t)||[];this._metadataMap.set(e.nodeName,i.map((function(e){return e.textContent.trim()})))}}},{key:"_parse",value:function(e){var t=e.documentElement;if("rdf:rdf"!==t.nodeName)for(t=t.firstChild;t&&"rdf:rdf"!==t.nodeName;)t=t.nextSibling;if(t&&"rdf:rdf"===t.nodeName&&t.hasChildNodes()){var i,a=h(t.childNodes);try{for(a.s();!(i=a.n()).done;){var n=i.value;if("rdf:description"===n.nodeName){var r,o=h(n.childNodes);try{for(o.s();!(r=o.n()).done;){var s=r.value,l=s.nodeName;switch(l){case"#text":continue;case"dc:creator":case"dc:subject":this._parseArray(s);continue}this._metadataMap.set(l,s.textContent.trim())}}catch(c){o.e(c)}finally{o.f()}}}}catch(c){a.e(c)}finally{a.f()}}}},{key:"serializable",get:function(){return{parsedData:this._metadataMap,rawData:this._data}}}]),e}();t.MetadataParser=n},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.StructTreeRoot=t.StructTreePage=void 0;var 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S.padding,"div"===i.name&&(i.name="span"),B.children.push(i),m.HTMLResult.success(I,T);switch(this.ui.checkButton&&(i.attributes.class[0]="xfaCaptionForCheckButton"),B.attributes.class||(B.attributes.class=[]),B.children.splice(0,0,i),this.caption.placement){case"left":case"inline":B.attributes.class.push("xfaLeft");break;case"right":B.attributes.class.push("xfaRight");break;case"top":B.attributes.class.push("xfaTop");break;case"bottom":B.attributes.class.push("xfaBottom")}return this.w=a,this.h=r,m.HTMLResult.success((0,c.createWrapper)(this,I),T)}}]),o}(n.XFAObject,n.$isBindable,n.$setValue,n.$toHTML);t.Field=Be;var Fe=function(e,t){d(a,e);var i=u(a);function a(e){var t;return b(this,a),(t=i.call(this,x,"fill",!0)).id=e.id||"",t.presence=(0,m.getStringOption)(e.presence,["visible","hidden","inactive","invisible"]),t.use=e.use||"",t.usehref=e.usehref||"",t.color=null,t.extras=null,t.linear=null,t.pattern=null,t.radial=null,t.solid=null,t.stipple=null,t}return 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t=u(i);function i(e){return b(this,i),t.call(this,e,"li")}return g(i)}(S),P=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"ol")}return g(i)}(S),z=function(e,t,i){d(s,e);var n=u(s);function s(e){return b(this,s),n.call(this,e,"p")}return g(s,[{key:t,value:function(e){r(o(s.prototype),a.$pushGlyphs,this).call(this,e,!1),e.addString("\n"),e.addPara(),e.popFont()}},{key:i,value:function(){return this[a.$getParent]()[a.$getChildren]().at(-1)===this?r(o(s.prototype),a.$text,this).call(this):r(o(s.prototype),a.$text,this).call(this)+"\n"}}]),s}(S,a.$pushGlyphs,a.$text),B=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"span")}return g(i)}(S),F=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"sub")}return g(i)}(S),E=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"sup")}return g(i)}(S),N=function(e){d(i,e);var t=u(i);function i(e){return b(this,i),t.call(this,e,"ul")}return 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g(e,[{key:"getValue",value:function(e){if(!this.node||!e)return"";var t=this.node.searchNode((0,n.parseXFAPath)(e),0);if(!t)return"";var i=t.firstChild;return i&&"value"===i.nodeName?t.children.map((function(e){return l(e.textContent)})):l(t.textContent)}}]),e}();t.DatasetReader=p},function(e,t,i){"use strict";Object.defineProperty(t,"__esModule",{value:!0}),t.XRef=void 0;var a=i(2),n=i(130),r=i(131),o=i(142),s=i(132),l=i(192),c=function(){function e(t,i){b(this,e),this.stream=t,this.pdfManager=i,this.entries=[],this.xrefstms=Object.create(null),this._cacheMap=new Map,this._pendingRefs=new n.RefSet,this.stats=new r.DocStats(i.msgHandler),this._newRefNum=null}return g(e,[{key:"getNewRef",value:function(){return null===this._newRefNum&&(this._newRefNum=this.entries.length||1),n.Ref.get(this._newRefNum++,0)}},{key:"resetNewRef",value:function(){this._newRefNum=null}},{key:"setStartXRef",value:function(e){this.startXRefQueue=[e]}},{key:"parse",value:function(){var e,t,i,o=arguments.length>0&&void 0!==arguments[0]&&arguments[0];o?((0,a.warn)("Indexing all PDF objects"),e=this.indexObjects()):e=this.readXRef(),e.assignXref(this),this.trailer=e;try{t=e.get("Encrypt")}catch(d){if(d instanceof r.MissingDataException)throw d;(0,a.warn)('XRef.parse - Invalid "Encrypt" reference: "'.concat(d,'".'))}if(t instanceof n.Dict){var s=e.get("ID"),c=s&&s.length?s[0]:"";t.suppressEncryption=!0,this.encrypt=new l.CipherTransformFactory(t,c,this.pdfManager.password)}try{i=e.get("Root")}catch(d){if(d instanceof r.MissingDataException)throw d;(0,a.warn)('XRef.parse - Invalid "Root" reference: "'.concat(d,'".'))}if(i instanceof n.Dict)try{if(i.get("Pages")instanceof n.Dict)return void(this.root=i)}catch(d){if(d instanceof r.MissingDataException)throw d;(0,a.warn)('XRef.parse - Invalid "Pages" reference: "'.concat(d,'".'))}if(!o)throw new r.XRefParseException;throw new a.InvalidPDFException("Invalid Root reference.")}},{key:"processXRefTable",value:function(e){"tableState"in this||(this.tableState={entryNum:0,streamPos:e.lexer.stream.pos,parserBuf1:e.buf1,parserBuf2:e.buf2});var t=this.readXRefTable(e);if(!(0,n.isCmd)(t,"trailer"))throw new a.FormatError("Invalid XRef table: could not find trailer dictionary");var i=e.getObj();if(i instanceof n.Dict||!i.dict||(i=i.dict),!(i instanceof n.Dict))throw new a.FormatError("Invalid XRef table: could not parse trailer dictionary");return delete this.tableState,i}},{key:"readXRefTable",value:function(e){var t,i=e.lexer.stream,r=this.tableState;for(i.pos=r.streamPos,e.buf1=r.parserBuf1,e.buf2=r.parserBuf2;;){if(!("firstEntryNum"in r)||!("entryCount"in r)){if((0,n.isCmd)(t=e.getObj(),"trailer"))break;r.firstEntryNum=t,r.entryCount=e.getObj()}var o=r.firstEntryNum,s=r.entryCount;if(!Number.isInteger(o)||!Number.isInteger(s))throw new a.FormatError("Invalid XRef table: wrong types in subsection header");for(var l=r.entryNum;l<s;l++){r.streamPos=i.pos,r.entryNum=l,r.parserBuf1=e.buf1,r.parserBuf2=e.buf2;var c={};c.offset=e.getObj(),c.gen=e.getObj();var d=e.getObj();if(d instanceof n.Cmd)switch(d.cmd){case"f":c.free=!0;break;case"n":c.uncompressed=!0}if(!Number.isInteger(c.offset)||!Number.isInteger(c.gen)||!c.free&&!c.uncompressed)throw new a.FormatError("Invalid entry in XRef subsection: ".concat(o,", ").concat(s));0===l&&c.free&&1===o&&(o=0),this.entries[l+o]||(this.entries[l+o]=c)}r.entryNum=0,r.streamPos=i.pos,r.parserBuf1=e.buf1,r.parserBuf2=e.buf2,delete r.firstEntryNum,delete r.entryCount}if(this.entries[0]&&!this.entries[0].free)throw new a.FormatError("Invalid XRef table: unexpected first object");return t}},{key:"processXRefStream",value:function(e){if(!("streamState"in this)){var t=e.dict,i=t.get("W"),a=t.get("Index");a||(a=[0,t.get("Size")]),this.streamState={entryRanges:a,byteWidths:i,entryNum:0,streamPos:e.pos}}return this.readXRefStream(e),delete this.streamState,e.dict}},{key:"readXRefStream",value:function(e){var t=this.streamState;e.pos=t.streamPos;for(var i=f(t.byteWidths,3),n=i[0],r=i[1],o=i[2],s=t.entryRanges;s.length>0;){var l=f(s,2),c=l[0],d=l[1];if(!Number.isInteger(c)||!Number.isInteger(d))throw new a.FormatError("Invalid XRef range fields: ".concat(c,", ").concat(d));if(!Number.isInteger(n)||!Number.isInteger(r)||!Number.isInteger(o))throw new a.FormatError("Invalid XRef entry fields length: ".concat(c,", ").concat(d));for(var u=t.entryNum;u<d;++u){t.entryNum=u,t.streamPos=e.pos;for(var p=0,m=0,h=0,y=0;y<n;++y){var b=e.getByte();if(-1===b)throw new a.FormatError("Invalid XRef byteWidths 'type'.");p=p<<8|b}0===n&&(p=1);for(var g=0;g<r;++g){var v=e.getByte();if(-1===v)throw new a.FormatError("Invalid XRef byteWidths 'offset'.");m=m<<8|v}for(var _=0;_<o;++_){var A=e.getByte();if(-1===A)throw new a.FormatError("Invalid XRef byteWidths 'generation'.");h=h<<8|A}var x={};switch(x.offset=m,x.gen=h,p){case 0:x.free=!0;break;case 1:x.uncompressed=!0;break;case 2:break;default:throw new a.FormatError("Invalid XRef entry type: ".concat(p))}this.entries[c+u]||(this.entries[c+u]=x)}t.entryNum=0,t.streamPos=e.pos,s.splice(0,2)}}},{key:"indexObjects",value:function(){var e=10,t=13,i=60;function s(a,n){for(var r="",o=a[n];o!==e&&o!==t&&o!==i&&!(++n>=a.length);)r+=String.fromCharCode(o),o=a[n];return r}function l(e,t,i){for(var a=i.length,n=e.length,r=0;t<n;){for(var o=0;o<a&&e[t+o]===i[o];)++o;if(o>=a)break;t++,r++}return r}var c=/^(\d+)\s+(\d+)\s+obj\b/,d=/\bendobj[\b\s]$/,u=/\s+(\d+\s+\d+\s+obj[\b\s<])$/,p=new Uint8Array([116,114,97,105,108,101,114]),m=new Uint8Array([115,116,97,114,116,120,114,101,102]),h=new Uint8Array([111,98,106]),f=new Uint8Array([47,88,82,101,102]);this.entries.length=0,this._cacheMap.clear();var y=this.stream;y.pos=0;for(var b,g=y.getBytes(),v=g.length,_=y.start,A=[],x=[];_<v;){var w=g[_];if(9!==w&&w!==e&&w!==t&&32!==w)if(37!==w){var S=s(g,_),C=void 0;if(S.startsWith("xref")&&(4===S.length||/\s/.test(S[4])))_+=l(g,_,p),A.push(_),_+=l(g,_,m);else if(C=c.exec(S)){var k=0|C[1],D=0|C[2],R=void 0,I=_+S.length,M=!1;if(this.entries[k]){if(this.entries[k].gen===D)try{new o.Parser({lexer:new o.Lexer(y.makeSubStream(I))}).getObj(),M=!0}catch(V){V instanceof r.ParserEOFException?(0,a.warn)("indexObjects -- checking object (".concat(S,'): "').concat(V,'".')):M=!0}}else M=!0;for(M&&(this.entries[k]={offset:_-y.start,gen:D,uncompressed:!0});I<g.length;){var T=I+l(g,I,h)+4;R=T-_;var P=Math.max(T-25,I),z=(0,a.bytesToString)(g.subarray(P,T));if(d.test(z))break;var B=u.exec(z);if(B&&B[1]){(0,a.warn)('indexObjects: Found new "obj" inside of another "obj", caused by missing "endobj" -- trying to recover.'),R-=B[1].length;break}I=T}var F=g.subarray(_,_+R),E=l(F,0,f);E<R&&F[E+5]<64&&(x.push(_-y.start),this.xrefstms[_-y.start]=1),_+=R}else S.startsWith("trailer")&&(7===S.length||/\s/.test(S[7]))?(A.push(_),_+=l(g,_,m)):_+=S.length+1}else do{if(++_>=v)break;w=g[_]}while(w!==e&&w!==t);else++_}for(var N=0,O=x.length;N<O;++N)this.startXRefQueue.push(x[N]),this.readXRef(!0);for(var G=0,L=A.length;G<L;++G){y.pos=A[G];var j=new o.Parser({lexer:new o.Lexer(y),xref:this,allowStreams:!0,recoveryMode:!0}),q=j.getObj();if((0,n.isCmd)(q,"trailer")){var H=j.getObj();if(H instanceof n.Dict){try{var U=H.get("Root");if(!(U instanceof n.Dict))continue;var Y=U.get("Pages");if(!(Y instanceof n.Dict))continue;var X=Y.get("Count");if(!Number.isInteger(X))continue}catch(V){continue}if(H.has("ID"))return H;b=H}}}if(b)return b;if(this.topDict)return this.topDict;throw new a.InvalidPDFException("Invalid PDF structure.")}},{key:"readXRef",value:function(){var e=arguments.length>0&&void 0!==arguments[0]&&arguments[0],t=this.stream,i=new Set;try{for(;this.startXRefQueue.length;){var l=this.startXRefQueue[0];if(i.has(l))(0,a.warn)("readXRef - skipping XRef table since it was already parsed."),this.startXRefQueue.shift();else{i.add(l),t.pos=l+t.start;var c=new o.Parser({lexer:new o.Lexer(t),xref:this,allowStreams:!0}),d=c.getObj(),u=void 0;if((0,n.isCmd)(d,"xref")){if(u=this.processXRefTable(c),this.topDict||(this.topDict=u),d=u.get("XRefStm"),Number.isInteger(d)){var p=d;p in this.xrefstms||(this.xrefstms[p]=1,this.startXRefQueue.push(p))}}else{if(!Number.isInteger(d))throw new a.FormatError("Invalid XRef stream header");if(!Number.isInteger(c.getObj())||!(0,n.isCmd)(c.getObj(),"obj")||!((d=c.getObj())instanceof s.BaseStream))throw new a.FormatError("Invalid XRef stream");if(u=this.processXRefStream(d),this.topDict||(this.topDict=u),!u)throw new a.FormatError("Failed to read XRef stream")}d=u.get("Prev"),Number.isInteger(d)?this.startXRefQueue.push(d):d instanceof n.Ref&&this.startXRefQueue.push(d.num),this.startXRefQueue.shift()}}return this.topDict}catch(m){if(m instanceof r.MissingDataException)throw m;(0,a.info)("(while reading XRef): "+m),this.startXRefQueue.shift()}if(!e)throw new r.XRefParseException}},{key:"getEntry",value:function(e){var t=this.entries[e];return t&&!t.free&&t.offset?t:null}},{key:"fetchIfRef",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];return e instanceof n.Ref?this.fetch(e,t):e}},{key:"fetch",value:function(e){var t=arguments.length>1&&void 0!==arguments[1]&&arguments[1];if(!(e instanceof n.Ref))throw new Error("ref object is not a reference");var i=e.num,r=this._cacheMap.get(i);if(void 0!==r)return r instanceof n.Dict&&!r.objId&&(r.objId=e.toString()),r;var o=this.getEntry(i);if(null===o)return this._cacheMap.set(i,o),o;if(this._pendingRefs.has(e))return this._pendingRefs.remove(e),(0,a.warn)("Ignoring circular reference: ".concat(e,".")),n.CIRCULAR_REF;this._pendingRefs.put(e);try{o=o.uncompressed?this.fetchUncompressed(e,o,t):this.fetchCompressed(e,o,t),this._pendingRefs.remove(e)}catch(l){throw this._pendingRefs.remove(e),l}return o instanceof n.Dict?o.objId=e.toString():o instanceof s.BaseStream&&(o.dict.objId=e.toString()),o}},{key:"fetchUncompressed",value:function(e,t){var i=arguments.length>2&&void 0!==arguments[2]&&arguments[2],a=e.gen,l=e.num;if(t.gen!==a)throw new r.XRefEntryException("Inconsistent generation in XRef: ".concat(e));var c=this.stream.makeSubStream(t.offset+this.stream.start),d=new o.Parser({lexer:new o.Lexer(c),xref:this,allowStreams:!0}),u=d.getObj(),p=d.getObj(),m=d.getObj();if(u!==l||p!==a||!(m instanceof n.Cmd))throw new r.XRefEntryException("Bad (uncompressed) XRef entry: ".concat(e));if("obj"!==m.cmd){if(m.cmd.startsWith("obj")&&(l=parseInt(m.cmd.substring(3),10),!Number.isNaN(l)))return l;throw new r.XRefEntryException("Bad (uncompressed) XRef entry: ".concat(e))}return(t=this.encrypt&&!i?d.getObj(this.encrypt.createCipherTransform(l,a)):d.getObj())instanceof s.BaseStream||this._cacheMap.set(l,t),t}},{key:"fetchCompressed",value:function(e,t){var i=t.offset,l=this.fetch(n.Ref.get(i,0));if(!(l instanceof s.BaseStream))throw new a.FormatError("bad ObjStm stream");var c=l.dict.get("First"),d=l.dict.get("N");if(!Number.isInteger(c)||!Number.isInteger(d))throw new a.FormatError("invalid first and n parameters for ObjStm stream");for(var u=new o.Parser({lexer:new o.Lexer(l),xref:this,allowStreams:!0}),p=new Array(d),m=new Array(d),h=0;h<d;++h){var f=u.getObj();if(!Number.isInteger(f))throw new a.FormatError("invalid object number in the ObjStm stream: ".concat(f));var y=u.getObj();if(!Number.isInteger(y))throw new a.FormatError("invalid object offset in the ObjStm stream: ".concat(y));p[h]=f,m[h]=y}for(var b=(l.start||0)+c,g=new Array(d),v=0;v<d;++v){var _=v<d-1?m[v+1]-m[v]:void 0;if(_<0)throw new a.FormatError("Invalid offset in the ObjStm stream.");var A=(u=new o.Parser({lexer:new o.Lexer(l.makeSubStream(b+m[v],_,l.dict)),xref:this,allowStreams:!0})).getObj();if(g[v]=A,!(A instanceof s.BaseStream)){var x=p[v],w=this.entries[x];w&&w.offset===i&&w.gen===v&&this._cacheMap.set(x,A)}}if(void 0===(t=g[t.gen]))throw new r.XRefEntryException("Bad (compressed) XRef entry: ".concat(e));return t}},{key:"fetchIfRefAsync",value:function(){var e=y(p().mark((function e(t,i){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:if(!(t instanceof n.Ref)){e.next=2;break}return e.abrupt("return",this.fetchAsync(t,i));case 2:return e.abrupt("return",t);case 3:case"end":return e.stop()}}),e,this)})));return function(t,i){return e.apply(this,arguments)}}()},{key:"fetchAsync",value:function(){var e=y(p().mark((function e(t,i){return p().wrap((function(e){for(;;)switch(e.prev=e.next){case 0:return e.prev=0,e.abrupt("return",this.fetch(t,i));case 4:if(e.prev=4,e.t0=e.catch(0),e.t0 instanceof r.MissingDataException){e.next=8;break}throw e.t0;case 8:return e.next=10,this.pdfManager.requestRange(e.t0.begin,e.t0.end);case 10:return e.abrupt("return",this.fetchAsync(t,i));case 11:case"end":return 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0!==i&&t!==e._backpressure&&(t?Ni(i):Gi(i)),e._backpressure=t}Object.defineProperties(It.prototype,{abort:{enumerable:!0},close:{enumerable:!0},getWriter:{enumerable:!0},locked:{enumerable:!0}}),"symbol"===typeof t.toStringTag&&Object.defineProperty(It.prototype,t.toStringTag,{value:"WritableStream",configurable:!0});var Jt=function(){function e(e){if(V(e,1,"WritableStreamDefaultWriter"),Ct(e,"First parameter"),Bt(e))throw new TypeError("This stream has already been locked for exclusive writing by another writer");this._ownerWritableStream=e,e._writer=this;var t=e._state;if("writable"===t)!Yt(e)&&e._backpressure?zi(this):Fi(this),Di(this);else if("erroring"===t)Bi(this,e._storedError),Di(this);else if("closed"===t)Fi(this),Ii(this);else{var i=e._storedError;Bi(this,i),Ri(this,i)}}return Object.defineProperty(e.prototype,"closed",{get:function(){return 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strict";e.exports="data:image/png;base64,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"},668:function(e){"use strict";e.exports="data:image/png;base64,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"},1478:function(e){"use 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"},8162:function(e){"use 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"},5608:function(e){"use 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N1cOv+vVDK+6lRBSAOqreuFWvG+BHCkAt1cJw9etdffxAYApAPVVCpcp1ApyiANSUPRwzXV+ma2Ft1mIyCkBdWW/mrNcF0JQCUFu2sMx2PQ9Zr4t1WIMJKQBkubGzXMc72a+PuKy9pBQAtm39G3z18e9V5TqJw5pLTAHgYdUbfdVxn+WzDBjBOitAAeDZajf8auNtyQZND9ZVIR+zB0A4t22Nj/y0SX0yD8ApTgB4JXqoRB8fQHgKAO9EDdmo4wJYigLAT6KFbbTxACxLAeA3EULXC5MAGlMA2GNm+Ap+gA4UAPaaEcTCH6ATBYAjRgay8AfoSAHgqBHBLPwBOlMAOKNnQAt/gAEUAM7qEdTCH2AQBYArWga28AcYSAHgqhbBLfwBBlMAaOFsgHuDH4BJfBogrTyCfM8nCQp9gMkUAFoT7gAL8BQAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQQoAABSkAABAQR+zBwAB3d/8/W3oKAA6UgDg07vQf/c1ygCwNE8BwL7wf/Vvzvw7gBAUACprEeJKALAkBYCqWga3EgAsRwGgoh6BrQQAS1EAqKZnUCsBwDIUACoR0AB/KABUMSr8lQxgCQoAFQhlgG8UALIT/gAvKABkJvwB3lAAyEr4A/xAASAj4Q/wCwWAbIQ/wA4KAJkIf4CdFACyEP4ABygAZCD8AQ5SAFhdtPC/zR4AwB4KACuLFv4Ay/iYPQCG2hOYqzyCjRj+q8wdgAJQxJGwfHxt5DAT/gAXKQD5nQ3LiEUgYvBvW6w5AtjFawByaxGYUUI3yji+E/7AkhSAvFoG5uzwnf393xH+wLIUgJx6BOasEBb+AB0oABwxOoyFP0AnCkA+vUNzVCgLf4COFADOyFIyjhL+QBoKAGf1CmnhDzCA9wHgivvWNhiF/zlR5421RF/nNKYA5DIjCFqVgKghFnVTjDpfrOt5TUVd9zSkANDC1RIQMcyiboAR54p8Ir4TKI15DUAuM2/Wq285HEnUTS/iXJGbNZeYAkBLRzeLiJuL8IevrL2kFABa27tZRNxUhD9QhgJAD78FVsRAixr+EEHEe5aLFABGi7iRRA7/iPNFTdZiMgpAPlHC7NVmEXEDiTJfAEMpAPR0f/PnKIQ/UJYCkFOkYLtvwv+siPMGJKEA5LVCwM1ibuAcpTQRBSA3Qfc3cwKwKQAVCLz/mAuAPxSAGgSfOQD4QgGoo3IAVr52aMm9lIgCUEvFm3fla1557EBwCkA9lUKl0rUCHKIA1FQhGCtcI4zknkpGAagr882c6doyXQsQiAJQW8ZwcU3QnjWYkAJAlhv7tuW5FojEfZWUAsC2rX+Drz7+PSpcI/FYd4kpADyseqOvOu4znHIwkrWWnALAs9Vu+NXG20rV62YMRbOIj9kDIJzbtsYnflXfoF5d/wo/N+Kpfi+VpQDwSvQSYMN6zbwAu3kKgHeihknUcQEsRQHgJ9HCNtp4AJalAPCbKKEbZRwAKSgA7DE7fGd/f4B0FAD2mhXCwh+gAwWAyIQ/QCcKAEeMDGThD9CRAsBRI4JZ+AN0pgBwRs+AFv4AAygAnNUjqIU/wCAKAFe0DGzhDzCQzwLgqkdwn/3sAMEPMIETAFo5E+TCH2ASJwC09Bzo704EhD5AAAoAvQh6gMA8BQAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFCQAgAABSkAAFDQx+wBQCD3nV936zoKgAEUANgf/N+/XhEAluUpAKo7Gv6t/i3AVAoAlbUI8Huj/wdgKAWAqoQ2UJoCQEU9wl+hAJaiAFBNz6BWAoBlKABUIqAB/lAAqGJU+CsZwBIUACoQygDfKABkJ/wBXlAAyEz4A7zhrYDJSPAD/MIJANkIf4AdFAAyEf4AOykAZCH8AQ5QAMhA+AMcpACwumjhf5s9AIA9FABWFi38AZbh1wBrehecKz16jRj+K80fUJwCUMeewHz+mshhJvwBLvIUQH737VxgRgzZbYs7LoClKAC5XQ3LaGEbbTwPHv0Dy1EA8moVllFCN8o4nt024Q8sSgHIqXVYzg7f2d//FcEPLE0BYK9ZISz8ATpQAPLpGZijw1j4A3SiAHDUqFAW/gAdKQCc0TuchT9AZwoAZ/UKaeEPMIB3AuSK+9Y2HIX/MRHni/VFXvM05AQglxmBkO39Bp5F3QjPvrsj7GF9FaEA0MKVzSLqZhM5/GEEay05BSCXmaGV6fMGhD98suYSUwBo6chmEXVjEf7wlbWXlAJAa0c/djgS4Q+vWYMJKQD08NNmEXUjEf5AKQpAPlGC7FVwRQ2zKHMGkUW9fzlJAaCn+5s/RyL8gZIUgJwihVrUX/Pbtljz9ErUeQMSUADyih5us5kfOE4pTcRbAVON4AfYnABkJ+y+Mh8AfygA+Qm9T+YB4IkCUEP18Kt+/dCKeykRBaCOqjdu1esG+JECUEu1MFz9elcfPxCYAlBPlVCpcp0ApygANWUPx0zXl+laWJu1mIwCUFfWmznrdQE0pQDUli0ss13PQ9brYh3WYEIKAFlu7CzX8U726yMuay8pBYBtW/8GX338e1W5TuKw5hJTAHhY9UZfddxn3bZ618x41lkBCgDPVrvhVxtvSzZoerCuCvFpgHx329b4yE+b1CfzAJziBIBXoodK9PEBhKcA8E7UkI06LoClKAD8JFrYRhsPwLIUAH4TJXSjjAMgBQWAPWaGr1clA3SgALDXjBAW/ACdKAAcMTKQhT9ARwoAR40IZuEP0JkCwBk9A1r4AwygAHBWj6AW/gCDKABc0TKwhT/AQAoAV7UIbuEPMJgCQAtXAlz4A0zg0wBp5RHkez5JUOgDTKYA0JpwB1iApwAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoCAFAAAKUgAAoKDMBeA2ewAALC9tlmQuAADAGwoAABSkAFx3nz0AgILsvRcpAABQkALQhiYKMI49twEFAAAKUgDa0UgB+rPXNpK9AKT9/U0AukudIdkLwGiaKUA/9tiGFID2LFCA9uytjVUoADOOcCxUgHZm7Kmpj/+3rUYBmEUJALjOXtrJx+wBJPdYuOmbJEBjgr+zKicAswPYQgbYb/aeOTszhnACMI7TAICfzQ7+UqqcAGxbnOC9bxY5wLNI+2KUrOjOCcA8TgSA6qKEfknVCsBti7fgvo9HIQCyirb/fldq/61WAFYQ/QYBIIFKrwF4KNXwANilXDZULAAAUF7VAlCu6QHwVslMqFoAtq3oDxyAL8pmQeUCAABlVS8AZZsfALUzoHoB2LbiCwCgqPJ7vwLwqfxCACjEnr8pAM8sCID87PV/KABfWRgAednjnygAf7NAAPKxt3+jALxmoQDkYU9/QQF4z4IBWJ+9/A2fBvizx8LxCX0AaxH8v3ACsI+FBLAOe/YOTgD2cxoAEJvgP8AJwHEWGEA89uaDnACc4zQAIAbBf5ICcI0iADCH4L9IAWhDEQAYQ/A3ogC0pQgA9CH4G1MA+nheqMoAwDlCvyMFoD9lAGA/oT+IAjDW94WtEADVCfxJ/g8UbezgdlqoTQAAAABJRU5ErkJggg=="},6627:function(e,t,i){"use 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Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Sertraline\' && medTwo == \'Vortioxetine\'","uid":1.12,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Sertraline\' && medTwo == \'Vilazodone\'","uid":1.13,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Sertraline\' && medTwo == \'Tricyclic Antidepressants\'","uid":1.14,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days before starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Sertraline\'","uid":2.01,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Citalopram\'","uid":2.02,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Escitalopram\'","uid":2.03,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Fluoxetine\'","uid":2.04,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Paroxetine\'","uid":2.05,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Fluvoxamine\'","uid":2.06,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Duloxetine\'","uid":2.07,"type":"overlay","text":"Cross taper medications over 1-2 week"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Venlafaxine\'","uid":2.08,"type":"overlay","text":"Cross taper medications over 1-2 week"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Desvenlafaxine\'","uid":2.09,"type":"overlay","text":"Cross taper medications over 1-2 week"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Bupropion\'","uid":2.1,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Mirtazapine\'","uid":2.11,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Vortioxetine\'","uid":2.12,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Vilazodone\'","uid":2.13,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Citalopram\' && medTwo == \'Tricyclic Antidepressants\'","uid":2.14,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days before starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Sertraline\'","uid":3.01,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Citalopram\'","uid":3.02,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Escitalopram\'","uid":3.03,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Fluoxetine\'","uid":3.04,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Paroxetine\'","uid":3.05,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Fluvoxamine\'","uid":3.06,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Duloxetine\'","uid":3.07,"type":"overlay","text":"Cross taper medications over 1-2 week"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Venlafaxine\'","uid":3.08,"type":"overlay","text":"Cross taper medications over 1-2 week"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Desvenlafaxine\'","uid":3.09,"type":"overlay","text":"Cross taper medications over 1-2 week"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Bupropion\'","uid":3.1,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Mirtazapine\'","uid":3.11,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Vortioxetine\'","uid":3.12,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Vilazodone\'","uid":3.13,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick cross-taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days while starting new medication)"},{"visible":"medOne == \'Escitalopram\' && medTwo == \'Tricyclic Antidepressants\'","uid":3.14,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br><br>Consider a quick taper for high doses of medication before starting new medication<br>(Example: Sertraline 200 mg taper to 100 mg for 2-3 days before starting new medication)"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Sertraline\'","uid":4.01,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Citalopram\'","uid":4.02,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Escitalopram\'","uid":4.03,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Fluoxetine\'","uid":4.04,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Paroxetine\'","uid":4.05,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Fluvoxamine\'","uid":4.06,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Duloxetine\'","uid":4.07,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Venlafaxine\'","uid":4.08,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Desvenlafaxine\'","uid":4.09,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Bupropion\'","uid":4.1,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Mirtazapine\'","uid":4.11,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Vortioxetine\'","uid":4.12,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Vilazodone\'","uid":4.13,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Fluoxetine\' && medTwo == \'Tricyclic Antidepressants\'","uid":4.14,"type":"overlay","text":"Stop old medication and start new medication at least 1 week later"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Sertraline\'","uid":5.01,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Citalopram\'","uid":5.02,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Escitalopram\'","uid":5.03,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Fluoxetine\'","uid":5.04,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Paroxetine\'","uid":5.05,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Fluvoxamine\'","uid":5.06,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Duloxetine\'","uid":5.07,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Venlafaxine\'","uid":5.08,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Desvenlafaxine\'","uid":5.09,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Bupropion\'","uid":5.1,"type":"overlay","text":"Add new medication then taper old medication slowly over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Mirtazapine\'","uid":5.11,"type":"overlay","text":"Add new medication then taper old medication slowly over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Vortioxetine\'","uid":5.12,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Vilazodone\'","uid":5.13,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Paroxetine\' && medTwo == \'Tricyclic Antidepressants\'","uid":5.14,"type":"overlay","text":"Slowly taper old medication over 2 weeks<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Sertraline\'","uid":6.01,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Citalopram\'","uid":6.02,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Escitalopram\'","uid":6.03,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Fluoxetine\'","uid":6.04,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Paroxetine\'","uid":6.05,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Fluvoxamine\'","uid":6.06,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Duloxetine\'","uid":6.07,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Venlafaxine\'","uid":6.08,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Desvenlafaxine\'","uid":6.09,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Bupropion\'","uid":6.1,"type":"overlay","text":"Add new medication then taper old medication slowly over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Mirtazapine\'","uid":6.11,"type":"overlay","text":"Add new medication then taper old medication slowly over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Vortioxetine\'","uid":6.12,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Vilazodone\'","uid":6.13,"type":"overlay","text":"Cross taper medications over 2 weeks"},{"visible":"medOne == \'Fluvoxamine\' && medTwo == \'Tricyclic Antidepressants\'","uid":6.14,"type":"overlay","text":"Slowly taper old medication over 2 weeks<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Sertraline\'","uid":7.01,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Citalopram\'","uid":7.02,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Escitalopram\'","uid":7.03,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Fluoxetine\'","uid":7.04,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Paroxetine\'","uid":7.05,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Fluvoxamine\'","uid":7.06,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Duloxetine\'","uid":7.07,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Venlafaxine\'","uid":7.08,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Desvenlafaxine\'","uid":7.09,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Bupropion\'","uid":7.1,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Mirtazapine\'","uid":7.11,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Vortioxetine\'","uid":7.12,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Vilazodone\'","uid":7.13,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Duloxetine\' && medTwo == \'Tricyclic Antidepressants\'","uid":7.14,"type":"overlay","text":"Slowly taper old medication over 2 weeks<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Sertraline\'","uid":8.01,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Citalopram\'","uid":8.02,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Escitalopram\'","uid":8.03,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Fluoxetine\'","uid":8.04,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Paroxetine\'","uid":8.05,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Fluvoxamine\'","uid":8.06,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Duloxetine\'","uid":8.07,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Venlafaxine\'","uid":8.08,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Desvenlafaxine\'","uid":8.09,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Bupropion\'","uid":8.1,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Mirtazapine\'","uid":8.11,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Vortioxetine\'","uid":8.12,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Vilazodone\'","uid":8.13,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Venlafaxine\' && medTwo == \'Tricyclic Antidepressants\'","uid":8.14,"type":"overlay","text":"Slowly taper old medication over 2 weeks<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Sertraline\'","uid":9.01,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Citalopram\'","uid":9.02,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Escitalopram\'","uid":9.03,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Fluoxetine\'","uid":9.04,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Paroxetine\'","uid":9.05,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Fluvoxamine\'","uid":9.06,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Duloxetine\'","uid":9.07,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Venlafaxine\'","uid":9.08,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Desvenlafaxine\'","uid":9.09,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Bupropion\'","uid":9.1,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Mirtazapine\'","uid":9.11,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Vortioxetine\'","uid":9.12,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Vilazodone\'","uid":9.13,"type":"overlay","text":"Cross taper medications over 1-2 weeks"},{"visible":"medOne == \'Desvenlafaxine\' && medTwo == \'Tricyclic Antidepressants\'","uid":9.14,"type":"overlay","text":"Slowly taper old medication over 2 weeks<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Sertraline\'","uid":10.01,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Citalopram\'","uid":10.02,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Escitalopram\'","uid":10.03,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Fluoxetine\'","uid":10.04,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Paroxetine\'","uid":10.05,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Fluvoxamine\'","uid":10.06,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Duloxetine\'","uid":10.07,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Venlafaxine\'","uid":10.08,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Desvenlafaxine\'","uid":10.09,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Bupropion\'","uid":10.1,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Mirtazapine\'","uid":10.11,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Vortioxetine\'","uid":10.12,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Vilazodone\'","uid":10.13,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Bupropion\' && medTwo == \'Tricyclic Antidepressants\'","uid":10.14,"type":"overlay","text":"Add new medication then taper old medication slowly over 1-2 weeks<br><br>(Example: Start new medication and taper bupropion by 150 mg every 1-2 weeks)"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Sertraline\'","uid":11.01,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Citalopram\'","uid":11.02,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Escitalopram\'","uid":11.03,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Fluoxetine\'","uid":11.04,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Paroxetine\'","uid":11.05,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Fluvoxamine\'","uid":11.06,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Duloxetine\'","uid":11.07,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Venlafaxine\'","uid":11.08,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Desvenlafaxine\'","uid":11.09,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Bupropion\'","uid":11.1,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Mirtazapine\'","uid":11.11,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Vortioxetine\'","uid":11.12,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Vilazodone\'","uid":11.13,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Mirtazapine\' && medTwo == \'Tricyclic Antidepressants\'","uid":11.14,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Sertraline\'","uid":12.01,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br>(taper high doses)"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Citalopram\'","uid":12.02,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br>(taper high doses)"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Escitalopram\'","uid":12.03,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br>(taper high doses)"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Fluoxetine\'","uid":12.04,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Paroxetine\'","uid":12.05,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Fluvoxamine\'","uid":12.06,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Duloxetine\'","uid":12.07,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Venlafaxine\'","uid":12.08,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Desvenlafaxine\'","uid":12.09,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Bupropion\'","uid":12.1,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Mirtazapine\'","uid":12.11,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Vortioxetine\'","uid":12.12,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Vilazodone\'","uid":12.13,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Vortioxetine\' && medTwo == \'Tricyclic Antidepressants\'","uid":12.14,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Sertraline\'","uid":13.01,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br>(taper high doses)"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Citalopram\'","uid":13.02,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br>(taper high doses)"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Escitalopram\'","uid":13.03,"type":"overlay","text":"Start new medication 1 day after stopping old medication<br>(taper high doses)"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Fluoxetine\'","uid":13.04,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Paroxetine\'","uid":13.05,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Fluvoxamine\'","uid":13.06,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Duloxetine\'","uid":13.07,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Venlafaxine\'","uid":13.08,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Desvenlafaxine\'","uid":13.09,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Bupropion\'","uid":13.1,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Mirtazapine\'","uid":13.11,"type":"overlay","text":"Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Vortioxetine\'","uid":13.12,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Vilazodone\'","uid":13.13,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Vilazodone\' && medTwo == \'Tricyclic Antidepressants\'","uid":13.14,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Sertraline\'","uid":14.01,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Citalopram\'","uid":14.02,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Escitalopram\'","uid":14.03,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Fluoxetine\'","uid":14.04,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Paroxetine\'","uid":14.05,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Fluvoxamine\'","uid":14.06,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Duloxetine\'","uid":14.07,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Venlafaxine\'","uid":14.08,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Desvenlafaxine\'","uid":14.09,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Bupropion\'","uid":14.1,"type":"overlay","text":"Cross taper medications over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Mirtazapine\'","uid":14.11,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Vortioxetine\'","uid":14.12,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Vilazodone\'","uid":14.13,"type":"overlay","text":"Slowly taper old medication over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered<br><br>Start new medication 1 day after stopping old medication"},{"visible":"medOne == \'Tricyclic Antidepressants\' && medTwo == \'Tricyclic Antidepressants\'","uid":14.14,"type":"overlay","text":"Cross taper medications over 1-2 weeks<br><br>Doses less than 50 mg do not need to be tapered"}]}]}')},9993:function(e){"use strict";e.exports=JSON.parse('{"variables":{"bmi":"null"},"derived":[],"sections":[{"valid":"true","state":"intro","title":"BMI (Adult)","type":"section","content":[{"visible":"true","id":"bmi","text":"BMI","type":"bmi"},{"type":"overlay","uid":"67.0","varInsert":["bmi"],"calc":"parseFloat(bmi)","visible":"bmi == \'null\'","text":"This calculator provides body mass index (BMI) and the corresponding BMI weight status category for adults 20 years and older."},{"type":"overlay","uid":"67.0","varInsert":["bmi"],"calc":"parseFloat(bmi)","visible":"value < 18.5","text":"<b>Underweight</b><br><var> kg/m\xb2<br><br><a href=\'https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html\'>Reference: CDC</a>"},{"type":"overlay","uid":"67.0","varInsert":["bmi"],"calc":"parseFloat(bmi)","visible":"value >= 18.5 && value < 25.0","text":"<b>Healthy weight</b><br><var> kg/m\xb2<br><br><a href=\'https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html\'>Reference: CDC</a>"},{"type":"overlay","uid":"67.0","varInsert":["bmi"],"calc":"parseFloat(bmi)","visible":"value >= 25.0 && value < 30.0","text":"<b>Overweight</b><br><var> kg/m\xb2<br><br><a href=\'https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html\'>Reference: CDC</a>"},{"type":"overlay","uid":"67.0","varInsert":["bmi"],"calc":"parseFloat(bmi)","visible":"value >= 30.0","text":"<b>Obese</b><br><var> kg/m\xb2<br><br>Refer to Special Population for Obesity when available. Alternative therapies or dosing adjustments may be indicated.<br><br><a href=\'https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html\'>Reference: CDC</a>"}]}]}')},4909:function(e){"use strict";e.exports=JSON.parse('{"variables":{"ckd":""},"derived":[],"sections":[{"valid":"true","state":"intro","title":"CKD-Epi","type":"section","content":[{"visible":"true","type":"overlay","uid":"1.0","text":"<big><b>Renal impairment</b></big><br>&#x2022;Defined as presence of kidney disease that impacts renal function and generally estimated by a threshold of eGFR < 90 mL/min/1.73m&#x00B2;<br>&#x2022;eGFR calculations based on CKD-EPI estimation<br>&#x2022;CKD-EPI calculations without race used in this application"},{"visible":"true","id":"ckd","text":"CKD-Epi","type":"ckd"},{"type":"overlay","uid":"67.0","calc":"parseInt(ckd)","varInsert":["ckd"],"visible":"value >= 90","text":"<b>Stage 1</b><br><var> ml/min/1.73 m\xb2<br><br>No dosing adjustments necessary at this time."},{"type":"overlay","uid":"68.0","varInsert":["ckd"],"calc":"parseInt(ckd)","visible":"value >= 60 && value <= 89","text":"<b>Stage 2</b><br><var> ml/min/1.73 m\xb2<br><br>Refer to Special Population for Renal Impairment when available. Alternative therapies or dosing adjustments may be indicated."},{"type":"overlay","uid":"69.0","varInsert":["ckd"],"calc":"parseInt(ckd)","visible":"value >= 45 && value <= 59","text":"<b>Stage 3a</b><br><var> ml/min/1.73 m\xb2<br><br>Refer to Special Population for Renal Impairment when available. Alternative therapies or dosing adjustments may be indicated."},{"type":"overlay","uid":"70.0","varInsert":["ckd"],"calc":"parseInt(ckd)","visible":"value >= 30 && value <= 44","text":"<b>Stage 3b</b><br><var> ml/min/1.73 m\xb2<br><br>Refer to Special Population for Renal Impairment when available. Alternative therapies or dosing adjustments may be indicated."},{"type":"overlay","uid":"71.0","varInsert":["ckd"],"calc":"parseInt(ckd)","visible":"value >= 15 && value <= 29","text":"<b>Stage 4</b><br><var> ml/min/1.73 m\xb2<br><br>Refer to Special Population for Renal Impairment when available. Alternative therapies or dosing adjustments may be indicated."},{"type":"overlay","uid":"72.0","varInsert":["ckd"],"calc":"parseInt(ckd)","visible":"value < 15","text":"<b>Stage 5</b><br><var> ml/min/1.73 m\xb2<br><br>Refer to Special Population for Renal Impairment when available. Alternative therapies or dosing adjustments may be indicated."}]}]}')},177:function(e){"use strict";e.exports=JSON.parse('{"variables":{"medication_history":false,"cows_rpr":0,"cows_sweating":0,"cows_skin":0,"cows_anxiety":0,"cows_yawning":0,"cows_tremor":0,"cows_gi":0,"cows_nose":0,"cows_aches":0,"cows_pupil":0,"cows_restlessness":0,"calc":""},"derived":[{"score":"(parseInt(cows_rpr) + parseInt(cows_sweating) + parseInt(cows_restlessness) + parseInt(cows_pupil) + parseInt(cows_aches) + parseInt(cows_nose) + parseInt(cows_gi) + parseInt(cows_tremor) + parseInt(cows_yawning) + parseInt(cows_anxiety) + parseInt(cows_skin))"}],"sections":[{"valid":"true","title":"COWS","state":"medication","content":[{"visible":true,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Somatic Symptom Disorder"}]}]},{"valid":"true","state":"intro","title":"COWS","type":"section","content":[{"visible":"true","id":"cows_rpr","text":"Resting pulse rate:\\n<i>Measured after patient is sitting/lying for one minute.</i>","type":"radio","groups":[{"id":"cows_rpr","type":"choice","choices":[{"text":"Pulse rate 80 or below (0)","value":"0"},{"text":"Pulse rate 81-100 (1)","value":"1"},{"text":"Pulse rate 101-120 (2)","value":"2"},{"text":"Pulse rate greater than 120 (4)","value":"4"}]}]},{"visible":"true","id":"cows_sweating","text":"Sweating:\\n<i>Over past \xbd hour not accounted for by room temperature or patient activity.</i>","type":"radio","groups":[{"id":"cows_sweating","type":"choice","choices":[{"text":"No report of chills of flushing (0)","value":"0"},{"text":"One subjective report of chills or flushing (1)","value":"1"},{"text":"Flushed or observable moistness on face (2)","value":"2"},{"text":"Beads of sweat on brow or face (3)","value":"3"},{"text":"Sweat streaming off face (4)","value":"4"}]}]},{"visible":"true","id":"cows_restlessness","text":"Restlessness:\\n<i>Observation during assessment.</i>","type":"radio","groups":[{"id":"cows_restlessness","type":"choice","choices":[{"text":"Able to sit still (0)","value":"0"},{"text":"Report difficulty sitting still, but is able to do so (1)","value":"1"},{"text":"Frequent shifting or extraneous movements of legs/arms (3)","value":"3"},{"text":"Unable to sit still for more than a few seconds (5)","value":"5"}]}]},{"visible":"true","id":"cows_pupil","text":"Pupil Size","type":"radio","groups":[{"id":"cows_pupil","type":"choice","choices":[{"text":"Pupils pinned or normal size for room light (0)","value":"0"},{"text":"Pupils possibly larger than normal for room light (1)","value":"1"},{"text":"Pupils moderately dilated (2)","value":"2"},{"text":"Pupils so dilated that only rim of the iris is visible (5)","value":"5"}]}]},{"visible":"true","id":"cows_aches","text":"Bone or Joint aches:\\n<i>If patient was having pains previously, only the additional component attributed to opiate withdrawal is scored.</i>","type":"radio","groups":[{"id":"cows_aches","type":"choice","choices":[{"text":"Not present (0)","value":"0"},{"text":"Mild diffuse discomfort (1)","value":"1"},{"text":"Patient reports severe diffuse aching of joints/muscles (2)","value":"2"},{"text":"Patient is rubbing joints or muscles and is unable to sit still because of discomfort (4)","value":"4"}]}]},{"visible":"true","id":"cows_nose","text":"Runny nose or tearing:\\n<i>Not accounted for by cold symptoms or allergies.</i>","type":"radio","groups":[{"id":"cows_nose","type":"choice","choices":[{"text":"Not present (0)","value":"0"},{"text":"Nasal stuffiness or unusually moist eyes (1)","value":"1"},{"text":"Nose running or tearing (2)","value":"2"},{"text":"Nose constantly running or tears treaming down cheeks (4)","value":"4"}]}]},{"visible":"true","id":"cows_gi","text":"GI Upset:\\n<i>Over last \xbd hour</i>","type":"radio","groups":[{"id":"cows_gi","type":"choice","choices":[{"text":"No GI symptoms (0)","value":"0"},{"text":"Stomach cramps (1)","value":"1"},{"text":"Nausea or loose stools (2)","value":"2"},{"text":"Vomiting or diarrhea (3)","value":"3"},{"text":"Multiple episodes of diarrhea or vomiting (5)","value":"5"}]}]},{"visible":"true","id":"cows_tremor","text":"Tremor:\\n<i>Observation of outstretched hands</i>","type":"radio","groups":[{"id":"cows_tremor","type":"choice","choices":[{"text":"No tremor (0)","value":"0"},{"text":"Tremor can be felt, but not observed (1)","value":"1"},{"text":"Slight tremor observable (2)","value":"2"},{"text":"Gross tremor or muscole twitching (4)","value":"4"}]}]},{"visible":"true","text":"Yawning:\\n<i>Observation during assessment</i>","type":"radio","id":"cows_yawning","groups":[{"id":"cows_yawning","type":"choice","choices":[{"text":"No yawning (0)","value":"0"},{"text":"Yawning once or twice during assessment (1)","value":"1"},{"text":"Yawning three or more times during assessment (2)","value":"2"},{"text":"Yawning several times/minute (4)","value":"4"}]}]},{"visible":"true","id":"cows_anxiety","text":"Anxiety or Irritability","type":"radio","groups":[{"id":"cows_anxiety","type":"choice","choices":[{"text":"None (0)","value":"0"},{"text":"Patient reports increasing irritability or anxiousness (1)","value":"1"},{"text":"Patient obviously irritable, anxious (2)","value":"2"},{"text":"Patient so irritable or anxious that participation in the assessment is difficult (4)","value":"4"}]}]},{"visible":"true","text":"Gooseflesh skin","type":"radio","id":"cows_skin","groups":[{"id":"cows_skin","type":"choice","choices":[{"text":"Skin is smooth (0)","value":"0"},{"text":"Piloerection of skin can be felt or hairs standing up on arms (3)","value":"3"},{"text":"Prominent piloerection (5)","value":"5"}]}]},{"visible":"score < 5","varInsert":["score"],"type":"overlay","uid":"63.0","text":"<big><b>Total Score: <var>.</b></big> <br><br><big><b>No active withdrawal range: 0-4.</b></big>"},{"type":"overlay","uid":"64.0","varInsert":["score"],"visible":"score >= 5 && score < 13 && cows_rpr !== \'\' && cows_sweating !== \'\' && cows_restlessness !== \'\' && cows_pupil !== \'\' && cows_aches !== \'\' && cows_nose !== \'\' && cows_gi !== \'\' && cows_tremor !== \'\' && cows_yawning !== \'\' && cows_anxiety !== \'\' && cows_skin !== \'\'","text":"<big><b>Total Score: <var>.</b></big> <br><br><big><b>Mild withdrawal range: 5-12.</b></big>"},{"type":"overlay","uid":"65.0","varInsert":["score"],"visible":"score >= 13 && score <= 24 && cows_rpr !== \'\' && cows_sweating !== \'\' && cows_restlessness !== \'\' && cows_pupil !== \'\' && cows_aches !== \'\' && cows_nose !== \'\' && cows_gi !== \'\' && cows_tremor !== \'\' && cows_yawning !== \'\' && cows_anxiety !== \'\' && cows_skin !== \'\'","text":"<big><b>Total Score: <var>.</b></big> <br><br><big><b>Moderate withdrawal range: 13-24.</b></big>"},{"type":"overlay","uid":"66.0","varInsert":["score"],"visible":"score >= 25 && score <= 36 && cows_rpr !== \'\' && cows_sweating !== \'\' && cows_restlessness !== \'\' && cows_pupil !== \'\' && cows_aches !== \'\' && cows_nose !== \'\' && cows_gi !== \'\' && cows_tremor !== \'\' && cows_yawning !== \'\' && cows_anxiety !== \'\' && cows_skin !== \'\'","text":"<big><b>Total Score: <var>.</b></big> <br><big><b>Moderately severe withdrawal range: 25-36.</b></big>"},{"type":"overlay","uid":"67.0","varInsert":["score"],"visible":"score > 36 && cows_rpr !== \'\' && cows_sweating !== \'\' && cows_restlessness !== \'\' && cows_pupil !== \'\' && cows_aches !== \'\' && cows_nose !== \'\' && cows_gi !== \'\' && cows_tremor !== \'\' && cows_yawning !== \'\' && cows_anxiety !== \'\' && cows_skin !== \'\'","text":"<big><b>Total Score: <var>.</b></big> <br><big><b>Severe withdrawal range: Greater than 36.</b></big>"},{"visible":true,"type":"overlay","uid":"68.0","text":"<small>The Clinical Opiate Withdrawal Scale (COWS) was developed by Wesson and Ling: Wesson, D. R., & Ling, W. (2003). The Clinical Opiate Withdrawal Scale (COWS). Journal of psychoactive drugs, 35(2), 253\u2013259.</small>"}]}]}')},2785:function(e){"use strict";e.exports=JSON.parse('{"variables":{"medication_history":false,"encephalopathy":-99,"ascites":-99,"bilirubin":-99,"albumin":-99,"isInr":"1","prothrombin":-99,"inr":-99,"score":-5},"derived":[{"score":"isInr == 0 ? parseInt(encephalopathy) + parseInt(ascites) + parseInt(bilirubin) + parseInt(albumin) + parseInt(prothrombin) : parseInt(encephalopathy) + parseInt(ascites) + parseInt(bilirubin) + parseInt(albumin) + parseInt(inr)"}],"sections":[{"valid":"true","state":"intro","title":"Child-Pugh","type":"section","content":[{"visible":"true","type":"overlay","uid":"1.0","text":"<big><b>Hepatic impairment</b></big><br>&#x2022;Defined as presence of cirrhosis or other disease that impacts liver function<br>&#x2022;Severity classified based on Child-Pugh score<br>&#x2022;Dosing recommendations based on Child-Pugh scores"},{"visible":"true","id":"encephalopathy","text":"Encephalopathy:","type":"radio","info":"Grade 0: normal consciousness, personality, neurological examination, electroencephalogram\\r\\n\\r\\nGrade 1: restless, sleep disturbed, irritable/agitated, tremor, impaired handwriting, 5 cps waves\\r\\n\\r\\nGrade 2: lethargic, time-disoriented, inappropriate, asterixis, ataxia, slow triphasic waves\\r\\n\\r\\nGrade 3: somnolent, stuporous, place-disoriented, hyperactive reflexes, rigidity, slower waves\\r\\n\\r\\nGrade 4: unrousable coma, no personality/behavior, decerebrate, slow 2-3 cps delta activity","groups":[{"id":"encephalopathy","type":"choice","choices":[{"text":"None","value":"0"},{"text":"Grade 1 or 2","value":"1"},{"text":"Grade 3 or 4","value":"2"}]}]},{"visible":"true","id":"ascites","text":"Ascites:","type":"radio","groups":[{"id":"ascites","type":"choice","choices":[{"text":"None","value":"0"},{"text":"Slight","value":"1"},{"text":"Moderate","value":"2"}]}]},{"visible":"true","id":"bilirubin","text":"Bilirubin:","type":"radio","groups":[{"id":"bilirubin","type":"choice","choices":[{"text":"Under 2 mg/ml","value":"0"},{"text":"2 to 3 mg/ml","value":"1"},{"text":"Over 3 mg/ml","value":"2"}]}]},{"visible":"true","id":"albumin","text":"Albumin:","type":"radio","groups":[{"id":"albumin","type":"choice","choices":[{"text":"Greater than 3.5mg/ml","value":"0"},{"text":"2.8 to 3.5mg/ml","value":"1"},{"text":"less than 2.8mg/ml","value":"2"}]}]},{"visible":"true","id":"isInr","text":"Prothrombin Time or INR?","type":"radio","groups":[{"id":"isInr","type":"choice","choices":[{"text":"Prothrombin Time","value":"0"},{"text":"INR","value":"1"}]}]},{"visible":"isInr == \'0\'","id":"prothrombin","text":"Prothrombin Time* (sec prolonged):","type":"radio","groups":[{"id":"prothrombin","type":"choice","choices":[{"text":"less than 4 sec","value":"0"},{"text":"4 to 6 sec","value":"1"},{"text":"over 6 sec","value":"2"}]}]},{"visible":"isInr == \'1\'","id":"inr","text":"INR:","type":"radio","groups":[{"id":"inr","type":"choice","choices":[{"text":"INR under 1.7","value":"0"},{"text":"INR 1.7 to 2.2","value":"1"},{"text":"INR above 2.2","value":"2"}]}]},{"visible":"score < 3 && score >= 0","type":"overlay","uid":"63.0","text":"<big><b>Child-Pugh A</b></big><br><br>Refer to Hepatic Impairment decision support tool when available. Alternative therapies or dosing adjustments may be indicated."},{"visible":"score < 6 && score >= 3","type":"overlay","uid":"64.0","text":"<big><b>Child-Pugh B</b></big><br><br>Refer to Hepatic Impairment decision support tool when available. Alternative therapies or dosing adjustments may be indicated."},{"visible":"score >= 6","type":"overlay","uid":"65.0","text":"<big><b>Child-Pugh C</b></big><br><br>Refer to Hepatic Impairment decision support tool when available. Alternative therapies or dosing adjustments may be indicated."},{"visible":"true","type":"overlay","uid":"65.0","text":"Reference: <a href=\'https://www.ncbi.nlm.nih.gov/books/NBK542308/\'>https://www.ncbi.nlm.nih.gov/books/NBK542308/</a>"}]}]}')},8254:function(e){"use strict";e.exports=JSON.parse('{"variables":{"qtc":"null"},"derived":[],"sections":[{"valid":"true","state":"intro","title":"ECG-QTC","type":"section","content":[{"visible":"false","id":"qtc","text":"ECG-QTC","type":"qtc"},{"visible":"true","uid":"G_3","title":"ECG Antipsychotic Recommendations","type":"collapse_segment","text":"ECG should be performed in patients > 45 years of age or those with a history of heart disease including prior MI, arrhythmia, and systolic dysfunction.","segments":[{"title":"QTc < 500msec","text":"No additional recommendations."},{"title":"QTc 500-549msec","text":"Monitor with follow-up ECG."},{"title":"QTc > 550msec","text":"Consult with cardiology prior to initiation. If already taking medication, discontinue pharmacotherapy and discuss with cardiology."}]}]}]}')},3573:function(e){"use strict";e.exports=JSON.parse('{"variables":{"medOne":"","medTwo":"","medications":["Antipsychotics","Lithium","Valproic","Carbamazepine","Lamotrigine"]},"derived":[],"sections":[{"valid":"true","title":"Switching","state":"intro","content":[{"visible":true,"type":"med_switch","text":"Select the medication you are switching from and to"},{"visible":"medOne == \'Antipsychotics\' && medTwo == \'Antipsychotics\'","uid":1.01,"type":"overlay","text":"Cross taper agents over 2 weeks\\n\\nMonitor for emerging side effects and need for additional titration\\n\\nLonger cross tapers may be needed for higher doses of antipsychotics\\n"},{"visible":"medOne == \'Antipsychotics\' && medTwo == \'Lithium\'","uid":1.02,"type":"overlay","text":"Start and titrate mood stabilizer to an effective dose then taper antipsychotic over a course of 2 weeks\\n\\nMonitor for emerging side effects and need for additional titration\\n\\nLonger cross tapers may be needed for higher doses of antipsychotics"},{"visible":"medOne == \'Antipsychotics\' && medTwo == \'Valproic\'","uid":1.03,"type":"overlay","text":"Start and titrate new medication to effective dose then taper antipsychotic over a course of 2 weeks\\r\\n\\r\\nMonitor for emerging side effects and need for additional titration\\r\\n\\r\\nLonger cross tapers may be needed for higher doses of antipsychotics\\r"},{"visible":"medOne == \'Antipsychotics\' && medTwo == \'Carbamazepine\'","uid":1.04,"type":"overlay","text":"Start and titrate new medication to effective dose then taper antipsychotic over a course of 2 weeks\\r\\n\\r\\nMonitor for emerging side effects and need for additional titration\\r\\n\\r\\nLonger cross tapers may be needed for higher doses of antipsychotics\\r"},{"visible":"medOne == \'Antipsychotics\' && medTwo == \'Lamotrigine\'","uid":1.05,"type":"overlay","text":"Start and titrate new medication to effective dose then taper antipsychotic over a course of 2 weeks\\r\\n\\r\\nMonitor for emerging side effects and need for additional titration\\r\\n\\r\\nLonger cross tapers may be needed for higher doses of antipsychotics\\r"},{"visible":"medOne == \'Lithium\' && medTwo == \'Antipsychotics\'","uid":2.01,"type":"overlay","text":"Start and titrate antipsychotic to an effective dose then taper lithium over a course of 2 weeks"},{"visible":"medOne == \'Lithium\' && medTwo == \'Lithium\'","uid":2.02,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Lithium\' && medTwo == \'Valproic\'","uid":2.03,"type":"overlay","text":"Start and titrate mood stabilizer to an effective dose then taper lithium over a course of 2 weeks\\r\\n"},{"visible":"medOne == \'Lithium\' && medTwo == \'Carbamazepine\'","uid":2.04,"type":"overlay","text":"Start and titrate mood stabilizer to an effective dose then taper lithium over a course of 2 weeks\\r\\n"},{"visible":"medOne == \'Lithium\' && medTwo == \'Lamotrigine\'","uid":2.05,"type":"overlay","text":"Start and titrate mood stabilizer to an effective dose then taper lithium over a course of 2 weeks\\r\\n"},{"visible":"medOne == \'Valproic\' && medTwo == \'Antipsychotics\'","uid":3.01,"type":"overlay","text":"Start antipsychotic and taper mood stabilizer over a course of 2 weeks"},{"visible":"medOne == \'Valproic\' && medTwo == \'Lithium\'","uid":3.02,"type":"overlay","text":"Start and titrate mood stabilizer to an effective dose then taper lithium over a course of 2 weeks\\r\\n"},{"visible":"medOne == \'Valproic\' && medTwo == \'Valproic\'","uid":3.03,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Valproic\' && medTwo == \'Carbamazepine\'","uid":3.04,"type":"overlay","text":"Taper old medication completely over 2 weeks prior to starting new medication"},{"visible":"medOne == \'Valproic\' && medTwo == \'Lamotrigine\'","uid":3.05,"type":"overlay","text":"Taper old medication completely over 2 weeks prior to starting new medication"},{"visible":"medOne == \'Carbamazepine\' && medTwo == \'Antipsychotics\'","uid":4.01,"type":"overlay","text":"Start antipsychotic and taper mood stabilizer over a course of 2 weeks"},{"visible":"medOne == \'Carbamazepine\' && medTwo == \'Lithium\'","uid":4.02,"type":"overlay","text":"Start and titrate mood stabilizer to an effective dose then taper lithium over a course of 2 weeks\\r\\n"},{"visible":"medOne == \'Carbamazepine\' && medTwo == \'Valproic\'","uid":4.03,"type":"overlay","text":"Taper old medication completely over 2 weeks prior to starting new medication"},{"visible":"medOne == \'Carbamazepine\' && medTwo == \'Carbamazepine\'","uid":4.04,"type":"overlay","text":"Please select a different new medication"},{"visible":"medOne == \'Carbamazepine\' && medTwo == \'Lamotrigine\'","uid":4.05,"type":"overlay","text":"Taper old medication completely over 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or your bed-partner elbows you for snoring at night)?</small>","type":"radio","groups":[{"id":"snoring","type":"choice","choices":[{"text":"Yes","value":"1"},{"text":"No","value":"0"}]}]},{"visible":"true","id":"tired","text":"<b>Tired</b><br><small>Do you often feel tired, fatigued, or sleepy during the daytime (such as falling asleep during driving or talking to someone)?</small>","type":"radio","groups":[{"id":"tired","type":"choice","choices":[{"text":"Yes","value":"1"},{"text":"No","value":"0"}]}]},{"visible":"true","id":"observed","text":"<b>Observed Apnea</b><br><small>Has anyone observed you stop breathing or choking/gasping during your sleep?</small>","type":"radio","groups":[{"id":"observed","type":"choice","choices":[{"text":"Yes","value":"1"},{"text":"No","value":"0"}]}]},{"visible":"true","id":"pressure","text":"<b>Pressure- Hypertension</b><br><small>Do you have or are being treated for high blood pressure?</small>","type":"radio","groups":[{"id":"pressure","type":"choice","choices":[{"text":"Yes","value":"1"},{"text":"No","value":"0"}]}]},{"visible":"true","id":"bmi","text":"<b>BMI</b><br><small>Body Mass Index more than 35 kg/m2?</small>","type":"radio","groups":[{"id":"bmi","type":"choice","choices":[{"text":"Yes","value":"1"},{"text":"No","value":"0"}]}]},{"visible":"true","id":"patAge","text":"<b>Age</b><br><small>Age older than 50?</small>","type":"radio","groups":[{"id":"patAge","type":"choice","choices":[{"text":"Yes","value":"1"},{"text":"No","value":"0"}]}]},{"visible":"true","id":"neck","text":"<b>Neck Size</b><br><small>Neck size large? (Measured around Adams apple) \\nIs your shirt collar 16 inches / 40cm or larger?</small>","type":"radio","groups":[{"id":"neck","type":"choice","choices":[{"text":"Yes","value":"1"},{"text":"No","value":"0"}]}]},{"visible":"true","id":"gender","text":"<b>Gender</b><br><small>What is your gender?</small>","type":"radio","groups":[{"id":"gender","type":"choice","choices":[{"text":"Male","value":"1"},{"text":"Female","value":"0"}]}]},{"visible":"highRisk && score == 3","varInsert":["score"],"type":"overlay","uid":"63.0","text":"<big><b>High Risk for OSA</b></big><br> Score: <var> <br><br>2.5 fold increase compared to patient with low risk score.<br><br>Further sleep evaluation needed."},{"visible":"highRisk && score == 4","varInsert":["score"],"type":"overlay","uid":"63.0","text":"<big><b>High Risk for OSA</b></big><br> Score: <var> <br><br>3 fold increase compared to patient with low risk score.<br><br>Further sleep evaluation needed."},{"visible":"score == 5","varInsert":["score"],"type":"overlay","uid":"63.0","text":"<big><b>High Risk for OSA</b></big><br> Score: <var> <br><br>5 fold increase compared to patient with low risk score.<br><br>Further sleep evaluation needed."},{"visible":"score == 6","varInsert":["score"],"type":"overlay","uid":"63.0","text":"<big><b>High Risk for OSA</b></big><br> Score: <var> <br><br>6 fold increase compared to patient with low risk score.<br><br>Further sleep evaluation needed."},{"visible":"score >= 7","varInsert":["score"],"type":"overlay","uid":"63.0","text":"<big><b>High Risk for OSA</b></big><br> Score: <var> <br><br>7 fold increase compared to patient with low risk score.<br><br>Further sleep evaluation needed."},{"visible":"score == 3 && !highRisk","varInsert":["score"],"type":"overlay","uid":"64.0","text":"<big><b>Intermediate Risk for OSA</b></big><br> Score: <var> <br><br>2.5 fold increase compared to patient with low risk score.<br><br>Further sleep evaluation needed."},{"visible":"score == 4 && !highRisk","varInsert":["score"],"type":"overlay","uid":"64.0","text":"<big><b>Intermediate Risk for OSA</b></big><br> Score: <var> <br><br>3 fold increase compared to patient with low risk score.<br><br>Further sleep evaluation needed."},{"visible":"score < 3 && !highRisk","varInsert":["score"],"type":"overlay","uid":"65.0","text":"<big><b>Low Risk for OSA</b></big><br> Score: <var>"}]}]}')},1157:function(e){"use strict";e.exports=JSON.parse('{"variables":{"medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'"}],"sections":[{"valid":"true","title":"Acute Stress Disorder Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Acute Stress Disorder"}]}]},{"valid":true,"title":"Acute Stress Disorder","state":"intro","content":[]},{"valid":"(patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Acute Stress Disorder","figure":["acute_t1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Immediate Interventions:</b><br>- Psychological First Aid (psychological debriefing not recommended)  (SOR C)<br>- Ensure adequate pain control (if applicable)<br>- Evaluate for acute, profound, and/or disabling anxiety, agitation, or sleep disturbance. If so, consider short (2-3 week) trial of benzodiazepine (Avoid if significant dissociative symptoms) (SOR C)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.1","type":"overlay","title":"Recommendation","text":"<b>Psychological First Aid Core Actions:</b><br>Consider accessing Psychological First Aid resources such as <a href=\'https://www.ptsd.va.gov/professional/treat/type/psych_firstaid_manual.asp\'>National Center for PTSD</a>, <a href=\'http://apps.who.int/iris/bitstream/handle/10665/44615/9789241548205_eng.pdf;jsessionid=DCF5BFEE17C541AA0CDB8054F5D8ED0C?sequence=1\'>WHO PSA Field Guide</a>, <a href=\'https://apps.apple.com/us/app/pfa-mobile/id551079424\'>PFA Mobile App</a>, <a href=\'https://apps.apple.com/us/app/pfa-mobile/id551079424\'>Psychological First Aid for Health Professionals</a><br><br><b>Psychological First Aid Core Actions:</b><br>- Contact and Engagement<br>- Safety and Comfor<br>- Stabilization<br>- Information Gathering<br>- Practical Assistance<br>- Links to Social Supports<br>- Information on Coping<br>- Links to Services","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.2","type":"overlay","title":"Recommendation","text":"<b>Subsequent continued symptoms 2-4 weeks after trauma exposure:</b><br>Trauma Focused CBT (If available)  (SOR A)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.3","type":"overlay","title":"Recommendation","text":"<b>Persistent symptoms greater than one month after trauma exposure:</b><br>If yes- Evaluate for PTSD and see PTSD decision support)<br>If no- Acute stress disorder resolved","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Acute Stress Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},9996:function(e){"use 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false,"unsuccessful_ped_meth_response":false,"medCount":29},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","adderall_inadequate":"medication_adderall == true && adderall_response === \'unsuccessful\'","adderall_xr_inadequate":"medication_adderall_xr == true && adderall_xr_response === \'unsuccessful\'","adzenys_xr_odt_inadequate":"medication_adzenys_xr_odt == true && adzenys_xr_odt_response === \'unsuccessful\'","adzenys_er_inadequate":"medication_adzenys_er == true && adzenys_er_response === \'unsuccessful\'","dextroamphetamine_inadequate":"medication_dextroamphetamine == true && dextroamphetamine_response === \'unsuccessful\'","dyanavel_xr_inadequate":"medication_dyanavel_xr == true && dyanavel_xr_response === \'unsuccessful\'","evekeo_odt_inadequate":"medication_evekeo_odt == true && evekeo_odt_response === \'unsuccessful\'","mydayis_inadequate":"medication_mydayis == true && mydayis_response === \'unsuccessful\'","vyvanse_inadequate":"medication_vyvanse == true && vyvanse_response === \'unsuccessful\'","aptensio_xr_inadequate":"medication_aptensio_xr == true && aptensio_xr_response === \'unsuccessful\'","concerta_inadequate":"medication_concerta == true && concerta_response === \'unsuccessful\'","cotempla_xr_odt_inadequate":"medication_cotempla_xr_odt == true && cotempla_xr_odt_response === \'unsuccessful\'","daytrana_patch_inadequate":"medication_daytrana_patch == true && daytrana_patch_response === \'unsuccessful\'","focalin_inadequate":"medication_focalin == true && focalin_response === \'unsuccessful\'","focalin_xr_inadequate":"medication_focalin_xr == true && focalin_xr_response === \'unsuccessful\'","jornay_pm_inadequate":"medication_jornay_pm == true && jornay_pm_response === \'unsuccessful\'","metadate_cd_inadequate":"medication_metadate_cd == true && metadate_cd_response === \'unsuccessful\'","methylin_inadequate":"medication_methylin == true && methylin_response === \'unsuccessful\'","procentra_inadequate":"medication_procentra == true && procentra_response === \'unsuccessful\'","quillichew_er_inadequate":"medication_quillichew_er == true && quillichew_er_response === \'unsuccessful\'","quillivant_xr_inadequate":"medication_quillivant_xr == true && quillivant_xr_response === \'unsuccessful\'","ritalin_inadequate":"medication_ritalin == true && ritalin_response === \'unsuccessful\'","ritalin_la_inadequate":"medication_ritalin_la == true && ritalin_la_response === \'unsuccessful\'","atomoxetine_inadequate":"medication_atomoxetine == true && atomoxetine_response === \'unsuccessful\'","bupropion_inadequate":"medication_bupropion == true && bupropion_response === \'unsuccessful\'","clonidine_xr_inadequate":"medication_clonidine_xr == true && clonidine_xr_response === \'unsuccessful\'","guanfacine_er_inadequate":"medication_guanfacine_er == true && guanfacine_er_response === \'unsuccessful\'","other_methylphenidates_inadequate":"medication_other_methylphenidates == true && other_methylphenidates_response === \'unsuccessful\'","other_amphetamines_inadequate":"medication_other_amphetamines == true && other_amphetamines_response === \'unsuccessful\'","adderall_partial":"medication_adderall == true && adderall_response === \'partial\'","adderall_xr_partial":"medication_adderall_xr == true && adderall_xr_response === \'partial\'","adzenys_xr_odt_partial":"medication_adzenys_xr_odt == true && adzenys_xr_odt_response === \'partial\'","adzenys_er_partial":"medication_adzenys_er == true && adzenys_er_response === \'partial\'","dextroamphetamine_partial":"medication_dextroamphetamine == true && dextroamphetamine_response === \'partial\'","dyanavel_xr_partial":"medication_dyanavel_xr == true && dyanavel_xr_response === \'partial\'","evekeo_odt_partial":"medication_evekeo_odt == true && evekeo_odt_response === \'partial\'","mydayis_partial":"medication_mydayis == true && mydayis_response === \'partial\'","vyvanse_partial":"medication_vyvanse == true && vyvanse_response === \'partial\'","aptensio_xr_partial":"medication_aptensio_xr == true && aptensio_xr_response === \'partial\'","concerta_partial":"medication_concerta == true && concerta_response === \'partial\'","cotempla_xr_odt_partial":"medication_cotempla_xr_odt == true && cotempla_xr_odt_response === \'partial\'","daytrana_patch_partial":"medication_daytrana_patch == true && daytrana_patch_response === \'partial\'","focalin_partial":"medication_focalin == true && focalin_response === \'partial\'","focalin_xr_partial":"medication_focalin_xr == true && focalin_xr_response === \'partial\'","jornay_pm_partial":"medication_jornay_pm == true && jornay_pm_response === \'partial\'","metadate_cd_partial":"medication_metadate_cd == true && metadate_cd_response === \'partial\'","methylin_partial":"medication_methylin == true && methylin_response === \'partial\'","procentra_partial":"medication_procentra == true && procentra_response === \'partial\'","quillichew_er_partial":"medication_quillichew_er == true && quillichew_er_response === \'partial\'","quillivant_xr_partial":"medication_quillivant_xr == true && quillivant_xr_response === \'partial\'","ritalin_partial":"medication_ritalin == true && ritalin_response === \'partial\'","ritalin_la_partial":"medication_ritalin_la == true && ritalin_la_response === \'partial\'","atomoxetine_partial":"medication_atomoxetine == true && atomoxetine_response === \'partial\'","bupropion_partial":"medication_bupropion == true && bupropion_response === \'partial\'","clonidine_xr_partial":"medication_clonidine_xr == true && clonidine_xr_response === \'partial\'","guanfacine_er_partial":"medication_guanfacine_er == true && guanfacine_er_response === \'partial\'","other_methylphenidates_partial":"medication_other_methylphenidates == true && other_methylphenidates_response === \'partial\'","other_amphetamines_partial":"medication_other_amphetamines == true && other_amphetamines_response === \'partial\'"},{"adderall_successful":"medication_adderall == true && adderall_response === \'successful\'","adderall_xr_successful":"medication_adderall_xr == true && adderall_xr_response === \'successful\'","adzenys_xr_odt_successful":"medication_adzenys_xr_odt == true && adzenys_xr_odt_response === \'successful\'","adzenys_er_successful":"medication_adzenys_er == true && adzenys_er_response === \'successful\'","dextroamphetamine_successful":"medication_dextroamphetamine == true && dextroamphetamine_response === \'successful\'","dyanavel_xr_successful":"medication_dyanavel_xr == true && dyanavel_xr_response === \'successful\'","evekeo_odt_successful":"medication_evekeo_odt == true && evekeo_odt_response === \'successful\'","mydayis_successful":"medication_mydayis == true && mydayis_response === \'successful\'","vyvanse_successful":"medication_vyvanse == true && vyvanse_response === \'successful\'","aptensio_xr_successful":"medication_aptensio_xr == true && aptensio_xr_response === \'successful\'","concerta_successful":"medication_concerta == true && concerta_response === \'successful\'","cotempla_xr_odt_successful":"medication_cotempla_xr_odt == true && cotempla_xr_odt_response === \'successful\'","daytrana_patch_successful":"medication_daytrana_patch == true && daytrana_patch_response === \'successful\'","focalin_successful":"medication_focalin == true && focalin_response === \'successful\'","focalin_xr_successful":"medication_focalin_xr == true && focalin_xr_response === \'successful\'","jornay_pm_successful":"medication_jornay_pm == true && jornay_pm_response === \'successful\'","metadate_cd_successful":"medication_metadate_cd == true && metadate_cd_response === \'successful\'","methylin_successful":"medication_methylin == true && methylin_response === \'successful\'","procentra_successful":"medication_procentra == true && procentra_response === \'successful\'","quillichew_er_successful":"medication_quillichew_er == true && quillichew_er_response === \'successful\'","quillivant_xr_successful":"medication_quillivant_xr == true && quillivant_xr_response === \'successful\'","ritalin_successful":"medication_ritalin == true && ritalin_response === \'successful\'","ritalin_la_successful":"medication_ritalin_la == true && ritalin_la_response === \'successful\'","atomoxetine_successful":"medication_atomoxetine == true && atomoxetine_response === \'successful\'","bupropion_successful":"medication_bupropion == true && bupropion_response === \'successful\'","clonidine_xr_successful":"medication_clonidine_xr == true && clonidine_xr_response === \'successful\'","guanfacine_er_successful":"medication_guanfacine_er == true && guanfacine_er_response === \'successful\'","other_methylphenidates_successful":"medication_other_methylphenidates == true && other_methylphenidates_response === \'successful\'","other_amphetamines_successful":"medication_other_amphetamines == true && other_amphetamines_response === \'successful\'"},{},{},{},{"nonstim_success":"(atomoxetine_successful ? 1 : 0) + (bupropion_successful ? 1 : 0) >= 1"},{"nonstim_ped_response":"(atomoxetine_partial ? 1 : 0) + (bupropion_partial ? 1 : 0) >= 1","alpha_ped_response":"(clonidine_xr_partial ? 1 : 0) + (guanfacine_er_partial ? 1 : 0) >= 1","stim_ped_response":"(adderall_partial ? 1 : 0) + (adderall_xr_partial ? 1 : 0) + (adzenys_xr_odt_partial ? 1 : 0) + (adzenys_er_partial ? 1 : 0) + (dextroamphetamine_partial ? 1 : 0) + (dyanavel_xr_partial ? 1 : 0) + (evekeo_odt_partial ? 1 : 0) + (mydayis_partial ? 1 : 0) + (vyvanse_partial ? 1 : 0) +  (aptensio_xr_partial ? 1 : 0) + (concerta_partial ? 1 : 0) + (cotempla_xr_odt_partial ? 1 : 0) + (daytrana_patch_partial ? 1 : 0) + (focalin_partial ? 1 : 0) + (focalin_xr_partial ? 1 : 0) + (jornay_pm_partial ? 1 : 0) + (metadate_cd_partial ? 1 : 0) + (methylin_partial ? 1 : 0) + (procentra_partial ? 1 : 0) + (quillichew_er_partial ? 1 : 0) + (quillivant_xr_partial ? 1 : 0) + (ritalin_partial ? 1 : 0) + (ritalin_la_partial ? 1 : 0) >= 1"},{"partial_ped_response":"(nonstim_ped_response ? 1 : 0) + (alpha_ped_response ? 1 : 0) + (stim_ped_response ? 1 : 0) >= 1"},{"take_meth":"(aptensio_xr_inadequate ? 1 : 0) + (concerta_inadequate ? 1 : 0) + (cotempla_xr_odt_inadequate ? 1 : 0) + (daytrana_patch_inadequate ? 1 : 0) + (focalin_inadequate ? 1 : 0) + (focalin_xr_inadequate ? 1 : 0) + (jornay_pm_inadequate ? 1 : 0) + (metadate_cd_inadequate ? 1 : 0) + (methylin_inadequate ? 1 : 0) + (procentra_inadequate ? 1 : 0) + (quillichew_er_inadequate ? 1 : 0) + (quillivant_xr_inadequate ? 1 : 0) + (ritalin_inadequate ? 1 : 0) + (ritalin_la_inadequate ? 1 : 0) + (other_methylphenidates_inadequate ? 1 : 0) >= 1","take_salt":"(adderall_inadequate ? 1 : 0) + (adderall_xr_inadequate ? 1 : 0) + (adzenys_xr_odt_inadequate ? 1 : 0) + (adzenys_er_inadequate ? 1 : 0) + (dextroamphetamine_inadequate ? 1 : 0) + (dyanavel_xr_inadequate ? 1 : 0) + (evekeo_odt_inadequate ? 1 : 0) + (mydayis_inadequate ? 1 : 0) + (vyvanse_inadequate ? 1 : 0) + (other_amphetamines_inadequate ? 1 : 0) >= 1"},{"unsuccessful_response":"(take_meth ? 1 : 0) + (take_salt ? 1 : 0) >= 1","unsuccessful_response_2":"(take_meth ? 1 : 0) + (take_salt ? 1 : 0) >= 2"},{"unsuccessful_ped_am_response":"(adderall_inadequate ? 1 : 0) + (adderall_xr_inadequate ? 1 : 0) + (adzenys_xr_odt_inadequate ? 1 : 0) + (adzenys_er_inadequate ? 1 : 0) + (dextroamphetamine_inadequate ? 1 : 0) + (dyanavel_xr_inadequate ? 1 : 0) + (evekeo_odt_inadequate ? 1 : 0) + (mydayis_inadequate ? 1 : 0) + (vyvanse_inadequate ? 1 : 0) >= 1","unsuccessful_ped_am_response_2":"(adderall_inadequate ? 1 : 0) + (adderall_xr_inadequate ? 1 : 0) + (adzenys_xr_odt_inadequate ? 1 : 0) + (adzenys_er_inadequate ? 1 : 0) + (dextroamphetamine_inadequate ? 1 : 0) + (dyanavel_xr_inadequate ? 1 : 0) + (evekeo_odt_inadequate ? 1 : 0) + (mydayis_inadequate ? 1 : 0) + (vyvanse_inadequate ? 1 : 0) >= 2"},{"unsuccessful_ped_meth_response":"(aptensio_xr_inadequate ? 1 : 0) + (concerta_inadequate ? 1 : 0) + (cotempla_xr_odt_inadequate ? 1 : 0) + (daytrana_patch_inadequate ? 1 : 0) + (focalin_inadequate ? 1 : 0) + (focalin_xr_inadequate ? 1 : 0) + (jornay_pm_inadequate ? 1 : 0) + (metadate_cd_inadequate ? 1 : 0) + (methylin_inadequate ? 1 : 0) + (procentra_inadequate ? 1 : 0) + (quillichew_er_inadequate ? 1 : 0) + (quillivant_xr_inadequate ? 1 : 0) + (ritalin_inadequate ? 1 : 0) + (ritalin_la_inadequate ? 1 : 0) >= 1","unsuccessful_ped_meth_response_2":"(aptensio_xr_inadequate ? 1 : 0) + (concerta_inadequate ? 1 : 0) + (cotempla_xr_odt_inadequate ? 1 : 0) + (daytrana_patch_inadequate ? 1 : 0) + (focalin_inadequate ? 1 : 0) + (focalin_xr_inadequate ? 1 : 0) + (jornay_pm_inadequate ? 1 : 0) + (metadate_cd_inadequate ? 1 : 0) + (methylin_inadequate ? 1 : 0) + (procentra_inadequate ? 1 : 0) + (quillichew_er_inadequate ? 1 : 0) + (quillivant_xr_inadequate ? 1 : 0) + (ritalin_inadequate ? 1 : 0) + (ritalin_la_inadequate ? 1 : 0)  >= 2"},{},{"partial_meth_response":"(aptensio_xr_partial ? 1 : 0) + (concerta_partial ? 1 : 0) + (cotempla_xr_odt_partial ? 1 : 0) + (daytrana_patch_partial ? 1 : 0) + (focalin_partial ? 1 : 0) + (focalin_xr_partial ? 1 : 0) + (jornay_pm_partial ? 1 : 0) + (metadate_cd_partial ? 1 : 0) + (methylin_partial ? 1 : 0) + (procentra_partial ? 1 : 0) + (quillichew_er_partial ? 1 : 0) + (quillivant_xr_partial ? 1 : 0) + (ritalin_partial ? 1 : 0) + (ritalin_la_partial ? 1 : 0) + (other_methylphenidates_partial ? 1 : 0) >= 1","partial_amp_response":"(adderall_partial ? 1 : 0) + (adderall_xr_partial ? 1 : 0) + (adzenys_xr_odt_partial ? 1 : 0) + (adzenys_er_partial ? 1 : 0) + (dextroamphetamine_partial ? 1 : 0) + (dyanavel_xr_partial ? 1 : 0) + (evekeo_odt_partial ? 1 : 0) + (mydayis_partial ? 1 : 0) + (vyvanse_partial ? 1 : 0) + (other_amphetamines_partial ? 1 : 0) >= 1"},{"successful_nonstim_meds":"(atomoxetine_current == \'current\' && atomoxetine_successful === true) || (bupropion_current == \'current\' && bupropion_successful === true) || (clonidine_xr_current == \'current\' && clonidine_xr_successful === true) || (guanfacine_er_current == \'current\' && guanfacine_er_successful === true) || (atomoxetine_current == \'prior\' && atomoxetine_successful === true) || (bupropion_current == \'prior\' && bupropion_successful === true) || (clonidine_xr_current == \'prior\' && clonidine_xr_successful === true) || (guanfacine_er_current == \'prior\' && guanfacine_er_successful === true)"},{"successful_meds":"(other_methylphenidates_current == \'current\' && other_methylphenidates_successful === true) || (other_amphetamines_current == \'current\' && other_amphetamines_successful === true) || (adderall_current == \'current\' && adderall_successful === true) || (adderall_xr_current == \'current\' && adderall_xr_successful === true) || (adzenys_xr_odt_current == \'current\' && adzenys_xr_odt_successful === true) || (adzenys_er_current == \'current\' && adzenys_er_successful === true) || (dextroamphetamine_current == \'current\' && dextroamphetamine_successful === true) || (dyanavel_xr_current == \'current\' && dyanavel_xr_successful === true) || (evekeo_odt_current == \'current\' && evekeo_odt_successful === true) || (mydayis_current == \'current\' && mydayis_successful === true) || (vyvanse_current == \'current\' && vyvanse_successful === true) || (aptensio_xr_current == \'current\' && aptensio_xr_successful === true) || (concerta_current == \'current\' && concerta_successful === true) || (cotempla_xr_odt_current == \'current\' && cotempla_xr_odt_successful === true) || (daytrana_patch_current == \'current\' && daytrana_patch_successful === true) || (focalin_current == \'current\' && focalin_successful === true) || (focalin_xr_current == \'current\' && focalin_xr_successful === true) || (jornay_pm_current == \'current\' && jornay_pm_successful === true) || (metadate_cd_current == \'current\' && metadate_cd_successful === true) || (methylin_current == \'current\' && methylin_successful === true) || (procentra_current == \'current\' && procentra_successful === true) || (quillichew_er_current == \'current\' && quillichew_er_successful === true) || (quillivant_xr_current == \'current\' && quillivant_xr_successful === true) || (ritalin_current == \'current\' && ritalin_successful === true) || (ritalin_la_current == \'current\' && ritalin_la_successful === true) || (atomoxetine_current == \'current\' && atomoxetine_successful === true) || (bupropion_current == \'current\' && bupropion_successful === true) || (clonidine_xr_current == \'current\' && clonidine_xr_successful === true) || (guanfacine_er_current == \'current\' && guanfacine_er_successful === true)","prior_successful_meds":"(other_methylphenidates_current == \'prior\' && other_methylphenidates_successful === true) || (other_amphetamines_current == \'prior\' && other_amphetamines_successful === true) || (adderall_current == \'prior\' && adderall_successful === true) || (adderall_xr_current == \'prior\' && adderall_xr_successful === true) || (adzenys_xr_odt_current == \'prior\' && adzenys_xr_odt_successful === true) || (adzenys_er_current == \'prior\' && adzenys_er_successful === true) || (dextroamphetamine_current == \'prior\' && dextroamphetamine_successful === true) || (dyanavel_xr_current == \'prior\' && dyanavel_xr_successful === true) || (evekeo_odt_current == \'prior\' && evekeo_odt_successful === true) || (mydayis_current == \'prior\' && mydayis_successful === true) || (vyvanse_current == \'prior\' && vyvanse_successful === true) || (aptensio_xr_current == \'prior\' && aptensio_xr_successful === true) || (concerta_current == \'prior\' && concerta_successful === true) || (cotempla_xr_odt_current == \'prior\' && cotempla_xr_odt_successful === true) || (daytrana_patch_current == \'prior\' && daytrana_patch_successful === true) || (focalin_current == \'prior\' && focalin_successful === true) || (focalin_xr_current == \'prior\' && focalin_xr_successful === true) || (jornay_pm_current == \'prior\' && jornay_pm_successful === true) || (metadate_cd_current == \'prior\' && metadate_cd_successful === true) || (methylin_current == \'prior\' && methylin_successful === true) || (procentra_current == \'prior\' && procentra_successful === true) || (quillichew_er_current == \'prior\' && quillichew_er_successful === true) || (quillivant_xr_current == \'prior\' && quillivant_xr_successful === true) || (ritalin_current == \'prior\' && ritalin_successful === true) || (ritalin_la_current == \'prior\' && ritalin_la_successful === true) || (atomoxetine_current == \'prior\' && atomoxetine_successful === true) || (bupropion_current == \'prior\' && bupropion_successful === true) || (clonidine_xr_current == \'prior\' && clonidine_xr_successful === true) || (guanfacine_er_current == \'prior\' && guanfacine_er_successful === true)"},{"ped_history":"(is_comorbid == \'Personal history of syncope\') || (is_comorbid == \'Personal history of arrhythmias\') || (is_comorbid == \'Family with early sudden death or long-QT syndrome\')"}],"sections":[{"valid":"true","title":"ADHD Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":"Adequate pharmacotherapy trial: <br><br><b>Stimulants:</b><br> 1-2 weeks at maximum tolerable and recommended dose. <br><br><b>Nonstimulants:</b><br>Minimum 6 weeks at maximum tolerable and recommended dose. <br><br>Adequate response defined as \u226540% reduction in ADHD symptoms for pediatric or adolescents and \u226530% reduction for adults."},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat ADHD"}]},{"visible":"medication_history === \'Yes\' && is_comorbid != \'Psychosis\' &&  is_comorbid_sub != \'Independent of ADHD\' &&  fam_history != \'Yes\' &&  is_comorbid != \'Personal history of syncope or arrhythmias\' &&  is_comorbid != \'Family with early sudden death or long-QT syndrome\' &&  is_comorbid_sub != \'Actively using amphetamine or cocaine\' &&  is_comorbid != \'Family history of sudden cardiac death\' &&  ped_type != \'Mild/Moderate\'","type":"title","text":[{"visible":"true","text":"Amphetamines"}]},{"visible":"medication_history === \'Yes\' && is_comorbid != \'Psychosis\' && is_comorbid_sub != \'Independent of ADHD\' && comorbidities != \'hepatic\' && patient_age != \'Geriatric\' && fam_history != \'Yes\' && is_comorbid != \'Personal history of syncope or arrhythmias\' && is_comorbid != \'Family with early sudden death or long-QT syndrome\' && is_comorbid_sub != \'Actively using amphetamine or cocaine\' && is_comorbid != \'Family history of sudden cardiac death\' && ped_type != \'Mild/Moderate\'","id":"medication_adderall","text":"Adderall","type":"switch","groups":[{"visible":"medication_adderall","id":"adderall_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_adderall && adderall_current === \'current\' && !((ped_age != \'No\' && patient_age != \'Adolescent\'))","id":"adderall_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_adderall && adderall_current === \'prior\' || medication_adderall && adderall_current === \'current\' && (ped_age != \'No\' && patient_age != \'Adolescent\')","id":"adderall_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful 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\'Yes\') && (comorbidities === \'renal\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd--obesity_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd--obesity_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd--obesity_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd--obesity_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Weigh risks and benefits of stimulants and consider use of nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (nonstim_success === true) && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (nonstim_success === true) && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Use nonstimulant or long-acting stimulant cautiously; Consider Vyvanse. See corresponding decision support tool if applicable","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Pediatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Personal history of epilepsy with adequate control\'","uid":"G_7","type":"overlay","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall"],"priority":"false"},{"visible":"is_comorbid == \'Tics\'","uid":"G_8","type":"overlay","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall","Atomoxetine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Mild\') && (prior_successful_meds === true) && (patient_age === \'Pediatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available).<br><br>If psychotherapy unsuccessful, restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Personal history of epilepsy with adequate control\'","uid":"G_7","type":"overlay","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall"],"priority":"false"},{"visible":"is_comorbid == \'Tics\'","uid":"G_8","type":"overlay","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall","Atomoxetine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (prior_successful_meds === true) && (patient_age === \'Pediatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available).<br><br>If psychotherapy unsuccessful, restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Personal history of epilepsy with adequate control\'","uid":"G_7","type":"overlay","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall"],"priority":"false"},{"visible":"is_comorbid == \'Tics\'","uid":"G_8","type":"overlay","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall","Atomoxetine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Pediatric\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Personal history of epilepsy with adequate control\'","uid":"G_7","type":"overlay","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall"],"priority":"false"},{"visible":"is_comorbid == \'Tics\'","uid":"G_8","type":"overlay","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall","Atomoxetine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Personal history of epilepsy with adequate control\'","uid":"G_7","type":"overlay","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall"],"priority":"false"},{"visible":"is_comorbid == \'Tics\'","uid":"G_8","type":"overlay","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall","Atomoxetine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (ped_type === \'Mild\') && (prior_successful_meds === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available).<br><br>If psychotherapy unsuccessful, restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Personal history of epilepsy with adequate control\'","uid":"G_7","type":"overlay","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall"],"priority":"false"},{"visible":"is_comorbid == \'Tics\'","uid":"G_8","type":"overlay","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall","Atomoxetine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (ped_type === \'Mild/Moderate\') && (prior_successful_meds === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available).<br><br>If psychotherapy unsuccessful, restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Personal history of epilepsy with adequate control\'","uid":"G_7","type":"overlay","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall"],"priority":"false"},{"visible":"is_comorbid == \'Tics\'","uid":"G_8","type":"overlay","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall","Atomoxetine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Personal history of epilepsy with adequate control\'","uid":"G_7","type":"overlay","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall"],"priority":"false"},{"visible":"is_comorbid == \'Tics\'","uid":"G_8","type":"overlay","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":["Ritalin","Focalin","Metadate CD","Ritalin LA","Focalin XR","Concerta","Quillivant XR","Jornay PM","Daytrana","Clonidine","Guanfacine ER","Vyvanse","Adderall XR","Adderall","Atomoxetine"],"priority":"false"}]},{"valid":"(consult_fam === \'No\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a2"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"Consult with cardiology prior to treatment","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Yes\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a2"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"Not a candidate for either either stimulants or nonstimulants","meds":[],"therapies":[]}]},{"valid":"(consult_rem === \'No\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a2"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"Consultation with cardiology before starting any phamacotherapy","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'No\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a3"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a3"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a8"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. 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Atomoxetine","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a5"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"6.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a5"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"5.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a5"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"6.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'No\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a3"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms&#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a3"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms&#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"8.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a8"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"9.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a4"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a10"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Psychosis\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a6"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>Psychosis:</b><br>Avoid stimulants and treat psychosis","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using amphetamine or cocaine\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Avoid stimulants<br><br>Consider nonstimulants","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'No\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br><br>","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"13.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br><br>","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"14.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br><br>","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"15.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"16","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"16","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a10"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'No\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"17","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"<b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"17.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"18","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"<b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"18.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"19","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"<b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice:</b><br><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"19.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a9"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"21","state":"recommendation","branch":"ADHD","figure":["adhd-cardiac_a10"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation if available","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'No\') && (patient_age === \'Geriatric\')","title":"","uid":"21","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a2"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"22","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a2"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Geriatric\')","title":"","uid":"23","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a8"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Try another stimulant from an alternate class including amphetamine salts (after risk benefit and shared decision making discussion):</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (bupropion_inadequate === false) && (patient_age === \'Geriatric\')","title":"","uid":"24","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a7"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (bupropion_inadequate === true) && (patient_age === \'Geriatric\')","title":"","uid":"24","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a10"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (patient_age === \'Geriatric\')","title":"","uid":"25","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a4"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"25.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"25.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"25.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (patient_age === \'Geriatric\')","title":"","uid":"26","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a4"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"26.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"26.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"26.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (patient_age === \'Geriatric\')","title":"","uid":"25","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a4"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"25.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"25.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"25.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (patient_age === \'Geriatric\')","title":"","uid":"26","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a4"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"26.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"26.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"26.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'No\') && (patient_age === \'Geriatric\')","title":"","uid":"27","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a2"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice:</b><br><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"28","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a2"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice:</b><br><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Geriatric\')","title":"","uid":"29","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a8"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Try another stimulant from an alternate class including amphetamine salts (after risk benefit and shared decision making discussion):</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (bupropion_inadequate === false) && (patient_age === \'Geriatric\')","title":"","uid":"30","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a7"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (bupropion_inadequate === true) && (patient_age === \'Geriatric\')","title":"","uid":"30","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a10"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Psychosis\') && (patient_age === \'Geriatric\')","title":"","uid":"31","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a5"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"<b>Psychosis:</b><br>Avoid stimulants and treat psychosis","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using amphetamine or cocaine\') && (patient_age === \'Geriatric\')","title":"","uid":"32","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Avoid stimulants<br><br>Consider nonstimulants<br><br>(Bupropion not FDA approved)","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'No\') && (patient_age === \'Geriatric\')","title":"","uid":"33","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice:</b><br><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"34","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice:</b><br><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Geriatric\')","title":"","uid":"35","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>Try another stimulant from an alternate class including amphetamine salts (after risk benefit and shared decision making discussion):</b><br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (bupropion_inadequate === false) && (patient_age === \'Geriatric\')","title":"","uid":"36","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (bupropion_inadequate === true) && (patient_age === \'Geriatric\')","title":"","uid":"36","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a10"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'No\') && (patient_age === \'Geriatric\')","title":"","uid":"37","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously.<br><br><b>First Choice:</b><br><br><b>Start a Methylphenidate</b><br><br>OR<br><br>Start Non-stimulant:Consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"38","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously.<br><br><b>First Choice:</b><br><br><b>Start a Methylphenidate</b><br><br>OR<br><br>Start Non-stimulant:Consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Geriatric\')","title":"","uid":"39","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously.<br><br><b>Try another stimulant from an alternate class including amphetamine salts (after risk benefit and shared decision making discussion):</b><br><b>Start a Methylphenidate</b><br><br>OR<br><br>Start Non-stimulant:<br>Consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (bupropion_inadequate === false) && (patient_age === \'Geriatric\')","title":"","uid":"40","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a9"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b>Consider Bupropion (not FDA approved)","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(bupropion_inadequate === true) && (patient_age === \'Geriatric\')","title":"","uid":"41","state":"recommendation","branch":"ADHD","figure":["adhd-geriatric_a10"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation if available","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a2"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. 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Atomoxetine<br>2. 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Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a3"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a7"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a10"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a4"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"46.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"46.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"46.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a4"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"47.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"47.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"47.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a4"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"46.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"46.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"46.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a4"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"47.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"47.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"47.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"48","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a2"],"content":[{"visible":true,"uid":"48.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"49","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a2"],"content":[{"visible":true,"uid":"49.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"50","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a8"],"content":[{"visible":true,"uid":"50.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Try another stimulant:</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a3"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a7"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a10"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Psychosis\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"52","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a5"],"content":[{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"<b>Psychosis:</b><br>Avoid stimulants and treat psychosis","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using amphetamine or cocaine\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"53","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"53.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Avoid stimulants<br><br>Consider nonstimulants<br><br>(Bupropion not FDA approved)","meds":["Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"54","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"55","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"56","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>Try another stimulant:</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a10"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"58","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously.<br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br>OR<br><br>Start Non-stimulant:Consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously.<br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br>OR<br><br>Start Non-stimulant:Consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously.<br><br><b>Try another stimulant:</b><br><br><b>First Choice: Stimulants</b><br><b>Start a Methylphenidate or Vyvanse</b><br><br>OR<br><br>Start Non-stimulant:<br>Consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"61","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"61.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"61","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a9"],"content":[{"visible":true,"uid":"61.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"62","state":"recommendation","branch":"ADHD","figure":["adhd-hepatic_a10"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation if available","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'No\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"63","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a2"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"63.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"64","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a2"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. 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Atomoxetine<br>2. 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Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"68.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"68.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"69","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a4"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"69.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"69.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"69.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"68","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a4"],"content":[{"visible":true,"uid":"68.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"68.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"68.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"68.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"69","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a4"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"69.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"69.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"69.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'No\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"70","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a2"],"content":[{"visible":true,"uid":"70.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"70.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"71","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a2"],"content":[{"visible":true,"uid":"71.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"71.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"72","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a8"],"content":[{"visible":true,"uid":"72.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"72.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"73","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a3"],"content":[{"visible":true,"uid":"73.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"74","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a7"],"content":[{"visible":true,"uid":"74.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"74","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a10"],"content":[{"visible":true,"uid":"74.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Psychosis\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"75","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a5"],"content":[{"visible":true,"uid":"75.0","type":"overlay","title":"Recommendation","text":"<b>Psychosis:</b><br>Avoid stimulants and treat psychosis","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using amphetamine or cocaine\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"76","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"76.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Avoid stimulants<br><br>Consider nonstimulants<br><br>(Bupropion not FDA approved)","meds":["Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'No\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"79","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"79.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"79.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"80","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"80.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. 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Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"81.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"82","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"82.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a10"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'No\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"84","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"84.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br>OR<br><br>Start Non-stimulant:<br>Atomoxetine or consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"84.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"85","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"85.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br>OR<br><br>Start Non-stimulant:<br>Atomoxetine or consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"85.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"86","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"86.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice:</b><br><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br>OR<br><br>Start Non-stimulant:<br>Atomoxetine or consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"86.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"87","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"87.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"88","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a9"],"content":[{"visible":true,"uid":"88.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"89","state":"recommendation","branch":"ADHD","figure":["adhd-obesity_a10"],"content":[{"visible":true,"uid":"89.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation if available","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"90","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a2"],"content":[{"visible":true,"uid":"90.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"90.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"91","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a2"],"content":[{"visible":true,"uid":"91.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"91.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"92","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a8"],"content":[{"visible":true,"uid":"92.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"92.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"93","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a3"],"content":[{"visible":true,"uid":"93.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a7"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a10"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a4"],"content":[{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"95.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"95.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"95.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"96","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a4"],"content":[{"visible":true,"uid":"96.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"96.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"96.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"96.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a4"],"content":[{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"95.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"95.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"95.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"96","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a4"],"content":[{"visible":true,"uid":"96.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"96.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"96.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"96.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: </b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"97","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a2"],"content":[{"visible":true,"uid":"97.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"97.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"98","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a2"],"content":[{"visible":true,"uid":"98.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"98.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"99","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a8"],"content":[{"visible":true,"uid":"99.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"99.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"100","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a3"],"content":[{"visible":true,"uid":"100.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a7"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms &#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a10"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Psychosis\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"102","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a5"],"content":[{"visible":true,"uid":"102.0","type":"overlay","title":"Recommendation","text":"<b>Psychosis:</b><br>Avoid stimulants and treat psychosis","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using amphetamine or cocaine\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"103","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"103.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Avoid stimulants<br><br>Consider nonstimulants<br><br>(Bupropion not FDA approved)","meds":["Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"106","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"106.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"106.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"107","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"107.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"107.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"108","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"108.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"108.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"109","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"109.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"110","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"110.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"110","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a10"],"content":[{"visible":true,"uid":"110.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"111","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"111.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>Atomoxetine or consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Concerta","Daytrana","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"111.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"112","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"112.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>Atomoxetine or consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Concerta","Daytrana","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"112.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"113","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"113.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>Atomoxetine or consider Bupropion (not FDA approved)","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Vyvanse","<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Concerta","Daytrana","<b>Non Stimulants</b>","Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"113.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"114","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"114.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice:</b><br>Start Atomoxetine<br><br>","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"115","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a9"],"content":[{"visible":true,"uid":"115.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion (not FDA approved)<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"116","state":"recommendation","branch":"ADHD","figure":["adhd-renal_a10"],"content":[{"visible":true,"uid":"116.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation if available","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"117","state":"recommendation","branch":"ADHD","figure":["adhd_a2"],"content":[{"visible":true,"uid":"117.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants (SOR A)</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"117.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"118","state":"recommendation","branch":"ADHD","figure":["adhd_a2"],"content":[{"visible":true,"uid":"118.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"118.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"119","state":"recommendation","branch":"ADHD","figure":["adhd_a8"],"content":[{"visible":true,"uid":"119.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"119.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"120","state":"recommendation","branch":"ADHD","figure":["adhd_a4"],"content":[{"visible":true,"uid":"120.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice: (SOR A)</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"121","state":"recommendation","branch":"ADHD","figure":["adhd_a5"],"content":[{"visible":true,"uid":"121.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"121","state":"recommendation","branch":"ADHD","figure":["adhd_a10"],"content":[{"visible":true,"uid":"121.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"122","state":"recommendation","branch":"ADHD","figure":["adhd_a6"],"content":[{"visible":true,"uid":"122.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"122.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"122.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"122.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD:</b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Anxiety\') && (is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"123","state":"recommendation","branch":"ADHD","figure":["adhd_a6"],"content":[{"visible":true,"uid":"123.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Anxiety concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"123.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"123.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"123.3","type":"overlay","title":"Recommendation","text":"<b>Anxiety symptoms&#x2022; Independent of ADHD:</b><br>See corresponding decision support tool","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"122","state":"recommendation","branch":"ADHD","figure":["adhd_a6"],"content":[{"visible":true,"uid":"122.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"122.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"122.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"122.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: (SOR A)</b><br>See corresponding decision support tool<br>Consider bupropion for the treatment of MDD (only without comorbid anxiety)","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Independent of ADHD\') && (medication_history === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"123","state":"recommendation","branch":"ADHD","figure":["adhd_a6"],"content":[{"visible":true,"uid":"123.0","type":"overlay","title":"Recommendation","text":"Treat ADHD and Depression concurrently","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"123.1","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"123.2","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"123.3","type":"overlay","title":"Recommendation","text":"<b>Depressive symptoms&#x2022; Independent of ADHD: (SOR A)</b><br>See corresponding decision support tool<br>Consider bupropion for the treatment of MDD (only without comorbid anxiety)","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"124","state":"recommendation","branch":"ADHD","figure":["adhd_a2"],"content":[{"visible":true,"uid":"124.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms&#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"124.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"125","state":"recommendation","branch":"ADHD","figure":["adhd_a2"],"content":[{"visible":true,"uid":"125.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms&#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"125.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"126","state":"recommendation","branch":"ADHD","figure":["adhd_a8"],"content":[{"visible":true,"uid":"126.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms&#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine (SOR A)<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"126.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates (SOR A)<br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"127","state":"recommendation","branch":"ADHD","figure":["adhd_a4"],"content":[{"visible":true,"uid":"127.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms&#x2022; Secondary to ADHD:</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br><b>Second Choice: (SOR A)</b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"128","state":"recommendation","branch":"ADHD","figure":["adhd_a5"],"content":[{"visible":true,"uid":"128.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Depressive or anxious symptoms&#x2022; Secondary to ADHD: (SOR A)</b> Treat ADHD and re-evaluate depressive or anxiety symptoms<br><br>Consider Bupropion<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Secondary to ADHD\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"128","state":"recommendation","branch":"ADHD","figure":["adhd_a10"],"content":[{"visible":true,"uid":"128.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Psychosis\') && (patient_age === \'Adult\')","title":"","uid":"129","state":"recommendation","branch":"ADHD","figure":["adhd_a7"],"content":[{"visible":true,"uid":"129.0","type":"overlay","title":"Recommendation","text":"<b>Psychosis:</b><br>Avoid stimulants and treat psychosis","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using amphetamine or cocaine\') && (patient_age === \'Adult\')","title":"","uid":"130","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"130.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Avoid stimulants<br><br>Consider nonstimulants","meds":["Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"133","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"133.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"133.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates <br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"134","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"134.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates <br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"135","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"135.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Weigh risks and benefits of stimulants<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"135.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates <br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"136","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"136.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice: </b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"137","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"137.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Actively using other substances\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"137","state":"recommendation","branch":"ADHD","figure":["adhd_a10"],"content":[{"visible":true,"uid":"137.0","type":"overlay","title":"Recommendation","text":"Recommend psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"138","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"138.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"138.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates <br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (patient_age === \'Adult\')","title":"","uid":"139","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"139.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"139.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates <br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"140","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"140.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Substance use disorder:</b><br>Use nonstimulant or long-acting stimulant cautiously. Consider Vyvanse.<br><br><b>Try another stimulant from an alternate class:</b><br><br><b>First Choice: Stimulants</b><br><b>Start an Amphetamine Salt</b><br>OR<br><b>Start a Methylphenidate</b><br><br><b>Second Choice:</b><br><br><b>Start Nonstimulant:</b><br>1. Atomoxetine<br>2. Bupropion","meds":["<b>Amphetamine Salts</b>","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"140.1","type":"overlay","title":"Recommendation","text":"Amphetamine salts are more effective than other stimulants and should be considered preferentially, particularly over methylphenidates <br><br>Medium to long-acting stimulants generally preferred for adults","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"141","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"141.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br><b>Second Choice: </b><br>Start Atomoxetine","meds":["Atomoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"142","state":"recommendation","branch":"ADHD","figure":["adhd_a9"],"content":[{"visible":true,"uid":"142.0","type":"overlay","title":"Recommendation","text":"<b>Combination pharmacotherapy and psychotherapy</b><br><br>Consider Bupropion<br><br>If unsuccessful, recommend psychiatry consultation","meds":["Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid_sub === \'Remote\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (atomoxetine_inadequate === true) && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"143","state":"recommendation","branch":"ADHD","figure":["adhd_a10"],"content":[{"visible":true,"uid":"143.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation if available","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (patient_age === \'Pediatric\')","title":"","uid":"117","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a5"],"content":[{"visible":true,"uid":"117.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"118","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a5"],"content":[{"visible":true,"uid":"118.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"118.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; If psychotherapy unsuccessful, consider pharmacotherapy<br><br>&#x2022; Shorter acting stimulants generally preferred in preschool age<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>&#x2022; Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"118.2","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"118","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"118.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"118.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"118.2","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"118","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"118.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"118.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. 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Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; Reevaluate diagnosis and consider alternate option:<br><pre>     - Trial of stimulant (of class not previously trialed if applicable)<br>     - Trial of nonstimulant<br>     - Psychiatry referral</pre>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"133.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (nonstim_ped_response === true) && (patient_age === \'Pediatric\')","title":"","uid":"134","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or alpha 2 agonist<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (alpha_ped_response === true) && (patient_age === \'Pediatric\')","title":"","uid":"134","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (stim_ped_response === true) && (patient_age === \'Pediatric\')","title":"","uid":"134","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>-Switch to different class of stimulants, or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"134.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'No\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (patient_age === \'Pediatric\')","title":"","uid":"135","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a5"],"content":[{"visible":true,"uid":"135.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"135.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"135.2","type":"overlay","title":"Recommendation","text":"If psychotherapy unsuccessful, consider pharmacotherapy<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"135.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"136","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a5"],"content":[{"visible":true,"uid":"136.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.2","type":"overlay","title":"Recommendation","text":"If psychotherapy unsuccessful, consider pharmacotherapy<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"136","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"136.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"136","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"136.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Mild/Moderate\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"136","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"136.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; Reevaluate diagnosis and consider alternate option:<br><pre>     - Trial of stimulant (of class not previously trialed if applicable)<br>     - Trial of nonstimulant<br>     - Psychiatry referral</pre>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"136.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'No\') && (ped_age === \'Yes\') && (ped_type === \'Severe\') && (patient_age === \'Pediatric\')","title":"","uid":"137","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"137.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"137.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"137.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Shorter acting stimulants generally preferred in preschool age<br><br>All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"137.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Severe\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"138","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"138.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"138.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"138.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Shorter acting stimulants generally preferred in preschool age<br><br>All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"138.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'Yes\') && (ped_type === \'Severe\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"138","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"138.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"138.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"138.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. 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Stimulant preferred. 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Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; Reevaluate diagnosis and consider alternate option:<br><pre>     - Trial of stimulant (of class not previously trialed if applicable)<br>     - Trial of nonstimulant<br>     - Psychiatry referral</pre>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"138.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'No\') && (ped_age === \'No\') && (ped_type === \'Mild\') && (patient_age === \'Pediatric\')","title":"","uid":"139","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a5"],"content":[{"visible":true,"uid":"139.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"139.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"139.2","type":"overlay","title":"Recommendation","text":"If psychotherapy unsuccessful, consider pharmacotherapy<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"139.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Mild\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"140","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a5"],"content":[{"visible":true,"uid":"140.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.2","type":"overlay","title":"Recommendation","text":"If psychotherapy unsuccessful, consider pharmacotherapy<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Mild\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"140","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"140.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Mild\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"140","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"140.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Mild\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"140","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"140.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; Reevaluate diagnosis and consider alternate option:<br><pre>     - Trial of stimulant (of class not previously trialed if applicable)<br>     - Trial of nonstimulant<br>     - Psychiatry referral</pre>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"140.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'No\') && (ped_age === \'No\') && (ped_type === \'Moderate/Severe\') && (patient_age === \'Pediatric\')","title":"","uid":"141","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"141.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"141.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"141.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>&#x2022; Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"141.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"142","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"142.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>&#x2022; Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"142","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"142.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"142","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a2"],"content":[{"visible":true,"uid":"142.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_age === \'No\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Pediatric\')","title":"","uid":"142","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"142.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; Reevaluate diagnosis and consider alternate option:<br><pre>     - Trial of stimulant (of class not previously trialed if applicable)<br>     - Trial of nonstimulant<br>     - Psychiatry referral</pre>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"142.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (nonstim_ped_response === true) && (patient_age === \'Pediatric\')","title":"","uid":"143","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"143.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or alpha 2 agonist<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (alpha_ped_response === true) && (patient_age === \'Pediatric\')","title":"","uid":"143","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"143.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (stim_ped_response === true) && (patient_age === \'Pediatric\')","title":"","uid":"143","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a3"],"content":[{"visible":true,"uid":"143.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Shorter acting stimulants generally preferred in preschool age<br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents<br><br>Adequate treatment response: &#x2265;40% symptom reduction","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>-Switch to different class of stimulants, or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"143.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If &gt;95%, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of syncope or arrhythmias\') && (patient_age === \'Pediatric\')","title":"","uid":"144","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a4"],"content":[{"visible":true,"uid":"144.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"144.1","type":"overlay","title":"Recommendation","text":"Consult cardiology prior to utilizing pharmacotherapy","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Family with early sudden death or long-QT syndrome\') && (patient_age === \'Pediatric\')","title":"","uid":"145","state":"recommendation","branch":"ADHD","figure":["adhd-Pediatric_a4"],"content":[{"visible":true,"uid":"145.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Behavioral Modification, parent training, and school-based interventions (if available)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"145.1","type":"overlay","title":"Recommendation","text":"Consult cardiology prior to utilizing pharmacotherapy","meds":[],"therapies":[]}]},{"valid":"(ped_type === \'Mild\') && (patient_age === \'Adolescent\')","title":"","uid":"117","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a5"],"content":[{"visible":true,"uid":"117.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend behavioral interventions (e.g., CBT)","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'No\') && (ped_type === \'Moderate/Severe\') && (patient_age === \'Adolescent\')","title":"","uid":"123","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"123.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"123.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>&#x2022; Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"123.2","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"124","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"124.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"124.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>&#x2022; Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"124.2","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"125","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"125.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"125.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"125.2","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"126","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"126.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"126.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"126.2","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"127","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"127.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"127.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; Reevaluate diagnosis and consider alternate option:<br><pre>     - Trial of stimulant (of class not previously trialed if applicable)<br>     - Trial of nonstimulant<br>     - Psychiatry referral</pre>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"127.2","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (nonstim_ped_response === true) && (patient_age === \'Adolescent\')","title":"","uid":"125","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"125.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"125.1","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or alpha 2 agonist<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"125.2","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (alpha_ped_response === true) && (patient_age === \'Adolescent\')","title":"","uid":"125","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"125.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"125.1","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"125.2","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'None\') && (medication_history === \'Yes\') && (stim_ped_response === true) && (patient_age === \'Adolescent\')","title":"","uid":"125","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"125.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"125.1","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>-Switch to different class of stimulants, or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"125.2","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'No\') && (ped_type === \'Moderate/Severe\') && (patient_age === \'Adolescent\')","title":"","uid":"132","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"132.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"132.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"132.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>&#x2022; Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"132.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"133","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"133.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>&#x2022; Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"133","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"133.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"133","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"133.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; If continued unsuccessful response, transition to alternate pharmacotherapy. Stimulant preferred. (E.g., If currently on methylphenidate, transition to amphetamine salt.)<br>&#x2022; Nonstimulants reasonable alternative based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === true) && (unsuccessful_ped_meth_response === true) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"133","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"133.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; Reevaluate diagnosis and consider alternate option:<br><pre>     - Trial of stimulant (of class not previously trialed if applicable)<br>     - Trial of nonstimulant<br>     - Psychiatry referral</pre>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"133.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (nonstim_ped_response === true) && (patient_age === \'Adolescent\')","title":"","uid":"134","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or alpha 2 agonist<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (alpha_ped_response === true) && (patient_age === \'Adolescent\')","title":"","uid":"134","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of epilepsy with adequate control\') && (medication_history === \'Yes\') && (stim_ped_response === true) && (patient_age === \'Adolescent\')","title":"","uid":"134","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.1","type":"overlay","title":"Recommendation","text":"<b>Seizure disorder present:</b><br>Consider cautious introduction of medication with close monitoring","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>-Switch to different class of stimulants, or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"134.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'No\') && (ped_type === \'Moderate/Severe\') && (patient_age === \'Adolescent\')","title":"","uid":"141","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"141.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"141.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"141.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. (Lancet Psychiatry. 2018)<br><br>&#x2022; Adequate treatment response: &#x2265;40% symptom reduction<br><br>Nonstimulants may be considered first choice based on clinical judgment and patient/family preference","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"141.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (ped_type === \'Moderate/Severe\') && (unsuccessful_ped_am_response === false) && (unsuccessful_ped_meth_response === false) && (partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"142","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a2"],"content":[{"visible":true,"uid":"142.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"142.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"142.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Combined psychotherapy and pharmacotherapy<br><br>&#x2022; Medium and long-acting stimulants generally preferred for most children and adolescents<br><br>&#x2022; All  things taken equally, consider methylphenidate as first choice in children and adolescents, based on meta-analysis data. 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(partial_ped_response === false) && (patient_age === \'Adolescent\')","title":"","uid":"142","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"142.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"142.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"142.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>&#x2022; Ensure appropriate dose titration / medication optimization: some individuals may require longer acting medication, or additional afternoon shorting acting dose<br>&#x2022; Reevaluate diagnosis and consider alternate option:<br><pre>     - Trial of stimulant (of class not previously trialed if applicable)<br>     - Trial of nonstimulant<br>     - Psychiatry referral</pre>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"142.3","type":"collapse","title":"Stimulant side effect management","text":"&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (nonstim_ped_response === true) && (patient_age === \'Adolescent\')","title":"","uid":"143","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"143.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"143.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Consider medium to long-acting stimulants<br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"143.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>- Augment with a stimulant or alpha 2 agonist<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"143.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, 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preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"143.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Tics\') && (medication_history === \'Yes\') && (stim_ped_response === true) && (patient_age === \'Adolescent\')","title":"","uid":"143","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a3"],"content":[{"visible":true,"uid":"143.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":["<b>Amphetamine Salts</b>","<i>Short Acting (4-6 hrs)</i>","Adderall","Evekeo ODT","ProCentra","<i>Medium Acting (6-8 hrs)</i>","Dexedrine Spansules","<i>Long Acting (8-10 hrs)</i>","Adderall XR","Adzenys XR-ODT","Adzenys ER","Dyanavel XR","Mydayis","Vyvanse","<b>Methylphenidate</b>","<i>Short Acting (4-6 hrs)</i>","Focalin","Ritalin","<i>Medium Acting (6-8 hrs)</i>","Metadate ER","<i>Long Acting (8-10 hrs)</i>","Aptensio XR","Concerta","Cotempla XR-ODT","Daytrana","Focalin XR","Jornay PM","Metadate CD","Quillichew ER","Quillivant XR","Ritalin LA","<b>Non Stimulants</b>","Atomoxetine","Viloxazine","Clonidine XR","Guanfacine ER"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"143.1","type":"overlay","title":"Recommendation","text":"<b>Tics</b><br><br><b>First line:</b><br>Consider nonstimulant / cautious use of stimulant if ineffective<br><br>Consider medium to long-acting stimulants<br>If considering stimulants: medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"143.2","type":"overlay","title":"Recommendation","text":"Titrate to maximum tolerable dose<br><br>If partial response (<40% symptom reduction) or intolerable dose titration side effects:<br>-Switch to different class of stimulants, or consider augmenting with nonstimulant<br><br>Medium and long-acting stimulants generally preferred for most children and adolescents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"143.3","type":"expand","title":"Recommendation","text":"<b>Stimulant side effects</b><br><br>&#x2022; Insomnia: Consider changing to shorter acting medication; consider clonidine<br>&#x2022; Weight loss: Ensure medication is given after breakfast; add nutritional supplement; consider changing to shorter acting medication<br>&#x2022; Elevated blood pressure: If 120/80, hold med & if BP normalizes, cautious reintroduction; if still elevated, work up for secondary hypertension and consider cardiology referral","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Personal history of syncope or arrhythmias\') && (patient_age === \'Adolescent\')","title":"","uid":"144","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a4"],"content":[{"visible":true,"uid":"144.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"144.1","type":"overlay","title":"Recommendation","text":"Consult cardiology prior to utilizing pharmacotherapy","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Family with early sudden death or long-QT syndrome\') && (patient_age === \'Adolescent\')","title":"","uid":"145","state":"recommendation","branch":"ADHD","figure":["adhd-Adolescent_a4"],"content":[{"visible":true,"uid":"145.0","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br><br>Recommend combination behavioral interventions (e.g, CBT) and pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"145.1","type":"overlay","title":"Recommendation","text":"Consult cardiology prior to utilizing pharmacotherapy","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"ADHD","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},4330:function(e){"use strict";e.exports=JSON.parse('{"variables":{"onset_stress":"","apnea_concern":"","is_comorbid":"","insomnia_type":"","medication_doxepin":false,"medication_trazodone":false,"medication_eszopiclone":false,"medication_zolpidem":false,"medication_zolpidem_er":false,"doxepin_current":false,"trazodone_current":false,"eszopiclone_current":false,"zolpidem_current":false,"zolpidem_er_current":false,"doxepin_successful":false,"trazodone_successful":false,"eszopiclone_successful":false,"zolpidem_successful":false,"zolpidem_er_successful":false,"onset_failed":false,"maintenance_failed":false,"successful_meds":false,"prior_successful_meds":false,"medication_history":"No","medCount":5},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : 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\'No\' && apnea_concern !== \'Yes\'","id":"medication_eszopiclone","text":"Eszopiclone","type":"switch","groups":[{"visible":"medication_eszopiclone","id":"eszopiclone_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_eszopiclone && eszopiclone_current === \'current\'","id":"eszopiclone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_eszopiclone && eszopiclone_current === \'prior\'","id":"eszopiclone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && onset_stress !== \'No\' && apnea_concern !== \'Yes\' && insomnia_type == \'Sleep-onset 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onset?"},{"id":"apnea_concern","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is there concern for sleep apnea or nocturnal hypoxia due to cardiopulmonary disease?"},{"id":"is_comorbid","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does patient have comorbid psychiatric disorder(s)?"},{"id":"insomnia_type","visible":"true","type":"radio","choices":"Sleep-onset insomnia, Sleep-maintenance insomnia","text":"Does the patient suffer from sleep-onset insomnia or sleep-maintenance insomnia?","groups":[{"id":"insomnia_type","type":"choice","choices":[{"text":"Sleep-onset insomnia","value":"Sleep-onset insomnia"},{"text":"Sleep-maintenance insomnia","value":"Sleep-maintenance insomnia"}]}]}]},{"valid":"(comorbidities === \'cardiac\') && (successful_meds === true)","title":"","uid":"0","state":"recommendation","branch":"Insomnia, 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<br>-See chronic insomnia decision support<br><br><b>Concern for OSA<b><br>-Refer for polysomnography prior to considering pharmacotherapy.","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-cardiac_i1"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br>Start Zolpidem or 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\'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-cardiac_i1"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"Reevaluate diagnosis and refer to chronic insomnia decision support if symptoms persist beyond three months","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (insomnia_type === \'Sleep-maintenance insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (maintenance_failed === true) && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Insomnia, 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stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'Yes\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"14","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Concern for OSA</b><br>-Refer for polysomnography prior to considering pharmacotherapy.","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'No\') && (apnea_concern === \'Yes\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"14","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Reevaluate Acute Insomnia Diagnosis</b><br>-Expand differential diagnosis <br>-See chronic insomnia decision support<br><br><b>Concern for OSA<b><br>-Refer for polysomnography prior to considering pharmacotherapy.","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"15","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br>Start Trazodone, Zolpidem, or Eszopiclone","meds":["Trazodone","Zolpidem","Eszopiclone"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (onset_failed === false) && (patient_age === \'Geriatric\')","title":"","uid":"16","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br>Start Trazodone, Zolpidem, or Eszopiclone","meds":["Trazodone","Zolpidem","Eszopiclone"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-maintenance insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"17","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br> Start Eszopiclone, Trazodone, Zolpidem ER, or Doxepin","meds":["Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-maintenance insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (maintenance_failed === false) && (patient_age === \'Geriatric\')","title":"","uid":"18","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br> Start Eszopiclone, Trazodone, Zolpidem ER, or Doxepin","meds":["Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'No\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"19","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"Start Trazodone, Zolpidem, or Eszopiclone","meds":["Trazodone","Zolpidem","Eszopiclone"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'No\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (onset_failed === false) && (patient_age === \'Geriatric\')","title":"","uid":"20","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Start Trazodone, Zolpidem, or Eszopiclone","meds":["Trazodone","Zolpidem","Eszopiclone"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'No\') && (insomnia_type === \'Sleep-maintenance insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"21","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Start Eszopiclone, Trazodone, Zolpidem ER, or Doxepin","meds":["Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'No\') && (insomnia_type === \'Sleep-maintenance 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&& (maintenance_failed === true) && (patient_age === \'Geriatric\')","title":"","uid":"24","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"Reevaluate diagnosis and refer to chronic insomnia decision support if symptoms persist beyond three months","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"25","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"<b>Reevaluate Acute Insomnia Diagnosis</b><br>-Expand differential diagnosis <br>-See chronic insomnia decision support","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"<b>Concern for OSA</b><br>-Refer for polysomnography prior to considering pharmacotherapy.","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'No\') && (apnea_concern === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"<b>Reevaluate Acute Insomnia Diagnosis</b><br>-Expand differential diagnosis <br>-See chronic insomnia decision support<br><br><b>Concern for OSA<b><br>-Refer for polysomnography prior to considering pharmacotherapy.","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br>Start Zolpidem or Eszopiclone","meds":["Zolpidem","Eszopiclone"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (onset_failed === false) && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br>Start Zolpidem or Eszopiclone","meds":["Zolpidem","Eszopiclone"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-maintenance insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br>Start Eszopiclone, Zolpidem ER, or Doxepin","meds":["Eszopiclone","Zolpidem ER","Doxepin"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'Yes\') && (insomnia_type === \'Sleep-maintenance insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (maintenance_failed === false) && (patient_age === \'Adult\')","title":"","uid":"30","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and insomnia concurrently (see appropriate decision support)<br><br>Start Eszopiclone, Zolpidem ER, or Doxepin","meds":["Eszopiclone","Zolpidem ER","Doxepin"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'No\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"Start Zolpidem or Eszopiclone","meds":["Zolpidem","Eszopiclone"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'No\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (onset_failed === false) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"Start Zolpidem or Eszopiclone","meds":["Zolpidem","Eszopiclone"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'No\') && (insomnia_type === \'Sleep-maintenance insomnia\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"Start Eszopiclone, Zolpidem ER, or Doxepin","meds":["Eszopiclone","Zolpidem ER","Doxepin"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (is_comorbid === \'No\') && (insomnia_type === \'Sleep-maintenance insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (maintenance_failed === false) && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"Start Eszopiclone, Zolpidem ER, or Doxepin","meds":["Eszopiclone","Zolpidem ER","Doxepin"],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"},{"visible":"true","uid":"G_6","type":"overlay","text":"Set expectations with patient that sedative hypnotics typically used 2-4 weeks then tapered","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (insomnia_type === \'Sleep-onset insomnia\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (onset_failed === true) && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"Reevaluate diagnosis and refer to chronic insomnia decision support if symptoms persist beyond three months","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'Yes\') && (apnea_concern === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (maintenance_failed === true) && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"Reevaluate diagnosis and refer to chronic insomnia decision support if symptoms persist beyond three months","meds":[],"therapies":[]},{"visible":"true","uid":"G_1","type":"overlay","text":"Review sleep hygiene and stimulus control along with other, appropriate nonpharmacologic treatments (SOR A)","meds":[],"priority":"false"}]},{"valid":"(onset_stress === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Insomnia, Acute","figure":["Acute-Insomnia-obesity_i1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<b>Reevaluate Acute Insomnia 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disorder</b><br><br>Treat comorbid psychiatric disorder concurrently<br>See corresponding decision support tool, avoid Bupropion/TCA\u2019s","meds":[],"priority":"false"}]},{"valid":"(phase === \'Active treatment\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Anorexia","figure":["anorexia_a3"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Active treatment:</b><br><br><b>Multidisciplinary Intervention:</b> Initial goal of treatment is weight gain<br>- Medical Evaluation of active treatment<br>- Psychotherapy<br>- Nutritional Rehabilitation","meds":["Olanzapine","Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy","Motivational Interviewing","Family based therapy","Cognitive Remediation"]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"collapse","title":"Medical evaluation of active treatment","text":"<b>Closely monitor for medical complications, especially refeeding syndrome:</b><br>-  Monitor vital signs, weight, BMI<br>- Weekly CMP, phosphorus, magnesium<br>- Target outpatient weight gain 0.2-0.5kg/wk<br>- Avoid rapid weight gain<br><br><b>Evaluate Response:</b><br><br>&#x2022; Successful weight gain resulting in BMI \u2265 18.5kg/m\xb2- transition to maintenance phase of care<br><br>&#x2022; Failure to gain weight despite nutritional rehabilitation and psychotherapy<br>- Consider referral to higher level of care<br>- Consider adding Olanzapine, if inadequate response consider Quetiapine<br><br>&#x2022; Weight \u2265 1.5kg/wk or electrolyte instability: assess with twice weekly CMP, phosphorus, and magnesium to monitor for refeeding syndrome and/or medical instability. If present consider hospitalization","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.2","type":"collapse","title":"Nutritional Rehabilitation","text":"- Monitoring<br>- Behavioral management<br>- Nutritional counseling","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>Comorbid psychiatric disorder</b><br><br>Treat comorbid psychiatric disorder concurrently<br>See corresponding decision support tool, avoid Bupropion/TCA\u2019s","meds":[],"priority":"false"}]},{"valid":"(phase === \'Maintenance (BMI \u2265 18.5kg/m\xb2)\') && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Anorexia","figure":["anorexia_a4"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Maintenance (BMI \u2265 18.5kg/m\xb2):</b><br><br><b>Consider continue multidisciplinary intervention as clinically appropriate.</b>","meds":[],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy","Motivational Interviewing","Family based therapy","Cognitive Remediation"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_7","type":"overlay","text":"<b>Reevaluate for remaining psychiatric disorder</b><br>- Treat comorbid psychiatric disorder concurrently<br>- See corresponding decision support tool, avoid Bupropion/TCA\u2019s","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\')","uid":"4.1","type":"collapse","title":"Nutritional Rehabilitation","text":"- Monitoring<br>- Behavioral management<br>- Nutritional counseling","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Anorexia","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},1562:function(e){"use strict";e.exports=JSON.parse('{"variables":{"is_effect":"","is_effect_sub":"","is_med_2":"","is_med_3":"","is_met_prior":"","is_met_during":"","is_met_sig":"","weight_gain":"","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","weight_gain":"((is_met_prior == \'Yes\') ? 1 : 0) + ((is_met_during == \'Yes\') ? 1 : 0) + ((is_met_sig == \'Yes\') ? 1 : 0) >= 1"}],"sections":[{"valid":"true","title":"Antipsychotic Management Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Antipsychotic Management"}]}]},{"valid":true,"title":"Antipsychotic Management","state":"intro","content":[{"id":"is_effect","visible":"true","type":"radio","choices":"Movement-related disorder, Medical disorder (not metabolic), Metabolic-related disorder","text":"Select the primary side effect:","groups":[{"id":"is_effect","type":"choice","choices":[{"text":"Movement-related disorder","value":"Movement-related disorder"},{"text":"Medical disorder (not metabolic)","value":"Medical disorder (not metabolic)"},{"text":"Metabolic-related disorder","value":"Metabolic-related disorder"}]}]},{"id":"is_effect_sub","visible":"is_effect == \'Movement-related disorder\'","type":"radio","choices":"Neuroleptic Malignant Syndrome, Acute Dystonia, Akathisia, Parkinsonism, Tardive Dyskinesia","text":"Select disorder:","groups":[{"id":"is_effect_sub","type":"choice","choices":[{"text":"Neuroleptic Malignant Syndrome","value":"Neuroleptic Malignant Syndrome"},{"text":"Acute Dystonia","value":"Acute Dystonia"},{"text":"Akathisia","value":"Akathisia"},{"text":"Parkinsonism","value":"Parkinsonism"},{"text":"Tardive Dyskinesia","value":"Tardive Dyskinesia"}]}]},{"id":"is_effect_sub","visible":"is_effect == \'Medical disorder (not metabolic)\'","type":"radio","choices":"QTc prolongation, Hyperprolactinemia, Orthostasis, Tobacco use disorder","text":"Select disorder:","groups":[{"id":"is_effect_sub","type":"choice","choices":[{"text":"QTc prolongation","value":"QTc prolongation"},{"text":"Hyperprolactinemia","value":"Hyperprolactinemia"},{"text":"Orthostasis","value":"Orthostasis"},{"text":"Tobacco use disorder","value":"Tobacco use disorder"}]}]},{"id":"is_med_2","visible":"is_effect_sub == \'Hyperprolactinemia\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Prolactin level >100 ng/mL?"},{"id":"is_med_3","visible":"is_effect_sub == \'Hyperprolactinemia\' && is_med_2 == \'Yes\' || is_effect_sub == \'Hyperprolactinemia\' && is_med_2 == \'No\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is the antipsychotic currently controlling psychosis adequately?"},{"id":"is_effect_sub","visible":"is_effect == \'Metabolic-related disorder\'","type":"radio","choices":"Weight gain, Pre-diabetes, Dyslipidemia, Tobacco use disorder","text":"Select disorder:","groups":[{"id":"is_effect_sub","type":"choice","choices":[{"text":"Weight gain","value":"Weight gain"},{"text":"Pre-diabetes","value":"Pre-diabetes"},{"text":"Dyslipidemia","value":"Dyslipidemia"},{"text":"Tobacco use disorder","value":"Tobacco use disorder"}]}]},{"id":"is_met_prior","visible":"is_effect_sub == \'Weight gain\' && is_effect == \'Metabolic-related disorder\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"BMI>30 prior to treatment initiation?"},{"id":"is_met_during","visible":"is_effect_sub == \'Weight gain\' && is_effect == \'Metabolic-related disorder\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"BMI rises above >30 during treatment?"},{"id":"is_met_sig","visible":"is_effect_sub == \'Weight gain\' && is_effect == \'Metabolic-related disorder\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Significant weight gain > 7% during treatment?"}]},{"valid":"(is_effect === \'Movement-related disorder\') && (is_effect_sub === \'Neuroleptic Malignant Syndrome\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Neuroleptic Malignant Syndrome:</b><br>  Stop antipsychotic and hospitalize<br>Consult with psychiatry before restarting antipsychotic in the future","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Movement-related disorder\') && (is_effect_sub === \'Acute Dystonia\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t2"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>General strategies</b> (SOR C):<br>1. Use the lowest effective dose<br>2. Switch to a medication with a different adverse effect profile<br>3. Treat with a concomitant medication<br><br><b>Acute Dystonia:</b><br>  Stop offending medication and proceed with symptomatic adjunctive medication concurrently (SOR C)","meds":["Benztropine","Diphenhydramine","Lorazepam","Diazepam"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"Start an adjunctive medication:<br>1. Benztropine<br>2. Diphenhydramine<br>3. Benzodiazepine","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Movement-related disorder\') && (is_effect_sub === \'Akathisia\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t3"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>General strategies</b> (SOR C):<br>1. Use the lowest effective dose<br>2. Switch to a medication with a different adverse effect profile<br>3. Treat with a concomitant medication<br><br><b>Akathisia:</b><br>Reduce dose or switch to a different antipsychotic (if an antipsychotic is needed) and proceed with symptomatic adjunctive medication concurrently (SOR C)","meds":["Propranolol","Benztropine","Lorazepam","Diazepam"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"Start an adjunctive medication:<br>1. Beta blocker<br>2. Benztropine<br>3. Benzodiazepine","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Movement-related disorder\') && (is_effect_sub === \'Parkinsonism\') && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t4"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>General strategies</b><br>  (SOR C):<br>1. Use the lowest effective dose<br>2. Switch to a medication with a different adverse effect profile<br>3. Treat with a concomitant medication<br><br><b>Parkinsonism:</b><br>  Reduce dose or switch to a different antipsychotic (if an antipsychotic is indicated) and proceed with symptomatic adjunctive medication concurrently (SOR C)","meds":["Benztropine","Diphenhydramine"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.1","type":"overlay","title":"Recommendation","text":"Start an adjunctive medication:<br>1. Benztropine<br>2. Diphenhydramine","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Movement-related disorder\') && (is_effect_sub === \'Tardive Dyskinesia\') && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t5"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>General strategies</b>(SOR C):<br>1. Use the lowest effective dose<br>2. Switch to a medication with a different adverse effect profile<br>3. Treat with a concomitant medication<br><br><b>Tardive Dyskinesia:</b><br>  Taper antipsyhotic and discontinue anticholinergic agents","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.1","type":"overlay","title":"Recommendation","text":"Consider neurology referral","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Medical disorder (not metabolic)\') && (is_effect_sub === \'QTc prolongation\') && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t11"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>QTc prolongation:</b><br> Avoid Ziprasidone","meds":[],"therapies":[]},{"visible":"true","uid":"G_3","title":"ECG Antipsychotic Recommendations","type":"collapse_segment","text":"ECG should be performed in patients > 45 years of age or those with a history of heart disease including prior MI, arrhythmia, and systolic dysfunction.","segments":[{"title":"QTc < 500msec","text":"No additional recommendations."},{"title":"QTc 500-549msec","text":"Monitor with follow-up ECG."},{"title":"QTc > 550msec","text":"Consult with cardiology prior to initiation. If already taking medication, discontinue pharmacotherapy and discuss with cardiology."}]}]},{"valid":"(is_effect === \'Medical disorder (not metabolic)\') && (is_effect_sub === \'Hyperprolactinemia\') && (is_med_2 === \'No\') && (is_med_3 === \'No\') && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t10"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Hyperprolactinemia:</b><br> Switch to another atypical antipsychotic. Avoid Risperidone and Paliperidone. <br><br>Reassess symptoms and recheck prolactin level in 2-4 weeks to assess response <br>Add adjunctive Aripiprazole if hyperprolactinemia persists","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(is_effect === \'Medical disorder (not metabolic)\') && (is_effect_sub === \'Hyperprolactinemia\') && (is_med_2 === \'No\') && (is_med_3 === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t10"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Hyperprolactinemia:</b><br> Ensure patient is on the lowest effective dose<br> AND<br> Consider use of adjunctive Aripiprazole (SOR B)<br><br>Reassess symptoms and recheck prolactin level in 2-4 weeks to assess response <br>Titrate Aripiprazole if hyperprolactinemia persists","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(is_effect === \'Medical disorder (not metabolic)\') && (is_effect_sub === \'Hyperprolactinemia\') && (is_med_2 === \'Yes\') && (is_med_3 === \'No\') && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t10"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Hyperprolactinemia:</b><br> Evaluate for pituitary adenoma with MRI concurrently (SOR C)<br><br>Switch to another atypical antipsychotic. Avoid Risperidone and Paliperidone. <br><br>Reassess symptoms and recheck prolactin level in 2-4 weeks to assess response <br>Add adjunctive Aripiprazole if hyperprolactinemia persists","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(is_effect === \'Medical disorder (not metabolic)\') && (is_effect_sub === \'Hyperprolactinemia\') && (is_med_2 === \'Yes\') && (is_med_3 === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t10"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Hyperprolactinemia:</b><br> Evaluate for pituitary adenoma with MRI concurrently (SOR C)<br><br> Ensure patient is on the lowest effective dose<br> AND<br> Consider use of adjunctive Aripiprazole (SOR B)<br><br>Reassess symptoms and recheck prolactin level in 2-4 weeks to assess response <br>Titrate Aripiprazole if hyperprolactinemia persists","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(is_effect === \'Medical disorder (not metabolic)\') && (is_effect_sub === \'Orthostasis\') && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t12"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>Orthostasis:</b><br> Evaluate medication list for other agents that may induce orthostasis","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"11.1","type":"overlay","title":"Recommendation","text":"Reduce dose or antipsychotic OR switch to another agent (avoid Risperidone or Quetiapine)","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Medical disorder (not metabolic)\') && (is_effect_sub === \'Tobacco use disorder\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t8"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>Tobacco use disorder:</b><br> See Tobacco Use Disorder Decision Support<br><br>Varenicline and nicotine replacement therapy are safe and effective in patients taking antipsychotics (SOR A)","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Metabolic-related disorder\') && (is_effect_sub === \'Weight gain\') && (weight_gain === true) && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t9"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<b>Weight gain:</b><br> Consider switch to weight neutral Antipsychotic. <br><br>Start Metformin (SOR A)","meds":["Metformin"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"13.1","type":"overlay","title":"Recommendation","text":"Consider addition of weight loss therapy based on patient preference and comorbidities if weight gain continues","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Metabolic-related disorder\') && (is_effect_sub === \'Weight gain\') && (weight_gain === false) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t9"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Weight gain:</b><br> Continue current pharmacotherapy and monitor weight gain with each visit","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Metabolic-related disorder\') && (is_effect_sub === \'Pre-diabetes\') && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t6"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>Pre-diabetes:</b><br> Counsel on diet and exercise and assess regularly","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"15.1","type":"overlay","title":"Recommendation","text":"Initiate anti-hyperglycemias as otherwise indicated by the ADA or AACE guidelines","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Metabolic-related disorder\') && (is_effect_sub === \'Dyslipidemia\') && (patient_age === \'Adult\')","title":"","uid":"16","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t7"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>Dyslipidemia:</b><br> Counsel on diet and exercise and assess regularly","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"16.1","type":"overlay","title":"Recommendation","text":"Initiate statin therapy as otherwise indicated by the ACC/AHA or USPSTF guidelines","meds":[],"therapies":[]}]},{"valid":"(is_effect === \'Metabolic-related disorder\') && (is_effect_sub === \'Tobacco use disorder\') && (patient_age === \'Adult\')","title":"","uid":"17","state":"recommendation","branch":"Antipsychotic Management","figure":["anti_t8"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"<b>Tobacco use disorder:</b><br> See Tobacco Use Disorder Decision Support<br><br>Varenicline and nicotine replacement therapy are safe and effective in patients taking antipsychotics (SOR A)","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Antipsychotic Management","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},6124:function(e){"use strict";e.exports=JSON.parse('{"variables":{"withdrawal":"","withdrawal_adol":"","withdrawal_ante":"","is_comorbid":"","hepatic":"","opioid_use":"","moderate_severe":"","hx_seizures_delirium":"","stage":"","medication_history":"No","medication_acamprosate":false,"medication_naltrexone":false,"acamprosate_inadequate":false,"naltrexone_inadequate":false,"successful_meds":false,"acamprosate_current":false,"naltrexone_current ":false,"acamprosate_partial":false,"naltrexone_partial ":false,"acamprosate_current_inadequate":false,"naltrexone_current_inadequate":false,"acamprosate_current_partial":false,"naltrexone_current_partial":false,"acamprosate_prior_inadequate":false,"naltrexone_prior_inadequate":false,"acamprosate_successful":false,"naltrexone_successful":false,"unsuccessful_response":false,"unsuccessful_response_2":false,"partial_response":false,"conditions_None":false,"conditions_CrCl__30":false,"conditions_Concomitant_opioid_use":false,"conditions_Elevated_liver_chemistries_ASTALT__3x_ULN":false,"medCount":2},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","need_detox":"withdrawal === \'Yes- Patient is in or at risk of acute alcohol withdrawal\' && (moderate_severe == \'Yes\' || hx_seizures_delirium == \'Yes\')","symptoms":"(withdrawal  != \'Yes\' && partum == \'None\') || withdrawal_adol === \'No- Not needed or already completed treatment\' ? \'medicated\' : \'unmedicated\'","acamprosate_inadequate":"medication_acamprosate == true && acamprosate_response === \'unsuccessful\'","naltrexone_inadequate":"medication_naltrexone == true && naltrexone_response === \'unsuccessful\'","acamprosate_current_inadequate":"medication_acamprosate == true && acamprosate_current == \'current\' && acamprosate_response === \'unsuccessful\'","naltrexone_current_inadequate":"medication_naltrexone == true && naltrexone_current == \'current\' && naltrexone_response === \'unsuccessful\'","acamprosate_current_partial":"medication_acamprosate == true && acamprosate_current == \'current\' && acamprosate_response === \'partial\'","naltrexone_current_partial":"medication_naltrexone == true && naltrexone_current == \'current\' && naltrexone_response === \'partial\'","acamprosate_prior_inadequate":"medication_acamprosate == true && acamprosate_current == \'prior\' && acamprosate_response === \'unsuccessful\'","naltrexone_prior_inadequate":"medication_naltrexone == true && naltrexone_current == \'prior\' && naltrexone_response === \'unsuccessful\'","acamprosate_successful":"medication_acamprosate == true && acamprosate_response === \'successful\'","naltrexone_successful":"medication_naltrexone == true && naltrexone_response === \'successful\'"},{"unsuccessful_response":"(acamprosate_inadequate ? 1 : 0) + (naltrexone_inadequate ? 1 : 0) >= 1","unsuccessful_response_2":"(acamprosate_inadequate ? 1 : 0) + (naltrexone_inadequate ? 1 : 0) + (acamprosate_current_partial ? 1 : 0) + (naltrexone_current_partial ? 1 : 0) >= 2","partial_response":"(acamprosate_current_partial ? 1 : 0) + (naltrexone_current_partial ? 1 : 0) >= 1"},{"conditions_com":"(conditions_CrCl__30 ? \\"naltrexone\\" : \'\') + ((conditions_Concomitant_opioid_use || conditions_Elevated_liver_chemistries_ASTALT__3x_ULN) ? \\"acamprosate\\" : \'\')"},{"conditions_com":"(conditions_com == \'\' ? \'None\' : conditions_com)"},{"hep_opi_use":"hepatic == \'Yes\' || opioid_use == \'Yes\'"},{"successful_meds":"(acamprosate_current == \'current\' && acamprosate_successful === true) || (naltrexone_current == \'current\' && naltrexone_successful === true) || (acamprosate_current == \'prior\' && acamprosate_successful === true) || (naltrexone_current == \'prior\' && naltrexone_successful === true)","prior_successful_meds":"(acamprosate_current == \'prior\' && acamprosate_successful === true) || (naltrexone_current == \'prior\' && naltrexone_successful === true)"},{"has_current":"(medication_acamprosate && acamprosate_current == \'current\') || (medication_naltrexone && naltrexone_current == \'current\')"},{"medBranch":"(withdrawal == \'Yes\') ? \'Alcohol Withdrawal Syndrome\' : \'AUD\'"}],"sections":[{"valid":"true","title":"AUD Medications","state":"medication","content":[{"visible":false,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat AUD"}]},{"visible":"medication_history === \'Yes\' && conditions_CrCl__30 != true &&  partum == \'None\'","type":"title","text":[{"visible":"true","text":"Glutamate Multi-Modal"}]},{"visible":"medication_history === \'Yes\' && conditions_CrCl__30 != true && partum == \'None\'","id":"medication_acamprosate","text":"Acamprosate","type":"switch","groups":[{"visible":"medication_acamprosate","id":"acamprosate_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_acamprosate && acamprosate_current === \'current\'","id":"acamprosate_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_acamprosate && acamprosate_current === \'prior\'","id":"acamprosate_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && hep_opi_use != true &&  conditions_Concomitant_opioids_use != true &&  conditions_Elevated_liver_chemistries_ASTALT__3x_ULN != true &&  partum == \'None\'","type":"title","text":[{"visible":"true","text":"mu-Opioid Receptor Antagonist"}]},{"visible":"medication_history === \'Yes\' && hep_opi_use != true && conditions_Concomitant_opioids_use != true && conditions_Elevated_liver_chemistries_ASTALT__3x_ULN != true && partum == \'None\'","id":"medication_naltrexone","text":"Naltrexone","type":"switch","groups":[{"visible":"medication_naltrexone","id":"naltrexone_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_naltrexone && naltrexone_current === \'current\'","id":"naltrexone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_naltrexone && naltrexone_current === \'prior\'","id":"naltrexone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"AUD","state":"intro","content":[{"id":"withdrawal","visible":"true && patient_age != \'Adolescent\' && partum == \'None\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is withdrawal treatment required?"},{"id":"withdrawal_ante","visible":"true && patient_age != \'Adolescent\' && partum != \'None\'","type":"choice","choices":[{"text":"Yes- Patient is in or at risk of acute alcohol withdrawal"},{"text":"No- Consider post-withdrawal treatment (maintenance treatment)"}],"text":"Is the patient currently using alcohol or experiencing withdrawal?"},{"id":"withdrawal_adol","visible":"true && patient_age == \'Adolescent\'","type":"choice","choices":[{"text":"Yes"},{"text":"No- Not needed or already completed treatment"}],"text":"Is alcohol withdrawal treatment needed?"},{"id":"criteria","visible":"withdrawal === \'Yes\' && partum == \'None\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does the patient meet criteria for ambulatory withdrawal? (See below)"},{"id":"criteria_ov","visible":"withdrawal === \'Yes\' && partum == \'None\'","type":"overlay","choices":[{"text":""}],"text":"Patients with prior withdrawal seizures or delirium tremens are not candidates for outpatient withdrawal treatment <br><br>Additionally, presence of any of the following alone or in combination may preclude outpatient withdrawal treatment<br>&#x2022; Long-duration of or heavy use of alcohol (e.g., more than 8 standard drinks daily)<br>&#x2022; Aged 65 and over<br>&#x2022; Physiological dependence on benzodiazepines<br>&#x2022; Significant medical comorbidity that are uncontrolled (e.g., hypertensive urgency)"},{"id":"hep_impar","visible":"withdrawal === \'Yes\' && criteria == \'Yes\' && partum == \'None\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is hepatic impairment present?"},{"id":"conditions","visible":"withdrawal === \'No\' && partum == \'None\'","type":"checkboxes","choices":[{"text":"CrCl < 30","value":"CrCl__30"},{"text":"Concomitant opioid use","value":"Concomitant_opioid_use"},{"text":"Elevated liver chemistries (AST/ALT > 3x ULN)","value":"Elevated_liver_chemistries_ASTALT__3x_ULN"}],"text":"Are any of the following conditions present?"},{"id":"is_comorbid","visible":"withdrawal === \'No- Consider post-withdrawal treatment (maintenance treatment)\' && partum == \'None\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does patient have comorbid psychiatric disorder(s)?"},{"id":"hepatic","visible":"(withdrawal === \'Yes- Patient is in or at risk of acute alcohol withdrawal\' && moderate_severe === \'No\' && hx_seizures_delirium === \'No\') || withdrawal_adol == \'No- Not needed or already completed treatment\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does patient have hepatic impairment?"},{"id":"gestational_age_23","visible":"withdrawal_ante === \'Yes- Patient is in or at risk of acute alcohol withdrawal\' && partum == \'Antepartum\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is current gestational age \u2265 23 weeks?"},{"id":"opioid_use","visible":"withdrawal_adol == \'No- Not needed or already completed treatment\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Concurrent opioid use?"}]},{"valid":"(withdrawal === \'Yes\') && (medication_history === \'Yes\') && (successful_meds === true) && (prior_successful_meds === false)","title":"","uid":"0","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-withdrawl_t8"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintenance therapy; continue minimum 1 year","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (medication_history === \'Yes\') && (successful_meds === true) && (prior_successful_meds === false)","title":"","uid":"0","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t8"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintenance therapy; continue minimum 1 year","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (medication_history === \'Yes\') && (successful_meds === true) && (prior_successful_meds === false)","title":"","uid":"0","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintenance therapy; continue minimum 1 year","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (medication_history === \'Yes\') && (prior_successful_meds === true)","title":"","uid":"0","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful treatment","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'Yes\') && (criteria === \'No\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-withdrawl_t1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"Higher level of care for withdrawal management recommended","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'Yes\') && (criteria === \'Yes\') && (hep_impar === \'No\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-withdrawl_t2"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"Fixed dose benzodiazepine taper recommended to treat withdrawal syndrome (SOR A)<br><br>Alternative treatment regimen for mild symptoms with gabapentin or carbamazepine (SOR B)<br><br>Thiamine 100 mg and a multivitamin recommended daily","meds":["Chlordiazepoxide","Lorazepam","Diazepam","Gabapentin","Carbamazepine"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"Daily contact for at least five days utilizing CIWA-Ar if in-person or SAWS if via telehealth. If severe symptoms or other complications develop, the patient should be directed to a higher level of care (e.g., ED). ","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'Yes\') && (criteria === \'Yes\') && (hep_impar === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-withdrawl_t2"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"Fixed dose lorazepam taper recommended to treat withdrawal syndrome (SOR A)<br><br>Alternative treatment regimen for mild symptoms with gabapentin. (SOR B)<br><br>Thiamine 100 mg and a multivitamin recommended daily","meds":["Lorazepam","Gabapentin"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"Daily contact for at least five days utilizing CIWA-Ar if in-person or SAWS if via telehealth. If severe symptoms or other complications develop, the patient should be directed to a higher level of care (e.g., ED).","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'None\') && (unsuccessful_response === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t1"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>First Choice Pharmacotherapy (SOR A):<br>Naltrexone<br>Acamprosate","meds":["Naltrexone","Acamprosate"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'naltrexone\') && (naltrexone_inadequate === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t1"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>First Choice Pharmacotherapy (SOR A):<br>Naltrexone","meds":["Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'naltrexone\') && (acamprosate_inadequate === false) && (naltrexone_inadequate === false) && (unsuccessful_response === false) && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t4"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Augment first choice pharmacotherapy with alternate class agent<br><br>Topiramate, Gabapentin, or Baclofen","meds":["Naltrexone","Topiramate","Gabapentin","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'acamprosate\') && (acamprosate_inadequate === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t1"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>First Choice Pharmacotherapy (SOR A):<br>Acamprosate","meds":["Acamprosate"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'acamprosate\') && (acamprosate_inadequate === false) && (naltrexone_inadequate === false) && (unsuccessful_response === false) && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t4"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Augment first choice pharmacotherapy with alternate class agent<br><br>Topiramate, Gabapentin, or Baclofen","meds":["Acamprosate","Topiramate","Gabapentin","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'naltrexoneacamprosate\') && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t4"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Second Choice Pharmacotherapy (SOR B):<br>Topiramate, Gabapentin, or Baclofen","meds":["Topiramate","Gabapentin","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'naltrexoneacamprosate\') && (acamprosate_inadequate === false) && (naltrexone_inadequate === false) && (unsuccessful_response === false) && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t3"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Augment first choice pharmacotherapy with alternate class agent<br><br>First Choice: Naltrexone or Acamprosate<br>Second Choice: Topiramate, Gabapentin, or Baclofen","meds":["Naltrexone","Acamprosate","Topiramate","Gabapentin","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'naltrexone\') && (naltrexone_inadequate === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t4"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Second Choice Pharmacotherapy (SOR B):<br>Topiramate, Gabapentin, or Baclofen","meds":["Topiramate","Gabapentin","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (conditions_com === \'acamprosate\') && (acamprosate_inadequate === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t4"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Second Choice Pharmacotherapy (SOR B):<br>Topiramate, Gabapentin, or Baclofen","meds":["Topiramate","Gabapentin","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (acamprosate_inadequate === false) && (naltrexone_inadequate === false) && (unsuccessful_response === false) && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t3"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Augment first choice pharmacotherapy with alternate class agent<br><br>First Choice: Naltrexone or Acamprosate<br>Second Choice: Topiramate, Gabapentin, or Baclofen","meds":["Naltrexone","Acamprosate","Topiramate","Gabapentin","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t2"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Switch to alternate class first choice treatment if there are no contraindications:<br>Naltrexone or Acamprosate","meds":["Naltrexone","Acamprosate"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal === \'No\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-medications_t4"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"Goals for treatment may range from reduction in use to improved functional capabilities to abstinence; such goals should be individualized and established collaboratively (SOR C)<br><br>Second Choice Pharmacotherapy (SOR B):<br>Topiramate, Gabapentin, or Baclofen","meds":["Topiramate","Gabapentin","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.1","type":"overlay","title":"Recommendation","text":"Thiamine 100 mg and a multivitamin recommended daily<br><br>For select patients desiring complete abstinence, disulfiram may be used after withdrawal treatment but is contraindicated in patients with severe cardiovascular disease, psychosis, or ongoing alcohol use (SOR B)","meds":[],"therapies":[]}]},{"valid":"(withdrawal_ante === \'Yes- Patient is in or at risk of acute alcohol withdrawal\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-antepartum_t1"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Inpatient Detoxification using Lorazepam</b><br>Use hospital protocol, symptom triggered, or fixed dose <br>Social services consultation","meds":["Lorazepam"],"therapies":[]},{"visible":"withdrawal === \'Yes- Patient is in or at risk of acute alcohol withdrawal\'","uid":"G-2","type":"overlay","text":"Prescribe Prenatal Vitamin + Thiamine","meds":[],"priority":"false"},{"visible":"(gestational_age_23 === \'Yes\')","uid":"10.1","type":"overlay","title":"Recommendation","text":"<b>&gt;23 weeks GA:</b><br>Continuous fetal monitoring in L&D with 1:1 Nursing for minimum 24 hours;<br>\\nTransition to floor with daily NST once stable/less symptomatic","meds":[],"therapies":[]},{"visible":"(gestational_age_23 === \'No\')","uid":"10.2","type":"overlay","title":"Recommendation","text":"<b>&lt;23 weeks GA:</b><br>General floor, Daily FHT\'s","meds":[],"therapies":[]}]},{"valid":"(withdrawal_ante === \'No- Consider post-withdrawal treatment (maintenance treatment)\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-antepartum_t1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Evaluate and treat for comorbid psychiatric disorder(s)<br>Recommend 12 step program (other options: SMART, WFS, etc.)","meds":[],"therapies":[]},{"visible":"withdrawal === \'Yes- Patient is in or at risk of acute alcohol withdrawal\'","uid":"G-2","type":"overlay","text":"Prescribe Prenatal Vitamin + Thiamine","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\')","uid":"20.1","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"64","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t1"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Lorazepam"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"64.1","type":"overlay","title":"Recommendation","text":"Inpatient detoxification preferred but ambulatory detoxification may be appropriate in individual circumstances.<br><br>Lorazepam taper recommended for detoxification.","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (hep_opi_use === true) && (acamprosate_current_inadequate === false) && (naltrexone_current_inadequate === false) && (acamprosate_prior_inadequate === false) && (naltrexone_prior_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"65","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t2"],"content":[{"visible":true,"uid":"65.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Acamprosate"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"65.1","type":"overlay","title":"Recommendation","text":"Start Acamprosate (avoid in CrCl &lt;30 mL/min)<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"65.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"65.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (hep_opi_use === false) && (acamprosate_current_inadequate === false) && (naltrexone_current_inadequate === false) && (acamprosate_prior_inadequate === false) && (naltrexone_prior_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"66","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t2"],"content":[{"visible":true,"uid":"66.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"66.1","type":"overlay","title":"Recommendation","text":"Start Naltrexone<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"66.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"66.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (acamprosate_current_inadequate === false) && (naltrexone_current_inadequate === true) && (acamprosate_prior_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"67","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t3"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Acamprosate"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.1","type":"overlay","title":"Recommendation","text":"<discontinue>Trial Acamprosate if no contraindications (avoid in CrCl &lt;30 mL/min)<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (hep_opi_use === false) && (acamprosate_current_inadequate === true) && (naltrexone_current_inadequate === false) && (naltrexone_prior_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"67","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t3"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.1","type":"overlay","title":"Recommendation","text":"<discontinue>Trial Naltrexone if no contraindications<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (acamprosate_current_inadequate === true) && (patient_age === \'Adolescent\')","title":"","uid":"69","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t4"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Gabapentin","Topiramate","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.1","type":"overlay","title":"Recommendation","text":"<discontinue>Consider alternate pharmacotherapy<br>1. Gabapentin<br>2. Topiramate<br>3. Baclofen<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (acamprosate_current_inadequate === false) && (acamprosate_prior_inadequate === false) && (naltrexone_prior_inadequate === true) && (patient_age === \'Adolescent\')","title":"","uid":"67","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t3"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Acamprosate"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.1","type":"overlay","title":"Recommendation","text":"Trial Acamprosate if no contraindications (avoid in CrCl &lt;30 mL/min)<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (hep_opi_use === false) && (naltrexone_current_inadequate === false) && (acamprosate_prior_inadequate === true) && (naltrexone_prior_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"67","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t3"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.1","type":"overlay","title":"Recommendation","text":"Trial Naltrexone if no contraindications<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"67.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (acamprosate_prior_inadequate === true) && (patient_age === \'Adolescent\')","title":"","uid":"69","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t4"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Gabapentin","Topiramate","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.1","type":"overlay","title":"Recommendation","text":"Consider alternate pharmacotherapy<br>1. Gabapentin<br>2. Topiramate<br>3. Baclofen<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (acamprosate_prior_inadequate === true) && (patient_age === \'Adolescent\')","title":"","uid":"69","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t4"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Gabapentin","Topiramate","Baclofen"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.1","type":"overlay","title":"Recommendation","text":"<discontinue>Consider alternate pharmacotherapy<br>1. Gabapentin<br>2. Topiramate<br>3. Baclofen<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"69.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":"(withdrawal_adol === \'No- Not needed or already completed treatment\') && (acamprosate_current_inadequate === true) && (naltrexone_current_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"68","state":"recommendation","branch":"Alcohol Use Disorder","figure":["AUD-adolescent_t3"],"content":[{"visible":true,"uid":"68.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"68.1","type":"overlay","title":"Recommendation","text":"<discontinue>Trial Naltrexone if no contraindications<br><br>Consider behavioral interventions in combination with  pharmacotherapy.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"68.2","type":"collapse","title":"Behavioral Interventions","text":"Any combination of available options: <br>&#x2022; Brief Intervention (e.g., Brief Negotiated Interview, MI) <br>&#x2022; Harm reduction strategies<br>&#x2022; Parent/Family Support (e.g., AI-Anon, support groups) and/or Parent/Family Intervention (e.g, CRAFT) <br>&#x2022; 12 step program (e.g. Young People AA) <br>&#x2022; Adolescent Community Reinforcement Approach (A-CRA) <br>&#x2022; CBT","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"68.3","type":"overlay","title":"Recommendation","text":"Clinical improvement (Individualized goals based on patient need and preference)<br>&#x2022; Abstinence Achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Alcohol Use Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},1064:function(e){"use strict";e.exports=JSON.parse('{"variables":{"is_impaired":"","severity":"","is_bipolar":"","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'"}],"sections":[{"valid":"true","title":"Autism Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Autism"}]}]},{"valid":true,"title":"Autism","state":"intro","content":[{"id":"is_impaired","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does the patient suffer from significant intellectual impairment"},{"id":"severity","visible":"is_impaired == \'Yes\'","type":"radio","choices":"Mild/Moderate, Severe","text":"Level of irritability:","groups":[{"id":"severity","type":"choice","choices":[{"text":"Mild/Moderate","value":"Mild/Moderate"},{"text":"Severe","value":"Severe"}]}]},{"id":"is_bipolar","visible":"severity == \'Severe\' && is_impaired == \'Yes\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is bipolar disorder present?"}]},{"valid":"(is_impaired === \'Yes\') && (severity === \'Mild/Moderate\')","title":"","uid":"1","state":"recommendation","branch":"Autism Spectrum Disorder","figure":["autism_a1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"Consider alpha-2 agonist","meds":["Guanfacine ER","Clonidine XR"],"therapies":[]}]},{"valid":"(is_impaired === \'Yes\') && (severity === \'Severe\') && (is_bipolar === \'Yes\')","title":"","uid":"2","state":"recommendation","branch":"Autism Spectrum Disorder","figure":["autism_a2"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"See pediatric bipolar decision support, avoid antidepressants and stimulants","meds":[],"therapies":[]}]},{"valid":"(is_impaired === \'Yes\') && (severity === \'Severe\') && (is_bipolar === \'No\')","title":"","uid":"3","state":"recommendation","branch":"Autism Spectrum Disorder","figure":["autism_a2"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"Consider Aripiprazole (preferred metabolic profile) or Risperidone","meds":["Aripiprazole","Risperidone"],"therapies":[]}]},{"valid":"(is_impaired === \'No\')","title":"","uid":"4","state":"recommendation","branch":"Autism Spectrum Disorder","figure":["autism_a3"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"Evaluate and treat psychiatric comorbidities. See corresponding pediatric decision support<br><br>If insomnia present, recommend sleep hygiene and consider melatonin","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Autism Spectrum Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},505:function(e){"use strict";e.exports=JSON.parse('{"variables":{"phase":"","is_comorbid":"","is_taper":"","is_withdrawl":"","medication_history":"","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'"}],"sections":[{"valid":"true","title":"Benzodiazepine Deprescribing Medications","state":"medication","content":[{"visible":false,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Benzodiazepine Deprescribing"}]}]},{"valid":true,"title":"Benzodiazepine Deprescribing","state":"intro","content":[{"id":"is_comorbid","visible":"true","type":"radio","choices":"Yes, No","text":"Is a comorbid disorder present?","groups":[{"id":"is_comorbid","type":"choice","choices":[{"text":"Yes","value":"Yes"},{"text":"No","value":"No"}]}]},{"id":"is_taper","visible":"true","type":"radio","choices":"Yes, No","text":"Is the patient currently undergoing taper?","groups":[{"id":"is_taper","type":"choice","choices":[{"text":"Yes","value":"Yes"},{"text":"No","value":"No"}]}]},{"id":"is_withdrawl","visible":"is_taper == \'Yes\'","type":"radio","choices":"Yes, No","text":"Are withdrawal symptoms present?","groups":[{"id":"is_withdrawl","type":"choice","choices":[{"text":"Yes","value":"Yes"},{"text":"No","value":"No"}]}]}]},{"valid":"(is_comorbid === \'Yes\') && (is_taper === \'No\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Benzodiazepine Deprescribing","figure":["benzo_b1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Patient and family education:</b><br>- Discuss risks of benzodiazepine use, possible loss of benzodiazepine efficacy, and potential of withdrawal symptoms<br>- Educate patient and family about process of gradual taper rather than abrupt discontinuation<br>- Discuss especially high risk of adverse events including seizures and hospitalization from abrupt discontinuation with Alprazolam or Clonazepam > 4 mg total<br>- Establish goals for deprescribing","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.1","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. Reevaluate need for benzodiazepine. Proceed with taper if clinically indicated.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.2","type":"overlay","title":"Recommendation","text":"<b>Deprescribing Strategies:</b><br>Decrease dose by 20% every 2 weeks<br><br>-or-<br><br>Decrease dose by 25% every 2 weeks; hold at 50% of dose for one month; then decrease by 5-10% weekly to monthly","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (is_taper === \'Yes\') && (is_withdrawl === \'No\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Benzodiazepine Deprescribing","figure":["benzo_b1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. Reevaluate need for benzodiazepine. Proceed with taper if clinically indicated.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"Continue taper and reevaluate for emerging psychiatric or withdrawal symptoms<br><br><b>Able to complete taper:</b><br>- Maintain benzodiazepine-free status<br> - Encourage appropriate coping and relapse-prevention skills<br><br><b>Unable to complete taper:</b><br>Consider restarting more gradual taper<br><br> -or-<br><br>Maintain patient on minimum effective benzodiazepine dose","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (is_taper === \'Yes\') && (is_withdrawl === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Benzodiazepine Deprescribing","figure":["benzo_b1"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. Reevaluate need for benzodiazepine. Proceed with taper if clinically indicated.","meds":["Buspirone","Clonidine","Gabapentin","Hydroxyzine"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"<b>Maintain Current Benzodiazepine Dose:</b><br>&#x2022; Resume taper in 1-2 weeks if withdrawal symptoms subside<br>&#x2022; Consider adjunctive medication for withdrawal symptoms: Buspirone, Clonidine, Gabapentin, Hydroxyzine","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'No\') && (is_taper === \'No\') && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Benzodiazepine Deprescribing","figure":["benzo_b1"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Patient and family education:</b><br>- Discuss risks of benzodiazepine use, possible loss of benzodiazepine efficacy, and potential of withdrawal symptoms<br>- Educate patient and family about process of gradual taper rather than abrupt discontinuation<br>- Discuss especially high risk of adverse events including seizures and hospitalization from abrupt discontinuation with Alprazolam or Clonazepam > 4 mg total<br>- Establish goals for deprescribing","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.1","type":"overlay","title":"Recommendation","text":"<b>Deprescribing Strategies:</b><br>Decrease dose by 20% every 2 weeks<br><br>-or-<br><br>Decrease dose by 25% every 2 weeks; hold at 50% of dose for one month; then decrease by 5-10% weekly to monthly","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'No\') && (is_taper === \'Yes\') && (is_withdrawl === \'No\') && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Benzodiazepine Deprescribing","figure":["benzo_b1"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"Continue taper and reevaluate for emerging psychiatric or withdrawal symptoms<br><br><b>Able to complete taper:</b><br>- Maintain benzodiazepine-free status<br> - Encourage appropriate coping and relapse-prevention skills<br><br><b>Unable to complete taper:</b><br>Consider restarting more gradual taper<br><br> -or-<br><br>Maintain patient on minimum effective benzodiazepine dose","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'No\') && (is_taper === \'Yes\') && (is_withdrawl === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Benzodiazepine Deprescribing","figure":["benzo_b1"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>Maintain Current Benzodiazepine Dose:</b><br>&#x2022; Resume taper in 1-2 weeks if withdrawal symptoms subside<br>&#x2022; Consider adjunctive medication for withdrawal symptoms: Buspirone, Clonidine, Gabapentin, Hydroxyzine","meds":["Buspirone","Clonidine","Gabapentin","Hydroxyzine"],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Benzodiazepine Deprescribing","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},1337:function(e){"use strict";e.exports=JSON.parse('{"variables":{"is_comorbid":"","medication_vyvanse":false,"medication_topiramate":false,"vyvanse_current":false,"topiramate_current":false,"vyvanse_inadequate":false,"topiramate_inadequate":false,"vyvanse_successful":false,"topiramate_successful":false,"medication_history":"No","medCount":2},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","vyvanse_inadequate":"medication_vyvanse == true && vyvanse_response === \'unsuccessful\'","topiramate_inadequate":"medication_topiramate == true && topiramate_response === \'unsuccessful\'"},{"vyvanse_successful":"medication_vyvanse == true && vyvanse_response === \'successful\'","topiramate_successful":"medication_topiramate == true && topiramate_response === \'successful\'"},{"successful_meds":"(vyvanse_current == \'current\' && vyvanse_successful === true) || (topiramate_current == \'current\' && topiramate_successful === true)","prior_successful_meds":"(vyvanse_current == \'prior\' && vyvanse_successful === true) || (topiramate_current == \'prior\' && topiramate_successful === true)"}],"sections":[{"valid":"true","title":"Binge Eating Disorder Medications","state":"medication","content":[{"visible":false,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Binge Eating Disorder"}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"Amphetamines"}]},{"visible":"medication_history === \'Yes\'","id":"medication_vyvanse","text":"Vyvanse","type":"switch","groups":[{"visible":"medication_vyvanse","id":"vyvanse_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_vyvanse && vyvanse_current === \'current\'","id":"vyvanse_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_vyvanse && vyvanse_current === \'prior\'","id":"vyvanse_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"Anticonvulsants"}]},{"visible":"medication_history === \'Yes\'","id":"medication_topiramate","text":"Topiramate","type":"switch","groups":[{"visible":"medication_topiramate","id":"topiramate_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_topiramate && topiramate_current === \'current\'","id":"topiramate_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_topiramate && topiramate_current === \'prior\'","id":"topiramate_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"Binge Eating Disorder","state":"intro","content":[{"id":"is_comorbid","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is a comorbid disorder present?"}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"Binge Eating Disorder","figure":["binge_b1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintenance Therapy minimum 1 year","meds":[],"therapies":["Cognitive Behavioral Therapy","Interpersonal Psychotherapy","Dialectical Behavior Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"Binge Eating Disorder","figure":["binge_b1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintenance Therapy minimum 1 year","meds":[],"therapies":["Cognitive Behavioral Therapy","Interpersonal Psychotherapy","Dialectical Behavior Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"Binge Eating Disorder","figure":["binge_b1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintenance Therapy minimum 1 year","meds":[],"therapies":["Cognitive Behavioral Therapy","Interpersonal Psychotherapy","Dialectical Behavior Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"Binge Eating Disorder","figure":["binge_b1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintenance Therapy minimum 1 year","meds":[],"therapies":["Cognitive Behavioral Therapy","Interpersonal Psychotherapy","Dialectical Behavior Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"1","state":"recommendation","branch":"Binge Eating Disorder","figure":["binge_b2"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":["Vyvanse"],"therapies":["Cognitive Behavioral Therapy","Interpersonal Psychotherapy","Dialectical Behavior Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"1.1","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Psychotherapy<br>- Behavioral weight loss therapy if overweight<br>- If failure to respond to multidisciplinary intervention consider pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"1.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral weight loss therapy:</b><br>- Exercise<br>- Caloric restriction<br>- Nutrition ","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"1.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Vyvanse <br><br><b>Vyvanse is not recommended if:</b><br>- History of cardiac arrhythmia or family history of sudden cardiac death.<br>- Mania/Bipolar disorder<br>- Psychosis/Schizophrenia<br>- Active substance use disorder","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (vyvanse_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"2","state":"recommendation","branch":"Binge Eating Disorder","figure":["binge_b2"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":["Vyvanse"],"therapies":["Cognitive Behavioral Therapy","Interpersonal Psychotherapy","Dialectical Behavior Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Psychotherapy<br>- Behavioral weight loss therapy if overweight<br>- If failure to respond to multidisciplinary intervention consider pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"2.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral weight loss therapy:</b><br>- Exercise<br>- Caloric restriction<br>- Nutrition ","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"2.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Vyvanse <br><br><b>Vyvanse is not recommended if:</b><br>- History of cardiac arrhythmia or family history of sudden cardiac death.<br>- Mania/Bipolar disorder<br>- Psychosis/Schizophrenia<br>- Active substance use disorder","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (vyvanse_inadequate === true) && (topiramate_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"3","state":"recommendation","branch":"Binge Eating Disorder","figure":["binge_b3"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Interpersonal Psychotherapy","Dialectical Behavior Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Psychotherapy<br>- Behavioral weight loss therapy if overweight<br>- If failure to respond to multidisciplinary intervention consider pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral weight loss therapy:</b><br>- Exercise<br>- Caloric restriction<br>- Nutrition ","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Topiramate","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (vyvanse_inadequate === true) && (topiramate_inadequate === true) && (patient_age === \'Adolescent\')","title":"","uid":"4","state":"recommendation","branch":"Binge Eating Disorder","figure":["binge_b4"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"therapies":["Cognitive Behavioral Therapy","Interpersonal Psychotherapy","Dialectical Behavior Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"4.1","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Psychotherapy<br>- Behavioral weight loss therapy if overweight<br>- If failure to respond to multidisciplinary intervention consider pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"4.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral weight loss therapy:</b><br>- Exercise<br>- Caloric restriction<br>- Nutrition ","meds":[],"therapies":[]},{"visible":"(patient_age === 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(asenapine_maniaSuccess ? 1 : 0) + (olanzapine_fluoxetine_maniaSuccess ? 1 : 0) + (olanzapine_maniaSuccess ? 1 : 0) + (quetiapine_maniaSuccess ? 1 : 0) + (cariprazine_maniaSuccess? 1 : 0) + (risperidone_maniaSuccess ? 1 : 0) + (ziprasidone_maniaSuccess? 1 : 0) + (otheratypicalantipsychotic_maniaSuccess ? 1 : 0)) >= 1","mania_well_controlled_success":"((lithium_maniaSuccess ? 1 : 0) + (valproate_maniaSuccess ? 1 : 0) + (aripiprazole_maniaSuccess ? 1 : 0) + (asenapine_maniaSuccess ? 1 : 0) + (olanzapine_maniaSuccess ? 1 : 0) + (olanzapine_fluoxetine_maniaSuccess ? 1 : 0) + (quetiapine_maniaSuccess ? 1 : 0) + (cariprazine_maniaSuccess? 1 : 0) + (risperidone_maniaSuccess ? 1 : 0) + (ziprasidone_maniaSuccess? 1 : 0)) >= 1","mania_well_controlled_with_mood_stabilizer":"((carbamazepine_maniaSuccess ? 1 : 0) + (lithium_maniaSuccess ? 1 : 0) + (valproate_maniaSuccess ? 1 : 0)) >= 1","mania_well_controlled_with_lithium":"(lithium_maniaSuccess ? 1 : 0) >= 1"},{"has_current":"(medication_atypical_antipsychotic && atypical_antipsychotic_current == \'current\') || (medication_carbamazepine && carbamazepine_current == \'current\') || (medication_lamotrigine && lamotrigine_current == \'current\') || (medication_lithium && lithium_current == \'current\') || (medication_lurasidone && lurasidone_current == \'current\') || (medication_valproate && valproate_current == \'current\') || (medication_aripiprazole && aripiprazole_current == \'current\') || (medication_asenapine && asenapine_current == \'current\') || (medication_lurasidone && lurasidone_current == \'current\') || (medication_olanzapine_fluoxetine && olanzapine_fluoxetine_current == \'current\') || (medication_olanzapine && olanzapine_current == \'current\') || (medication_quetiapine && quetiapine_current == \'current\') || (medication_cariprazine && cariprazine_current == \'current\') || (medication_risperidone && risperidone_current == \'current\') || (medication_ziprasidone && ziprasidone_current == \'current\') || (medication_otheratypicalantipsychotic && otheratypicalantipsychotic_current == \'current\') || (medication_carbamazepine && carbamazepine_current == \'current\') || (medication_lamotrigine && lamotrigine_current == \'current\') || (medication_lithium && lithium_current == \'current\') || (medication_valproate && valproate_current == \'current\')"},{"unsuccessful_1_depression_meds":"((lamotrigine_inadequate ? 1 : 0) + (atypicalantipsychotic_inadequate ? 1 : 0)) >= 1","unsuccessful_2_depression_meds":"((lamotrigine_inadequate ? 1 : 0) + (lurasidone_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (cariprazine_inadequate ? 1 : 0) + (olanzapine_fluoxetine_inadequate ? 1 : 0)) >= 2"},{"partial_1_depression_meds":"((lamotrigine_partial ? 1 : 0) + (atypicalantipsychotic_partial ? 1 : 0)) >= 1","partial_2_depression_meds":"((lamotrigine_partial ? 1 : 0) + (lurasidone_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0) + (olanzapine_fluoxetine_partial ? 1 : 0)) >= 2"},{"inadequate_1_depression_meds":"((unsuccessful_1_depression_meds ? 1 : 0) + (partial_1_depression_meds ? 1 : 0)) >= 1","inadequate_2_depression_meds":"((lamotrigine_inadequate ? 1 : 0) + (lurasidone_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (cariprazine_inadequate ? 1 : 0) + (olanzapine_inadequate ? 1 : 0) + (olanzapine_fluoxetine_inadequate ? 1 : 0) + (lamotrigine_partial ? 1 : 0) + (lurasidone_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0) + (olanzapine_partial ? 1 : 0) + (olanzapine_fluoxetine_partial ? 1 : 0)) >= 2"},{"unsuccessful_1_manic_meds":"((aripiprazole_inadequate ? 1 : 0) + (olanzapine_inadequate ? 1 : 0) + (risperidone_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (cariprazine_inadequate ? 1 : 0) + (ziprasidone_inadequate ? 1 : 0) + (asenapine_inadequate ? 1 : 0)) >= 1","unsuccessful_2_manic_meds":"((aripiprazole_inadequate ? 1 : 0) + (olanzapine_inadequate ? 1 : 0) + (risperidone_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (cariprazine_inadequate ? 1 : 0) + (ziprasidone_inadequate ? 1 : 0) + (asenapine_inadequate ? 1 : 0)) >= 2"},{"unsuccessful_1_manic_meds_ped":"((olanzapine_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (ziprasidone_inadequate ? 1 : 0) + (asenapine_inadequate ? 1 : 0)) >= 1","unsuccessful_2_manic_meds_ped":"((olanzapine_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (ziprasidone_inadequate ? 1 : 0) + (asenapine_inadequate ? 1 : 0)) >= 2"},{"partial_1_current_manic_meds_ped":"(((olanzapine_partial && olanzapine_current == \'current\') ? 1 : 0) + ((quetiapine_partial && quetiapine_current == \'current\') ? 1 : 0) + ((ziprasidone_partial && ziprasidone_current == \'current\') ? 1 : 0) + ((asenapine_partial && asenapine_current == \'current\') ? 1 : 0)) >= 1","partial_1_manic_meds_ped":"((olanzapine_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (ziprasidone_partial ? 1 : 0) + (asenapine_partial ? 1 : 0)) >= 1","partial_2_manic_meds_ped":"((olanzapine_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (ziprasidone_partial ? 1 : 0) + (asenapine_partial ? 1 : 0)) >= 2"},{"partial_1_current_manic_meds":"(((aripiprazole_partial && aripiprazole_current == \'current\') ? 1 : 0) + ((olanzapine_partial && olanzapine_current == \'current\') ? 1 : 0) + ((risperidone_partial && risperidon_current == \'current\') ? 1 : 0) + ((quetiapine_partial && quetiapine_current == \'current\') ? 1 : 0) + ((cariprazine_partial && cariprazine_current == \'current\') ? 1 : 0) + ((ziprasidone_partial && ziprasidone_current == \'current\') ? 1 : 0) + ((asenapine_partial && asenapine_current == \'current\') ? 1 : 0)) >= 1","partial_1_manic_meds":"((aripiprazole_partial ? 1 : 0) + (olanzapine_partial ? 1 : 0) + (risperidone_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0) + (ziprasidone_partial ? 1 : 0) + (asenapine_partial ? 1 : 0)) >= 1","partial_2_manic_meds":"((aripiprazole_partial ? 1 : 0) + (olanzapine_partial ? 1 : 0) + (risperidone_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0) + (ziprasidone_partial ? 1 : 0) + (asenapine_partial ? 1 : 0)) >= 2"},{"inadequate_1_depression_meds_ad":"((quetiapine_inadequate ? 1 : 0) + (cariprazine_inadequate ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0)) >= 1"},{"unsuccessful_1_manic_meds_ad":"((olanzapine_inadequate ? 1 : 0) + (cariprazine_inadequate ? 1 : 0) + (asenapine_inadequate ? 1 : 0)) >= 1","partial_1_manic_meds_ad":"((olanzapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0) + (asenapine_partial ? 1 : 0)) >= 1"},{"unsuccessful_1_depression_pregnancy":"((lamotrigine_inadequate ? 1 : 0) + (lurasidone_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (aripiprazole_inadequate ? 1 : 0)) >= 1","unsuccessful_2_depression_pregnancy":"((lamotrigine_inadequate ? 1 : 0) + (lurasidone_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (aripiprazole_inadequate ? 1 : 0)) >= 2"},{"partial_1_depression_pregnancy":"((lamotrigine_partial ? 1 : 0) + (lurasidone_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (aripiprazole_partial ? 1 : 0)) >= 1","partial_2_depression_pregnancy":"((lamotrigine_partial ? 1 : 0) + (lurasidone_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (aripiprazole_partial ? 1 : 0)) >= 2"},{"inadequate_1_depression_pregnancy":"((unsuccessful_1_depression_pregnancy ? 1 : 0) + (partial_1_depression_pregnancy ? 1 : 0)) >= 1","inadequate_2_depression_pregnancy":"((lamotrigine_inadequate ? 1 : 0) + (lurasidone_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (aripiprazole_inadequate ? 1 : 0) + (lamotrigine_partial ? 1 : 0) + (lurasidone_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (aripiprazole_partial ? 1 : 0)) >= 2"},{"inadequate_1_atypical_pregnancy":"((lurasidone_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (aripiprazole_inadequate ? 1 : 0) + (lurasidone_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (aripiprazole_partial ? 1 : 0)) >= 1"},{"inadequate_mood_stabilizer_1":"(((lithium_inadequate && comorbidities != \'cardiac\') ? 1 : 0) + ((valproate_inadequate && comorbidities != \'hepatic\') ? 1 : 0) + ((carbamazepine_inadequate && comorbidities != \'hepatic\') ? 1 : 0) + ((lithium_partial && comorbidities != \'cardiac\') ? 1 : 0) + ((valproate_partial && comorbidities != \'hepatic\') ? 1 : 0) + ((carbamazepine_partial && comorbidities != \'hepatic\') ? 1 : 0)) >= 1"},{"inadequate_mood_stabilizer":"((lithium_inadequate ? 1 : 0) + (valproate_inadequate ? 1 : 0) + (carbamazepine_inadequate ? 1 : 0) + (lithium_partial ? 1 : 0) + (valproate_partial ? 1 : 0) + (carbamazepine_partial ? 1 : 0)) >= 3","inadequate_cardiac_mood_stabilizer":"((valproate_inadequate ? 1 : 0) + (carbamazepine_inadequate ? 1 : 0) + (valproate_partial ? 1 : 0) + (carbamazepine_partial ? 1 : 0)) >= 2","inadequate_hepatic_mood_stabilizer":"((lithium_inadequate ? 1 : 0) + (lithium_partial ? 1 : 0)) >= 1"},{"partial_mood_stabilizer":"((lithium_partial ? 1 : 0) + (valproate_partial ? 1 : 0) + (carbamazepine_partial ? 1 : 0)) >= 1"},{"current_unsuccessful":"(atypical_antipsychotic_current == \'current\' && atypical_antipsychotic_inadequate == true) || (carbamazepine_current == \'current\' && carbamazepine_inadequate == true) || (lamotrigine_current == \'current\' && lamotrigine_inadequate == true) || (lithium_current == \'current\' && lithium_inadequate == true) || (lurasidone_current == \'current\' && lurasidone_inadequate == true) || (valproate_current == \'current\' && valproate_inadequate == true) || (aripiprazole_current == \'current\' && aripiprazole_inadequate == true) || (asenapine_current == \'current\' && asenapine_inadequate == true) || (lurasidone_current == \'current\' && lurasidone_inadequate == true) || (olanzapine_fluoxetine_current == \'current\' && olanzapine_fluoxetine_inadequate == true) || (olanzapine_current == \'current\' && olanzapine_inadequate == true) || (quetiapine_current == \'current\' && quetiapine_inadequate == true) || (cariprazine_current == \'current\' && cariprazine_inadequate == true) || (risperidone_current == \'current\' && risperidone_inadequate == true) || (ziprasidone_current == \'current\' && ziprasidone_inadequate == true) || (otheratypicalantipsychotic_current == \'current\' && otheratypicalantipsychotic_inadequate == true) || (carbamazepine_current == \'current\' && carbamazepine_inadequate == true) || (lamotrigine_current == \'current\' && lamotrigine_inadequate == true) || (lithium_current == \'current\' && lithium_inadequate == true) || (valproate_current == \'current\' && valproate_inadequate == true)","current_partial":"(atypical_antipsychotic_current == \'current\' && atypical_antipsychotic_partial == true) || (carbamazepine_current == \'current\' && carbamazepine_partial == true) || (lamotrigine_current == \'current\' && lamotrigine_partial == true) || (lithium_current == \'current\' && lithium_partial == true) || (lurasidone_current == \'current\' && lurasidone_partial == true) || (valproate_current == \'current\' && valproate_partial == true) || (aripiprazole_current == \'current\' && aripiprazole_partial == true) || (asenapine_current == \'current\' && asenapine_partial == true) || (lurasidone_current == \'current\' && lurasidone_partial == true) || (olanzapine_fluoxetine_current == \'current\' && olanzapine_fluoxetine_partial == true) || (olanzapine_current == \'current\' && olanzapine_partial == true) || (quetiapine_current == \'current\' && quetiapine_partial == true) || (cariprazine_current == \'current\' && cariprazine_partial == true) || (risperidone_current == \'current\' && risperidone_partial == true) || (ziprasidone_current == \'current\' && ziprasidone_partial == true) || (otheratypicalantipsychotic_current == \'current\' && otheratypicalantipsychotic_partial == true) || (carbamazepine_current == \'current\' && carbamazepine_partial == true) || (lamotrigine_current == \'current\' && lamotrigine_partial == true) || (lithium_current == \'current\' && lithium_partial == true) || (valproate_current == \'current\' && valproate_partial == true)"},{"inadequate_1_manic_meds":"((unsuccessful_1_manic_meds ? 1 : 0) + (partial_1_manic_meds ? 1 : 0)) >= 1","inadequate_2_manic_meds":"((((unsuccessful_2_manic_meds ? 1 : 0) + (partial_2_manic_meds ? 1 : 0)) >= 1) || (((unsuccessful_1_manic_meds ? 1 : 0) + (partial_1_manic_meds ? 1 : 0)) >= 2))"},{"inadequate_1_manic_meds_ped":"((unsuccessful_1_manic_meds_ped ? 1 : 0) + (partial_1_manic_meds_ped ? 1 : 0)) >= 1","inadequate_2_manic_meds_ped":"((((unsuccessful_2_manic_meds_ped ? 1 : 0) + (partial_2_manic_meds_ped ? 1 : 0)) >= 1) || (((unsuccessful_1_manic_meds_ped ? 1 : 0) + (partial_1_manic_meds_ped ? 1 : 0)) >= 2))"},{"partial_control_meds":"((quetiapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0) + (olanzapine_fluoxetine_partial ? 1 : 0) + (lamotrigine_partial ? 1 : 0)) >= 1","inadequate_1_manic_control_meds":"((quetiapine_inadequate ? 1 : 0) + (cariprazine_inadequate ? 1 : 0) + ((olanzapine_fluoxetine_inadequate && comorbidities != \'hepatic\' && comorbidities != \'obesity\') ? 1 : 0) + (lamotrigine_inadequate ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0) + ((olanzapine_fluoxetine_partial && comorbidities != \'hepatic\' && comorbidities != \'obesity\') ? 1 : 0) + (lamotrigine_partial ? 1 : 0)) >= 1","inadequate_2_manic_control_meds":"((quetiapine_inadequate ? 1 : 0) + (cariprazine_inadequate ? 1 : 0) + ((olanzapine_fluoxetine_inadequate && comorbidities != \'hepatic\' && comorbidities != \'obesity\') ? 1 : 0) + (lamotrigine_inadequate ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (cariprazine_partial ? 1 : 0) + ((olanzapine_fluoxetine_partial && comorbidities != \'hepatic\' && comorbidities != \'obesity\') ? 1 : 0) + (lamotrigine_partial ? 1 : 0)) >= 2"},{"pregnancy_euth_meds":"(medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\') || (medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\') || (medication_carbamazepine === true && carbamazepine_current === \'current\') || (medication_carbamazepine === true && carbamazepine_current === \'prior\') || (medication_lamotrigine === true && lamotrigine_current === \'current\') || (medication_lamotrigine === true && lamotrigine_current === \'prior\') || (medication_lithium === true && lithium_current === \'current\') || (medication_lithium === true && lithium_current === \'prior\') || (medication_valproate === true && valproate_current === \'current\') || (medication_valproate === true && valproate_current === \'prior\')"},{"medication_success":"(medication_aripiprazole == true && aripiprazole_response === \'successful\') || (medication_asenapine == true && asenapine_response == 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\'successful\')"},{"prior_successful_atypical_manic":"(aripiprazole_current == \'prior\' && aripiprazole_successful === true) || (asenapine_current == \'prior\' && asenapine_successful === true) || (olanzapine_current == \'prior\' && olanzapine_successful === true && comorbidities != \'cardiac\' && comorbidities != \'hepatic\') || (quetiapine_current == \'prior\' && quetiapine_successful === true && comorbidities != \'obesity\') || (cariprazine_current == \'prior\' && cariprazine_successful === true && patient_age != \'Pediatric\') || (risperidone_current == \'prior\' && risperidone_successful === true) || (ziprasidone_current == \'prior\' && ziprasidone_successful === true && comorbidities != \'cardiac\' && patient_age != \'Pediatric\')","prior_successful_atypical_depressed":"(lurasidone_current == \'prior\' && lurasidone_successful === true && recent_mania == \'No\') || (olanzapine_fluoxetine_current == \'prior\' && olanzapine_fluoxetine_successful === true && comorbidities != 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Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":"Adequate pharmacotherapy trial: minimum two weeks at maximum clinically indicated and tolerable dose.<br><br>Discontinue Antidepressants"},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Bipolar Disorder"}]},{"visible":"medication_history === \'Yes\' && partum != \'None\' &&  (symptoms == \'mania_euthymic\', symptoms == \'monitor\') &&  recent_mania != \'Yes\'","type":"title","text":[{"visible":"true","text":"Patient\'s current successful or prior successful bipolar medications"}]},{"visible":"medication_history === \'Yes\' && partum != \'None\' && (symptoms == \'mania_euthymic\' || symptoms == \'monitor\') && recent_mania != \'Yes\'","id":"medication_atypical_antipsychotic","text":"Atypical 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If already taking medication, discontinue pharmacotherapy and discuss with cardiology."}]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"50","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-cardiac_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"50.0","type":"overlay","title":"Recommendation","text":"Patients with a history of mania may benefit from maintenance therapy.","meds":[],"therapies":[]},{"visible":"true","uid":"G_3","title":"ECG Antipsychotic Recommendations","type":"collapse_segment","text":"ECG should be performed in patients > 45 years of age or those with a history of heart disease including prior MI, arrhythmia, and systolic dysfunction.","segments":[{"title":"QTc < 500msec","text":"No additional recommendations."},{"title":"QTc 500-549msec","text":"Monitor with follow-up ECG."},{"title":"QTc > 550msec","text":"Consult with cardiology prior to initiation. If already taking medication, discontinue pharmacotherapy and discuss with cardiology."}]}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-hepatic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>For more severe symptoms start Aripiprazole, Cariprazine, or Risperidone<br> <br> For less severe symptoms start Quetiapine or Ziprasidone or Asenapine <br> <br> In some severe cases (e.g., insomnia, agitation) consider adding lorazepam.","meds":["Aripiprazole","Cariprazine","Risperidone","Quetiapine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"52","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-hepatic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>For more severe symptoms start Aripiprazole, Cariprazine, or Risperidone<br> <br> For less severe symptoms start Quetiapine or Ziprasidone or Asenapine <br> <br> In some severe cases (e.g., insomnia, agitation) consider adding lorazepam.","meds":["Aripiprazole","Cariprazine","Risperidone","Quetiapine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"53","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-hepatic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"53.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Attempt a second trial of other first choice antipsychotic.","meds":["Aripiprazole","Cariprazine","Risperidone"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"54","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-hepatic_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br><discontinue>Start a mood stabilizer","meds":["Lithium"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === true) && (patient_age === \'Adult\')","title":"","uid":"55","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-hepatic_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br>Augment first choice treatment with a mood stabilizer.","meds":["Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"56","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (partial_1_current_manic_meds === true) && (inadequate_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"58","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Attempt a second trial of first choice treatments","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_hepatic_mood_stabilizer === false) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_hepatic_mood_stabilizer === true) && (patient_age === \'Adult\')","title":"","uid":"61","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"61.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === true) && (patient_age === \'Adult\')","title":"","uid":"62","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"Augment treatment with alternate class first choice agent","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_hepatic_mood_stabilizer === false) && (patient_age === \'Adult\')","title":"","uid":"63","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br>Augment first choice treatment with a mood stabilizer","meds":["Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_hepatic_mood_stabilizer === true) && (patient_age === \'Adult\')","title":"","uid":"64","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"65","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3","Bipolar-hepatic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"65.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start Lithium<br><br><b>Antimanic therapy: Lithium</b><br><br>Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br><br><b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant (avoid SNRI\u2019s)","meds":["Cariprazine","Quetiapine","Lamotrigine","Aripiprazole","Asenapine","Risperidone","Ziprasidone","Lithium"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"65.1","type":"collapse","title":"No mania/maintenance medication","text":"<b>First Choice Options:</b><br><br>Start Cariprazine, Quetiapine, or another Atypical Antipsychotic paired with Lamotrigine<br><br><b>Second Choice Options:</b><br><br>If unsuccessful response then:<br>&#x2022; Discontinue current medication(s)<br>&#x2022; Start Lithium","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"66","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3","Bipolar-hepatic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"66.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b><br><br>Start Cariprazine, Quetiapine, or another Atypical Antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (lamotrigine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"67","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Attempt a second trial of other first choice antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"68","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"68.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Attempt a second trial of other first choice antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === false) && (inadequate_hepatic_mood_stabilizer === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"69","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === false) && (inadequate_hepatic_mood_stabilizer === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"70","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"70.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === true) && (inadequate_hepatic_mood_stabilizer === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"71","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"71.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br>Augment first choice treatment with a mood stabilizer","meds":["Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === true) && (inadequate_hepatic_mood_stabilizer === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"72","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"72.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs and bupropion, with very slow titration. Must be taking antipsychotic/mood stabilizer.","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"73","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-hepatic_b3"],"content":[{"visible":true,"uid":"73.0","type":"overlay","title":"Recommendation","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b>","meds":["Lamotrigine","Cariprazine","Quetiapine","Lurasidone","Lithium"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"73.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start Lithium","meds":[],"therapies":[]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"73.2","type":"collapse","title":"Antimanic therapy: Lithium","text":"Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment","meds":[],"therapies":[]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"73.3","type":"overlay","title":"Recommendation","text":"<b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant (avoid SNRI\u2019s)","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"100","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-hepatic_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"100.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-hepatic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"Patients with a history of mania may benefit from maintenance therapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"79","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-obesity_b1"],"content":[{"visible":"olanzapine_successful === true || olanzapine_fluoxetine_successful === true","uid":"G_36","type":"overlay","text":"Other first choice antipsychotics could be an alternative, if not previously trialed, given the metabolic risk of Olanzapine.","meds":[],"priority":"true"},{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"79.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>For more severe symptoms start Aripiprazole or Cariprazine <br> <br> For less severe symptoms start Aripiprazole, Ziprasidone, or Asenapine <br> <br>In some severe cases (e.g., insomnia, agitation) consider adding a benzodiazepine such as clonazepam.","meds":["Aripiprazole","Cariprazine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"80","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-obesity_b1"],"content":[{"visible":"olanzapine_successful === true || olanzapine_fluoxetine_successful === true","uid":"G_36","type":"overlay","text":"Other first choice antipsychotics could be an alternative, if not previously trialed, given the metabolic risk of Olanzapine.","meds":[],"priority":"true"},{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"80.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>For more severe symptoms start Aripiprazole or Cariprazine <br> <br> For less severe symptoms start Aripiprazole, Ziprasidone, or Asenapine <br> <br>In some severe cases (e.g., insomnia, agitation) consider adding a benzodiazepine such as clonazepam.","meds":["Aripiprazole","Cariprazine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-obesity_b1","Antipsychotic-Metabolic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Attempt a second trial of other first choice antipsychotic <br> <br> First choice due to lower metabolic risk should be Aripiprazole or Cariprazine. <br> <br> Second choice due to higher metabolic risk should be Olanzapine or Risperidone","meds":["Aripiprazole","Cariprazine","Olanzapine","Risperidone"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"81.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, Olanzapine, or Olanzapine + Fluoxetine Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"82","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-obesity_b2","Antipsychotic-Metabolic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"82.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === true) && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-obesity_b2","Antipsychotic-Metabolic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br>Augment first choice treatment with a mood stabilizer","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"84","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"olanzapine_successful === true || olanzapine_fluoxetine_successful === true","uid":"G_36","type":"overlay","text":"Other first choice antipsychotics could be an alternative, if not previously trialed, given the metabolic risk of Olanzapine.","meds":[],"priority":"true"},{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"84.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"84.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (partial_1_current_manic_meds === true) && (inadequate_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"85","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"olanzapine_successful === true || olanzapine_fluoxetine_successful === true","uid":"G_36","type":"overlay","text":"Other first choice antipsychotics could be an alternative, if not previously trialed, given the metabolic risk of Olanzapine.","meds":[],"priority":"true"},{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"85.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"85.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"85","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"olanzapine_successful === true || olanzapine_fluoxetine_successful === true","uid":"G_36","type":"overlay","text":"Other first choice antipsychotics could be an alternative, if not previously trialed, given the metabolic risk of Olanzapine.","meds":[],"priority":"true"},{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"85.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"85.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"86","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"86.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Attempt a second trial of first choice treatments","meds":["Lurasidone","Cariprazine","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"86.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, Olanzapine, or Olanzapine + Fluoxetine Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === false) && (patient_age === \'Adult\')","title":"","uid":"87","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"87.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === true) && (patient_age === \'Adult\')","title":"","uid":"88","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"88.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding paroxetine and mirtazapine, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === true) && (patient_age === \'Adult\')","title":"","uid":"89","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"89.0","type":"overlay","title":"Recommendation","text":"Augment treatment with alternate class first choice agent","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"89.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, Olanzapine, or Olanzapine + Fluoxetine Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === false) && (patient_age === \'Adult\')","title":"","uid":"90","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"lamotrigine_partial == true","uid":"G_35","type":"overlay","text":"Avoid combinations of any two of the following: Carbamazepine, Lamotrigine, or Valproate<br><br>Consult psychiatry for further recommendations","meds":[],"priority":"true"},{"visible":true,"uid":"90.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br>Augment first choice treatment with a mood stabilizer in the order listed below.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === true) && (patient_age === \'Adult\')","title":"","uid":"91","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"91.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding paroxetine and mirtazapine, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"92","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"olanzapine_successful === true || olanzapine_fluoxetine_successful === true","uid":"G_36","type":"overlay","text":"Other first choice antipsychotics could be an alternative, if not previously trialed, given the metabolic risk of Olanzapine.","meds":[],"priority":"true"},{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"92.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br>&#x2800;3. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b><br><br><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start either &#x2800;<br>1. Lithium, &#x2800;<br>2. Valproate&#x2800;<br>3. Carbamazepine<br><br><b>Antimanic therapy: Lithium</b><br><br>Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start Valproate or Carbamazepine<br><br><b>Antimanic therapy: Valproate or Carbamazepine</b><br><br>Continue Valproate or Carbamazepine and:<br><br>1st step: Add Bipolar Depression First Choice Antipsychotic<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start Lithium<br><br><b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant (avoid Paroxetine and Mirtazapine)","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone","Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"92.1","type":"collapse","title":"No mania/maintenance medication","text":"<b>First Choice Options:</b><br><br>Start Cariprazine, Quetiapine, another Atypical Antipsychotic paired with Lamotrigine, or Olanzapine + Fluoxetine under special circumstances.<br><br><b>Second Choice Options:</b><br><br>If unsuccessful response then:<br>&#x2022; Discontinue current medication(s)<br>&#x2022; Start:<br>&#x2800;<br>1. Lithium, &#x2800;<br>2. Valproate&#x2800;<br>3. Carbamazepine","meds":[],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"92.2","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, Olanzapine, or Olanzapine + Fluoxetine Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"93","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"olanzapine_successful === true || olanzapine_fluoxetine_successful === true","uid":"G_36","type":"overlay","text":"Other first choice antipsychotics could be an alternative, if not previously trialed, given the metabolic risk of Olanzapine.","meds":[],"priority":"true"},{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"93.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b><br><br>Start Cariprazine, Quetiapine, another Atypical Antipsychotic paired with Lamotrigine, or Olanzapine + Fluoxetine under special circumstances.","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"93.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, Olanzapine, or Olanzapine + Fluoxetine Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (lamotrigine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Attempt a second trial of other first choice antipsychotic paired with Lamotrigine or Olanzapine + Fluoxetine under special circumstances.","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"94.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, Olanzapine, or Olanzapine + Fluoxetine Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Attempt a second trial of other first choice antipsychotic paired with Lamotrigine or Olanzapine + Fluoxetine under special circumstances.","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"94.1","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, Olanzapine, or Olanzapine + Fluoxetine Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"96","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar 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Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"97","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"lamotrigine_partial == true","uid":"G_35","type":"overlay","text":"Avoid combinations of any two of the following: Carbamazepine, Lamotrigine, or Valproate<br><br>Consult psychiatry for further recommendations","meds":[],"priority":"true"},{"visible":true,"uid":"97.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br>Augment first choice treatment with a mood stabilizer in the order listed below.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"98","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"98.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding paroxetine and mirtazapine, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"99","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-obesity_b3","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"99.0","type":"overlay","title":"Recommendation","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br>&#x2800;3. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b>","meds":["Lamotrigine","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lurasidone","Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"99.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start either 1. Lithium, 2. Valproate, or 3. Carbamazepine","meds":[],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"99.2","type":"collapse","title":"Antimanic therapy: Lithium","text":"Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start Valproate or Carbamazepine","meds":[],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"99.3","type":"collapse","title":"Antimanic therapy: Valproate or Carbamazepine","text":"Continue Valproate or Carbamazepine and:<br><br>1st step: Add Bipolar Depression First Choice Antipsychotic<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start Lithium","meds":[],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"99.4","type":"overlay","title":"Recommendation","text":"<b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant (avoid Paroxetine and Mirtazapine)","meds":[],"therapies":[]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"99.5","type":"overlay","title":"Recommendation","text":"<b>Obesity:</b> <br><br>If taking Quetiapine, Olanzapine, or Olanzapine + Fluoxetine Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"118","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-obesity_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"118.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"119","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-obesity_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"119.0","type":"overlay","title":"Recommendation","text":"Patients with a history of mania may benefit from maintenance therapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"120","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-renal_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"120.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>For more severe symptoms start Aripiprazole, Cariprazine, Risperidone, or Olanzapine<br> <br> For less severe symptoms start Quetiapine or Ziprasidone or Asenapine <br> <br>In some severe cases (e.g., insomnia, agitation) consider adding lorazepam.","meds":["Aripiprazole","Cariprazine","Risperidone","Olanzapine","Quetiapine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"121","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-renal_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"121.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>For more severe symptoms start Aripiprazole, Cariprazine, Risperidone, or Olanzapine<br> <br> For less severe symptoms start Quetiapine or Ziprasidone or Asenapine <br> <br>In some severe cases (e.g., insomnia, agitation) consider adding lorazepam.","meds":["Aripiprazole","Cariprazine","Risperidone","Olanzapine","Quetiapine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"122","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-renal_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"122.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Attempt a second trial of other first choice antipsychotic","meds":["Aripiprazole","Cariprazine","Olanzapine","Risperidone"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"123","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-renal_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"123.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br><discontinue>Start a mood stabilizer","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_4","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === true) && (patient_age === \'Adult\')","title":"","uid":"124","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-renal_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"124.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br>Augment first choice treatment with a mood stabilizer","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_4","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"125","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"125.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (partial_1_current_manic_meds === true) && (inadequate_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"126","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"126.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"126","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"126.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"127","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"127.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Attempt a second trial of first choice treatments","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === false) && (patient_age === \'Adult\')","title":"","uid":"128","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"128.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_4","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === true) && (patient_age === \'Adult\')","title":"","uid":"129","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"129.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === true) && (patient_age === \'Adult\')","title":"","uid":"130","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"130.0","type":"overlay","title":"Recommendation","text":"Augment treatment with alternate class first choice agent","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === false) && (patient_age === \'Adult\')","title":"","uid":"131","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"lamotrigine_partial == true","uid":"G_35","type":"overlay","text":"Avoid combinations of any two of the following: Carbamazepine, Lamotrigine, or Valproate<br><br>Consult psychiatry for further recommendations","meds":[],"priority":"true"},{"visible":true,"uid":"131.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br>Augment first choice treatment with a mood stabilizer in the order listed below.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_4","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === true) && (patient_age === \'Adult\')","title":"","uid":"132","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"132.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"133","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"133.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br>&#x2800;3. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b><br><br><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start either<br>&#x2800;1. Valproate<br>&#x2800;2. Carbamazepine<br>&#x2800;3. Lithium<br><br><b>Antimanic therapy: Lithium</b><br><br>Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start 1. Valproate or 2. Carbamazepine<br><br><b>Antimanic therapy: Valproate or Carbamazepine</b><br><br>Continue Valproate or Carbamazepine and:<br><br>1st step: Add Bipolar Depression First Choice Antipsychotic<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice Antipsychotic<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start Lithium<br><br><b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant (avoid SNRI\u2019s)","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone","Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"133.1","type":"collapse","title":"No mania/maintenance medication","text":"<b>First Choice Options:</b><br><br>Start Cariprazine, Quetiapine, Olanzapine + Fluoxetine, or another Atypical Antipsychotic paired with Lamotrigine<br><br><b>Second Choice Options:</b><br><br>If unsuccessful response then:<br>&#x2022; Discontinue current medication(s)<br>&#x2022; Start:<br>&#x2800;1. Valproate<br>&#x2800;2. Carbamazepine<br>&#x2800;3. Lithium","meds":[],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_4","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"134","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b><br><br>Start Cariprazine, Quetiapine, Olanzapine + Fluoxetine, or another Atypical Antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (lamotrigine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"135","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"135.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Attempt a second trial of other first choice antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"135","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"135.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Attempt a second trial of other first choice antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"136","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"136.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_4","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"137","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"137.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"138","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"lamotrigine_partial == true","uid":"G_35","type":"overlay","text":"Avoid combinations of any two of the following: Carbamazepine, Lamotrigine, or Valproate<br><br>Consult psychiatry for further recommendations","meds":[],"priority":"true"},{"visible":true,"uid":"138.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br>Augment first choice treatment with a mood stabilizer in the order listed below.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_4","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"139","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"139.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"140","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-renal_b3"],"content":[{"visible":true,"uid":"140.0","type":"overlay","title":"Recommendation","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br>&#x2800;3. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b>","meds":["Lamotrigine","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lurasidone","Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_4","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"140.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start either 1. Valproate, 2. Carbamazepine, or 3. Lithium","meds":[],"therapies":[]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"140.2","type":"collapse","title":"Antimanic therapy: Lithium","text":"Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start 1. Valproate or 2. Carbamazepine","meds":[],"therapies":[]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"140.3","type":"collapse","title":"Antimanic therapy: Valproate or Carbamazepine","text":"Continue Valproate or Carbamazepine and:<br><br>1st step: Add Bipolar Depression First Choice Antipsychotic<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice Antipsychotic<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start Lithium","meds":[],"therapies":[]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"140.4","type":"overlay","title":"Recommendation","text":"<b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant (avoid SNRI\u2019s)","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"157","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-renal_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"157.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"158","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-renal_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"158.0","type":"overlay","title":"Recommendation","text":"Patients with a history of mania may benefit from maintenance therapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"159","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-geriatric_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"159.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>For more severe symptoms start Aripiprazole, Cariprazine, Risperidone, or Olanzapine<br> <br> For less severe symptoms start Quetiapine or Ziprasidone or Asenapine <br> <br>In some severe cases (e.g., insomnia, agitation) consider adding lorazepam.","meds":["Aripiprazole","Cariprazine","Risperidone","Olanzapine","Quetiapine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === false) && (patient_age === \'Geriatric\')","title":"","uid":"160","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-geriatric_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"160.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>For more severe symptoms start Aripiprazole, Cariprazine, Risperidone, or Olanzapine<br> <br> For less severe symptoms start Quetiapine or Ziprasidone or Asenapine <br> <br>In some severe cases (e.g., insomnia, agitation) consider adding lorazepam.","meds":["Aripiprazole","Cariprazine","Risperidone","Olanzapine","Quetiapine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (patient_age === \'Geriatric\')","title":"","uid":"161","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-geriatric_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"161.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b> <br><br>Attempt a second trial of other first choice antipsychotic","meds":["Aripiprazole","Cariprazine","Olanzapine","Risperidone"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === false) && (patient_age === \'Geriatric\')","title":"","uid":"162","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-geriatric_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"162.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br><discontinue>Start a mood stabilizer","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"163","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-geriatric_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"163.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br>Augment first choice treatment with a mood stabilizer","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"164","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"164.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b> <br><br>Atypical Antipsychotic or Lamotrigine<br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (partial_1_current_manic_meds === true) && (inadequate_1_depression_meds === false) && (patient_age === \'Geriatric\')","title":"","uid":"165","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"165.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b> <br><br>Atypical Antipsychotic or Lamotrigine<br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === false) && (patient_age === \'Geriatric\')","title":"","uid":"165","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"165.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b> <br><br>Atypical Antipsychotic or Lamotrigine<br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === false) && (patient_age === \'Geriatric\')","title":"","uid":"166","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"166.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b> <br><br>Attempt a second trial of first choice treatments. <br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine.","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === false) && (patient_age === \'Geriatric\')","title":"","uid":"167","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"167.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === true) && (patient_age === \'Geriatric\')","title":"","uid":"168","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"168.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"169","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"169.0","type":"overlay","title":"Recommendation","text":"Augment treatment with alternate class first choice agent. <br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine..","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === false) && (patient_age === \'Geriatric\')","title":"","uid":"170","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"lamotrigine_partial == true","uid":"G_35","type":"overlay","text":"Avoid combinations of any two of the following: Carbamazepine, Lamotrigine, or Valproate<br><br>Consult psychiatry for further recommendations","meds":[],"priority":"true"},{"visible":true,"uid":"170.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br>Augment first choice treatment with a mood stabilizer in the order listed below.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === true) && (patient_age === \'Geriatric\')","title":"","uid":"171","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"171.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"172","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"172.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br>&#x2800;3. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b><br><br><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start either <br>&#x2800;&#x2800;1. Valproate<br>&#x2800;&#x2800;2. Carbamazepine<br>&#x2800;&#x2800;3. Lithium<br><br><b>Antimanic therapy: Lithium</b><br><br>Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start 1. Valproate or 2. Carbamazepine<br><br><b>Antimanic therapy: Valproate or Carbamazepine</b><br><br>Continue Valproate or Carbamazepine and:<br><br>1st step: Add Bipolar Depression First Choice Antipsychotic<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice Antipsychotic<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start Lithium<br><br><b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone","Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"172.1","type":"collapse","title":"No mania/maintenance medication","text":"<b>First Choice Options</b><br><br>Start Cariprazine, Quetiapine, Olanzapine + Fluoxetine, or another Atypical Antipsychotic paired with Lamotrigine<br><br><b>Second Choice Options:</b><br><br>If unsuccessful response then:<br>&#x2022; Discontinue current medication(s)<br>&#x2022; Start:<br>&#x2800;1. Valproate<br>&#x2800;2. Carbamazepine<br>&#x2800;3. Lithium","meds":[],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === false) && (patient_age === \'Geriatric\')","title":"","uid":"173","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"173.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Start Cariprazine, Quetiapine, Olanzapine + Fluoxetine, or another Atypical Antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (lamotrigine_trialed === false) && (patient_age === \'Geriatric\')","title":"","uid":"174","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"174.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Attempt a second trial of other first choice antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (lamotrigine_trialed === true) && (patient_age === \'Geriatric\')","title":"","uid":"174","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"174.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Attempt a second trial of other first choice antipsychotic paired with Lamotrigine","meds":["Cariprazine","Quetiapine","Lamotrigine","Olanzapine + Fluoxetine","Aripiprazole","Asenapine","Risperidone","Ziprasidone"],"therapies":[]},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === false) && (lamotrigine_trialed === true) && (patient_age === \'Geriatric\')","title":"","uid":"175","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"175.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === true) && (lamotrigine_trialed === true) && (patient_age === \'Geriatric\')","title":"","uid":"176","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"176.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === false) && (lamotrigine_trialed === true) && (patient_age === \'Geriatric\')","title":"","uid":"177","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"lamotrigine_partial == true","uid":"G_35","type":"overlay","text":"Avoid combinations of any two of the following: Carbamazepine, Lamotrigine, or Valproate<br><br>Consult psychiatry for further recommendations","meds":[],"priority":"true"},{"visible":true,"uid":"177.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options</b> <br><br>Augment first choice treatment with a mood stabilizer in the order listed below.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === true) && (lamotrigine_trialed === true) && (patient_age === \'Geriatric\')","title":"","uid":"178","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"178.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options:</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs with very slow titration. Must be taking antipsychotic/mood stabilizer","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"179","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-geriatric_b3"],"content":[{"visible":true,"uid":"179.0","type":"overlay","title":"Recommendation","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br>&#x2800;3. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b>","meds":["Lamotrigine","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lurasidone","Lithium","Valproate","Carbamazepine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"(patient_age === \'Geriatric\')","uid":"179.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start either <br>&#x2800;&#x2800;1. Valproate<br>&#x2800;&#x2800;2. Carbamazepine<br>&#x2800;&#x2800;3. Lithium","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"179.2","type":"collapse","title":"Antimanic therapy: Lithium","text":"Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start 1. Valproate or 2. Carbamazepine","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"179.3","type":"collapse","title":"Antimanic therapy: Valproate or Carbamazepine","text":"Continue Valproate or Carbamazepine and:<br><br>1st step: Add Bipolar Depression First Choice Antipsychotic<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice Antipsychotic<br><br>3rd step: If second trial of first choice treatment ineffective, discontinue and start Lithium","meds":[],"therapies":[]},{"visible":"(patient_age === \'Geriatric\')","uid":"179.4","type":"overlay","title":"Recommendation","text":"<b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"196","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-geriatric_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"196.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"197","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-geriatric_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"197.0","type":"overlay","title":"Recommendation","text":"Patients with a history of mania may benefit from maintenance therapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"198","state":"recommendation","branch":"Bipolar Mania","figure":["Pediatric-Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"198.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Aripiprazole<br>(Discontinue antidepressants)","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_trialed === false) && (patient_age === \'Pediatric\')","title":"","uid":"199","state":"recommendation","branch":"Bipolar Mania","figure":["Pediatric-Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"199.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Aripiprazole<br>(Discontinue antidepressants)","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_trialed === true) && (risperidone_trialed === false) && (patient_age === \'Pediatric\')","title":"","uid":"200","state":"recommendation","branch":"Bipolar Mania","figure":["Pediatric-Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"200.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br><discontinue>Trial Risperidone","meds":["Risperidone"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds_ped === false) && (aripiprazole_trialed === true) && (risperidone_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"201","state":"recommendation","branch":"Bipolar Mania","figure":["Pediatric-Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"201.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b><br><br><discontinue>Psychiatry Consult (if available) <br><br>If psychiatry consultation not available, consider: Olanzapine for more severe symptoms. <br> <br>For less severe symptoms trial either Quetiapine or Asenapine.","meds":["Olanzapine","Quetiapine","Asenapine"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds_ped === true) && (partial_1_manic_meds_ped === false) && (aripiprazole_trialed === true) && (risperidone_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"202","state":"recommendation","branch":"Bipolar Mania","figure":["Pediatric-Bipolar-Disorder_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"202.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br>Switch to a mood stabilizer such as Valproate or Lithium (ideally prescribed in conjunction with psychiatrist recommendation)<br> <i>Use Lithium with careful patient selection and clinician comfort with monitoring protocol</i>","meds":["Valproate","Lithium"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds_ped === true) && (partial_1_manic_meds_ped === true) && (aripiprazole_trialed === true) && (risperidone_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"203","state":"recommendation","branch":"Bipolar Mania","figure":["Pediatric-Bipolar-Disorder_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"203.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br>Augment with a mood stabilizer such as Valproate or Lithium <br> <i>Use Lithium with careful patient selection and clinician comfort with monitoring protocol</i>","meds":["Valproate","Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"204","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"204.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Lurasidone","meds":["Lurasidone"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (partial_1_current_manic_meds_ped === true) && (lurasidone_trialed === false) && (patient_age === \'Pediatric\')","title":"","uid":"205","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"205.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Lurasidone","meds":["Lurasidone"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_2_depression_meds === false) && (lurasidone_trialed === false) && (patient_age === \'Pediatric\')","title":"","uid":"205","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"205.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Lurasidone","meds":["Lurasidone"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_2_depression_meds === false) && (lurasidone_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"206","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"206.0","type":"overlay","title":"Recommendation","text":"<b>Second choice medications:</b> <br>(Cross taper from previous medication) <br>1.Lamotrigine <br>2.Olanzapine","meds":["Lamotrigine","Olanzapine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_2_depression_meds === true) && (lurasidone_trialed === true) && (aripiprazole_trialed === false) && (patient_age === \'Pediatric\')","title":"","uid":"207","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"207.0","type":"overlay","title":"Recommendation","text":"Trial all other second choice medications <br> <br>If all first and second choice medications have been trialed, refer to Psychiatry. <br> <br>For partial response to first and second choice medication, add aripiprazole.","meds":["Aripiprazole","Lamotrigine","Olanzapine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_2_depression_meds === true) && (aripiprazole_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"208","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"208.0","type":"overlay","title":"Recommendation","text":"If depressive symptoms persist try psychiatry referral if available","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"209","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"209.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms<br><br>See below for pharmacotherapy options based on effective antimanic treatment.<br><br><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, consult psychiatry<br><br><b>Antimanic therapy: Lithium or Valproate</b><br><br>Continue Lithium or Valproate and:<br><br>1st step: Add Lurasidone<br><br>2nd step: If Lurasidone ineffective, discontinue Lurasidone and start Olanzapine<br><br>3rd step: If Olanzapine treatment ineffective, consult psychiatry","meds":["Aripiprazole","Risperidone","Lamotrigine","Lurasidone","Olanzapine","Valproate","Lithium"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"209.1","type":"collapse","title":"No mania/maintenance medication","text":"<b>First Choice Options:</b> <br><br>Start Lamotrigine paired with one of the following antipsychotics:<br>1. Aripiprazole<br>2. Risperidone<br><br>If unsuccessful response then:<br>&#x2022; Discontinue current medication(s)<br>&#x2022; Start Olanzapine<br>&#x2022; Refer to psychiatry","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === false) && (aripiprazole_trialed === false) && (risperidone_trialed === false) && (patient_age === \'Pediatric\')","title":"","uid":"210","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"210.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start Lamotrigine paired with one of the following antipsychotics:<br>1. Aripiprazole<br>2. Risperidone","meds":["Aripiprazole","Risperidone","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === false) && (aripiprazole_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"211","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true && medication_aripiprazole == true && medication_risperidone == true && medication_lamotrigine == true","uid":"G_37","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"211.0","type":"overlay","title":"Recommendation","text":"Maximize current therapy <br> <br> If already maximized, add Lamotrigine to current atypical antipsychotic mania treatment","meds":["Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === false) && (risperidone_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"211","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true && medication_aripiprazole == true && medication_risperidone == true && medication_lamotrigine == true","uid":"G_37","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"211.0","type":"overlay","title":"Recommendation","text":"Maximize current therapy <br> <br> If already maximized, add Lamotrigine to current atypical antipsychotic mania treatment","meds":["Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (aripiprazole_trialed === false) && (risperidone_trialed === false) && (patient_age === \'Pediatric\')","title":"","uid":"212","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true && medication_aripiprazole == true && medication_risperidone == true && medication_lamotrigine == true","uid":"G_37","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"212.0","type":"overlay","title":"Recommendation","text":"Pair atypical antipsychotic to current Lamotrigine treatment. ","meds":["Aripiprazole","Risperidone","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (aripiprazole_trialed === false) && (risperidone_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"212","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"212.0","type":"overlay","title":"Recommendation","text":"If all first and second choice medications have been trialed, refer to Psychiatry. <br> <br>For partial response to first and second choice medication, add aripiprazole.","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (aripiprazole_trialed === true) && (patient_age === \'Pediatric\')","title":"","uid":"213","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"213.0","type":"overlay","title":"Recommendation","text":"If depressive symptoms persist try psychiatry referral if available","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"214","state":"recommendation","branch":"Bipolar Depression","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":true,"uid":"214.0","type":"overlay","title":"Recommendation","text":"Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms<br><br>See below for pharmacotherapy options based on effective antimanic treatment.","meds":["Lamotrigine","Olanzapine","Lurasidone"],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"214.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, consult psychiatry","meds":[],"therapies":[]},{"visible":"(patient_age === \'Pediatric\')","uid":"214.2","type":"collapse","title":"Antimanic therapy: Lithium or Valproate","text":"Continue Lithium or Valproate and:<br><br>1st step: Add Lurasidone<br><br>2nd step: If Lurasidone ineffective, discontinue Lurasidone and start Olanzapine<br><br>3rd step: If Olanzapine treatment ineffective, consult psychiatry","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"228","state":"recommendation","branch":"Bipolar Euthymic","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"228.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"229","state":"recommendation","branch":"Bipolar Euthymic","figure":["Pediatric-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"229.0","type":"overlay","title":"Recommendation","text":"Restart medication that was used to successfully treat mania in the past or consider the addition of aripiprazole.","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"198","state":"recommendation","branch":"Bipolar Mania","figure":["Adolescent-Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"198.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Aripiprazole<br>(Discontinue antidepressants)","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_trialed === false) && (patient_age === \'Adolescent\')","title":"","uid":"199","state":"recommendation","branch":"Bipolar Mania","figure":["Adolescent-Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"199.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Aripiprazole<br>(Discontinue antidepressants)","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_trialed === true) && (risperidone_trialed === false) && (patient_age === \'Adolescent\')","title":"","uid":"200","state":"recommendation","branch":"Bipolar Mania","figure":["Adolescent-Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"200.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br><discontinue>Trial Risperidone","meds":["Risperidone"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (quetiapine_trialed === false) && (aripiprazole_trialed === true) && (risperidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"201","state":"recommendation","branch":"Bipolar Mania","figure":["Adolescent-Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"201.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b><br><br><discontinue>Start Quetiapine<br><br>Consider psychiatry consultation","meds":["Quetiapine"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (unsuccessful_1_manic_meds_ad === false) && (partial_1_manic_meds_ad === false) && (quetiapine_trialed === true) && (aripiprazole_trialed === true) && (risperidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"202","state":"recommendation","branch":"Bipolar Mania","figure":["Adolescent-Bipolar-Disorder_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"202.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options:</b> <br><br><discontinue>Start either Asenapine, Cariprazine, or Olanzapine<br><br>Consider psychiatry consultation","meds":["Asenapine","Cariprazine","Olanzapine"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (unsuccessful_1_manic_meds_ad === false) && (partial_1_manic_meds_ad === true) && (aripiprazole_trialed === true) && (risperidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"203","state":"recommendation","branch":"Bipolar Mania","figure":["Adolescent-Bipolar-Disorder_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"203.0","type":"overlay","title":"Recommendation","text":"Augment with either Lithium or Valproate, ideally in conjunction with a psychiatrist","meds":["Lithium","Valproate"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (unsuccessful_1_manic_meds_ad === true) && (quetiapine_trialed === true) && (aripiprazole_trialed === true) && (risperidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"202","state":"recommendation","branch":"Bipolar Mania","figure":["Adolescent-Bipolar-Disorder_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"202.0","type":"overlay","title":"Recommendation","text":"Discontinue previous antipsychotic treatment and start Lithium or Valproate, ideally in conjunction with a psychiatrist","meds":["Lithium","Valproate"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"204","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"204.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Lurasidone or Lamotrigine","meds":["Lurasidone","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (partial_1_current_manic_meds_ped === true) && (lamotrigine_trialed === false) && (lurasidone_trialed === false) && (patient_age === \'Adolescent\')","title":"","uid":"205","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"205.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Lurasidone or Lamotrigine","meds":["Lurasidone","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === false) && (lurasidone_trialed === false) && (patient_age === \'Adolescent\')","title":"","uid":"205","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"205.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br>Start Lurasidone or Lamotrigine","meds":["Lurasidone","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (lurasidone_trialed === false) && (patient_age === \'Adolescent\')","title":"","uid":"205","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"205.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br><discontinue>Start Lurasidone","meds":["Lurasidone"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === false) && (lurasidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"205","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"205.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Option:</b> <br><br><discontinue>Start Lamotrigine","meds":["Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (inadequate_1_depression_meds_ad === false) && (lurasidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"206","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"206.0","type":"overlay","title":"Recommendation","text":"<b>Second choice medications:</b> <br>(Cross taper from previous medication) <br>Quetiapine<br>Cariprazine","meds":["Quetiapine","Cariprazine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (inadequate_1_depression_meds_ad === true) && (lurasidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"207","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"207.0","type":"overlay","title":"Recommendation","text":"Trial alternate atypical antipsychotic that hasn\'t been trialed or Lithium<br><br>Consider Psychiatry Referral","meds":["Quetiapine","Cariprazine","Olanzapine","Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"209","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"209.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms<br><br>See below for pharmacotherapy options based on effective antimanic treatment.<br><br><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, consult psychiatry<br><br><b>Antimanic therapy: Lithium or Valproate</b><br><br>Continue Lithium or Valproate and:<br><br>1st step: Add Lurasidone<br><br>2nd step: If Lurasidone ineffective, discontinue Lurasidone and start Olanzapine<br><br>3rd step: If Olanzapine treatment ineffective, consult psychiatry","meds":["Aripiprazole","Risperidone","Lamotrigine","Quetiapine","Cariprazine","Olanzapine","Lithium"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"209.1","type":"collapse","title":"No mania/maintenance medication","text":"<b>First Choice Options:</b> <br><br>Start Lamotrigine paired with one of the following antipsychotics:<br>1. Aripiprazole<br>2. Risperidone<br><br><br><br>If unsuccessful response then:<br>&#x2022; Discontinue current medication(s)<br>&#x2022; Trial Quetiapine, Cariprazine, Olanzapine, or Lithium<br>&#x2022; Refer to psychiatry","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === false) && (aripiprazole_trialed === false) && (risperidone_trialed === false) && (patient_age === \'Adolescent\')","title":"","uid":"210","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"210.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start Lamotrigine paired with one of the following antipsychotics:<br>1. Aripiprazole<br>2. Risperidone","meds":["Aripiprazole","Risperidone","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === false) && (aripiprazole_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"211","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true && medication_aripiprazole == true && medication_risperidone == true && medication_lamotrigine == true","uid":"G_37","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"211.0","type":"overlay","title":"Recommendation","text":"Maximize current therapy <br> <br> If already maximized, add Lamotrigine to current atypical antipsychotic mania treatment","meds":["Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === false) && (risperidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"212","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true && medication_aripiprazole == true && medication_risperidone == true && medication_lamotrigine == true","uid":"G_37","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"212.0","type":"overlay","title":"Recommendation","text":"Maximize current therapy <br> <br> If already maximized, add Lamotrigine to current atypical antipsychotic mania treatment","meds":["Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (aripiprazole_trialed === false) && (risperidone_trialed === false) && (patient_age === \'Adolescent\')","title":"","uid":"213","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true && medication_aripiprazole == true && medication_risperidone == true && medication_lamotrigine == true","uid":"G_37","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"213.0","type":"overlay","title":"Recommendation","text":"Pair atypical antipsychotic to current Lamotrigine treatment. ","meds":["Aripiprazole","Risperidone","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (risperidone_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"214","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"214.0","type":"overlay","title":"Recommendation","text":"Trial alternate atypical antipsychotic that hasn\'t been trialed or Lithium.<br><br>Refer to Psychiatry.","meds":["Quetiapine","Cariprazine","Olanzapine","Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (lamotrigine_trialed === true) && (aripiprazole_trialed === true) && (patient_age === \'Adolescent\')","title":"","uid":"215","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"215.0","type":"overlay","title":"Recommendation","text":"Trial alternate atypical antipsychotic that hasn\'t been trialed or Lithium.<br><br>Refer to Psychiatry.","meds":["Quetiapine","Cariprazine","Olanzapine","Lithium"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"214","state":"recommendation","branch":"Bipolar Depression","figure":["Adolescent-Bipolar-Disorder_b3"],"content":[{"visible":true,"uid":"214.0","type":"overlay","title":"Recommendation","text":"Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms<br><br>See below for pharmacotherapy options based on effective antimanic treatment.","meds":["Lamotrigine","Lurasidone","Quetiapine","Cariprazine"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"214.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, consult psychiatry","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"214.2","type":"collapse","title":"Antimanic therapy: Lithium or Valproate","text":"Continue Lithium or Valproate and:<br><br>1st step: Add Lurasidone<br><br>2nd step: If Lurasidone ineffective, discontinue Lurasidone and start Olanzapine<br><br>3rd step: If Olanzapine treatment ineffective, consult psychiatry","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"228","state":"recommendation","branch":"Bipolar Euthymic","figure":["Adolescent-Bipolar-Disorder_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"228.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"229","state":"recommendation","branch":"Bipolar Euthymic","figure":["Adolescent-Bipolar-Disorder_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"229.0","type":"overlay","title":"Recommendation","text":"Restart/Continue medication that has successfully treated mania.<br><br>If no prior successful antimanic medication consider Aripiprazole.","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"230","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-preconception_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"230.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start a first choice medication","meds":["Aripiprazole","Quetiapine","Olanzapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"231","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-preconception_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"231.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start a first choice medication","meds":["Aripiprazole","Quetiapine","Olanzapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"232","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-preconception_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"232.0","type":"overlay","title":"Recommendation","text":"If unsuccessful, attempt a second trial of other first choice antipsychotic","meds":["Aripiprazole","Quetiapine","Olanzapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"233","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-preconception_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"233.0","type":"overlay","title":"Recommendation","text":"Start Lithium","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (lithium_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"234","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-preconception_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"234.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation, if available","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"235","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"235.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (partial_1_current_manic_meds === true) && (inadequate_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"236","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"236.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"236","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"236.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Atypical Antipsychotic or Lamotrigine","meds":["Lurasidone","Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (partial_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"237","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"237.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Attempt a second trial of first choice treatments","meds":["Lurasidone","Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (partial_1_depression_pregnancy === false) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"238","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"238.0","type":"overlay","title":"Recommendation","text":"Start Lithium","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (partial_1_depression_pregnancy === false) && (lithium_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"239","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"239.0","type":"overlay","title":"Recommendation","text":"Cautious introduction of SSRI with continued mood stabilizer.<br><br> Psychiatry consultation, if available","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (partial_1_depression_pregnancy === true) && (patient_age === \'Adult\')","title":"","uid":"240","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"240.0","type":"overlay","title":"Recommendation","text":"Combine an Atypical antipsychotic and Lamotrigine","meds":["Lurasidone","Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"241","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"241.0","type":"overlay","title":"Recommendation","text":"Start Lithium","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lithium_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"242","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"242.0","type":"overlay","title":"Recommendation","text":"Cautious introduction of SSRI with continued mood stabilizer.<br><br> Psychiatry consultation, if available","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"243","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b1","Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"243.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Aripiprazole<br>&#x2800;2. Quetiapine<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b><br><br><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue Antipsychotic and Lamotrigine and start either <br>&#x2800;&#x2800;&#x2022; Aripiprazole or Quetiapine if not previously trialed<br>&#x2800;&#x2800;&#x2022; Lithium<br><br><b>Antimanic therapy: Lithium</b><br><br>Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800;&#x2022; Aripiprazole<br>&#x2800;&#x2800;&#x2022; Lurasidone<br>&#x2800;&#x2800;&#x2022; Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br><br><b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant","meds":["Lurasidone","Aripiprazole","Quetiapine","Lamotrigine","Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"(patient_age === \'Adult\')","uid":"243.1","type":"collapse","title":"No mania/maintenance medication","text":"<b>First Choice Options</b> <br><br>Start Aripiprazole or Quetiapine at anti-manic doses<br><br>If unsuccessful response then:<br>&#x2022; Discontinue current medication(s)<br>&#x2022; Start Lithium<br>&#x2022; Refer to psychiatry","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"244","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b1","Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"244.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b><br><br>Start Aripiprazole or Quetiapine at anti-manic doses","meds":["Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (partial_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"245","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"245.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b> <br><br>1. Add Lamotrigine to current anti-mania / maintenance therapy <br>2. Change to Aripiprazole at anti-manic doses <br>3. Change to Quetiapine at anti-manic doses<br><br>Start Lithium","meds":["Lamotrigine","Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (partial_1_depression_pregnancy === false) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"246","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"246.0","type":"overlay","title":"Recommendation","text":"Start Lithium","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (partial_1_depression_pregnancy === false) && (lithium_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"247","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"247.0","type":"overlay","title":"Recommendation","text":"Cautious introduction of SSRI with continued mood stabilizer.<br><br> Psychiatry consultation, if available","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (partial_1_depression_pregnancy === true) && (patient_age === \'Adult\')","title":"","uid":"248","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"248.0","type":"overlay","title":"Recommendation","text":"Combine an Atypical antipsychotic and Lamotrigine","meds":["Lurasidone","Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"249","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"249.0","type":"overlay","title":"Recommendation","text":"Start Lithium","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lithium_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"250","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"250.0","type":"overlay","title":"Recommendation","text":"Cautious introduction of SSRI with continued mood stabilizer.<br><br> Psychiatry consultation, if available","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"251","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-preconception_b3"],"content":[{"visible":true,"uid":"251.0","type":"overlay","title":"Recommendation","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Aripiprazole<br>&#x2800;2. Quetiapine<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b>","meds":["Lamotrigine","Aripiprazole","Quetiapine","Lurasidone","Lithium"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"251.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start either <br>&#x2800;&#x2800;&#x2022; Switch to Aripiprazole or Quetiapine if not previously trialed<br>&#x2800;&#x2800;&#x2022; or start Lithium","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"251.2","type":"collapse","title":"Antimanic therapy: Lithium","text":"Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800;&#x2022; Aripiprazole<br>&#x2800;&#x2800;&#x2022; Lurasidone<br>&#x2800;&#x2800;&#x2022; Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"251.3","type":"overlay","title":"Recommendation","text":"<b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"269","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-preconception_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"269.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (pregnancy_euth_meds === false) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"270","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-preconception_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"270.0","type":"overlay","title":"Recommendation","text":"Maintenance relapse prevention: use previously effective treatment at lowest effective dose.","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (pregnancy_euth_meds === true) && (patient_age === \'Adult\')","title":"","uid":"271","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-preconception_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"271.0","type":"overlay","title":"Recommendation","text":"Patients currently or previously controlled with medications should consider the following","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_17","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_18","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (lurasidone_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"272","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-preconception_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"272.0","type":"overlay","title":"Recommendation","text":"Maintenance relapse prevention: use previously effective treatment at lowest effective dose.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'No\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"273","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-preconception_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"273.0","type":"overlay","title":"Recommendation","text":"Patients with a history of mania may benefit from maintenance therapy.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (pregnancy_euth_meds === false) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"274","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-preconception_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"274.0","type":"overlay","title":"Recommendation","text":"Maintenance relapse prevention: use previously effective treatment at lowest effective dose (SOR B). Regimen should include an anti-manic medication.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (pregnancy_euth_meds === true) && (patient_age === \'Adult\')","title":"","uid":"275","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-preconception_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"275.0","type":"overlay","title":"Recommendation","text":"Maintenance relapse prevention: use previously effective treatment at lowest effective dose (SOR B). Regimen should include an anti-manic medication.","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_22","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_24","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_26","type":"overlay","text":"<b>Lamotrigine:</b> <br><br>Continue taking Lamotrigine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_28","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium. Consider MFM consultation for preconception counseling.","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (lurasidone_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"276","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-preconception_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"276.0","type":"overlay","title":"Recommendation","text":"Maintenance relapse prevention: use previously effective treatment at lowest effective dose (SOR B). Regimen should include an anti-manic medication.","meds":[],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"277","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-antepartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"277.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start a first choice medication such as Aripiprazole or Quetiapine","meds":["Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"278","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-antepartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"278.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start a first choice medication such as Aripiprazole or Quetiapine","meds":["Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_manic_meds === true) && (quetiapine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"279","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-antepartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"279.0","type":"overlay","title":"Recommendation","text":"Trial Quetiapine","meds":["Quetiapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_manic_meds === true) && (lithium_trialed === false) && (quetiapine_trialed === true) && (olanzapine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"280","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-antepartum_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"280.0","type":"overlay","title":"Recommendation","text":"Trial Lithium or Olanzapine","meds":["Lithium","Olanzapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_manic_meds === true) && (lithium_trialed === false) && (quetiapine_trialed === true) && (olanzapine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"281","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-antepartum_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"281.0","type":"overlay","title":"Recommendation","text":"Trial Lithium","meds":["Lithium"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_manic_meds === true) && (lithium_trialed === true) && (quetiapine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"282","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-antepartum_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"282.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation, if available","meds":[],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"283","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"283.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start combination therapy with Atypical Antipsychotic and Lamotrigine","meds":["Aripiprazole","Lurasidone","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (partial_1_current_manic_meds === true) && (inadequate_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"284","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"284.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start combination therapy with Atypical Antipsychotic and Lamotrigine","meds":["Aripiprazole","Lurasidone","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === false) && (lamotrigine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"284","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"284.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start combination therapy with Atypical Antipsychotic and Lamotrigine","meds":["Aripiprazole","Lurasidone","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === true) && (lamotrigine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"285","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"285.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start combination therapy with Atypical Antipsychotic and Lamotrigine","meds":["Aripiprazole","Lurasidone","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === false) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"286","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"286.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start combination therapy with Atypical Antipsychotic and Lamotrigine","meds":["Aripiprazole","Lurasidone","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === true) && (lamotrigine_trialed === true) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"287","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"287.0","type":"overlay","title":"Recommendation","text":"Start Lithium if &gt;12 week EGA","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === true) && (lamotrigine_trialed === true) && (lithium_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"288","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"288.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation, if available. <br> <br> Try a cautious introduction of SSRI with continued mood stabilizer.","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"289","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b1","Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"289.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Aripiprazole<br>&#x2800;2. Quetiapine<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b><br><br><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start Lithium<br><br><b>Antimanic therapy: Lithium</b><br><br>Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800;&#x2022; Aripiprazole<br>&#x2800;&#x2800;&#x2022; Lurasidone<br>&#x2800;&#x2800;&#x2022; Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br><br>&#x2800;Note: If severe depressive symptoms, may consider addition of combination Antipsychotic and Lamotrigine to Lithium<br><br><b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant","meds":["Aripiprazole","Lurasidone","Quetiapine","Lamotrigine","Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"(patient_age === \'Adult\')","uid":"289.1","type":"collapse","title":"No mania/maintenance medication","text":"<b>First Choice Options</b> <br><br>Start Aripiprazole or Quetiapine at anti-manic doses, plus Lamotrigine<br><br>If unsuccessful response then:<br>&#x2022; Discontinue current medication(s)<br>&#x2022; Start Lithium if &gt;12 week EGA<br>&#x2022; Refer to psychiatry","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"290","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b1","Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"290.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b> <br><br>Start Aripiprazole or Quetiapine at anti-manic doses, plus Lamotrigine","meds":["Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"291","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"291.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start combination therapy with Atypical Antipsychotic and Lamotrigine","meds":["Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (lamotrigine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"292","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"292.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start combination therapy with Atypical Antipsychotic and Lamotrigine","meds":["Aripiprazole","Quetiapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (lamotrigine_trialed === true) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"293","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"293.0","type":"overlay","title":"Recommendation","text":"Start Lithium if &gt;12 week EGA","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (lamotrigine_trialed === true) && (lithium_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"294","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"294.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation, if available. <br> <br> Try a cautious introduction of SSRI with continued mood stabilizer.","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"295","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-antepartum_b3","Bipolar-antepartum_b6"],"content":[{"visible":true,"uid":"295.0","type":"overlay","title":"Recommendation","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Aripiprazole<br>&#x2800;2. Quetiapine<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b>","meds":["Lamotrigine","Aripiprazole","Quetiapine","Lurasidone","Lithium"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"295.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start Lithium","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"295.2","type":"collapse","title":"Antimanic therapy: Lithium","text":"Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800;&#x2022; Aripiprazole<br>&#x2800;&#x2800;&#x2022; Lurasidone<br>&#x2800;&#x2800;&#x2022; Quetiapine<br><br>2nd step: If first choice trial ineffective, discontinue and start alternate Bipolar Depression First Choice treatment<br><br>&#x2800;Note: If severe depressive symptoms, may consider addition of combination Antipsychotic and Lamotrigine to Lithium","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"295.3","type":"overlay","title":"Recommendation","text":"<b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"308","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"308.0","type":"overlay","title":"Recommendation","text":"Recommend initiation of maintenance therapy.<br><br>If patient defers treatment then recommend prophylactic therapy at 36 weeks (ideally) or postpartum day 1.","meds":["Aripiprazole","Quetiapine","Lurasidone"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (lamotrigine_trialed === false) && (pregnancy_euth_meds === true) && (patient_age === \'Adult\')","title":"","uid":"309","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"309.0","type":"overlay","title":"Recommendation","text":"Patients currently or previously controlled with medications should consider the following","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (pregnancy_euth_meds === false) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"310","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"310.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (lamotrigine_trialed === true) && (pregnancy_euth_meds === true) && (patient_age === \'Adult\')","title":"","uid":"311","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"311.0","type":"overlay","title":"Recommendation","text":"<b>Lamotrigine</b><br><br>Continue and evaluate symptoms.<br><br>In certain circumstances, Lamotrigine monotherapy may be reasonable; however, does not offer mania prophylaxis","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (lurasidone_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"312","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"312.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_15","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Consider Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_16","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_20","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_21","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"313","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"313.0","type":"overlay","title":"Recommendation","text":"Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine","Lurasidone"],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (pregnancy_euth_meds === false) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"314","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"314.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_22","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (pregnancy_euth_meds === true) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"315","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"315.0","type":"overlay","title":"Recommendation","text":"Patients currently or previously controlled with medications should consider the following","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_22","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (lurasidone_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"316","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-antepartum_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"316.0","type":"overlay","title":"Recommendation","text":"Patients currently or previously controlled with medications should consider the following","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_22","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_19","type":"overlay","text":"<b>Lithium:</b> <br><br>Discuss risks/benefits of continuing Lithium. Consider MFM consultation","meds":[],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate and start an Atypical Antipsychotic with Folic Acid 4mg","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"317","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-postpartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"317.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start a first choice medication such as Aripiprazole or Quetiapine","meds":["Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"318","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-postpartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"318.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start a first choice medication such as Aripiprazole or Quetiapine","meds":["Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (breastfeeding === \'No\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"319","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-postpartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"319.0","type":"overlay","title":"Recommendation","text":"Switch to Lithium or alternate atypical antipsychotic such as Quetiapine or Olanzapine","meds":["Lithium","Quetiapine","Olanzapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (breastfeeding === \'Yes\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"320","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-postpartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"320.0","type":"overlay","title":"Recommendation","text":"Switch to alternative atypical antipsychotic such as Quetiapine or Olanzapine","meds":["Quetiapine","Olanzapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"321","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-postpartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"321.0","type":"overlay","title":"Recommendation","text":"Trial any pharmacotherapy which has not been trialed. <br> <br>Psychiatry consultation, if available.","meds":["Lithium","Quetiapine","Olanzapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_manic_meds === true) && (lithium_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"322","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-postpartum_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"322.0","type":"overlay","title":"Recommendation","text":"Trial any pharmacotherapy which has not been trialed. <br> <br>Psychiatry consultation, if available.","meds":["Lithium","Quetiapine","Olanzapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"323","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"323.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start an Atypical Antipsychotic","meds":["Aripiprazole","Lurasidone","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (partial_1_current_manic_meds === true) && (inadequate_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"324","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"324.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start an Atypical Antipsychotic","meds":["Aripiprazole","Lurasidone","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"324","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"324.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options:</b> <br><br>Start an Atypical Antipsychotic","meds":["Aripiprazole","Lurasidone","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (inadequate_2_depression_meds === \'Continue Valproate or Carbamazepine and:\') && (lamotrigine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"325","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"325.0","type":"overlay","title":"Recommendation","text":"Add Lamotrigine","meds":["Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (breastfeeding === \'No\') && (inadequate_1_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"326","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"326.0","type":"overlay","title":"Recommendation","text":"Trial Lithium","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (breastfeeding === \'Yes\') && (inadequate_1_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"327","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"327.0","type":"overlay","title":"Recommendation","text":"Discontinue breastfeeding and trial Lithium","meds":["Lithium"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (breastfeeding === \'No\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (partial_1_depression_pregnancy === false) && (lithium_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"328","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"328.0","type":"overlay","title":"Recommendation","text":"Switch to Lithium or combination therapy with Lamotrigine and an atypical antipsychotic such as Quetiapine or Olanzapine","meds":["Lithium","Quetiapine","Olanzapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (breastfeeding === \'Yes\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (partial_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"329","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"329.0","type":"overlay","title":"Recommendation","text":"Start combination therapy with Lamotrigine and an atypical antipsychotic such as Quetiapine or Olanzapine","meds":["Quetiapine","Olanzapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Lithium</b> <br>Discontinue breastfeeding and maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_depression_pregnancy === true) && (patient_age === \'Adult\')","title":"","uid":"330","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"330.0","type":"overlay","title":"Recommendation","text":"Trial any of the pharmacotherapy that has not been trialed. <br> <br>Psychiatry consultation, if available. <br> <br> Try a cautious introduction of SSRI with continued mood stabilizer.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Lithium","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\'","uid":"G_32","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"331","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b1","Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"331.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Aripiprazole<br>&#x2800;2. Quetiapine<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b><br><br><b>Antimanic therapy: Antipsychotic</b><br>If breastfeeding:<br><br>&#x2800;1. Switch to combination Quetiapine + Lamotrigine or Olanzapine + Lamotrigine<br><br>&#x2800;2. If no response, discontinue breastfeeding and switch to Lithium<br><br>&#x2800;3. If no response<br>&#x2800;&#x2800;&#x2022; Switch to any above listed pharmacotherapy that hasn\u2019t been trialed (See decision support tool for further guidance) or<br>&#x2800;&#x2800;&#x2022; Consult psychiatry or<br>&#x2800;&#x2800;&#x2022; Continue antimanic pharmacotherapy and consider cautious introduction of SSRI<br><br>If not breastfeeding:<br><br>&#x2800;1. Switch to Lithium, Quetiapine + Lamotrigine, or Olanzapine + Lamotrigine<br>&#x2800;2. If no response, ensure trial of Lithium<br>&#x2800;3. If no response<br>&#x2800;&#x2800;&#x2022; Switch to any above listed pharmacotherapy that hasn\u2019t been trialed (See decision support tool for further guidance) or<br>&#x2800;&#x2800;&#x2022; Consult psychiatry or<br>&#x2800;&#x2800;&#x2022; Continue antimanic pharmacotherapy and consider cautious introduction of SSRI<br><br><b>Antimanic therapy: Lithium</b><br><br>Continue Lithium (avoid breastfeeding) and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800;&#x2022; Aripiprazole<br>&#x2800;&#x2800;&#x2022; Lurasidone<br>&#x2800;&#x2800;&#x2022; Quetiapine<br><br>2nd step: If no response, add combination Quetiapine + Lamotrigine or Olanzapine + Lamotrigine<br><br>3rd step: If no response<br>&#x2800;&#x2800;&#x2022; Continue and switch to any above listed pharmacotherapy that hasn\u2019t been trialed (See decision support tool for further guidance) or<br>&#x2800;&#x2800;&#x2022; Consult psychiatry or<br>&#x2800;&#x2800;&#x2022; Continue Lithium and consider cautious introduction of SSRI<br><br>","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Lithium","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\')","uid":"331.1","type":"collapse","title":"No mania/maintenance medication","text":"1. Start combination Quetiapine + Lamotrigine or Olanzapine + Lamotrigine<br>2. If no response, discontinue breastfeeding and switch to Lithium<br>3. If no response:<br>&#x2022; Switch to any above listed pharmacotherapy that hasn\u2019t been trialed (See decision support tool for further guidance)<br>&#x2022; Consult psychiatry","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"332","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b1","Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"332.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options</b> <br><br>Start Aripiprazole or Quetiapine at anti-manic doses","meds":["Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (breastfeeding === \'No\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"333","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"333.0","type":"overlay","title":"Recommendation","text":"Switch to Lithium or combination therapy with Lamotrigine and an atypical antipsychotic such as Quetiapine or Olanzapine","meds":["Lithium","Quetiapine","Olanzapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\'","uid":"G_32","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (breastfeeding === \'Yes\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === false) && (patient_age === \'Adult\')","title":"","uid":"334","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"334.0","type":"overlay","title":"Recommendation","text":"Start combination therapy with Lamotrigine and an atypical antipsychotic such as Quetiapine or Olanzapine","meds":["Quetiapine","Olanzapine","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_depression_pregnancy === true) && (inadequate_2_depression_pregnancy === true) && (patient_age === \'Adult\')","title":"","uid":"335","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"335.0","type":"overlay","title":"Recommendation","text":"Trial any of the pharmacotherapy that has not been trialed. <br> <br>Psychiatry consultation, if available. <br> <br> Try a cautious introduction of SSRI with continued mood stabilizer.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Lithium","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\'","uid":"G_32","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lamotrigine_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"336","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"336.0","type":"overlay","title":"Recommendation","text":"Add Lamotrigine","meds":["Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'current\' || breastfeeding == \'Yes\' && medication_lithium === true && lithium_current === \'prior\'","uid":"G_33","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"337","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"337.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation, if available. <br> <br> Try a cautious introduction of SSRI with continued mood stabilizer.","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (inadequate_1_depression_pregnancy === true) && (partial_1_depression_pregnancy === true) && (lamotrigine_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"338","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"338.0","type":"overlay","title":"Recommendation","text":"Trial any of the pharmacotherapy that has not been trialed. <br> <br>Psychiatry consultation, if available. <br> <br> Try a cautious introduction of SSRI with continued mood stabilizer.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Lithium","Lamotrigine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'current\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Discontinue Carbamazepine","meds":[],"priority":"false"},{"visible":"medication_carbamazepine == true && carbamazepine_current === \'prior\'","uid":"G_8","type":"overlay","text":"<b>Carbamazepine</b> Avoid Carbamazepine","meds":[],"priority":"false"},{"visible":"breastfeeding == \'Yes\'","uid":"G_32","type":"overlay","text":"<b>NOTE: </b> <br>Patients should discontinue breastfeeding before starting Lithium","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Discontinue Valproate","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'prior\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Avoid Valproate","meds":[],"priority":"false"}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (mania_well_controlled === \'Yes\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"339","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-postpartum_b3"],"content":[{"visible":true,"uid":"339.0","type":"overlay","title":"Recommendation","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Aripiprazole<br>&#x2800;2. Quetiapine<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b>","meds":["Lamotrigine","Aripiprazole","Quetiapine","Olanzapine","Lurasidone","Lithium"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"339.1","type":"collapse","title":"Antimanic therapy: Antipsychotic","text":"If breastfeeding:<br><br>&#x2800;1. Switch to combination Quetiapine + Lamotrigine or Olanzapine + Lamotrigine<br><br>&#x2800;2. If no response, discontinue breastfeeding and switch to Lithium<br><br>&#x2800;3. If no response<br>&#x2800;&#x2800;&#x2022; Switch to any above listed pharmacotherapy that hasn\u2019t been trialed (See decision support tool for further guidance) or<br>&#x2800;&#x2800;&#x2022; Consult psychiatry or<br>&#x2800;&#x2800;&#x2022; Continue antimanic pharmacotherapy and consider cautious introduction of SSRI<br><br>If not breastfeeding:<br><br>&#x2800;1. Switch to Lithium, Quetiapine + Lamotrigine, or Olanzapine + Lamotrigine<br>&#x2800;2. If no response, ensure trial of Lithium<br>&#x2800;3. If no response<br>&#x2800;&#x2800;&#x2022; Switch to any above listed pharmacotherapy that hasn\u2019t been trialed (See decision support tool for further guidance) or<br>&#x2800;&#x2800;&#x2022; Consult psychiatry or<br>&#x2800;&#x2800;&#x2022; Continue antimanic pharmacotherapy and consider cautious introduction of SSRI","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"339.2","type":"collapse","title":"Antimanic therapy: Lithium","text":"Continue Lithium (avoid breastfeeding) and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800;&#x2022; Aripiprazole<br>&#x2800;&#x2800;&#x2022; Lurasidone<br>&#x2800;&#x2800;&#x2022; Quetiapine<br><br>2nd step: If no response, add combination Quetiapine + Lamotrigine or Olanzapine + Lamotrigine<br><br>3rd step: If no response<br>&#x2800;&#x2800;&#x2022; Continue and switch to any above listed pharmacotherapy that hasn\u2019t been trialed (See decision support tool for further guidance) or<br>&#x2800;&#x2800;&#x2022; Consult psychiatry or<br>&#x2800;&#x2800;&#x2022; Continue Lithium and consider cautious introduction of SSRI","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"339.3","type":"overlay","title":"Recommendation","text":"<b>Continued inadequate response despite completing all treatment options listed above</b><br><br>Continue antimanic pharmacotherapy and consider cautious introduction of lowest manufactured dose of antidepressant","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"353","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-postpartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"353.0","type":"overlay","title":"Recommendation","text":"Recommend initiation of maintenance therapy.<br><br>If patient defers treatment then recommend prophylactic therapy at 36 weeks (ideally) or postpartum day 1.","meds":[],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (pregnancy_euth_meds === true) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"354","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-postpartum_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"354.0","type":"overlay","title":"Recommendation","text":"Patients currently or previously controlled with medications should consider the following","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_34","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium but avoid breastfeeding","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (pregnancy_euth_meds === false) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"355","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-postpartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"355.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":["Aripiprazole","Lurasidone","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_34","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium but avoid breastfeeding","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (lurasidone_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"356","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-postpartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"356.0","type":"overlay","title":"Recommendation","text":"Continue to monitor. Some patients with a history severe depression may benefit from pharmacotherapy.","meds":["Aripiprazole","Lurasidone","Quetiapine"],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_34","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium but avoid breastfeeding","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"357","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-postpartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"357.0","type":"overlay","title":"Recommendation","text":"Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"therapies":[]}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (pregnancy_euth_meds === false) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"358","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-postpartum_b5"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"358.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_34","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium but avoid breastfeeding","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (pregnancy_euth_meds === true) && (lurasidone_trialed === false) && (patient_age === \'Adult\')","title":"","uid":"359","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-postpartum_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"359.0","type":"overlay","title":"Recommendation","text":"Patients currently or previously controlled with medications should consider the following","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_34","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium but avoid breastfeeding","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Euthymic\') && (recent_mania === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (lurasidone_trialed === true) && (patient_age === \'Adult\')","title":"","uid":"360","state":"recommendation","branch":"Bipolar Euthymic","figure":["Bipolar-postpartum_b6"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"360.0","type":"overlay","title":"Recommendation","text":"Patients currently or previously controlled with medications should consider the following","meds":[],"therapies":[]},{"visible":"medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'current\' || medication_atypical_antipsychotic === true && atypical_antipsychotic_current === \'prior\'","uid":"G_14","type":"overlay","text":"<b>Atypical Antipsychotics:</b> <br><br>Continue taking Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'current\'","uid":"G_23","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Discontinue Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_carbamazepine === true && carbamazepine_current === \'prior\'","uid":"G_25","type":"overlay","text":"<b>Carbamazepine:</b> <br><br>Avoid taking Carbamazepine. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\' || medication_lamotrigine === true && lamotrigine_current === \'prior\'","uid":"G_27","type":"overlay","text":"<b>Lamotrigine:</b> Continue and evaluate symptoms.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' || medication_lithium === true && lithium_current === \'prior\'","uid":"G_34","type":"overlay","text":"<b>Lithium:</b> <br><br>Continue taking Lithium but avoid breastfeeding","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\' || medication_lurasidone === true && lurasidone_current === \'prior\'","uid":"G_31","type":"overlay","text":"<b>Lurasidone:</b> Discontinue Lurasidone.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'current\'","uid":"G_29","type":"overlay","text":"<b>Valproate:</b> <br><br>Discontinue Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"},{"visible":"medication_valproate === true && valproate_current === \'prior\'","uid":"G_30","type":"overlay","text":"<b>Valproate:</b> <br><br>Avoid taking Valproate. Start Folic Acid 4mg.<br><br>Recommend anti-manic maintenance with atypical antipsychotic.","meds":["Aripiprazole","Quetiapine"],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"361","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"361.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options (SOR A)</b> <br><br>For more severe symptoms start Aripiprazole, Cariprazine, Risperidone, or Olanzapine<br> <br> For less severe symptoms start Aripiprazole, Cariprazine, Quetiapine or Ziprasidone or Asenapine <br> <br>In some severe cases (e.g., insomnia, agitation) consider adding a benzodiazepine such as clonazepam.","meds":["Aripiprazole","Cariprazine","Risperidone","Olanzapine","Quetiapine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"362","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"362.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options (SOR A)</b> <br><br>For more severe symptoms start Aripiprazole, Cariprazine, Risperidone, or Olanzapine<br> <br> For less severe symptoms start Quetiapine or Ziprasidone or Asenapine <br> <br>In some severe cases (e.g., insomnia, agitation) consider adding a benzodiazepine such as clonazepam.","meds":["Aripiprazole","Cariprazine","Risperidone","Olanzapine","Quetiapine","Ziprasidone","Asenapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"363","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"363.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options (SOR A)</b> <br><br>Attempt a second trial of other first choice antipsychotic.","meds":["Aripiprazole","Cariprazine","Risperidone","Olanzapine"],"therapies":[]},{"visible":"medication_quetiapine === true && quetiapine_current === \'current\'","uid":"G_7","type":"overlay","text":"<b>Quetiapine</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_aripiprazole === true && aripiprazole_current === \'current\' && partum != \'None\'","uid":"G_8","type":"overlay","text":"<b>Aripiprazole</b> <br>If first trial, titrate toward max dose.","meds":[],"priority":"false"},{"visible":"medication_lurasidone === true && lurasidone_current === \'current\'","uid":"G_9","type":"overlay","text":"<b>Lurasidone</b> <br>Stop Lurasidone and start anti-manic atypical antipsychotic.","meds":[],"priority":"false"},{"visible":"medication_lamotrigine === true && lamotrigine_current === \'current\'","uid":"G_10","type":"overlay","text":"<b>Lamotrigine</b> <br>Continue Lamotrigine if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"},{"visible":"medication_lithium === true && lithium_current === \'current\' && breastfeeding != \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Lithium</b> <br>Maximize Lithium dose to achieve serum therapeutic target 0.8-1.2mEq/L","meds":[],"priority":"false"},{"visible":"medication_valproicacid === true && valproicacid_current === \'current\'","uid":"G_13","type":"overlay","text":"<b>Valproate</b> <br>Continue Valproate if effective for bipolar depression or alternate disorder and add atypical antipsychotic for mania.","meds":[],"priority":"false"}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === false) && (patient_age === \'Adult\')","title":"","uid":"364","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-Disorder_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"364.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options (SOR B)</b> <br><br><discontinue>Start a mood stabilizer","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]}]},{"valid":"(present === \'Manic\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_manic_meds === true) && (inadequate_2_manic_meds === true) && (partial_1_manic_meds === true) && (patient_age === \'Adult\')","title":"","uid":"365","state":"recommendation","branch":"Bipolar Mania","figure":["Bipolar-Disorder_b2"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"true","uid":"G_38","type":"overlay","text":"Discontinue antidepressants. ","meds":[],"priority":"true"},{"visible":true,"uid":"365.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options (SOR B)</b> <br><br>Augment first choice treatment with a mood stabilizer","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"366","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"366.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options (SOR A)</b> <br><br>Atypical Antipsychotic or Lamotrigine<br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine (SOR A).","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (partial_1_current_manic_meds === true) && (inadequate_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"367","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"367.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options (SOR A)</b><br><br>Atypical Antipsychotic or Lamotrigine<br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine (SOR A).","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"368","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"368.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options (SOR A)</b> <br><br>Atypical Antipsychotic or Lamotrigine<br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine (SOR A).","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === false) && (patient_age === \'Adult\')","title":"","uid":"369","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"369.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Options (SOR A)</b> <br><br>Attempt a second trial of first choice treatments. <br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine. (SOR A).","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === false) && (patient_age === \'Adult\')","title":"","uid":"370","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"370.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options (SOR B)</b> <br><br><discontinue>Start a mood stabilizer.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === false) && (inadequate_mood_stabilizer === true) && (patient_age === \'Adult\')","title":"","uid":"371","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"371.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options (SOR C):</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, with very slow titration. Must be taking antipsychotic/mood stabilizer.","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === false) && (partial_1_depression_meds === true) && (patient_age === \'Adult\')","title":"","uid":"372","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b3"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"372.0","type":"overlay","title":"Recommendation","text":"Augment treatment with alternate class first choice agent. <br><br>If using an atypical antipsychotic for first choice treatment for bipolar depression, consider Lurasidone over Cariprazine, Quetiapine, or Olanzapine + Fluoxetine. (SOR A).","meds":["Lurasidone","Cariprazine","Quetiapine","Olanzapine + Fluoxetine","Lamotrigine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === false) && (patient_age === \'Adult\')","title":"","uid":"373","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":"lamotrigine_partial == true","uid":"G_35","type":"overlay","text":"Avoid combinations of any two of the following: Carbamazepine, Lamotrigine, or Valproate<br><br>Consult psychiatry for further recommendations","meds":[],"priority":"true"},{"visible":true,"uid":"373.0","type":"overlay","title":"Recommendation","text":"<b>Second Choice Options (SOR B)</b> <br><br>Augment first choice treatment with a mood stabilizer in the order listed below.","meds":["Lithium","Valproate","Carbamazepine"],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (inadequate_1_depression_meds === true) && (inadequate_2_depression_meds === true) && (partial_1_depression_meds === true) && (inadequate_mood_stabilizer === true) && (patient_age === \'Adult\')","title":"","uid":"374","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b4"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"374.0","type":"overlay","title":"Recommendation","text":"<b>Final Choice Options (SOR C):</b> <br><br>Cautious introduction of lowest manufactured dose of antidepressants, avoiding SNRIs with very slow titration. Must be taking antipsychotic/mood stabilizer.","meds":[],"therapies":[]}]},{"valid":"(present === \'Depressed\') && (recent_mania === \'Yes\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"375","state":"recommendation","branch":"Bipolar Depression","figure":["Bipolar-Disorder_b3","Bipolar-Disorder_b1"],"content":[{"visible":"current_unsuccessful == true || current_partial == true","uid":"G_36","type":"overlay","text":"Stop current unsuccessful medication used to treat Bipolar Disorder","meds":[],"priority":"true"},{"visible":true,"uid":"375.0","type":"collapse","title":"Taking mania/maintenance medication","text":"<b>Treatment Strategies</b><br><br>Two options exist for the treatment of Bipolar Depression when on effective antimanic treatment:<br><br>&#x2022; Continue effective anti-manic treatment and add additional pharmacotherapy for depressive symptoms or<br>&#x2022; Switch to antipsychotic effective for both bipolar depression and mania<br>&#x2800;1. Cariprazine<br>&#x2800;2. Quetiapine<br>&#x2800;3. Olanzapine Fluoxetine Combination (at antimanic doses)<br><br><b>See below for pharmacotherapy options based on effective antimanic treatment.</b><br><br><b>Antimanic therapy: Antipsychotic</b><br><br>Continue antipsychotic and:<br><br>1st step: Add Lamotrigine<br><br>2nd step: If Lamotrigine ineffective, discontinue and start either<br>&#x2800;&#x2800;1. Lithium<br>&#x2800;&#x2800;2. Valproate<br>&#x2800;&#x2800;3. Carbamazepine<br><br><b>Antimanic therapy: Lithium</b><br><br>Continue Lithium and:<br><br>1st step: Add Bipolar Depression First Choice treatment: Antipsychotic or Lamotrigine<br>&#x2800;&#x2800; 1. Lurasidone<br>&#x2800;&#x2800; 2. Cariprazine<br>&#x2800;&#x2800; 3. Quetiapine<br>&#x2800;&#x2800; 4. 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response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"SNRI Antidepressants"}]},{"visible":"medication_history === \'Yes\'","id":"medication_duloxetine","text":"Duloxetine","type":"switch","groups":[{"visible":"medication_duloxetine","id":"duloxetine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_duloxetine && duloxetine_current === \'current\'","id":"duloxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_duloxetine && duloxetine_current === \'prior\'","id":"duloxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_desvenlafaxine","text":"Desvenlafaxine","type":"switch","groups":[{"visible":"medication_desvenlafaxine","id":"desvenlafaxine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_desvenlafaxine && desvenlafaxine_current === \'current\'","id":"desvenlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_desvenlafaxine && desvenlafaxine_current === \'prior\'","id":"desvenlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_venlafaxine","text":"Venlafaxine","type":"switch","groups":[{"visible":"medication_venlafaxine","id":"venlafaxine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_venlafaxine && venlafaxine_current === \'current\'","id":"venlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_venlafaxine && venlafaxine_current === \'prior\'","id":"venlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"Bulimia","state":"intro","content":[{"id":"is_hospital","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does patient meet any indication for hospitalization?"},{"id":"HAI","visible":"true","type":"overlay","choices":[{"text":""}],"text":"<b>Hospital Admission Indications:</b><br><br>- Medical / Psychiatric Instability<br>- Cardiac Dysrhythmias or qTc \u2265 500 msec<br>- Pulse < 40 bpm<br>- BP < 80/60 mmHg<br>- Orthostatic Hypotension<br>- Severe Dehydration<br>- Electrolyte imbalance (K < 3, Phos < 2, Hypoglycemia)<br>- Temp < 97 degrees<br>- BMI < 15 or IBW < 70%<br>- Marked edema<br>- Marked suicidality or possible recent attempt"},{"id":"is_comorbid","visible":"true","type":"radio","choices":"None, Depression, Other","text":"Is a comorbid disorder present?","groups":[{"id":"is_comorbid","type":"choice","choices":[{"text":"None","value":"None"},{"text":"Depression","value":"Depression"},{"text":"Other","value":"Other"}]}]},{"id":"severity","visible":"is_comorbid == \'Depression\'","type":"radio","choices":"Mild/Moderate, Severe","text":"What is the severity of depression?","groups":[{"id":"severity","type":"choice","choices":[{"text":"Mild/Moderate","value":"Mild/Moderate"},{"text":"Severe","value":"Severe"}]}]}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"Bulimia","figure":["bulimia_b1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintenance 12 months of stability prior to considering slow taper","meds":[],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"is_comorbid == \'Depression\'","uid":"G_3","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression  concurrently.  Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"Bulimia","figure":["bulimia_b1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintenance 12 months of stability prior to considering slow taper","meds":[],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"is_comorbid == \'Depression\'","uid":"G_3","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression  concurrently.  Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"Bulimia","figure":["bulimia_b1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintenance 12 months of stability prior to considering slow taper","meds":[],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"is_comorbid == \'Depression\'","uid":"G_3","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression  concurrently.  Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"Bulimia","figure":["bulimia_b1"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintenance 12 months of stability prior to considering slow taper","meds":[],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"is_comorbid == \'Depression\'","uid":"G_3","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression  concurrently.  Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(is_hospital === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"1","state":"recommendation","branch":"Bulimia","figure":["bulimia_b2"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Inpatient hospitalization</b>","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"2","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"2.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"2.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === false) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"3","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === false) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"4","state":"recommendation","branch":"Bulimia","figure":["bulimia_b4"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"4.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"4.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to alternate SSRI or SNRI (consider cross taper)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_3","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression  concurrently.  Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"5","state":"recommendation","branch":"Bulimia","figure":["bulimia_b5"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"5.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"5.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to Topiramate (consider cross taper)<br><br>Evaluate for comorbid mood disorder and see corresponding decision support tool<br><br>Psychiatry Consultation if available","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'Yes\') && (partial_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"6","state":"recommendation","branch":"Bulimia","figure":["bulimia_b6"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"6.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"6.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Add Topiramate","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (medication_history === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"7","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>- Recommend pharmacotherapy","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"7.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"7.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === false) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"8","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>- Recommend pharmacotherapy","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"8.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"8.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === false) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"9","state":"recommendation","branch":"Bulimia","figure":["bulimia_b4"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>Consider pharmacotherapy","meds":["Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"9.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"9.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to alternate SSRI or SNRI (consider cross taper)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_3","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression  concurrently.  Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"10","state":"recommendation","branch":"Bulimia","figure":["bulimia_b5"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>Consider pharmacotherapy","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"10.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"10.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to Topiramate (consider cross taper)<br><br>Evaluate for comorbid mood disorder and see corresponding decision support tool<br><br>Psychiatry Consultation if available","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (partial_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"11","state":"recommendation","branch":"Bulimia","figure":["bulimia_b6"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>Consider pharmacotherapy","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"11.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"11.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Add Topiramate","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"12","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"12.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"12.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_ssri_1 === false) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"13","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"13.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"13.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === false) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"14","state":"recommendation","branch":"Bulimia","figure":["bulimia_b4"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"14.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"14.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to alternate SSRI or SNRI (consider cross taper)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (partial_ssri_snri === false) && (patient_age === \'Adolescent\')","title":"","uid":"15","state":"recommendation","branch":"Bulimia","figure":["bulimia_b5"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"15.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"15.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to Topiramate (consider cross taper)<br><br>Evaluate for comorbid mood disorder and see corresponding decision support tool<br><br>Psychiatry Consultation if available","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partial_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"16","state":"recommendation","branch":"Bulimia","figure":["bulimia_b6"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adolescent\')","uid":"16.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"16.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Add Topiramate","meds":[],"therapies":[]}]},{"valid":"(is_hospital === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Bulimia","figure":["bulimia_b2"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Inpatient hospitalization</b>","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"2.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === false) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === false) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Bulimia","figure":["bulimia_b4"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"4.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to alternate SSRI or SNRI (consider cross taper)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_3","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression  concurrently.  Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Bulimia","figure":["bulimia_b5"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"5.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to Topiramate (consider cross taper)<br><br>Evaluate for comorbid mood disorder and see corresponding decision support tool<br><br>Psychiatry Consultation if available","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (medication_history === \'Yes\') && (partial_ssri_snri === true) && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Bulimia","figure":["bulimia_b6"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"6.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Add Topiramate","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>- Recommend pharmacotherapy","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"7.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === false) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>- Recommend pharmacotherapy","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"8.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === false) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Bulimia","figure":["bulimia_b4"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>Consider pharmacotherapy","meds":["Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"9.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to alternate SSRI or SNRI (consider cross taper)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_3","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression  concurrently.  Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Bulimia","figure":["bulimia_b5"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>Consider pharmacotherapy","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"10.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"10.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to Topiramate (consider cross taper)<br><br>Evaluate for comorbid mood disorder and see corresponding decision support tool<br><br>Psychiatry Consultation if available","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (partial_ssri_snri === true) && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Bulimia","figure":["bulimia_b6"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br>Consider pharmacotherapy","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"11.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"11.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Add Topiramate","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"12.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"12.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_ssri_1 === false) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Bulimia","figure":["bulimia_b3"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"13.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"13.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Fluoxetine (often requires higher doses)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === false) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Bulimia","figure":["bulimia_b4"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"14.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to alternate SSRI or SNRI (consider cross taper)","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Depression\'","uid":"G_1","type":"overlay","text":"<b>Comorbid depression:</b><br>Treat bulimia and severe depression concurrently with Fluoxetine. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Other\'","uid":"G_2","type":"overlay","text":"<b>Other comorbid disorder:</b><br>See corresponding decision support. Avoid Bupropion/TCA\'s","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (partial_ssri_snri === false) && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"Bulimia","figure":["bulimia_b5"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"15.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"15.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Transition to Topiramate (consider cross taper)<br><br>Evaluate for comorbid mood disorder and see corresponding decision support tool<br><br>Psychiatry Consultation if available","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partial_ssri_snri === true) && (patient_age === \'Adult\')","title":"","uid":"16","state":"recommendation","branch":"Bulimia","figure":["bulimia_b6"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>Multidisciplinary Intervention:</b><br>- Nutritional Rehabilitation<br>- Psychotherapy: CBT or CBT-E<br><br><b>If failure to respond to six week trial of multidisciplinary intervention consider pharmacotherapy</b>","meds":["Topiramate"],"therapies":["Cognitive Behavioral Therapy","Enhanced Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"16.1","type":"collapse","title":"Pretreatment Assessment","text":"- Vital signs, Orthostatics, BMI, EKG<br>- UA, CBC, CMP, TSH, INR<br>- Phosphorus, Magnesium, Amylase<br>- UPT, UDS, 25-OH VitD","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"16.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Add Topiramate","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Bulimia","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},8863:function(e){"use strict";e.exports=JSON.parse('{"variables":{"onset_stress":"No","apnea_concern":"No","is_comorbid":"No","insomnia_type":"","medication_doxepin":"No","medication_trazodone":false,"medication_eszopiclone":false,"medication_zolpidem":false,"onset_failed":false,"maintenance_failed":false,"successful_meds":false,"prior_successful_meds":false,"medication_history":"No","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","doxepin_inadequate":"medication_doxepin == true && doxepin_response === \'unsuccessful\'"}],"sections":[{"valid":"true","title":"Chronic Insomnia Medications","state":"medication","content":[{"visible":false,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Chronic Insomnia"}]}]},{"valid":true,"title":"Chronic Insomnia","state":"intro","content":[{"id":"hypnotic","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is patient currently taking sedative hypnotic for insomnia?"},{"id":"evaluation","visible":"true","type":"radio","choices":"Circadian-rhythm disorder, Medical comorbidities, Psychiatric comorbidities, Comorbid sleep disorder, Medication/substance abuse history, N/A","text":"Evaluate for the following:","groups":[{"id":"evaluation","type":"choice","choices":[{"text":"Circadian-rhythm disorder","value":"Circadian-rhythm disorder"},{"text":"Medical comorbidities","value":"Medical comorbidities"},{"text":"Psychiatric comorbidities","value":"Psychiatric comorbidities"},{"text":"Comorbid sleep disorder","value":"Comorbid sleep disorder"},{"text":"Medication/substance abuse history","value":"Medication/substance abuse history"},{"text":"N/A","value":"N/A"}]}]},{"id":"insomnia_type","visible":"true","type":"radio","choices":"Sleep-onset insomnia, Sleep-maintenance insomnia","text":"Does the patient suffer from sleep-onset insomnia or sleep-maintenance insomnia?","groups":[{"id":"insomnia_type","type":"choice","choices":[{"text":"Sleep-onset insomnia","value":"Sleep-onset insomnia"},{"text":"Sleep-maintenance insomnia","value":"Sleep-maintenance insomnia"}]}]}]},{"valid":"(hypnotic === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-cardiac_i1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>First-line treatment</b> CBT-I <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls<br><br>If unable to participate in CBT-I, or remaining symptoms despite CBT-I, consider pharmacotherapy","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Zolpidem ER, or Eszopiclone <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Zolpidem ER"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Zolpidem ER, or Suvorexant<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Suvorexant","Zolpidem ER"],"priority":"false"}]},{"valid":"(hypnotic === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-cardiac_i1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"CBT-I and then consider taper of pharmacotherapy <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training <br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Zolpidem ER, or Eszopiclone <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Zolpidem ER"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Zolpidem ER, or Suvorexant<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Suvorexant","Zolpidem ER"],"priority":"false"}]},{"valid":"(hypnotic === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"3","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>First-line treatment</b> CBT-I <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.<br><br>If unable to participate in CBT-I, or remaining symptoms despite CBT-I, consider pharmacotherapy","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest):Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(hypnotic === \'Yes\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"4","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-geriatric_i1"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"CBT-I and then consider taper of pharmacotherapy <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training <br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest):Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(hypnotic === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>First-line treatment</b> CBT-I <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.<br><br>If unable to participate in CBT-I, or remaining symptoms despite CBT-I, consider pharmacotherapy","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Zolpidem ER, or Doxepin<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Suvorexant, Zolpidem ER, or Doxepin<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(hypnotic === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-hepatic_i1"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"CBT-I and then consider taper of pharmacotherapy <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Zolpidem ER, or Doxepin<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Suvorexant, Zolpidem ER, or Doxepin<br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(hypnotic === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-obesity_i1"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>First-line treatment</b> CBT-I <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.<br><br>If unable to participate in CBT-I, or remaining symptoms despite CBT-I, consider pharmacotherapy","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"}]},{"valid":"(hypnotic === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-obesity_i1"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"CBT-I and then consider taper of pharmacotherapy <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"}]},{"valid":"(hypnotic === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-renal_i1"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>First-line treatment</b> CBT-I <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.<br><br>If unable to participate in CBT-I, or remaining symptoms despite CBT-I, consider pharmacotherapy","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(hypnotic === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia-renal_i1"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"CBT-I and then consider taper of pharmacotherapy <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_1","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_2","type":"overlay","text":"<b>Pharmacotherapy</b> <br><br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(hypnotic === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia_i1"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>First-line treatment</b> (SOR A): CBT-I <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.<br><br>If unable to participate in CBT-I, or remaining symptoms despite CBT-I, consider pharmacotherapy","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_101","type":"overlay","text":"<b>Pharmacotherapy (SOR A)</b> <br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_102","type":"overlay","text":"<b>Pharmacotherapy (SOR A)</b> <br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"}]},{"valid":"(hypnotic === \'Yes\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia_i1"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"CBT-I and then consider taper of pharmacotherapy <br><br>Core components of CBT-I<br>1. Sleep restriction<br>2. Stimulus control<br>3. Sleep hygiene<br>4. Relaxation training<br><br>Contraindications to sleep restriction component: seizure disorder, bipolar disorder, high risk for falls.","meds":[],"therapies":["Cognitive Behavioral Therapy for Insomnia"]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_101","type":"overlay","text":"<b>Pharmacotherapy (SOR A)</b> <br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_102","type":"overlay","text":"<b>Pharmacotherapy (SOR A)</b> <br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"}]},{"valid":true,"title":"","uid":"13","state":"recommendation","branch":"Insomnia, Chronic","figure":["Chronic-Insomnia_i1"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]},{"visible":"evaluation == \'Comorbid sleep disorder\'","uid":"G_6","type":"overlay","text":"<b>Comorbid sleep disorder</b><br>Optimize medical treatment; refer for polysomnography if OSA suspected","meds":[],"priority":"false"},{"visible":"evaluation == \'Circadian-rhythm disorder\'","uid":"G_7","type":"overlay","text":"<b>Circadian-Rhythm disorder</b><br>Consider using appropriately timed light therapy and melatonin.  If treated but chronic insomnia persists, consider the following","meds":[],"priority":"false"},{"visible":"evaluation == \'Medical comorbidities\' || evaluation == \'Psychiatric comorbidities\'","uid":"G_8","type":"overlay","text":"<b>Medical/Psychiatric comorbidities</b><br>Maximize treatment of medical/psychiatric comorbidities.","meds":[],"priority":"false"},{"visible":"evaluation == \'Medication/substance abuse history\'","uid":"G_9","type":"overlay","text":"<b>Medication/substance abuse history</b><br>Minimize insomnia-producing medications if possible; limit or discontinue late-day caffeine, ETOH","meds":[],"priority":"false"},{"visible":"insomnia_type == \'Sleep-onset insomnia\'","uid":"G_101","type":"overlay","text":"<b>Pharmacotherapy (SOR A)</b> <br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Zolpidem ER","Doxepin"],"priority":"false"},{"visible":"insomnia_type != \'Sleep-onset insomnia\'","uid":"G_102","type":"overlay","text":"<b>Pharmacotherapy (SOR A)</b> <br>If unable to participate in CBT-I or remaining symptoms despite CBT-I, start/continue one of the following (listed from shortest half-life to longest): Zolpidem, Gabapentin, Eszopiclone, Trazodone, Suvorexant, Zolpidem ER, or Doxepin <br><br> - Consider treatment for 4-5 weeks, then discuss slow taper combined with CBT-I guidance<br><br>- Some individuals will require chronic therapy","meds":["Zolpidem","Gabapentin","Eszopiclone","Trazodone","Suvorexant","Zolpidem ER","Doxepin"],"priority":"false"}]}]}')},7876:function(e){"use strict";e.exports=JSON.parse('{"variables":{"severity":"","is_concern":"","is_symptom":"","severity_agitation":"","is_depression":"","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'"}],"sections":[{"valid":"true","title":"Dementia (Alzheimer\'s and-or Vascular) Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Dementia (Alzheimer\'s and-or Vascular)"}]}]},{"valid":true,"title":"Dementia (Alzheimer\'s and-or Vascular)","state":"intro","content":[{"id":"severity","visible":"true","type":"radio","choices":"Mild/Moderate, Severe","text":"What is the severity of patients dementia?","groups":[{"id":"severity","type":"choice","choices":[{"text":"Mild/Moderate","value":"Mild/Moderate"},{"text":"Severe","value":"Severe"}]}]},{"id":"is_concern","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is there a persistent neuropsychiatric symptom despite maximal treatment with Cholinesterase inhibitors and/or Memantine? "},{"id":"is_symptom","visible":"is_concern == \'Yes\'","type":"radio","choices":"Agitation/Aggression, Hypersexuality, Insomnia, Apathy, Depressive Symptoms","text":"Neuropsychiatric Symptom of Concern","groups":[{"id":"is_symptom","type":"choice","choices":[{"text":"Agitation/Aggression","value":"Agitation/Aggression"},{"text":"Hypersexuality","value":"Hypersexuality"},{"text":"Insomnia","value":"Insomnia"},{"text":"Apathy","value":"Apathy"},{"text":"Depressive Symptoms","value":"Depressive Symptoms"}]}]},{"id":"severity_agitation","visible":"is_symptom == \'Agitation/Aggression\' && is_concern == \'Yes\'","type":"radio","choices":"Mild/Moderate, Severe","text":"Agitation/Aggression severity:","groups":[{"id":"severity_agitation","type":"choice","choices":[{"text":"Mild/Moderate","value":"Mild/Moderate"},{"text":"Severe","value":"Severe"}]}]},{"id":"is_depression","visible":"is_symptom == \'Insomnia\' && is_concern == \'Yes\' || is_symptom == \'Apathy\' && is_concern == \'Yes\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is comorbid depression present?"}]},{"valid":"(severity === \'Mild/Moderate\') && (is_symptom === \'Agitation/Aggression\') && (severity_agitation === \'Mild/Moderate\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"1","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1","dem_d3"],"content":[{"visible":true,"uid":"1.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Aripiprazole","Risperidone","Quetiapine","Olanzapine","Citalopram","Galantamine"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"1.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"1.2","type":"overlay","title":"Recommendation","text":"<b>Agitation/Aggression:</b><br>Prior to pharmacotherapy, evaluate and treat for underlying etiology (pain, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit) (SOR C)<br><br><b>Mild/Moderate:</b><br>Continue/maximize Cholinesterase Inhibitor (SOR A)<br><br>Consider addition of atypical antipsychotic if inadequate response (black box warning for increased mortality)<br><br>Consider addition of citalopram (with or without comorbid depression)","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (is_symptom === \'Agitation/Aggression\') && (severity_agitation === \'Severe\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"2","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1","dem_d4"],"content":[{"visible":true,"uid":"2.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Aripiprazole","Risperidone","Quetiapine","Olanzapine","Citalopram","Galantamine"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"2.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"2.2","type":"overlay","title":"Recommendation","text":"<b>Mild/Moderate:</b> Start a cholinesterase inhibitor (SOR A)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>For poor tolerability to cholinesterase inhibitor, switch to Memantine.<br><br>For progression from mild to moderate or moderate to severe, add Memantine (SOR B)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"2.3","type":"overlay","title":"Recommendation","text":"<b>Agitation/Aggression:</b><br>Prior to pharmacotherapy, evaluate and treat for underlying etiology (pain, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit) (SOR C)<br><br><b>Severe:</b><br>Combination Cholinesterase Inhibitor and Atypical Antipsychotic (SOR A) (black box warning for increased mortality)","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (is_symptom === \'Hypersexuality\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"3","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1","dem_d5"],"content":[{"visible":true,"uid":"3.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Medroxyprogesterone Acetate","Galantamine"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"3.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"3.2","type":"overlay","title":"Recommendation","text":"<b>Mild/Moderate:</b> Start a cholinesterase inhibitor (SOR A)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>For poor tolerability to cholinesterase inhibitor, switch to Memantine.<br><br>For progression from mild to moderate or moderate to severe, add Memantine (SOR B)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"3.3","type":"overlay","title":"Recommendation","text":"<b>Hypersexuality:</b><br>Behavioral interventions: redirect and consider discontinuing/avoiding stimulants<br><br><b>Consider Pharmacotherapy (SOR A):</b><br>Start an SSRI. If ineffective, consider medroxyprogesterone acetate.","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (is_symptom === \'Insomnia\') && (is_depression === \'Yes\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"4","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1","dem_d6"],"content":[{"visible":true,"uid":"4.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Mirtazapine","Trazodone","Suvorexant","Galantamine"],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"4.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"4.2","type":"overlay","title":"Recommendation","text":"<b>Mild/Moderate:</b> Start a cholinesterase inhibitor (SOR A)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>For poor tolerability to cholinesterase inhibitor, switch to Memantine.<br><br>For progression from mild to moderate or moderate to severe, add Memantine (SOR B)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"4.3","type":"overlay","title":"Recommendation","text":"<b>Insomnia:</b><br>Maximize sleep hygiene<br><br><b>Pharmacotherapy (SOR A):</b><br>Start Mirtazapine. If ineffective, discontinue Mirtazapine, consider Trazodone or Suvorexant<br><br>May consider melatonin at any point during treatment","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (is_symptom === \'Insomnia\') && (is_depression === \'No\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"5","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1","dem_d6"],"content":[{"visible":true,"uid":"5.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Trazodone","Suvorexant","Galantamine"],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"5.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"5.2","type":"overlay","title":"Recommendation","text":"<b>Mild/Moderate:</b> Start a cholinesterase inhibitor (SOR A)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>For poor tolerability to cholinesterase inhibitor, switch to Memantine.<br><br>For progression from mild to moderate or moderate to severe, add Memantine (SOR B)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"5.3","type":"overlay","title":"Recommendation","text":"<b>Insomnia:</b><br>Maximize sleep hygiene<br><br><b>Pharmacotherapy (SOR A):</b><br>Start Trazodone or Suvorexant<br><br>May consider melatonin at any point during treatment","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (is_symptom === \'Apathy\') && (is_depression === \'Yes\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"6","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1","dem_d7"],"content":[{"visible":true,"uid":"6.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Bupropion","Methylphenidate","Galantamine"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"6.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"6.2","type":"overlay","title":"Recommendation","text":"<b>Mild/Moderate:</b> Start a cholinesterase inhibitor (SOR A)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>For poor tolerability to cholinesterase inhibitor, switch to Memantine.<br><br>For progression from mild to moderate or moderate to severe, add Memantine (SOR B)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"6.3","type":"overlay","title":"Recommendation","text":"<b>Apathy:</b><br>Start Bupropion (SOR B). If ineffective, discontinue Bupropion, consider stimulant (SOR B)","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (is_symptom === \'Apathy\') && (is_depression === \'No\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"7","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1","dem_d7"],"content":[{"visible":true,"uid":"7.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Methylphenidate","Bupropion","Galantamine"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"7.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"7.2","type":"overlay","title":"Recommendation","text":"<b>Mild/Moderate:</b> Start a cholinesterase inhibitor (SOR A)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>For poor tolerability to cholinesterase inhibitor, switch to Memantine.<br><br>For progression from mild to moderate or moderate to severe, add Memantine (SOR B)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"7.3","type":"overlay","title":"Recommendation","text":"<b>Apathy:</b><br>Consider stimulant (SOR B)<br>If inadequate response, consider Bupropion","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (is_symptom === \'Depressive Symptoms\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"7","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1","dem_d8"],"content":[{"visible":true,"uid":"7.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Galantamine"],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"7.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"7.2","type":"overlay","title":"Recommendation","text":"<b>Mild/Moderate:</b> Start a cholinesterase inhibitor (SOR A)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>For poor tolerability to cholinesterase inhibitor, switch to Memantine.<br><br>For progression from mild to moderate or moderate to severe, add Memantine (SOR B)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"7.3","type":"overlay","title":"Recommendation","text":"See MDD decision support","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (is_symptom === \'Agitation/Aggression\') && (severity_agitation === \'Mild/Moderate\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"8","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2","dem_d3"],"content":[{"visible":true,"uid":"8.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Aripiprazole","Risperidone","Quetiapine","Olanzapine","Citalopram","Brexpiprazole"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"8.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"8.2","type":"overlay","title":"Recommendation","text":"<b>Agitation/Aggression:</b><br>Prior to pharmacotherapy, evaluate and treat for underlying etiology (pain, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit) (SOR C)<br><br><b>Mild/Moderate:</b><br>Continue/maximize Cholinesterase Inhibitor (SOR A)<br><br>Consider addition of citalopram (with or without comorbid depression)<br><br>Consider addition of atypical antipsychotic if inadequate response (black box warning for increased mortality)<br>1. Risperidone<br>2. Aripiprazole or Brexpiprazole<br>3. Olanzapine or Quetiapine (sedating)","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (is_symptom === \'Agitation/Aggression\') && (severity_agitation === \'Severe\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"9","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2","dem_d4"],"content":[{"visible":true,"uid":"9.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Aripiprazole","Risperidone","Quetiapine","Olanzapine","Citalopram","Brexpiprazole"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"9.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"9.2","type":"overlay","title":"Recommendation","text":"<b>Agitation/Aggression:</b><br>Prior to pharmacotherapy, evaluate and treat for underlying etiology (pain, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit) (SOR C)<br><br><b>Severe:</b><br>Combination Cholinesterase Inhibitor and Atypical Antipsychotic (SOR A) (black box warning for increased mortality)<br>1. Risperidone<br>2. Aripiprazole or Brexpiprazole<br>3. Olanzapine or Quetiapine (sedating)","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (is_symptom === \'Hypersexuality\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"10","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2","dem_d5"],"content":[{"visible":true,"uid":"10.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Medroxyprogesterone Acetate"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"10.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"10.2","type":"overlay","title":"Recommendation","text":"<b>Hypersexuality:</b><br>Behavioral interventions: redirect and consider discontinuing/avoiding stimulants<br><br><b>Consider Pharmacotherapy (SOR A):</b><br>Start an SSRI. If ineffective, consider medroxyprogesterone acetate.","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (is_symptom === \'Insomnia\') && (is_depression === \'Yes\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"11","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2","dem_d6"],"content":[{"visible":true,"uid":"11.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Mirtazapine","Trazodone","Suvorexant"],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"11.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"11.2","type":"overlay","title":"Recommendation","text":"<b>Insomnia:</b><br>Maximize sleep hygiene<br><br><b>Pharmacotherapy (SOR A):</b><br>Start Mirtazapine. If ineffective, discontinue Mirtazapine, consider Trazodone or Suvorexant<br><br>May consider melatonin at any point during treatment","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (is_symptom === \'Insomnia\') && (is_depression === \'No\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"12","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2","dem_d6"],"content":[{"visible":true,"uid":"12.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Trazodone","Suvorexant"],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"12.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"12.2","type":"overlay","title":"Recommendation","text":"<b>Insomnia:</b><br>Maximize sleep hygiene<br><br><b>Pharmacotherapy (SOR A):</b><br>Start Trazodone or Suvorexant<br><br>May consider melatonin at any point during treatment","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (is_symptom === \'Apathy\') && (is_depression === \'Yes\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"13","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2","dem_d7"],"content":[{"visible":true,"uid":"13.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Bupropion","Methylphenidate"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"13.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"13.2","type":"overlay","title":"Recommendation","text":"<b>Apathy:</b><br>Start Bupropion (SOR B). If ineffective, discontinue Bupropion, consider stimulant (SOR B)","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (is_symptom === \'Apathy\') && (is_depression === \'No\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"14","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2","dem_d7"],"content":[{"visible":true,"uid":"14.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine","Methylphenidate","Bupropion"],"therapies":[]},{"visible":"true","uid":"G_2","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"14.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"14.2","type":"overlay","title":"Recommendation","text":"<b>Apathy:</b><br>Consider stimulant (SOR B)<br>If inadequate response, consider Bupropion","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (is_symptom === \'Depressive Symptoms\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"15","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2","dem_d8"],"content":[{"visible":true,"uid":"15.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine"],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"15.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"15.2","type":"overlay","title":"Recommendation","text":"See MDD decision support","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild/Moderate\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"16","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d1"],"content":[{"visible":true,"uid":"16.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Memantine","Galantamine"],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"16.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"16.2","type":"overlay","title":"Recommendation","text":"<b>Mild/Moderate:</b> Start a cholinesterase inhibitor (SOR A)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>For poor tolerability to cholinesterase inhibitor, switch to Memantine.<br><br>For progression from mild to moderate or moderate to severe, add Memantine (SOR B)","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (patient_age === \'Adult\' || patient_age === \'Geriatric\')","title":"","uid":"17","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":["dem_d2"],"content":[{"visible":true,"uid":"17.0","type":"collapse","title":"Evaluation and Assessment","text":"<b>Initial:</b> Complete Functional Assessment Staging Tool (FAST)<br><b>Interval:</b> Complete FAST if change in deficits<br><b>Yearly:</b> FAST and +/- cognitive assessment(e.g., MOCA)<br><br>Complete Advance Care Planning and Serious Illness Conversation(e.g., MPOA, MOST/POLST) <a href=\'https://dementia-directive.org\' target=\'blank\'>dementia-directive.org</a><br><br><b>Differentiate delirium and dementia</b><br>Evaluate and treat for underlying etiology (pain, constipation, urinary retention, delirium, infection, medication side effect, depression, anxiety, sleep disturbance, sensory deficit), time course. <br>See corresponding Decision Support Tool (if applicable)","meds":["Donepezil","Rivastigmine","Memantine"],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"17.1","type":"collapse","title":"Non-pharmacological Interventions:","text":"-Caregiver support<br>-Aerobic exercise at least 3 times weekly<br>-Maintain structure (i.e., structured day or day program)<br>-Provide a familiar and calm space<br>-Maximize sleep, especially<br>avoiding sleep-wake reverse cycles<br>-Minimize polypharmacy, specifically<br>anticholinergic medications,<br>benzodiazepines, and opioids as possible<br>-Provide appropriate audiovisual aids<br>-Screen and treat mood disorders<br>-Assess for bladder and bowel dysfunction<br>-Avoid confrontation (use verbal and non verbal cues)<br>-Provide a security object (i.e., blanket or doll)<br>-Ensure adequate sleep, including evaluating for sleep apnea<br>-Consider addressing modifiable risk factors<br>(i.e., limit alcohol intake, cannabis use), which may delay progression<br>-Discuss driving<br>-Vascular Dementia: HTN control, Statin, Tobacco, Anti-platelet","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\' || patient_age === \'Geriatric\')","uid":"17.2","type":"overlay","title":"Recommendation","text":"<b>Severe:</b> Consider Donepezil and Memantine if there is a potential for meaningful preservation of function. (SOR C)<br><br>Goal to slow decline<br><br><b>Side Effect Management Strategies</b><br>&#x2022; GI symptoms: take at night or reduce dose<br>&#x2022; Vivid dreams: administer during daytime or reduce dose<br><br>If poorly tolerated, discontinue medication.","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Dementia (Alzheimer\'s and-or Vascular)","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},6578:function(e){"use strict";e.exports=JSON.parse('{"variables":{"medication_history":"No","medication_sertraline":false,"medication_escitalopram":false,"medication_fluoxetine":false,"medication_citalopram":false,"medication_other_ssri":false,"medication_desvenlafaxine":false,"medication_duloxetine":false,"medication_venlafaxine":false,"medication_bupropion":false,"medication_mirtazapine":false,"medication_lorazepam":false,"medication_olanzapine_fluoxetine":false,"medication_nortriptyline":false,"medication_desipramine":false,"medication_aripiprazole":false,"medication_risperidone":false,"medication_lithium":false,"medication_triiodothyronine":false,"medication_lamotrigine":false,"medication_lurasidone":false,"medication_methylphenidate":false,"medication_quetiapine":false,"sertraline_current":false,"escitalopram_current":false,"fluoxetine_current":false,"citalopram_current":false,"other_ssri_current":false,"desvenlafaxine_current":false,"duloxetine_current":false,"venlafaxine_current":false,"bupropion_current":false,"mirtazapine_current":false,"lorazepam_current":false,"olanzapine_fluoxetine_current":false,"nortriptyline_current":false,"desipramine_current":false,"aripiprazole_current":false,"quetiapine_current":false,"risperidone_current":false,"lithium_current":false,"triiodothyronine_current":false,"lamotrigine_current":false,"lurasidone_current":false,"methylphenidate_current":false,"sertraline_successful":false,"escitalopram_successful":false,"fluoxetine_successful":false,"citalopram_successful":false,"other_ssri_successful":false,"desvenlafaxine_successful":false,"duloxetine_successful":false,"venlafaxine_successful":false,"bupropion_successful":false,"mirtazapine_successful":false,"lorazepam_successful":false,"olanzapine_fluoxetine_successful":false,"nortriptyline_successful":false,"desipramine_successful":false,"aripiprazole_successful":false,"quetiapine_successful":false,"risperidone_successful":false,"lithium_successful":false,"triiodothyronine_successful":false,"lamotrigine_successful":false,"lurasidone_successful":false,"methylphenidate_successful":false,"comorbid_med_inadequate":false,"comorbid_med_sideEffect":false,"comorbid_med_partial":false,"ssri_snri_partial":false,"bup_mirtaz_partial":false,"all_meds_failed_2":false,"all_meds_failed_3":false,"all_meds_failed_4":false,"all_meds_inadequate":false,"all_meds_sideEffect":false,"all_meds_partial":false,"ssri_snri_unsuccessful":false,"bup_mirtaz_unsuccessful":false,"bup_mirtaz_unsuccessful_2":false,"bup_atyp_unsuccessful":false,"bup_atyp_unsuccessful_2":false,"first_augment":false,"tca_failed":false,"successful_ssri_snri":false,"prior_successful_ssri_snri":false,"medBranch":"","d_comorbid":"","euthymic":"","class_failed_2":false,"ssri_inadequate":false,"snri_inadequate":false,"depression_type":"","ped_type":"","ped_age":"","medCount":17},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","sertraline_inadequate":"medication_sertraline == true && sertraline_response == \'unsuccessful\'","sertraline_partial":"medication_sertraline == true && sertraline_response == \'partial\'","escitalopram_inadequate":"medication_escitalopram == true && escitalopram_response === \'unsuccessful\'","escitalopram_partial":"medication_escitalopram == true && escitalopram_response === \'partial\'","fluoxetine_inadequate":"medication_fluoxetine == true && fluoxetine_response === \'unsuccessful\'","fluoxetine_partial":"medication_fluoxetine == true && fluoxetine_response === 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\'partial\'","quetiapine_inadequate":"medication_quetiapine == true && quetiapine_response == \'unsuccessful\'","quetiapine_partial":"medication_quetiapine == true && quetiapine_response == \'partial\'","risperidone_inadequate":"medication_risperidone == true && risperidone_response == \'unsuccessful\'","risperidone_partial":"medication_risperidone == true && risperidone_response == \'partial\'","lithium_inadequate":"medication_lithium == true && lithium_response == \'unsuccessful\'","lithium_partial":"medication_lithium == true && lithium_response == \'partial\'","triiodothyronine_inadequate":"medication_triiodothyronine == true && triiodothyronine_response == \'unsuccessful\'","triiodothyronine_partial":"medication_triiodothyronine == true && triiodothyronine_response == \'partial\'","lamotrigine_inadequate":"medication_lamotrigine == true && lamotrigine_response == \'unsuccessful\'","lamotrigine_partial":"medication_lamotrigine == true && lamotrigine_response == 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desvenlafaxine_response == \'successful\'","duloxetine_successful":"medication_duloxetine == true && duloxetine_response == \'successful\'","venlafaxine_successful":"medication_venlafaxine == true && venlafaxine_response == \'successful\'","bupropion_successful":"medication_bupropion == true && bupropion_response == \'successful\'","mirtazapine_successful":"medication_mirtazapine == true && mirtazapine_response == \'successful\'","lorazepam_successful":"medication_lorazepam == true && lorazepam_response == \'successful\'","nortriptyline_successful":"medication_nortriptyline == true && nortriptyline_response == \'successful\'","desipramine_successful":"medication_desipramine == true && desipramine_response == \'successful\'","aripiprazole_successful":"medication_aripiprazole == true && aripiprazole_response == \'successful\'","risperidone_successful":"medication_risperidone == true && risperidone_response == \'successful\'","lithium_successful":"medication_lithium == true && lithium_response == \'successful\'","triiodothyronine_successful":"medication_triiodothyronine == true && triiodothyronine_response == \'successful\'","lamotrigine_successful":"medication_lamotrigine == true && lamotrigine_response == \'successful\'","lurasidone_successful":"medication_lurasidone == true && lurasidone_response == \'successful\'","quetiapine_successful":"medication_quetiapine == true && quetiapine_response == \'successful\'","methylphenidate_successful":"medication_methylphenidate == true && methylphenidate_response == \'successful\'","on_ssri_snri_1":"(medication_sertraline ? 1 : 0) + (medication_escitalopram ? 1 : 0) + (medication_fluoxetine ? 1 : 0) + (medication_citalopram ? 1 : 0) + (medication_duloxetine ? 1 : 0) + (medication_venlafaxine ? 1 : 0) >= 1","on_ssri_snri_2":"(medication_sertraline ? 1 : 0) + (medication_escitalopram ? 1 : 0) + (medication_fluoxetine ? 1 : 0) + (medication_citalopram ? 1 : 0) + (medication_duloxetine ? 1 : 0) + (medication_venlafaxine ? 1 : 0) >= 2"},{"euthymic_mild":"partum == \'Antepartum\' && euthymic == \'Yes\' && depression_type == \'Mild\' || partum == \'Postpartum\' && euthymic == \'Yes\' && depression_type == \'Mild\'"},{"fluoxetine_unsuccessful":"(fluoxetine_inadequate ? 1 : 0) + (fluoxetine_partial ? 1 : 0) >= 1","escitalopram_unsuccessful":"(escitalopram_inadequate ? 1 : 0) + (escitalopram_partial ? 1 : 0) >= 1"},{"class_failed_2":"(ssri_inadequate ? 1 : 0) + (snri_inadequate? 1 : 0)+ (bupropion_inadequate ? 1 : 0) + (mirtazapine_inadequate ? 1 : 0) >= 2"},{"ssri_snri_partial":"(sertraline_partial ? 1 : 0) + (escitalopram_partial ? 1 : 0) + (fluoxetine_partial ? 1 : 0) + (citalopram_partial ? 1 : 0) + (desvenlafaxine_partial ? 1 : 0) + (duloxetine_partial ? 1 : 0) + (venlafaxine_partial ? 1 : 0) + (other_ssri_partial ? 1 : 0) >= 1","bup_mirtaz_partial":"(bupropion_partial ? 1 : 0) + (mirtazapine_partial ? 1 : 0) >= 1"},{"all_meds_failed_2":"(sertraline_inadequate ? 1 : 0) + (escitalopram_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0) + (citalopram_inadequate ? 1 : 0) + (other_ssri_inadequate ? 1 : 0) + (desvenlafaxine_inadequate ? 1 : 0) + (duloxetine_inadequate ? 1 : 0) + (venlafaxine_inadequate ? 1 : 0) + (bupropion_inadequate ? 1 : 0) + (mirtazapine_inadequate ? 1 : 0) >= 2","all_meds_failed_3":"(sertraline_inadequate ? 1 : 0) + (escitalopram_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0) + (citalopram_inadequate ? 1 : 0) + (other_ssri_inadequate ? 1 : 0) + (desvenlafaxine_inadequate ? 1 : 0) + (duloxetine_inadequate ? 1 : 0) + (venlafaxine_inadequate ? 1 : 0) + (bupropion_inadequate ? 1 : 0) + (mirtazapine_inadequate ? 1 : 0) >= 3","all_meds_failed_4":"(sertraline_inadequate ? 1 : 0) + (escitalopram_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0) + (citalopram_inadequate ? 1 : 0) + (other_ssri_inadequate ? 1 : 0) + (desvenlafaxine_inadequate ? 1 : 0) + (duloxetine_inadequate ? 1 : 0) + (venlafaxine_inadequate ? 1 : 0) + (bupropion_inadequate ? 1 : 0) + 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=== \'current\' && (patient_age == \'Pediatric\') && d_comorbid != \'Yes\'","id":"desipramine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' &&  patient_age != \'Adolescent\'","type":"title","text":[{"visible":"true","text":"Augmentation Pharmacotherapy"}]},{"visible":"medication_history === \'Yes\' && patient_age != \'Pediatric\' && euthymic_mild == false && patient_age != \'Adolescent\'","id":"medication_aripiprazole","text":"Aripiprazole","type":"switch","groups":[{"visible":"medication_aripiprazole","id":"aripiprazole_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_aripiprazole && aripiprazole_current === \'current\' && d_comorbid != \'Yes\' && !((patient_age == \'Pediatric\'))","id":"aripiprazole_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_aripiprazole && aripiprazole_current === \'prior\' && d_comorbid != \'Yes\' || medication_aripiprazole && aripiprazole_current === \'current\' && (patient_age == \'Pediatric\') && d_comorbid != \'Yes\'","id":"aripiprazole_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && comorbidities == \'childbearing\' && euthymic_mild == false && patient_age != \'Adolescent\'","id":"medication_quetiapine","text":"Quetiapine","type":"switch","groups":[{"visible":"medication_quetiapine","id":"quetiapine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_quetiapine && quetiapine_current === \'current\' && d_comorbid != \'Yes\' && !((patient_age == \'Pediatric\'))","id":"quetiapine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_quetiapine && quetiapine_current === \'prior\' && d_comorbid != \'Yes\' || medication_quetiapine && quetiapine_current === \'current\' && (patient_age == \'Pediatric\') && d_comorbid != \'Yes\'","id":"quetiapine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && patient_age != \'Pediatric\' && comorbidities != \'childbearing\' && patient_age != \'Adolescent\'","id":"medication_lithium","text":"Lithium","type":"switch","groups":[{"visible":"medication_lithium","id":"lithium_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_lithium && lithium_current === \'current\' && d_comorbid != \'Yes\' && !((patient_age == \'Pediatric\'))","id":"lithium_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_lithium && lithium_current === \'prior\' && d_comorbid != \'Yes\' || medication_lithium && lithium_current === \'current\' && (patient_age == \'Pediatric\') && d_comorbid != \'Yes\'","id":"lithium_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && patient_age != \'Pediatric\' && comorbidities != \'childbearing\' && patient_age != \'Adolescent\'","id":"medication_lamotrigine","text":"Lamotrigine","type":"switch","groups":[{"visible":"medication_lamotrigine","id":"lamotrigine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_lamotrigine && lamotrigine_current === \'current\' && d_comorbid != \'Yes\' && !((patient_age == \'Pediatric\'))","id":"lamotrigine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_lamotrigine && lamotrigine_current === \'prior\' && d_comorbid != \'Yes\' || medication_lamotrigine && lamotrigine_current === \'current\' && (patient_age == \'Pediatric\') && d_comorbid != \'Yes\'","id":"lamotrigine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && patient_age != \'Pediatric\' && comorbidities != \'childbearing\' && patient_age != \'Adolescent\'","id":"medication_lurasidone","text":"Lurasidone","type":"switch","groups":[{"visible":"medication_lurasidone","id":"lurasidone_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_lurasidone && lurasidone_current === \'current\' && d_comorbid != \'Yes\' && !((patient_age == \'Pediatric\'))","id":"lurasidone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_lurasidone && lurasidone_current === \'prior\' && d_comorbid != \'Yes\' || medication_lurasidone && lurasidone_current === \'current\' && (patient_age == \'Pediatric\') && d_comorbid != \'Yes\'","id":"lurasidone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"Depressive Disorder","state":"intro","content":[{"id":"depression_type","visible":"patient_age != \'Pediatric\' && patient_age != \'Adolescent\' && partum != \'Preconception\' && partum != \'Antepartum\' && partum != \'Postpartum\'","type":"choice","choices":[{"text":"Mild-Moderate"},{"text":"Severe"}],"text":"What severity is the patient\'s depression?"},{"id":"euthymic","visible":"patient_age != \'Pediatric\' && patient_age != \'Adolescent\' && partum != \'Preconception\' && comorbidities == \'childbearing\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is the patient currently euthymic with a history of MDD and/or postpartum depression?"},{"id":"depression_type","visible":"partum != \'Preconception\' && comorbidities == \'childbearing\' && euthymic == \'Yes\'","type":"choice","choices":[{"text":"Mild"},{"text":"Moderate"},{"text":"Severe"}],"text":"What severity was the patient\'s depression?"},{"id":"depression_type","visible":"partum != \'Preconception\' && comorbidities == \'childbearing\' && euthymic == \'No\'","type":"choice","choices":[{"text":"Mild"},{"text":"Moderate"},{"text":"Severe"}],"text":"What severity is the patient\'s depression?"},{"id":"ped_type","visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","type":"choice","choices":[{"text":"Mild"},{"text":"Moderate"},{"text":"Severe"}],"text":"What severity is the patient\'s depression?"},{"id":"d_comorbid","visible":"patient_age != \'Pediatric\' && patient_age != \'Adolescent\' && partum != \'Antepartum\' && partum != \'Postpartum\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does the patient suffer from psychosis?"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (bupropion_successful === true)","title":"","uid":"2","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"Discuss risks and benefits of Bupropion use in first trimester","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Pediatric\')","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: Maintenance minimum 6-12 months. Consider taper after symptom free for 1 year.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Pediatric\')","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy: Maintenance minimum 6-12 months. Consider taper after symptom free for 1 year.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: Maintenance minimum 6-12 months.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy: Maintenance minimum 6-12 months.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: <br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy:<br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: minimum 6-12 mo postpartum","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication (unless MAOI). Continue maintenance therapy minimum 6-12 mo postpartum.","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Postpartum\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: Maintenance minimum 6-12 months.","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Postpartum\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication (unless MAOI). Continue maintenance therapy minimum 6-12 mo postpartum.","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: <br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy:<br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: <br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy:<br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: <br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy:<br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: <br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy:<br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: <br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy:<br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue current medication as maintenance therapy: <br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Continue current medication as maintenance therapy:<br>-1st episode: 6-9 months <br>-Recurrent episode: at least 2 years (SOR A)","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(d_comorbid === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consider hospitalization. Start an antidepressant and an antipsychotic.","meds":["Aripiprazole","Risperidone","Lurasidone","Olanzapine","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_9","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_3","title":"ECG Antipsychotic Recommendations","type":"collapse_segment","text":"ECG should be performed in patients > 45 years of age or those with a history of heart disease including prior MI, arrhythmia, and systolic dysfunction.","segments":[{"title":"QTc < 500msec","text":"No additional recommendations."},{"title":"QTc 500-549msec","text":"Monitor with follow-up ECG."},{"title":"QTc > 550msec","text":"Consult with cardiology prior to initiation. If already taking medication, discontinue pharmacotherapy and discuss with cardiology."}]}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d1"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>First choice: Start an SSRI or Mirtazapine <br><br>Second choice: Start an SNRI <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> 1. Consider an SSRI 2. Consider an SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d1"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>First choice: Start an SSRI or Mirtazapine <br><br>Second choice: Start an SNRI <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> 1. Consider an SSRI 2. Consider an SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d1"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>First choice: Start an SSRI or an Atypical Antipsychotic such as Mirtazapine <br>Second choice: Start an SNRI <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> 1. Consider an SSRI 2. Consider an SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d1"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>First choice: Start an SSRI or an Atypical Antipsychotic such as Mirtazapine <br>Second choice: Start an SNRI <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> 1. Consider an SSRI 2. Consider an SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (all_meds_partial === true) && (bup_mirtaz_partial === true) && (ssri_snri_partial === false) && (ssri_snri_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d2"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with Aripiprazole or 1. An SSRI 2. An SNRI<br><br><b>Second Choice augmentation option:</b><br>Start Lurasidone.","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Lurasidone"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_9","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_3","title":"ECG Antipsychotic Recommendations","type":"collapse_segment","text":"ECG should be performed in patients > 45 years of age or those with a history of heart disease including prior MI, arrhythmia, and systolic dysfunction.","segments":[{"title":"QTc < 500msec","text":"No additional recommendations."},{"title":"QTc 500-549msec","text":"Monitor with follow-up ECG."},{"title":"QTc > 550msec","text":"Consult with cardiology prior to initiation. If already taking medication, discontinue pharmacotherapy and discuss with cardiology."}]}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (all_meds_partial === true) && (bup_mirtaz_partial === false) && (ssri_snri_partial === true) && (bup_mirtaz_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"16","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d2"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with Aripiprazole or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>Start Lurasidone.","meds":["Aripiprazole","Mirtazapine","Lurasidone"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_9","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_3","title":"ECG Antipsychotic Recommendations","type":"collapse_segment","text":"ECG should be performed in patients > 45 years of age or those with a history of heart disease including prior MI, arrhythmia, and systolic dysfunction.","segments":[{"title":"QTc < 500msec","text":"No additional recommendations."},{"title":"QTc 500-549msec","text":"Monitor with follow-up ECG."},{"title":"QTc > 550msec","text":"Consult with cardiology prior to initiation. If already taking medication, discontinue pharmacotherapy and discuss with cardiology."}]}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (all_meds_partial === true) && (patient_age === \'Adult\')","title":"","uid":"17","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d2"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation agent and augment current antidepressant with one of the following: <br><br><b>First choice augmentation option:</b> <br>-Aripiprazole <br>-If current antidepressent is Mirtazapine: 1. An SSRI 2. An SNRI<br>-If current antidepressent is an SSRI or an SNRI: Mirtazapine <br><br><b>Second Choice augmentation option:</b><br>Start Lurasidone.","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Mirtazapine","Lurasidone"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_9","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_3","title":"ECG Antipsychotic Recommendations","type":"collapse_segment","text":"ECG should be performed in patients > 45 years of age or those with a history of heart disease including prior MI, arrhythmia, and systolic dysfunction.","segments":[{"title":"QTc < 500msec","text":"No additional recommendations."},{"title":"QTc 500-549msec","text":"Monitor with follow-up ECG."},{"title":"QTc > 550msec","text":"Consult with cardiology prior to initiation. If already taking medication, discontinue pharmacotherapy and discuss with cardiology."}]}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"18","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d1"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial:</b> <br>Switch to an antidepressant in the same or a different class","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === false) && (patient_age === \'Adult\')","title":"","uid":"19","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d3"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, or Mirtazapine","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (class_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"190","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d3"],"content":[{"visible":true,"uid":"190.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, or Mirtazapine","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (all_meds_failed_3 === true) && (class_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-cardiac_d3"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(d_comorbid === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consider hospitalization. Start an antidepressant and an antipsychotic.","meds":["Aripiprazole","Risperidone","Lurasidone","Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"21","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d1"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Bupropion, SSRI, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>None:</b> Consider Bupropion <br><br><b>Anxiety:</b> Consider SSRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"22","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d1"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Bupropion, SSRI, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>None:</b> Consider Bupropion <br><br><b>Anxiety:</b> Consider SSRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"21","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d1"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Bupropion, SSRI, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>None:</b> Consider Bupropion <br><br><b>Anxiety:</b> Consider SSRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"22","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d1"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Bupropion, SSRI, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>None:</b> Consider Bupropion <br><br><b>Anxiety:</b> Consider SSRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_partial === true) && (bup_mirtaz_partial === true) && (ssri_snri_partial === false) && (ssri_snri_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"24","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d2"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with Aripiprazole or an SSRI<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Lurasidone","Lithium","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_partial === true) && (bup_mirtaz_partial === false) && (ssri_snri_partial === true) && (bup_mirtaz_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"25","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d2"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with Aripiprazole or with Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Bupropion","Mirtazapine","Lurasidone","Lithium","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_partial === true) && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d2"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation agent and augment current antidepressant with one of the following: <br><br><b>First choice augmentation option:</b> <br>-Aripiprazole <br>-If current antidepressent is Buproprion or Mirtazapine: An SSRI<br>-If current antidepressent is an SSRI: Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality<br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Bupropion","Mirtazapine","Lurasidone","Lithium","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d1"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial:</b> <br>Switch to an antidepressant in the same or a different class","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === false) && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d3"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_failed_3 === true) && (class_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"280","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d3"],"content":[{"visible":true,"uid":"280.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_failed_3 === true) && (tca_failed === false) && (class_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d3"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start a TCA such as Nortriptyline or Desipramine (ECG before initiation and at each dose increase) <br>Consider psychiatry consultation","meds":["Nortriptyline","Desipramine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (all_meds_failed_3 === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"30","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-hepatic_d3"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(d_comorbid === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consider hospitalization. Start an antidepressant and an antipsychotic. <br><br><b>First Choice:</b> Start Aripiprazole or Lurasidone <br><br><b>Second Choice:</b> Start Risperidone or Olanzapine","meds":["Aripiprazole","Lurasidone","Risperidone","Olanzapine","Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d1"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d1"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d1"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d1"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_partial === true) && (bup_mirtaz_partial === true) && (ssri_snri_partial === false) && (ssri_snri_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d2"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with an SSRI or SNRI<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_partial === true) && (bup_mirtaz_partial === false) && (ssri_snri_partial === true) && (bup_mirtaz_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d2"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Bupropion","Mirtazapine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_partial === true) && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d2"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation agent and augment current antidepressant with one of the following: <br><br><b>First choice augmentation option:</b> <br>-Aripiprazole <br>-If current antidepressent is Buproprion or Mirtazapine: 1. An SSRI 2. An SNRI<br>-If current antidepressent is an SSRI or an SNRI: Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Bupropion","Mirtazapine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial:</b> <br>Switch to an antidepressant in the same or a different class","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_failed_2 === true) && (class_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d3"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_failed_2 === true) && (class_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"380","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d3"],"content":[{"visible":true,"uid":"380.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_failed_3 === true) && (tca_failed === false) && (class_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"39","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d3"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start a TCA such as Nortriptyline or Desipramine (ECG before initiation and at each dose increase) <br>Consider psychiatry consultation","meds":["Nortriptyline","Desipramine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (all_meds_failed_3 === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"40","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-obesity_d3"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(d_comorbid === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consider hospitalization. Start an antidepressant and an antipsychotic.","meds":["Aripiprazole","Risperidone","Lurasidone","Olanzapine","Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d1"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d1"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d1"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d1"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (all_meds_partial === true) && (bup_mirtaz_partial === true) && (ssri_snri_partial === false) && (ssri_snri_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"44","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d2"],"content":[{"visible":true,"uid":"44.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with an SSRI or SNRI<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_9","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (all_meds_partial === true) && (bup_mirtaz_partial === false) && (ssri_snri_partial === true) && (bup_mirtaz_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d2"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Bupropion","Mirtazapine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_9","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (all_meds_partial === true) && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d2"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation agent and augment current antidepressant with one of the following: <br><br><b>First choice augmentation option:</b> <br>-Aripiprazole <br>-If current antidepressent is Buproprion or Mirtazapine: 1. An SSRI 2. An SNRI<br>-If current antidepressent is an SSRI or an SNRI: Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Bupropion","Mirtazapine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"true","uid":"G_9","type":"overlay","text":"<warning>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d1"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial:</b> <br>Switch to an antidepressant in the same or a different class","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === false) && (patient_age === \'Adult\')","title":"","uid":"48","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d3"],"content":[{"visible":true,"uid":"48.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (all_meds_failed_3 === true) && (class_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"480","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d3"],"content":[{"visible":true,"uid":"480.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (all_meds_failed_3 === true) && (tca_failed === false) && (class_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"49","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d3"],"content":[{"visible":true,"uid":"49.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start a TCA such as Nortriptyline or Desipramine (ECG before initiation and at each dose increase) <br>Consider psychiatry consultation","meds":["Nortriptyline","Desipramine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (all_meds_failed_3 === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"50","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-renal_d3"],"content":[{"visible":true,"uid":"50.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_7","type":"overlay","text":"Consider the addition of a Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(d_comorbid === \'Yes\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"20","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consider hospitalization. Start an antidepressant and an antipsychotic.","meds":["Aripiprazole","Risperidone","Lurasidone","Olanzapine","Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"51","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d1"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"52","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d1"],"content":[{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"51","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d1"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"52","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d1"],"content":[{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_partial === true) && (bup_mirtaz_partial === true) && (ssri_snri_partial === false) && (ssri_snri_unsuccessful_1 === false) && (patient_age === \'Geriatric\')","title":"","uid":"54","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d2"],"content":[{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with an SSRI or SNRI<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_partial === true) && (bup_mirtaz_partial === false) && (ssri_snri_partial === true) && (bup_mirtaz_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"55","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d2"],"content":[{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Bupropion","Mirtazapine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_partial === true) && (patient_age === \'Geriatric\')","title":"","uid":"56","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d2"],"content":[{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation agent and augment current antidepressant with one of the following: <br><br><b>First choice augmentation option:</b> <br>-Aripiprazole <br>-If current antidepressent is Buproprion or Mirtazapine: 1. An SSRI 2. An SNRI<br>-If current antidepressent is an SSRI or an SNRI: Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Bupropion","Mirtazapine","Lithium","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (class_failed_2 === false) && (patient_age === \'Geriatric\')","title":"","uid":"57","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d1"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial:</b> <br>Switch to an antidepressant in the same or a different class","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_failed_2 === true) && (class_failed_2 === false) && (patient_age === \'Geriatric\')","title":"","uid":"58","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d3"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (fluoxetine_unsuccessful === \'escitalopram_unsuccessful\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === false) && (class_failed_2 === true) && (patient_age === \'Geriatric\')","title":"","uid":"58","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d3"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"},{"visible":"true","uid":"G_10","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_failed_3 === true) && (class_failed_2 === true) && (patient_age === \'Geriatric\')","title":"","uid":"59","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-geriatric_d3"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_6","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment","meds":[],"priority":"false"}]},{"valid":"(ped_type === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"60","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d1"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<discontinue>Combination pharmacotherapy and CBT<br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (ssri_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"61","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d1"],"content":[{"visible":true,"uid":"61.0","type":"overlay","title":"Recommendation","text":"<discontinue>Combination pharmacotherapy and CBT<br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"62","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d1"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"<discontinue>Recommend CBT alone or combination CBT and pharmacotherapy. If inadequate response to CBT alone, consider adding pharmacotherapy. <br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (ssri_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"63","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d1"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"<discontinue>Recommend CBT alone or combination CBT and pharmacotherapy. If inadequate response to CBT alone, consider adding pharmacotherapy. <br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Mild\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"64","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d1"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"<discontinue>Recommend CBT. If inadequate response, consider adding pharmacotherapy.<br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Mild\') && (medication_history === \'Yes\') && (partum === \'None\') && (ssri_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"65","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d1"],"content":[{"visible":true,"uid":"65.0","type":"overlay","title":"Recommendation","text":"<discontinue>Recommend CBT. If inadequate response, consider adding pharmacotherapy.<br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ssri_inadequate === true) && (fluoxetine_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"66","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d3"],"content":[{"visible":true,"uid":"66.0","type":"overlay","title":"Recommendation","text":"<b>Second choice:</b><br><discontinue>Start Fluoxetine","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ssri_inadequate === true) && (fluoxetine_inadequate === true) && (ssri_snri_unsuccessful_2 === false) && (patient_age === \'Pediatric\')","title":"","uid":"67","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d3"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"<b>Second choice:</b><br><discontinue>Start Sertraline or Escitalopram <br><br>Second trial of SSRI vs. SNRI equally efficacious; SSRI may be more tolerable.","meds":["Sertraline","Escitalopram"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ped_inadequate_3 === false) && (ssri_snri_unsuccessful_2 === true) && (patient_age === \'Pediatric\')","title":"","uid":"68","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d3"],"content":[{"visible":true,"uid":"68.0","type":"overlay","title":"Recommendation","text":"<b>Third choice:</b> <br><discontinue>Start Venlafaxine or Bupropion","meds":["Venlafaxine","Bupropion"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ped_inadequate_3 === true) && (ssri_snri_unsuccessful_2 === true) && (patient_age === \'Pediatric\')","title":"","uid":"69","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-pediatric_d3"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation<br>Some psychiatric experts recommend cautious augmentation in partial response or combination therapy with other medications","meds":["Aripiprazole","Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"60","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d1"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<discontinue>Combination pharmacotherapy and CBT<br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (ssri_unsuccessful === false) && (patient_age === \'Adolescent\')","title":"","uid":"61","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d1"],"content":[{"visible":true,"uid":"61.0","type":"overlay","title":"Recommendation","text":"<discontinue>Combination pharmacotherapy and CBT<br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"62","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d1"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"<discontinue>Recommend CBT alone or combination CBT and pharmacotherapy. If inadequate response to CBT alone, consider adding pharmacotherapy. <br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (ssri_unsuccessful === false) && (patient_age === \'Adolescent\')","title":"","uid":"63","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d1"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"<discontinue>Recommend CBT alone or combination CBT and pharmacotherapy. If inadequate response to CBT alone, consider adding pharmacotherapy. <br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Mild\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"64","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d1"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"<discontinue>Recommend CBT. If inadequate response, consider adding pharmacotherapy.<br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(ped_type === \'Mild\') && (medication_history === \'Yes\') && (partum === \'None\') && (ssri_unsuccessful === false) && (patient_age === \'Adolescent\')","title":"","uid":"65","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d1"],"content":[{"visible":true,"uid":"65.0","type":"overlay","title":"Recommendation","text":"<discontinue>Recommend CBT. If inadequate response, consider adding pharmacotherapy.<br><br><b>First choice:</b> <br>Start SSRI. Fluoxetine is the most studied SSRI in pediatric population and is recommended as first choice by some organizations.","meds":["Fluoxetine","Escitalopram","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ssri_unsuccessful === true) && (fluoxetine_unsuccessful === false) && (patient_age === \'Adolescent\')","title":"","uid":"66","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d2"],"content":[{"visible":true,"uid":"66.0","type":"overlay","title":"Recommendation","text":"<b>Second choice:</b><br><discontinue>Start Fluoxetine","meds":["Fluoxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ssri_unsuccessful === true) && (ssri_unsuccessful_2 === false) && (fluoxetine_unsuccessful === true) && (patient_age === \'Adolescent\')","title":"","uid":"67","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d2"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"<b>Second choice:</b><br><discontinue>Start Escitalopram or Sertraline","meds":["Escitalopram","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ssri_unsuccessful === true) && (ssri_unsuccessful_2 === true) && (fluoxetine_unsuccessful === true) && (third_ado_unsuccessful === false) && (third_ado_partial === false) && (patient_age === \'Adolescent\')","title":"","uid":"68","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d2"],"content":[{"visible":true,"uid":"68.0","type":"overlay","title":"Recommendation","text":"<b>Third choice:</b> <br><discontinue>Start Fluoxetine, Sertraline, Escitalopram, Venlafaxine, Bupropion, or Mirtazapine","meds":["Fluoxetine","Sertraline","Escitalopram","Venlafaxine","Bupropion","Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (third_ado_unsuccessful === true) && (third_ado_partial === false) && (patient_age === \'Adolescent\')","title":"","uid":"69","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d2"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"Psychiatry referral","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (third_ado_partial === true) && (patient_age === \'Adolescent\')","title":"","uid":"70","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-adolescent_d3"],"content":[{"visible":true,"uid":"70.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b><br>Continue current antidepressant and augment:<br>&#x2022 On SSRI/SNRI: Add Bupropion or Mirtazapine<br>&#x2022 On Bupropion or Mirtazapine: Add SSRI/SNRI<br><br><b>Second Choice augmentation option:</b><br>Continue current antidepressant and augment with Aripiprazole or Lurasidone","meds":["Sertraline","Venlafaxine","Fluoxetine","Escitalopram","Bupropion","Mirtazapine","Aripiprazole","Lurasidone"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(d_comorbid === \'Yes\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consider hospitalization. Start an antidepressant and an antipsychotic.","meds":["Aripiprazole","Risperidone","Lurasidone","Olanzapine","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'No\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"70","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d1"],"content":[{"visible":true,"uid":"70.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine<br><br>In context of preconception counseling, pharmacotherapy decision should be made congruently with antepartum decision support tool","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"71","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d1"],"content":[{"visible":true,"uid":"71.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start SSRI, SNRI, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine<br><br>In context of preconception counseling, pharmacotherapy decision should be made congruently with antepartum decision support tool","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(partum === \'Preconception\') && (all_meds_partial === true) && (bup_mirtaz_partial === true) && (ssri_snri_partial === false) && (ssri_snri_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"74","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d2"],"content":[{"visible":true,"uid":"74.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with an SSRI or SNRI<br><br><b>Second Choice augmentation option:</b><br>Consider Bupropion. Discuss risks and benefits of Bupropion use in first trimester.","meds":["Aripiprazole","Quetiapine","Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(partum === \'Preconception\') && (all_meds_partial === true) && (bup_mirtaz_partial === false) && (ssri_snri_partial === true) && (bup_mirtaz_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"75","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d2"],"content":[{"visible":true,"uid":"75.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>Consider Bupropion. Discuss risks and benefits of Bupropion use in first trimester.","meds":["Aripiprazole","Quetiapine","Mirtazapine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(partum === \'Preconception\') && (all_meds_partial === true) && (patient_age === \'Adult\')","title":"","uid":"76","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d2"],"content":[{"visible":true,"uid":"76.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation agent and augment current antidepressant with one of the following: <br><br><b>First choice augmentation option:</b> <br>-An atypical antipsychotic <br>-If current antidepressent is Mirtazapine: An SSRI or an SNRI<br>-If current antidepressent is an SSRI or an SNRI: Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>Consider Bupropion. Discuss risks and benefits of Bupropion use in first trimester.","meds":["Aripiprazole","Quetiapine","Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine","Mirtazapine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(partum === \'Preconception\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"77","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d1"],"content":[{"visible":true,"uid":"77.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial:</b> <br>Switch to an antidepressant in the same or a different class","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(partum === \'Preconception\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === false) && (patient_age === \'Adult\')","title":"","uid":"78","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d3"],"content":[{"visible":true,"uid":"78.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, or Mirtazapine","meds":["Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(partum === \'Preconception\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === true) && (all_meds_failed_4 === false) && (patient_age === \'Adult\')","title":"","uid":"78","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d3"],"content":[{"visible":true,"uid":"78.0","type":"overlay","title":"Recommendation","text":"<b>Fourth Trial:</b> <br>Switch to other alternate therapy such as an SNRI or Mirtazapine","meds":["Mirtazapine","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(partum === \'Preconception\') && (all_meds_failed_3 === true) && (all_meds_failed_4 === true) && (patient_age === \'Adult\')","title":"","uid":"79","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d3"],"content":[{"visible":true,"uid":"79.0","type":"overlay","title":"Recommendation","text":"<discontinue>Discuss risks and benefits of Bupropion use in first trimester. If patient agrees with use, start Bupropion. If not, start Nortriptyline (ECG before initiation and at each dose increase) <br><br>Consider psychiatry consultation","meds":["Bupropion","Nortriptyline"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(partum === \'Preconception\') && (all_meds_failed_4 === true) && (patient_age === \'Adult\')","title":"","uid":"80","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-preconception_d3"],"content":[{"visible":true,"uid":"80.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one<br><br>Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one<br><br>Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"Recommend pharmacotherapy beginning third trimester or postpartum day one. Psychotherapy is recommend throughout pregnancy<br><br>Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"82","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"82.0","type":"overlay","title":"Recommendation","text":"Recommend pharmacotherapy beginning third trimester or postpartum day one. Psychotherapy is recommend throughout pregnancy<br><br>Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Moderate\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one<br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Moderate\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one<br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(depression_type === \'Moderate\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Moderate\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"84","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"84.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Mild\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy.","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(depression_type === \'Mild\') && (medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild\') && (medication_history === \'Yes\') && (partum === \'Antepartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"84","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d1"],"content":[{"visible":true,"uid":"84.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Antepartum\') && (all_meds_partial === true) && (ssri_snri_partial === true) && (bup_atyp_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"85","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d2"],"content":[{"visible":true,"uid":"85.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or Bupropion. Discuss risks and benefits of bupropion use in first trimester.","meds":["Aripiprazole","Quetiapine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Antepartum\') && (all_meds_partial === true) && (ssri_snri_partial === true) && (bup_atyp_unsuccessful === true) && (bup_atyp_unsuccessful_2 === false) && (patient_age === \'Adult\')","title":"","uid":"87","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d2"],"content":[{"visible":true,"uid":"87.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation pharmacotherapy and trial a different agent","meds":["Aripiprazole","Quetiapine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Antepartum\') && (all_meds_partial === true) && (ssri_snri_partial === true) && (bup_atyp_unsuccessful === true) && (bup_atyp_unsuccessful_2 === true) && (patient_age === \'Adult\')","title":"","uid":"87","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d2"],"content":[{"visible":true,"uid":"87.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation pharmacotherapy and trial Mirtazapine","meds":["Mirtazapine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Antepartum\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"88","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d3"],"content":[{"visible":true,"uid":"88.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial:</b> <br><discontinue>Start alternate SSRI","meds":["Sertraline","Escitalopram","Fluoxetine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Antepartum\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === false) && (patient_age === \'Adult\')","title":"","uid":"89","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d3"],"content":[{"visible":true,"uid":"89.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br><discontinue>Start Mirtazapine, an SNRI, or Bupropion. Discuss risks and benefits of bupropion use in first trimester.","meds":["Mirtazapine","Duloxetine","Venlafaxine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Antepartum\') && (all_meds_failed_3 === true) && (all_meds_failed_4 === false) && (patient_age === \'Adult\')","title":"","uid":"90","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d3"],"content":[{"visible":true,"uid":"90.0","type":"overlay","title":"Recommendation","text":"<b>Fourth Trial:</b> <br>Switch to a medication which has not previously been trialed such as Mirtazapine, an SNRI, or Bupropion. Discuss risks and benefits of bupropion use in first trimester.","meds":["Mirtazapine","Duloxetine","Venlafaxine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Antepartum\') && (all_meds_failed_3 === true) && (all_meds_failed_4 === true) && (patient_age === \'Adult\')","title":"","uid":"91","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-antepartum_d3"],"content":[{"visible":true,"uid":"91.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"92","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"92.0","type":"overlay","title":"Recommendation","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one<br><br>Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"93","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"93.0","type":"overlay","title":"Recommendation","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one<br><br>Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"92","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"92.0","type":"overlay","title":"Recommendation","text":"Recommend pharmacotherapy beginning third trimester or postpartum day one. Psychotherapy is recommend throughout pregnancy<br><br>Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"93","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"93.0","type":"overlay","title":"Recommendation","text":"Recommend pharmacotherapy beginning third trimester or postpartum day one. Psychotherapy is recommend throughout pregnancy<br><br>Combination psychotherapy and pharmacotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Moderate\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one<br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Moderate\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one<br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]}]},{"valid":"(depression_type === \'Moderate\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"Recommend pharmacotherapy beginning third trimester or postpartum day one. Psychotherapy is recommend throughout pregnancy<br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Moderate\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"Recommend pharmacotherapy beginning third trimester or postpartum day one. Psychotherapy is recommend throughout pregnancy<br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(euthymic === \'Yes\') && (depression_type === \'Mild\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy.","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild\') && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild\') && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d1"],"content":[{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial:</b> <br>Start Sertraline or Escitalopram","meds":["Sertraline","Escitalopram"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Postpartum\') && (all_meds_partial === true) && (ssri_snri_partial === true) && (bup_atyp_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"96","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d2"],"content":[{"visible":true,"uid":"96.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option:</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or Bupropion.","meds":["Aripiprazole","Quetiapine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Postpartum\') && (all_meds_partial === true) && (ssri_snri_partial === true) && (bup_atyp_unsuccessful === true) && (bup_atyp_unsuccessful_2 === false) && (patient_age === \'Adult\')","title":"","uid":"97","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d2"],"content":[{"visible":true,"uid":"97.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation pharmacotherapy and trial a different agent","meds":["Aripiprazole","Quetiapine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Postpartum\') && (all_meds_partial === true) && (ssri_snri_partial === true) && (bup_atyp_unsuccessful === true) && (bup_atyp_unsuccessful_2 === true) && (mirtaz_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"98","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d2"],"content":[{"visible":true,"uid":"98.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation pharmacotherapy and trial Mirtazapine","meds":["Mirtazapine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Postpartum\') && (all_meds_partial === true) && (ssri_snri_partial === true) && (bup_atyp_unsuccessful === true) && (bup_atyp_unsuccessful_2 === true) && (mirtaz_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"102","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d2"],"content":[{"visible":true,"uid":"102.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Postpartum\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"99","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d3"],"content":[{"visible":true,"uid":"99.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial:</b> <br><discontinue>Start alternate SSRI","meds":["Sertraline","Escitalopram","Fluoxetine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Postpartum\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === false) && (patient_age === \'Adult\')","title":"","uid":"100","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d3"],"content":[{"visible":true,"uid":"100.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br><discontinue>Start Mirtazapine, an SNRI, or Bupropion. Avoid Bupropion if comorbid GAD","meds":["Mirtazapine","Duloxetine","Venlafaxine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Postpartum\') && (all_meds_failed_3 === true) && (all_meds_failed_4 === false) && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d3"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"<b>Fourth Trial:</b> <br>Switch to a medication which has not previously been trialed such as Mirtazapine, an SNRI, or Bupropion.","meds":["Mirtazapine","Duloxetine","Venlafaxine","Bupropion"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(partum === \'Postpartum\') && (all_meds_failed_3 === true) && (all_meds_failed_4 === true) && (patient_age === \'Adult\')","title":"","uid":"102","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive-postpartum_d3"],"content":[{"visible":true,"uid":"102.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"euthymic == \'Yes\'","uid":"G_8","type":"overlay","text":"History of MDD and/or postpartum depression: Recommend pharmacotherapy beginning third trimester or postpartum day one","meds":[],"priority":"false"}]},{"valid":"(d_comorbid === \'Yes\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consider hospitalization. Start an antidepressant and an antipsychotic.","meds":["Aripiprazole","Risperidone","Lurasidone","Olanzapine","Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial (SOR A):</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d1"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"Combination psychotherapy and pharmacotherapy<br><br><b>First Trial (SOR A):</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine<br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial (SOR A):</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine <br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(depression_type === \'Mild-Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (all_meds_inadequate === false) && (all_meds_partial === false) && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d1"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"Recommend psychotherapy. If inadequate response, consider adding pharmacotherapy. <br><br>For patients who prefer pharmacotherapy or have a history of recurrent depression,  consider pharmacotherapy alone or in combination with psychotherapy<br><br><b>First Trial (SOR A):</b> <br>Start SSRI, SNRI, Bupropion, or Mirtazapine<br><br>Tailor treatment for current symptoms.<br><b>Chronic pain:</b> Consider Duloxetine <br><b>Anxiety:</b> Consider SSRI or SNRI <br><b>Prominent insomnia or poor appetite:</b> Consider Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_partial === true) && (bup_mirtaz_partial === true) && (ssri_snri_partial === false) && (ssri_snri_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d2"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option (SOR B):</b> <br>Continue current antidepressant and augment with an atypical antipsychotic or with an SSRI or SNRI<br><br><b>Second Choice augmentation option (SOR B):</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_partial === true) && (bup_mirtaz_partial === false) && (ssri_snri_partial === true) && (bup_mirtaz_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d2"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>First choice augmentation option (SOR B):</b> <br>Continue current antidepressant and augment with Aripiprazole or Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option (SOR B):</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Bupropion","Mirtazapine","Lithium","Lurasidone","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_partial === true) && (ssri_snri_unsuccessful_1 === true) && (bup_mirtaz_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d2"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"Discontinue previous augmentation agent and augment current antidepressant with one of the following: <br>(SOR B)<br><b>First choice augmentation option:</b><br>-Aripiprazole <br>-If current antidepressent is Buproprion or Mirtazapine: 1. An SSRI 2. An SNRI<br>-If current antidepressent is an SSRI or an SNRI: Bupropion or Mirtazapine<br><br><b>Second Choice augmentation option:</b><br>- Lithium for chronic suicidality <br>- Lurasidone <br>- For prominent residual anergia consider using a stimulant such as Methylphenidate","meds":["Aripiprazole","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine","Bupropion","Mirtazapine","Lithium","Methylphenidate"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_inadequate === true) && (all_meds_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d1"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial (SOR B):</b> <br>Switch to an antidepressant in the same or a different class","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_failed_2 === true) && (all_meds_failed_3 === false) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d3"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_failed_3 === true) && (class_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"900","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d3"],"content":[{"visible":true,"uid":"900.0","type":"overlay","title":"Recommendation","text":"<b>Third Trial:</b> <br>Switch to a medication class which has not previously been trialed such as an SSRI, SNRI, Bupropion, or Mirtazapine","meds":["Bupropion","Mirtazapine","Sertraline","Escitalopram","Fluoxetine","Citalopram","Duloxetine","Venlafaxine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_failed_3 === true) && (tca_failed === false) && (class_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d3"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start a TCA such as Nortriptyline or Desipramine (ECG before initiation and at each dose increase) <br>Consider psychiatry consultation","meds":["Nortriptyline","Desipramine"],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (all_meds_failed_3 === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Depressive Disorder","figure":["Depressive_d3"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Evidence-based psychotherapy in primary care"]},{"visible":"true","uid":"G_4","type":"overlay","text":"Consider the addition of a COX-2 inhibitor and/or Omega-3 as adjunctive pharmacotherapy at all steps of treatment (SOR B)","meds":[],"priority":"false"}]},{"valid":true,"title":"","uid":"103","state":"recommendation","branch":"Depressive 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\'cardiac\'","id":"medication_amitriptyline","text":"Amitriptyline","type":"switch","groups":[{"visible":"medication_amitriptyline","id":"amitriptyline_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_amitriptyline && amitriptyline_current === \'current\'","id":"amitriptyline_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_amitriptyline && amitriptyline_current === \'prior\'","id":"amitriptyline_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"Anticonvulsants"}]},{"visible":"medication_history === \'Yes\'","id":"medication_pregabalin","text":"Pregabalin","type":"switch","groups":[{"visible":"medication_pregabalin","id":"pregabalin_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_pregabalin && pregabalin_current === \'current\'","id":"pregabalin_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_pregabalin && pregabalin_current === \'prior\'","id":"pregabalin_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_gabapentin","text":"Gabapentin","type":"switch","groups":[{"visible":"medication_gabapentin","id":"gabapentin_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_gabapentin && gabapentin_current === \'current\'","id":"gabapentin_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_gabapentin && gabapentin_current === \'prior\'","id":"gabapentin_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"Fibromyalgia","state":"intro","content":[{"id":"is_comorbid","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does patient have comorbid 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reevaluation.","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_7","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart effective interventions with routine reevaluation.","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_7","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (successful_meds === true)","title":"","uid":"0","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Continue effective interventions with routine reevaluation.","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_7","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (prior_successful_meds === 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consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. 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Duloxetine or 2. 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Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-cardiac_b1"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-cardiac_b1"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"8.1","type":"overlay","title":"Recommendation","text":"Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-cardiac_b2"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"10.1","type":"overlay","title":"Recommendation","text":"Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-cardiac_b1"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"11.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the augmentation of pharmacotherapy from a different class based on predominant symptoms:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-cardiac_b1"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"12.1","type":"overlay","title":"Recommendation","text":"Augment with agent from different class based on predominant symptoms. Continue exercise program and psychological interventions.<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (patient_age === \'Geriatric\')","title":"","uid":"13","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"13.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"14","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"14.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"15","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"15.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"16","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"16.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"17","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b2"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"17.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider specialty referral and psychologic interventions<br><br><b>Specialty referrals</b><br>Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (patient_age === \'Geriatric\')","title":"","uid":"18","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"18.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"19","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"19.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"20","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"20.1","type":"overlay","title":"Recommendation","text":"Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"21","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"21.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"22","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b2"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"22.1","type":"overlay","title":"Recommendation","text":"Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partial_response === true) && (patient_age === \'Geriatric\')","title":"","uid":"23","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"23.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the augmentation of pharmacotherapy from a different class based on predominant symptoms:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partial_response === true) && (patient_age === \'Geriatric\')","title":"","uid":"24","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-geriatric_b1"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Geriatric\')","uid":"24.1","type":"overlay","title":"Recommendation","text":"Augment with agent from different class based on predominant symptoms. Continue exercise program and psychological interventions.<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"25","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"25.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br> If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"26.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"27.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"28.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b2"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"29.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider specialty referral and psychologic interventions<br><br><b>Specialty referrals</b><br>Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"30","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"30.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"31.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"32.1","type":"overlay","title":"Recommendation","text":"Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"33.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b2"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"34.1","type":"overlay","title":"Recommendation","text":"Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"35.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the augmentation of pharmacotherapy from a different class based on predominant symptoms:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-hepatic_b1"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"36.1","type":"overlay","title":"Recommendation","text":"Augment with agent from different class based on predominant symptoms. Continue exercise program and psychological interventions.<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"37.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"38.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"39","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"39.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"40","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"40.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b2"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"41.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider specialty referral and psychologic interventions<br><br><b>Specialty referrals</b><br>Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"42.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"43.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"44","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"44.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"44.1","type":"overlay","title":"Recommendation","text":"Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"45.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b2"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"46.1","type":"overlay","title":"Recommendation","text":"Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"47.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the augmentation of pharmacotherapy from a different class based on predominant symptoms:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'obesity\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"48","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-obesity_b1"],"content":[{"visible":true,"uid":"48.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"48.1","type":"overlay","title":"Recommendation","text":"Augment with agent from different class based on predominant symptoms. Continue exercise program and psychological interventions.<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"49","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"49.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"49.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"50","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"50.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"50.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"51.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"52","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"52.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"53","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b2"],"content":[{"visible":true,"uid":"53.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"53.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider specialty referral and psychologic interventions<br><br><b>Specialty referrals</b><br>Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"54","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"54.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"55","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"55.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"56","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"56.1","type":"overlay","title":"Recommendation","text":"Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"57.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"58","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b2"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"58.1","type":"overlay","title":"Recommendation","text":"Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"59.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the augmentation of pharmacotherapy from a different class based on predominant symptoms:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (comorbidities === \'renal\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia-renal_b1"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"60.1","type":"overlay","title":"Recommendation","text":"Augment with agent from different class based on predominant symptoms. Continue exercise program and psychological interventions.<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"62","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"62.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation) (SOR A)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"63","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"63.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation) (SOR A)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"64","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"64.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran\\n","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"65","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"65.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"65.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation) (SOR A)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"66","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b2"],"content":[{"visible":true,"uid":"66.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"66.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Consider specialty referral and psychologic interventions<br><br><b>Specialty referrals</b><br>Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"67","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"67.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation) (SOR A)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"68","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"68.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"68.1","type":"overlay","title":"Recommendation","text":"If inadequate response to exercise and/or psychotherapy, consider the addition of pharmacotherapy:<br>Assess for predominant symptoms for monotherapy (or augmentation) (SOR A)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"69","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"69.1","type":"overlay","title":"Recommendation","text":"Consider a second trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"70","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"70.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"70.1","type":"overlay","title":"Recommendation","text":"Consider a third trial of a different medication class:<br>Assess for predominant symptoms for monotherapy (or augmentation) (SOR A)<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"71","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b2"],"content":[{"visible":true,"uid":"71.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"71.1","type":"overlay","title":"Recommendation","text":"Consider: Physical therapy, Rheumatology, Pain Management, PM&R, Sleep Medicine, Psychiatry<br><br><b>Psychologic Interventions</b> (if not done previously)","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"72","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"72.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"72.1","type":"overlay","title":"Recommendation","text":"Treat psychiatric disorder and fibromyalgia concurrently (see appropriate decision support)<br><br>Augment with agent from different class based on predominant symptoms. Continue exercise program and psychological interventions.<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"73","state":"recommendation","branch":"Fibromyalgia","figure":["Fibromyalgia_b1"],"content":[{"visible":true,"uid":"73.0","type":"overlay","title":"Recommendation","text":"Initial treatment should include:<br><br><b>Patient Education</b><br>Sleep Hygiene, Nature of Disease, Treatment Approaches / Experience<br><br><b>Exercise Program (SOR A)</b><br>Aerobic, Resistance Training, Aquatherapy<br><br><b>Psychotherapy</b>","meds":["Pregabalin","Gabapentin","Duloxetine","Milnacipran","Amitriptyline","Desipramine","Imipramine","Nortriptyline"],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"73.1","type":"overlay","title":"Recommendation","text":"Augment with agent from different class based on predominant symptoms. Continue exercise program and psychological interventions.<br><br><b>None:</b> TCA<br><b>Depression:</b> Duloxetine<br><b>Sleep disturbance:</b> Pregabalin or Gabapentin<br><b>Fatigue:</b> 1. Duloxetine or 2. Milnacipran","meds":[],"therapies":["Cognitive Behavioral Therapy","Cognitive Behavioral Therapy for Insomnia","Acceptance and Commitment Therapy"]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Fibromyalgia","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},2909:function(e){"use strict";e.exports=JSON.parse('{"variables":{"fam_history":"","postmenopausal":"","medication_history":"No","medication_bupropion":false,"medication_flibanserin":false,"bupropion_current":false,"flibanserin_current":false,"bupropion_inadequate":false,"flibanserin_inadequate":false,"bupropion_successful":false,"flibanserin_successful":false,"medCount":2,"bupropion_response":"","flibanserin_response":""},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","bupropion_inadequate":"medication_bupropion == true && bupropion_response === \'unsuccessful\'","flibanserin_inadequate":"medication_flibanserin == true && flibanserin_response === \'unsuccessful\'"},{"bupropion_successful":"medication_bupropion == true && bupropion_response === \'successful\'","flibanserin_successful":"medication_flibanserin == true && flibanserin_response === \'successful\'"},{"successful_meds":"(bupropion_current == \'current\' && bupropion_successful === true) || (flibanserin_current == \'current\' && flibanserin_successful === true)","prior_successful_meds":"(bupropion_current == \'prior\' && bupropion_successful === true) || (flibanserin_current == \'prior\' && flibanserin_successful === true)"}],"sections":[{"valid":"true","title":"FSAID Medications","state":"medication","content":[{"visible":false,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat FSAID"}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"Norepinephrine Dopamine Reuptake Inhibitor"}]},{"visible":"medication_history === \'Yes\'","id":"medication_bupropion","text":"Bupropion","type":"switch","groups":[{"visible":"medication_bupropion","id":"bupropion_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_bupropion && bupropion_current === \'current\' && bupropion_response !== \'partial\' && bupropion_response !== \'partial with avoidance symptoms\' && bupropion_response !== \'partial with hyperarousal symptoms\' && bupropion_response !== \'partial with re-experiencing symptoms\'","id":"bupropion_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_bupropion && bupropion_current === \'prior\'","id":"bupropion_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"medication_bupropion && bupropion_response !== \'\' && bupropion_response !== \'successful\' && bupropion_response !== \'unsuccessful\'","id":"bupropion_response","type":"choice","choices":[{"text":"Successful","value":"successful"},{"text":"Unsuccessful","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && postmenopausal == \'No\'","type":"title","text":[{"visible":"true","text":"Mixed agonist-antagonist postsynaptic serotonergic receptors"}]},{"visible":"medication_history === \'Yes\' && postmenopausal == \'No\'","id":"medication_flibanserin","text":"Flibanserin","type":"switch","groups":[{"visible":"medication_flibanserin","id":"flibanserin_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_flibanserin && flibanserin_current === \'current\' && flibanserin_response !== \'partial\' && flibanserin_response !== \'partial with avoidance symptoms\' && flibanserin_response !== \'partial with hyperarousal symptoms\' && flibanserin_response !== \'partial with re-experiencing symptoms\'","id":"flibanserin_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_flibanserin && flibanserin_current === \'prior\'","id":"flibanserin_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"medication_flibanserin && flibanserin_response !== \'\' && flibanserin_response !== \'successful\' && flibanserin_response !== \'unsuccessful\'","id":"flibanserin_response","type":"choice","choices":[{"text":"Successful","value":"successful"},{"text":"Unsuccessful","value":"unsuccessful"}]}]}]},{"valid":true,"title":"FSAID","state":"intro","content":[{"id":"fam_history","visible":"true","type":"radio","choices":"None, Comorbid psychiatric disorder, Substance use disorder, Medications which may affect sexual function (eg SSRI TCA contraceptives Benzodiazepines antipsychotics), Partner sexual dysfunction, Non gynecological medical etiology, Gynecological etiology, Abuse- physical/sexual/emotional, Intimate partner violence","text":"Evaluate for history which may impact female sexual interest/arousal (Medical/Sexual/Psychosocial)","groups":[{"id":"fam_history","type":"choice","choices":[{"text":"None","value":"None"},{"text":"Comorbid psychiatric disorder","value":"Comorbid psychiatric disorder"},{"text":"Substance use disorder","value":"Substance use disorder"},{"text":"Medications which may affect sexual function (eg SSRI TCA contraceptives Benzodiazepines antipsychotics)","value":"Medications which may affect sexual function (eg SSRI TCA contraceptives Benzodiazepines antipsychotics)"},{"text":"Partner sexual dysfunction","value":"Partner sexual dysfunction"},{"text":"Non gynecological medical etiology","value":"Non gynecological medical etiology"},{"text":"Gynecological etiology","value":"Gynecological etiology"},{"text":"Abuse- physical/sexual/emotional","value":"Abuse- physical/sexual/emotional"},{"text":"Intimate partner violence","value":"Intimate partner violence"}]}]},{"id":"postmenopausal","visible":"fam_history != \'\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is the patient postmenopausal?"}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true)","title":"","uid":"0","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true)","title":"","uid":"0","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective dose and adjust as needed to meet life needs","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Comorbid psychiatric disorder\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Comorbid psychiatric disorder\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Comorbid psychiatric disorder\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Flibanserin","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Flibanserin","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Comorbid psychiatric disorder\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bremelanotide","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Bremelanotide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Comorbid psychiatric disorder\') && (postmenopausal === \'Yes\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Testosterone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Substance use disorder\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>Substance use disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Substance use disorder\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Substance use disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Substance use disorder\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Substance use disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Flibanserin","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Flibanserin","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Substance use disorder\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Substance use disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bremelanotide","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Bremelanotide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"9.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Substance use disorder\') && (postmenopausal === \'Yes\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Substance use disorder:</b><br><br>See corresponding decision support<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Testosterone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"10.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"10.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"10.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"10.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Medications which may affect sexual function (eg SSRI TCA contraceptives Benzodiazepines antipsychotics)\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>Medications which may affect sexual function:</b><br><br><b>SSRI:</b><br>See SSRI sexual dysfunction decision support<br><br><b>Other:</b><br>Reassess need for medication and transition if appropriate<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"11.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"11.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"11.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"11.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Medications which may affect sexual function (eg SSRI TCA contraceptives Benzodiazepines antipsychotics)\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>Medications which may affect sexual function:</b><br><br><b>SSRI:</b><br>See SSRI sexual dysfunction decision support<br><br><b>Other:</b><br>Reassess need for medication and transition if appropriate<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"12.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"12.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"12.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"12.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Medications which may affect sexual function (eg SSRI TCA contraceptives Benzodiazepines antipsychotics)\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<b>Medications which may affect sexual function:</b><br><br><b>SSRI:</b><br>See SSRI sexual dysfunction decision support<br><br><b>Other:</b><br>Reassess need for medication and transition if appropriate<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Flibanserin","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"13.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"13.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Flibanserin","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"13.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"13.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Medications which may affect sexual function (eg SSRI TCA contraceptives Benzodiazepines antipsychotics)\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Medications which may affect sexual function:</b><br><br><b>SSRI:</b><br>See SSRI sexual dysfunction decision support<br><br><b>Other:</b><br>Reassess need for medication and transition if appropriate<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bremelanotide","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Bremelanotide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Medications which may affect sexual function (eg SSRI TCA contraceptives Benzodiazepines antipsychotics)\') && (postmenopausal === \'Yes\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>Medications which may affect sexual function:</b><br><br><b>SSRI:</b><br>See SSRI sexual dysfunction decision support<br><br><b>Other:</b><br>Reassess need for medication and transition if appropriate<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Testosterone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"15.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"15.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"15.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"15.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Partner sexual dysfunction\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"16","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>Partner sexual dysfunction:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"16.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"16.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"16.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"16.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Partner sexual dysfunction\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"17","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"<b>Partner sexual dysfunction:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"17.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"17.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"17.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"17.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Partner sexual dysfunction\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"18","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"<b>Partner sexual dysfunction:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Flibanserin","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"18.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"18.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Flibanserin","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"18.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"18.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Partner sexual dysfunction\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"19","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"<b>Partner sexual dysfunction:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bremelanotide","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"19.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"19.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Bremelanotide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"19.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"19.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Partner sexual dysfunction\') && (postmenopausal === \'Yes\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"<b>Partner sexual dysfunction:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Testosterone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"20.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"20.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"20.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"20.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Non gynecological medical etiology\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"21","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"<b>Non gynecological medical etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"21.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"21.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"21.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"21.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Non gynecological medical etiology\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"22","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"<b>Non gynecological medical etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"22.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"22.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"22.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"22.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Non gynecological medical etiology\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"23","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"<b>Non gynecological medical etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Flibanserin","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"23.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"23.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Flibanserin","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"23.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"23.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Non gynecological medical etiology\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"24","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"<b>Non gynecological medical etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bremelanotide","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"24.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"24.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Bremelanotide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"24.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"24.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Non gynecological medical etiology\') && (postmenopausal === \'Yes\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"25","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"<b>Non gynecological medical etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Testosterone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"25.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"25.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"25.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"25.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Gynecological etiology\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"<b>Gynecological etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"26.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"26.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"26.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"26.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Gynecological etiology\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<b>Gynecological etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"27.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"27.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"27.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"27.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Gynecological etiology\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<b>Gynecological etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Flibanserin","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"28.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"28.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Flibanserin","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"28.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"28.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Gynecological etiology\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"<b>Gynecological etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bremelanotide","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"29.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"29.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Bremelanotide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"29.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"29.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Gynecological etiology\') && (postmenopausal === \'Yes\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"30","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"<b>Gynecological etiology:</b><br><br>Treat underlying cause and reassess<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Testosterone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"30.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"30.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"30.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"30.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Abuse- physical/sexual/emotional\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"<b>Abuse- physical/sexual/emotional:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"31.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"31.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"31.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"31.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Abuse- physical/sexual/emotional\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"<b>Abuse- physical/sexual/emotional:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"32.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"32.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"32.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"32.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Abuse- physical/sexual/emotional\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"<b>Abuse- physical/sexual/emotional:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Flibanserin","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"33.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"33.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Flibanserin","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"33.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"33.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Abuse- physical/sexual/emotional\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"<b>Abuse- physical/sexual/emotional:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bremelanotide","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"34.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"34.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Bremelanotide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"34.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"34.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Abuse- physical/sexual/emotional\') && (postmenopausal === \'Yes\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"<b>Abuse- physical/sexual/emotional:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Testosterone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"35.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"35.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"35.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"35.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Intimate partner violence\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"<b>Intimate partner violence:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"36.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"36.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"36.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"36.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Intimate partner violence\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<b>Intimate partner violence:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"37.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"37.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"37.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"37.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Intimate partner violence\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"<b>Intimate partner violence:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Flibanserin","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"38.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"38.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Flibanserin","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"38.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"38.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Intimate partner violence\') && (postmenopausal === \'No\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (flibanserin_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"39","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f3"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"<b>Intimate partner violence:</b><br><br>Refer to appropriate psychosocial services and agencies available in community<br><br>If symptoms persist despite adequate intervention, consider treatment for Female with Sexual Interest Arousal Disorder","meds":["Bremelanotide","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"39.1","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"39.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Switch to Bremelanotide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"39.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"39.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'Intimate partner 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psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"40.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"40.3","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"40.4","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'None\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"36.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"36.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"36.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'None\') && (medication_history === \'Yes\') && (bupropion_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":["Bupropion","Buspirone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"37.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br>Start Bupropion<br><br>Consider Buspirone: Buspirone is less studied, however, it may be useful in some circumstances","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"37.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"37.3","type":"collapse","title":"Behavior Modification","text":"- 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\'Adult\')","uid":"39.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"39.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(fam_history === \'None\') && (postmenopausal === \'Yes\') && (medication_history === \'Yes\') && (bupropion_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"40","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":["fsaid_f2"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"<b>Female with Sexual Interest Arousal Disorder Treatment:</b><br>-If symptoms persist greater than 6 months and cause significant distress, consider treatment<br><br><b>Assess and establish treatment expectations and goals:</b><br>- Combined psychotherapy and behavioral modification<br>- If inadequate response to combined psychotherapy and behavioral modification, consider pharmacotherapy<br>- Consider topical oils (i.e. Zestra) in addition to pharmacotherapy","meds":["Testosterone","Zestra"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"40.1","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy:</b><br><br>Consider testosterone therapy with specialist consultation if necessary","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"40.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"40.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Female Sexual Interest/Arousal Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},7406:function(e){"use strict";e.exports=JSON.parse('{"variables":{"is_comorbid":"","on_ssri_snri_1":false,"on_ssri_snri_2":false,"ssri_partial_1":false,"augment_unsuccessful":false,"ssri_inadequate_partum_1":false,"ssri_inadequate_partum_2":false,"ssri_inadequate_1":false,"ssri_inadequate_2":false,"snri_inadequate_1":false,"snri_inadequate_2":false,"ssri_inadequate_ad_3":false,"ssri_partial_partum_1":false,"first_gad_inadequate":false,"first_gad_partial":false,"second_gad_unsuccessful_1":false,"second_gad_unsuccessful_2 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!= \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","escitalopram_inadequate":"medication_escitalopram == true && escitalopram_response === \'unsuccessful\'","escitalopram_partial":"medication_escitalopram == true && escitalopram_response === \'partial\'","fluoxetine_inadequate":"medication_fluoxetine == true && fluoxetine_response === \'unsuccessful\'","fluoxetine_partial":"medication_fluoxetine == true && fluoxetine_response === \'partial\'","sertraline_inadequate":"medication_sertraline == true && sertraline_response == \'unsuccessful\'","sertraline_partial":"medication_sertraline == true && sertraline_response == 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\'Yes\'","id":"other_tca_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"Generalized Anxiety Disorder","state":"intro","content":[{"id":"is_comorbid","visible":"patient_age != \'Pediatric\' && patient_age != \'Adolescent\' && partum === \'None\' || partum === \'Preconception\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does the patient suffer from comorbid depression?"},{"id":"current_therapy","visible":"patient_age != \'Pediatric\' && patient_age != \'Adolescent\' && partum != \'Preconception\' && partum != \'None\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is the patient currently or have previously been controlled with pharmacotherapy?"},{"id":"severity","visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","type":"choice","choices":[{"text":"Mild"},{"text":"Moderate"},{"text":"Severe"}],"text":"What is the severity of the patients anxiety?"}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Pediatric\')","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-pediatric_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum 6-12 months; Consider taper after symptom free for 1 year ","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Pediatric\')","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-pediatric_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum 6-12 months; Consider taper after symptom free for 1 year ","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-adolescent_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum 6-12 months; Consider taper after symptom free for 1 year ","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-adolescent_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum 6-12 months; Consider taper after symptom free for 1 year ","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-antepartum_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. ","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-antepartum_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. ","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Postpartum\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-postpartum_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. ","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Postpartum\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-postpartum_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. ","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-cardiac_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-cardiac_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-renal_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD-renal_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"GAD","figure":["GAD_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"GAD","figure":["GAD-cardiac_g1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>1. Start an SSRI<br>2. Start an SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"GAD","figure":["GAD-cardiac_g1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>1. Start Buspirone or SSRI <br>2. Start an SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"GAD","figure":["GAD-cardiac_g2"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. 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Start an SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"GAD","figure":["GAD-cardiac_g1"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>1. Start Buspirone or SSRI<br>2. Start an SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"4.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"GAD","figure":["GAD-cardiac_g1"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"Switch to 1. SSRI <br>2. SNRI   <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"GAD","figure":["GAD-cardiac_g1"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>First choice 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Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Quetiapine","Gabapentin","Pregabalin","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"34.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (patient_age === \'Geriatric\')","title":"","uid":"34","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g2"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Quetiapine","Gabapentin","Pregabalin","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"34.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"23","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g1"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"24","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g1"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Geriatric\')","uid":"24.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"25","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g1"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI   <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"26","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g1"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to different SSRI/SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"27","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g1"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial Buspirone or a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"27.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"28","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g1"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to a different SSRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"29","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"30","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"31","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Geriatric\')","title":"","uid":"32","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (patient_age === \'Geriatric\')","title":"","uid":"33","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"33.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_gad_partial === true) && (patient_age === \'Geriatric\')","title":"","uid":"34","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g2"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI  and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"34.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"35","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g2"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI  ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"36","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone<br><br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"37","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"38","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Geriatric\')","title":"","uid":"39","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (patient_age === \'Geriatric\')","title":"","uid":"40","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"40.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"36","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone<br><br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"37","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"38","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Geriatric\')","title":"","uid":"39","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (patient_age === \'Geriatric\')","title":"","uid":"40","state":"recommendation","branch":"GAD","figure":["GAD-geriatric_g3"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"40.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g1"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g1"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone or SSRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"42.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (patient_age === \'Adult\')","title":"","uid":"54","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g2"],"content":[{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Buspirone","Mirtazapine","Quetiapine","Gabapentin","Pregabalin","Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"54.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"55","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g2"],"content":[{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Buspirone","Mirtazapine","Quetiapine","Gabapentin","Pregabalin","Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === false) && (ssri_inadequate_2 === false) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g1"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === false) && (ssri_inadequate_2 === false) && (medication_buspirone === false) && (patient_age === \'Adult\')","title":"","uid":"44","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g1"],"content":[{"visible":true,"uid":"44.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone or SSRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (patient_age === \'Adult\')","uid":"44.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === false) && (ssri_inadequate_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g1"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_1 === true) && (ssri_inadequate_2 === false) && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g1"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to different SSRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_1 === true) && (ssri_inadequate_2 === false) && (medication_buspirone === false) && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g1"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial Buspirone or a different SSRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"47.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_1 === true) && (ssri_inadequate_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (patient_age === \'Adult\')","title":"","uid":"48","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g1"],"content":[{"visible":true,"uid":"48.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to a different SSRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_2 === true) && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"49","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"49.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_2 === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"50","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"50.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_2 === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_2 === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"52","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_2 === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"53","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"53.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"53.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === false) && (patient_age === \'Adult\')","title":"","uid":"54","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g2"],"content":[{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"54.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"55","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g2"],"content":[{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"56","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"58","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"60.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"56","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Buspirone <br> <br><discontinue>Start Mirtazapine","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"58","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"60.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"GAD","figure":["GAD-hepatic_g3"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"62","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g1"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"63","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g1"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"63.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"75","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g2"],"content":[{"visible":true,"uid":"75.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Pregabalin/Gabapentin<br>&#x2800;&#x2800;b. Second Choice: Mirtazapine or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Pregabalin/Gabapentin<br>&#x2800;&#x2800;b. Second Choice: Mirtazapine or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Quetiapine","Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"75.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"76","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g2"],"content":[{"visible":true,"uid":"76.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Pregabalin/Gabapentin<br>&#x2800;&#x2800;b. Second Choice: Mirtazapine or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Pregabalin/Gabapentin<br>&#x2800;&#x2800;b. Second Choice: Mirtazapine or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Quetiapine","Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"64","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g1"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"65","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g1"],"content":[{"visible":true,"uid":"65.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"65.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"66","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g1"],"content":[{"visible":true,"uid":"66.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI   <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"67","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g1"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to different SSRI/SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"68","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g1"],"content":[{"visible":true,"uid":"68.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial Buspirone or a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"68.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"69","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g1"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"70","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"70.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === false) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"71","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"71.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Quetiapine or Mirtazapine","meds":["Quetiapine","Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"72","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"72.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"73","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"73.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Quetiapine ","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"74","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"74.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"74.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"74","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"74.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_gad_partial === true) && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"75","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g2"],"content":[{"visible":true,"uid":"75.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI  and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"75.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_gad_partial === false) && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"76","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g2"],"content":[{"visible":true,"uid":"76.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI  ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"77","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"77.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI  and Buspirone <br> <br>Start Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === false) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"78","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"78.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine or Mirtazapine","meds":["Quetiapine","Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"79","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"79.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"80","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"80.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine ","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"81.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"77","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"77.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI  and Buspirone <br> <br>Start Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === false) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"78","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"78.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine or Mirtazapine","meds":["Quetiapine","Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"79","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"79.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"80","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"80.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine ","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"81.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"GAD","figure":["GAD-obesity_g3"],"content":[{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"82","state":"recommendation","branch":"GAD","figure":["GAD-renal_g1"],"content":[{"visible":true,"uid":"82.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"GAD","figure":["GAD-renal_g1"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"83.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"GAD","figure":["GAD-renal_g2"],"content":[{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Quetiapine","Gabapentin","Pregabalin","Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"95.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"96","state":"recommendation","branch":"GAD","figure":["GAD-renal_g2"],"content":[{"visible":true,"uid":"96.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Quetiapine","Gabapentin","Pregabalin","Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"84","state":"recommendation","branch":"GAD","figure":["GAD-renal_g1"],"content":[{"visible":true,"uid":"84.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"85","state":"recommendation","branch":"GAD","figure":["GAD-renal_g1"],"content":[{"visible":true,"uid":"85.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"85.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"86","state":"recommendation","branch":"GAD","figure":["GAD-renal_g1"],"content":[{"visible":true,"uid":"86.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI   <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"87","state":"recommendation","branch":"GAD","figure":["GAD-renal_g1"],"content":[{"visible":true,"uid":"87.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to different SSRI/SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"88","state":"recommendation","branch":"GAD","figure":["GAD-renal_g1"],"content":[{"visible":true,"uid":"88.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial Buspirone or a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"88.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"89","state":"recommendation","branch":"GAD","figure":["GAD-renal_g1"],"content":[{"visible":true,"uid":"89.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"90","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"90.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"91","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"91.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"92","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"92.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"93","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"93.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\')","uid":"94.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_gad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"GAD","figure":["GAD-renal_g2"],"content":[{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"95.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"96","state":"recommendation","branch":"GAD","figure":["GAD-renal_g2"],"content":[{"visible":true,"uid":"96.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI  ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"97","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"97.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"98","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"98.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"99","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"99.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"100","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"100.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\')","uid":"101.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"97","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"97.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"98","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"98.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"99","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"99.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"100","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"100.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\')","uid":"101.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"GAD","figure":["GAD-renal_g3"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"102","state":"recommendation","branch":"GAD","figure":["GAD_g1"],"content":[{"visible":true,"uid":"102.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"103","state":"recommendation","branch":"GAD","figure":["GAD_g1"],"content":[{"visible":true,"uid":"103.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Start Buspirone, SSRI, or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"103.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"115","state":"recommendation","branch":"GAD","figure":["GAD_g2"],"content":[{"visible":true,"uid":"115.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Quetiapine","Gabapentin","Pregabalin","Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"115.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"116","state":"recommendation","branch":"GAD","figure":["GAD_g2"],"content":[{"visible":true,"uid":"116.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Quetiapine","Gabapentin","Pregabalin","Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"104","state":"recommendation","branch":"GAD","figure":["GAD_g1"],"content":[{"visible":true,"uid":"104.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"105","state":"recommendation","branch":"GAD","figure":["GAD_g1"],"content":[{"visible":true,"uid":"105.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Start Buspirone, SSRI, or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"105.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"106","state":"recommendation","branch":"GAD","figure":["GAD_g1"],"content":[{"visible":true,"uid":"106.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"107","state":"recommendation","branch":"GAD","figure":["GAD_g1"],"content":[{"visible":true,"uid":"107.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Change to different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"108","state":"recommendation","branch":"GAD","figure":["GAD_g1"],"content":[{"visible":true,"uid":"108.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Change to Buspirone or a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"108.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"109","state":"recommendation","branch":"GAD","figure":["GAD_g1"],"content":[{"visible":true,"uid":"109.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Change to a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"110","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"110.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine (SOR B)","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"111","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"111.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Quetiapine, Pregabalin, or Gabapentin (SOR A)","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"112","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"112.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin (SOR A)","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"113","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"113.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Quetiapine (SOR A)","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"114","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"114.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA). (SOR C)<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"114.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"114","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"114.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_gad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"115","state":"recommendation","branch":"GAD","figure":["GAD_g2"],"content":[{"visible":true,"uid":"115.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"115.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"116","state":"recommendation","branch":"GAD","figure":["GAD_g2"],"content":[{"visible":true,"uid":"116.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"117","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"117.0","type":"overlay","title":"Recommendation","text":"<b>SSRI/SNRI primary pharmacotherpy:</b><br><br>Discontinue both SSRI/SNRI and Buspirone.<br><br>Trial different SSRI/SNRI.<br><br><b>Buspirone primary pharmacotherapy:</b><br><br>Discontinue prior augmentation therapy. Continue Buspirone.<br><br>Trial different SSRI/SNRI.","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"118","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"118.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"119","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"119.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"120","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"120.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"121","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"121.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA). (SOR C)<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"121.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"121","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"121.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (patient_age === \'Adult\')","title":"","uid":"117","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"117.0","type":"overlay","title":"Recommendation","text":"<b>SSRI/SNRI primary pharmacotherpy:</b><br><br>Discontinue both SSRI/SNRI and Buspirone.<br><br>Trial different SSRI/SNRI.<br><br><b>Buspirone primary pharmacotherapy:</b><br><br>Discontinue prior augmentation therapy. Continue Buspirone.<br><br>Trial different SSRI/SNRI.","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === true) && (medication_buspirone === true) && (patient_age === \'Adult\')","title":"","uid":"117","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"117.0","type":"overlay","title":"Recommendation","text":"Discontinue prior augmentation therapy<br><br><b>Further augmentation therapy options:</b><br><br>First Choice: Mirtazapine<br>Second Choice: Pregabalin/Gabapentin or Quetiapine<br>Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Mirtazapine","Pregabalin","Gabapentin","Quetiapine","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"118","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"118.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"119","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"119.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"120","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"120.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"121","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"121.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA). (SOR C)<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"121.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"121","state":"recommendation","branch":"GAD","figure":["GAD_g3"],"content":[{"visible":true,"uid":"121.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"122","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g1"],"content":[{"visible":true,"uid":"122.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"123","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g1"],"content":[{"visible":true,"uid":"123.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'Preconception\') && (patient_age === \'Adult\')","uid":"123.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"124","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g1"],"content":[{"visible":true,"uid":"124.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"125","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g1"],"content":[{"visible":true,"uid":"125.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'Preconception\') && (patient_age === \'Adult\')","uid":"125.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"126","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g1"],"content":[{"visible":true,"uid":"126.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI   <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"127","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g1"],"content":[{"visible":true,"uid":"127.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to different SSRI/SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"128","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g1"],"content":[{"visible":true,"uid":"128.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial Buspirone or a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'Preconception\') && (patient_age === \'Adult\')","uid":"128.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"129","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g1"],"content":[{"visible":true,"uid":"129.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Change to a different SSRI/SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"130","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"130.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"131","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"131.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"132","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"132.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"133","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"133.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"134","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial Nortriptyline<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Nortriptyline","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'Preconception\')","uid":"134.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"134","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_gad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"135","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g2"],"content":[{"visible":true,"uid":"135.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'Preconception\') && (patient_age === \'Adult\')","uid":"135.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"136","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g2"],"content":[{"visible":true,"uid":"136.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI  ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"137","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"137.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"138","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"138.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"139","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"139.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"140","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"140.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"141","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"141.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial Nortriptyline<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Nortriptyline","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'Preconception\')","uid":"141.1","type":"overlay","title":"Recommendation","text":"Note: Consider Nortriptyline prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === true) && (patient_age === \'Adult\')","title":"","uid":"134","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"134.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation ","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === false) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"137","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"137.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"138","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"138.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Quetiapine, Pregabalin, or Gabapentin","meds":["Quetiapine","Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"139","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"139.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === false) && (preg_gab_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"140","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"140.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br><discontinue>Start Quetiapine","meds":["Quetiapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'Preconception\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_gad_partial === true) && (mirtazapine_unsuccessful === true) && (quetiapine_unsuccessful === true) && (preg_gab_unsuccessful === true) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"141","state":"recommendation","branch":"GAD","figure":["GAD-preconception_g3"],"content":[{"visible":true,"uid":"141.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial Nortriptyline<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Nortriptyline","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'Preconception\')","uid":"141.1","type":"overlay","title":"Recommendation","text":"Note: Consider Nortriptyline prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive 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May increase on day two by 40 mg/day per day as needed. Max recommended dose 80mg BID.","notes":"","alert":"caution"},{"id":"Ziprasidone","name":"Ziprasidone","class":"Atypical (SGA) Antipsychotics","brands":"Geodon","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"sedation, akathisia, dizziness, rash","side_effects_rare":"QTc prolongation, bradycardia, drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Consume with minimum 500 calories\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a699062.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Mania dosing: <br>Start 40 mg BID with minimum 500 calorie meal.  May increase on day two by 40 mg/day per day as needed. Max recommended dose 80mg BID.","notes":"","alert":""},{"id":"Ziprasidone","name":"Ziprasidone","class":"Atypical (SGA) Antipsychotics","brands":"Geodon","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"sedation, akathisia, dizziness, rash","side_effects_rare":"QTc prolongation, bradycardia, drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Consume with minimum 500 calories\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a699062.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Mania dosing: <br>Start 40 mg BID with minimum 500 calorie meal.  May increase on day two by 40 mg/day per day as needed. Max recommended dose 80mg BID.","notes":"","alert":""},{"id":"Ziprasidone","name":"Ziprasidone","class":"Atypical (SGA) Antipsychotics","brands":"Geodon","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"sedation, akathisia, dizziness, rash","side_effects_rare":"QTc prolongation, bradycardia, drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Consume with minimum 500 calories\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a699062.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Mania dosing: <br>Start 40 mg BID with minimum 500 calorie meal.  May increase on day two by 40 mg/day per day as needed. Max recommended dose 80mg BID.","notes":"","alert":""},{"id":"Disulfiram","name":"Disulfiram","class":"Aldehyde Dehydrogenase Inhibitor","brands":"Antabuse","monitor":"No specific recommendation.","side_effects_common":"skin eruptions, sedation, metallic taste, flushing, headache, tachycardia","side_effects_rare":"hepatic toxicity, MI, CHF, respiratory depression","info":"Used for aversion therapy; causes unpleasant symptoms when taken with alcohol (flushing, nausea, vomiting, palpitations). Inform patient to avoid using medications containing alcohol or foods containing ethanol. Use only in highly motivated patients with strong support/ psychotherapeutic treatment.\\n\\nBlack box warning for use without consent-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682602.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Patient must be abstinent from alcohol for a minimum of 12 hours prior to starting\\nStart 250-500 mg/day\\nMaintenance is between 250 mg or 500 mg daily","notes":"","alert":""},{"id":"Disulfiram","name":"Disulfiram","class":"Aldehyde Dehydrogenase Inhibitor","brands":"Antabuse","monitor":"No specific recommendation.","side_effects_common":"skin eruptions, sedation, metallic taste, flushing, headache, tachycardia","side_effects_rare":"hepatic toxicity, MI, CHF, respiratory depression","info":"Used for aversion therapy; causes unpleasant symptoms when taken with alcohol (flushing, nausea, vomiting, palpitations). Inform patient to avoid using medications containing alcohol or foods containing ethanol. Use only in highly motivated patients with strong support/ psychotherapeutic treatment.\\n\\nBlack box warning for use without consent-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682602.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adolescent"],"dosing":"Patient must be abstinent from alcohol for a minimum of 12 hours prior to starting\\nStart and maintain daily dose of 250 mg.","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Start 0.1mg at bedtime\\nTitrate by 0.1mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 0.4mg/day","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Start 0.1mg at bedtime\\nTitrate by 0.1mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 0.4mg/day","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"orthostatic hypotension, dry mouth, dizziness, constipation, somnolence;","side_effects_rare":"sinus bradycardia,\\nAV block","info":"Avoid abrupt discontinuation","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["pediatric"],"dosing":"Start 0.1mg at bedtime\\nTitrate by 0.1mg/day in minimum one week as clinical indicated and tolerable\\nMaximum dose 0.4mg/day","notes":"FDA indicated for treatment of ADHD in children and adolescents (6-17 years); off label for ASD","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["adolescent"],"dosing":"Start 0.1mg at bedtime\\nTitrate by 0.1mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 0.4mg/day","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["adult"],"dosing":"Start 0.1mg nightly\\nMay increase by 0.1mg/day at weekly intervals in divided twice daily doses, with larger dose at nighttime\\nMax dose 0.4mg/day in twice daily divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 0.1mg nightly\\nMay increase by 0.1mg/day at weekly intervals in divided twice daily doses, with larger dose at nighttime\\nMax dose 0.4mg/day in twice daily divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 0.1mg nightly\\nMay increase by 0.1mg/day at weekly intervals in divided twice daily doses, with larger dose at nighttime\\nMax dose 0.4mg/day in twice daily divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 0.1mg nightly\\nMay increase by 0.1mg/day at weekly intervals in divided twice daily doses, with larger dose at nighttime\\nMax dose 0.4mg/day in twice daily divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 0.1mg nightly\\nMay increase by 0.1mg/day at weekly intervals in divided twice daily doses, with larger dose at nighttime\\nMax dose 0.4mg/day in twice daily divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"Start 0.1mg nightly\\nMay increase by 0.1mg/day at weekly intervals in divided twice daily doses, with larger dose at nighttime\\nMax dose 0.4mg/day in twice daily divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"Start 0.1mg nightly\\nMay increase by 0.1mg/day at weekly intervals in divided twice daily doses, with larger dose at nighttime\\nMax dose 0.4mg/day in twice daily divided doses","notes":"Manufacturer recommends dose adjustment consistent with degree of renal failure, however, no specifics identified.","alert":"caution"},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 0.1mg at HS\\nMay increase by 0.1mg/day at weekly intervals and divided doses (BID), with larger dose at HS \\nMax dose 0.4mg/day in divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start 0.1mg at HS\\nMay increase by 0.1mg/day at weekly intervals and divided doses (BID), with larger dose at HS \\nMax dose 0.4mg/day in divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 0.1mg at HS\\nMay increase by 0.1mg/day at weekly intervals and divided doses (BID), with larger dose at HS \\nMax dose 0.4mg/day in divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 0.1mg at HS\\nMay increase by 0.1mg/day at weekly intervals and divided doses (BID), with larger dose at HS \\nMax dose 0.4mg/day in divided doses","notes":"","alert":""},{"id":"Clonidine XR","name":"Clonidine XR","class":"Alpha-2 Agonists","brands":"Kapvay","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 0.1mg at HS\\nMay increase by 0.1mg/day at weekly intervals and divided doses (BID), with larger dose at HS \\nMax dose 0.4mg/day in divided doses","notes":"Manufacturer recommends dose adjustment consistent with degree of renal failure, however, no specifics identified.","alert":"caution"},{"id":"Clonidine","name":"Clonidine","class":"Alpha-2 Agonists","brands":"Catapres","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Benzodiazepine Deprescribing","branch":[],"population":["adult"],"dosing":"Use 0.1-0.2 mg every 6 hours as needed for anxiety/agitation","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"Drowsiness, headache, dry mouth, dizziness, abdominal discomfort, orthostasis","side_effects_rare":"sinus bradycardia,\\nAV block","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"Drowsiness, headache, dry mouth, dizziness, abdominal discomfort, orthostasis","side_effects_rare":"sinus bradycardia,\\nAV block","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"Drowsiness, headache, dry mouth, dizziness, abdominal discomfort, orthostasis","side_effects_rare":"sinus bradycardia,\\nAV block","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"Drowsiness, headache, dry mouth, dizziness, abdominal discomfort, orthostasis","side_effects_rare":"sinus bradycardia,\\nAV block","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"Drowsiness, headache, dry mouth, dizziness, abdominal discomfort, orthostasis","side_effects_rare":"sinus bradycardia,\\nAV block","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Start 1mg at nighttime\\nIncrease by 1 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 4mg/day (6-12yo) or 7 mg/day (13-17 yo)","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Start 1mg at nighttime\\nIncrease by 1 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 7 mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["adult"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"Start 1mg at night \\nIncrease by 1mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 4mg/day","notes":"","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["pediatric"],"dosing":"Start 1mg at nighttime\\nIncrease by 1 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 4mg/day (6-12yo) or 7mg/day (13-17 yo)","notes":"FDA indicated for treatment of ADHD in children and adolescents (6-17 years); off label to treat agitation in ASD","alert":""},{"id":"Guanfacine ER","name":"Guanfacine ER","class":"Alpha-2 Agonists","brands":"Intuniv","monitor":"No specific recommendation.","side_effects_common":"sedation/fatigue, weakness, dizziness, dry mouth, constipation","side_effects_rare":"hypotension, syncope, sinus bradycardia","info":"","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["adolescent"],"dosing":"Start 1mg at nighttime\\nIncrease by 1 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 7 mg/day","notes":"FDA indicated for treatment of ADHD in children and adolescents (6-17 years); off label to treat agitation in ASD","alert":""},{"id":"Prazosin","name":"Prazosin","class":"Alpha-adrenergic Receptor Blocker","brands":"Minipress","monitor":"No specific recommendation.","side_effects_common":"dizziness, somnolence, headache","side_effects_rare":"orthostasic hypotension, syncope, priapism","info":"none","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 1mg nightly\\nIncrease by 1mg/night every 3 days as clinically inidcated and tolerable\\nMax dose 15mg/day","notes":"lower maximum doses may be effective in civilian patients (Taylor 2008)","alert":""},{"id":"Prazosin","name":"Prazosin","class":"Alpha-adrenergic Receptor Blocker","brands":"Minipress","monitor":"No specific recommendation.","side_effects_common":"dizziness, somnolence, headache","side_effects_rare":"orthostasic hypotension, syncope, priapism","info":"none","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"Start 1mg nightly\\nIncrease by 1mg/night every 3 days as clinically inidcated and tolerable\\nMax dose 15mg/day","notes":"lower maximum doses may be effective in civilian patients (Taylor 2008)  caution in patients at risk for hypotension","alert":""},{"id":"Prazosin","name":"Prazosin","class":"Alpha-adrenergic Receptor Blocker","brands":"Minipress","monitor":"No specific recommendation.","side_effects_common":"dizziness, somnolence, headache","side_effects_rare":"orthostasic hypotension, syncope, priapism","info":"none","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start 1mg nightly\\nIncrease by 1mg/night every 3 days as clinically inidcated and tolerable\\nMax dose 15mg/day","notes":"lower maximum doses may be effective in civilian patients (Taylor 2008) caution in patients at risk for falls/hypotension","alert":""},{"id":"Prazosin","name":"Prazosin","class":"Alpha-adrenergic Receptor Blocker","brands":"Minipress","monitor":"No specific recommendation.","side_effects_common":"dizziness, somnolence, headache","side_effects_rare":"orthostasic hypotension, syncope, priapism","info":"none","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 1mg nightly\\nIncrease by 1mg/night every 3 days as clinically inidcated and tolerable\\nMax dose 15mg/day","notes":"lower maximum doses may be effective in civilian patients (Taylor 2008)","alert":""},{"id":"Prazosin","name":"Prazosin","class":"Alpha-adrenergic Receptor Blocker","brands":"Minipress","monitor":"No specific recommendation.","side_effects_common":"dizziness, somnolence, headache","side_effects_rare":"orthostasic hypotension, syncope, priapism","info":"none","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 1mg nightly\\nIncrease by 1mg/night every 3 days as clinically inidcated and tolerable\\nMax dose 15mg/day","notes":"lower maximum doses may be effective in civilian patients (Taylor 2008)","alert":""},{"id":"Prazosin","name":"Prazosin","class":"Alpha-adrenergic Receptor Blocker","brands":"Minipress","monitor":"No specific recommendation.","side_effects_common":"dizziness, somnolence, headache","side_effects_rare":"orthostasic hypotension, syncope, priapism","info":"none","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 1mg nightly\\nIncrease by 1mg/night every 3 days as clinically inidcated and tolerable\\nMax dose 15mg/day","notes":"lower maximum doses may be effective in civilian patients (Taylor 2008)","alert":""},{"id":"Dexedrine Spansules","name":"Dexedrine Spansules","class":"Amphetamines","brands":"Dexedrine Spansules","monitor":"No specific recommendation.","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May be sprinkled but not crushed and placed in food for administration\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Medium Acting (6-8hrs):\\nStart 5mg/day\\nTitrate by 5mg/day in minimum one week as clinically indicated and tolerable\\nMay be administered in once or twice daily dosing (doses administered at least 8 hours apart)\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"Dexedrine Spansules","name":"Dexedrine Spansules","class":"Amphetamines","brands":"Dexedrine Spansules","monitor":"No specific recommendation.","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May be sprinkled but not crushed and placed in food for administration\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Medium Acting (6-8hrs):\\nStart 5mg/day\\nTitrate by 5mg/day in minimum one week as clinically indicated and tolerable\\nMay be administered in once or twice daily dosing (doses administered at least 8 hours apart)\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"ProCentra","name":"ProCentra","class":"Amphetamines","brands":"ProCentra","monitor":"No specific recommendation.","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation\\n\\nHigh-abuse potential with short acting formulations of amphetamine products\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Short Acting (3-4 hours):\\n\\nAge 3-5-\\nStart 2.5 mg daily\\nMay add an additional 2.5 mg dose at lunchtime for twice daily dosing\\nTitrate 2.5mg/dose in minimum one week as clinically indicated and tolerable\\nMay be administered in two or three times daily dosing (doses administered at least 4 hours apart)\\nMaximum dose 40 mg/day in 2-3 divided dose\\n\\nAge 6 or older-\\nStart 5 mg once or twice daily\\nTitrate 5mg/dose in minimum one week as clinically indicated and tolerable\\nMay be administered in two or three times daily dosing (doses administered at least 4 hours apart)\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"ProCentra","name":"ProCentra","class":"Amphetamines","brands":"ProCentra","monitor":"No specific recommendation.","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation\\n\\nHigh-abuse potential with short acting formulations of amphetamine products\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Short Acting (3-4 hours):\\nStart 5 mg once or twice daily\\nTitrate 5mg/dose in minimum one week as clinically indicated and tolerable\\nMay be administered in two or three times daily dosing (doses administered at least 4 hours apart)\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (8-12 hours):\\n\\nCrCl >30 mL/min:\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day\\n\\n\\nCrCl 15-30 mL/min:\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 50 mg/day\\n\\n\\nCrCl <15 mL/min:\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nAvailable as capsule or chewable tablet.\\n\\nCapsule contents may be dissolved in liquid.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"Long Acting (8-10 hrs)","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adult"],"dosing":"Long acting (8-12 hours):\\nStart 30 mg/day\\nIncrease by 10-20 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Adderall XR","name":"Adderall XR","class":"Amphetamines","brands":"Adderall XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nCan be sprinkled in food (do not crush) \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (10-12 hours):\\nStart 10-20 mg/day\\nIncrease by 10-20 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day \\nOccasional maximum dose 60 mg/day","notes":"","alert":""},{"id":"Adderall XR","name":"Adderall XR","class":"Amphetamines","brands":"Adderall XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nCan be sprinkled in food (do not crush) \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (10-12 hours):\\nStart 10-20 mg/day\\nIncrease by 10-20 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"Adderall XR","name":"Adderall XR","class":"Amphetamines","brands":"Adderall XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nCan be sprinkled in food (do not crush) \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (10-12 hours):\\nStart 10-20 mg/day\\nIncrease by 10-20 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day \\nOccasional maximum dose 60 mg/day","notes":"","alert":""},{"id":"Adderall XR","name":"Adderall XR","class":"Amphetamines","brands":"Adderall XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nCan be sprinkled in food (do not crush) \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (10-12 hours):\\nCrCl >15 mL/min:\\nStart 10-20 mg/day\\nIncrease by 10-20 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day \\nOccasional maximum dose 60 mg/day\\n\\nCrCl <15 mL/min:\\nStart 5-10 mg/day\\nIncrease by 5-10 mg day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 15 mg/day\\n\\nESRD on dialysis:\\nDo not use","notes":"","alert":"caution"},{"id":"Adderall XR","name":"Adderall XR","class":"Amphetamines","brands":"Adderall XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nCan be sprinkled in food (do not crush) \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (10-12 hours):\\n\\nChildren ages 6-12:\\nStart 5 mg/day\\nIncrease by 5 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day \\n\\nChildren age 13 and older:\\nStart 10 mg/day\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"Adderall XR","name":"Adderall XR","class":"Amphetamines","brands":"Adderall XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nCan be sprinkled in food (do not crush) \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (10-12 hours):\\nStart 10 mg/day\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"Mydayis","name":"Mydayis","class":"Amphetamines","brands":"Mydayis","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (10-16 hours):\\nStart 12.5 mg daily\\nIncrease by 12.5 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 50 mg/day","notes":"","alert":""},{"id":"Mydayis","name":"Mydayis","class":"Amphetamines","brands":"Mydayis","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (10-16 hours):\\nStart 12.5 mg daily\\nIncrease by 12.5 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 50 mg/day","notes":"","alert":""},{"id":"Mydayis","name":"Mydayis","class":"Amphetamines","brands":"Mydayis","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (10-16 hours):\\nStart 12.5 mg daily\\nIncrease by 12.5 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 50 mg/day","notes":"","alert":""},{"id":"Mydayis","name":"Mydayis","class":"Amphetamines","brands":"Mydayis","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (10-16 hours):\\n\\nChildren age 13-17:\\nStart 12.5 mg daily\\nIncrease by 12.5 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 25 mg/day","notes":"","alert":""},{"id":"Mydayis","name":"Mydayis","class":"Amphetamines","brands":"Mydayis","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (10-16 hours):\\nStart 12.5 mg daily\\nIncrease by 12.5 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 25 mg/day","notes":"","alert":""},{"id":"Adderall","name":"Adderall","class":"Amphetamines","brands":"Adderall","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nTypically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Short acting (3-4 hours):\\nStart 5 mg twice daily\\nIncrease by 5 mg/dose in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day in 2 or 3 divided doses","notes":"","alert":""},{"id":"Adderall","name":"Adderall","class":"Amphetamines","brands":"Adderall","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nTypically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Short acting (3-4 hours):\\nStart 5 mg twice daily\\nIncrease by 5 mg/dose in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day in 2 or 3 divided doses","notes":"","alert":""},{"id":"Adderall","name":"Adderall","class":"Amphetamines","brands":"Adderall","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nTypically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Short acting (3-4 hours):\\nStart 5 mg twice daily\\nIncrease by 5 mg/dose in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day in 2 or 3 divided doses","notes":"","alert":""},{"id":"Adderall","name":"Adderall","class":"Amphetamines","brands":"Adderall","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nTypically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Short acting (3-4 hours):\\n\\nCrCl >15 mL/min:\\nStart 5 mg twice daily\\nIncrease by 5 mg/dose in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day in 2 or 3 divided doses\\n\\nCrCl <15 mL/min:\\nStart 2.5-5 mg twice daily\\nIncrease by 5 mg/day in divided doses in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 15 mg/day\\n\\nESRD on dialysis:\\nDo not use","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Adderall","name":"Adderall","class":"Amphetamines","brands":"Adderall","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nTypically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Short acting (3-4 hours):\\nStart 5 mg twice daily\\nIncrease by 5 mg/dose in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day in 2 or 3 divided doses 5mg","notes":"","alert":""},{"id":"Adderall","name":"Adderall","class":"Amphetamines","brands":"Adderall","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nTypically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Short acting (3-4 hours):\\nStart 5 mg twice daily\\nIncrease by 5 mg/dose in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 40 mg/day in 2 or 3 divided doses 5mg","notes":"","alert":""},{"id":"Adzenys XR-ODT","name":"Adzenys XR-ODT","class":"Amphetamines","brands":"Adzenys XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (8-12 hours):\\n\\nAge 6-12-\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 18.8mg/day\\n\\nAge 12 and older-\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys XR-ODT","name":"Adzenys XR-ODT","class":"Amphetamines","brands":"Adzenys XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys XR-ODT","name":"Adzenys XR-ODT","class":"Amphetamines","brands":"Adzenys XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys XR-ODT","name":"Adzenys XR-ODT","class":"Amphetamines","brands":"Adzenys XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys XR-ODT","name":"Adzenys XR-ODT","class":"Amphetamines","brands":"Adzenys XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys XR-ODT","name":"Adzenys XR-ODT","class":"Amphetamines","brands":"Adzenys XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys ER","name":"Adzenys ER","class":"Amphetamines","brands":"Adzenys ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (8-12 hours):\\n\\nAge 6-12-\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 18.8mg/day\\n\\nAge 12 and older-\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys ER","name":"Adzenys ER","class":"Amphetamines","brands":"Adzenys ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys ER","name":"Adzenys ER","class":"Amphetamines","brands":"Adzenys ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys ER","name":"Adzenys ER","class":"Amphetamines","brands":"Adzenys ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys ER","name":"Adzenys ER","class":"Amphetamines","brands":"Adzenys ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Adzenys ER","name":"Adzenys ER","class":"Amphetamines","brands":"Adzenys ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (8-12 hours):\\nStart 6.3 mg daily\\nIncrease by 3.1-6.3 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 12.5 mg/day","notes":"","alert":""},{"id":"Dyanavel XR","name":"Dyanavel XR","class":"Amphetamines","brands":"Dyanavel XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (12 hours):\\nStart 2.5-5.0 mg/day\\nIncrease by 2.5-10 mg in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Dyanavel XR","name":"Dyanavel XR","class":"Amphetamines","brands":"Dyanavel XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (12 hours):\\nStart 2.5-5.0 mg/day\\nIncrease by 2.5-10 mg in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Dyanavel XR","name":"Dyanavel XR","class":"Amphetamines","brands":"Dyanavel XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (12 hours):\\nStart 2.5-5.0 mg/day\\nIncrease by 2.5-10 mg in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Dyanavel XR","name":"Dyanavel XR","class":"Amphetamines","brands":"Dyanavel XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (12 hours):\\nStart 2.5-5.0 mg/day\\nIncrease by 2.5-10 mg in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Dyanavel XR","name":"Dyanavel XR","class":"Amphetamines","brands":"Dyanavel XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (12 hours):\\nStart 2.5-5.0 mg/day\\nIncrease by 2.5-10 mg in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Dyanavel XR","name":"Dyanavel XR","class":"Amphetamines","brands":"Dyanavel XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Liquid formulation.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (12 hours):\\nStart 2.5-5.0 mg/day\\nIncrease by 2.5-10 mg in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Evekeo ODT","name":"Evekeo ODT","class":"Amphetamines","brands":"Evekeo ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nTypically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nMust be dissolved completely by placing on or under the tongue. Do not chew or crush.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Short acting (4-6 hours):\\n\\nAge 3-5-\\nStart 2.5 mg once or twice daily\\nMay increase by 2.5 mg/dose in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 40 mg/day in once or twice daily dosing\\n\\nAge 6 and older-\\nStart 5 mg once or twice daily\\nMay increase by 5 mg/dose in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 40 mg/day in once or twice daily dosing","notes":"","alert":""},{"id":"Evekeo ODT","name":"Evekeo ODT","class":"Amphetamines","brands":"Evekeo ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nTypically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nMust be dissolved completely by placing on or under the tongue. Do not chew or crush.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a601234.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Short acting (4-6 hours):\\nStart 5 mg once or twice daily\\nMay increase by 5 mg/dose in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 40 mg/day in once or twice daily dosing","notes":"","alert":""},{"id":"Testosterone","name":"Testosterone","class":"Androgen","brands":"Transdermal patch","monitor":"No specific recommendation.","side_effects_common":"acne, breast pain, hirsutism, headache, weight gain","side_effects_rare":"potential long term risks of breast cancer and heart disease, may\\nwarrant consultation with OB/Gyn or Endocrinology","info":"","length":"","diagnosis":"Female Sexual Interest/Arousal Disorder","branch":[],"population":["adult"],"dosing":"Start and maintain dose of 300mcg/day transdermal patch applied twice each week\\nRequires compounding pharmacy due to low dose\\nPlease note: benefits increase gradually over weeks to months","notes":"","alert":""},{"id":"Benztropine","name":"Benztropine","class":"Anticholinergic","brands":"Cogentin","monitor":"No specific recommendation.","side_effects_common":"dry mouth, blurred vision, constipation, urinary retention, sedation;","side_effects_rare":"confusion or delirium, especially in elderly, may worsen angle-closure glaucoma","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["adult"],"dosing":"Start 1mg BID; maximum dose 3mg BID","notes":"","alert":""},{"id":"Benztropine","name":"Benztropine","class":"Anticholinergic","brands":"Cogentin","monitor":"No specific recommendation.","side_effects_common":"dry mouth, blurred vision, constipation, urinary retention, sedation;","side_effects_rare":"confusion or delirium, especially in elderly, may worsen angle-closure glaucoma","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["cardiac"],"dosing":"Starting dose 1mg BID.\\nTitrate to symptoms of EPS.\\nMax dose 3mg BID.","notes":"","alert":""},{"id":"Benztropine","name":"Benztropine","class":"Anticholinergic","brands":"Cogentin","monitor":"No specific recommendation.","side_effects_common":"dry mouth, blurred vision, constipation, urinary retention, sedation;","side_effects_rare":"confusion or delirium, especially in elderly, may worsen angle-closure glaucoma","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["geriatric"],"dosing":"*Start at low end of dosing range and increase only as needed and as tolerated.\\nStarting dose 1mg BID.\\nTitrate to symptoms of EPS.\\nMax dose 3mg BID.","notes":"","alert":""},{"id":"Benztropine","name":"Benztropine","class":"Anticholinergic","brands":"Cogentin","monitor":"No specific recommendation.","side_effects_common":"dry mouth, blurred vision, constipation, urinary retention, sedation;","side_effects_rare":"confusion or delirium, especially in elderly, may worsen angle-closure glaucoma","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["hepatic"],"dosing":"HEPATIC DOSING \u2013 No dosage adjustments necessary.\\nUSUAL DOSING \u2013\\nStarting dose 1mg BID.\\nTitrate to symptoms of EPS.\\nMax dose 3mg BID.","notes":"","alert":""},{"id":"Benztropine","name":"Benztropine","class":"Anticholinergic","brands":"Cogentin","monitor":"No specific recommendation.","side_effects_common":"dry mouth, blurred vision, constipation, urinary retention, sedation;","side_effects_rare":"confusion or delirium, especially in elderly, may worsen angle-closure glaucoma","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["obesity"],"dosing":"Starting dose 1mg BID.\\nTitrate to symptoms of EPS.\\nMax dose 3mg BID.","notes":"","alert":""},{"id":"Benztropine","name":"Benztropine","class":"Anticholinergic","brands":"Cogentin","monitor":"No specific recommendation.","side_effects_common":"dry mouth, blurred vision, constipation, urinary retention, sedation","side_effects_rare":"confusion or delirium, especially in elderly, may worsen angle-closure glaucoma","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["renal"],"dosing":"RENAL \u2013 No dosage adjustment necessary.\\nUSUAL DOSING \u2013\\nStarting dose 1mg BID.\\nTitrate to symptoms of EPS.\\nMax dose 3mg BID.","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Alcohol Use Disorder","branch":["Alcohol Withdrawal Syndrome"],"population":["adult"],"dosing":"Fixed-Dose Regimen:\\nDay 1- 300 mg every 6 hours\\nDay 2- 300 mg every 8 hours\\nDay 3- 300 mg every 12 hours\\nDay 4 -300 mg nightly\\nDay 5 -300 mg nightly","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Alcohol Use Disorder","branch":["AUD"],"population":["adult"],"dosing":"Start 300mg daily \\nMay increase by 300mg every 1-2 days as tolerated and clinically indicated\\nTarget dose 600mg three times daily\\n\\nCrCl adjustments:\\n30-49 mL/minute/1.73 m2: decrease dose by ~50% (max daily dose 900 mg/day)\\n15-29 mL/minute/1.73 m2: decrease dose by ~75% (max daily dose 600 mg/day)\\n<15 mL/minute/1.73 m2: decrease dose by ~90% (max daily dose 300 mg/day)","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adolescent"],"dosing":"Start 100-300 mg three times daily\\nIncrease up to maximum dose of 300 mg three times daily","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["adult"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["cardiac"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["geriatric"],"dosing":"Start 100 at bedtime \\nIncrease by 100 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax recommended dose 1200mg- 2400mg/day in three divided doses, Occasional Max dose 3600mg/day in three divided doses","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["hepatic"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["obesity"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["renal"],"dosing":"Start 100-300 mg at bedtime \\nTitrate upwards as tolerated and as clinically necessary toward maximum daily dose based on CrCl:\\n>79:      3600mg/day in 3 divided doses.\\n50-79:   1800mg/day in 3 divided doses.\\n30-49:    900mg/day in 2-3 divided doses.\\n15-29:    600mg/day in 1-2 divided doses.\\n<15:       300 mg/day in 1 daily dose.","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax recommended dose 1200mg- 2400mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 100 mg at bedtime \\nIncrease by 100 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax recommended dose 1200mg- 2400mg/day in three divided doses, Occasional Max dose 3600mg/day in three divided doses","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 100-300 mg at bedtime \\nTitrate upwards as tolerated and as clinically necessary toward maximum daily dose based on CrCl:\\n>79:      3600mg/day in 3 divided doses.\\n50-79:   1800mg/day in 3 divided doses.\\n30-49:    900mg/day in 2-3 divided doses.\\n15-29:    600mg/day in 1-2 divided doses.\\n<15:       300 mg/day in 1 daily dose.","notes":"CrCl specific dose adjustments","alert":"caution"},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["adult"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg/night in minimum one week as clinically indicated and tolerable\\nMax dose 900mg/night in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["cardiac"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg/night in minimum one week as clinically indicated and tolerable\\nMax dose 900mg/night in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["geriatric"],"dosing":"Start 100 mg at bedtime \\nIncrease by 100 mg/night in minimum one week as clinically indicated and tolerable\\nMax dose 900mg/night in three divided doses","notes":"","alert":"caution"},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["hepatic"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg/night in minimum one week as clinically indicated and tolerable\\nMax dose 900mg/night in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["obesity"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg/night in minimum one week as clinically indicated and tolerable\\nMax dose 900mg/night in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["renal"],"dosing":"Start 100-300 mg at bedtime \\nTitrate upwards as tolerated and as clinically necessary toward maximum daily dose based on CrCl:\\n>79         900mg/night\\n>50-79    600mg/night\\n<49         300 mg/night","notes":"please see specific dosing recommendations","alert":"caution"},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 100 mg at bedtime \\nIncrease by 100 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax recommended dose 1200mg- 2400mg/day in three divided doses, Occasional Max dose 3600mg/day in three divided doses","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 100-300 mg at bedtime \\nTitrate upwards as tolerated and as clinically necessary toward maximum daily dose based on CrCl:\\n>79:      3600mg/day in 3 divided doses.\\n50-79:   1800mg/day in 3 divided doses.\\n30-49:    900mg/day in 2-3 divided doses.\\n15-29:    600mg/day in 1-2 divided doses.\\n<15:       300 mg/day in 1 daily dose.","notes":"CrCl specific dose adjustments","alert":"caution"},{"id":"Gabapentin","name":"Gabapentin","class":"GABA Analog","brands":"Neurontin","monitor":"No specific recommendation.","side_effects_common":"dizziness, sedation, CNS depression, ataxia, weight gain","side_effects_rare":"DRESS","info":"FDA warning (2019): Caution when using concurrently with other CNS depressants (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Benzodiazepine Deprescribing","branch":[],"population":["adult"],"dosing":"Start 100-300 mg at bedtime \\nIncrease by 100-300 mg towards three times daily dosing in minimum one week as clinically indicated and tolerable\\nMax dose 3600mg/day in three divided doses","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nTypical max recommended dose 100 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nTypical max recommended dose 100 mg/day","notes":"Off-label for PTSD","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nTypical max recommended dose 100 mg/day","notes":"Off-label for PTSD","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nTypical max recommended dose 100 mg/day\\n\\n\\nModerate to severe impairment without ascites- decrease initial, escalation, maintenance, and maximum doses by 25%\\n\\nModerate to severe impairment with ascites- decrease initial, escalation, maintenance, and maximum doses by 50%","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nTypical max recommended dose 100 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nTypical max recommended dose 100 mg/day","notes":"","alert":""},{"id":"Oxcarbazepine","name":"Oxcarbazepine","class":"Mood Stabilizers","brands":"Trileptal","monitor":"Monitor serum sodium regularly while on treatment\\n\\nCheck for HLA-B*1502 in patients of Asian descent prior to starting","side_effects_common":"headache, ataxia, dizziness, nausea, vomiting, drowsiness.","side_effects_rare":"SJS, TEN (Toxic Epidermal Necrolysis), anaphylaxis, angioedema, hyponatremia.\\nUse with caution in patients with hypersensitivity to carbamazepine.","info":"Dosing provided for IR formulation. If using XR higher doses may be needed as IR and XR are not dose quivalent","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Start dose 300 mg twice daily\\nIncrease by 300 mg per dose every two to four days as clinicially indicated and tolerable\\nMaximum dose 2400mg/day","notes":"","alert":""},{"id":"Phenytoin","name":"Phenytoin","class":"Anticonvulsants","brands":"Dilantin","monitor":"Check 12-hour serum trough level two weeks after the first dose, and one week after any dose change in order to avoid toxicity. Try to keep level \u2264 20mcg/mL.","side_effects_common":"headache, nausea, vomiting, constipation, dizziness, ataxia, swollen gums, tremors, rash, nystagmus, drowsiness.","side_effects_rare":"hypotension, severe cardiac arrhythmias, hepatotoxicity and acute liver failure, blood dyscrasias (potentially affecting all cell lines), SJS (Stevens-Johnson Syndrome), DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), suicidality","info":"","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Start and maintain dose of 100 mg three times daily\\nAlternatively may adiminster 200mg in the morning and 100 mg at night\\nTreat for 6-12 weeks before deciding if the medication is helpful\\nOccasional maximum dose 400mg/day (in two or three times a day divided doses)","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["adult"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 450mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["cardiac"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 450mg/day in 2-3 divided doses","notes":"Peripheral edema may occur in up to 16% of patients","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["geriatric"],"dosing":"Start 25-50 mg at bedtime\\nIncrease by 25-150mg/day toward 2-3 times daily dosing in minimum one week if clinically indicated and tolerable\\nMax dose 450mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["hepatic"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 450mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["obesity"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 450mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["renal"],"dosing":"Start 25-50 mg at bedtime\\nTitrate upwards as clinically indicated and tolerable toward recommended daily dose based on CrCl:\\n\u2265 60     450mg/day in 2-3 divided doses \\n30-60   75-300 mg/day in 2-3 divided doses\\n15-30   25mg-50 mg/day in 1-2 divided doses\\n<15      25-75mg/day in a single daily dose","notes":"Please see specific dosing recommendation","alert":"caution"},{"id":"Topiramate","name":"Topiramate","class":"Anticonvulsants","brands":"Topamax","monitor":"No specific recommendation.","side_effects_common":"somnolence/fatigue, dizziness,\\nmemory difficulties, confusion, ataxia, parasthesias, nausea, anorexia, weight loss, changes in taste perception","side_effects_rare":"metabolic acidosis, renal stones, osteomalacia, rare activation of suicidality, secondary angle-closure glaucoma, hyperammonemmia, hyperthermia and oligohidrosis (children)","info":"","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Week 1\\nStart 25 mg nightly\\n\\nWeek 2\\nIncrease to 50 mg nightly\\n\\nWeek 3\\nAdd a second dose of 25mg in the morning and continue dose of 50 mg nightly\\n\\nWeek 4 \\nIncrease to 50 mg twice daily\\n\\nWeek 5\\nIncrease to 50 mg in the morning and 100 mg nightly\\n\\nWeek 6\\nIncrease to 100 mg twice daily\\n\\nWeek 7\\nIncrease to 100 mg in the morning and 150mg nightly\\n\\nWeek 8 and thereafter\\nMaintain dose at 150mg twice daily\\n\\nIf CrCl <70 mL/minute/1.73 m2: Decrease dose by 50% and titrate slowly.  (If pt receiving dialysis then reviewed specific dialysis recommendations)","notes":"Avoid using in patients taking HCTZ, metformin, valproic acid. Decreases levels of oral contraceptives","alert":""},{"id":"Topiramate","name":"Topiramate","class":"Anticonvulsants","brands":"Topamax","monitor":"No specific recommendation.","side_effects_common":"somnolence/fatigue, dizziness,\\nmemory difficulties, confusion, ataxia, parasthesias, nausea, anorexia, weight loss, changes in taste perception","side_effects_rare":"metabolic acidosis, renal stones, osteomalacia, rare activation of suicidality, secondary angle-closure glaucoma, hyperammonemmia, hyperthermia and oligohidrosis (children)","info":"","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adolescent"],"dosing":"Week 1\\nStart 25 mg nightly\\n\\nWeek 2\\nIncrease to 50 mg nightly\\n\\nWeek 3\\nAdd a second dose of 25mg in the morning and continue dose of 50 mg nightly\\n\\nWeek 4 \\nIncrease to 50 mg twice daily\\n\\nWeek 5\\nIncrease to 50 mg in the morning and 100 mg nightly\\n\\nWeek 6\\nIncrease to 100 mg twice daily\\n\\nWeek 7 and thereafter\\nMaintain dose at 100mg twice daily","notes":"Avoid using in patients taking HCTZ, metformin, valproic acid. Decreases levels of oral contraceptives","alert":""},{"id":"Topiramate","name":"Topiramate","class":"Anticonvulsants","brands":"Topamax","monitor":"No specific recommendation.","side_effects_common":"somnolence/fatigue, dizziness,\\nmemory difficulties, confusion, ataxia, parasthesias, nausea, anorexia, weight loss, changes in taste perception","side_effects_rare":"metabolic acidosis, renal stones, osteomalacia, rare activation of suicidality, secondary angle-closure glaucoma, hyperammonemmia, hyperthermia and oligohidrosis (children)","info":"","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adult"],"dosing":"Week 1\\nStart 25 mg nightly\\n\\nWeek 2\\nIncrease to 50 mg nightly\\n\\nWeek 3\\nAdd a second dose of 25mg in the morning and continue dose of 50 mg nightly\\n\\nWeek 4 \\nIncrease to 50 mg twice daily\\n\\nWeek 5\\nIncrease to 50 mg in the morning and 100 mg nightly\\n\\nWeek 6\\nIncrease to 100 mg twice daily\\n\\nWeek 7\\nIncrease to 100 mg in the morning and 150mg nightly\\n\\nWeek 8 and thereafter\\nMaintain dose at 150mg twice daily","notes":"","alert":""},{"id":"Topiramate","name":"Topiramate","class":"Anticonvulsants","brands":"Topamax","monitor":"No specific recommendation.","side_effects_common":"somnolence/fatigue, dizziness,\\nmemory difficulties, confusion, ataxia, parasthesias, nausea, anorexia, weight loss, changes in taste perception","side_effects_rare":"metabolic acidosis, renal stones, osteomalacia, rare activation of suicidality, secondary angle-closure glaucoma, hyperammonemmia, hyperthermia and oligohidrosis (children)","info":"","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adolescent"],"dosing":"Week 1\\nStart 25 mg nightly\\n\\nWeek 2\\nIncrease to 50 mg nightly\\n\\nWeek 3\\nAdd a second dose of 25mg in the morning and continue dose of 50 mg nightly\\n\\nWeek 4 \\nIncrease to 50 mg twice daily\\n\\nWeek 5\\nIncrease to 50 mg in the morning and 100 mg nightly\\n\\nWeek 6\\nIncrease to 100 mg twice daily\\n\\nWeek 7 and thereafter\\nMaintain dose at 100mg twice daily","notes":"","alert":""},{"id":"Topiramate","name":"Topiramate","class":"Anticonvulsants","brands":"Topamax","monitor":"No specific recommendation.","side_effects_common":"somnolence/fatigue, dizziness,\\nmemory difficulties, confusion, ataxia, parasthesias, nausea, anorexia, weight loss, changes in taste perception","side_effects_rare":"metabolic acidosis, renal stones, osteomalacia, rare activation of suicidality, secondary angle-closure glaucoma, hyperammonemmia, hyperthermia and oligohidrosis (children)","info":"","length":"","diagnosis":"Binge Eating Disorder","branch":[],"population":["adult"],"dosing":"Start 25mg/day\\nAdd an additional 25mg dose during the day in minimum one week\\nIncrease further by 25mg/dose in minimum one week as clinically indicated and tolerable\\nMaximum total daily dose 400mg (200mg twice daily)","notes":"","alert":""},{"id":"Topiramate","name":"Topiramate","class":"Anticonvulsants","brands":"Topamax","monitor":"No specific recommendation.","side_effects_common":"somnolence/fatigue, dizziness,\\nmemory difficulties, confusion, ataxia, parasthesias, nausea, anorexia, weight loss, changes in taste perception","side_effects_rare":"metabolic acidosis, renal stones, osteomalacia, rare activation of suicidality, secondary angle-closure glaucoma, hyperammonemmia, hyperthermia and oligohidrosis (children)","info":"","length":"","diagnosis":"Binge Eating Disorder","branch":[],"population":["adolescent"],"dosing":"Start 25mg/day\\nAdd an additional 25mg dose during the day in minimum one week\\nIncrease further by 25mg/dose in minimum one week as clinically indicated and tolerable\\nMaximum total daily dose 100mg","notes":"Avoid using in patients taking HCTZ, metformin, valproic acid. Decreases levels of oral contraceptives","alert":""},{"id":"Topiramate","name":"Topiramate","class":"Anticonvulsants","brands":"Topamax","monitor":"No specific recommendation.","side_effects_common":"somnolence/fatigue, dizziness,\\nmemory difficulties, confusion, ataxia, parasthesias, nausea, anorexia, weight loss, changes in taste perception","side_effects_rare":"metabolic acidosis, renal stones, osteomalacia, rare activation of suicidality, secondary angle-closure glaucoma, hyperammonemmia, hyperthermia and oligohidrosis (children)","info":"","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adult"],"dosing":"Start 25mg/day\\nAdd an additional 25mg dose during the day in minimum one week\\nIncrease further by 25mg/dose in minimum one week as clinically indicated and tolerable\\nMaximum total daily dose 400mg (200mg twice daily)","notes":"","alert":""},{"id":"Topiramate","name":"Topiramate","class":"Anticonvulsants","brands":"Topamax","monitor":"No specific recommendation.","side_effects_common":"somnolence/fatigue, dizziness,\\nmemory difficulties, confusion, ataxia, parasthesias, nausea, anorexia, weight loss, changes in taste perception","side_effects_rare":"metabolic acidosis, renal stones, osteomalacia, rare activation of suicidality, secondary angle-closure glaucoma, hyperammonemmia, hyperthermia and oligohidrosis (children)","info":"","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Start 25mg/day\\nAdd an additional 25mg dose during the day in minimum one week\\nIncrease further by 25mg/dose in minimum one week as clinically indicated and tolerable\\nMaximum total daily dose 400mg (200mg twice daily)","notes":"","alert":""},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["adult"],"dosing":"10 mg 30 minutes before bedtime","notes":"A liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":""},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["geriatric"],"dosing":"3-6mg 30 minutes before bedtime (available as brand name Silenor)","notes":"Doses >6mg should not be used in the elderly due to anticholinergic side effects.\\n\\nA liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":""},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["hepatic"],"dosing":"3-10 mg 30 minutes before bedtime. Hepatically metabolized, so lower doses recommended.","notes":"See specific dosing recommendations. \\n\\nA liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":"caution"},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["obesity"],"dosing":"10 mg 30 minutes before bedtime","notes":"A liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":""},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["renal"],"dosing":"10 mg 30 minutes before bedtime","notes":"A liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":""},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["adult"],"dosing":"10 mg 30 minutes before bedtime","notes":"A liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":""},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["geriatric"],"dosing":"3-6mg 30 minutes before bedtime (available as brand name Silenor)","notes":"Doses >6mg should not be used in the elderly due to anticholinergic side effects.\\n\\nA liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":""},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["hepatic"],"dosing":"3-10 mg 30 minutes before bedtime. Hepatically metabolized, so lower doses recommended.","notes":"See specific dosing recommendations. \\n\\nA liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":"caution"},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["obesity"],"dosing":"10 mg 30 minutes before bedtime","notes":"A liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":""},{"id":"Doxepin","name":"Doxepin","class":"Tricyclic Antidepressants","brands":"Sinequan, Silenor","monitor":"none when used at low doses","side_effects_common":"nausea, dry mouth, urinary retention, constipation (anticholinergic side effects)","side_effects_rare":"orthostasis","info":"FDA black box warning for increased suicidality in patients age 18-24 years\\n\\nhttps://medlineplus.gov/druginfo/meds/a682390.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["renal"],"dosing":"10 mg 30 minutes before bedtime","notes":"A liquid concentrate is also available. To use a lower dose, capsule may be opened and partial contents dissolved in liquid.","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["adult"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["geriatric"],"dosing":"Start 12.5-25mg nightly\\nIncrease by 12.5-25mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 150mg/night","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["renal"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["adult"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["geriatric"],"dosing":"Start 12.5-25mg nightly\\nIncrease by 12.5-25mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 150mg/night","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["renal"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start 12.5-25mg nightly\\nIncrease by 12.5-25mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 150mg/night","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg nightly\\nIncrease by 25-50 mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 200mg/night","notes":"","alert":""},{"id":"Trazodone","name":"Trazodone","class":"Serotonin receptor antagonist and reuptake inhibitor","brands":"Desyrel","monitor":"No specific recommendation.","side_effects_common":"dry mouth, dizziness, orthostatic hypotension, drowsiness, headache, nausea, vomitting, blurred vision","side_effects_rare":"priapism, syncope, seizures","info":"FDA black box warning for increased suicidality in patients &lt;24 years of age\\n\\nhttps://medlineplus.gov/druginfo/meds/a681038.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 12.5-25mg nightly\\nIncrease by 12.5-25mg/day nightly every 3-4 days as clinically indicated and tolerable\\nMax dose 150mg/night","notes":"","alert":""},{"id":"Metformin","name":"Metformin","class":"Antidiabetic/Weight Loss Agent","brands":"Glucophage","monitor":"No specific recommendation.","side_effects_common":"Diarrhea, nausea, flatulence, abdominal bloating","side_effects_rare":"Lactic acidosis","info":"Black box warning for lactic acidosis-\\n\\nhttps://medlineplus.gov/druginfo/meds/a696005.html","length":"","diagnosis":"Antipsychotic Management","branch":[],"population":["adult"],"dosing":"IR\\nStarting dose 500 mg once or twice daily\\nIncrease by 500 mg/dose increments every 1-2 weeks based on tolerability\\nMaximum dose 1000 mg twice daily\\n\\nER\\nStarting dose 500 mg daily.\\nIncrease by 500 mg/day increments weekly, based on tolerability\\nMaximum dose 2000 mg/day.","notes":"","alert":""},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"50-100 mg nightly","notes":"","alert":""},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"50-100 mg nightly","notes":"","alert":""},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"50-100 mg nightly","notes":"","alert":""},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"50-100 mg nightly","notes":"","alert":""},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"GFR > 50 mL/min- 50-100 mg nightly\\nGFR \u2264 50 mL/min- 25-50 mg nightly","notes":"CrCl specific dose adjustments","alert":"caution"},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Benzodiazepine Deprescribing","branch":[],"population":["adult"],"dosing":"25-50 mg up to four times daily as needed for anxiety/insomnia","notes":"","alert":""},{"id":"Diphenhydramine","name":"Diphenhydramine","class":"Antihistamines","brands":"Benadryl, Nytol, et al","monitor":"No specific recommendation.","side_effects_common":"dry mouth, ataxia, urinary retention, constipation, memory problems, sedation, blurred vision (antipsychotic side effects)","side_effects_rare":"tachycardia, blurred vision.","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["preconception"],"dosing":"25 mg nightly\\nFor occasional use only","notes":"","alert":""},{"id":"Diphenhydramine","name":"Diphenhydramine","class":"Antihistamines","brands":"Benadryl, Nytol, et al","monitor":"No specific recommendation.","side_effects_common":"dry mouth, ataxia, urinary retention, constipation, memory problems, sedation, blurred vision (antipsychotic side effects)","side_effects_rare":"tachycardia, blurred vision.","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"25 mg nightly\\nFor occasional use only","notes":"","alert":""},{"id":"Doxylamine","name":"Doxylamine","class":"Antihistamines","brands":"NyQuil, et al","monitor":"No specific recommendation.","side_effects_common":"dry mouth, ataxia, urinary retention, constipation, memory problems","side_effects_rare":"tachycardia, blurred vision.","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["preconception"],"dosing":"25mg at HS. For occasional use only","notes":"","alert":""},{"id":"Doxylamine","name":"Doxylamine","class":"Antihistamines","brands":"NyQuil, et al","monitor":"No specific recommendation.","side_effects_common":"dry mouth, ataxia, urinary retention, constipation, memory problems","side_effects_rare":"tachycardia, blurred vision.","info":"","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"25 mg at HS. For occasional use only","notes":"","alert":""},{"id":"Benztropine","name":"Benztropine","class":"Anticholinergic","brands":"Cogentin","monitor":"No specific recommendation.","side_effects_common":"Sedation, dry mouth, blurred vision, constipation, urinary retention.","side_effects_rare":"confusion or delirium, may worsen angle-closure glaucoma.","info":"","length":"","diagnosis":"Antipsychotic Management","branch":[],"population":["adult"],"dosing":"Acute Dystonia\\nStarting dose 1-2mg once (Preferentially IM/IV) \\nSubsequent doses 1-2mg once or twice daily\\n\\nParkinsonism\\nStarting dose 0.5mg nightly\\nIncrease by 0.5mg/day every 5 days as clinically indicated and tolerable\\nMay administer in divided doses\\nMax dose 8mg/day","notes":"Consider parental administration for severe dystonia","alert":""},{"id":"Diphenhydramine","name":"Diphenhydramine","class":"Antihistamines","brands":"Benadryl","monitor":"No specific recommendation.","side_effects_common":"Sedation, dry mouth, ataxia, constipation, urinary retention, blurred vision","side_effects_rare":"tachycardia","info":"FDA Safety Alert- September 2020.  The FDA has issued a drug safety communication warning that taking higher than recommended doses of diphenhydramine can lead to serious heart problems, seizures, coma, or even death.\\n\\nConsider parental administration for severe dystonia","length":"","diagnosis":"Antipsychotic Management","branch":[],"population":["adult"],"dosing":"Starting dose 25-50 mg once \\nSubsequent dose 25mg every 4-6 hours as needed for continued symptoms","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Female Sexual Interest/Arousal Disorder","branch":[],"population":["adult"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Benzodiazepine Deprescribing","branch":[],"population":["adult"],"dosing":"Start 5-10 mg twice daily scheduled and additional 5-10 mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["pediatric"],"dosing":"Start 5mg/day\\nIncrease by 5mg/day in twice daily dosing in weekly increments as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adolescent"],"dosing":"Start 5mg/day\\nIncrease by 5mg/day in twice daily dosing in weekly increments as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["antepartum"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["postpartum"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A and B:\\nStart 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day\\n\\nChild-Pugh C: avoid use","notes":"","alert":"caution"},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Mild to moderate impairment\\nStart 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day\\n\\nSevere impairment: avoid use","notes":"","alert":"caution"},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A and B:\\nStart 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day\\n\\nChild-Pugh C: avoid use","notes":"","alert":"caution"},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Buspirone","name":"Buspirone","class":"Serotonin 5-HT1A receptor partial agonist","brands":"BuSpar","monitor":"No specific recommendation.","side_effects_common":"dizziness/lightheadedness, drowsiness, nausea, headache, excitement/jitteriness","side_effects_rare":"none","info":"May be taken with or without food, however, increased absorption occurs up to two-fold with food.  Patient should be consistent on if they take with or without food.","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Mild to moderate impairment\\nStart 5mg twice daily scheduled and additional 5mg dose as needed daily\\nIncrease to 10 mg twice daily scheduled and additional 10 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nSubsequent increase to 15-20 mg twice daily scheduled and additional 15-20 mg dose as needed daily if clinically indicated and tolerable in 2-3 days\\nMax dose 60mg/day\\n\\nSevere impairment: avoid use","notes":"","alert":"caution"},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Antipsychotic Management","branch":[],"population":["adult"],"dosing":"Starting dose 1mg daily\\nIncrease by 1mg/day every 1 week as clinically indicated and tolerable\\nMax dose 5mg","notes":"For use in treating hyperprolactenemia","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["pediatric"],"dosing":"Preschool age children:\\nStart 1.25 mg/day\\nIncrease by 1.25 mg/day every 5 days as clinically indicated and tolerable\\nMaximum dose 5 mg/day\\n\\nAges 6-17:\\nStart 2-2.5 mg/day for one week, then increase to 5 mg/day\\nIncrease by 5 mg/day every 7 days as clinically indicated and tolerable\\nMaximum daily dose 15mg/day","notes":"FDA indicated for treatment of irritability in autism (6-17 years)","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["adolescent"],"dosing":"Start 2-2.5 mg/day for one week, then increase to 5 mg/day\\nIncrease by 5 mg/day every 7 days as clinically indicated and tolerable\\nMaximum daily dose 15mg/day","notes":"FDA indicated for treatment of irritability in autism (6-17 years)","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Mania dosing:<br>Start 10-15mg daily. Max recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Mania dosing:<br> Start 10-15mg daily. Max recommended dose 30mg/day; (no dosage adjustment necessary)","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["hepatic"],"dosing":"Mania dosing:<br> Start 10-15mg daily. Max recommended dose 30mg/day; (no dosage adjustment necessary)","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Mania dosing:<br> Start 10-15mg daily. Max recommended dose 30mg/day; (no dosage adjustment necessary)","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Mania dosing:<br> Start 10-15mg daily. Max recommended dose 30mg/day; (no dosage adjustment necessary)","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Mania dosing:<br> Starting dose 5mg-10 mg/day. <br>Gradually titrate upwards based on clinical response and tolerability.<br>Max dose 30mg/day.","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Abilify is not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Mania dosing:<br> Start 2-5mg/day; increase by 5mg weekly to target dose of 10 mg/day; typical max dose 15mg/day; occasional max dose 30mg/day for children 12 and older <br><br>Depression dosing:<br>Start 2-5mg/day; increase by 5mg weekly as clinically indicated and tolerable; typical max dose 15mg/day; occasional max dose 30mg/day for children 12 and older","notes":"FDA-approved for mania / mixed features ages 10 and older (monotherapy and adjunctive). <br><br> Off label use for bipolar depression","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Mania dosing:<br> Start 2-5mg/day; increase by 5mg weekly to target dose of 10 mg/day; typical max dose 15mg/day; occasional max dose 30mg/day <br><br>Depression dosing:<br>Start 2-5mg/day; increase by 5mg weekly as clinically indicated and tolerable; typical max dose 15mg/day; occasional max dose 30mg/day","notes":"FDA-approved for mania / mixed features ages 10 and older (monotherapy and adjunctive). <br><br> Off label use for bipolar depression","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["preconception","antepartum","postpartum"],"dosing":"Mania dosing: <br> Start 10-15 mg daily. Max recommended dose 30mg/day  <br><br> Depression dosing: <br> Start 5-10 mg/day. Max recommended dose 15-30 mg/day.","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["adult"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["pediatric"],"dosing":"Start 1mg/day, may increase by 1mg/day no more than weekly. max recommended dose 15mg/day","notes":"Off-label for Pediatric MDD","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["adolescent"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["preconception"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["antepartum"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["postpartum"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["cardiac"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["geriatric"],"dosing":"Start 1-2mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Abilify is not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["hepatic"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["obesity"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["renal"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["adult","preconception"],"dosing":"Start 10-15mg daily. Max recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["cardiac"],"dosing":"Start 10-15mg daily. Max recommended dose 30mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["geriatric"],"dosing":"Starting dose 5mg-10 mg/day. \\nGradually titrate upwards based on clinical response and tolerability.\\nMax dose 30mg/day.","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Abilify is not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["hepatic"],"dosing":"Start 10-15mg daily. Max recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["obesity"],"dosing":"Start 10-15mg daily. Max recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["renal"],"dosing":"Start 10-15mg daily. Max recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 1 mg/day\\nIncrease by 1 mg/day as clinically indicated and tolerable\\nMax recommended dose 5 mg/day","notes":"Black box dementia warning \u2013 minimize use in this population.","alert":"caution"},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["adult"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 1-2mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Abilify is not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 1-2mg/day, increase to 2-5mg after one week.  Max dose 5-15mg/day.","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["adult"],"dosing":"Start 10-15 mg/day. Maximum recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["cardiac"],"dosing":"Start 10-15 mg/day. Maximum recommended dose 30mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start 1-2mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Abilify is not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["geriatric"],"dosing":"Start 5-10 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax recommended dose 30mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Abilify is not approved for the treatment of patients with dementia-related psychosis.\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["hepatic"],"dosing":"Start 10-15 mg/day. Maximum recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["obesity"],"dosing":"Start 10-15 mg/day. Maximum recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 2mg-5mg/day\\nIncrease to 5mg in minimum one week as clinically indicated and tolerable\\nFurther increases by 5mg in minimum one week as clinically indicated and tolerable\\nMax recommended dose 15mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["renal"],"dosing":"Start 10-15 mg/day. Maximum recommended dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Psychosis","branch":[],"population":["pediatric"],"dosing":"Start 2-5 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nTarget dose 10 mg.  \\nMax dose <12yo 15mg, otherwise max dose 30mg","notes":"FDA-approved for schizophrenia ages 13 and older","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Psychosis","branch":[],"population":["adolescent"],"dosing":"Start 2-5 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nTarget dose 10 mg.  \\nMax dose 30mg","notes":"FDA-approved for schizophrenia ages 13 and older","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Psychosis","branch":[],"population":["postpartum"],"dosing":"Start 10-15 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["adult"],"dosing":"Start 10-15 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["preconception"],"dosing":"Start 10-15 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"Start 10-15 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["cardiac"],"dosing":"Start 10-15 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Abilify is not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["hepatic"],"dosing":"Start 10-15 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["obesity"],"dosing":"Start 10-15 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"","alert":""},{"id":"Aripiprazole","name":"Aripiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Abilify","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"pathologic gambling and impulse control disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a603012.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["renal"],"dosing":"Start 10-15 mg/day\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"","alert":""},{"id":"Asenapine","name":"Asenapine","class":"Atypical (SGA) Antipsychotics","brands":"Saphris","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, oral hypoesthesia, somnolence, dizziness, orthostasis","side_effects_rare":"anaphylaxis, angioedema","info":"Do not swallow sublingual formulation. Avoid eating/drinking/chewing/swallowing for 10 minutes after taking medication \\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a610015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Mania dosing: <br>Start 5 mg sublingually twice daily. Increase as needed up to 10 mg sublingually twice daily. Max 20 mg/day.","notes":"","alert":""},{"id":"Asenapine","name":"Asenapine","class":"Atypical (SGA) Antipsychotics","brands":"Saphris","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, oral hypoesthesia, somnolence, dizziness, orthostasis","side_effects_rare":"anaphylaxis, angioedema","info":"Do not swallow sublingual formulation. Avoid eating/drinking/chewing/swallowing for 10 minutes after taking medication \\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a610015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Mania dosing: <br> Start 5 mg sublingually twice daily. Increase as needed up to 10 mg sublingually twice daily. Max 20 mg/day. (no dose adjustment necessary)","notes":"","alert":""},{"id":"Asenapine","name":"Asenapine","class":"Atypical (SGA) Antipsychotics","brands":"Saphris","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, oral hypoesthesia, somnolence, dizziness, orthostasis","side_effects_rare":"anaphylaxis, angioedema","info":"Do not swallow sublingual formulation. Avoid eating/drinking/chewing/swallowing for 10 minutes after taking medication \\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a610015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["hepatic"],"dosing":"Mania dosing: <br>HEPATIC \u2013 \\nChild-Pugh Class A or B- Start 5 mg sublingually twice daily. Increase as needed up to 10 mg sublingually twice daily. Max 20 mg/day. (no dose adjustment necessary)\\nChild-Pugh Class C- CONTRAINDICATED.","notes":"","alert":"caution"},{"id":"Asenapine","name":"Asenapine","class":"Atypical (SGA) Antipsychotics","brands":"Saphris","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, oral hypoesthesia, somnolence, dizziness, orthostasis","side_effects_rare":"anaphylaxis, angioedema","info":"Do not swallow sublingual formulation. Avoid eating/drinking/chewing/swallowing for 10 minutes after taking medication \\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a610015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Mania dosing: <br>Start 5 mg sublingually twice daily. Increase as needed up to 10 mg sublingually twice daily. Max 20 mg/day. (no dose adjustment necessary)","notes":"","alert":""},{"id":"Asenapine","name":"Asenapine","class":"Atypical (SGA) Antipsychotics","brands":"Saphris","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, oral hypoesthesia, somnolence, dizziness, orthostasis","side_effects_rare":"anaphylaxis, angioedema","info":"Do not swallow sublingual formulation. Avoid eating/drinking/chewing/swallowing for 10 minutes after taking medication \\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a610015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Mania dosing: <br>Start 5 mg sublingually twice daily. Increase as needed up to 10 mg sublingually twice daily. Max 20 mg/day. (no dose adjustment necessary)","notes":"","alert":""},{"id":"Asenapine","name":"Asenapine","class":"Atypical (SGA) Antipsychotics","brands":"Saphris","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, oral hypoesthesia, somnolence, dizziness, orthostasis","side_effects_rare":"anaphylaxis, angioedema","info":"Do not swallow sublingual formulation. Avoid eating/drinking/chewing/swallowing for 10 minutes after taking medication \\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a610015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Mania dosing: <br>Starting dose 2.5mg- 5mg sublingually twice daily. Increase as necessary based on clinical response and tolerability up to 10 mg sublingually twice daily. Increase as needed up to 10 mg SL BID. Max 20 mg/day.","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Asenapine","name":"Asenapine","class":"Atypical (SGA) Antipsychotics","brands":"Saphris","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, oral hypoesthesia, somnolence, dizziness, orthostasis","side_effects_rare":"anaphylaxis, angioedema","info":"Do not swallow sublingual formulation. Avoid eating/drinking/chewing/swallowing for 10 minutes after taking medication \\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a610015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Mania dosing: <br>Starting dose 5 mg/day in 2 divided doses sublingually; after 3 days can increase to 10 mg/day in 2 divided doses; after 3 more days can increase to 20 mg/day in 2 divided doses.","notes":"FDA-approved for mania/ mixed mania ages 10 and older (monotherapy)","alert":""},{"id":"Asenapine","name":"Asenapine","class":"Atypical (SGA) Antipsychotics","brands":"Saphris","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, oral hypoesthesia, somnolence, dizziness, orthostasis","side_effects_rare":"anaphylaxis, angioedema","info":"Do not swallow sublingual formulation. Avoid eating/drinking/chewing/swallowing for 10 minutes after taking medication \\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a610015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Mania dosing: <br>Starting dose 5 mg/day in 2 divided doses sublingually; after 3 days can increase to 10 mg/day in 2 divided doses; after 3 more days can increase to 20 mg/day in 2 divided doses.","notes":"FDA-approved for mania/ mixed mania ages 10 and older (monotherapy)","alert":""},{"id":"Brexpiprazole","name":"Brexpiprazole","class":"Atypical (SGA) Antipsychotics","brands":"Rexulti","monitor":"Atypical (SGA) antipsychotic monitoring:<br>BMI monthly for 3 months, then every 3 months<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually<br>Consider ECG upon initiation<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, insomnia, tremors, somnolence, weight gain","side_effects_rare":"orthostasis, syncope","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a615046.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 0.5mg daily for 7 days\\nOn day 8-14 increase to 1mg daily\\nOn day 15 increase to 2mg daily\\nAfter 14 days at 2mg dose, if tolerated and clinically indicated, may increase to 3mg daily","notes":"FDA-approved for agitation associated with Alzheimer\'s dementia\\n\\nFDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Start 20 mg daily with food. Increase by 20 mg/day weekly as clincally indicated and tolerable. Usual dose 20-120mg/day.","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Start 20 mg/day with food; may increase after 1 week; occasional maximum dose 80 mg/day.","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Start 20 mg/day with food; may increase after 1 week; occasional maximum dose 80 mg/day.","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["preconception"],"dosing":"Start 20 mg/day with food. Usual dose 20-80mg/day.","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["antepartum"],"dosing":"Start 20 mg/day with food. Usual dose 20-80mg/ day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["postpartum"],"dosing":"Start 20 mg/day with food. Usual dose 20-80mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Start 20 mg daily with food. Usual dose 20-120mg/day.","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u2265 50 mL/min- Start 20 mg daily with food. Usual dose 20-120mg/day.\\nCrCl< 50 mL/min- Starting dose 20 mg/day.  Max dose 80mg/day.","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Start 20 mg daily with food. Usual dose 20-120mg/day.","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Start 20 mg daily with food. Usual dose 20-120mg/day.","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"Latuda","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh Class A- Start 20 mg daily with food. Usual dose 20-120mg/day. (no dosage adjustment necessary)\\nChild-Pugh Class B- Starting dose 20 mg/day.  Max dose 80mg/day.\\nChild-Pugh Class C- starting dose 20 mg/day.  Max dose 40 mg/day.","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["adult"],"dosing":"Start 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["adolescent"],"dosing":"Start 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["preconception"],"dosing":"Start 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["cardiac"],"dosing":"Start 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["geriatric"],"dosing":"Start 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["hepatic"],"dosing":"Start 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nChild-Pugh Class A & B- Max dose 60mg/day\\nChild-Pugh Class C- Max dose 40 mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["obesity"],"dosing":"Start 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["renal"],"dosing":"Start 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["adult"],"dosing":"Start 40 mg daily with food.\\nIncrease by 40 mg in minimum one week as clinically indicated and tolerable\\nMax dose 160mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["preconception"],"dosing":"Start 40 mg daily with food.\\nIncrease by 40 mg in minimum one week as clinically indicated and tolerable\\nMax dose 160mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["cardiac"],"dosing":"Start 40 mg daily with food.\\nIncrease by 40 mg in minimum one week as clinically indicated and tolerable\\nMax dose 160mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["geriatric"],"dosing":"Start 40 mg daily with food.\\nIncrease by 40 mg in minimum one week as clinically indicated and tolerable\\nMax dose 160mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["hepatic"],"dosing":"Child-Pugh Class A - \\nStart 40 mg daily with food.\\nIncrease by 40 mg in minimum one week as clinically indicated and tolerable\\nMax dose 160mg/day\\n\\nChild-Pugh B- \\nStart 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day\\n\\nChild-Pugh Class C-\\nStart 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["obesity"],"dosing":"Start 40 mg daily with food.\\nIncrease by 40 mg in minimum one week as clinically indicated and tolerable\\nMax dose 160mg/day","notes":"","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["renal"],"dosing":"CrCl \u2265 50 mL/min- \\nStart 40 mg daily with food.\\nIncrease by 40 mg in minimum one week as clinically indicated and tolerable\\nMax dose 160mg/day\\n\\nCrCl< 50 mL/min- \\nStart 20 mg daily with food.\\nIncrease by 20 mg in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["preconception"],"dosing":"Start 40 mg daily with food.\\nIncrease by 40 mg/day in minimum 3 day intervals as clinically indicated and tolerable\\nMax dose 160mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Lurasidone","name":"Lurasidone","class":"Atypical (SGA) Antipsychotics","brands":"","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, akathisia, nausea","side_effects_rare":"orthostasis, syncope","info":"Consume with minimum 350 calories.   Titrate slowly; watch for emerging manic symptoms; uncommon cases will need mood stabilizer.\\n\\nFDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a611016.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"Start 40 mg daily with food.\\nIncrease by 40 mg/day in minimum 3 day intervals as clinically indicated and tolerable\\nMax dose 160mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Anorexia Nervosa","branch":[],"population":["adult"],"dosing":"Start 2.5mg/day\\nIncrease by 2.5mg/day in minimum one week to effective dose\\nMaximum dose 10 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Anorexia Nervosa","branch":[],"population":["adolescent"],"dosing":"Start 2.5mg/day\\nIncrease by 2.5mg/day in minimum one week to effective dose\\nMaximum dose 10 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Mania dosing: \\nStart 10 mg daily. Increase by 5 mg daily in weekly increments as needed to max dose of 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac","renal","geriatric"],"dosing":"Mania dosing: \\nStart 10 mg daily. Increase by 5 mg daily in weekly increments as need to max dose of 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Mania dosing: \\nStart 10 mg daily. Increase by 5 mg daily in weekly increments as need to max dose of 20 mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Mania dosing: \\nStart 2.5- 5mg/day\\nIncrease by 2.5- 5 mg/day once a week until desired efficacy is reached\\nMax dose 20 mg/day \\nDepressive dosing:\\nStart 2.5- 5mg/day\\nIncrease by 2.5- 5 mg/day once a week until desired efficacy is reached\\nNo consensus on max dose; however, do not exceed 20 mg/day","notes":"FDA-approved for mania/ mixed mania ages 13 and older\\n\\nMonotherapy off label for Bipolar Depression\\n\\nMetabolic side effects may be more likely in children/adolscents, more frequent monitoring required","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Mania dosing: \\nStart 2.5- 5mg/day\\nIncrease by 2.5- 5 mg/day once a week until desired efficacy is reached\\nMax dose 20 mg/day \\nDepressive dosing:\\nStart 2.5- 5mg/day\\nIncrease by 2.5- 5 mg/day once a week until desired efficacy is reached\\nNo consensus on max dose; however, do not exceed 20 mg/day","notes":"FDA-approved for mania/ mixed mania ages 13 and older\\n\\nMonotherapy off label for Bipolar Depression\\n\\nMetabolic side effects may be more likely in children/adolscents, more frequent monitoring required","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["preconception","antepartum"],"dosing":"Mania dosing: <br>Start 5-10 mg daily. Increase by 5 mg daily in weekly icrements as need to max dose of 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["postpartum"],"dosing":"Mania dosing:\\nStart 5-10 mg daily. Increase by 5 mg daily in weekly icrements as need to max dose of 20 mg/day <br><br>\\nDepressive dosing:\\nStart 5mg daily. Increase by 5 mg daily in weekly icrements as need to max dose of 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["preconception"],"dosing":"Start 2.5-5mg daily\\nIncrease by 2.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["adult"],"dosing":"Start 5-10 mg daily\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["cardiac"],"dosing":"Start 5-10 mg daily\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"See ECG recommendations","alert":"warning"},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["geriatric"],"dosing":"Start 5-10 mg daily\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["obesity"],"dosing":"Start 5-10 mg daily\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["renal"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 1.25 mg daily\\nIncrease slowly by 1.25 mg/day as clinically indicated and tolerable\\nMaximum dose 5 mg/day","notes":"Black box dementia warning \u2013 minimize use in this population.","alert":"caution"},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["adult"],"dosing":"Start 2.5-5 mg daily\\nIncrease slowly and as tolerated to a mean target dose 5mg-10 mg/day\\nMax dose 10-20 mg daily","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 5-10 mg daily\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"See ECG recommendations","alert":"warning"},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg daily\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"Start 5-10 mg daily\\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 2.5 mg daily\\nIncrease slowly and as tolerated to a mean target dose 5mg-10 mg/day\\nMax dose 10-20 mg daily","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Psychosis","branch":[],"population":["pediatric"],"dosing":"Start 2.5- 5mg/day\\nIncrease by 2.5- 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"FDA-approved >12yo for schizophrenia\\n\\nMetabolic side effects may be more likely in children/adolscents, more frequent monitoring required","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Psychosis","branch":[],"population":["adolescent"],"dosing":"Start 2.5- 5mg/day\\nIncrease by 2.5- 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"FDA-approved >12yo for schizophrenia\\n\\nMetabolic side effects may be more likely in children/adolscents, more frequent monitoring required","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Psychosis","branch":[],"population":["postpartum"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["adult"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["cardiac"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"See ECG recommendations","alert":"warning"},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["obesity"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["renal"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["preconception"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Olanzapine","name":"Olanzapine","class":"Atypical (SGA) Antipsychotics","brands":"Zyprexa","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"Significant weight gain, hyperglycemia/diabetes mellitus, dyslipidemia, somnolence (dose-dependent), dry mouth, constipation","side_effects_rare":"drug reaction with eosinophilia and systemic symptoms (DRESS)","info":"Cigarette smoking- clearance may increase by approximately 40%\\n\\nFDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a601213.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"Start 5-10 mg/day\\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Anorexia Nervosa","branch":[],"population":["adult"],"dosing":"Start 25mg HS day 1; 25mg BID day 2; 50 mg HS day 3; 50 mg BID day 4; 50 mg AM, 75mg HS day 5; 75mg BID day 6. May increase by 25mg/day increments to effective dose or as tolerated. Max dose 400mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Anorexia Nervosa","branch":[],"population":["adolescent"],"dosing":"Start 25mg HS day 1; 25mg BID day 2; 50 mg HS day 3; 50 mg BID day 4; 50 mg AM, 75mg HS day 5; 75mg BID day 6. May increase by 25mg/day increments to effective dose or as tolerated. Max dose 400mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Mania\\nIR:\\nStarting dose 50 mg BID. Increase by 100 mg/day until 200mg BID on day 4.\\nTarget dose 400-800mg/day.\\nMaximum recommended dose 800mg/day.\\n\\nXR:\\nStarting dose 300 mg qHS.\\nIncrease as tolerated and clinically necessary to target dose of 400mg-800mg/day.\\n\\nDepression\\nIR: \\nstart 50 mg qHS day 1, increase to 100 mg qHS day 2, increase to 200 mg qHS day 3, increase to 300 mg qHS day 4; target dose 300 mg/day; max dose 600 mg/ day\\n\\nXR:\\n300 mg qHS","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["hepatic"],"dosing":"Mania\\nIR- Starting dose 25mg/day.  Titrate by 25mg- 50 mg/day increments to clinically effective and tolerable dose.\\nXR- Starting dose 50 mg/day.  Increase by 50 mg/day increments to clinically effective and tolerable dose.\\n\\nDepression\\nIR- Starting dose 25mg/day.  Titrate by 25mg- 50 mg/day increments to clinically effective and tolerable dose.\\nXR- Starting dose 50 mg/day.  Increase by 50 mg/day increments to clinically effective and tolerable dose.","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Mania\\nIR:\\nStarting dose 50 mg BID. Increase by 100 mg/day until 200mg BID on day 4.\\nTarget dose 400-800mg/day.\\nMaximum recommended dose 800mg/day.\\n\\nXR:\\nStarting dose 300 mg qHS.\\nIncrease as tolerated and clinically necessary to target dose of 400mg-800mg/day.\\n\\nDepression\\nIR: \\nstart 50 mg qHS day 1, increase to 100 mg qHS day 2, increase to 200 mg qHS day 3, increase to 300 mg qHS day 4; target dose 300 mg/day; max dose 600 mg/ day\\n\\nXR:\\n300 mg qHS","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Mania\\nIR:\\nStarting dose 50 mg BID. Increase by 100 mg/day until 200mg BID on day 4.\\nTarget dose 400-800mg/day.\\nMaximum recommended dose 800mg/day.\\n\\nXR:\\nStarting dose 300 mg qHS.\\nIncrease as tolerated and clinically necessary to target dose of 400mg-800mg/day.\\n\\nDepression\\nIR: \\nstart 50 mg qHS day 1, increase to 100 mg qHS day 2, increase to 200 mg qHS day 3, increase to 300 mg qHS day 4; target dose 300 mg/day; max dose 600 mg/ day\\n\\nXR:\\n300 mg qHS","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Mania\\nIR:\\nStarting dose 12.5mg- 25mg/day increase by 12.5mg-25mg/day increments to clinically effective and tolerable dose\\nMax dose: no specific recommendations, do not exceed 800mg/day\\n\\nXR:\\nStarting dose 50 mg/day increase by 50 mg/day increments to clinically effective and tolerable dose\\nMax dose: no specific recommendations, do not exceed 800mg/day\\n\\nDepression\\nIR:\\nStarting dose 12.5mg- 25mg/day increase by 12.5mg-25mg/day increments to clinically effective and tolerable dose\\nMax dose: no specific recommendations, do not exceed 600mg/day\\n\\nXR:\\nStarting dose 50 mg/day increase by 50 mg/day increments to clinically effective and tolerable dose\\nMax dose: no specific recommendations, do not exceed 300 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Mania\\nIR:\\nStarting dose 50 mg BID. Increase by 100 mg/day until 200mg BID on day 4.\\nTarget dose 400-800mg/day.\\nMaximum recommended dose 800mg/day.\\n\\nXR:\\nStarting dose 300 mg qHS.\\nIncrease as tolerated and clinically necessary to target dose of 400mg-800mg/day.\\n\\nDepression\\nIR: \\nstart 50 mg qHS day 1, increase to 100 mg qHS day 2, increase to 200 mg qHS day 3, increase to 300 mg qHS day 4; target dose 300 mg/day; max dose 600 mg/day\\n\\nXR:\\n300 mg qHS","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Mania\\nIR- Starting dose 25mg BID, increase to 50 mg BID day 2, increase to 100 mg BID day 3,  increase to 150 mg BID day 4, increase to 200 mg BID day 5.  Recommended dose range 400-600 mg/day\\n\\nXR- Starting dose 50 mg qHS day 1, increase to 100 mg qHS day 2, then increase 100 mg nightly until dose of 400mg qHS reached. Recommended dose range 400-600 mg/day","notes":"FDA-approved for mania ages 10 and older (monotherapy and adjunct).","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Mania\\nIR- Starting dose 25mg BID, increase to 50 mg BID day 2, increase to 100 mg BID day 3,  increase to 150 mg BID day 4, increase to 200 mg BID day 5.  Recommended dose range 400-600 mg/day\\n\\nXR- Starting dose 50 mg qHS day 1, increase to 100 mg qHS day 2, then increase 100 mg nightly until dose of 400mg qHS reached. Recommended dose range 400-600 mg/day","notes":"FDA-approved for mania ages 10 and older (monotherapy and adjunct).","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["preconception"],"dosing":"Mania\\nIR:\\nStarting dose 50 mg BID. Increase by 100 mg/day until 200mg BID on day 4.\\nTarget dose 400-800mg/day.\\nMaximum recommended dose 800mg/day.\\n\\nXR:\\nStarting dose 300 mg qHS.\\nIncrease as tolerated and clinically necessary to target dose of 400mg-800mg/day.\\n\\nDepression\\nIR: \\nstart 50 mg qHS day 1, increase to 100 mg qHS day 2, increase to 200 mg qHS day 3, increase to 300 mg qHS day 4; target dose 300 mg/day; max dose 600 mg/ day\\n\\nXR:\\n300 mg qHS","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["antepartum"],"dosing":"Mania\\nIR:\\nStarting dose 50 mg BID. Increase by 100 mg/day until 200mg BID on day 4.\\nTarget dose 400-800mg/day.\\nMaximum recommended dose 800mg/day.\\n\\nXR:\\nStarting dose 300 mg qHS.\\nIncrease as tolerated and clinically necessary to target dose of 400mg-800mg/day.\\n\\nDepression\\nIR: \\nstart 50 mg qHS day 1, increase to 100 mg qHS day 2, increase to 200 mg qHS day 3, increase to 300 mg qHS day 4; target dose 300 mg/day; max dose 600 mg/ day\\n\\nXR:\\n300 mg qHS","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["postpartum"],"dosing":"Mania\\nIR:\\nStarting dose 50 mg BID. Increase by 100 mg/day until 200mg BID on day 4.\\nTarget dose 400-800mg/day.\\nMaximum recommended dose 800mg/day.\\n\\nXR:\\nStarting dose 300 mg qHS.\\nIncrease as tolerated and clinically necessary to target dose of 400mg-800mg/day.\\n\\nDepression\\nIR: \\nstart 50 mg qHS day 1, increase to 100 mg qHS day 2, increase to 200 mg qHS day 3, increase to 300 mg qHS day 4; target dose 300 mg/day; max dose 600 mg/ day\\n\\nXR:\\n300 mg qHS","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["preconception"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["antepartum"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Depressive Disorder","branch":["Augmentation"],"population":["postpartum"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["antepartum"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["postpartum"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"refer to ECG recommendations","alert":"warning"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"IR\\nStart 12.5-25mg/day \\nIncrease by 12.5-25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"IR\\nStart 25-50 mg/day \\nIncrease by 25-50 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 12.5 mg nightly\\nIncrease by 12.5 mg/day as clinically indicated and tolerable\\nMaximum dose 150 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["adult"],"dosing":"IR\\nStart 25 mg/day \\nIncrease by 25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day\\n\\nXR\\nStart 25 mg/day \\nIncrease by 25 mg/day in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum target dose 400mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["cardiac"],"dosing":"IR\\nStart 25 mg/day \\nIncrease by 25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day\\n\\nXR\\nStart 25 mg/day \\nIncrease by 25 mg/day in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day","notes":"","alert":"warning"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["hepatic"],"dosing":"IR\\nStart 25 mg/day \\nIncrease by 25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day\\n\\nXR\\nStart 25 mg/day \\nIncrease by 25 mg/day in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day","notes":"","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["geriatric"],"dosing":"IR\\nStart 25 mg/day \\nIncrease by 25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMean target dose 300 mg/day\\n\\nXR\\nStart 25 mg/day \\nIncrease by 25 mg/day in minimum one week as clinically indicated and tolerable\\nMean target dose 300 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"IR\\nStart 25 mg/day \\nIncrease by 25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day\\n\\nXR\\nStart 25 mg/day \\nIncrease by 25 mg/day in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day","notes":"","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"IR\\nStart 25 mg/day \\nIncrease by 25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day\\n\\nXR\\nStart 25 mg/day \\nIncrease by 25 mg/day in minimum one week as clinically indicated and tolerable\\nTypical target dose 300 mg/day\\nMaximum dose 400 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"IR\\nStart 25 mg/day \\nIncrease by 25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMean target dose 150-300 mg/day\\n\\nXR\\nStart 25 mg/day \\nIncrease by 25 mg/day in minimum one week as clinically indicated and tolerable\\nMean target dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"refer to ECG recommendations","alert":"warning"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"IR\\nStart 12.5-25mg/day \\nIncrease by 12.5-25 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"IR\\nStart 25-50 mg/day \\nIncrease by 25-50 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"IR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in single or divided doses in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nXR\\nStart 50 mg/day \\nIncrease by 50-100 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"Off-label for PTSD","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["adult"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["cardiac"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["geriatric"],"dosing":"IR:\\nStarting dose 12.5mg- 25mg/day increase by 12.5mg-25mg/day increments to clinically effective and tolerable dose\\nMax dose: no specific recommendations, do not exceed 800mg/day\\n\\nXR:\\nStarting dose 50 mg/day increase by 50 mg/day increments to clinically effective and tolerable dose\\nMax dose: no specific recommendations, do not exceed 800mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["hepatic"],"dosing":"IR- Starting dose 25mg/day.  Titrate by 25mg- 50 mg/day increments to clinically effective and tolerable dose.\\n\\nXR- Starting dose 50 mg/day.  Increase by 50 mg/day increments to clinically effective and tolerable dose.","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["obesity"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["renal"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Psychosis","branch":[],"population":["pediatric"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 50 mg daily day 1, increase by 100 mg each day until reaching target dose of 400mg/day\\nIncrease by 100 every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"FDA-approved >12yo for schizophrenia","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Psychosis","branch":[],"population":["adolescent"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 50 mg daily day 1, increase by 100 mg each day until reaching target dose of 400mg/day\\nIncrease by 100 every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"FDA-approved >12yo for schizophrenia","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Psychosis","branch":[],"population":["postpartum"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["adult"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["cardiac"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["geriatric"],"dosing":"IR:\\nStarting dose 12.5mg- 25mg/day increase by 12.5mg-25mg/day increments to clinically effective and tolerable dose\\nMax dose: no specific recommendations, do not exceed 800mg/day\\n\\nXR:\\nStarting dose 50 mg/day increase by 50 mg/day increments to clinically effective and tolerable dose\\nMax dose: no specific recommendations, do not exceed 800mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["hepatic"],"dosing":"IR- Starting dose 25mg/day.  Titrate by 25mg- 50 mg/day increments to clinically effective and tolerable dose.\\n\\nXR- Starting dose 50 mg/day.  Increase by 50 mg/day increments to clinically effective and tolerable dose.","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["obesity"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"High associaiton with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["renal"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["preconception"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Quetiapine","name":"Quetiapine","class":"Atypical (SGA) Antipsychotics","brands":"Seroquel","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation\\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"dizziness, sedation, weight gain, constipation, hypotension","side_effects_rare":"Orthostatic hypotension\\n\\nCataract formation- conflicting data exists surrounding cataract formation","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a698019.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"IR\\nStart 25mg twice daily day 1, increase to 50 mg twice daily day 2, 100 mg twice daily day 3, 150mg twice daily day 4, then 200mg twice daily on day 5 \\nFurther increase of 50-100 mg/day in minimum 3 days as clinically indicated and tolerable\\nMax dose 800mg/day\\n\\nXR\\nStart 300 mg/day \\nIncrease by 100-300 mg every 1 day as clinically indicated and tolerable\\nMax dose 800mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS","info":"","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["pediatric"],"dosing":"15-20 kg:\\nStart 0.25 mg/day\\nAfter \u2265 4 days may increase to 0.5 mg/day\\nAfter an additional 14 days may increase in increments of 0.25 mg/day at \u2265 2 week intervals\\nTherapeutic effect reached plateau at 1mg/d in clinical trials \\n\\n\u226520 kg: \\nStart 0.5 mg/day\\nAfter \u2265 4 days may increase to 1 mg/day\\nAfter an additional 14 days may increase in increments of 0.5 mg/day at \u22652 week intervals\\nTherapeutic effect reached plateau at 2.5 mg/day (3mg/d in >45kg) in clinical trials","notes":"FDA indicated for treatment of irritability in autism (5-17 years)","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS","info":"","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["adolescent"],"dosing":"Start 0.5 mg/day\\nAfter \u2265 4 days may increase to 1 mg/day\\nAfter an additional 14 days may increase in increments of 0.5 mg/day at \u22652 week intervals\\nTherapeutic effect reached plateau at 2.5 mg/day (3mg/d in >45kg) in clinical trials","notes":"FDA indicated for treatment of irritability in autism (5-17 years)","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Mania dosing: <br>Start 2 mg daily in 1-2 divided doses. Increase by 1 mg/day per day as needed. Max recommended dose 6 mg/day.","notes":"","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["hepatic"],"dosing":"Mania dosing: <br>Child-Pugh Class A or B- Start 2 mg daily in 1-2 divided doses. Increase by 1 mg/day per day as needed. Max recommended dose 6 mg/day.\\n<br>Child-Pugh Class C- Starting dose 0.5mg BID.  Increase as clinically indicated by 0.5mg BID. Maximum total weekly increase of 1.5mg BID.","notes":"","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Mania dosing: <br>CrCl \u2265 30 mL/min- Start 2 mg daily in 1-2 divided doses. Increase by 1 mg/day per day as needed. Max recommended dose 6 mg/day.\\n<br>CrCl < 30 mL/min- Starting dose 0.5mg BID.  Increase as clinically indicated by 0.5mg BID. Maximum total weekly increase of 1.5mg BID.","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Mania dosing: <br>Start 2 mg daily in 1-2 divided doses. Increase by 1 mg/day per day as needed. Max recommended dose 6 mg/day.","notes":"","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Mania dosing: <br>Start 2 mg daily in 1-2 divided doses. Increase by 1 mg/day per day as needed. Max recommended dose 6 mg/day.","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Mania dosing: <br>Starting dose 0.5mg BID.  Increase as clinically indicated by 0.5mg BID. Maximum total weekly increase of 1.5mg BID.","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"somnolence, orthostatic hypotension, weight gain","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS","info":"none","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Mania dosing: <br>Start 0.5 mg/day; can increase every 24 hours in increments of 0.5-1 mg/ day; target dose 2-3 mg/day.  Max recommended dose 3mg/day","notes":"FDA-approved for mania/ mixed mania ages 10 and older (monotherapy and adjunct).\\n\\nMetabolic and sedation side effects may be more likely in children/adolscents, more frequent monitoring required","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"somnolence, orthostatic hypotension, weight gain","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS","info":"none","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Mania dosing: <br>Start 0.5 mg/day; can increase every 24 hours in increments of 0.5-1 mg/ day; target dose 2-3 mg/day.  Max recommended dose 3mg/day","notes":"FDA-approved for mania/ mixed mania ages 10 and older (monotherapy and adjunct).\\n\\nMetabolic and sedation side effects may be more likely in children/adolscents, more frequent monitoring required","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["adult"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 6 mg/day","notes":"","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["preconception"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nTypical max dose 3mg/day","notes":"","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["cardiac"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 6 mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["geriatric"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in two divided doses \\nMax recommended dose 6 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["hepatic"],"dosing":"Child-Pugh Class A or B\\nStart 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 6 mg/day\\n\\nChild-Pugh Class C\\nStart 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 2 divided doses","notes":"See specific dosing recommendation changes","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["obesity"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 6 mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Depressive Disorder","branch":["Psychosis"],"population":["renal"],"dosing":"CrCl \u2265 30 mL/min-\\nStart 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 6 mg/day\\n\\nCrCl < 30mL/min- titrate more slowly than usual dosing.\\n Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 2 divided doses","notes":"Dosing for Augmentation","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 0.25 mg daily\\nMay add a second dose during the (0.25 mg twice daily)\\nIncrease by 0.25 mg/dose as clinically indicated and tolerable\\nMaximum daily dose 2 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["adult"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 3 mg/day","notes":"","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 3 mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in two divided doses \\nMax recommended dose 3 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh Class A or B\\nStart 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 3 mg/day\\n\\nChild-Pugh Class C\\nStart 0.5 mg/ day\\nIncrease by 0.5 mg/day in minimum one week as clinically indicated and tolerable\\nDose in 2 divided doses \\nMax recommended dose 3 mg/day but may need to stay below this level depending on toelrability","notes":"See specific dosing recommendation changes","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 3 mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"CrCl > 60 mL/min-\\nStart 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax recommended dose 3 mg/day\\n\\nCrCl 30-60 mL/min\\nStart 0.5 mg/ day\\nIncrease by 0.5 mg in minimum one week as clinically indicated and tolerable\\nDose in 2 divided doses \\nMaximum recommende dose 2 mg daily\\n\\nCrCl 10-30 mL/min\\nStart 0.25-0.5 mg/ day\\nIncrease by 0.25-0.5 mg in minimum one week as clinically indicated and tolerable\\nDose in 2 divided doses \\nMaximum recommende dose 1.5 mg daily\\n\\nCrCl <10 mL/min\\nStart 0.25-0.5 mg/ day\\nIncrease by 0.25-0.5 mg in minimum one week as clinically indicated and tolerable\\nDose in 2 divided doses \\nMaximum recommende dose 1.0 mg daily","notes":"Dosing for Augmentation","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax dose 4mg/day","notes":"","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"Start Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax dose 4mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in two divided doses \\nMax dose 4mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh Class A or B\\nStart Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax dose 4mg/day\\n\\nChild-Pugh Class C\\nStart Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 2 divided doses \\nMax dose 4mg/day divided BID","notes":"See specific dosing recommendation changes","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax dose 4mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u2265 30 mL/min-\\nStart Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 1 to 2 divided doses \\nMax dose 4mg/day\\n\\nCrCl < 30mL/min- titrate more slowly than usual dosing.\\nStart Start 0.5mg/ day\\nIncrease by 0.5mg- 1mg/day in minimum one week as clinically indicated and tolerable\\nDose in 2 divided doses \\nMax dose 4mg/day divided BID","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS","info":"","length":"","diagnosis":"Psychosis","branch":[],"population":["pediatric"],"dosing":"Start 0.5 mg/day; can increase every 24 hours in increments of 0.5-1 mg/ day; target dose 2-3 mg/day. Max recommended dose 3mg/day","notes":"FDA-approved >12yo for schizophrenia","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS","info":"","length":"","diagnosis":"Psychosis","branch":[],"population":["adolescent"],"dosing":"Start 0.5 mg/day; can increase every 24 hours in increments of 0.5-1 mg/ day; target dose 2-3 mg/day. Max recommended dose 3mg/day","notes":"FDA-approved >12yo for schizophrenia","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["adult"],"dosing":"Start 2 mg daily in 1-2 divided doses\\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable\\nMax recommended dose 6 mg/day","notes":"","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["cardiac"],"dosing":"Start 2 mg daily in 1-2 divided doses\\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable\\nMax recommended dose 6 mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["geriatric"],"dosing":"Start 0.5mg twice daily\\nIncrease by 1mg.day in divided doses daily as clinically indicated and tolerable\\nMaximum total weekly increase of 1.5mg BID.\\nShould not exceed 6 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["hepatic"],"dosing":"Child Pugh A/B- \\nStart 2 mg daily in 1-2 divided doses \\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable \\nMax recommended dose 6 mg/day  \\n\\nChild Pugh C-  \\nStart 0.5mg twice daily \\nIncrease by 1mg/day in divided doses daily as clinically indicated and tolerable. Titrate more slowly than usual dosing\\nMaximum total weekly increase of 1.5mg BID. \\nShould not exceed 6 mg/day","notes":"See specific dosing recommendation changes","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["obesity"],"dosing":"Start 2 mg daily in 1-2 divided doses\\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable\\nMax recommended dose 6 mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["renal"],"dosing":"CrCl \u2265 30 mL/min- \\nStart 2 mg daily in 1-2 divided doses \\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable \\nMax recommended dose 6 mg/day  \\n\\nCrCl < 30mL/min-  \\nStart 0.5mg twice daily \\nIncrease by 1mg/day in divided doses daily as clinically indicated and tolerable. Titrate more slowly than usual dosing\\nMaximum total weekly increase of 1.5mg BID. \\nShould not exceed 6 mg/day","notes":"See specific dosing recommendation changes","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["preconception"],"dosing":"Start 2 mg daily in 1-2 divided doses\\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable\\nMax recommended dose 6 mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"Start 2 mg daily in 1-2 divided doses\\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable\\nMax recommended dose 6 mg/day","notes":"Healthcare providers are encouraged to enroll women exposed to atypical antipsychotics during pregnancy in the National Pregnancy Registry for Atypical Antipsychotics. Antipsychotic use during the third trimester increases the risk for EPS and withdrawal symptoms in newborns following delivery.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["adult"],"dosing":"Start 2 mg daily in 1-2 divided doses\\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable\\nMax recommended dose 6 mg/day","notes":"","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["cardiac"],"dosing":"Start 2 mg daily in 1-2 divided doses\\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable\\nMax recommended dose 6 mg/day","notes":"see ECG recommendations","alert":"warning"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["geriatric"],"dosing":"Start 0.5mg twice daily\\nIncrease by 1mg.day in divided doses daily as clinically indicated and tolerable\\nMaximum total weekly increase of 1.5mg BID.\\nShould not exceed 6 mg/day","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["hepatic"],"dosing":"Child Pugh A/B- \\nStart 2 mg daily in 1-2 divided doses \\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable \\nMax recommended dose 6 mg/day  \\n\\nChild Pugh C-  \\nStart 0.5mg twice daily \\nIncrease by 1mg/day in divided doses daily as clinically indicated and tolerable. Titrate more slowly than usual dosing\\nMaximum total weekly increase of 1.5mg BID. \\nShould not exceed 6 mg/day","notes":"See specific dosing recommendation changes","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["obesity"],"dosing":"Start 2 mg daily in 1-2 divided doses\\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable\\nMax recommended dose 6 mg/day","notes":"High association with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Risperidone","name":"Risperidone","class":"Atypical (SGA) Antipsychotics","brands":"Risperdal","monitor":"Atypical (SGA) antipsychotic monitoring: <br>BMI monthly for 3 months, then every 3 months <br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually <br>Consider ECG upon initiation <br>Monitor for extrapyramidal symptoms","side_effects_common":"somnolence, orthostatic hypotension, weight gain","side_effects_rare":"hyperprolactinemia, EPS (typically at \u2265 4mg/day)","info":"FDA box warning: -Increase mortality risk in older adults with dementia https://medlineplus.gov/druginfo/meds/a694015.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":["clinically significant hallucinations"],"population":["renal"],"dosing":"CrCl \u2265 30 mL/min- \\nStart 2 mg daily in 1-2 divided doses \\nIncrease by 1-2mg/day in divided doses daily as clinically indicated and tolerable \\nMax recommended dose 6 mg/day  \\n\\nCrCl < 30mL/min-  \\nStart 0.5mg twice daily \\nIncrease by 1mg/day in divided doses daily as clinically indicated and tolerable. Titrate more slowly than usual dosing\\nMaximum total weekly increase of 1.5mg BID. \\nShould not exceed 6 mg/day","notes":"See specific dosing recommendation changes","alert":"caution"},{"id":"Cariprazine","name":"Cariprazine","class":"Atypical (SGA) Antipsychotics","brands":"Vraylar","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, nausea and vomiting, insomnia, tremors, somnolence, weight gain","side_effects_rare":"seizures, movement related disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a615050.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Mania\\nStart 1.5 mg daily then increase to 3 mg on day 2\\nIncrease by 1.5 mg daily in minimum one week as clinically indicated\\nMaximum dose 6 mg daily\\n\\nDepression\\nStart 1.5 mg daily\\nIncrease to 3 mg in minimum one week as clinically indicated\\nMaximum dose 3 mg daily","notes":"","alert":""},{"id":"Cariprazine","name":"Cariprazine","class":"Atypical (SGA) Antipsychotics","brands":"Vraylar","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, nausea and vomiting, insomnia, tremors, somnolence, weight gain","side_effects_rare":"seizures, movement related disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a615050.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Mania\\nStart 1.5 mg daily then increase to 3 mg on day 2\\nIncrease by 1.5 mg daily in minimum one week as clinically indicated\\nMaximum dose 6 mg daily\\n\\nDepression\\nStart 1.5 mg daily\\nIncrease to 3 mg in minimum one week as clinically indicated\\nMaximum dose 3 mg daily","notes":"","alert":""},{"id":"Cariprazine","name":"Cariprazine","class":"Atypical (SGA) Antipsychotics","brands":"Vraylar","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, nausea and vomiting, insomnia, tremors, somnolence, weight gain","side_effects_rare":"seizures, movement related disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a615050.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Mania\\nStart 1.5 mg daily then increase to 3 mg on day 2\\nIncrease by 1.5 mg daily in minimum one week as clinically indicated\\nMaximum dose 6 mg daily\\n\\nDepression\\nStart 1.5 mg daily\\nIncrease to 3 mg in minimum one week as clinically indicated\\nMaximum dose 3 mg daily","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Cariprazine","name":"Cariprazine","class":"Atypical (SGA) Antipsychotics","brands":"Vraylar","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, nausea and vomiting, insomnia, tremors, somnolence, weight gain","side_effects_rare":"seizures, movement related disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a615050.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A or B\\n\\nMania\\nStart 1.5 mg daily then increase to 3 mg on day 2\\nIncrease by 1.5 mg daily in minimum one week as clinically indicated\\nMaximum dose 6 mg daily\\n\\nDepression\\nStart 1.5 mg daily\\nIncrease to 3 mg in minimum one week as clinically indicated\\nMaximum dose 3 mg daily\\n\\nChild-Pugh C\\n\\nDo not use","notes":"","alert":"caution"},{"id":"Cariprazine","name":"Cariprazine","class":"Atypical (SGA) Antipsychotics","brands":"Vraylar","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, nausea and vomiting, insomnia, tremors, somnolence, weight gain","side_effects_rare":"seizures, movement related disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a615050.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"CrCl >30 mL/min\\n\\nMania\\nStart 1.5 mg daily then increase to 3 mg on day 2\\nIncrease by 1.5 mg daily in minimum one week as clinically indicated\\nMaximum dose 6 mg daily\\n\\nDepression\\nStart 1.5 mg daily\\nIncrease to 3 mg in minimum one week as clinically indicated\\nMaximum dose 3 mg daily\\n\\nCrCl <30 mL/min\\n\\nDo not use","notes":"","alert":"caution"},{"id":"Cariprazine","name":"Cariprazine","class":"Atypical (SGA) Antipsychotics","brands":"Vraylar","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, nausea and vomiting, insomnia, tremors, somnolence, weight gain","side_effects_rare":"seizures, movement related disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a615050.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Mania\\nStart 1.5 mg daily then increase to 3 mg on day 2\\nIncrease by 1.5 mg daily in minimum one week as clinically indicated\\nMaximum dose 6 mg daily\\n\\nDepression\\nStart 1.5 mg daily\\nIncrease to 3 mg in minimum one week as clinically indicated\\nMaximum dose 3 mg daily","notes":"","alert":""},{"id":"Cariprazine","name":"Cariprazine","class":"Atypical (SGA) Antipsychotics","brands":"Vraylar","monitor":"Atypical (SGA) antipsychotic monitoring: \\n<br>BMI monthly for 3 months, then every 3 months\\n<br>Blood pressure, lipids, HbA1c upon initiation, after 3 months, then annually\\n<br>Consider ECG upon initiation \\n<br>Monitor for extrapyramidal symptoms","side_effects_common":"akathisia, anxiety, nausea and vomiting, insomnia, tremors, somnolence, weight gain","side_effects_rare":"seizures, movement related disorders","info":"FDA box warning:\\n-Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 18-24 years with MDD and other psychiatric disorders\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a615050.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Mania\\nStart 1.5 mg daily\\nIncrease by 1.5 mg daily in minimum one week as clinically indicated and tolerated\\nMaximum dose 6 mg daily\\n\\nDepression\\nStart 1.5 mg daily\\nIncrease by 1.5 mg daily in minimum one week as clinically indicated and tolerated\\nMaximum dose 3 mg daily","notes":"","alert":""},{"id":"Olanzapine + Fluoxetine","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"","side_effects_common":"","side_effects_rare":"","info":"","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"","alert":""},{"id":"Olanzapine + Fluoxetine","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"","side_effects_common":"","side_effects_rare":"","info":"","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"","alert":""},{"id":"Olanzapine + Fluoxetine","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"","side_effects_common":"","side_effects_rare":"","info":"","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"","alert":""},{"id":"Olanzapine + Fluoxetine","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"","side_effects_common":"","side_effects_rare":"","info":"","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Olanzapine + Fluoxetine","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"","side_effects_common":"","side_effects_rare":"","info":"","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"High associaiton with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["pediatric"],"dosing":"Start 7.5-15mg once daily at bedtime\\nIncrease by 7.5-15mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Off label. Limited dosing guidance","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adolescent"],"dosing":"Start 7.5-15mg once daily at bedtime\\nIncrease by 7.5-15mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["preconception"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["postpartum"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 7.5-15mg once daily at bedtime\\nIncrease by 7.5-15mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Manufacturer labeling does not recommend specific dose adjustments.  Some experts recommend decreasing dose by 50% and decreasing max dose to 30mg/day.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 15mg once daily at bedtime Increase by 15 mg/day every 1-2 weeks if clinically indicated and tolerable Max dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["antepartum"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["postpartum"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 7.5-15mg once daily at bedtime\\nIncrease by 7.5-15mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Manufacturer labeling does not recommend specific dose adjustments.  Some experts recommend decreasing dose by 50% and decreasing max dose to 30mg/day.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 7.5 mg once daily at bedtime\\nIncrease by 7.5 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["adult"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["cardiac"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["geriatric"],"dosing":"Start 7.5-15mg once daily at bedtime\\nIncrease by 7.5-15mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["hepatic"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Manufacturer labeling does not recommend specific dose adjustments.  Some experts recommend decreasing dose by 50% and decreasing max dose to 30mg/day.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["obesity"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["renal"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start 7.5-15mg once daily at bedtime\\nIncrease by 7.5-15mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Manufacturer labeling does not recommend specific dose adjustments.  Some experts recommend decreasing dose by 50% and decreasing max dose to 30mg/day.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["adult"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["cardiac"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["geriatric"],"dosing":"Start 7.5-15mg once daily at bedtime\\nIncrease by 7.5-15mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["hepatic"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Manufacturer labeling does not recommend specific dose adjustments.  Some experts recommend decreasing dose by 50% and decreasing max dose to 30mg/day.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["obesity"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["renal"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 7.5-15mg once daily at bedtime\\nIncrease by 7.5-15mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"Manufacturer labeling does not recommend specific dose adjustments.  Some experts recommend decreasing dose by 50% and decreasing max dose to 30mg/day.","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 15mg once daily at bedtime\\nIncrease by 15 mg/day every 1-2 weeks if clinically indicated and tolerable\\nMax dose 45 mg/day","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"SSRI-Induced Sexual Dysfunction","branch":[],"population":["adult"],"dosing":"Start 15mg nightly\\nIncrease by 15mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 45mg/day.","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adult"],"dosing":"Start 15mg nightly\\nIncrease by 15mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 45mg/day.","notes":"","alert":""},{"id":"Mirtazapine","name":"Mirtazapine","class":"Atypical Antidepressants","brands":"Remeron","monitor":"weight and BMI at each office visit","side_effects_common":"nausea, insomnia, headache, somnolence, weight gain","side_effects_rare":"agranulocytosis or severe neutropenia","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697009.html","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adolescent"],"dosing":"Start 15mg nightly\\nIncrease by 15mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 45mg/day.","notes":"","alert":""},{"id":"Eszopiclone","name":"Eszopiclone","class":"Benzodiazepine Receptor Agonists","brands":"Lunesta","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior, worsened suicidial ideation in patients who are depressed","info":"FDA black box warning for life-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a605009.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["adult"],"dosing":"Start 1mg at bedtime\\nIncrease up to 3mg nightly as clinically indicated and tolerable","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Eszopiclone","name":"Eszopiclone","class":"Benzodiazepine Receptor Agonists","brands":"Lunesta","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior, worsened suicidial ideation in patients who are depressed","info":"FDA black box warning for life-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a605009.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["cardiac"],"dosing":"Start 1mg at bedtime\\nIncrease up to 3mg nightly as clinically indicated and tolerable","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Eszopiclone","name":"Eszopiclone","class":"Benzodiazepine Receptor Agonists","brands":"Lunesta","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior, worsened suicidial ideation in patients who are depressed","info":"FDA black box warning for life-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a605009.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["geriatric"],"dosing":"Start 1mg at bedtime\\nIncrease up to 2mg nightly as clinically indicated and tolerable","notes":"See specific dosing recommendations.\\n\\nAvoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":"caution"},{"id":"Eszopiclone","name":"Eszopiclone","class":"Benzodiazepine Receptor Agonists","brands":"Lunesta","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior, worsened suicidial ideation in patients who are depressed","info":"FDA black box warning for life-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a605009.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A and B:\\nStart 1mg at bedtime\\nIncrease up to 3mg nightly as clinically indicated and tolerable\\n\\nChild-Pugh C:\\nStart 1mg at bedtime\\nIncrease up to 2mg nightly as clinically indicated and tolerable","notes":"See specific dosing recommendations.\\n\\nAvoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":"caution"},{"id":"Eszopiclone","name":"Eszopiclone","class":"Benzodiazepine Receptor Agonists","brands":"Lunesta","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior, worsened suicidial ideation in patients who are depressed","info":"FDA black box warning for life-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a605009.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["obesity"],"dosing":"Start 1mg at bedtime\\nIncrease up to 3mg nightly as clinically indicated and tolerable","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Eszopiclone","name":"Eszopiclone","class":"Benzodiazepine Receptor Agonists","brands":"Lunesta","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior, worsened suicidial ideation in patients who are depressed","info":"FDA black box warning for life-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a605009.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["renal"],"dosing":"Start 1mg at bedtime\\nIncrease up to 3mg nightly as clinically indicated and tolerable","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Eszopiclone","name":"Eszopiclone","class":"Benzodiazepine Receptor Agonists","brands":"Lunesta","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior, worsened suicidial ideation in patients who are depressed","info":"FDA black box warning for life-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a605009.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["adult"],"dosing":"Start 1mg at bedtime\\nIncrease up to 3mg nightly as clinically indicated and tolerable","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Eszopiclone","name":"Eszopiclone","class":"Benzodiazepine Receptor Agonists","brands":"Lunesta","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior, worsened suicidial ideation in patients who are depressed","info":"FDA black box warning for life-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a605009.html","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["cardiac"],"dosing":"Start 1mg at bedtime\\nIncrease up to 3mg nightly as clinically indicated and tolerable","notes":"Avoid taking with fatty food (decreases 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phone calls)","info":"FDA black box warning for \\nlife-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a693025.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["adult"],"dosing":"Start 5mg in women and 5-10 mg in men. Take at bedtime.","notes":"Needs to be taken at least 8 hours before planned wake time","alert":""},{"id":"Zolpidem","name":"Zolpidem","class":"Benzodiazepine Receptor Agonists","brands":"Ambien","monitor":"No specific recommendation.","side_effects_common":"dizziness, grogginess, next-day sedation, headache, dry  mouth","side_effects_rare":"anaphylaxis, complex\\nsleep-related behavior\\n(sleep-driving, cooking,\\neating, phone calls)","info":"FDA black box warning for \\nlife-threatening sleep behaviors\\n\\nhttps://medlineplus.gov/druginfo/meds/a693025.html","length":"","diagnosis":"Insomnia, Acute","branch":[],"population":["cardiac"],"dosing":"Start 5mg in women and 5-10 mg in men. 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Take at bedtime.","notes":"Needs to be taken at least 8 hours before planned wake time","alert":""},{"id":"Clonazepam","name":"Clonazepam","class":"Benzodiazepines","brands":"Klonopin","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682279.html","length":"","diagnosis":"Acute Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 0.125-0.5mg twice daily as needed\\nLimit use to 2-4 weeks then taper and discontinue.","notes":"","alert":""},{"id":"Clonazepam","name":"Clonazepam","class":"Benzodiazepines","brands":"Klonopin","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682279.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 0.5mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 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May increase based on response and tolerability up to 8mg/day in divided doses.","notes":"","alert":""},{"id":"Clonazepam","name":"Clonazepam","class":"Benzodiazepines","brands":"Klonopin","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682279.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"Starting dose 0.5mg/day in two divided doses. May increase based on response and tolerability up to 8mg/day in divided doses.","notes":"","alert":""},{"id":"Clonazepam","name":"Clonazepam","class":"Benzodiazepines","brands":"Klonopin","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682279.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 0.5mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day","notes":"","alert":""},{"id":"Clonazepam","name":"Clonazepam","class":"Benzodiazepines","brands":"Klonopin","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682279.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 0.5mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day","notes":"","alert":""},{"id":"Clonazepam","name":"Clonazepam","class":"Benzodiazepines","brands":"Klonopin","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682279.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 0.5mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day","notes":"","alert":""},{"id":"Diazepam","name":"Diazepam","class":"Benzodiazepines","brands":"Valium","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682047.html","length":"","diagnosis":"Antipsychotic Management","branch":[],"population":["adult"],"dosing":"Administer 5mg- 10 mg once\\nSubsequent doses 5-10 mg every 6 hours as needed\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"Diazepam","name":"Diazepam","class":"Benzodiazepines","brands":"Valium","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682047.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Fixed-Dose Regimen:\\nDay 1- 10 mg every 6 hours\\nDay 2- 10 mg every 8 hours\\nDay 3- 10 mg every 12 hours\\nDay 4 -10 mg nightly\\nDay 5 -10 mg nightly\\nDo not use if comorbid hepatic impairment is present","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682047.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["antepartum"],"dosing":"Symptom-Triggered Regimen:\\nAdminister 2mg-4mg as needed, dose and frequency determined by withdrawal symptom severity using CIWA-Ar\\n\\nFixed-Dose Regimen:\\nDay 1- 2 mg every 8 hours\\nDay 2- 2 mg every 8 hours\\nDay 3- 1 mg every 8 hours\\nDay 4 -1 mg every 12 hours\\nDay 5 -1 mg at nighttime","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682047.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Fixed-Dose Regimen:\\nDay 1- 2 mg every 8 hours\\nDay 2- 2 mg every 8 hours\\nDay 3- 1 mg every 8 hours\\nDay 4 -1 mg every 12 hours\\nDay 5 -1 mg at nighttime","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682047.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adolescent"],"dosing":"Fixed-Dose Regimen:\\nDay 1- 2 mg every 8 hours\\nDay 2- 2 mg every 8 hours\\nDay 3- 1 mg every 8 hours\\nDay 4 -1 mg every 12 hours\\nDay 5 -1 mg at nighttime","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682047.html","length":"","diagnosis":"Antipsychotic Management","branch":[],"population":["adult"],"dosing":"Start 0.5mg- 1mg twice daily\\nMay cautiously increase dose based on response and tolerability up to 6 mg/day in divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["antepartum"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["postpartum"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"Use the lowest possible effective dose for the shortest possible period of time","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 0.5-1mg twice daily   Increase by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable Max dose 6mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["adult"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["cardiac"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["geriatric"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"Use the lowest possible effective dose for the shortest possible period of time","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["hepatic"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["obesity"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["renal"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["preconception"],"dosing":"Starting dose 0.5mg to 2mg q 4-6 hours prn. May increase based on response and tolerability up to 10 mg/day in divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["antepartum"],"dosing":"Starting dose 0.5mg to 2mg q 4-6 hours prn. May increase based on response and tolerability up to 10 mg/day in divided doses.","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"Use the lowest possible effective dose for the shortest possible period of time","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 0.5-1mg twice daily  \\nIncrease by 0.5-1mg/day in twice daily dosing in minimum 3-7 days as clinically indicated and tolerable\\nMax dose 6mg/day 2-3 divided doses","notes":"","alert":""},{"id":"Oxazepam","name":"Oxazepam","class":"Benzodiazepines","brands":"Serax","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhtthttps://medlineplus.gov/druginfo/meds/a682050.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Fixed-Dose Regimen:\\nDay 1- 30 mg every 6 hours\\nDay 2- 30 mg every 8 hours\\nDay 3- 30 mg every 12 hours\\nDay 4 -30 mg nightly\\nDay 5 -30 mg nightly\\nDo not use if comorbid hepatic impairment is present","notes":"","alert":""},{"id":"Chlordiazepoxide","name":"Chlordiazepoxide","class":"Benzodiazepines","brands":"Librium","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682078.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Fixed-Dose Regimen:\\nDay 1- 50 mg every 6-12 hours\\nDay 2- 25 mg every 8 hours\\nDay 3- 25 mg every 12 hours\\nDay 4 -25 mg nightly\\nDay 5 -25 mg nightly\\nDo not use if comorbid hepatic impairment is present","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"May mask clinical signs of hypoglycemia and hyperthyroidism","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682078.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Akathisia\\n\\nIR\\nStarting dose 10 mg twice daily\\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 120mg/day\\n\\nER\\nStarting dose 20 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"May mask clinical signs of hypoglycemia and hyperthyroidism","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682078.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Akathisia\\n\\nIR\\nStarting dose 10 mg twice daily\\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 120mg/day\\n\\nER\\nStarting dose 20 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"May mask clinical signs of hypoglycemia and hyperthyroidism","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682078.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Akathisia\\n\\nIR\\nStarting dose 10 mg twice daily\\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 120mg/day\\n\\nER\\nStarting dose 20 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"May mask clinical signs of hypoglycemia and hyperthyroidism","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682078.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Akathisia\\n\\nIR\\nStarting dose 10 mg twice daily\\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 120mg/day\\n\\nER\\nStarting dose 20 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"May mask clinical signs of hypoglycemia and hyperthyroidism","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682078.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Akathisia\\n\\nIR\\nStarting dose 10 mg twice daily\\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 120mg/day\\n\\nER\\nStarting dose 20 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"may mask clinical signs of hypoglycemia and hyperthyroidism","info":"","length":"","diagnosis":"Antipsychotic Management","branch":[],"population":["adult"],"dosing":"Akathisia\\n\\nIR\\nStarting dose 10 mg twice daily\\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 120mg/day\\n\\nER\\nStarting dose 20 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"may mask clinical signs of hypoglycemia and hyperthyroidism","info":"","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Take 10-20 mg 30-60 minutes prior to performance activity\\nIncrease future doses by 10-20 mg as clinically indicated and tolerable\\nMax dose 40 mg/dose up to three times daily","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"may mask clinical signs of hypoglycemia and hyperthyroidism","info":"","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adolescent"],"dosing":"Take 10-20 mg 30-60 minutes prior to performance activity\\nIncrease future doses by 10-20 mg as clinically indicated and tolerable\\nMax dose 40 mg/dose up to three times daily","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"may mask clinical signs of hypoglycemia and hyperthyroidism","info":"","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Take 10-20 mg 30-60 minutes prior to performance activity\\nIncrease future doses by 10-20 mg as clinically indicated and tolerable\\nMax dose 40 mg/dose up to three times daily","notes":"Careful patient selection with respect to underlying cardiac disease and polypharmacy","alert":"caution"},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"may mask clinical signs of hypoglycemia and hyperthyroidism","info":"","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Take 10-20 mg 30-60 minutes prior to performance activity\\nIncrease future doses by 10-20 mg as clinically indicated and tolerable\\nMax dose 40 mg/dose up to three times daily","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"may mask clinical signs of hypoglycemia and hyperthyroidism","info":"","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Take 10-20 mg 30-60 minutes prior to performance activity\\nIncrease future doses by 10-20 mg as clinically indicated and tolerable\\nMax dose 40 mg/dose up to three times daily","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"may mask clinical signs of hypoglycemia and hyperthyroidism","info":"","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Take 10-20 mg 30-60 minutes prior to performance activity\\nIncrease future doses by 10-20 mg as clinically indicated and tolerable\\nMax dose 40 mg/dose up to three times daily","notes":"","alert":""},{"id":"Propranolol","name":"Propranolol","class":"Beta Blocker","brands":"Inderal","monitor":"No specific recommendation.","side_effects_common":"Dizziness, fatigue, bradycardia, hypotension.\\nMay exacerbate asthma, COPD, CHF","side_effects_rare":"may mask clinical signs of hypoglycemia and hyperthyroidism","info":"","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Take 10-20 mg 30-60 minutes prior to performance activity\\nIncrease future doses by 10-20 mg as clinically indicated and tolerable\\nMax dose 40 mg/dose up to three times daily","notes":"","alert":""},{"id":"Zestra","name":"Zestra","class":"Botanical oil","brands":"over the counter","monitor":"No specific recommendation.","side_effects_common":"mild genital burning sensation","side_effects_rare":"none reported.","info":"","length":"","diagnosis":"Female Sexual Interest/Arousal Disorder","branch":[],"population":["adult"],"dosing":"Apply to clitoris/ labia/ vagina before sex.","notes":"","alert":""},{"id":"Tetrabenazine","name":"Tetrabenazine","class":"Vesicular Monoamine Transporter 2 (VMAT2) Inhibitor","brands":"Xenazine","monitor":"No specific recommendation.","side_effects_common":"Sedation, akathisia, EPS symptoms, fatigue, depression","side_effects_rare":"QT prolongation, especially in those with other risk factors","info":"","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 12.5 mg 2 or 3 times daily\\nIncrease by 12.5 mg daily in minimum one week interval to maximum tolerable and effective dose\\nUsual dose 25 mg 3 times daily\\nMaximum recommended total daily dose 200 mg/day","notes":"","alert":""},{"id":"Donepezil","name":"Donepezil","class":"Cholinesterase Inhibitor","brands":"Aricept","monitor":"No specific recommendation.","side_effects_common":"nausea, vomiting, increased gastric acid secretion, diarrhea, weight loss, insomnia, dizziness, myalgia","side_effects_rare":"bradycardia, heart block, seizures, syncope","info":"Doses above 10 mg should not be used due to limited effectiveness data","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 5 mg daily for 4-6 weeks\\nAfter 4-6 weeks may increase to 10 mg daily\\nMaximum dose 10 mg/day","notes":"","alert":""},{"id":"Rivastigmine","name":"Rivastigmine","class":"Cholinesterase Inhibitor","brands":"Exelon","monitor":"No specific recommendation.","side_effects_common":"nausea, vomiting, increased gastric acid secretion, diarrhea, weight loss, insomnia, dizziness, myalgia, local skin site reactions with transdermal patch","side_effects_rare":"bradycardia, heart block, seizures, syncope","info":"","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Oral formulation:\\nStart 1.5 mg twice daily\\nIncrease to 3 mg twice daily in minimum 2 weeks as clinically indicated and tolerable\\nMay further increase to a maximum dose of 6 mg twice daily in minimum 2 weeks if needed\\n\\nTransdermal patch:\\nStart with 4.6 mg/24 hour patch\\nMay increase to 9.5 mg/23 hour patch in minimum 4 weeks as clinically indicated and tolerable\\nMay further increase to maximum dose of 13.3 mg/24 hours in minimum 4 weeks if needed","notes":"Mild to moderate dementia: either Oral or Transdermal patch\\n\\nSevere dementia: Transdermal patch","alert":""},{"id":"Drospirenone and Ethinyl Estradiol","name":"Drospirenone and Ethinyl Estradiol","class":"Combined Oral Contraceptives (COC)","brands":"YAZ, Yazmin, among others","monitor":"No specific recommendation.","side_effects_common":"Headache, vaginal bleeding, nausea/vomiting, and cramping","side_effects_rare":"arterial thromboembolism, cerebral thrombosis, hypertension, thrombophlebitis, MI, pulmonary embolism, gall bladder disease, mastalgia, hyperkalemia","info":"Black Box Warning: CV risk for women who smoke, development of endometrial cancer without progesterone opposition.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682922.html","length":"","diagnosis":"Premenstrual Dysphoric Disorder","branch":[],"population":["adult"],"dosing":"Take one pill daily in a continuous fashion (skipping the placebo pills).  If breakthrough bleeding occurs, take a 3-day break from the pills, then restart.  It is necessary to take the pills for at least three weeks before taking any breaks (ie., must complete a full pill pack at least once before taking a break even if irregular bleeding occurs during the first month of use).\\n\\nIf patient prefers to take the pills cyclically, it is recommended to take only a 4-day break in order to decrease the hormone-free interval.\\n\\nIf does not have a full response, increase estrogen component to 30 mcg equivalent, if possible.","notes":"","alert":""},{"id":"Galantamine","name":"Galantamine","class":"Cholinesterase Inhibitor","brands":"","monitor":"","side_effects_common":"nausea, vomiting, increased gastric acid secretion, diarrhea, weight loss, insomnia, dizziness, myalgia","side_effects_rare":"bradycardia, heart block, seizures, syncope","info":"","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"IR tablet or solution\\nStart 4mg twice daily\\nAfter 4 weeks, if well tolerated and clinically indicated, may increase to 8mg twice daily\\nAfter 4 weeks, if well tolerated and clinically indicated, may increase to 12mg twice daily\\n\\nER capsule\\nStart 8mg one daily\\nAfter 4 weeks, if well tolerated and clinically indicated, may increase to 16mg daily\\nAfter 4 weeks, if well tolerated and clinically indicated, may increase to 24mg daily","notes":"","alert":""},{"id":"Clonazepam","name":"Clonazepam","class":"Benzodiazepines","brands":"Klonopin","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682279.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Use 0.5-1.5 mg three to four times a day as needed for anxiety\\nMax dose 6 mg/day","notes":"","alert":""},{"id":"Clonazepam","name":"Clonazepam","class":"Benzodiazepines","brands":"Klonopin","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682279.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Use 0.5-1.5 mg three to four times a day as needed for anxiety\\nMax dose 6 mg/day","notes":"","alert":""},{"id":"Clonidine","name":"Clonidine","class":"Alpha-2 Agonists","brands":"Catapres","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Use 0.1-0.2 mg every 6 hours as needed for anxiety/agitation","notes":"","alert":""},{"id":"Clonidine","name":"Clonidine","class":"Alpha-2 Agonists","brands":"Catapres","monitor":"No specific recommendation.","side_effects_common":"sedation, dizziness, dry mouth, depression or anxiety, nausea, hypotension","side_effects_rare":"sinus bradycardia, AV block,\\nhypertensive encephalopathy during withdrawal (must taper to d/c)","info":"Must taper prior to discontinuation to prevent rebound hypertension and minimize the risk of encephalopathy","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Use 0.1-0.2 mg every 6 hours as needed for anxiety/agitation","notes":"","alert":""},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"25-50 mg up to four times daily as needed for anxiety/insomnia","notes":"","alert":""},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"25-50 mg up to four times daily as needed for anxiety/insomnia","notes":"","alert":""},{"id":"Hydroxyzine","name":"Hydroxyzine","class":"Antihistamines","brands":"Atarax, Vistaril","monitor":"No specific recommendation.","side_effects_common":"dry mouth, sedation, tremor","side_effects_rare":"respiratory depression","info":"","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"25-50 mg up to four times daily as needed for anxiety/insomnia","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Use 1 mg every 4-6 hours as needed for anxiety\\nMax dose 6mg/day","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Use 1 mg every 4-6 hours as needed for anxiety\\nMax dose 6mg/day","notes":"","alert":""},{"id":"Lorazepam","name":"Lorazepam","class":"Benzodiazepines","brands":"Ativan","monitor":"No specific recommendation.","side_effects_common":"Somnolence, ataxia","side_effects_rare":"Anterograde amnesia, paradoxical reaction, increased fall risk, respiratory depression","info":"FDA has issued a Drug Safety Communication requiring an update to the Benzodiazepine Box Warning to include the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions in order to help improve their safe use.\\n\\nFDA box warning- Risks from concomitant use with opioids.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682053.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"Use 0.5-1 mg every 4-6 hours as needed for anxiety\\nMax dose 6mg/day","notes":"","alert":""},{"id":"Ibuprofen","name":"Ibuprofen","class":"Analgesic","brands":"Advil, Motrin","monitor":"No specific recommendation.","side_effects_common":"Epigastric pain, heartburn, nausea, dizziness, skin rash, increased LFTs, anemia US","side_effects_rare":"CV events and GI bleeding","info":"Warning for CV risk and GI bleeding:\\n\\nhttps://medlineplus.gov/druginfo/meds/a682159.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Use 200mg-400mg every 4-6 hours as needed for myalgias\\nUsual dosing range 1200mg-2400mg daily","notes":"","alert":""},{"id":"Ibuprofen","name":"Ibuprofen","class":"Analgesic","brands":"Advil, Motrin","monitor":"No specific recommendation.","side_effects_common":"Epigastric pain, heartburn, nausea, dizziness, skin rash, increased LFTs, anemia US","side_effects_rare":"CV events and GI bleeding","info":"Warning for CV risk and GI bleeding:\\n\\nhttps://medlineplus.gov/druginfo/meds/a682159.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Use 200mg-400mg every 4-6 hours as needed for myalgias\\nUsual dosing range 1200mg-2400mg daily","notes":"","alert":""},{"id":"Loperamide","name":"Loperamide","class":"Antidiarrheal","brands":"Immodium","monitor":"No specific recommendation.","side_effects_common":"Dizziness, constipation, abdominal cramps, nausea","side_effects_rare":"","info":"Cases of torsades de pointes, cardiac arrest, and death have been reported with the use of a higher than recommended dose.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682280.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Starting dose 4mg once, followed by 2mg after each loose stool\\nMax dose 16mg/day","notes":"","alert":""},{"id":"Loperamide","name":"Loperamide","class":"Antidiarrheal","brands":"Immodium","monitor":"No specific recommendation.","side_effects_common":"Dizziness, constipation, abdominal cramps, nausea","side_effects_rare":"","info":"Cases of torsades de pointes, cardiac arrest, and death have been reported with the use of a higher than recommended dose.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682280.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Starting dose 4mg once, followed by 2mg after each loose stool\\nMax dose 16mg/day","notes":"","alert":""},{"id":"Loperamide","name":"Loperamide","class":"Antidiarrheal","brands":"Immodium","monitor":"No specific recommendation.","side_effects_common":"Dizziness, constipation, abdominal cramps, nausea","side_effects_rare":"","info":"Cases of torsades de pointes, cardiac arrest, and death have been reported with the use of a higher than recommended dose.\\n\\nhttps://medlineplus.gov/druginfo/meds/a682280.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"Starting dose 4mg once, followed by 2mg after each loose stool\\nMax dose 16mg/day","notes":"","alert":""},{"id":"Ondansetron","name":"Ondansetron","class":"5-HT3 Receptor Antagonist","brands":"Zofran","monitor":"No specific recommendation.","side_effects_common":"Headache, fatigue, drowsiness, constipation, dose-dependent QT prolongation","side_effects_rare":"","info":"","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Use 4mg-8mg every 12 hours as needed for nausea/vomiting\\nMax dose 16mg/day","notes":"","alert":""},{"id":"Ondansetron","name":"Ondansetron","class":"5-HT3 Receptor Antagonist","brands":"Zofran","monitor":"No specific recommendation.","side_effects_common":"Headache, fatigue, drowsiness, constipation, dose-dependent QT prolongation","side_effects_rare":"","info":"","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Use 4mg-8mg every 12 hours as needed for nausea/vomiting\\nMax dose 16mg/day","notes":"","alert":""},{"id":"Ondansetron","name":"Ondansetron","class":"5-HT3 Receptor Antagonist","brands":"Zofran","monitor":"No specific recommendation.","side_effects_common":"Headache, fatigue, drowsiness, constipation, dose-dependent QT prolongation","side_effects_rare":"","info":"","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"Use 4mg-8mg every 12 hours as needed for nausea/vomiting\\nMax dose 16mg/day","notes":"","alert":""},{"id":"Acetaminophen","name":"Acetaminophen","class":"Analgesic","brands":"Tylenol","monitor":"No specific recommendation.","side_effects_common":"skin rash, skin blistering, other skin related problems","side_effects_rare":"hepatotoxicity and hypersensitivity","info":"Use can be associated with liver failure:\\n\\nhttps://medlineplus.gov/druginfo/meds/a681004.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"Use 500-1000 mg up to three times a day as needed for myalgias\\nMax dose 3000mg/day","notes":"","alert":""},{"id":"Olanzapine + Fluoxetine separate","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"No specific recommendation.","side_effects_common":"nausea, insomnia, headache,  increased risk for diabetes, dizziness, sedation,\\nperipheral edema, dry mouth, weight gain","side_effects_rare":"hyponatremia, GI bleeding, agranulocytosis or severe neutropenia, DRESS, TD, NMS","info":"","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["preconception"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"","alert":""},{"id":"Olanzapine + Fluoxetine separate","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"No specific recommendation.","side_effects_common":"nausea, insomnia, headache,  increased risk for diabetes, dizziness, sedation,\\nperipheral edema, dry mouth, weight gain","side_effects_rare":"hyponatremia, GI bleeding, agranulocytosis or severe neutropenia, DRESS, TD, NMS","info":"","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["cardiac"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"see ECG recommendations","alert":"warning"},{"id":"Olanzapine + Fluoxetine separate","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"No specific recommendation.","side_effects_common":"nausea, insomnia, headache,  increased risk for diabetes, dizziness, sedation,\\nperipheral edema, dry mouth, weight gain","side_effects_rare":"hyponatremia, GI bleeding, agranulocytosis or severe neutropenia, DRESS, TD, NMS","info":"","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["geriatric"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"FDA box warning- Elderly patients with dementia-related psychosis treated with antipsychotics are at an increased risk of death. Not approved for the treatment of patients with dementia-related psychosis.","alert":""},{"id":"Olanzapine + Fluoxetine separate","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"No specific recommendation.","side_effects_common":"nausea, insomnia, headache,  increased risk for diabetes, dizziness, sedation,\\nperipheral edema, dry mouth, weight gain","side_effects_rare":"hyponatremia, GI bleeding, agranulocytosis or severe neutropenia, DRESS, TD, NMS","info":"","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"High associaiton with weight gain and metabolic dysfunction","alert":"caution"},{"id":"Olanzapine + Fluoxetine separate","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"No specific recommendation.","side_effects_common":"nausea, insomnia, headache,  increased risk for diabetes, dizziness, sedation,\\nperipheral edema, dry mouth, weight gain","side_effects_rare":"hyponatremia, GI bleeding, agranulocytosis or severe neutropenia, DRESS, TD, NMS","info":"","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"","alert":""},{"id":"Acamprosate","name":"Acamprosate","class":"Glutamate Multi-Modal","brands":"Campral","monitor":"Monitor creatinine clearance and adjust or stop medication per dosing guidelines","side_effects_common":"diarrhea (transient), weakness, anxiety, insomnia, depression, peripheral edema","side_effects_rare":"suicidality, cases of renal failure reported","info":"","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Starting and maintenance dose of 666mg three times daily\\nIn patients with creatinine clearance between 30 and 50, use 333mg three times daily\\nDo not use in patients with creatinine clearance less than 30 mL/min","notes":"","alert":""},{"id":"Acamprosate","name":"Acamprosate","class":"Glutamate Multi-Modal","brands":"Campral","monitor":"Monitor creatinine clearance and adjust or stop medication per dosing guidelines","side_effects_common":"diarrhea (transient), weakness, anxiety, insomnia, depression, peripheral edema","side_effects_rare":"suicidality, cases of renal failure reported","info":"","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adolescent"],"dosing":"Starting and maintenance dose of 333mg three times daily\\nDo not use in patients with creatinine clearance less than 30 mL/min","notes":"","alert":""},{"id":"Leuprolide acetate","name":"Leuprolide acetate","class":"GnRH Agonist","brands":"Lupron Depot","monitor":"No specific recommendation.","side_effects_common":"Pain at injection site\\n\\nOther side effects from the GnRH agonist (hot flushes, vaginal dryness, decreased libido, mood swings, headache, decreased bone density) may be mitigated somewhat by the add-back therapy.","side_effects_rare":"","info":"","length":"","diagnosis":"Premenstrual Dysphoric Disorder","branch":[],"population":["adult"],"dosing":"Start and maintain dose of 3.75 mg intramuscularlly administered monthly\\n\\nGenerally given with add-back estrogen and progesterone, such as oral estradiol 1mg + oral micronized progesterone 100 mg.","notes":"","alert":""},{"id":"Medroxyprogesterone Acetate","name":"Medroxyprogesterone Acetate","class":"Progestin-only Contraceptive (POC)","brands":"Depo-Provera","monitor":"No specific recommendation.","side_effects_common":"headache, weight gain, abdominal pain","side_effects_rare":"anaphylaxis/ angioedema,\\nbone density loss, seizures, thromboembolism","info":"","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"100 mg-600mg IM weekly or 100 mg-500mg/day orally.","notes":"","alert":""},{"id":"Bremelanotide","name":"Bremelanotide","class":"Melanocortin Receptor Agonist","brands":"Vyleesi","monitor":"No specific recommendation.","side_effects_common":"nausea (40%), flushing, injection site reactions, headache, vomiting","side_effects_rare":"transient(up to 12 hour) increase in bp and decrease in heart rate after each dose, focal hyperpigmentation in 1% patients (may be permanent in half of these)","info":"","length":"","diagnosis":"Female Sexual Interest/Arousal Disorder","branch":[],"population":["adult"],"dosing":"Administer 1.75 mg via subcutaneous injection as needed at minimum 45 minutes before sexual activity\\nLimit use to once daily and no more than eight uses per month","notes":"","alert":""},{"id":"Melatonin","name":"Melatonin","class":"Melatonin","brands":"Several OTC formulations","monitor":"No specific recommendation.","side_effects_common":"headaches, dizziness, drowsiness, grogginess next day","side_effects_rare":"none reported","info":"","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["pediatric"],"dosing":"Preschool:\\nUse 0.3mg-1mg 30 minutes- 3 hours before bedtime \\n\\nSchool-aged children:\\nUse 2.5mg- 5mg 30 minutes- 3 hours before bedtime\\n\\nOlder children and adolescents:\\nUse 2.5mg- 5mg 30 minutes- 3 hours before bedtime\\nHowever, may require up to 5mg-10 mg","notes":"Used off-label for insomnia","alert":""},{"id":"Melatonin","name":"Melatonin","class":"Melatonin","brands":"Several OTC formulations","monitor":"No specific recommendation.","side_effects_common":"headaches, dizziness, drowsiness, grogginess next day","side_effects_rare":"none reported","info":"","length":"","diagnosis":"Autism Spectrum Disorder","branch":[],"population":["adolescent"],"dosing":"Use 2.5mg- 5mg 30 minutes- 3 hours before bedtime\\nHowever, may require up to 5mg-10 mg","notes":"Used off-label for insomnia","alert":""},{"id":"Aptensio XR","name":"Aptensio XR","class":"Methylphenidate & derivatives","brands":"Aptensio XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (12 hours):\\nStart 10 mg daily\\nIncrease by 10 mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Aptensio XR","name":"Aptensio XR","class":"Methylphenidate & derivatives","brands":"Aptensio XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (12 hours):\\nStart 10 mg daily\\nIncrease by 10 mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Aptensio XR","name":"Aptensio XR","class":"Methylphenidate & derivatives","brands":"Aptensio XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (12 hours):\\nStart 10 mg daily\\nIncrease by 10 mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Aptensio XR","name":"Aptensio XR","class":"Methylphenidate & derivatives","brands":"Aptensio XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (12 hours):\\nStart 10 mg daily\\nIncrease by 10 mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Aptensio XR","name":"Aptensio XR","class":"Methylphenidate & derivatives","brands":"Aptensio XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Long acting (12 hours):\\nStart 10 mg daily\\nIncrease by 10 mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Aptensio XR","name":"Aptensio XR","class":"Methylphenidate & derivatives","brands":"Aptensio XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Long acting (12 hours):\\nStart 10 mg daily\\nIncrease by 10 mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Aptensio XR","name":"Aptensio XR","class":"Methylphenidate & derivatives","brands":"Aptensio XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (12 hours):\\nStart 10 mg daily\\nIncrease by 10 mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Aptensio XR","name":"Aptensio XR","class":"Methylphenidate & derivatives","brands":"Aptensio XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (12 hours):\\nStart 10 mg daily\\nIncrease by 10 mg/day in minimum one weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Focalin XR","name":"Focalin XR","class":"Methylphenidate & derivatives","brands":"Focalin XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nDo not use in patients with glaucoma\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (8-12):\\nStart 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Focalin XR","name":"Focalin XR","class":"Methylphenidate & derivatives","brands":"Focalin XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nDo not use in patients with glaucoma\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (8-12):\\nStart 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Focalin XR","name":"Focalin XR","class":"Methylphenidate & derivatives","brands":"Focalin XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nDo not use in patients with glaucoma\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Long acting (8-12): \\nStart 10 mg/day Increase by 10 mg/day in minimum one week as clinically indicated and tolerable \\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Focalin XR","name":"Focalin XR","class":"Methylphenidate & derivatives","brands":"Focalin XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nDo not use in patients with glaucoma\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Long acting (8-12):\\nStart 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Focalin XR","name":"Focalin XR","class":"Methylphenidate & derivatives","brands":"Focalin XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nDo not use in patients with glaucoma\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (8-12):\\nStart 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Focalin XR","name":"Focalin XR","class":"Methylphenidate & derivatives","brands":"Focalin XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nDo not use in patients with glaucoma\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html\\n\\nMay be sprinkled in applesauce. Capsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (8-12):\\nStart 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Focalin","name":"Focalin","class":"Methylphenidate & derivatives","brands":"Focalin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Typically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Short acting (3-4 hours):\\nStarting dose 2.5mg twice daily\\nTitrate by 2.5mg-5mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Focalin","name":"Focalin","class":"Methylphenidate & derivatives","brands":"Focalin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Typically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Short acting (3-4 hours):\\nStarting dose 2.5mg twice daily\\nTitrate by 2.5mg-5mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Focalin XR","name":"Focalin XR","class":"Methylphenidate & derivatives","brands":"Focalin XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html\\n\\nCapsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (8-12 hours):\\nStart 5mg daily\\nTitrate by 5mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 30mg/day","notes":"","alert":""},{"id":"Focalin XR","name":"Focalin XR","class":"Methylphenidate & derivatives","brands":"Focalin XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a603014.html\\n\\nCapsule contents should not be crushed, chewed, or divided.","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nStart 5mg daily\\nTitrate by 5mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 30mg/day","notes":"","alert":""},{"id":"Ritalin LA","name":"Ritalin LA","class":"Methylphenidate & derivatives","brands":"Ritalin LA","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nMay be sprinkled in applesauce. Do not crush or chew.  \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (8-12 hours):\\nStart 10-20 mg daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Ritalin LA","name":"Ritalin LA","class":"Methylphenidate & derivatives","brands":"Ritalin LA","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nMay be sprinkled in applesauce. Do not crush or chew.  \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nStart 10-20 mg daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Ritalin LA","name":"Ritalin LA","class":"Methylphenidate & derivatives","brands":"Ritalin LA","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nMay be sprinkled in applesauce. Do not crush or chew.  \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (8-12 hours):\\nStart 10-20 mg daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Ritalin LA","name":"Ritalin LA","class":"Methylphenidate & derivatives","brands":"Ritalin LA","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nMay be sprinkled in applesauce. Do not crush or chew.  \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (8-12 hours):\\nStart 10-20 mg daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Ritalin LA","name":"Ritalin LA","class":"Methylphenidate & derivatives","brands":"Ritalin LA","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nMay be sprinkled in applesauce. Do not crush or chew.  \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Long acting (8-12 hours):\\nStart 10-20 mg daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Ritalin LA","name":"Ritalin LA","class":"Methylphenidate & derivatives","brands":"Ritalin LA","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nMay be sprinkled in applesauce. Do not crush or chew.  \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Long acting (8-12 hours):\\nStart 10-20 mg daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Ritalin LA","name":"Ritalin LA","class":"Methylphenidate & derivatives","brands":"Ritalin LA","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nMay be sprinkled in applesauce. Do not crush or chew.  \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (8-12 hours):\\nStart 10-20 mg daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Ritalin LA","name":"Ritalin LA","class":"Methylphenidate & derivatives","brands":"Ritalin LA","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM.\\n\\nMay be sprinkled in applesauce. Do not crush or chew.  \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (8-12 hours):\\nStart 10-20 mg daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate ER","name":"Metadate ER","class":"Methylphenidate & derivatives","brands":"Metadate ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Medium Acting (6-8 hours): \\nStart 10 mg twice daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30 mg twice daily","notes":"","alert":""},{"id":"Metadate ER","name":"Metadate ER","class":"Methylphenidate & derivatives","brands":"Metadate ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Medium Acting (6-8 hours): \\nStart 10 mg twice daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30 mg twice daily","notes":"","alert":""},{"id":"Metadate ER","name":"Metadate ER","class":"Methylphenidate & derivatives","brands":"Metadate ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Medium Acting (6-8 hours): \\nStart 10 mg twice daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30 mg twice daily","notes":"","alert":""},{"id":"Metadate ER","name":"Metadate ER","class":"Methylphenidate & derivatives","brands":"Metadate ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Medium Acting (6-8 hours): \\nStart 10 mg twice daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30 mg twice daily","notes":"","alert":""},{"id":"Metadate ER","name":"Metadate ER","class":"Methylphenidate & derivatives","brands":"Metadate ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Medium Acting (6-8 hours): \\nStart 10 mg twice daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30 mg twice daily","notes":"","alert":""},{"id":"Metadate ER","name":"Metadate ER","class":"Methylphenidate & derivatives","brands":"Metadate ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Medium Acting (6-8 hours): \\nStart 10 mg twice daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30 mg twice daily","notes":"","alert":""},{"id":"Metadate CD","name":"Metadate CD","class":"Methylphenidate & derivatives","brands":"Metadate CD","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg daily\\nIncrease by 10-20 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate CD","name":"Metadate CD","class":"Methylphenidate & derivatives","brands":"Metadate CD","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg daily\\nIncrease by 10-20 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate CD","name":"Metadate CD","class":"Methylphenidate & derivatives","brands":"Metadate CD","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg daily\\nIncrease by 10-20 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate CD","name":"Metadate CD","class":"Methylphenidate & derivatives","brands":"Metadate CD","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg daily\\nIncrease by 10-20 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate CD","name":"Metadate CD","class":"Methylphenidate & derivatives","brands":"Metadate CD","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg daily\\nIncrease by 10-20 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate CD","name":"Metadate CD","class":"Methylphenidate & derivatives","brands":"Metadate CD","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg daily\\nIncrease by 10-20 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate CD","name":"Metadate CD","class":"Methylphenidate & derivatives","brands":"Metadate CD","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg daily\\nIncrease by 10-20 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate CD","name":"Metadate CD","class":"Methylphenidate & derivatives","brands":"Metadate CD","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, tremor, dizziness, nausea","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg daily\\nIncrease by 10-20 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg daily","notes":"","alert":""},{"id":"Metadate ER","name":"Metadate ER","class":"Methylphenidate & derivatives","brands":"Metadate ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Medium Acting (6-8 hours): \\nStart 10 mg twice daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30 mg twice daily","notes":"","alert":""},{"id":"Metadate ER","name":"Metadate ER","class":"Methylphenidate & derivatives","brands":"Metadate ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"May supplement with short acting in the afternoon to cover the rest of the day; however, do not give after 5 PM. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Medium Acting (6-8 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Medium Acting (6-8 hours): \\nStart 10 mg twice daily\\nIncrease by 10 mg/dose in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 30 mg twice daily","notes":"","alert":""},{"id":"Concerta","name":"Concerta","class":"Methylphenidate & derivatives","brands":"Concerta","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (10-16 hours):\\nStart 18-36 mg/day\\nIncrease by 18 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 72 mg/day","notes":"","alert":""},{"id":"Concerta","name":"Concerta","class":"Methylphenidate & derivatives","brands":"Concerta","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (10-16 hours):\\nStart 18-36 mg/day\\nIncrease by 18 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 72 mg/day","notes":"","alert":""},{"id":"Concerta","name":"Concerta","class":"Methylphenidate & derivatives","brands":"Concerta","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Long acting (10-16 hours):\\nStart 18-36 mg/day\\nIncrease by 18 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 72 mg/day","notes":"","alert":""},{"id":"Concerta","name":"Concerta","class":"Methylphenidate & derivatives","brands":"Concerta","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Long acting (10-16 hours):\\nStart 18-36 mg/day\\nIncrease by 18 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 72 mg/day","notes":"","alert":""},{"id":"Concerta","name":"Concerta","class":"Methylphenidate & derivatives","brands":"Concerta","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (10-16 hours):\\nStart 18-36 mg/day\\nIncrease by 18 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 72 mg/day","notes":"","alert":""},{"id":"Concerta","name":"Concerta","class":"Methylphenidate & derivatives","brands":"Concerta","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (10-16 hours):\\nStart 18-36 mg/day\\nIncrease by 18 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 72 mg/day","notes":"","alert":""},{"id":"Concerta","name":"Concerta","class":"Methylphenidate & derivatives","brands":"Concerta","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (10-16 hours):\\nStart 18 mg/day\\nIncrease by 18 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 54 mg/day for children up to 12 years of age and 72 mg/day for children 12 years of age and older","notes":"","alert":""},{"id":"Concerta","name":"Concerta","class":"Methylphenidate & derivatives","brands":"Concerta","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (10-16 hours):\\nStart 18 mg/day\\nIncrease by 18 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 72 mg/day","notes":"","alert":""},{"id":"Cotempla XR-ODT","name":"Cotempla XR-ODT","class":"Methylphenidate & derivatives","brands":"Cotempla XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (12 hours):\\nStart 17.3 mg sublingually daily\\nIncrease by 8.6-17.3 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 51.8 mg/day","notes":"","alert":""},{"id":"Cotempla XR-ODT","name":"Cotempla XR-ODT","class":"Methylphenidate & derivatives","brands":"Cotempla XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (12 hours):\\nStart 17.3 mg sublingually daily\\nIncrease by 8.6-17.3 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 51.8 mg/day","notes":"","alert":""},{"id":"Cotempla XR-ODT","name":"Cotempla XR-ODT","class":"Methylphenidate & derivatives","brands":"Cotempla XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Long acting (12 hours):\\nStart 17.3 mg sublingually daily\\nIncrease by 8.6-17.3 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 51.8 mg/day","notes":"","alert":""},{"id":"Cotempla XR-ODT","name":"Cotempla XR-ODT","class":"Methylphenidate & derivatives","brands":"Cotempla XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Long acting (12 hours):\\nStart 17.3 mg sublingually daily\\nIncrease by 8.6-17.3 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 51.8 mg/day","notes":"","alert":""},{"id":"Cotempla XR-ODT","name":"Cotempla XR-ODT","class":"Methylphenidate & derivatives","brands":"Cotempla XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Long acting (12 hours):\\nStart 17.3 mg sublingually daily\\nIncrease by 8.6-17.3 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 51.8 mg/day","notes":"","alert":""},{"id":"Cotempla XR-ODT","name":"Cotempla XR-ODT","class":"Methylphenidate & derivatives","brands":"Cotempla XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Long acting (12 hours):\\nStart 17.3 mg sublingually daily\\nIncrease by 8.6-17.3 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 51.8 mg/day","notes":"","alert":""},{"id":"Cotempla XR-ODT","name":"Cotempla XR-ODT","class":"Methylphenidate & derivatives","brands":"Cotempla XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Long acting (12 hours):\\nStart 17.3 mg sublingually daily\\nIncrease by 8.6-17.3 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 51.8 mg/day","notes":"","alert":""},{"id":"Cotempla XR-ODT","name":"Cotempla XR-ODT","class":"Methylphenidate & derivatives","brands":"Cotempla XR-ODT","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Must be dissolved completely by placing on or under the tongue. Do not chew or crush. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Long acting (12 hours):\\nStart 17.3 mg sublingually daily\\nIncrease by 8.6-17.3 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 51.8 mg/day","notes":"","alert":""},{"id":"Quillichew ER","name":"Quillichew ER","class":"Methylphenidate & derivatives","brands":"Quillichew ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Table is chewable. 20 and 30 mg tablets are scored for easier titration. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (8-12 hours):\\nChew 20 mg/day\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Quillichew ER","name":"Quillichew ER","class":"Methylphenidate & derivatives","brands":"Quillichew ER","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Table is chewable. 20 and 30 mg tablets are scored for easier titration. \\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nChew 20 mg/day\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Quillivant XR","name":"Quillivant XR","class":"Methylphenidate & derivatives","brands":"Quillivant XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg/day\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Quillivant XR","name":"Quillivant XR","class":"Methylphenidate & derivatives","brands":"Quillivant XR","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Black box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Long acting (8-12 hours):\\nStart 20 mg/day\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 60 mg/day","notes":"","alert":""},{"id":"Daytrana","name":"Daytrana","class":"Methylphenidate & derivatives","brands":"Daytrana","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, skin site reactions (reported in 10-40% of children)","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality, serious skin reactions which may sensitive the body thus increasing the chance of further systemic reactions","info":"Absorption occurs for several hours after patch is removed. \\n\\nSerious skin reactions can occur; however, less serious but more common reactions are expected (reported in 10-40% of children). The FDA issued a warning for the development of leukoderma with use of Daytrana. Recommended to apply to the hip area in an alternating fashion to minimize skin side effects.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a606014.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Start 10 mg patch daily \\nApply at least 2 hours before desired onset time\\nRemove after a maximum time of 9 hours and at least 3 hours prior to bedtime\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day\\nOccasional maximum dose 60 mg/day","notes":"","alert":""},{"id":"Daytrana","name":"Daytrana","class":"Methylphenidate & derivatives","brands":"Daytrana","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, skin site reactions (reported in 10-40% of children)","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality, serious skin reactions which may sensitive the body thus increasing the chance of further systemic reactions","info":"Absorption occurs for several hours after patch is removed. \\n\\nSerious skin reactions can occur; however, less serious but more common reactions are expected (reported in 10-40% of children). The FDA issued a warning for the development of leukoderma with use of Daytrana. Recommended to apply to the hip area in an alternating fashion to minimize skin side effects.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a606014.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Start 10 mg patch daily \\nApply at least 2 hours before desired onset time\\nRemove after a maximum time of 9 hours and at least 3 hours prior to bedtime\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day\\nOccasional maximum dose 60 mg/day","notes":"","alert":""},{"id":"Daytrana","name":"Daytrana","class":"Methylphenidate & derivatives","brands":"Daytrana","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, skin site reactions (reported in 10-40% of children)","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality, serious skin reactions which may sensitive the body thus increasing the chance of further systemic reactions","info":"Absorption occurs for several hours after patch is removed. \\n\\nSerious skin reactions can occur; however, less serious but more common reactions are expected (reported in 10-40% of children). The FDA issued a warning for the development of leukoderma with use of Daytrana. Recommended to apply to the hip area in an alternating fashion to minimize skin side effects.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a606014.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Start 10 mg patch daily \\nApply at least 2 hours before desired onset time\\nRemove after a maximum time of 9 hours and at least 3 hours prior to bedtime\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day\\nOccasional maximum dose 60 mg/day","notes":"","alert":""},{"id":"Daytrana","name":"Daytrana","class":"Methylphenidate & derivatives","brands":"Daytrana","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, skin site reactions (reported in 10-40% of children)","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality, serious skin reactions which may sensitive the body thus increasing the chance of further systemic reactions","info":"Absorption occurs for several hours after patch is removed. \\n\\nSerious skin reactions can occur; however, less serious but more common reactions are expected (reported in 10-40% of children). The FDA issued a warning for the development of leukoderma with use of Daytrana. Recommended to apply to the hip area in an alternating fashion to minimize skin side effects.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a606014.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Start 10 mg patch daily \\nApply at least 2 hours before desired onset time\\nRemove after a maximum time of 9 hours and at least 3 hours prior to bedtime\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day\\nOccasional maximum dose 60 mg/day","notes":"","alert":""},{"id":"Daytrana","name":"Daytrana","class":"Methylphenidate & derivatives","brands":"Daytrana","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, skin site reactions (reported in 10-40% of children)","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality, serious skin reactions which may sensitive the body thus increasing the chance of further systemic reactions","info":"Absorption occurs for several hours after patch is removed. \\n\\nSerious skin reactions can occur; however, less serious but more common reactions are expected (reported in 10-40% of children). The FDA issued a warning for the development of leukoderma with use of Daytrana. Recommended to apply to the hip area in an alternating fashion to minimize skin side effects.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a606014.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Start 10 mg patch daily \\nApply at least 2 hours before desired onset time\\nRemove after a maximum time of 9 hours and at least 3 hours prior to bedtime\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day\\nOccasional maximum dose 60 mg/day","notes":"","alert":""},{"id":"Daytrana","name":"Daytrana","class":"Methylphenidate & derivatives","brands":"Daytrana","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, skin site reactions (reported in 10-40% of children)","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality, serious skin reactions which may sensitive the body thus increasing the chance of further systemic reactions","info":"Absorption occurs for several hours after patch is removed. \\n\\nSerious skin reactions can occur; however, less serious but more common reactions are expected (reported in 10-40% of children). The FDA issued a warning for the development of leukoderma with use of Daytrana. Recommended to apply to the hip area in an alternating fashion to minimize skin side effects.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a606014.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Start 10 mg patch daily \\nApply at least 2 hours before desired onset time\\nRemove after a maximum time of 9 hours and at least 3 hours prior to bedtime\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day\\nOccasional maximum dose 60 mg/day","notes":"","alert":""},{"id":"Daytrana","name":"Daytrana","class":"Methylphenidate & derivatives","brands":"Daytrana","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, skin site reactions (reported in 10-40% of children)","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality, serious skin reactions which may sensitive the body thus increasing the chance of further systemic reactions","info":"Absorption occurs for several hours after patch is removed. \\n\\nSerious skin reactions can occur; however, less serious but more common reactions are expected (reported in 10-40% of children). The FDA issued a warning for the development of leukoderma with use of Daytrana. Recommended to apply to the hip area in an alternating fashion to minimize skin side effects.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a606014.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Start 10 mg patch daily \\nApply at least 2 hours before desired onset time\\nRemove after a maximum time of 9 hours and at least 3 hours prior to bedtime\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day","notes":"","alert":""},{"id":"Daytrana","name":"Daytrana","class":"Methylphenidate & derivatives","brands":"Daytrana","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics, skin site reactions (reported in 10-40% of children)","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality, serious skin reactions which may sensitive the body thus increasing the chance of further systemic reactions","info":"Absorption occurs for several hours after patch is removed. \\n\\nSerious skin reactions can occur; however, less serious but more common reactions are expected (reported in 10-40% of children). The FDA issued a warning for the development of leukoderma with use of Daytrana. Recommended to apply to the hip area in an alternating fashion to minimize skin side effects.\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a606014.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Start 10 mg patch daily \\nApply at least 2 hours before desired onset time\\nRemove after a maximum time of 9 hours and at least 3 hours prior to bedtime\\nIncrease by 10 mg/day in minimum 1 weeks as clinically indicated and tolerable\\nMaximum dose 30 mg/day","notes":"","alert":""},{"id":"Ritalin","name":"Ritalin or Methylin","class":"Methylphenidate & derivatives","brands":"Ritalin or Methylin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nRitalin available as tablet, Methylin available as chewable tablet or oral solution\\n\\nDo not use in patients with glaucoma.\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Short acting (3-4 hours):\\nStart 5-10 mg twice daily\\nIncrease 5-10 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg/day in two or three divided doses","notes":"","alert":""},{"id":"Ritalin","name":"Ritalin or Methylin","class":"Methylphenidate & derivatives","brands":"Ritalin or Methylin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nRitalin available as tablet, Methylin available as chewable tablet or oral solution\\n\\nDo not use in patients with glaucoma.\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Short acting (3-4 hours):\\nStart 5-10 mg twice daily\\nIncrease 5-10 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg/day in two or three divided doses","notes":"","alert":""},{"id":"Ritalin","name":"Ritalin or Methylin","class":"Methylphenidate & derivatives","brands":"Ritalin or Methylin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nRitalin available as tablet, Methylin available as chewable tablet or oral solution\\n\\nDo not use in patients with glaucoma.\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Short acting (3-4 hours):\\nStart 5-10 mg twice daily\\nIncrease 5-10 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg/day in two or three divided doses","notes":"","alert":""},{"id":"Ritalin","name":"Ritalin or Methylin","class":"Methylphenidate & derivatives","brands":"Ritalin or Methylin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nRitalin available as tablet, Methylin available as chewable tablet or oral solution\\n\\nDo not use in patients with glaucoma.\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Short acting (3-4 hours):\\nStart 5-10 mg twice daily\\nIncrease 5-10 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg/day in two or three divided doses","notes":"","alert":""},{"id":"Ritalin","name":"Ritalin or Methylin","class":"Methylphenidate & derivatives","brands":"Ritalin or Methylin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nRitalin available as tablet, Methylin available as chewable tablet or oral solution\\n\\nDo not use in patients with glaucoma.\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Short acting (3-4 hours):\\nStart 5-10 mg twice daily\\nIncrease 5-10 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg/day in two or three divided doses","notes":"","alert":""},{"id":"Ritalin","name":"Ritalin or Methylin","class":"Methylphenidate & derivatives","brands":"Ritalin or Methylin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Higher abuse potential compared to long acting formulations. Use with caution in adults. \\n\\nRitalin available as tablet, Methylin available as chewable tablet or oral solution\\n\\nDo not use in patients with glaucoma.\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Short acting (3-4 hours):\\nStart 5-10 mg twice daily\\nIncrease 5-10 mg/day in minimum 1 week as clinically indicated and tolerable\\nMaximum dose 60 mg/day in two or three divided doses","notes":"","alert":""},{"id":"Ritalin","name":"Ritalin or Methylin","class":"Methylphenidate & derivatives","brands":"Ritalin or Methylin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Typically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nRitalin available as tablet, Methylin available as chewable tablet or oral solution","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Short acting (3-4 hours):\\nStart 2.5-5 mg twice daily\\nIncrease by 2.5-5 mg/dose in minimum one week as clinically indicated and tolerable\\nMaximum dose 60 mg/day in two or three divided doses (or 2 mg/kg/day which is lower)","notes":"","alert":""},{"id":"Ritalin","name":"Ritalin or Methylin","class":"Methylphenidate & derivatives","brands":"Ritalin or Methylin","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Typically dosed in the morning and at lunchtime (at least 4 hours apart). Occasionally may be given three times daily. Avoid use after 5 PM.\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html\\n\\nRitalin available as tablet, Methylin available as chewable tablet or oral solution","length":"Short Acting (4-6 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Short acting (3-4 hours):\\nStart 2.5-5 mg twice daily\\nIncrease by 2.5-5 mg/dose in minimum one week as clinically indicated and tolerable\\nMaximum dose 60 mg/day in two or three divided doses (or 2 mg/kg/day which is lower)","notes":"","alert":""},{"id":"Jornay PM","name":"Jornay PM","class":"Methylphenidate & derivatives","brands":"Jornay PM","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Start with lowest manufactured dose in the morning. Increase at weekly intervals if necessary and as tolerated. May not need target dose or maximum dose\\n\\nMay be sprinkled into applesauce\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Start 20 mg/day administered at nighttime (between 6:30 PM and 9:30 PM)\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day.","notes":"","alert":""},{"id":"Jornay PM","name":"Jornay PM","class":"Methylphenidate & derivatives","brands":"Jornay PM","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Start with lowest manufactured dose in the morning. Increase at weekly intervals if necessary and as tolerated. May not need target dose or maximum dose\\n\\nMay be sprinkled into applesauce\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Start 20 mg/day administered at nighttime (between 6:30 PM and 9:30 PM)\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day.","notes":"","alert":""},{"id":"Jornay PM","name":"Jornay PM","class":"Methylphenidate & derivatives","brands":"Jornay PM","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Start with lowest manufactured dose in the morning. Increase at weekly intervals if necessary and as tolerated. May not need target dose or maximum dose\\n\\nMay be sprinkled into applesauce\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Start 20 mg/day administered at nighttime (between 6:30 PM and 9:30 PM)\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day.","notes":"","alert":""},{"id":"Jornay PM","name":"Jornay PM","class":"Methylphenidate & derivatives","brands":"Jornay PM","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Start with lowest manufactured dose in the morning. Increase at weekly intervals if necessary and as tolerated. May not need target dose or maximum dose\\n\\nMay be sprinkled into applesauce\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Start 20 mg/day administered at nighttime (between 6:30 PM and 9:30 PM)\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day.","notes":"","alert":""},{"id":"Jornay PM","name":"Jornay PM","class":"Methylphenidate & derivatives","brands":"Jornay PM","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Start with lowest manufactured dose in the morning. Increase at weekly intervals if necessary and as tolerated. May not need target dose or maximum dose\\n\\nMay be sprinkled into applesauce\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"Start 20 mg/day administered at nighttime (between 6:30 PM and 9:30 PM)\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day.","notes":"","alert":""},{"id":"Jornay PM","name":"Jornay PM","class":"Methylphenidate & derivatives","brands":"Jornay PM","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Start with lowest manufactured dose in the morning. Increase at weekly intervals if necessary and as tolerated. May not need target dose or maximum dose\\n\\nMay be sprinkled into applesauce\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Start 20 mg/day administered at nighttime (between 6:30 PM and 9:30 PM)\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day.","notes":"","alert":""},{"id":"Jornay PM","name":"Jornay PM","class":"Methylphenidate & derivatives","brands":"Jornay PM","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Start with lowest manufactured dose in the morning. Increase at weekly intervals if necessary and as tolerated. May not need target dose or maximum dose\\n\\nMay be sprinkled into applesauce\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Start 20 mg/day administered at nighttime (between 6:30 PM and 9:30 PM)\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day.","notes":"","alert":""},{"id":"Jornay PM","name":"Jornay PM","class":"Methylphenidate & derivatives","brands":"Jornay PM","monitor":"Obtain a cardiac history (including family history) and perform a cardiac examination prior to starting stimulants; however, routine EKG for patients without cardiac risk factors is not required. (AAP/AHA recommendation)","side_effects_common":"insomnia, anorexia\\nweight loss, headache, nausea,\\ntics;","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Start with lowest manufactured dose in the morning. Increase at weekly intervals if necessary and as tolerated. May not need target dose or maximum dose\\n\\nMay be sprinkled into applesauce\\n\\nBlack box warning for misuse potential- \\n\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"Long Acting (8-10 hrs)","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Start 20 mg/day administered at nighttime (between 6:30 PM and 9:30 PM)\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day.","notes":"","alert":""},{"id":"Flibanserin","name":"Flibanserin","class":"Mixed agonist-antagonist postsynaptic serotonergic receptors","brands":"Addyi","monitor":"No specific recommendation.","side_effects_common":"dizziness, somnolence, nausea, fatigue","side_effects_rare":"hypotension and dizziness (especially with taken with alcohol), syncope","info":"Black box waring-interaction with alcohol \\n\\nhttps://medlineplus.gov/druginfo/meds/a615040.html","length":"","diagnosis":"Female Sexual Interest/Arousal Disorder","branch":[],"population":["adult"],"dosing":"Start and maintain dose of 100 mg nightly\\nDiscontinue after 8 weeks if no improvement","notes":"","alert":""},{"id":"Carbamazepine","name":"Carbamazepine","class":"Mood Stabilizers","brands":"Tegretol","monitor":"Carbamazepine level, CBC w/ differential, sodium, LFTs, pregnancy test, HLA-B1502 in people of Asian descent. Aim for blood level of 4-12 mcg/ml","side_effects_common":"dizziness, sedation, nausea, headache, rash","side_effects_rare":"myelosuppression, hepatitis, jaundice, SJS/TEN, angioedema, SIADH","info":"Avoid in women of childbearing age/pregnancy\\n\\nCarbamazepine may decrease drug plasma concentration of hormonal contraceptives, consider non-hormonal contraception\\n\\nFDA box warning:\\n-Aplastic anemia and agranulocytosis\\n-Serious dermatologic reactions and HLA-B*1502 allele\\n\\nhttps://medlineplus.gov/druginfo/meds/a682237.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Starting dose 200 mg BID; increase gradually by 200 mg/day every 3 days as tolerated and clinically indicated. \\nTarget dose: 400mg-600 mg BID\\nMax dose 800 mg BID \\nGoal serum level of 4-12 mcg/ml","notes":"","alert":""},{"id":"Carbamazepine","name":"Carbamazepine","class":"Mood Stabilizers","brands":"Tegretol","monitor":"Carbamazepine level, CBC w/ differential, sodium, LFTs, pregnancy test, HLA-B1502 in people of Asian descent. Aim for blood level of 4-12 mcg/ml","side_effects_common":"dizziness, sedation, nausea, headache, rash","side_effects_rare":"myelosuppression, hepatitis, jaundice, SJS/TEN, angioedema, SIADH","info":"Avoid in women of childbearing age/pregnancy\\n\\nCarbamazepine may decrease drug plasma concentration of hormonal contraceptives, consider non-hormonal contraception\\n\\nFDA box warning:\\n-Aplastic anemia and agranulocytosis\\n-Serious dermatologic reactions and HLA-B*1502 allele\\n\\nhttps://medlineplus.gov/druginfo/meds/a682237.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Starting dose 200 mg BID; increase gradually by 200 mg/day every 3 days as tolerated and clinically indicated. \\nTarget dose: 400mg-600 mg BID\\nMax dose 800 mg BID \\nGoal serum level of 4-12 mcg/ml","notes":"May cause conduction abnormalities, including AV block. In a scientific statement from the American Heart Association, carbamazepine has been determined to be an agent that may exacerbate underlying myocardial dysfunction (magnitude: major) in patients with heart failure.","alert":""},{"id":"Carbamazepine","name":"Carbamazepine","class":"Mood Stabilizers","brands":"Tegretol","monitor":"Carbamazepine level, CBC w/ differential, sodium, LFTs, pregnancy test, HLA-B1502 in people of Asian descent. Aim for blood level of 4-12 mcg/ml","side_effects_common":"dizziness, sedation, nausea, headache, rash","side_effects_rare":"myelosuppression, hepatitis, jaundice, SJS/TEN, angioedema, SIADH","info":"Avoid in women of childbearing age/pregnancy\\n\\nCarbamazepine may decrease drug plasma concentration of hormonal contraceptives, consider non-hormonal contraception\\n\\nFDA box warning:\\n-Aplastic anemia and agranulocytosis\\n-Serious dermatologic reactions and HLA-B*1502 allele\\n\\nhttps://medlineplus.gov/druginfo/meds/a682237.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Starting dose 200 mg BID; increase gradually by 200 mg/day every 3 days as tolerated and clinically indicated. \\nTarget dose: 400mg-600 mg BID\\nMax dose 800 mg BID \\n(Dosing is the same for both the IR and XR formulations)\\nAim for blood level of 4-12 mcg/ml","notes":"","alert":""},{"id":"Carbamazepine","name":"Carbamazepine","class":"Mood Stabilizers","brands":"Tegretol","monitor":"Carbamazepine level, CBC w/ differential, sodium, LFTs, pregnancy test, HLA-B1502 in people of Asian descent. Aim for blood level of 4-12 mcg/ml","side_effects_common":"dizziness, sedation, nausea, headache, rash","side_effects_rare":"myelosuppression, hepatitis, jaundice, SJS/TEN, angioedema, SIADH","info":"Avoid in women of childbearing age/pregnancy\\n\\nCarbamazepine may decrease drug plasma concentration of hormonal contraceptives, consider non-hormonal contraception\\n\\nFDA box warning:\\n-Aplastic anemia and agranulocytosis\\n-Serious dermatologic reactions and HLA-B*1502 allele\\n\\nhttps://medlineplus.gov/druginfo/meds/a682237.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Starting dose 200 mg BID; increase gradually by 200 mg/day every 3 days as tolerated and clinically indicated. \\nTarget dose: 400mg-600 mg BID\\nMax dose 800 mg BID \\nGoal serum level of 4-12 mcg/ml","notes":"","alert":""},{"id":"Carbamazepine","name":"Carbamazepine","class":"Mood Stabilizers","brands":"Tegretol","monitor":"Carbamazepine level, CBC w/ differential, sodium, LFTs, pregnancy test, HLA-B1502 in people of Asian descent. Aim for blood level of 4-12 mcg/ml","side_effects_common":"dizziness, sedation, nausea, headache, rash","side_effects_rare":"myelosuppression, hepatitis, jaundice, SJS/TEN, angioedema, SIADH","info":"Avoid in women of childbearing age/pregnancy\\n\\nCarbamazepine may decrease drug plasma concentration of hormonal contraceptives, consider non-hormonal contraception\\n\\nFDA box warning:\\n-Aplastic anemia and agranulocytosis\\n-Serious dermatologic reactions and HLA-B*1502 allele\\n\\nhttps://medlineplus.gov/druginfo/meds/a682237.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Starting dose 200 mg BID; increase gradually by 200 mg/day every 3 days as tolerated and clinically indicated. \\nTarget dose: 400mg-600 mg BID\\nMax dose 800 mg BID \\nGoal serum level of 4-12 mcg/ml","notes":"in moderate to severe kidney dysfunction, serum 10,11-carbamazepine epoxide levels may be increased. Consider measuring 10,11-carbamazepine epoxide levels in instances where toxicity is suspected, but serum carbamazepine levels are within normal range.","alert":""},{"id":"Carbamazepine","name":"Carbamazepine","class":"Mood Stabilizers","brands":"Tegretol","monitor":"Carbamazepine level, CBC w/ differential, sodium, LFTs, pregnancy test, HLA-B1502 in people of Asian descent. Aim for blood level of 4-12 mcg/ml","side_effects_common":"dizziness, sedation, nausea, headache, rash","side_effects_rare":"myelosuppression, hepatitis, jaundice, SJS/TEN, angioedema, SIADH","info":"Avoid in women of childbearing age/pregnancy\\n\\nCarbamazepine may decrease drug plasma concentration of hormonal contraceptives, consider non-hormonal contraception\\n\\nFDA box warning:\\n-Aplastic anemia and agranulocytosis\\n-Serious dermatologic reactions and HLA-B*1502 allele\\n\\nhttps://medlineplus.gov/druginfo/meds/a682237.html","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Starting dose 200mg/day in two divided doses.\\nMay increase by 200mg/day every 5 days to max dose of 800mg- 1800mg/day.\\nMay check level to avoid toxicity (keep \u2264 10-12 mcg/mL).\\nCarbamazepine may alter the metabolism of other medications.\\nMay check interactions with Lexicomp drug interactions tool on Up to Date.","notes":"","alert":""},{"id":"Carbamazepine","name":"Carbamazepine","class":"Mood Stabilizers","brands":"Tegretol","monitor":"short term use does not necessitate monitoring","side_effects_common":"dizziness, sedation, nausea, headache, rash","side_effects_rare":"myelosuppression, hepatitis, jaundice, SJS/TEN, angioedema, SIADH","info":"Avoid in women of childbearing age/pregnancy\\n\\nCarbamazepine may decrease drug plasma concentration of hormonal contraceptives, consider non-hormonal contraception\\n\\nFDA box warning:\\n-Aplastic anemia and agranulocytosis\\n-Serious dermatologic reactions and HLA-B*1502 allele\\n\\nhttps://medlineplus.gov/druginfo/meds/a682237.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Day 0: 400mg PM dose\\nDay 1: 400mg in AM and 400mg in PM\\nDay 2: 400mg in AM and 200mg in PM\\nDay 3: 200mg in AM and 200mg in PM\\nDay 4: 200mg in AM and 200mg in PM\\nDay 5: 200mg in AM","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"Higher risk of SJS/TEN in pediatric age group","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"Higher risk of SJS/TEN in pediatric age group","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["preconception"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["antepartum"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["postpartum"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["hepatic"],"dosing":"Mild impairment- \\nStart 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day\\n\\nModerate to severe impairment without ascites- decrease initial, escalation, maintenance, and maximum doses by 25%\\n\\nModerate to severe impairment with ascites- decrease initial, escalation, maintenance, and maximum doses by 50%","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Lamotrigine","name":"Lamotrigine","class":"Mood Stabilizers","brands":"Lamictal","monitor":"No specific recommendation.","side_effects_common":"dizziness, headache, rash","side_effects_rare":"Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), angioedema","info":"FDA box warning:\\n-Skin rash and risk of SJS/TEN\\nhttps://medlineplus.gov/druginfo/meds/a695007.html","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Start 25 mg daily for 2 weeks, then increase to 50 mg daily for 2 weeks, then 100 mg daily. \\nMay titrate further at minimum one week later as tolerated and clinically indicated. \\nMax recommended dose 200 mg/day","notes":"","alert":""},{"id":"Valproate","name":"Valproate","class":"Mood Stabilizers","brands":"Depakote","monitor":"Baseline PREGNANCY TEST, Wt/BMI; CBC, PT/PTT, LFTs, glucose, lipids. VPA levels 3 days after each dose change or when adding new medication that alters metabolism. Once dose is stable, levels q 6 months. CBC and LFTs q 6 mos. Valproate is a P450 inhibitor, unlike other mood stabilizing anticonvulsants.","side_effects_common":"teratogenic in pregnancy, thrombocytopenia, PCOS, weight gain, somnolence, tremor, hair loss, nausea, fatigue, dizziness","side_effects_rare":"hepatotoxicity, pancreatitis","info":"Avoid in women of childbearing age/pregnancy\\n\\nER formulation- 80% bioavailability compared to IR formulation\\n\\nFDA box warning:\\n-Hepatotoxicity\\n-Patients with mitochondrial disease\\n-Fetal risk\\n-Pancreatitis\\n\\nhttps://medlineplus.gov/druginfo/meds/a682412.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Start 250 mg three times daily; increase by 250 to 500mg total daily dose every 1-3 day toward clinical response and therapeutic serum level (50-125 mcg/ml).  Consider checking drug level on day 5-6.\\n\\nER formulation available: review manufacturer\'s prescription label","notes":"","alert":""},{"id":"Valproate","name":"Valproate","class":"Mood Stabilizers","brands":"Depakote","monitor":"Baseline PREGNANCY TEST, Wt/BMI; CBC, PT/PTT, LFTs, glucose, lipids. VPA levels 3 days after each dose change or when adding new medication that alters metabolism. Once dose is stable, levels q 6 months. CBC and LFTs q 6 mos. Valproate is a P450 inhibitor, unlike other mood stabilizing anticonvulsants.","side_effects_common":"teratogenic in pregnancy, thrombocytopenia, PCOS, weight gain, somnolence, tremor, hair loss, nausea, fatigue, dizziness","side_effects_rare":"hepatotoxicity, pancreatitis","info":"Avoid in women of childbearing age/pregnancy\\n\\nER formulation- 80% bioavailability compared to IR formulation\\n\\nFDA box warning:\\n-Hepatotoxicity\\n-Patients with mitochondrial disease\\n-Fetal risk\\n-Pancreatitis\\n\\nhttps://medlineplus.gov/druginfo/meds/a682412.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"Start 250 mg three times daily; increase by 250 to 500mg total daily dose every 1-3 day toward clinical response and therapeutic serum level (50-125 mcg/ml).  Consider checking drug level on day 5-6.\\n\\nER formulation available: review manufacturer\'s prescription label","notes":"due to decreased protein binding in renal impairment, monitoring of free valproate concentrations may be of clinical value, as total valproate concentrations may be misleading.","alert":""},{"id":"Valproate","name":"Valproate","class":"Mood Stabilizers","brands":"Depakote","monitor":"Baseline PREGNANCY TEST, Wt/BMI; CBC, PT/PTT, LFTs, glucose, lipids. VPA levels 3 days after each dose change or when adding new medication that alters metabolism. Once dose is stable, levels q 6 months. CBC and LFTs q 6 mos. Valproate is a P450 inhibitor, unlike other mood stabilizing anticonvulsants.","side_effects_common":"teratogenic in pregnancy, thrombocytopenia, PCOS, weight gain, somnolence, tremor, hair loss, nausea, fatigue, dizziness","side_effects_rare":"hepatotoxicity, pancreatitis","info":"Avoid in women of childbearing age/pregnancy\\n\\nER formulation- 80% bioavailability compared to IR formulation\\n\\nFDA box warning:\\n-Hepatotoxicity\\n-Patients with mitochondrial disease\\n-Fetal risk\\n-Pancreatitis\\n\\nhttps://medlineplus.gov/druginfo/meds/a682412.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["cardiac"],"dosing":"Start 250 mg three times daily; increase by 250 to 500mg total daily dose every 1-3 day toward clinical response and therapeutic serum level (50-125 mcg/ml).  Consider checking drug level on day 5-6.\\n\\nER formulation available: review manufacturer\'s prescription label","notes":"","alert":""},{"id":"Valproate","name":"Valproate","class":"Mood Stabilizers","brands":"Depakote","monitor":"Baseline PREGNANCY TEST, Wt/BMI; CBC, PT/PTT, LFTs, glucose, lipids. VPA levels 3 days after each dose change or when adding new medication that alters metabolism. Once dose is stable, levels q 6 months. CBC and LFTs q 6 mos. Valproate is a P450 inhibitor, unlike other mood stabilizing anticonvulsants.","side_effects_common":"teratogenic in pregnancy, thrombocytopenia, PCOS, weight gain, somnolence, tremor, hair loss, nausea, fatigue, dizziness","side_effects_rare":"hepatotoxicity, pancreatitis","info":"Avoid in women of childbearing age/pregnancy\\n\\nER formulation- 80% bioavailability compared to IR formulation\\n\\nFDA box warning:\\n-Hepatotoxicity\\n-Patients with mitochondrial disease\\n-Fetal risk\\n-Pancreatitis\\n\\nhttps://medlineplus.gov/druginfo/meds/a682412.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Start 250 mg three times daily; increase by 250 to 500mg total daily dose every 1-3 day toward clinical response and therapeutic serum level (50-125 mcg/ml).  Consider checking drug level on day 5-6.\\n\\nER formulation available: review manufacturer\'s prescription label","notes":"High association with weight gain","alert":"caution"},{"id":"Valproate","name":"Valproate","class":"Mood Stabilizers","brands":"Depakote","monitor":"Baseline PREGNANCY TEST, Wt/BMI; CBC, PT/PTT, LFTs, glucose, lipids. VPA levels 3 days after each dose change or when adding new medication that alters metabolism. Once dose is stable, levels q 6 months. CBC and LFTs q 6 mos. Valproate is a P450 inhibitor, unlike other mood stabilizing anticonvulsants.","side_effects_common":"teratogenic in pregnancy, thrombocytopenia, PCOS, weight gain, somnolence, tremor, hair loss, nausea, fatigue, dizziness","side_effects_rare":"hepatotoxicity, pancreatitis","info":"Avoid in women of childbearing age/pregnancy\\n\\nER formulation- 80% bioavailability compared to IR formulation\\n\\nFDA box warning:\\n-Hepatotoxicity\\n-Patients with mitochondrial disease\\n-Fetal risk\\n-Pancreatitis\\n\\nhttps://medlineplus.gov/druginfo/meds/a682412.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Start 125-250 mg three times daily; increase by 125 to 250mg total daily dose every 2-5 day toward clinical response and therapeutic serum level (50-125 mcg/ml).  Consider checking drug level on day 5-6.\\n\\nER formulation available: review manufacturer\'s prescription label","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Valproate","name":"Valproate","class":"Mood Stabilizers","brands":"Depakote","monitor":"Baseline PREGNANCY TEST, Wt/BMI; CBC, PT/PTT, LFTs, glucose, lipids. VPA levels 3 days after each dose change or when adding new medication that alters metabolism. Once dose is stable, levels q 6 months. CBC and LFTs q 6 mos. Valproate is a P450 inhibitor, unlike other mood stabilizing anticonvulsants.","side_effects_common":"teratogenic in pregnancy, thrombocytopenia, PCOS, weight gain, somnolence, tremor, hair loss, nausea, fatigue, dizziness","side_effects_rare":"hepatotoxicity, pancreatitis","info":"Avoid in women of childbearing age/pregnancy\\n\\nER formulation- 80% bioavailability compared to IR formulation\\n\\nFDA box warning:\\n-Hepatotoxicity\\n-Patients with mitochondrial disease\\n-Fetal risk\\n-Pancreatitis\\n\\nhttps://medlineplus.gov/druginfo/meds/a682412.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Starting dose 15mg/kg/day divided twice to three times daily\\nIncrease 5mg-10 mg/kg/day in minumum one week as tolerated and clinically indicated\\nMax dose 60mg/kg/ day\\n\\nER formulation available: review manufacturer\'s prescription label","notes":"off-label for pedi bipolar disorder","alert":""},{"id":"Valproate","name":"Valproate","class":"Mood Stabilizers","brands":"Depakote","monitor":"Baseline PREGNANCY TEST, Wt/BMI; CBC, PT/PTT, LFTs, glucose, lipids. VPA levels 3 days after each dose change or when adding new medication that alters metabolism. Once dose is stable, levels q 6 months. CBC and LFTs q 6 mos. Valproate is a P450 inhibitor, unlike other mood stabilizing anticonvulsants.","side_effects_common":"teratogenic in pregnancy, thrombocytopenia, PCOS, weight gain, somnolence, tremor, hair loss, nausea, fatigue, dizziness","side_effects_rare":"hepatotoxicity, pancreatitis","info":"Avoid in women of childbearing age/pregnancy\\n\\nER formulation- 80% bioavailability compared to IR formulation\\n\\nFDA box warning:\\n-Hepatotoxicity\\n-Patients with mitochondrial disease\\n-Fetal risk\\n-Pancreatitis\\n\\nhttps://medlineplus.gov/druginfo/meds/a682412.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Starting dose 15mg/kg/day divided twice to three times daily\\nIncrease 5mg-10 mg/kg/day in minumum one week as tolerated and clinically indicated\\nMax dose 60mg/kg/ day\\n\\nER formulation available: review manufacturer\'s prescription label","notes":"off-label for pedi bipolar disorder","alert":""},{"id":"Valproate","name":"Valproate","class":"Mood Stabilizers","brands":"Depakote","monitor":"Baseline PREGNANCY TEST, Wt/BMI; CBC, PT/PTT, LFTs, glucose, lipids. VPA levels 3 days after each dose change or when adding new medication that alters metabolism. Once dose is stable, levels q 6 months. CBC and LFTs q 6 mos. Valproate is a P450 inhibitor, unlike other mood stabilizing anticonvulsants.","side_effects_common":"teratogenic in pregnancy, thrombocytopenia, PCOS, weight gain, somnolence, tremor, hair loss, nausea, fatigue, dizziness","side_effects_rare":"hepatotoxicity, pancreatitis","info":"Avoid in women of childbearing age/pregnancy\\n\\nER formulation- 80% bioavailability compared to IR formulation\\n\\nFDA box warning:\\n-Hepatotoxicity\\n-Patients with mitochondrial disease\\n-Fetal risk\\n-Pancreatitis\\n\\nhttps://medlineplus.gov/druginfo/meds/a682412.html","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Start 250 mg three times daily; increase by 250 to 500mg total daily dose every 1-3 day toward clinical response and therapeutic serum level (50-125 mcg/ml).  Consider checking drug level on day 5-6.\\n\\nER formulation available: review manufacturer\'s prescription label","notes":"","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adult"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.8-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["geriatric"],"dosing":"Starting dose 300 mg qHS.\\nIncrease slowly to 300 mg BID\\nAfter 5-7 days at a stable therapeutic dose check serum level 12 hours after last dose (target is 0.4- 0.8 mEq/L).\\nMake further adjustments as needed based on clinical response, tolerability, and serum concentration.","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["hepatic"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.8-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["obesity"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.8-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"High association with weight gain","alert":"caution"},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["renal"],"dosing":"CrCl 30-89 mL/min\\nStarting dose 300 mg qHS.\\nIncrease slowly to 300 mg BID\\nAfter 5-7 days at a stable therapeutic dose check serum level 12 hours after last dose (target is 0.8-1.2 mEq/L).\\nMake further adjustments as needed based on clinical response, tolerability, and serum concentration.\\n\\nCrCl < 30 mL/min- avoid use.","notes":"Consider Lithium only in consultation with psychiatry/nephrology if available in your community. Low starting dose and more frequent monitoring needed.","alert":"warning"},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["pediatric"],"dosing":"Start 300 mg nightly. Increase by 300 mg/d every 7 days if <30kg or every 3-5 days if >30kg as clinically indicated.   \\nAfter 5-7 days at a stable therapeutic dose check serum level 12 hours after last dose (target is 0.8-1.2 mEq/L)","notes":"off-label for bipolar depression; off-label for mainia and maintenace in children <12 years old","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["adolescent"],"dosing":"Start 300 mg nightly. Increase by 300 mg/d every 7 days if <30kg or every 3-5 days if >30kg as clinically indicated.   \\nAfter 5-7 days at a stable therapeutic dose check serum level 12 hours after last dose (target is 0.8-1.2 mEq/L)","notes":"off-label for bipolar depression; off-label for mainia and maintenace in children <12 years old","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["preconception"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTypical target serum level of 0.8-1.2 mEq/L; however, some patients may have clinical response at levels below this range.\\n\\n\\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"Although historically concerning for teratogenicity; the incidence of such anomalies are lower than previously reported: \\n<12 weeks gestation, risk of CV malformation low; \\n>12 weeks malformation risk generally non concerning\\n\\nFornaro M, Maritan E, Ferranti R, Zaninotto L, Miola A, Anastasia A, Murru A, Sol\xe9 E, Stubbs B, Carvalho AF, Serretti A, Vieta E, Fusar-Poli P, McGuire P, Young AH, Dazzan P, Vigod SN, Correll CU, Solmi M. Lithium Exposure During Pregnancy and the Postpartum Period: A Systematic Review and Meta-Analysis of Safety and Efficacy Outcomes. Am J Psychiatry. 2020 Jan 1;177(1):76-92. doi: 10.1176/appi.ajp.2019.19030228. Epub 2019 Oct 18. PMID: 31623458.\\n\\nPatorno E, Huybrechts KF, Bateman BT, et al. Lithium Use in Pregnancy and the Risk of Cardiac Malformations. N Engl J Med. 2017;376(23):2245-2254. doi:10.1056/NEJMoa1612222","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["antepartum"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTypical target serum level of 0.8-1.2 mEq/L; however, some patients may have clinical response at levels below this range.\\n\\n\\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"Should be avoided in breastfeeding- weigh risks and benefits\\n\\nAlthough historically concerning for teratogenicity; the incidence of such anomalies are lower than previously reported: \\n<12 weeks gestation, risk of CV malformation low; \\n>12 weeks malformation risk generally non concerning\\n\\nFornaro M, Maritan E, Ferranti R, Zaninotto L, Miola A, Anastasia A, Murru A, Sol\xe9 E, Stubbs B, Carvalho AF, Serretti A, Vieta E, Fusar-Poli P, McGuire P, Young AH, Dazzan P, Vigod SN, Correll CU, Solmi M. Lithium Exposure During Pregnancy and the Postpartum Period: A Systematic Review and Meta-Analysis of Safety and Efficacy Outcomes. Am J Psychiatry. 2020 Jan 1;177(1):76-92. doi: 10.1176/appi.ajp.2019.19030228. Epub 2019 Oct 18. PMID: 31623458.\\n\\nPatorno E, Huybrechts KF, Bateman BT, et al. Lithium Use in Pregnancy and the Risk of Cardiac Malformations. N Engl J Med. 2017;376(23):2245-2254. doi:10.1056/NEJMoa1612222","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"Li+ level, TSH, BMP: at initiation,at 1\u20132 mos, then every 6 to 12 mos. Li+ level at every dose change (12h after last dose) and when adding new medication that alters metabolism, such as NSAIDS, ACE inhibitors, and HCTZ. Toxicity >1.5 mEq/L but may see signs at lower levels, especially in elderly","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Bipolar Disorder","branch":[],"population":["postpartum"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.8-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"Discontinue Breastfeeding","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"No specific recommendation.","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.6-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"No specific recommendation.","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["geriatric"],"dosing":"Starting dose 300 mg qHS.\\nIncrease slowly to 300 mg BID\\nAfter 5-7 days at a stable therapeutic dose check serum level 12 hours after last dose (target is 0.4- 0.8 mEq/L).\\nMake further adjustments as needed based on clinical response, tolerability, and serum concentration.","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"No specific recommendation.","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.6-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"No specific recommendation.","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.6-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"High association with weight gain","alert":"caution"},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"No specific recommendation.","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"CrCl 30-89 mL/min\\nStarting dose 300 mg qHS.\\nIncrease slowly to 300 mg BID\\nAfter 5-7 days at a stable therapeutic dose check serum level 12 hours after last dose (target is 0.6-1.2 mEq/L).\\nMake further adjustments as needed based on clinical response, tolerability, and serum concentration.\\n\\nCrCl < 30 mL/min- avoid use.","notes":"Consider Lithium only in consultation with psychiatry/nephrology if available in your community. Lower starting dose and frequent monitoring needed.","alert":"warning"},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"No specific recommendation.","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.8-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"","alert":""},{"id":"Lithium","name":"Lithium","class":"Mood Stabilizers","brands":"Eskalith, Lithobid, et al","monitor":"No specific recommendation.","side_effects_common":"GI upset, tremor, thirst/polyuria, hypothyroidism, acne, leukocytosis","side_effects_rare":"nephrogenic DI, dysrhythmia, bradycardia","info":"Lithium levels increased by NSAIDs, ACE inhibitors, and HCTZ.\\n\\nLithium levels may be inversely affected by dietary sodium intake.\\n\\nFDA box warning:\\n-Lithium toxicity is closely related to serum concentrations and can occur at doses close to therapeutic levels.  Facilities for prompt and accurate serum lithium determinations should be available before initiating therapy.\\n\\nhttps://medlineplus.gov/druginfo/meds/a681039.html","length":"","diagnosis":"Psychosis","branch":[],"population":["postpartum"],"dosing":"Start 300 mg nightly or 600mg nightly or divided twice daily. Increase by 300 mg/d in 3-5 days as clinically indicated.  \\nCheck serum level in 5-7 days (12h after last dose). \\nTarget serum level of 0.8-1.2 mEq/L. \\nCheck serum level 5-7 days after each subsequent dose adjustment \\nAn increase of 300 mg/day changes serum level ~0.25 \xb1 0.1 mEq/L","notes":"Discontinue Breastfeeding","alert":""},{"id":"Naltrexone","name":"Naltrexone","class":"mu-Opioid Receptor Antagonist","brands":"ReVia (Vivitrol is LAI formulation)","monitor":"Check LFTs prior to administration; contraindicated with acute elevations in LFTs (3x upper limit of normal)","side_effects_common":"headache, nausea, vomiting, somnolence, anorexia, injection site reactions (IM formulations only)","side_effects_rare":"hepatocellular injury, eosinopihlllic pneumnia, serious injection site reactions (IM formulations only)","info":"Black box warning for hepatocellular injury\\n\\nhttps://medlineplus.gov/druginfo/meds/a685041.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Oral\\nStart 50 mg daily and increase to maximum 100 mg daily in minimum one week if tolerable and clinically indicated. \\n\\n\\nIM\\nStart and maintain dose of 380 mg IM every 4 weeks\\nInject gluteally and alternate sides month to month","notes":"","alert":""},{"id":"Naltrexone","name":"Naltrexone","class":"mu-Opioid Receptor Antagonist","brands":"ReVia (Vivitrol is LAI formulation)","monitor":"Check LFTs prior to administration; contraindicated with acute elevations in LFTs (3x upper limit of normal)","side_effects_common":"headache, nausea, vomiting, somnolence, anorexia, injection site reactions (IM formulations only)","side_effects_rare":"hepatocellular injury, eosinopihlllic pneumnia, serious injection site reactions (IM formulations only)","info":"Black box warning for hepatocellular injury\\n\\nhttps://medlineplus.gov/druginfo/meds/a685041.html","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adolescent"],"dosing":"Oral\\nStart 25 mg daily\\nIncrease dose by 25 mg daily in minimum one week if tolerable and clinically indicated. \\n\\nMaximum daily dose 100 mg\\n\\nIM\\nStart and maintain dose of 380 mg IM every 4 weeks\\nInject gluteally and alternate sides month to month","notes":"","alert":""},{"id":"Naltrexone","name":"Naltrexone","class":"Opioid Antagonist","brands":"ReVia (Vivitrol is LAI formulation)","monitor":"Check LFTs prior to administration; contraindicated with acute elevations in LFTs (3x upper limit of normal)","side_effects_common":"headache, nausea, vomiting, somnolence, anorexia, injection site reactions (IM formulations only)","side_effects_rare":"hepatocellular injury, eosinopihlllic pneumnia, serious injection site reactions (IM formulations only)","info":"Black box warning for hepatocellular injury\\n\\nhttps://medlineplus.gov/druginfo/meds/a685041.html","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adult"],"dosing":"Oral\\nStart 50 mg daily and increase to maximum 100 mg daily in minimum one week if tolerable and clinically indicated. \\n. \\n\\nIM\\nStart and maintain dose of 380 mg IM every 4 weeks\\nInject gluteally and alternate sides month to month","notes":"","alert":""},{"id":"Naltrexone","name":"Naltrexone","class":"Opioid Antagonist","brands":"ReVia (Vivitrol is LAI formulation)","monitor":"Check LFTs prior to administration; contraindicated with acute elevations in LFTs (3x upper limit of normal)","side_effects_common":"headache, nausea, vomiting, somnolence, anorexia, injection site reactions (IM formulations only)","side_effects_rare":"hepatocellular injury, eosinopihlllic pneumnia, serious injection site reactions (IM formulations only)","info":"Black box warning for hepatocellular injury\\n\\nhttps://medlineplus.gov/druginfo/meds/a685041.html","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adolescent"],"dosing":"Oral\\nStart 25 mg daily\\nIncrease dose by 25 mg daily in minimum one week if tolerable and clinically indicated. \\nMaximum daily dose 100 mg\\n\\nIM\\nStart and maintain dose of 380 mg IM every 4 weeks\\nInject gluteally and alternate sides month to month","notes":"","alert":""},{"id":"Varenicline","name":"Varenicline","class":"Nicotine Receptor Partial Agonist","brands":"Chantix","monitor":"No specific recommendation.","side_effects_common":"Insomnia, vivid dreams, nausea,vomiting, headache, constipation, flatulence","side_effects_rare":"activation of agitation, depression, suicidality, seizures","info":"Data from multiple studies conclude that varenicline is safe and effective for smoking cessation in patients with serious mental illness (including schizophrenia and bipolar disorder)","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adult"],"dosing":"Start 0.5 mg daily for 3 days\\nIncrease to 0.5 mg twice daily for for days 4-7\\nIncrease to 1 mg twice daily for week 2 and beyond \\nTreatment should continue for a total of 12 weeks total","notes":"","alert":""},{"id":"Varenicline","name":"Varenicline","class":"Nicotine Receptor Partial Agonist","brands":"Chantix","monitor":"No specific recommendation.","side_effects_common":"Insomnia, vivid dreams, nausea,vomiting, headache, constipation, flatulence","side_effects_rare":"activation of agitation, depression, suicidality, seizures","info":"Data from multiple studies conclude that varenicline is safe and effective for smoking cessation in patients with serious mental illness (including schizophrenia and bipolar disorder)","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adolescent"],"dosing":"Start 0.5 mg daily for 3 days\\nIncrease to 0.5 mg twice daily for for days 4-7\\nIncrease to 1 mg twice daily for week 2 and beyond \\nTreatment should continue for a total of 12 weeks total","notes":"","alert":""},{"id":"Nicotine Gum","name":"Nicotine Gum","class":"Nicotine Replacement Therapy","brands":"Nicorette","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adult"],"dosing":"Directions for use:\\nChew 1 piece of gum prn urge to smoke, up to 24 pieces/day\\nChew gum slowly until it tingles, then park gum between cheek and gum until tingle if gone, repeat until most of tingle is gone. \\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 4 mg strength if first cigarette is smoked within 30 minutes of waking; otherwise use 2mg strength. \\nWeeks 1-6- chew I piece of gum every 1-2 hours (at least 9 pieces/day is associated with more successful during the first 6 weeks or treatment) \\nWeeks 7-9- chew 1 piece of gum every 2-4 hours\\nWeeks 10- 12- chew 1 piece of gum every 4-8 hours","notes":"","alert":""},{"id":"Nicotine Gum","name":"Nicotine Gum","class":"Nicotine Replacement Therapy","brands":"Nicorette","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["antepartum"],"dosing":"Directions for use:\\nChew 1 piece of gum prn urge to smoke, up to 24 pieces/day\\nChew gum slowly until it tingles, then park gum between cheek and gum until tingle if gone, repeat until most of tingle is gone. \\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 4 mg strength if first cigarette is smoked within 30 minutes of waking; otherwise use 2mg strength. \\nWeeks 1-6- chew I piece of gum every 1-2 hours (at least 9 pieces/day is associated with more successful during the first 6 weeks or treatment) \\nWeeks 7-9- chew 1 piece of gum every 2-4 hours\\nWeeks 10- 12- chew 1 piece of gum every 4-8 hours","notes":"","alert":""},{"id":"Nicotine Gum","name":"Nicotine Gum","class":"Nicotine Replacement Therapy","brands":"Nicorette","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adolescent"],"dosing":"Directions for use:\\nChew 1 piece of gum prn urge to smoke, up to 24 pieces/day\\nChew gum slowly until it tingles, then park gum between cheek and gum until tingle if gone, repeat until most of tingle is gone. \\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 4 mg strength if smoking >10 cigarettes per day or first cigarette is smoked within 30 minutes of waking; otherwise use 2mg strength.  (at least 9 pieces/day is associated with more successful during the first 6 weeks or treatment.  Max 24 pieces a day)\\n\\nWeeks 1-6- chew I piece of gum every 1-2 hours (at least 9 pieces/day is associated with more successful during the first 6 weeks or treatment) \\nWeeks 7-9- chew 1 piece of gum every 2-4 hours\\nWeeks 10- 12- chew 1 piece of gum every 4-8 hours","notes":"","alert":""},{"id":"Nicotine Inhaled","name":"Nicotine Inhaled","class":"Nicotine Replacement Therapy","brands":"Nicotrol Inhaler","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adult"],"dosing":"Directions for use:\\nUsing frequent continuous puffing, for 20 minutes per cartridge. \\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 6-16 cartridges/day for up to 12 weeks, then gradually decrease daily dose over 6-12 weeks\\nUse beyond 6 months has not been studied","notes":"","alert":""},{"id":"Nicotine Inhaled","name":"Nicotine Inhaled","class":"Nicotine Replacement Therapy","brands":"Nicotrol Inhaler","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["antepartum"],"dosing":"Directions for use:\\nUsing frequent continuous puffing, for 20 minutes per cartridge. \\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 6-16 cartridges/day for up to 12 weeks, then gradually decrease daily dose over 6-12 weeks\\nUse beyond 6 months has not been studied","notes":"","alert":""},{"id":"Nicotine Inhaled","name":"Nicotine Inhaled","class":"Nicotine Replacement Therapy","brands":"Nicotrol Inhaler","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adolescent"],"dosing":"Directions for use:\\nUsing frequent continuous puffing, for 20 minutes per cartridge. \\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 6-16 cartridges/day for up to 12 weeks, then gradually decrease daily dose over 6-12 weeks\\nUse beyond 6 months has not been studied","notes":"","alert":""},{"id":"Nicotine Lozenge","name":"Nicotine Lozenge","class":"Nicotine Replacement Therapy","brands":"Nicorette, Nicorette Mini","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adult"],"dosing":"Directions for use:\\nUse 1 lozenge at a time only\\nMaximum dose is 5 lozenges in a 6 hours period, and no more than 20 lozenges/day\\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 4 mg strength if first cigarette is smoked within 30 minutes of waking; otherwise use 2mg strength. \\nWeeks 1-6- 1 lozenge every 1-2 hours (at least 9 pieces/day is associated with more successful during the first 6 weeks or treatment) \\nWeeks 7-9- 1 lozenge every 2-4 hours\\nWeeks 10- 12- c1 lozenge every 4-8 hours","notes":"","alert":""},{"id":"Nicotine Lozenge","name":"Nicotine Lozenge","class":"Nicotine Replacement Therapy","brands":"Nicorette, Nicorette Mini","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["antepartum"],"dosing":"Directions for use:\\nUse 1 lozenge at a time only\\nMaximum dose is 5 lozenges in a 6 hours period, and no more than 20 lozenges/day\\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 4 mg strength if first cigarette is smoked within 30 minutes of waking; otherwise use 2mg strength. \\nWeeks 1-6- 1 lozenge every 1-2 hours (at least 9 pieces/day is associated with more successful during the first 6 weeks or treatment) \\nWeeks 7-9- 1 lozenge every 2-4 hours\\nWeeks 10- 12- c1 lozenge every 4-8 hours","notes":"","alert":""},{"id":"Nicotine Lozenge","name":"Nicotine Lozenge","class":"Nicotine Replacement Therapy","brands":"Nicorette, Nicorette Mini","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adolescent"],"dosing":"Directions for use:\\nUse 1 lozenge at a time only\\nMaximum dose is 5 lozenges in a 6 hours period, and no more than 20 lozenges/day\\nUse up to 12 weeks recommended to increase chances of success\\n\\nDosing:\\nUse 4 mg strength if first cigarette is smoked within 30 minutes of waking; otherwise use 2mg strength. \\nWeeks 1-6- 1 lozenge every 1-2 hours (at least 9 pieces/day is associated with more successful during the first 6 weeks or treatment) \\nWeeks 7-9- 1 lozenge every 2-4 hours\\nWeeks 10- 12- c1 lozenge every 4-8 hours","notes":"","alert":""},{"id":"Nicotine Nasal Spray","name":"Nicotine Nasal Spray","class":"Nicotine Replacement Therapy","brands":"Nicotrol NS","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adult"],"dosing":"Use 1-2 doses/hour as needed\\n1 dose is equal to one spray in each nostril\\nAdjust dose basaed on response up to 5 doses/hour\\nMaximum 40 doses/day\\nOnce effectiveness achieved, slowly discontinue/taper over a 4-6 week period\\nUse only recommend for 3 months","notes":"","alert":""},{"id":"Nicotine Nasal Spray","name":"Nicotine Nasal Spray","class":"Nicotine Replacement Therapy","brands":"Nicotrol NS","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["antepartum"],"dosing":"Use 1-2 doses/hour as needed\\n1 dose is equal to one spray in each nostril\\nAdjust dose basaed on response up to 5 doses/hour\\nMaximum 40 doses/day\\nOnce effectiveness achieved, slowly discontinue/taper over a 4-6 week period\\nUse only recommend for 3 months","notes":"","alert":""},{"id":"Nicotine Transdermal Patch","name":"Nicotine Transdermal Patch","class":"Nicotine Replacement Therapy","brands":"NicoDerm CQ, others","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["antepartum"],"dosing":"Directions for use:\\nRotate sites to avoid skin irritation. \\nUse 4-8 weeks then taper slowly. \\nUse short term products (gum or lozenge) for cravings in combination with transdermal patch. \\n\\nDosing:\\n\\nIf patient smokes 14 or more cigarettes daily-\\nStart 21 mg/day patch for 6 weeks\\nFollow with 14 mg/day patch for 2 weeks then 7 mg/day patch for 2 weeks\\n\\nIf patient smokes less than 14 cigarettes daily-\\nStart 14 mg/day patch for 6 weeks\\nFollow with 7 mg/day patch for 2 weeks","notes":"","alert":""},{"id":"Nicotine Transdermal Patch","name":"Nicotine Transdermal Patch","class":"Nicotine Replacement Therapy","brands":"Nicoderm CQ; Nicorette","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"For best results, use a long term product (patch) plus a short term product (gum, lozenge). These products are available OTC","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adult"],"dosing":"Directions for use:\\nRotate sites to avoid skin irritation. \\nUse 4-8 weeks then taper slowly. \\nUse short term products (gum or lozenge) for cravings in combination with transdermal patch. \\n\\nDosing:\\n\\nIf patient smokes 14 or more cigarettes daily-\\nStart 21 mg/day patch for 6 weeks\\nFollow with 14 mg/day patch for 2 weeks then 7 mg/day patch for 2 weeks\\n\\nIf patient smokes less than 14 cigarettes daily-\\nStart 14 mg/day patch for 6 weeks\\nFollow with 7 mg/day patch for 2 weeks","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"SR (12 hour)\\nStart 150 mg daily, then increase to 150 mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400 mg/day\\n\\n\\nER (24 hour)\\nStart 150 mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450 mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450 mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"ADHD","branch":[],"population":["geriatric"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150 mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450 mg/day\\n\\nSR (12 hour)\\nStart 150 mg daily, then increase to 150 mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400 mg/day\\n\\n\\nER (24 hour)\\nStart 150 mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450 mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450 mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A\\nIR\\nStart 50 mg twice daily, then increase to 50 mg three times daily on day 4\\nIncrease to 75 mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 225 mg/day\\n\\nSR (12 hour)\\nStart 100 mg daily\\nIncrease to 100 mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 200mg/day\\n\\n\\nER (24 hour)\\n150mg every other day \\n\\nChild-Pugh B-C: Use with extreme caution \\nIR\\nStart 50 mg daily\\nIncrease to 75 mg daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 75mg daily\\n\\nSR (12 hour)\\nStart 100 mg daily\\nIncrease to 100 mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 200mg/day\\n\\n\\nER (24 hour)\\n150mg every other day","notes":"Extensively hepatically metabolized.  Metabolite activity 20-50% potency of Bupropion","alert":"caution"},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150 mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450 mg/day\\n\\nSR (12 hour)\\nStart 150 mg daily, then increase to 150 mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400 mg/day\\n\\n\\nER (24 hour)\\nStart 150 mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450 mg daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450 mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150 mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450 mg/day\\n\\nSR (12 hour)\\nStart 150 mg daily, then increase to 150 mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400 mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily\\nIncrease to 300 mg in minimum 2-3 weeks daily if clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"Active metabolite renally excreted.  Consider decreased dosing in renal impairment.  Manufacturer does not provide dose/titration specifications","alert":"caution"},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["pediatric"],"dosing":"IR\\n<11yo\\nStart 37.5mg twice daily\\nIncrease to 37.5 three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\n>11yo\\nStart 37.5mg-75mg twice daily \\nIncrease to 37.5-75mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour) \\n>11yo\\nStart 100 mg daily, then increase to 100 mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\n>12yo\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"Off-label","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adolescent"],"dosing":"IR\\nStart 37.5mg-75mg twice daily \\nIncrease to 37.5-75mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour) \\nStart 100 mg daily, then increase to 100 mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["preconception"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["antepartum"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["postpartum"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["geriatric"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A\\nIR\\nStart 50 mg twice daily, then increase to 50 mg three times daily on day 4\\nIncrease to 75mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 225mg/day\\n\\nSR (12 hour)\\nStart 100 mg daily\\nIncrease to 100 mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 200mg/day\\n\\n\\nER (24 hour)\\n150mg every other day \\n\\nChild-Pugh B-C: Use with extreme caution \\nIR\\nStart 50 mg daily\\nIncrease to 75mg daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 75mg daily\\n\\nSR (12 hour)\\nStart 100 mg daily\\nIncrease to 100 mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 200mg/day\\n\\n\\nER (24 hour)\\n150mg every other day","notes":"Extensively hepatically metabolized.  Metabolite activity 20-50% potency of Bupropion","alert":"caution"},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"IR\\nStart 100 mg twice daily,  then increase to 100 mg three times daily on day 4\\nIncrease to 150mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily\\nIncrease to 300 mg in minimum 2-3 weeks daily if clinically indicated and tolerable\\nMax dose 300mgmg/day","notes":"Active metabolite renally excreted.  Consider decreased dosing in renal impairment.  Manufacturer does not provide dose/titration specifications","alert":"caution"},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Female Sexual Interest/Arousal Disorder","branch":[],"population":["adult"],"dosing":"Bupropion SR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nBupropion ER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"SR (12 hour)\\nStart 37.5mg daily\\nIncrease by 37.5mg every 3 days if clinically indicated and tolerable\\nMax dose 150mg twice daily","notes":"","alert":"caution"},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"SSRI-Induced Sexual Dysfunction","branch":[],"population":["adult"],"dosing":"SR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adult"],"dosing":"SR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4 Increase to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable \\nMax dose 400mg/day \\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4 \\nIncrease to 450mg daily in minimum 2-3 week if tolerable \\nMax/target dose 450mg/day\\nUse ER preferentially if available (based on RCT data to support its use)","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"To minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adolescent"],"dosing":"IR\\nStart 37.5mg-75mg twice daily \\nIncrease to 37.5-75mg three times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 450mg/day\\n\\nSR (12 hour) \\nStart 100 mg daily, then increase to 100 mg twice daily on day 4\\nIncrease to 200mg twice times daily in minimum 2-3 weeks if clinically indicated and tolerable\\nMax dose 400mg/day\\n\\n\\nER (24 hour)\\nStart 150mg daily, then increase to 300 mg daily on day 4\\nIncrease to 450mg daily in minimum 2-3 week if clinically indicated and tolerable\\nMax dose 450mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Zyban, Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"Black box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html\\n\\nTo minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adult"],"dosing":"Bupropion SR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nInitiate one week prior to quit date","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Zyban, Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"Black box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html\\n\\nTo minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adolescent"],"dosing":"Bupropion SR (12 hour)\\n>14yo and >40.5kg: Start 150mg daily, then increase to 150mg twice daily on day 4\\nInitiate one week prior to quit date \\nMax dose: 300mg/day","notes":"","alert":""},{"id":"Bupropion","name":"Bupropion","class":"Norepinephrine Dopamine Reuptake Inhibitor","brands":"Zyban, Wellbutrin","monitor":"No specific recommendation.","side_effects_common":"agitation, dry mouth, insomnia, nausea, headache, weight loss","side_effects_rare":"seizures","info":"Black box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a695033.html\\n\\nTo minimize risk of seizures, IR doses should be at least 6 hours apart and SR doses should be at least 8 hours apart\\n\\nDo not chew, divide, or crush SR/ER Tablets\\n\\nUse recommended only for GA of 12 weeks or greater","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["antepartum"],"dosing":"Bupropion SR (12 hour)\\nStart 150mg daily, then increase to 150mg twice daily on day 4\\nInitiate one week prior to quit date","notes":"","alert":""},{"id":"Atomoxetine","name":"Atomoxetine","class":"Norepinephrine Reuptake Inhibitor","brands":"Straterra","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nAppears to be more effective in improving attention than in controlling hyperactivity. Can combine with stimulants if necessary.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a603013.html","length":"","diagnosis":"ADHD","branch":[],"population":["adult"],"dosing":"Start 40 mg/day and increase to 80 mg/day after a minimum of 3 days\\nIncrease to maximum dose of 100 mg/day after an additional 2-4 weeks as clinically indicated and tolerable\\nMay administer in single daily dose of divided into twice daily dosing","notes":"","alert":""},{"id":"Atomoxetine","name":"Atomoxetine","class":"Norepinephrine Reuptake Inhibitor","brands":"Straterra","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nAppears to be more effective in improving attention than in controlling hyperactivity. Can combine with stimulants if necessary.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a603013.html","length":"","diagnosis":"ADHD","branch":[],"population":["cardiac"],"dosing":"Start 40 mg/day and increase to 80 mg/day after a minimum of 3 days\\nIncrease to maximum dose of 100 mg/day after an additional 2-4 weeks as clinically indicated and tolerable\\nMay administer in single daily dose of divided into twice daily dosing","notes":"","alert":""},{"id":"Atomoxetine","name":"Atomoxetine","class":"Norepinephrine Reuptake Inhibitor","brands":"Straterra","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nAppears to be more effective in improving attention than in controlling hyperactivity. Can combine with stimulants if necessary.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a603013.html","length":"","diagnosis":"ADHD","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A:\\nStart 40 mg/day and increase to 80 mg/day after a minimum of 3 days\\nIncrease to maximum dose of 100 mg/day after an additional 2-4 weeks as clinically indicated and tolerable\\nMay administer in single daily dose of divided into twice daily dosing\\n\\nChild-Pugh B:\\nStart 20 mg/day and increase to 40 mg/day after a minimum of 3 days\\nIncrease to maximum dose of 50 mg/day after an additional 2-4 weeks as clinically indicated and tolerable\\nMay administer in single daily dose of divided into twice daily dosing\\n\\nChild-Pugh C:\\nStart 10 mg/day and increase to 20 mg/day after a minimum of 3 days\\nMay administer in single daily dose of divided into twice daily dosing","notes":"See specific dosing recommendations","alert":"caution"},{"id":"Atomoxetine","name":"Atomoxetine","class":"Norepinephrine Reuptake Inhibitor","brands":"Straterra","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nAppears to be more effective in improving attention than in controlling hyperactivity. Can combine with stimulants if necessary.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a603013.html","length":"","diagnosis":"ADHD","branch":[],"population":["obesity"],"dosing":"Start 40 mg/day and increase to 80 mg/day after a minimum of 3 days\\nIncrease to maximum dose of 100 mg/day after an additional 2-4 weeks as clinically indicated and tolerable\\nMay administer in single daily dose of divided into twice daily dosing","notes":"","alert":""},{"id":"Atomoxetine","name":"Atomoxetine","class":"Norepinephrine Reuptake Inhibitor","brands":"Straterra","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nAppears to be more effective in improving attention than in controlling hyperactivity. Can combine with stimulants if necessary.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a603013.html","length":"","diagnosis":"ADHD","branch":[],"population":["renal"],"dosing":"Start 40 mg/day and increase to 80 mg/day after a minimum of 3 days\\nIncrease to maximum dose of 100 mg/day after an additional 2-4 weeks as clinically indicated and tolerable\\nMay administer in single daily dose of divided into twice daily dosing","notes":"","alert":""},{"id":"Atomoxetine","name":"Atomoxetine","class":"Norepinephrine Reuptake Inhibitor","brands":"Straterra","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nAppears to be more effective in improving attention than in controlling hyperactivity. Can combine with stimulants if necessary.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a603013.html","length":"","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"< 70kg: \\nStart 0.5mg/kg/day\\nIncrease to 1.2 mg/kg/day after a minimum of 3 days\\nMay increase to max dose of 1.4mg/kg/day (or 100 mg/day whichever is less) as clinically indicated and tolerable\\nMay administer in single dose or divided into twice daily dosing\\n\\n> 70kg: \\nStart 40 mg/day and increase to 80 mg/day after a minimum of 3 days\\nIncrease to maximum dose of 100 mg/day after an additional 2-4 weeks as clinically indicated and tolerable\\nMay administer in single daily dose of divided into twice daily dosing","notes":"","alert":""},{"id":"Atomoxetine","name":"Atomoxetine","class":"Norepinephrine Reuptake Inhibitor","brands":"Straterra","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nAppears to be more effective in improving attention than in controlling hyperactivity. Can combine with stimulants if necessary.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a603013.html","length":"","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"< 70kg: \\nStart 0.5mg/kg/day\\nIncrease to 1.2 mg/kg/day after a minimum of 3 days\\nMay increase to max dose of 1.4mg/kg/day (or 100 mg/day whichever is less) as clinically indicated and tolerable\\nMay administer in single dose or divided into twice daily dosing\\n\\n> 70kg: \\nStart 40 mg/day and increase to 80 mg/day after a minimum of 3 days\\nIncrease to maximum dose of 100 mg/day after an additional 2-4 weeks as clinically indicated and tolerable\\nMay administer in single daily dose of divided into twice daily dosing","notes":"","alert":""},{"id":"Viloxazine","name":"Viloxazine","class":"Norepinephrine Reuptake Inhibitor","brands":"Qelbree","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nCapsule may be opened and sprinkled on food.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a621027.html","length":"","diagnosis":"ADHD","branch":[],"population":["pediatric"],"dosing":"Age 6-11:\\nStart 100 mg/day\\nIncrease by 100 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 400 mg/day\\n\\nAge 12-17:\\nStart 200 mg/day\\nIncrease by 200 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 400 mg/day","notes":"","alert":""},{"id":"Viloxazine","name":"Viloxazine","class":"Norepinephrine Reuptake Inhibitor","brands":"Qelbree","monitor":"No specific recommendation.","side_effects_common":"sedation, fatigue, nausea, increased blood pressure (mild), insomnia, dizziness, anxiety, agitation, anticholinergic side effects (e.g. dry mouth), sexual dysfunction, dysmenorrhea","side_effects_rare":"derangement of blood pressure (hypertension or hypotension), increased heart rate and risk of cardiac adverse events, especially orthostatic, suicidality, chemical hepatitis","info":"Minimum therapeutic trial 6-8 weeks, although improvement can continue for up to 8-12 weeks\\n\\nCapsule may be opened and sprinkled on food.\\n\\nBlack box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a621027.html","length":"","diagnosis":"ADHD","branch":[],"population":["adolescent"],"dosing":"Start 200 mg/day\\nIncrease by 200 mg/day in minimum one week interval as clinically indicated and tolerable\\nMaximum dose 400 mg/day","notes":"","alert":""},{"id":"Nicotine Transdermal Patch","name":"Nicotine Transdermal Patch","class":"Nicotine Replacement Therapy","brands":"Nicoderm CQ; Nicorette","monitor":"No specific recommendation.","side_effects_common":"Headache, nausea, hiccups, dyspepsia,\\ntongue/mouth/throat irritation, cough, rhinitis, jaw ache (gum), skin reactions (patch)","side_effects_rare":"","info":"For best results, use a long term product (patch) plus a short term product (gum, lozenge). These products are available OTC","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adolescent"],"dosing":"Directions for use:\\nRotate sites to avoid skin irritation. \\nUse 4-8 weeks then taper slowly. \\nUse short term products (gum or lozenge) for cravings in combination with transdermal patch. \\n\\nDosing:\\n\\nIf patient smokes >10 or more cigarettes daily and weights >45kg-\\nStart 21 mg/day patch for 6 weeks\\nFollow with 14 mg/day patch for 2 weeks then 7 mg/day patch for 2 weeks\\n\\nIf patient smokes less than <10 cigarettes daily or weights <45kg-\\nStart 14 mg/day patch for 6 weeks\\nFollow with 7 mg/day patch for 2 weeks","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 25-50 mg at bedtime\\nIncrease by 25-150mg/day toward 2-3 times daily dosing in minimum one week if clinically indicated and tolerable\\nMax dose 450mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg at bedtime\\nTitrate upwards as clinically indicated and tolerable toward recommended daily dose based on CrCl:\\n\u2265 60:     600mg/day in 2-3 divided doses \\n30-60:   75-300 mg/day in 2-3 divided doses\\n15-30:   25mg-50 mg/day in 1-2 divided doses\\n<15:      25-75mg/day in a single daily dose","notes":"CrCl specific dose adjustments","alert":"caution"},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 25-50 mg at bedtime\\nIncrease by 25-150mg/day toward 2-3 times daily dosing in minimum one week if clinically indicated and tolerable\\nMax dose 450mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 75mg twice daily\\nIncrease by 75-150mg/day in minimum one week if clinically indicated and tolerable\\nMax dose 600mg/day in 2-3 divided doses","notes":"","alert":""},{"id":"Pregabalin","name":"Pregabalin","class":"GABA Analog","brands":"Lyrica","monitor":"No specific recommendation.","side_effects_common":"peripheral edema, dizziness, CNS depression, sedation, weight gain;","side_effects_rare":"Angiodema (higher risk in patients with history of angioedema or those taking ACE Inhibitors), case reports of rhabdomyolysis","info":"FDA warning (2019): Caution when using concurrently with other CNS depressents (eg. opioids, benzodiazepines, alcohol) due to increased risk of respiratory depression","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg at bedtime\\nTitrate upwards as clinically indicated and tolerable toward recommended daily dose based on CrCl:\\n\u2265 60:     600mg/day in 2-3 divided doses \\n30-60:   75-300 mg/day in 2-3 divided doses\\n15-30:   25mg-50 mg/day in 1-2 divided doses\\n<15:      25-75mg/day in a single daily dose","notes":"CrCl specific dose adjustments","alert":"caution"},{"id":"Naloxone","name":"Naloxone","class":"Opioid Antagonist","brands":"Narcan Nasal Spray","monitor":"No specific recommendation.","side_effects_common":"Symptoms of opioid withdrawal, including body aches, fever, sweating, rhinorrhea, sneezing, piloerection, weakness, shivering, restlessness, diarrhea, N/V, abdominal cramps, increased BP, tachycardia","side_effects_rare":"","info":"The Centers for Disease Control and Prevention recommend prescribing Naloxone to patients using opioids for chronic pain if their daily morphine equivalents are 50 or more:\\n\\nhttps://www.cdc.gov/drugoverdose/pdf/prescribing/Guidelines_Factsheet-a.pdf","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Bystander to spray into one nostril (dose delivery 0.4 mg); may repeat into other nostril with additional doses every 2-3 minutes if no or minimal response and until emergency response arrives.","notes":"","alert":""},{"id":"Naloxone","name":"Naloxone","class":"Opioid Antagonist","brands":"Narcan Nasal Spray","monitor":"No specific recommendation.","side_effects_common":"Symptoms of opioid withdrawal, including body aches, fever, sweating, rhinorrhea, sneezing, piloerection, weakness, shivering, restlessness, diarrhea, N/V, abdominal cramps, increased BP, tachycardia","side_effects_rare":"","info":"The Centers for Disease Control and Prevention recommend prescribing Naloxone to patients using opioids for chronic pain if their daily morphine equivalents are 50 or more:\\n\\nhttps://www.cdc.gov/drugoverdose/pdf/prescribing/Guidelines_Factsheet-a.pdf","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Bystander to spray into one nostril (dose delivery 0.4 mg); may repeat into other nostril with additional doses every 2-3 minutes if no or minimal response and until emergency response arrives.","notes":"","alert":""},{"id":"Naloxone","name":"Naloxone","class":"Opioid Antagonist","brands":"Narcan Nasal Spray","monitor":"No specific recommendation.","side_effects_common":"Symptoms of opioid withdrawal, including body aches, fever, sweating, rhinorrhea, sneezing, piloerection, weakness, shivering, restlessness, diarrhea, N/V, abdominal cramps, increased BP, tachycardia","side_effects_rare":"","info":"The Centers for Disease Control and Prevention recommend prescribing Naloxone to patients using opioids for chronic pain if their daily morphine equivalents are 50 or more:\\n\\nhttps://www.cdc.gov/drugoverdose/pdf/prescribing/Guidelines_Factsheet-a.pdf","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"Bystander to spray into one nostril (dose delivery 0.4 mg); may repeat into other nostril with additional doses every 2-3 minutes if no or minimal response and until emergency response arrives.","notes":"","alert":""},{"id":"Suvorexant","name":"Suvorexant","class":"Orexin Receptor Agonist","brands":"Belsomra","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["adult"],"dosing":"Start 10 mg 30 minutes before bedtime.  \\nMay increase to 20 mg if 10 mg dose is not effective.","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Suvorexant","name":"Suvorexant","class":"Orexin Receptor Agonist","brands":"Belsomra","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["cardiac"],"dosing":"Start 10 mg 30 minutes before bedtime.  \\nMay increase to 20 mg if 10 mg dose is not effective.","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Suvorexant","name":"Suvorexant","class":"Orexin Receptor Agonist","brands":"Belsomra","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["geriatric"],"dosing":"Start 10 mg 30 minutes before bedtime.  \\nMay increase to 20 mg if 10 mg dose is not effective.","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Suvorexant","name":"Suvorexant","class":"Orexin Receptor Agonist","brands":"Belsomra","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A and B:\\nStart 10 mg 30 minutes before bedtime.  \\nMay increase to 20 mg if 10 mg dose is not effective.\\n\\nChild-Pugh C:\\nDo not use.","notes":"See specific dosing recommendations.\\n\\nAvoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":"caution"},{"id":"Suvorexant","name":"Suvorexant","class":"Orexin Receptor Agonist","brands":"Belsomra","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["obesity"],"dosing":"Start 10 mg 30 minutes before bedtime.  \\nMay increase to 20 mg if 10 mg dose is not effective.","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Suvorexant","name":"Suvorexant","class":"Orexin Receptor Agonist","brands":"Belsomra","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Insomnia, Chronic","branch":[],"population":["renal"],"dosing":"Start 10 mg 30 minutes before bedtime.  \\nMay increase to 20 mg if 10 mg dose is not effective.","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Suvorexant","name":"Suvorexant","class":"Orexin Receptor Agonist","brands":"Belsomra","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 10 mg 30 minutes before bedtime.  \\nMay increase to 20 mg if 10 mg dose is not effective.","notes":"Avoid taking with fatty food (decreases absorption).\\n\\nNeeds to be taken at least 8 hours before planned wake time.","alert":""},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"Start 10 mg QHS, increase by 10 mg increments as tolerated; target dose 50-150mg/day","notes":"","alert":""},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["antepartum"],"dosing":"Start 10 mg QHS, increase by 10 mg increments as tolerated; target dose 50-150mg/day.","notes":"","alert":""},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"No specific recommendation.","side_effects_common":"headache, dry mouth, abnormal dreams","side_effects_rare":"impaired alertness and motor function, sleep paralysis and cataplexy-like symptoms, hypnagogic/hypnopompic hallucinations","info":"","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["postpartum"],"dosing":"Start 10 mg QHS, increase by 10 mg increments as tolerated; target dose 50-150mg/day.","notes":"","alert":""},{"id":"Olanzapine + Fluoxetine combine","name":"Olanzapine + Fluoxetine","class":"Atypical (SGA) Antipsychotics / SSRI","brands":"Symbyax","monitor":"No specific recommendation.","side_effects_common":"nausea, insomnia, headache,  increased risk for diabetes, dizziness, sedation,\\nperipheral edema, dry mouth, weight gain","side_effects_rare":"hyponatremia, GI bleeding, agranulocytosis or severe neutropenia, DRESS, TD, NMS","info":"","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Begin Olanzapine 6mg/ Fluoxetine 25mg qHS\\nIncrease dose as clinically indicated and tolerated \\nTypical dose Olanzapine 6mg-12mg/ Fluoxetine 25mg-50 mg/day\\n\\nApproximate corresponding dosing of individual components of Olanzapine with Fluoxetine as compared to Olanzapine Fluoxetine Combination (OFC)\\nOlanzapine 5mg + Fluoxetine 20 mg = OFC 6/25\\nOlanzapine 12.5mg + Fluoxetine 20 mg = OFC 12/25\\nOlanzapine 5mg + Fluoxetine 50 mg = OFC 6/50\\nOlanzapine 12.5mg + Fluoxetine 50 mg = OFC 12/50","notes":"","alert":""},{"id":"Buprenorphine-Naloxone SL Tabs","name":"Buprenorphine- Naloxone SL Tabs","class":"Opioid Agonists, partial","brands":"Zubsolv","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Typical range is 4 mg/2 mg up to 32 mg/ 8 mg daily in 2-3 divided doses. See corresponding decision support for details on titration.","notes":"","alert":""},{"id":"Buprenorphine-Naloxone SL Tabs","name":"Buprenorphine- Naloxone SL Tabs","class":"Opioid Agonists, partial","brands":"Zubsolv","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Typical range is 4 mg/2 mg up to 32 mg/ 8 mg daily in 2-3 divided doses. See corresponding decision support for details on titration.","notes":"","alert":""},{"id":"Buprenorphine-Naloxone SL Tabs","name":"Buprenorphine- Naloxone SL Tabs","class":"Opioid Agonists, partial","brands":"Zubsolv","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"Typical range is 4 mg/2 mg up to 32 mg/ 8 mg daily in 2-3 divided doses. See corresponding decision support for details on titration.","notes":"","alert":""},{"id":"Buprenorphine-Naloxone SL Films","name":"Buprenorphine- Naloxone SL Films","class":"Opioid Agonists, partial","brands":"Suboxone","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Typical range is 4 mg/2 mg up to 32 mg/ 8 mg daily in 2-3 divided doses. See corresponding decision support for details on titration","notes":"","alert":""},{"id":"Buprenorphine-Naloxone SL Films","name":"Buprenorphine- Naloxone SL Films","class":"Opioid Agonists, partial","brands":"Suboxone","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Typical range is 4 mg/2 mg up to 32 mg/ 8 mg daily in 2-3 divided doses. See corresponding decision support for details on titration","notes":"","alert":""},{"id":"Buprenorphine-Naloxone SL Films","name":"Buprenorphine- Naloxone SL Films","class":"Opioid Agonists, partial","brands":"Suboxone","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"Typical range is 4 mg/2 mg up to 32 mg/ 8 mg daily in 2-3 divided doses. See corresponding decision support for details on titration","notes":"","alert":""},{"id":"Buprenorphine SL Tabs","name":"Buprenorphine SL Tabs","class":"Opioid Agonists, partial","brands":"Subutex","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adult"],"dosing":"Typical range is 4 mg up to 32 mg daily in 2-3 divided doses. See corresponding decision support for details on titration.","notes":"","alert":""},{"id":"Buprenorphine SL Tabs","name":"Buprenorphine SL Tabs","class":"Opioid Agonists, partial","brands":"Subutex","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["adolescent"],"dosing":"Typical range is 4 mg up to 32 mg daily in 2-3 divided doses. See corresponding decision support for details on titration.","notes":"","alert":""},{"id":"Buprenorphine SL Tabs","name":"Buprenorphine SL Tabs","class":"Opioid Agonists, partial","brands":"Subutex","monitor":"No specific recommendation.","side_effects_common":"Headache, pain, vomiting, sweating, oral hypoesthesia, glossodynia","side_effects_rare":"Hepatitis","info":"The FDA announced a possible association of burenorphine dissolving products and dental problems, including cavities, infections, etc in early 2022: \\n\\nhttps://medlineplus.gov/druginfo/meds/a605002.html","length":"","diagnosis":"Opioid Use Disorder","branch":[],"population":["antepartum"],"dosing":"Typical range is 4 mg up to 32 mg daily in 2-3 divided doses. See corresponding decision support for details on titration.","notes":"","alert":""},{"id":"Sildenafil","name":"Sildenafil","class":"Phosphodiesterase-5 inhibitor","brands":"Viagra","monitor":"No specific recommendation.","side_effects_common":"headache, heartburn, flushing","side_effects_rare":"impairment in color discrimination, sudden decrease in hearing, hypotension when\\nused with alpha blockers or alcohol, priapism","info":"Do not use in patients as taking nitrates\\n\\nUse with caution in patients on alpha-adrenergic blockers\\n\\nDo not take with a high fat meal","length":"","diagnosis":"SSRI-Induced Sexual Dysfunction","branch":[],"population":["adult"],"dosing":"Administer 50 mg as needed 30min- 4hours before sexual activity\\nMay increase to 100 mg as needed if inadeqauate response\\nConsider using dose of 25mg if age \u2265 65 or on CYP3A4 inhibitors\\nLimit use to once daily","notes":"","alert":""},{"id":"Tadalafil","name":"Tadalafil","class":"Phosphodiesterase-5 inhibitor","brands":"Cialis","monitor":"No specific recommendation.","side_effects_common":"headache, heartburn, flushing.","side_effects_rare":"impairment in color discrimination, sudden decrease in hearing, hypotension when\\nused with alpha blockers or alcohol, priapism","info":"Do not use in patients as taking nitrates\\n\\nUse with caution in patients on alpha-adrenergic blocker\\n\\nNo dietary restrictions","length":"","diagnosis":"SSRI-Induced Sexual Dysfunction","branch":[],"population":["adult"],"dosing":"As needed:\\nAdminister 10 mg as needed 30-60min before sexual activity\\nAdjust dose to maximum of 20 mg based on response\\nEffects may last 36 hours\\nLimit use to once daily\\n\\nOnce-daily:\\nStart 2.5mg/day\\nIncrease to 5mg/day based on response\\nMaximum dose 5mg/day","notes":"","alert":""},{"id":"Drospirenone","name":"Drospirenone","class":"Progestin-only Contraceptive (POC)","brands":"Slynd","monitor":"No specific recommendation.","side_effects_common":"Breakthrough bleeding (65%), acne, abnormal uterine bleeding, headache, nausea, weight gain.","side_effects_rare":"hyperkalemia","info":"","length":"","diagnosis":"Premenstrual Dysphoric Disorder","branch":[],"population":["adult"],"dosing":"Start and maintain 4 mg/day (standard dosing in blister pack)\\n\\nIf inadequate response, consider addition of estrogen, if eligible.","notes":"","alert":""},{"id":"Vortioxetine","name":"Vortioxetine","class":"Serotonin Modulator","brands":"Trintellix","monitor":"No specific recommendation.","side_effects_common":"nausea, vomiting, constipation, sexual side effects (less compared to other serotenergic agents), dry mouth","side_effects_rare":"bruising/ bleeding, seizures, suicidality","info":"Black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a614003.html","length":"","diagnosis":"SSRI-Induced Sexual Dysfunction","branch":[],"population":["adult"],"dosing":"Start 5-10 mg/day\\nIncrease in 5-10 mg increments in minimum one week as clinically indicated and tolerable\\nMaximum dose 20 mg/day","notes":"","alert":""},{"id":"Vilazodone","name":"Vilazodone","class":"Serotonin Modulator","brands":"Viibryd","monitor":"No specific recommendation.","side_effects_common":"nausea, vomiting, constipation, sexual side effects (less compared to other serotenergic agents), dry mouth","side_effects_rare":"bruising/ bleeding, seizures, possibly hyponatremia, suicidality","info":"Black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a611020.html","length":"","diagnosis":"SSRI-Induced Sexual Dysfunction","branch":[],"population":["adult"],"dosing":"Start 10 mg/day\\nIn one week increase to 20 mg/day\\nFurther increase by 20 mg in minimum one week as clinically indicated and tolerable\\nMaximum dose 40 mg/day","notes":"","alert":""},{"id":"Melatonin","name":"Melatonin","class":"Melatonin","brands":"Several OTC forms","monitor":"No specific recommendation.","side_effects_common":"drowsiness, dizziness, headache, grogginess next day","side_effects_rare":"none reported","info":"","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start and maintain dose of 0.25mg- 0.5mg in early evening (4-6 PM)","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adult"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adolescent"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 40-60mg/day in single dose or divided\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adolescent"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum two weeks as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"Off-label","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adolescent"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum two weeks as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"Off-label","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["preconception"],"dosing":"Start 40-60mg/day in single dose or divided\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["postpartum"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 40-60mg/day in single dose or divided\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"Start 40-60mg/day in single dose or divided\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"CrCl >30 mL/min\\nStart 40-60mg/day in single dose or divided\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day\\n\\nCrCl <30 mL/min- Avoid use","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["adult"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["cardiac"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["geriatric"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["obesity"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["renal"],"dosing":"CrCl \u226530 mL/min\\nStart 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day\\n\\n\\nCrCl < 30mL/min- avoid use","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 30-60mg/day in single dose or divided dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["antepartum"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["postpartum"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 30-60mg/day in single dose or divided dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 30-60mg/day in single dose or divided dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u2265 30mL/min\\nStart 30-60mg/day in single dose or divided dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day\\n\\nCrCl <30 mL/min- avoid use","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Premenstrual Dysphoric Disorder","branch":[],"population":["adult"],"dosing":"Start 30mg/day in single dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 30-60mg/day in single dose or divided dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 30-60mg/day in single dose or divided dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 20-30mg/day in single dose \\nIncrease by 20-30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 30-60mg/day in single dose or divided dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Duloxetine","name":"Duloxetine","class":"SNRI Antidepressants","brands":"Cymbalta","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, diarrhea, decreased appetite, insomnia, sweating, dizziness, sexual side effects","side_effects_rare":"elevated LFTs, hepatitis, hepatic failure, orthostatic hypotension, urinary retention, serotonin syndrome, syncope","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a604030.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u2265 30mL/min\\nStart 30-60mg/day in single dose or divided dose\\nIncrease by 30mg/day in single or divided increments in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day\\n\\nCrCl <30 mL/min- avoid use","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Milnacipran","name":"Milnacipran","class":"SNRI Antidepressants","brands":"Savella","monitor":"No specific recommendation.","side_effects_common":"headache, insomnia, nausea, constipation,\\nhot flashes;","side_effects_rare":"bleeding risk, hepatotoxicity, SIADH/\\nhyponatremia, serotonin syndrome","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a609016.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["adult"],"dosing":"Day 1: 12.5mg/day\\nDay 2: 12.5mg twice daily\\nDay 4: 25mg twice daily\\nDay 7: 50 mg twice daily\\n\\nMax dose 100 mg twice daily","notes":"","alert":""},{"id":"Milnacipran","name":"Milnacipran","class":"SNRI Antidepressants","brands":"Savella","monitor":"No specific recommendation.","side_effects_common":"headache, insomnia, nausea, constipation,\\nhot flashes;","side_effects_rare":"bleeding risk, hepatotoxicity, SIADH/\\nhyponatremia, serotonin syndrome","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a609016.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["cardiac"],"dosing":"Day 1: 12.5mg/day\\nDay 2: 12.5mg twice daily\\nDay 4: 25mg twice daily\\nDay 7: 50 mg twice daily\\n\\nMax dose 100 mg twice daily","notes":"","alert":""},{"id":"Milnacipran","name":"Milnacipran","class":"SNRI Antidepressants","brands":"Savella","monitor":"No specific recommendation.","side_effects_common":"headache, insomnia, nausea, constipation,\\nhot flashes;","side_effects_rare":"bleeding risk, hepatotoxicity, SIADH/\\nhyponatremia, serotonin syndrome","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a609016.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["geriatric"],"dosing":"Day 1: 12.5mg/day\\nDay 2: 12.5mg twice daily\\nDay 4: 25mg twice daily\\nDay 7: 50 mg twice daily\\n\\nMax dose 100 mg twice daily","notes":"","alert":""},{"id":"Milnacipran","name":"Milnacipran","class":"SNRI Antidepressants","brands":"Savella","monitor":"No specific recommendation.","side_effects_common":"headache, insomnia, nausea, constipation,\\nhot flashes;","side_effects_rare":"bleeding risk, hepatotoxicity, SIADH/\\nhyponatremia, serotonin syndrome","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a609016.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["hepatic"],"dosing":"Day 1: 12.5mg/day\\nDay 2: 12.5mg twice daily\\nDay 4: 25mg twice daily\\nDay 7: 50 mg twice daily\\n\\nMax dose 100 mg twice daily","notes":"Use with caution in severe hepatic impairment","alert":"caution"},{"id":"Milnacipran","name":"Milnacipran","class":"SNRI Antidepressants","brands":"Savella","monitor":"No specific recommendation.","side_effects_common":"headache, insomnia, nausea, constipation,\\nhot flashes;","side_effects_rare":"bleeding risk, hepatotoxicity, SIADH/\\nhyponatremia, serotonin syndrome","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a609016.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["obesity"],"dosing":"Day 1: 12.5mg/day\\nDay 2: 12.5mg twice daily\\nDay 4: 25mg twice daily\\nDay 7: 50 mg twice daily\\n\\nMax dose 100 mg twice daily","notes":"","alert":""},{"id":"Milnacipran","name":"Milnacipran","class":"SNRI Antidepressants","brands":"Savella","monitor":"No specific recommendation.","side_effects_common":"headache, insomnia, nausea, constipation,\\nhot flashes;","side_effects_rare":"bleeding risk, hepatotoxicity, SIADH/\\nhyponatremia, serotonin syndrome","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a609016.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["renal"],"dosing":"Mild impairment\\nDay 1: 12.5mg/day\\nDay 2: 12.5mg twice daily\\nDay 4: 25mg twice daily\\nDay 7: 50 mg twice daily\\n\\nMax dose 100 mg twice daily\\n\\nModerate impairment (CrCl >30 mL/min)- use with caution\\nDay 1: 12.5mg/day\\nDay 2: 12.5mg twice daily\\nDay 4: 25mg twice daily\\nDay 7: 50 mg twice daily\\n\\nMax dose 100 mg twice daily\\n\\n\\nSevere impairment (CrCl \u226429 mL/min) \\nDay 1: 12.5mg/day\\nDay 4: 12.5mg twice daily\\nDay 7: 25mg twice daily\\n\\nMax dose 50 mg twice daily\\n\\n\\nESRD (CrCl \u226415 mL/min) - avoid use","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adult"],"dosing":"IR: \\nStart 37.5-75mg/day (doses >37.5mg administered in 2-3 divided doses)\\nIncrease by 75mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 375mg/day divided three times daily\\n\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day (some guidelines support max ER dosing of 375mg/day)","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adolescent"],"dosing":"IR: \\nStart 37.5-75mg/day (doses >37.5mg administered in 2-3 divided doses)\\nIncrease by 75mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 375mg/day divided three times daily\\n\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day (some guidelines support max ER dosing of 375mg/day)","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"IR: \\nStart 37.5-75mg/day (doses >37.5mg administered in 2-3 divided doses)\\nIncrease by 75mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 375mg/day divided three times daily\\n\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day (some guidelines support max ER dosing of 375mg/day)","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["pediatric"],"dosing":"8-12yo\\nIR:\\nStart 12.5mg/day for 3 days, then 12.5mg twice daily for 3 days, then 12.5mg three times daily\\nMax dose 75mg/day divided three times daily\\n\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week\\nMax dose 75mg/day\\n\\n\\n>13yo\\nIR:\\nStart 25mg/day for 3 days, then 25mg twice daily for 3 days, then 25mg three times daily\\nMax dose 75mg/day divided three times daily\\n\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week\\nmax dose 225mg/day","notes":"Off-label","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adolescent"],"dosing":"IR:\\nStart 25mg/day for 3 days, then 25mg twice daily for 3 days, then 25mg three times daily\\nMax dose 75mg/day divided three times daily\\n\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week\\nmax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adolescent"],"dosing":"IR:\\nStart 25mg/day for 3 days, then 25mg twice daily for 3 days, then 25mg three times daily\\nMax dose 75mg/day divided three times daily\\n\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week\\nmax dose 225mg/day","notes":"Off-label","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adolescent"],"dosing":"IR:\\nStart 25mg/day for 3 days, then 25mg twice daily for 3 days, then 25mg three times daily\\nMax dose 75mg/day divided three times daily\\n\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week\\nmax dose 225mg/day","notes":"Off-label","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["preconception"],"dosing":"IR: \\nStart 37.5-75mg/day (doses >37.5mg administered in 2-3 divided doses)\\nIncrease by 75mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day divided three times daily\\n\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["antepartum"],"dosing":"IR: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in divided doses 2 or 3 times daily in minimum one week\\nMax dose 225mg/day divided three times daily\\n\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["postpartum"],"dosing":"IR: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day divided three times daily\\n\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["cardiac"],"dosing":"IR: \\nStart 37.5-75mg/day (doses >37.5mg administered in 2-3 divided doses)\\nIncrease by 75mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 375mg/day divided three times daily\\n\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["geriatric"],"dosing":"IR: \\nStart 37.5-75mg/day (doses >37.5mg administered in 2-3 divided doses)\\nIncrease by 75mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 375mg/day divided three times daily\\n\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"IR: \\nStart 37.5-75mg/day (doses >37.5mg administered in 2-3 divided doses)\\nIncrease by 75mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 375mg/day divided three times daily\\n\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day (some guidelines support max ER dosing of 375mg/day)","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u2265 30 mL/min\\nIR: \\nStart 37.5-75mg/day (doses >37.5mg administered in 2-3 divided doses)\\nIncrease by 75mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 375mg/day divided three times daily\\n\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day (some guidelines support max ER dosing of 375mg/day)\\n\\n\\nCrCl <30 mL/min- \\nIR: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in divided doses 2 or 3 times daily in minimum one week as clinically indicated and tolerable\\nMax dose 187.5mg/day divided three times daily\\n\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 112.5mg/day","notes":"Please note specific dosing recomendations","alert":"caution"},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"ER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["pediatric"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 8-12yo:75mg.  >13yo: 225mg/day","notes":"Off-label","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"ER: \\nStart 37.5-75mg/day \\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["antepartum"],"dosing":"ER: \\nStart 37.5-75mg/day \\nIncrease by 37.5mg/day in 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effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"ER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"ER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"ER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u226530mL/min-\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day\\n\\nCrCl < 30mL/min- \\nER: \\nStart 37.5-75mg/day\\nIncrease by 37.5-75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 112.5mg/day","notes":"Please note specific dosing recomendations","alert":"caution"},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5g/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["adult"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["geriatric"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["cardiac"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["obesity"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u226530mL/min-\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day\\n\\nCrCl < 30mL/min- \\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 112.5mg/day","notes":"Please note specific dosing recomendations","alert":"caution"},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5-75mg/day in minimum one week  as clinically indicated and tolerable\\nDoses 225mg/day and greater should be divided twice daily\\nMax dose 375mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5-75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"ER: \\nStart 37.5mg/day\\nIncrease by 37.5-75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 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anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u226530mL/min-\\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day\\n\\nCrCl < 30mL/min- \\nER: \\nStart 37.5mg/day\\nIncrease by 37.5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 112.5mg/day","notes":"Please note specific dosing recomendations","alert":"caution"},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"ER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"ER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 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SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"ER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 225mg/day","notes":"","alert":""},{"id":"Venlafaxine","name":"Venlafaxine","class":"SNRI Antidepressants","brands":"Effexor XR","monitor":"No specific recommendation.","side_effects_common":"nausea, dry mouth, dizziness, agitation, headache, sexual side effects, anorexia, constipation, sweating","side_effects_rare":"hypertension, SIADH","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a694020.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"CrCl \u226530mL/min-\\nER: \\nStart 37.5-75mg/day\\nIncrease by 75mg/day in minimum one week as clinically indicated and tolerable\\nmax dose 225mg/day\\n\\nCrCl < 30mL/min- \\nER: \\nStart 37.5-75mg/day\\nIncrease by 37.5-75mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 112.5mg/day","notes":"Please note specific dosing recomendations","alert":"caution"},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects.","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects.","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects.","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"SSRI-Induced Sexual Dysfunction","branch":[],"population":["adult"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects.","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"","alert":""},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects.","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects.","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side 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old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"Mild to moderate renal impairment:\\nStart 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day\\n\\nSevere renal impairment (CrCl < 20 mL/min)\\nhas not been studied, use with caution","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects.","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Citalopram","name":"Citalopram","class":"SSRI Antidepressants","brands":"Celexa","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects.","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a699001.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 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the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 5-10 mg/day \\nIncrease by 5 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 10 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"Mild to moderate renal impairment:\\nStart 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day\\n\\nSevere renal impairment (CrCl < 20 mL/min)\\nhas not been studied, use with caution","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["pediatric"],"dosing":"Start 5mg/day\\nIncrease by 5-10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"FDA-approved ages 7 and older","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["preconception"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["antepartum"],"dosing":"Start 5-10 mg/day \\nIncrease by 5-10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["postpartum"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg/day \\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 10 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 5-10 mg/day \\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 10 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Mild to moderate renal impairment:\\nStart 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day\\n\\nSevere renal impairment (CrCl < 20 mL/min)\\nhas not been studied, use with caution","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 5mg/day \\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["adult"],"dosing":"Start 5 mg/day for 1 week, then increase to 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["cardiac"],"dosing":"Start 5 mg/day for 1 week, then increase to 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["hepatic"],"dosing":"Start 5 mg/day \\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 10 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["geriatric"],"dosing":"Start 5mg/day \\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 10 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["obesity"],"dosing":"Start 5 mg/day for 1 week, then increase to 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["renal"],"dosing":"Mild to moderate renal impairment:\\nStart 5mg/day for 1 week, then increase to 10 mg/day\\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day\\n\\nSevere renal impairment (CrCl < 20 mL/min)\\nhas not been studied, use with caution","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Premenstrual Dysphoric Disorder","branch":[],"population":["adult"],"dosing":"May be taken continously, during luteal phase, or on a symptom triggered basis.\\n\\nContinuous:\\nStart 5mg/day \\nIncrease by 5mg/day in minimum 1 week as clinically indicated and tolerable\\nMax dose 20 mg/day\\n\\nLuteal phase:\\nStart 5 mg/day on day 14 of cycle\\nIncrease by 5 mg/day with each subsequent cycle as clinically indicated and tolerable\\nMax dose 20 mg/day\\n\\nSymptom triggered:\\nStart 5 mg/day\\nIncrease by 5 mg/day as needed with each subsequent cycle as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg/day \\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 10 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 5-10 mg/day \\nIncrease by 5mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 10 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Mild to moderate renal impairment:\\nStart 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day\\n\\nSevere renal impairment (CrCl < 20 mL/min)\\nhas not been studied, use with caution","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Escitalopram","name":"Escitalopram","class":"SSRI Antidepressants","brands":"Lexapro","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a603005.html","length":"","diagnosis":"Somatic Symptom Disorder","branch":[],"population":["adult"],"dosing":"Start 5mg/day.\\nTitrate by 5mg/day increments every 1-4 weeks as clinically indicated and tolerable\\nMax dose 20 mg/day.","notes":"Some patients with Somatic Symptom Disorder may better tolerate slow titration","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adult"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adolescent"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["pediatric"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adolescent"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60 mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["pediatric"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adolescent"],"dosing":"Start 10 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Depressive 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and tolerable\\nMax dose: 80mg/day\\n(In general, higher doses of SSRIs than used for MDD may be necessary for effective treatment of OCD. Some experts recommend occasional max dose of 120mg/day)","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["geriatric"],"dosing":"Starting dose 10 mg/day.\\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day.","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day\\n(In general, higher doses of SSRIs than used for MDD may be necessary for effective treatment of OCD. Some experts recommend occasional max dose of 120mg/day)","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"Start 20 mg/day \\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side 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Disorder","branch":[],"population":["geriatric"],"dosing":"Start 10 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 10-20 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 10-20 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Premenstrual Dysphoric Disorder","branch":[],"population":["adult"],"dosing":"May be taken continously, during luteal phase, or on a symptom triggered basis.\\n\\nContinuous:\\nStart 10 mg/day \\nIncrease by 10 mg/day in minimum 1 week as clinically indicated and tolerable\\nMax dose 30 mg/day\\n\\nLuteal phase:\\nStart 10 mg/day on day 14 of cycle\\nIncrease by 10 mg/day with each subsequent cycle as clinically indicated and tolerable\\nMax dose 30 mg/day\\n\\nSymptom triggered:\\nStart 10 mg/day\\nIncrease by 10 mg/day as needed with each subsequent cycle as clinically indicated and tolerable\\nMax dose 20 mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 10-20 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 10-20 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 10 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 10 mg/day \\nIncrease by 10 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 30mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 10-20 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 10-20 mg/day \\nIncrease by 10-20 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day","notes":"","alert":""},{"id":"Fluoxetine","name":"Fluoxetine","class":"SSRI Antidepressants","brands":"Prozac","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a689006.html","length":"","diagnosis":"Somatic Symptom Disorder","branch":[],"population":["adult"],"dosing":"Start 10 mg/day.\\nTitrate by 10 mg/day increments every 1-4 weeks as clinically indicated and tolerable\\nMax dose 80mg/day","notes":"","alert":""},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adult"],"dosing":"Start 50 mg/day (IR) or 100 mg/day (ER) at bedtime\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adolescent"],"dosing":"Start 50 mg/day (IR) or 100 mg/day (ER) at bedtime\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["adult"],"dosing":"Start 50 mg/day (IR) or 100 mg/day (ER) at bedtime\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n(In general, higher doses of SSRIs than used for MDD may be necessary for effective treatment of OCD. Some experts recommend occasional max dose of 450mg/day)","notes":"","alert":""},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["cardiac"],"dosing":"Start 50 mg/day (IR) or 100 mg/day (ER) at bedtime\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 50 mg/day (IR) or 100 mg/day (ER) at bedtime\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh A:\\nStart 50 mg/day (IR) or 100 mg/day (ER) at bedtime\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n\\nChild-Pugh B and C:\\nStart 25mg/day (IR) or 50 mg/day (ER) at bedtime\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 150mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"Start 50 mg/day (IR) or 100 mg/day (ER) at bedtime\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day\\n(In general, higher doses of SSRIs than used for MDD may be necessary for effective treatment of OCD. Some experts recommend occasional max dose of 450mg/day)","notes":"","alert":""},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"Start 50 mg/day (IR) or 100 mg/day (ER) at bedtime\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Fluvoxamine","name":"Fluvoxamine","class":"SSRI Antidepressants","brands":"Luvox","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Immediate release formulation may twice daily dosing at total daily dose &gt;100 mg/day \\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a695004.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Start 25mg/day (IR) or 50 mg/day (ER) at bedtime\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Paroxetine","name":"Paroxetine","class":"SSRI Antidepressants","brands":"Paxil","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a698032.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 20 mg/day (IR) or 25mg/d (CR)\\nIncrease by 10-20 mg/day (IR) or 12.5mg (CR) in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day (IR) or 75mg/d (CR)","notes":"","alert":""},{"id":"Paroxetine","name":"Paroxetine","class":"SSRI Antidepressants","brands":"Paxil","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a698032.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"Start 20 mg/day (IR) or 25mg/d (CR)\\nIncrease by 10-20 mg/day (IR) or 12.5mg (CR) in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day (IR) or 75mg/d (CR)","notes":"","alert":""},{"id":"Paroxetine","name":"Paroxetine","class":"SSRI Antidepressants","brands":"Paxil","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a698032.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["geriatric"],"dosing":"Start 10 mg/day (IR) or 12.5mg/d (CR)\\nIncrease by 10 mg/day (IR) or 12.5mg (CR) in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day (IR) or 50 mg/d (CR)","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Paroxetine","name":"Paroxetine","class":"SSRI Antidepressants","brands":"Paxil","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a698032.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"HEPATIC DOSING \u2013\\nMild to moderate impairment\\nStart 20 mg/day (IR) or 25mg/d (CR)\\nIncrease by 10-20 mg/day (IR) or 12.5mg (CR) in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day (IR) or 75mg/d (CR)\\n\\nSevere impairment- starting dose 10 mg/day.  \\nStart 10 mg/day (IR) or 12.5mg/d (CR)\\nIncrease by 10 mg/day (IR) or 12.5mg (CR) in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day (IR) or 50 mg/d (CR)","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Paroxetine","name":"Paroxetine","class":"SSRI Antidepressants","brands":"Paxil","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a698032.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 20 mg/day (IR) or 25mg/d (CR)\\nIncrease by 10-20 mg/day (IR) or 12.5mg (CR) in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day (IR) or 75mg/d (CR)","notes":"High association with weight gain","alert":"caution"},{"id":"Paroxetine","name":"Paroxetine","class":"SSRI Antidepressants","brands":"Paxil","monitor":"No specific recommendation.","side_effects_common":"insomnia, anxiety, nausea, sexual side effects, weight gain, headache","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, discontinuation syndrome, seizure","info":"Black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a698032.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"RENAL DOSING-\\nCrCl between >30\\nMild to moderate impairment\\nStart 20 mg/day (IR) or 25mg/d (CR)\\nIncrease by 10-20 mg/day (IR) or 12.5mg (CR) in minimum one week as clinically indicated and tolerable\\nMax dose 60mg/day (IR) or 75mg/d (CR)\\n\\nCrCl <30 mL/min\\nStart 10 mg/day (IR) or 12.5mg/d (CR)\\nIncrease by 10 mg/day (IR) or 12.5mg (CR) in minimum one week as clinically indicated and tolerable\\nMax dose 40 mg/day (IR) or 50 mg/d (CR)","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adult"],"dosing":"Start 50 mg/day\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Bulimia Nervosa","branch":[],"population":["adolescent"],"dosing":"Start 50 mg/day\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Intermittent Explosive Disorder","branch":[],"population":["adult"],"dosing":"Start 50 mg/day\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 50 mg/day\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["pediatric"],"dosing":"6-12yo\\nStart 12.5-25mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day\\n\\n>12yo \\nStart 25-50 mg/day\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"Off-label","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adolescent"],"dosing":"Start 25 mg/day\\nIncrease by 25 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adolescent"],"dosing":"Start 25-50 mg/day\\nIncrease by 50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 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seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["obesity"],"dosing":"Start 25mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["geriatric"],"dosing":"Start 25mg/day\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["renal"],"dosing":"Start 25mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["cardiac"],"dosing":"Start 25-50 mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh Class A:\\nStart 25mg/day\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day\\n\\nChild-Pugh Class B or C:\\nDo not use","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Premenstrual Dysphoric Disorder","branch":[],"population":["adult"],"dosing":"May be taken continously, during luteal phase, or on a symptom triggered basis.\\n\\nContinuous:\\nStart 25 mg/day \\nIncrease by 25-50 mg/day in minimum 1 week as clinically indicated and tolerable\\nMax dose 200 mg/day\\n\\nLuteal phase:\\nStart 25 mg/day on day 14 of cycle\\nIncrease by 25-50 mg/day with each subsequent cycle as clinically indicated and tolerable\\nMax dose 150 mg/day\\n\\nSymptom triggered:\\nStart 25 mg/day\\nIncrease by 25-50 mg/day as needed with each subsequent cycle as clinically indicated and tolerable\\nMax dose 150 mg/day","notes":"If using >100 mg/day for luteal phase or symptom triggered dosing, each subsequent cycle start 50 mg/day for 2-3 days then increase to target dose thereafter","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 25mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["cardiac"],"dosing":"Start 25mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["geriatric"],"dosing":"Start 25mg/day\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Child-Pugh Class A:\\nStart 25mg/day\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day\\n\\nChild-Pugh Class B or C:\\nDo not use","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 25mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 25mg/day\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"","alert":""},{"id":"Sertraline","name":"Sertraline","class":"SSRI Antidepressants","brands":"Zoloft","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, sexual side effects","side_effects_rare":"Bleeding (especially GI bleeding- increased risk with NSAIDs/antiplatelets/anticoagulants), hyponatremia/SIADH,  serotonin syndrome, seizure","info":"black box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a697048.html","length":"","diagnosis":"Somatic Symptom Disorder","branch":[],"population":["adult"],"dosing":"Start 12.5-25mg/day\\nTitrate by 12.5mg- 25mg/day increments every 1-4 weeks as clinically indicated and tolerable\\nMax dose 200mg/day","notes":"Some patients with Somatic Symptom Disorder may better tolerate slow titration","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"","diagnosis":"Binge Eating Disorder","branch":[],"population":["adult"],"dosing":"Start 30mg/day daily\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Vyvanse","name":"Vyvanse","class":"Amphetamines","brands":"Vyvanse","monitor":"No specific recommendation.","side_effects_common":"insomnia,\\nheadache, exacerbation of tics, tremor, dizziness, anorexia, dry mouth, constipation, diarrhea, sexual dysfunction","side_effects_rare":"psychosis, seizures, cardiovascular events (hypertension, palpitations,\\ntachycardia, sudden death), rare induction of mania or suicidality","info":"Prodrug formulation that limits abuse or misuse potential\\n\\nBlack box warning for misuse potential-\\n\\nhttps://medlineplus.gov/druginfo/meds/a607047.html","length":"","diagnosis":"Binge Eating Disorder","branch":[],"population":["adolescent"],"dosing":"Start 30mg/day daily\\nIncrease by 20 mg/day in minimum one week as clinically indicated and tolerable\\nMaximum dose 70 mg/day","notes":"","alert":""},{"id":"Methylphenidate","name":"Methylphenidate","class":"Methylphenidate & derivatives","brands":"Ritalin","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, vomiting, weight loss, tics, agitation, elevated blood pressure","side_effects_rare":"psychosis, seizures, priapism, sudden death in patients with preexisting cardiac abnormalities","info":"FDA Box warning\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 5 mg daily or twice daily\\nIncrease by 5mg/dose every 1-4 days as clinically indicated and tolerable\\nMax dose 20 mg twice daily","notes":"","alert":""},{"id":"Methylphenidate","name":"Methylphenidate","class":"Methylphenidate & derivatives","brands":"Ritalin","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, vomiting, weight loss, tics, agitation, elevated blood pressure","side_effects_rare":"psychosis, seizures, priapism, sudden death in patients with preexisting cardiac abnormalities","info":"FDA Box warning\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["geriatric"],"dosing":"Start 2.5-5mg daily or twice daily\\nIncrease by 2.5-5mg/dose every 1-4 days as clinically indicated and tolerable\\nMax dose 20 mg twice daily","notes":"Please note the specific dosing recommendations.","alert":"caution"},{"id":"Methylphenidate","name":"Methylphenidate","class":"Methylphenidate & derivatives","brands":"Ritalin","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, vomiting, weight loss, tics, agitation, elevated blood pressure","side_effects_rare":"psychosis, seizures, priapism, sudden death in patients with preexisting cardiac abnormalities","info":"FDA Box warning\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 5 mg daily or twice daily\\nIncrease by 5mg/dose every 1-4 days as clinically indicated and tolerable\\nMax dose 20 mg twice daily","notes":"","alert":""},{"id":"Methylphenidate","name":"Methylphenidate","class":"Methylphenidate & derivatives","brands":"Ritalin","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, vomiting, weight loss, tics, agitation, elevated blood pressure","side_effects_rare":"psychosis, seizures, priapism, sudden death in patients with preexisting cardiac abnormalities","info":"FDA Box warning\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"Start 5 mg daily or twice daily\\nIncrease by 5mg/dose every 1-4 days as clinically indicated and tolerable\\nMax dose 20 mg twice daily","notes":"","alert":""},{"id":"Methylphenidate","name":"Methylphenidate","class":"Methylphenidate & derivatives","brands":"Ritalin","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, vomiting, weight loss, tics, agitation, elevated blood pressure","side_effects_rare":"psychosis, seizures, priapism, sudden death in patients with preexisting cardiac abnormalities","info":"FDA Box warning\\nhttps://medlineplus.gov/druginfo/meds/a682188.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"Start 5 mg daily or twice daily\\nIncrease by 5mg/dose every 1-4 days as clinically indicated and tolerable\\nMax dose 20 mg twice daily","notes":"","alert":""},{"id":"Methylphenidate","name":"Methylphenidate","class":"Methylphenidate & derivatives","brands":"Ritalin","monitor":"No specific recommendation.","side_effects_common":"insomnia, headache, nausea, vomiting, weight loss, tics, agitation, elevated blood pressure","side_effects_rare":"psychosis, seizures, priapism, sudden death in patients with preexisting cardiac abnormalities","info":"Most studied in patients with dementia. Other stimulants may be reasonable altenatives.","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 2.5 mg daily\\nIncrease by 2.5 mg/day in minimum one week as clinically indicated and tolerable\\nStart with short acting formulation and if tolerated and clinically helpful may consider ER formulation","notes":"","alert":""},{"id":"Modafinil","name":"Modafinil","class":"CNS Stimulant","brands":"Provigil","monitor":"No specific recommendation.","side_effects_common":"elevations in HR and BP, head, GI upset, insomnia","side_effects_rare":"psychosis or mania, rash including Stevens-Johnson syndrome (SJS), hypersensitivity, angioedema, and anaphylaxis","info":"Important cytochrome enzyme interactions. Always check interactions with currently prescribed medications.","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adult"],"dosing":"Start 100 mg/day\\nIncrease to 200mg/day in 3 days if tolerable\\nFurther increase by 100 mg/day increments in intervals of at least one week\\nMax dose 400mg/day","notes":"","alert":""},{"id":"Modafinil","name":"Modafinil","class":"CNS Stimulant","brands":"Provigil","monitor":"No specific recommendation.","side_effects_common":"elevations in HR and BP, head, GI upset, insomnia","side_effects_rare":"psychosis or mania, rash including Stevens-Johnson syndrome (SJS), hypersensitivity, angioedema, and anaphylaxis","info":"Important cytochrome enzyme interactions. Always check interactions with currently prescribed medications.","length":"","diagnosis":"Stimulant Use Disorder","branch":[],"population":["adolescent"],"dosing":"Start 100 mg/day\\nIncrease to 200mg/day in 3 days if tolerable\\nFurther increase by 100 mg/day increments in intervals of at least one week\\nMax dose 400mg/day","notes":"","alert":""},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["adult"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable\\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["hepatic"],"dosing":"Start 5 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["obesity"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["renal"],"dosing":"Start 5 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg/day (once daily or divided doses)\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nTarget Dose 100-200mg/day\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 25mg/day (once daily or divided doses)\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 100 mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg/day  (once daily or divided doses)\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nTarget Dose 100-200mg/day\\nMax dose 300 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg/day  (once daily or divided doses)\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nTarget Dose 100-200mg/day\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Amitriptyline","name":"Amitriptyline","class":"Tricyclic Antidepressants","brands":"Elavil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682388.html","length":"","diagnosis":"Somatic Symptom Disorder","branch":[],"population":["adult"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Clomipramine","name":"Clomipramine","class":"Tricyclic Antidepressants","brands":"Anafranil","monitor":"Obtaine a baseline EKG\\nMonitor EKG and drug levels at each dose titration after 75mg/day\\n\\nIf co-treated with SSRI, monitor drug levels starting at 75mg/day.","side_effects_common":"sedation, fatigue, nausea, diarrhea, increased appetitie, anticholinergic side effects (e.g. dry mouth), headache, restlesness, heartburn, weight gain, sexual side effects","side_effects_rare":"seizures, cardiac effects (prolonged QT, arrhythmias, hypotension, tachycardia), EPS symptoms, increased intraocular pressure, paralytic ileus, hyperthermia, overdose toxicity (as little as 10-day supply can be fatal)","info":"Black box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a697002.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["adult"],"dosing":"Augmentation: \\nStart 10 mg/day, increase by 10 mg-25mg/day until intolerable side effects occur, full response is reached, or maximum dose is reached. Do not exceed 75 mg daily. If using concurrently with an SSRI, consider lowering the dose of the SSRI when starting clomipramine. \\n\\nTreatment:\\nStart 10 mg/day, increase by 10 mg-25mg/day until intolerable side effects occur, full response is reached, or maximum dose is reached. Mean target dose 30mg-150mg/day. Occasional max dose 250mg/day.","notes":"","alert":""},{"id":"Clomipramine","name":"Clomipramine","class":"Tricyclic Antidepressants","brands":"Anafranil","monitor":"Obtaine a baseline EKG\\nMonitor EKG and drug levels at each dose titration after 75mg/day\\n\\nIf co-treated with SSRI, monitor drug levels starting at 75mg/day.","side_effects_common":"sedation, fatigue, nausea, diarrhea, increased appetitie, anticholinergic side effects (e.g. dry mouth), headache, restlesness, heartburn, weight gain, sexual side effects","side_effects_rare":"seizures, cardiac effects (prolonged QT, arrhythmias, hypotension, tachycardia), EPS symptoms, increased intraocular pressure, paralytic ileus, hyperthermia, overdose toxicity (as little as 10-day supply can be fatal)","info":"Black box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a697002.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["obesity"],"dosing":"Augmentation: \\nStart 10 mg/day, increase by 10 mg-25mg/day until intolerable side effects occur, full response is reached, or maximum dose is reached. Do not exceed 75 mg daily. If using concurrently with an SSRI, consider lowering the dose of the SSRI when starting clomipramine. \\n\\nTreatment:\\nStart 10 mg/day, increase by 10 mg-25mg/day until intolerable side effects occur, full response is reached, or maximum dose is reached. Mean target dose 30mg-150mg/day. Occasional max dose 250mg/day.","notes":"Please note high association with weight gain when using treatment dosing","alert":"caution"},{"id":"Clomipramine","name":"Clomipramine","class":"Tricyclic Antidepressants","brands":"Anafranil","monitor":"Obtaine a baseline EKG\\nMonitor EKG and drug levels at each dose titration after 75mg/day\\n\\nIf co-treated with SSRI, monitor drug levels starting at 75mg/day.","side_effects_common":"sedation, fatigue, nausea, diarrhea, increased appetitie, anticholinergic side effects (e.g. dry mouth), headache, restlesness, heartburn, weight gain, sexual side effects","side_effects_rare":"seizures, cardiac effects (prolonged QT, arrhythmias, hypotension, tachycardia), EPS symptoms, increased intraocular pressure, paralytic ileus, hyperthermia, overdose toxicity (as little as 10-day supply can be fatal)","info":"Black box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a697002.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["renal"],"dosing":"Augmentation: \\nStart 10 mg/day, increase by 10 mg-25mg/day until intolerable side effects occur, full response is reached, or maximum dose is reached. Do not exceed 75 mg daily. If using concurrently with an SSRI, consider lowering the dose of the SSRI when starting clomipramine. \\n\\nTreatment:\\nStart 10 mg/day, increase by 10 mg-25mg/day until intolerable side effects occur, full response is reached, or maximum dose is reached\\nMaximum dose 150mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Clomipramine","name":"Clomipramine","class":"Tricyclic Antidepressants","brands":"Anafranil","monitor":"Obtaine a baseline EKG\\nMonitor EKG and drug levels at each dose titration after 75mg/day\\n\\nIf co-treated with SSRI, monitor drug levels starting at 75mg/day.","side_effects_common":"sedation, fatigue, nausea, diarrhea, increased appetitie, anticholinergic side effects (e.g. dry mouth), headache, restlesness, heartburn, weight gain, sexual side effects","side_effects_rare":"seizures, cardiac effects (prolonged QT, arrhythmias, hypotension, tachycardia), EPS symptoms, increased intraocular pressure, paralytic ileus, hyperthermia, overdose toxicity (as little as 10-day supply can be fatal)","info":"Black box for suicidality &lt;24 years old:\\n\\nhttps://medlineplus.gov/druginfo/meds/a697002.html","length":"","diagnosis":"Obsessive-Compulsive Disorder","branch":[],"population":["antepartum"],"dosing":"Augmentation: \\nStart 10 mg/day, increase by 10 mg-25mg/day until intolerable side effects occur, full response is reached, or maximum dose is reached. Do not exceed 75 mg daily. If using concurrently with an SSRI, consider lowering the dose of the SSRI when starting clomipramine. \\n\\nTreatment:\\nStart 10 mg/day, increase by 10 mg-25mg/day until intolerable side effects occur, full response is reached, or maximum dose is reached\\nMaximum dose 150mg/day","notes":"","alert":""},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg/day (once daily or divided doses)\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nTarget Dose 100-200mg/day\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 25mg/day (once daily or divided doses)\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 150mg/day","notes":"see specific dosing recommendations","alert":"caution"},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg/day  (once daily or divided doses)\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nTarget Dose 100-200mg/day\\nMax dose 300 mg/day","notes":"high association with weight gain","alert":"caution"},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["renal"],"dosing":"Start 25mg/day (once daily or divided doses)\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 150mg/day","notes":"see specific dosing recommendations","alert":"caution"},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["adult"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable\\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["hepatic"],"dosing":"Start 5 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["obesity"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["renal"],"dosing":"Start 5 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg/day (once daily or divided doses)\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nTarget Dose 100-200mg/day\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 25mg/day (once daily or divided doses)\\nIncrease by 25mg/day in minimum one week as clinically indicated and tolerable\\nMax dose 150mg/day","notes":"Please note the specific dosing recommendations","alert":"caution"},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg/day  (once daily or divided doses)\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nTarget Dose 100-200mg/day\\nMax dose 300 mg/day","notes":"High association with weight gain","alert":"caution"},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg/day  (once daily or divided doses)\\nIncrease by 25-50 mg/day in minimum one week as clinically indicated and tolerable\\nTarget Dose 100-200mg/day\\nMax dose 300 mg/day","notes":"","alert":""},{"id":"Desipramine","name":"Desipramine","class":"Tricyclic Antidepressants","brands":"Norpramin","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682387.html","length":"","diagnosis":"Somatic Symptom Disorder","branch":[],"population":["adult"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["adult"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable\\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["hepatic"],"dosing":"Start 5 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["obesity"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["renal"],"dosing":"Start 5 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"","alert":""},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"High association with weight gain","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"use with caution, may require lower doses","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Generalized Anxiety Disorder","branch":[],"population":["hepatic"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"use with caution, may require lower doses","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["hepatic"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"use with caution, may require lower doses","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"","alert":""},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"High association with weight gain","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Posttraumatic Stress Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"use with caution, may require lower doses","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["hepatic"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"use with caution, may require lower doses","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"","alert":""},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"High association with weight gain","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Panic Disorder","branch":[],"population":["renal"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"use with caution, may require lower doses","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["adult"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"","alert":""},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, urinary retention, headache, dizziness, somnolence","side_effects_rare":"Arrhythmia, cardiac conduction abnormalities (including AV block), seizures","info":"Increased lethality in overdose compared to other medication classes\\n\\nblack box for suicidality &lt;24 years old\\n\\nhttps://medlineplus.gov/druginfo/meds/a682389.html","length":"","diagnosis":"Social Anxiety Disorder","branch":[],"population":["obesity"],"dosing":"Start 25-50 mg/nightly \\nIncrease by 25-50 mg/nightly every 2-3 days  as clinically indicated and tolerable\\nMax dose 200mg/nightly","notes":"High association with weight gain","alert":"caution"},{"id":"Imipramine","name":"Imipramine","class":"Tricyclic Antidepressants","brands":"Tofranil","monitor":"ECG before initiation and at each dose increase","side_effects_common":"dry mouth, blurred vision, weight gain, sexual dysfunction, constipation, 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arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["adult"],"dosing":"Start 25mg once daily or at bedtime\\nIncrease by 25 mg/day every 1 week if clinically indicated and tolerable\\nOnce daily or divided doses (up to 4 times/day)\\nMax dose 150 mg/day","notes":"","alert":""},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"ECG before initiation and at each dose increase","side_effects_common":"sedation, dry mouth, blurry\\nvision, urinary hesitation,\\nweight gain, constipation;","side_effects_rare":"seizure, cardiac effects\\n(orthostasis, QTc prolongation, AV\\nblock, arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["preconception"],"dosing":"Start 25mg once daily or at bedtime\\nIncrease by 25 mg/day every 1 week if clinically indicated and tolerable\\nOnce daily or divided doses (up to 4 times/day)\\nMax dose 150 mg/day","notes":"","alert":""},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"ECG before initiation and at each dose increase","side_effects_common":"sedation, dry mouth, blurry\\nvision, urinary hesitation,\\nweight gain, constipation;","side_effects_rare":"seizure, cardiac effects\\n(orthostasis, QTc prolongation, AV\\nblock, arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["hepatic"],"dosing":"Start 25mg once daily or at bedtime\\nIncrease by 25 mg/day every 1 week if clinically indicated and tolerable\\nOnce daily or divided doses (up to 4 times/day)\\nMax dose 150 mg/day","notes":"Manufacturer labeling does not recommend specific dose adjustments.  Some experts recommend decreasing initial and maintenance dose by 50%.","alert":"caution"},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"ECG before initiation and at each dose increase","side_effects_common":"sedation, dry mouth, blurry\\nvision, urinary hesitation,\\nweight gain, constipation;","side_effects_rare":"seizure, cardiac effects\\n(orthostasis, QTc prolongation, AV\\nblock, arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Depressive Disorder","branch":[],"population":["obesity"],"dosing":"Start 25mg once daily or at bedtime\\nIncrease by 25 mg/day every 1 week if clinically indicated and tolerable\\nOnce daily or divided doses (up to 4 times/day)\\nMax dose 150 mg/day","notes":"high association with weight gain","alert":"caution"},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic 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constipation;","side_effects_rare":"seizure, cardiac effects\\n(orthostasis, QTc prolongation, AV\\nblock, arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["adult"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"ECG before initiation and at each dose increase","side_effects_common":"sedation, dry mouth, blurry\\nvision, urinary hesitation,\\nweight gain, constipation;","side_effects_rare":"seizure, cardiac effects\\n(orthostasis, QTc prolongation, AV\\nblock, arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["geriatric"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable\\nMaximum dose 75 mg/day","notes":"Please see specific dosing recommendations","alert":"caution"},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"ECG before initiation and at each dose increase","side_effects_common":"sedation, dry mouth, blurry\\nvision, urinary hesitation,\\nweight gain, constipation;","side_effects_rare":"seizure, cardiac effects\\n(orthostasis, QTc prolongation, AV\\nblock, arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Fibromyalgia","branch":[],"population":["hepatic"],"dosing":"Start 5 mg, 1-3 hours before bedtime\\nIncrease by 5 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constipation;","side_effects_rare":"seizure, cardiac effects\\n(orthostasis, QTc prolongation, AV\\nblock, arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Somatic Symptom Disorder","branch":[],"population":["adult"],"dosing":"Start 5-10 mg, 1-3 hours before bedtime\\nIncrease by 5-10 mg/day in mimunim interval of 2 weeks as clinically indicated and tolerable \\nMaximum dose 75 mg/day","notes":"","alert":""},{"id":"Nortriptyline","name":"Nortriptyline","class":"Tricyclic Antidepressants","brands":"Pamelor","monitor":"ECG before initiation and at each dose increase","side_effects_common":"sedation, dry mouth, blurry\\nvision, urinary hesitation,\\nweight gain, constipation;","side_effects_rare":"seizure, cardiac effects\\n(orthostasis, QTc prolongation, AV\\nblock, arrhythmias)","info":"black box for suicidality &lt;24 years old\\nhttps://medlineplus.gov/druginfo/meds/a682620.html","length":"","diagnosis":"Tobacco Use Disorder","branch":[],"population":["adult"],"dosing":"Start 25 mg daily for 3 days\\nIncrease to 50 daily on days 4-7\\nIncrease to 75 mg daily on days 8 and beyond","notes":"","alert":""},{"id":"Perphenazine","name":"Perphenazine","class":"Typical (FGA) Antipsychotics","brands":"Trilafon","monitor":"EPS","side_effects_common":"EPS, headache, drowsiness,\\nprolactin elevation;","side_effects_rare":"tachycardia - especially with\\nsudden marked increase in dose, NMS","info":"FDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a682165.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["adult"],"dosing":"Start 8-16mg/day in 2-3 divided doses\\nIncrease in minimum one week as clinically indicated and tolerable\\nMaximum FDA-approved dose is 24 mg/day for non-hospitalized patients","notes":"","alert":""},{"id":"Perphenazine","name":"Perphenazine","class":"Typical (FGA) Antipsychotics","brands":"Trilafon","monitor":"EPS","side_effects_common":"EPS, headache, drowsiness,\\nprolactin elevation;","side_effects_rare":"tachycardia - especially with\\nsudden marked increase in dose, NMS","info":"FDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a682165.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["obesity"],"dosing":"Start 8-16mg/day in 2-3 divided doses\\nIncrease in minimum one week as clinically indicated and tolerable\\nMaximum FDA-approved dose is 24 mg/day for non-hospitalized patients","notes":"","alert":""},{"id":"Perphenazine","name":"Perphenazine","class":"Typical (FGA) Antipsychotics","brands":"Trilafon","monitor":"EPS","side_effects_common":"EPS, headache, drowsiness,\\nprolactin elevation;","side_effects_rare":"tachycardia - especially with\\nsudden marked increase in dose, NMS","info":"FDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a682165.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["renal"],"dosing":"Start 8mg/day in 2-3 divided doses\\nIncrease in minimum one week as clinically indicated and tolerable\\nMaximum FDA-approved dose is 24 mg/day for non-hospitalized patients","notes":"","alert":""},{"id":"Trifluoperazine","name":"Trifluoperazine","class":"Typical (FGA) Antipsychotics","brands":"Stelazine","monitor":"EPS","side_effects_common":"EPS, headache, drowsiness,\\nprolactin elevation;","side_effects_rare":"priapism,NMS","info":"FDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a682121.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["adult"],"dosing":"Start 1-2mg twice daily\\nIncrease in minimum one week as clinically indicated and tolerable toward usual dose range of 5-10 mg twice daily\\nMax FDA-approved dose 40 mg/day","notes":"","alert":""},{"id":"Trifluoperazine","name":"Trifluoperazine","class":"Typical (FGA) Antipsychotics","brands":"Stelazine","monitor":"EPS","side_effects_common":"EPS, headache, drowsiness,\\nprolactin elevation;","side_effects_rare":"priapism,NMS","info":"FDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a682121.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["obesity"],"dosing":"Start 1-2mg twice daily\\nIncrease in minimum one week as clinically indicated and tolerable toward usual dose range of 5-10 mg twice daily\\nMax FDA-approved dose 40 mg/day","notes":"","alert":""},{"id":"Trifluoperazine","name":"Trifluoperazine","class":"Typical (FGA) Antipsychotics","brands":"Stelazine","monitor":"EPS","side_effects_common":"EPS, headache, drowsiness,\\nprolactin elevation;","side_effects_rare":"priapism,NMS","info":"FDA box warning:\\n-Increase mortality risk in older adults with dementia\\n\\nhttps://medlineplus.gov/druginfo/meds/a682121.html","length":"","diagnosis":"Schizophrenia Spectrum","branch":[],"population":["renal"],"dosing":"Start 1-2mg twice daily\\nIncrease in minimum one week as clinically indicated and tolerable toward usual dose range of 5-10 mg twice daily\\nMax FDA-approved dose 40 mg/day","notes":"","alert":""},{"id":"Baclofen","name":"Baclofen","class":"Spinal Nerve Conduction Inhibitor","brands":"Fleqsuvy; Gablofen; Lioresal; Lyvispah; Ozobax","monitor":"No specific recommendation.","side_effects_common":"Nausea, vomiting, drowsiness, asthenia","side_effects_rare":"","info":"","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adolescent"],"dosing":"Start 5 mg three times daily\\nIncrease by 5 mg per dose in minimum 3 days as clinically indicated and tolerable\\nMaximum 60 mg total daily dose","notes":"","alert":""},{"id":"Baclofen","name":"Baclofen","class":"Spinal Nerve Conduction Inhibitor","brands":"Fleqsuvy; Gablofen; Lioresal; Lyvispah; Ozobax","monitor":"No specific recommendation.","side_effects_common":"Nausea, vomiting, drowsiness, asthenia","side_effects_rare":"","info":"","length":"","diagnosis":"Alcohol Use Disorder","branch":[],"population":["adult"],"dosing":"Start 5 mg three times daily\\nIncrease by 5 mg per dose in minimum 3 days as clinically indicated and tolerable\\nMaximum 60 mg total daily dose\\n\\nCrCl adjustments:\\n50 to 80 mL/minute/1.73 m2: start 5mg twice daily, max dose 50 mg/day\\n30 to <50 mL/minute/1.73 m2: start 2.5mg every 8 hours. max dose 40 mg/day\\n<30 mL/minute/1.73 m2:  Avoid use","notes":"","alert":""},{"id":"Memantine","name":"Memantine","class":"N-Methyl-D-Aspartate (NMDA) Receptor Antagonist","brands":"Namenda","monitor":"No specific recommendation.","side_effects_common":"Confusion, headache, dizziness","side_effects_rare":"delirium, hallucinations","info":"","length":"","diagnosis":"Dementia (Alzheimer\'s and-or Vascular)","branch":[],"population":["adult","geriatric"],"dosing":"Start 5 mg daily\\nIncrease by 5 mg per dose in minimum 1 week as clinically indicated and tolerable\\nMaximum 20 mg total daily dose","notes":"","alert":""}]')},4063:function(e){"use strict";e.exports=JSON.parse('[{"link":"https://wacoguide.org/conference","title":"Annual Behavioral Health Update: ADHD and Substance Use Throughout the Lifespan","image":"adhdlife_news.png"},{"link":"https://integrationacademy.ahrq.gov/bhi-directory?c-8-PP  ","title":"Waco Guide featured in AHRQ Behavioral Health Ecosystem","image":"theAcadamy.png"},{"link":"https://residency.wacofamilymedicine.org/waco-guide-to-psychopharmacology-in-primary-care-wins-the-society-of-teachers-of-family-medicine-innovative-program-award/","title":"Waco Guide editor-in-chief featured speaker at 2025 Virginia Academy of Family 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Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_71","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"7","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-geriatric_b1"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention (SOR A)","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_71","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (patient_age === \'Geriatric\')","title":"","uid":"8","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-geriatric_b1"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial of SSRI</b><br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_71","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (partial_response === false) && (unsuccessful_atypical === false) && (patient_age === \'Geriatric\')","title":"","uid":"9","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-geriatric_b2"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Start an atypical antipsychotic:</b><br> Aripiprazole, Olanzapine, Quetiapine, Risperidone","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (partial_response === false) && (unsuccessful_atypical === true) && (patient_age === \'Geriatric\')","title":"","uid":"9","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-geriatric_b2"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Psychiatry referral(if available)</b>","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partial_response === true) && (patient_age === \'Geriatric\')","title":"","uid":"10","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-geriatric_b3"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Augment:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'No\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-hepatic_b1"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention ","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-hepatic_b1"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial of SSRI</b><br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-hepatic_b1"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial of SSRI</b><br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (partial_response === false) && (unsuccessful_atypical === false) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-hepatic_b2"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Start an atypical antipsychotic:</b><br> Aripiprazole, Quetiapine, Risperidone","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (partial_response === false) && (unsuccessful_atypical === true) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-hepatic_b2"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Psychiatry referral(if available)</b>","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (partial_response === true) && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-hepatic_b3"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>Augment:</b><br>Atypical antipsychotic: Aripiprazole, Quetiapine, Risperidone","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (clomipramine_inadequate === false) && (partial_response === true) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"16","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b3"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue Clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics:  <br>First Choice: Aripiprazole <br>Second Choice: Quetiapine or Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(patient_age === \'Adult\')","uid":"16.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br><b>Augment </b><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><br><b>Second Choice:</b><br>Atypical antipsychotic:<br>First Choice: Aripiprazole <br>Second Choice: Quetiapine or Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'No\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"17","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b1"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI <br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention ","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"18","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b1"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI <br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention ","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"19","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b1"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial of SSRI</b><br>Consider higher dosing range<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Stop Clomipramine<br><br>Treat OCD with SSRI <br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention ","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"21","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b1"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Stop Clomipramine<br><br><b>Second Trial of SSRI</b><br>Consider higher dosing range<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (clomipramine_inadequate === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"22","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b2"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"Stop current medication and start Clomipramine","meds":["Clomipramine"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (clomipramine_inadequate === true) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"23","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b2"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"<discontinue><b>Start an atypical antipsychotic:</b><br>First Choice: Aripiprazole <br>Second Choice: Quetiapine or Risperidone<br><br>Psychiatry referral (if available)","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"true","uid":"G_7","type":"overlay","text":"<b>Obesity:</b> <br>If taking Quetiapine or Risperidone, refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics ","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (clomipramine_inadequate === true) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"24","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b1"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI <br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention ","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (partial_response === true) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"25","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b3"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"<b>Augment </b><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><br><b>Second Choice:</b><br>Atypical antipsychotic:<br>First Choice: Aripiprazole <br>Second Choice: Quetiapine or Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":["Clomipramine","Aripiprazole","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"true","uid":"G_7","type":"overlay","text":"<b>Obesity:</b> <br>If taking Quetiapine or Risperidone, refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics ","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (partial_response === true) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b2"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue Clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics:  <br>First Choice: Aripiprazole <br>Second Choice: Quetiapine or Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"(patient_age === \'Adult\')","uid":"26.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br><b>Augment </b><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><br><b>Second Choice:</b><br>Atypical antipsychotic:<br>First Choice: Aripiprazole <br>Second Choice: Quetiapine or Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"true","uid":"G_7","type":"overlay","text":"<b>Obesity:</b> <br>If taking Quetiapine or Risperidone, refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics ","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-obesity_b2"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue Clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics:  <br>First Choice: Aripiprazole <br>Second Choice: Quetiapine or Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"(patient_age === \'Adult\')","uid":"27.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br><b>Augment </b><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><br><b>Second Choice:</b><br>Atypical antipsychotic:<br>First Choice: Aripiprazole <br>Second Choice: Quetiapine or Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"true","uid":"G_7","type":"overlay","text":"<b>Obesity:</b> <br>If taking Quetiapine or Risperidone, refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics ","meds":[],"priority":"false"},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (clomipramine_inadequate === false) && (partial_response === true) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b3"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue Clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"(patient_age === \'Adult\')","uid":"28.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br><b>Augment</b><br><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><br><b>Second Choice:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'No\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b1"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"If Clomipramine used for Primary Pharmacotherapy","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"30","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b1"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI <br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention ","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b1"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial of SSRI</b><br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b1"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"Stop Clomipramine<br><br>Treat OCD with SSRI <br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention ","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b1"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"Stop Clomipramine<br><br><b>Second Trial of SSRI</b><br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (clomipramine_inadequate === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b2"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"Stop current medication and start Clomipramine","meds":["Clomipramine"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (clomipramine_inadequate === true) && (partial_response === false) && (clomipramine_partial === false) && (unsuccessful_atypical === false) && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b2"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"<b>Start an atypical antipsychotic:</b><br> Aripiprazole, Olanzapine, Quetiapine, Risperidone","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (clomipramine_inadequate === true) && (partial_response === false) && (clomipramine_partial === false) && (unsuccessful_atypical === true) && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b2"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"<b>Psychiatry referral(if available)</b>","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (clomipramine_inadequate === true) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI <br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention ","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_15","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (partial_response === true) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b3"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"<b>Augment</b><br><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><br><b>Second Choice:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":["Clomipramine","Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (partial_response === true) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"39","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b2"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue Clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"(patient_age === \'Adult\')","uid":"39.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br><b>Augment</b><br><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><br><b>Second Choice:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"40","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-renal_b2"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue Clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"(patient_age === \'Adult\')","uid":"40.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br><b>Augment</b><br><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><br><b>Second Choice:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"},{"visible":"is_tic != \'Yes\'","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b1"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline","Escitalopram"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (unsuccessful_response_SNRI === false) && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b1"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline","Escitalopram"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b2"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial of SSRI</b><br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline","Escitalopram"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === false) && (partial_response === false) && (patient_age === \'Adult\')","title":"","uid":"44","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b2"],"content":[{"visible":true,"uid":"44.0","type":"overlay","title":"Recommendation","text":"Third trial of different SSRI","meds":["Fluoxetine","Fluvoxamine","Sertraline","Escitalopram"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (unsuccessful_response_SNRI === false) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b2"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"<discontinue><b>Trial of SNRI:</b><br>1. Duloxetine<br>2. Venlafaxine","meds":["Duloxetine","Venlafaxine"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (partial_response === true) && (unsuccessful_atypical === false) && (partial_atypical === false) && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b3"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"<b>Augment with an Atypical antipsychotic: </b><br>Aripiprazole, Olanzapine, Quetiapine","meds":["Aripiprazole","Olanzapine","Quetiapine"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (partial_response === true) && (unsuccessful_atypical === true) && (partial_atypical === false) && (clomipramine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b3"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"<b>Discontinue Atypical antipsychotic</b><br><br><b>Augment SSRI with Clomipramine</b>","meds":["Clomipramine"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (partial_response === true) && (partial_atypical === true) && (clomipramine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"48","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b3"],"content":[{"visible":true,"uid":"48.0","type":"overlay","title":"Recommendation","text":"<b>Continue Atypical antipsychotic and SSRI</b><br><br><b>Augment with Clomipramine</b>","meds":["Clomipramine"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (partial_response === true) && (partial_atypical === true) && (clomipramine_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"49","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b3"],"content":[{"visible":true,"uid":"49.0","type":"overlay","title":"Recommendation","text":"<b>Continue pharmacotherapy that was beneficial</b><br><br><b>Augment with Mirtazapine or Buspirone</b><br>If inadequate response, consider Psychiatry referral if available","meds":["Mirtazapine","Buspirone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (partial_response === true) && (unsuccessful_atypical === true) && (clomipramine_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"50","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b3"],"content":[{"visible":true,"uid":"50.0","type":"overlay","title":"Recommendation","text":"<b>Continue pharmacotherapy that was beneficial</b><br><br><b>Augment with Mirtazapine or Buspirone</b><br>If inadequate response, consider Psychiatry referral if available","meds":["Mirtazapine","Buspirone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (unsuccessful_response_3 === true) && (partial_response === false) && (unsuccessful_response_SNRI === true) && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD-antepartum_b2"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"Psychiatry referral (if available)","meds":[],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Atypical antipsychotics<br>2. Alpha-2 agonist  <br>3. Tetrabenazine","meds":["Aripiprazole","Quetiapine","Olanzapine","Clonidine XR","Tetrabenazine"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response_2 === false) && (unsuccessful_response_3 === false) && (clomipramine_inadequate === false) && (partial_response === true) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"52","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b3"],"content":[{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"(patient_age === \'Adult\')","uid":"52.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br>Augment (SOR B)</b><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><b>Second Choice:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"53","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b1"],"content":[{"visible":true,"uid":"53.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI (SOR A)<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention (SOR A)","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"54","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b1"],"content":[{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI (SOR A)<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention (SOR A)","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"55","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b1"],"content":[{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"<b>Second Trial of SSRI</b><br>Consider higher dosing range<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"56","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b1"],"content":[{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"Stop Clomipramine<br><br>Treat OCD with SSRI (SOR A)<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention (SOR A)","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === false) && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b1"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"Stop Clomipramine<br><br><b>Second Trial of SSRI</b><br>Consider higher dosing range<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (clomipramine_inadequate === false) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"58","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b2"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"Stop current medication and start Clomipramine (SOR A)","meds":["Clomipramine"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (clomipramine_inadequate === true) && (partial_response === false) && (clomipramine_partial === false) && (unsuccessful_atypical === false) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b2"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"<discontinue><b>Start an atypical antipsychotic:</b><br>Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>Psychiatry referral(if available)","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === true) && (unsuccessful_response_2 === true) && (clomipramine_inadequate === true) && (partial_response === false) && (clomipramine_partial === false) && (unsuccessful_atypical === true) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b2"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<b>Psychiatry referral(if available)</b>","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (unsuccessful_response === false) && (unsuccessful_response_2 === false) && (clomipramine_inadequate === true) && (partial_response === false) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"61","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b1"],"content":[{"visible":true,"uid":"61.0","type":"overlay","title":"Recommendation","text":"Treat OCD with SSRI (SOR A)<br><br><b>Psychotherapy:</b><br>Recommend CBT with exposure with response prevention (SOR A)","meds":["Fluoxetine","Fluvoxamine","Sertraline"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partial_response === true) && (clomipramine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"62","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b3"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"<b>Augment (SOR B)</b><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><b>Second Choice:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":["Clomipramine","Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partial_response === true) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"63","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b2"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"(patient_age === \'Adult\')","uid":"63.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br>Augment (SOR B)</b><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><b>Second Choice:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partial_response === false) && (clomipramine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"64","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":["OCD_b2"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Primary Pharmacotherapy</b><br><br>Treatment should include pharmacotherapy and psychotherapy:<br><br>Continue clomipramine <br><br>Maximize CBT<br><br>Augment with atypical antipsychotics: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring<br><br>Psychiatry referral (if available)","meds":["Clomipramine","Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":["CBT-Exposure with Response Prevention"]},{"visible":"(patient_age === \'Adult\')","uid":"64.1","type":"overlay","title":"Recommendation","text":"<b>If Clomipramine used for Augmentation <br>(doses \u2264 75mg)</b><br><br>Augment (SOR B)</b><br><b>First Choice: </b><br>Clomipramine* (\u2264 75mg)<br><b>Second Choice:</b><br>Atypical antipsychotic: Aripiprazole, Olanzapine, Quetiapine, Risperidone<br><br>*Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":[]},{"visible":"is_comorbid == \'Yes\'","uid":"G_1","type":"overlay","text":"<b>For psychiatric comorbidities:</b><br>See corresponding decision support and treat concurrently","meds":[],"priority":"false"},{"visible":"is_tic == \'Yes\'","uid":"G_2","type":"overlay","text":"<b>Impairing tic disorders</b><br>1. Alpha-2 agonist <br>2. Aripiprazole<br>3. Risperidone","meds":["Clonidine XR","Guanfacine ER","Aripiprazole","Risperidone"],"priority":"false"}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Obsessive-Compulsive Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},898:function(e){"use strict";e.exports=JSON.parse('{"variables":{"phase":"","criteria":"","is_meth":"","pref_location":"","previous":"","aged":"","teen_criteria":"","desire_treat":"","cur_treat":"","pre_treat":"","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'"}],"sections":[{"valid":"true","title":"Opioid Use Disorder Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Opioid Use Disorder"}]}]},{"valid":true,"title":"Opioid Use Disorder","state":"intro","content":[{"id":"phase","visible":"true && partum != \'Antepartum\' && patient_age != \'Adolescent\'","type":"radio","choices":"Treatment Initiation, Treatment Follow-up, Treatment Discontinuation","text":"Select treatment phase:","groups":[{"id":"phase","type":"choice","choices":[{"text":"Treatment Initiation","value":"Treatment Initiation"},{"text":"Treatment Follow-up","value":"Treatment Follow-up"},{"text":"Treatment Discontinuation","value":"Treatment Discontinuation"}]}]},{"id":"criteria","visible":"phase == \'Treatment Initiation\' || partum == \'Antepartum\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does patient meet criteria for opioid use disorder?"},{"id":"is_meth","visible":"criteria == \'Yes\' && phase == \'Treatment Initiation\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is the patient currently using methadone?"},{"id":"desire_treat","visible":"criteria == \'Yes\' && partum == \'Antepartum\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does the patient desire treatment for OUD?"},{"id":"cur_treat","visible":"criteria == \'Yes\' && desire_treat == \'Yes\' && partum == \'Antepartum\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is the patient currently on treatment for OUD?"},{"id":"pre_treat","visible":"criteria == \'Yes\' && desire_treat == \'Yes\' && cur_treat == \'No\' && partum == \'Antepartum\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Was the patient successfully treated in the past?"},{"id":"pref_location","visible":"is_meth != \'\' && criteria == \'Yes\' && partum != \'Antepartum\' && phase == \'Treatment Initiation\'","type":"radio","choices":"In-office, Home","text":"Does the patient prefer in-office or at home induction?","groups":[{"id":"pref_location","type":"choice","choices":[{"text":"In-office","value":"In-office"},{"text":"Home","value":"Home"}]}]},{"id":"criteria","visible":"phase == \'Treatment Follow-up\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Patient having cravings or using opioids of abuse:"},{"id":"criteria","visible":"phase == \'Treatment Discontinuation\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Patient demonstrates adherence to treatment and is at a minimum 6 months into remission"},{"id":"previous","visible":"is_meth == \'No\' && partum == \'Antepartum\' && criteria == \'Yes\'","type":"radio","choices":"None, Methadone, Naltrexone, Buprenorphine containing products","text":"Patient previously treated with one of the following effective therapies?","groups":[{"id":"previous","type":"choice","choices":[{"text":"None","value":"None"},{"text":"Methadone","value":"Methadone"},{"text":"Naltrexone","value":"Naltrexone"},{"text":"Buprenorphine containing products","value":"Buprenorphine containing products"}]}]},{"id":"aged","visible":"true && patient_age == \'Adolescent\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Patient aged 16 or over"},{"id":"teen_criteria","visible":"aged != \\"\\" && patient_age == \'Adolescent\'","type":"radio","choices":"None, Severe OUD (by DSM-5-TR), Cravings for opioids, Withdrawal symptoms, High-risk for overdose from opioids (e.g. use of fentanyl)","text":"Does the patient have any of the following?","groups":[{"id":"teen_criteria","type":"choice","choices":[{"text":"None","value":"None"},{"text":"Severe OUD (by DSM-5-TR)","value":"Severe OUD (by DSM-5-TR)"},{"text":"Cravings for opioids","value":"Cravings for opioids"},{"text":"Withdrawal symptoms","value":"Withdrawal symptoms"},{"text":"High-risk for overdose from opioids (e.g. use of fentanyl)","value":"High-risk for overdose from opioids (e.g. use of fentanyl)"}]}]}]},{"valid":"(phase === \'Treatment Initiation\') && (criteria === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud_o3"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"Patient is not a candidate for buprenorphine-naloxone treatment.","meds":[],"therapies":[]}]},{"valid":"(phase === \'Treatment Initiation\') && (criteria === \'Yes\') && (is_meth === \'Yes\') && (pref_location === \'In-office\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud_o1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Taper methadone prior to switching:</b><br>Coordinate care with methadone provider to taper daily dose to target 30-40 mg over several weeks. If able to complete taper and get to target dose, proceed with induction with buprenorphine-naloxone. If unable to complete taper, continue methadone therapy at effective dose.<br><br>Consider prescribing naloxone for overdose reversal for patients prior to starting buprenorphine.","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone","Clonazepam","Clonidine","Hydroxyzine","Ibuprofen","Loperamide","Lorazepam","Ondansetron"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]},{"visible":"(patient_age === \'Adult\')","uid":"2.2","type":"overlay","title":"Recommendation","text":"<b>Induction Process:</b><br><br>Patients must be in moderate withdrawal prior to starting medication. <br>A minimum interval off other opioids is: <br>&#x2022; 12 hours for short-acting <br>&#x2022; 24 hours for intermediate-acting <br>&#x2022; 72 hours for long-acting opioids.<br><br>Use adjunctive medications (comfort medications) to help with withdrawal symptoms occurring before initiation.<br><br><b>In-Office Induction:</b><br>Day 1 (in-office): Administer buprenorphine-naloxone 4/1 mg every hour to alleviate withdrawal symptoms. Maximum dose 12/3 mg during the induction phase.<br><br>Day 2: Patient takes buprenorphine-naloxone 8/2 mg twice daily","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"<b>Adjunctive Medication (to treat withdrawal):</b><br>Agitation/diaphoresis: Clonidine<br>Anxiety: Clonidine, Hydroxyzine<br>Insomnia: Hydroxyzine<br>Myalgias: Ibuprofen<br>Nausea/vomiting: Ondansetron<br>Severe anxiety: Clonazepam (only for the most severe cases)","meds":[],"therapies":[]}]},{"valid":"(phase === \'Treatment Initiation\') && (criteria === \'Yes\') && (is_meth === \'Yes\') && (pref_location === \'Home\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud_o2"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Taper methadone prior to switching:</b><br>Coordinate care with methadone provider to taper daily dose to target 30-40 mg over several weeks. If able to complete taper and get to target dose, proceed with induction with buprenorphine-naloxone. If unable to complete taper, continue methadone therapy at effective dose.<br><br>Consider prescribing naloxone for overdose reversal for patients prior to starting buprenorphine.","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone","Clonazepam","Clonidine","Hydroxyzine","Ibuprofen","Loperamide","Lorazepam","Ondansetron"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]},{"visible":"(patient_age === \'Adult\')","uid":"3.2","type":"overlay","title":"Recommendation","text":"<b>Induction Process:</b><br><br>Patients must be in moderate withdrawal prior to starting medication. <br>A minimum interval off other opioids is: <br>&#x2022; 12 hours for short-acting <br>&#x2022; 24 hours for intermediate-acting <br>&#x2022; 72 hours for long-acting opioids.<br><br>Use adjunctive medications (comfort medications) to help with withdrawal symptoms occurring before initiation.<br><br><b>At-Home Induction:</b><br>Day 1 (at-home): Patient self-administers buprenorphine 4/1 mg, waits 45 minutes, administers an additional 4/1 mg, waits 6 hours, then administers a final 4/1 mg. Maximum dose 12/3 mg during the induction phase.<br><br>Day 2: Patient takes buprenorphine-naloxone 8/2 mg twice daily.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"<b>Adjunctive Medication (to treat withdrawal):</b><br>Agitation/diaphoresis: Clonidine<br>Anxiety: Clonidine, Hydroxyzine<br>Insomnia: Hydroxyzine<br>Myalgias: Ibuprofen<br>Nausea/vomiting: Ondansetron<br>Severe anxiety: Clonazepam (only for the most severe cases)","meds":[],"therapies":[]}]},{"valid":"(phase === \'Treatment Initiation\') && (criteria === \'Yes\') && (is_meth === \'No\') && (pref_location === \'In-office\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud_o1"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Induction Process:</b><br><br>Patients must be in moderate withdrawal prior to starting medication. <br>A minimum interval off other opioids is: <br>&#x2022; 12 hours for short-acting <br>&#x2022; 24 hours for intermediate-acting <br>&#x2022; 72 hours for long-acting opioids. <br><br>Use adjunctive medications (comfort medications) to help with withdrawal symptoms occurring before initiation.<br><br><b>In-Office Induction:</b><br>Day 1 (in-office): Administer buprenorphine-naloxone 4/1 mg every hour to alleviate withdrawal symptoms. Maximum dose 12/3 mg during the induction phase.<br><br>Day 2: Patient takes buprenorphine-naloxone 8/2 mg twice daily<br><br>Consider prescribing naloxone for overdose reversal for patients prior to starting buprenorphine.","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone","Clonazepam","Clonidine","Hydroxyzine","Ibuprofen","Loperamide","Lorazepam","Ondansetron"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]},{"visible":"(patient_age === \'Adult\')","uid":"4.1","type":"overlay","title":"Recommendation","text":"<b>Comfort Medications (to treat withdrawal prior to starting medication):</b><br>Agitation/diaphoresis: Clonidine<br>Anxiety: Clonidine, Hydroxyzine<br>Insomnia: Hydroxyzine<br>Myalgias: Ibuprofen<br>Nausea/vomiting: Ondansetron<br>Severe anxiety: Clonazepam (only for the most severe cases)","meds":[],"therapies":[]}]},{"valid":"(phase === \'Treatment Initiation\') && (criteria === \'Yes\') && (is_meth === \'No\') && (pref_location === \'Home\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud_o2"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>Induction Process:</b><br><br>Patients must be in moderate withdrawal prior to starting medication. <br>A minimum interval off other opioids is: <br>&#x2022; 12 hours for short-acting <br>&#x2022; 24 hours for intermediate-acting <br>&#x2022; 72 hours for long-acting opioids. <br><br>Use adjunctive medications (comfort medications) to help with withdrawal symptoms occurring before initiation.<br><br><b>At-Home Induction:</b><br>Day 1 (at-home): Patient self-administers buprenorphine 4/1 mg, waits 45 minutes, administers an additional 4/1 mg, waits 6 hours, then administers a final 4/1 mg. Maximum dose 12/3 mg during the induction phase.<br><br>Day 2: Patient takes buprenorphine-naloxone 8/2 mg twice daily.<br><br>Consider prescribing naloxone for overdose reversal for patients prior to starting buprenorphine.","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone","Clonazepam","Clonidine","Hydroxyzine","Ibuprofen","Loperamide","Lorazepam","Ondansetron"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]},{"visible":"(patient_age === \'Adult\')","uid":"5.1","type":"overlay","title":"Recommendation","text":"<b>Comfort Medications (to treat withdrawal prior to starting medication):</b><br>Agitation/diaphoresis: Clonidine<br>Anxiety: Clonidine, Hydroxyzine<br>Insomnia: Hydroxyzine<br>Myalgias: Ibuprofen<br>Nausea/vomiting: Ondansetron<br>Severe anxiety: Clonazepam (only for the most severe cases)","meds":[],"therapies":[]}]},{"valid":"(phase === \'Treatment Follow-up\') && (criteria === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-follow_o2"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>Maintenance Treatment:</b><br>Continue treatment for a minimum 6 months after remission of opioid use disorder but consider longer, if not indefinitely, based patient goals. Space visits out incrementally, but ensure the patient is seen at least every 3 months.<br><br><b>Urine drug screening:</b><br> Consider testing urine samples for buprenorphine to monitor treatment progress and adherence during treatment (if available).","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]}]},{"valid":"(phase === \'Treatment Follow-up\') && (criteria === \'Yes\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-follow_o1"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Titrate Buprenorphine-Naloxone:</b><br>Increase dose stepwise in 4/1 mg intervals and utilize split dosing for late-day cravings (e.g., 8/2 mg twice daily rather than 16/4 mg once daily). Do not exceed 32/8 mg total daily dose. Weekly follow-up until maintenance dose established.<br><br><b>Urine drug screening:</b><br> Consider testing urine samples for buprenorphine to monitor treatment progress and adherence during treatment (if available).","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]}]},{"valid":"(phase === \'Treatment Discontinuation\') && (criteria === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-discontinue_o1"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"Continue medication therapy for opioid use disorder for a minimum of 6 months into remission.","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]}]},{"valid":"(phase === \'Treatment Discontinuation\') && (criteria === \'Yes\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-discontinue_o2"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Slowly Discontinue Buprenorphine-Naloxone:</b><br>Decrease buprenorphine-naloxone dose by 2/0.5 mg every two weeks and monitor closely. If symptoms or withdrawal develops or if new cravings/opioid use occur, increase dose to an effective level and stop discontinuation","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]}]},{"valid":"(criteria === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o1"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"Patient is not a candidate for buprenorphine-naloxone or buprenorphine treatment.","meds":[],"therapies":[]}]},{"valid":"(criteria === \'Yes\') && (desire_treat === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o2"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"Refer to support group and/or counseling.<br><br>Continue to follow for obstetrical care and assess readiness for treatment using motivational interviewing<br><br>Counsel patient on harm reduction strategies:<br>&#x2022; Prescribe Naloxone<br>&#x2022; Use of substances in groups<br>&#x2022; Alternative route for use (e.g., insufflation rather than injection)<br>&#x2022; Use of Naloxone","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"11.1","type":"overlay","title":"Recommendation","text":"<b>Obstetrical Considerations:</b><br>&#x2022; Growth scan every 4 weeks starting at 28 weeks<br>&#x2022; Maternal-Fetal Medicine referral for level II ultrasound at 18-22 weeks<br>&#x2022; Routine hepatitis and HIV testing","meds":[],"therapies":[]}]},{"valid":"(criteria === \'Yes\') && (desire_treat === \'Yes\') && (cur_treat === \'Yes\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o3"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"Continue current therapy<br><br>Although there is limited data on Naltrexone in  pregnancy, patients may continue after  risk/benefit discussion based on preference and  history of treatment.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"12.1","type":"overlay","title":"Recommendation","text":"<b>Obstetrical Considerations:</b><br>&#x2022; Growth scan every 4 weeks starting at 28 weeks<br>&#x2022; Maternal-Fetal Medicine referral for level II ultrasound at 18-22 weeks<br>&#x2022; Routine hepatitis and HIV testing","meds":[],"therapies":[]}]},{"valid":"(criteria === \'Yes\') && (desire_treat === \'Yes\') && (cur_treat === \'No\') && (pre_treat === \'Yes\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o4"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"Restart prior treatment<br><br>If prior successful response to Naltrexone, consider using Buprenorphine or Methadone alternatively given its safety/efficacy in pregnancy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"13.1","type":"overlay","title":"Recommendation","text":"<b>Obstetrical Considerations:</b><br>&#x2022; Growth scan every 4 weeks starting at 28 weeks<br>&#x2022; Maternal-Fetal Medicine referral for level II ultrasound at 18-22 weeks<br>&#x2022; Routine hepatitis and HIV testing","meds":[],"therapies":[]}]},{"valid":"(criteria === \'Yes\') && (desire_treat === \'Yes\') && (cur_treat === \'No\') && (pre_treat === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o1"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Buprenorphine Induction</b><br>Proceed with Buprenorphine Induction. (Buprenorphine-naloxone may be equally considered, especially if there is a high risk for diversion or IV use.)<br><br>Consider referral to a methadone treatment facility (OTP) if available in your community based on patient preference. Additionally, if the patient previously had an unsuccessful trial of buprenorphine therapy consider referral to an OTP<br><br>Establish Goals of treatment:<br>&#x2022; Abstinence achieved<br>&#x2022; Significant reduction in hazardous use<br>&#x2022; Functional recovery<br><br>Adjunctive pharmacotherapy to consider during induction:<br>&#x2022; Agitation/diaphoresis/anxiety: hydroxyzine<br>&#x2022; Insomnia: hydroxyzine<br>&#x2022; Myalgias: acetaminophen<br>&#x2022; Nausea/vomiting: ondansetron","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]},{"visible":"(patient_age === \'Adult\')","uid":"14.1","type":"overlay","title":"Recommendation","text":"<b>Level of Care for Initiating Treatment:</b><br>&#x2022; In preferential order, proceed with inpatient, in-office, or home induction based on patient preference.<br>&#x2022; See corresponding decision support tools but note specific perinatal dosing recommendations in the dosing guide","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.2","type":"overlay","title":"Recommendation","text":"<b>Obstetrical Considerations:</b><br>&#x2022; Growth scan every 4 weeks starting at 28 weeks<br>&#x2022; Maternal-Fetal Medicine referral for level II ultrasound at 18-22 weeks<br>&#x2022; Routine hepatitis and HIV testing","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.3","type":"overlay","title":"Recommendation","text":"<b>Maintenance</b><br>&#x2022; Continue weekly follow up during stabilization  then bi-weekly for maintenance<br>&#x2022; Provide patient education regarding physiologic changes in pregnancy and the need for increased dose/frequency later in pregnancy if cravings develop","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.4","type":"overlay","title":"Recommendation","text":"<b>Intrapartum management:</b><br><br>&#9702; No contraindication to neuraxial anesthesia<br>&#9702; Continue Buprenorphine intrapartum with addition of non-opioid medications as needed<br>&#9702; If full agonist opioid required, may consider higher dosing of full agonist opioid<br><br><b>Postpartum Management</b><br><br>&#9702; Buprenorphine or methadone is not a contraindication to breastfeeding or couplet care<br>&#9702; Continue Buprenorphine postpartum with addition of non-opioid medications as needed<br>&#9702; Continue the dose of which was successful in pregnancy and via shared decision-making may consider dose de-escalation over following year as perinatal metabolism returns to baseline","meds":[],"therapies":[]}]},{"valid":"(phase === \'FALSE\') && (criteria === \'Yes\') && (desire_treat === \'Yes\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o1"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"Continue methadone treatment during pregnancy.","meds":[],"therapies":[]}]},{"valid":"(phase === \'FALSE\') && (criteria === \'Yes\') && (desire_treat === \'No\') && (previous === \'Methadone\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o1"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"Refer to methadone treatment program","meds":[],"therapies":[]}]},{"valid":"(phase === \'FALSE\') && (criteria === \'Yes\') && (desire_treat === \'No\') && (previous === \'Naltrexone\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o1"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<warning><b>Disclaimer</b><br>Naltrexone should not be used to treat opioid use disorder in pregnancy.","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone","Acetaminophen","Hydroxyzine","Ondansetron"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]},{"visible":"(phase === \'FALSE\') && (patient_age === \'Adult\')","uid":"13.1","type":"overlay","title":"Recommendation","text":"<b>Start with Buprenorphine Induction:</b><br><br>Buprenorphine-naloxone may be equally considered, especially if there is a high risk for diversion or IV use.","meds":[],"therapies":[]},{"visible":"(phase === \'FALSE\') && (patient_age === \'Adult\')","uid":"13.2","type":"overlay","title":"Recommendation","text":"<b>Obstetrical Considerations:</b><br>&#x2022; Growth scan every 4 weeks starting at 28 weeks<br>&#x2022; Maternal-Fetal Medicine referral for level II ultrasound at 18-22 weeks<br>&#x2022; Routine hepatitis and HIV testing","meds":[],"therapies":[]},{"visible":"(phase === \'FALSE\') && (patient_age === \'Adult\')","uid":"13.3","type":"overlay","title":"Recommendation","text":"<b>Level of Care for Initiating Treatment:</b><br>Induction should be performed in the hospital. However, in office inductions may be a reasonable alternative. Additionally, at home inductions can be considered in special circumstances are a third-choice option.<br><br>Proceed with induction<br><br>Agitation/diaphoresis/anxiety: Hydroxyzine<br>Insomnia: Hydroxyzine<br>Myalgias: Acetaminophen<br>Nausea/vomiting: Ondansetron<br><br>May need a dose increase later in pregnancy due to physiologic changes","meds":[],"therapies":[]},{"visible":"(phase === \'FALSE\') && (patient_age === \'Adult\')","uid":"13.4","type":"overlay","title":"Recommendation","text":"<b>Labor and Delivery Considerations:</b><br>&#x2022; Continue buprenorphine or other therapy while inpatient and give additional opioid analgesics as needed<br>&#x2022; Buprenorphine use is not a contraindication to breasting feeding or couplet care","meds":[],"therapies":[]}]},{"valid":"(phase === \'FALSE\') && (criteria === \'Yes\') && (desire_treat === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-antepartum_o1"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Start with Buprenorphine Induction:</b><br><br>Buprenorphine-naloxone may be equally considered, especially if there is a high risk for diversion or IV use.","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone","Acetaminophen","Hydroxyzine","Ondansetron"],"therapies":["Cognitive Behavioral Therapy","Peer support (12-step program)"]},{"visible":"(phase === \'FALSE\') && (patient_age === \'Adult\')","uid":"14.1","type":"overlay","title":"Recommendation","text":"<b>Obstetrical Considerations:</b><br>&#x2022; Growth scan every 4 weeks starting at 28 weeks<br>&#x2022; Maternal-Fetal Medicine referral for level II ultrasound at 18-22 weeks<br>&#x2022; Routine hepatitis and HIV testing","meds":[],"therapies":[]},{"visible":"(phase === \'FALSE\') && (patient_age === \'Adult\')","uid":"14.2","type":"overlay","title":"Recommendation","text":"<b>Level of Care for Initiating Treatment:</b><br>Induction should be performed in the hospital. However, in office inductions may be a reasonable alternative. Additionally, at home inductions can be considered in special circumstances are a third-choice option.<br><br>Proceed with induction<br><br>Agitation/diaphoresis/anxiety: Hydroxyzine<br>Insomnia: Hydroxyzine<br>Myalgias: Acetaminophen<br>Nausea/vomiting: Ondansetron<br><br>May need a dose increase later in pregnancy due to physiologic changes","meds":[],"therapies":[]},{"visible":"(phase === \'FALSE\') && (patient_age === \'Adult\')","uid":"14.3","type":"overlay","title":"Recommendation","text":"<b>Labor and Delivery Considerations:</b><br>&#x2022; Continue buprenorphine or other therapy while inpatient and give additional opioid analgesics as needed<br>&#x2022; Buprenorphine use is not a contraindication to breasting feeding or couplet care","meds":[],"therapies":[]}]},{"valid":"(teen_criteria === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"15","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-adolescent_o1"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"Not a candidate for Buprenorphine-Naloxone","meds":[],"therapies":[]}]},{"valid":"(patient_age === \'Adolescent\')","title":"","uid":"16","state":"recommendation","branch":"Opioid Use Disorder","figure":["oud-adolescent_o1"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":["Buprenorphine-Naloxone SL Films","Buprenorphine-Naloxone SL Tabs","Buprenorphine SL Tabs","Naloxone","Clonazepam","Clonidine","Hydroxyzine","Ibuprofen","Loperamide","Lorazepam","Ondansetron"],"therapies":[]},{"visible":"aged == \'No\'","uid":"g_6","type":"overlay","text":"Consider off-label use of Buprenorphine-Naloxone","meds":[],"priority":"false"},{"visible":true,"uid":"16.1","type":"overlay","title":"Recommendation","text":"Treatment with Buprenorphine-Naloxone (SOR A)<br><br>See corresponding decision support tools of intake, induction, stabilization and maintenance protocols.<br><br><b>Additional treatment considerations:</b><br>&#x2022;Consider at home induction unless there are confidentiality issues and/or parents are not involved in treatment.<br>&#x2022;Patients may respond well and find medication more tolerable with lower doses (total 4-8 mg daily).<br>&#x2022;Continue weekly follow up during stabilization then bi-weekly for maintenance, extending to every 1-3 months after a period of clinical and social stability.<br>&#x2022;Continue for at least 6 months into remission. See corresponding decision support for discontinuation.<br><br><b>Note:</b> In accordance with the MATE Act, all practitioners with an unrestricted DEA license may prescribe buprenorphine for OUD","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Opioid Use Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},8340:function(e){"use strict";e.exports=JSON.parse('{"variables":{"on_ssri_snri_1":false,"on_ssri_snri_2":false,"ssri_partial_1":false,"ssri_inadequate_1":false,"ssri_inadequate_2":false,"ssri_partial_partum_1":false,"first_gad_inadequate":false,"first_gad_partial":false,"mirtazapine_unsuccessful":false,"medBranch":null,"medication_history":"No","medication_fluoxetine":false,"medication_sertraline":false,"medication_escitalopram":false,"medication_citalopram":false,"medication_clonazepam":false,"medication_venlafaxine":false,"medication_duloxetine":false,"medication_mirtazapine":false,"medication_imipramine":false,"medication_nortriptyline":false,"medication_lorazepam":false,"medication_paroxetine":false,"medication_other_snri":false,"medication_other_atypical":false,"medication_desvenlafaxine":false,"medication_other_ssri":false,"fluoxetine_current":false,"sertraline_current":false,"escitalopram_current":false,"citalopram_current":false,"clonazepam_current":false,"paroxetine_current":false,"duloxetine_current":false,"venlafaxine_current":false,"desvenlafaxine_current":false,"mirtazapine_current":false,"imipramine_current":false,"nortriptyline_current":false,"lorazepam_current":false,"other_snri_current":false,"other_ssri_current":false,"other_atypical_current":false,"fluoxetine_successful":false,"sertraline_successful":false,"escitalopram_successful":false,"citalopram_successful":false,"clonazepam_successful":false,"paroxetine_successful":false,"duloxetine_successful":false,"venlafaxine_successful":false,"desvenlafaxine_successful":false,"mirtazapine_successful":false,"imipramine_successful":false,"nortriptyline_successful":false,"lorazepam_successful":false,"other_snri_successful":false,"other_ssri_successful":false,"other_atypical_successful":false,"successful_ssri_snri":false,"prior_successful_ssri_snri":false,"medCount":11},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","fluoxetine_inadequate":"medication_fluoxetine == true && fluoxetine_response === \'unsuccessful\'","fluoxetine_partial":"medication_fluoxetine == true && fluoxetine_response === \'partial\'","sertraline_inadequate":"medication_sertraline == true && sertraline_response == \'unsuccessful\'","sertraline_partial":"medication_sertraline == true && sertraline_response == \'partial\'","escitalopram_inadequate":"medication_escitalopram == true && escitalopram_response === \'unsuccessful\'","escitalopram_partial":"medication_escitalopram == true && escitalopram_response === \'partial\'","citalopram_inadequate":"medication_citalopram == true && citalopram_response == \'unsuccessful\'","citalopram_partial":"medication_citalopram == true && citalopram_response == \'partial\'","clonazepam_inadequate":"medication_clonazepam == true && clonazepam_response == \'unsuccessful\'","clonazepam_partial":"medication_clonazepam == true && clonazepam_response == \'partial\'","paroxetine_inadequate":"medication_paroxetine == true && paroxetine_response == \'unsuccessful\'","paroxetine_partial":"medication_paroxetine == true && paroxetine_response == \'partial\'","other_ssri_inadequate":"medication_other_ssri == true && other_ssri_response == \'unsuccessful\'","other_ssri_partial":"medication_other_ssri == true && other_ssri_response == \'partial\'","duloxetine_inadequate":"medication_duloxetine == true && duloxetine_response == \'unsuccessful\'","duloxetine_partial":"medication_duloxetine == true && duloxetine_response == \'partial\'","venlafaxine_inadequate":"medication_venlafaxine == true && venlafaxine_response == \'unsuccessful\'","venlafaxine_partial":"medication_venlafaxine == true && venlafaxine_response == \'partial\'","desvenlafaxine_inadequate":"medication_desvenlafaxine == true && desvenlafaxine_response == \'unsuccessful\'","desvenlafaxine_partial":"medication_desvenlafaxine == true && desvenlafaxine_response == \'partial\'","other_snri_inadequate":"medication_other_snri == true && other_snri_response == \'unsuccessful\'","other_snri_partial":"medication_other_snri == true && other_snri_response == \'partial\'","other_atypical_inadequate":"medication_other_atypical == true && other_atypical_response == \'unsuccessful\'","other_atypical_partial":"medication_other_atypical == true && other_atypical_response == \'partial\'","mirtazapine_inadequate":"medication_mirtazapine == true && mirtazapine_response == \'unsuccessful\'","mirtazapine_partial":"medication_mirtazapine == true && 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\'successful\'","clonazepam_successful":"medication_clonazepam == true && clonazepam_response == \'successful\'","paroxetine_successful":"medication_paroxetine == true && paroxetine_response == \'successful\'","duloxetine_successful":"medication_duloxetine == true && duloxetine_response == \'successful\'","venlafaxine_successful":"medication_venlafaxine == true && venlafaxine_response == \'successful\'","desvenlafaxine_successful":"medication_desvenlafaxine == true && desvenlafaxine_response == \'successful\'","mirtazapine_successful":"medication_mirtazapine == true && mirtazapine_response == \'successful\'","imipramine_successful":"medication_imipramine == true && imipramine_response == \'successful\'","nortriptyline_successful":"medication_nortriptyline == true && nortriptyline_response == \'successful\'","lorazepam_successful":"medication_lorazepam == true && lorazepam_response == \'successful\'","other_snri_successful":"medication_other_snri == true && other_snri_response == \'successful\'","other_ssri_successful":"medication_other_ssri == true && other_ssri_response == \'successful\'","other_atypical_successful":"medicationother_atypical == true && other_atypical_response == \'successful\'","on_ssri_snri_1":"(medication_escitalopram ? 1 : 0) + (medication_fluoxetine ? 1 : 0) + (medication_sertraline ? 1 : 0) + (medication_citalopram ? 1 : 0) + (medication_other_ssri ? 1 : 0) + (medication_venlafaxine ? 1 : 0) + (medication_duloxetine ? 1 : 0) + (medication_desvenlafaxine ? 1 : 0)  + (medication_paroxetine ? 1 : 0) >= 1","on_ssri_snri_2":"(medication_escitalopram ? 1 : 0) + (medication_fluoxetine ? 1 : 0) + (medication_sertraline ? 1 : 0) + (medication_citalopram ? 1 : 0) + (medication_other_ssri ? 1 : 0) + (medication_venlafaxine ? 1 : 0) + (medication_duloxetine ? 1 : 0) + (medication_desvenlafaxine ? 1 : 0)  + (medication_paroxetine ? 1 : 0) >= 2"},{"ssri_inadequate_1":"(escitalopram_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0) +  (sertraline_inadequate ? 1 : 0) + (citalopram_inadequate ? 1 : 0) + (paroxetine_inadequate? 1 : 0) + (other_ssri_inadequate? 1 : 0) >= 1   ","ssri_inadequate_2":"(escitalopram_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0) +  (sertraline_inadequate ? 1 : 0) + (citalopram_inadequate ? 1 : 0) + (paroxetine_inadequate? 1 : 0) + (other_ssri_inadequate? 1 : 0) >= 2","ssri_partial_1":"(escitalopram_partial ? 1 : 0) + (fluoxetine_partial ? 1 : 0) +  (sertraline_partial ? 1 : 0) + (citalopram_partial ? 1 : 0) + (paroxetine_partial ? 1 : 0) + (other_ssri_partial? 1 : 0)  >= 1","first_gad_inadequate":"(escitalopram_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0) + (sertraline_inadequate ? 1 : 0) + (citalopram_inadequate ? 1 : 0) + (venlafaxine_inadequate ? 1 : 0) + (duloxetine_inadequate ? 1 : 0) + (desvenlafaxine_inadequate ? 1 : 0) + (paroxetine_inadequate ? 1 : 0) + (other_ssri_inadequate ? 1 : 0) >= 1","first_gad_partial":"(escitalopram_partial ? 1 : 0) + (fluoxetine_partial ? 1 : 0) + (sertraline_partial ? 1 : 0) + (citalopram_partial ? 1 : 0) + (venlafaxine_partial ? 1 : 0) + (duloxetine_partial ? 1 : 0) + (desvenlafaxine_partial ? 1 : 0) + (paroxetine_partial ? 1 : 0) + (other_ssri_partial ? 1 : 0) >= 1","mirtazapine_unsuccessful":"mirtazapine_inadequate == true || mirtazapine_partial == true","successful_ssri_snri":"(fluoxetine_current == \'current\' && fluoxetine_successful === true) || (sertraline_current == \'current\' && sertraline_successful === true) || (escitalopram_current == \'current\' && escitalopram_successful === true) || (citalopram_current == \'current\' && citalopram_successful === true) || (clonazepam_current == \'current\' && clonazepam_successful === true) || (paroxetine_current == \'current\' && paroxetine_successful === true) || (duloxetine_current == \'current\' && duloxetine_successful === true) || (venlafaxine_current == \'current\' && venlafaxine_successful === true) || (other_ssri_current == \'current\' && other_ssri_successful === true) || (desvenlafaxine_current == \'current\' && desvenlafaxine_successful === true) || (mirtazapine_current == \'current\' && mirtazapine_successful === true) || (nortriptyline_current == \'current\' && nortriptyline_successful === true) || (imipramine_current == \'current\' && imipramine_successful === true) || (lorazepam_current == \'current\' && lorazepam_successful === true) || (other_atypical_current == \'current\' && other_atypical_successful === true)","prior_successful_ssri_snri":"(fluoxetine_current == \'prior\' && fluoxetine_successful === true) || (sertraline_current == \'prior\' && sertraline_successful === true) || (escitalopram_current == \'prior\' && escitalopram_successful === true) || (citalopram_current == \'prior\' && citalopram_successful === true) || (paroxetine_current == \'prior\' && paroxetine_successful === true) || (duloxetine_current == \'prior\' && duloxetine_successful === true) || (venlafaxine_current == \'prior\' && venlafaxine_successful === true) || (other_ssri_current == \'prior\' && other_ssri_successful === true) || (desvenlafaxine_current == \'prior\' && desvenlafaxine_successful === true) || (mirtazapine_current == \'prior\' && mirtazapine_successful === true) || (nortriptyline_current == \'prior\' && nortriptyline_successful === true) || (imipramine_current == \'prior\' && imipramine_successful === true) || (other_atypical_current == \'prior\' && other_atypical_successful === true)"},{"has_current":"(medication_citalopram && citalopram_current == \'current\') || (medication_escitalopram && escitalopram_current == \'current\') || (medication_fluoxetine && fluoxetine_current == \'current\') || (medication_paroxetine && paroxetine_current == \'current\') || (medication_sertraline && sertraline_current == \'current\') || (medication_other_ssri && other_ssri_current == \'current\') || (medication_duloxetine && duloxetine_current == \'current\') || (medication_venlafaxine && venlafaxine_current == \'current\') || (medication_desvenlafaxine && desvenlafaxine_current == \'current\') || (medication_mirtazapine && mirtazapine_current == \'current\') || (medication_imipramine && imipramine_current == \'current\')"}],"sections":[{"valid":"true","title":"Panic Disorder Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":"Adequate pharmacotherapy trial: minimum 6-8 weeks at maximum clinically indicated and tolerable dose."},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Panic Disorder"}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"SSRI Antidepressants"}]},{"visible":"medication_history === \'Yes\'","id":"medication_citalopram","text":"Citalopram","type":"switch","groups":[{"visible":"medication_citalopram","id":"citalopram_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_citalopram && citalopram_current === \'current\'","id":"citalopram_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_citalopram && citalopram_current === \'prior\'","id":"citalopram_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_escitalopram","text":"Escitalopram","type":"switch","groups":[{"visible":"medication_escitalopram","id":"escitalopram_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_escitalopram && escitalopram_current === \'current\'","id":"escitalopram_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_escitalopram && escitalopram_current === \'prior\'","id":"escitalopram_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_fluoxetine","text":"Fluoxetine","type":"switch","groups":[{"visible":"medication_fluoxetine","id":"fluoxetine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_fluoxetine && fluoxetine_current === \'current\'","id":"fluoxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_fluoxetine && fluoxetine_current === \'prior\'","id":"fluoxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_paroxetine","text":"Paroxetine","type":"switch","groups":[{"visible":"medication_paroxetine","id":"paroxetine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_paroxetine && paroxetine_current === \'current\'","id":"paroxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_paroxetine && paroxetine_current === \'prior\'","id":"paroxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_sertraline","text":"Sertraline","type":"switch","groups":[{"visible":"medication_sertraline","id":"sertraline_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_sertraline && sertraline_current === \'current\'","id":"sertraline_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_sertraline && sertraline_current === \'prior\'","id":"sertraline_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_other_ssri","text":"Other SSRI","type":"switch","groups":[{"visible":"medication_other_ssri","id":"other_ssri_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_other_ssri && other_ssri_current === \'current\'","id":"other_ssri_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_other_ssri && other_ssri_current === \'prior\'","id":"other_ssri_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && comorbidities != \'hepatic\'","type":"title","text":[{"visible":"true","text":"SNRI Antidepressants"}]},{"visible":"medication_history === \'Yes\' && comorbidities != \'hepatic\'","id":"medication_duloxetine","text":"Duloxetine","type":"switch","groups":[{"visible":"medication_duloxetine","id":"duloxetine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_duloxetine && duloxetine_current === \'current\'","id":"duloxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_duloxetine && duloxetine_current === \'prior\'","id":"duloxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && comorbidities != \'hepatic\'","id":"medication_venlafaxine","text":"Venlafaxine","type":"switch","groups":[{"visible":"medication_venlafaxine","id":"venlafaxine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_venlafaxine && venlafaxine_current === \'current\'","id":"venlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_venlafaxine && venlafaxine_current === \'prior\'","id":"venlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && comorbidities != \'hepatic\'","id":"medication_desvenlafaxine","text":"Desvenlafaxine","type":"switch","groups":[{"visible":"medication_desvenlafaxine","id":"desvenlafaxine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_desvenlafaxine && desvenlafaxine_current === \'current\'","id":"desvenlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_desvenlafaxine && desvenlafaxine_current === \'prior\'","id":"desvenlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"Other Antidepressant"}]},{"visible":"medication_history === \'Yes\'","id":"medication_mirtazapine","text":"Mirtazapine","type":"switch","groups":[{"visible":"medication_mirtazapine","id":"mirtazapine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_mirtazapine && mirtazapine_current === \'current\'","id":"mirtazapine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_mirtazapine && mirtazapine_current === \'prior\'","id":"mirtazapine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"Tricyclic Antidepressant"}]},{"visible":"medication_history === \'Yes\'","id":"medication_imipramine","text":"Imipramine","type":"switch","groups":[{"visible":"medication_imipramine","id":"imipramine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_imipramine && imipramine_current === \'current\'","id":"imipramine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_imipramine && imipramine_current === \'prior\'","id":"imipramine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"Panic Disorder","state":"intro","content":[]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'cardiac\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper. (SOR A)","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>First choice:</b> <br>Start an SSRI <br><br><b>Second choice:</b> <br>Start an SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>First choice:</b> <br>Start an SSRI <br><br><b>Second choice:</b> <br>Start an SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g1"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === false) && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g3"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === true) && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g3"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<discontinue>Refer to Psychiatry. <br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (first_gad_inadequate === false) && (first_gad_partial === true) && (mirtazapine_inadequate  === false) && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g2"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"Continue SSRI or SNRI and augment with Mirtazapine <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (first_gad_inadequate === false) && (first_gad_partial === true) && (mirtazapine_inadequate  === true) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-cardiac_g2"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br>Continue SSRI or SNRI and Mirtazapine.<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"8","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g1"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI, initiated at lowest dose dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"9","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g1"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI, initiated at lowest dose dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"10","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g1"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === false) && (patient_age === \'Geriatric\')","title":"","uid":"11","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g3"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === true) && (patient_age === \'Geriatric\')","title":"","uid":"12","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g3"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<discontinue>Refer to Psychiatry. ","meds":[],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_inadequate === false) && (first_gad_partial === true) && (mirtazapine_inadequate  === false) && (patient_age === \'Geriatric\')","title":"","uid":"13","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g2"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"Continue SSRI or SNRI and augment with Mirtazapine <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_inadequate === false) && (first_gad_partial === true) && (mirtazapine_inadequate  === true) && (patient_age === \'Geriatric\')","title":"","uid":"14","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-geriatric_g2"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br>Continue SSRI or SNRI and Mirtazapine.<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g1"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI, initiated at lowest dose dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === false) && (ssri_inadequate_2 === false) && (patient_age === \'Adult\')","title":"","uid":"16","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g1"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI, initiated at lowest dose dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === true) && (ssri_inadequate_2 === false) && (patient_age === \'Adult\')","title":"","uid":"17","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g1"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different SSRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_2 === true) && (mirtazapine_inadequate  === false) && (patient_age === \'Adult\')","title":"","uid":"18","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g3"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_2 === true) && (mirtazapine_inadequate  === true) && (patient_age === \'Adult\')","title":"","uid":"19","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g3"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA). <br>OR<br>Consider lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"19.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines ","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (mirtazapine_inadequate  === false) && (mirtazapine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"20","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g2"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and augment with Mirtazapine <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (mirtazapine_inadequate  === false) && (mirtazapine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"21","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-hepatic_g2"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Mirtazapine and trial TCA (Imipramine most studied TCA).<br>OR<br>Consider lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"21.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines <br>Combination SSRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (mirtazapine_inadequate  === true) && (mirtazapine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g2"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"<discontinue>Continue SSRI and trial TCA (Imipramine most studied TCA). <br>OR<br>Consider lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\')","uid":"43.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines <br>Combination SSRI or SNRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"22","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g1"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI, initiated at lowest dose dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"23","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g1"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI, initiated at lowest dose dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"24","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g1"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === false) && (patient_age === \'Adult\')","title":"","uid":"25","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g3"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === true) && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g3"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA). <br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"26.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines ","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (first_gad_inadequate === false) && (first_gad_partial === true) && (mirtazapine_inadequate  === false) && (mirtazapine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g2"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"Continue SSRI or SNRI and augment with Mirtazapine <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (first_gad_inadequate === false) && (first_gad_partial === true) && (mirtazapine_inadequate  === false) && (mirtazapine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g2"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"Continue SSRI or SNRI and Mirtazapine and trial TCA (Imipramine most studied TCA). <br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"28.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines <br>Combination SSRI or SNRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (mirtazapine_inadequate  === true) && (mirtazapine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-obesity_g2"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"<discontinue>Continue SSRI or SNRI and trial TCA (Imipramine most studied TCA). <br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\')","uid":"43.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines <br>Combination SSRI or SNRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g1"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI, initiated at lowest dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive 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management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g1"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === false) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g3"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === true) && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g3"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA) <br>OR<br>Consider lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\')","uid":"33.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines ","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (first_gad_inadequate === false) && (first_gad_partial === true) && (mirtazapine_inadequate  === false) && (mirtazapine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g2"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"Continue SSRI or SNRI and augment with Mirtazapine <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (first_gad_inadequate === false) && (first_gad_partial === true) && (mirtazapine_inadequate  === false) && (mirtazapine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g2"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"Continue SSRI or SNRI and Mirtazapine and trial TCA (Imipramine most studied TCA). <br>OR<br>Consider lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\')","uid":"35.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines <br>Combination SSRI or SNRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (mirtazapine_inadequate  === true) && (mirtazapine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder-renal_g2"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"<discontinue>Continue SSRI or SNRI and trial TCA (Imipramine most studied TCA). <br>OR<br>Consider lorazepam","meds":["Imipramine","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\')","uid":"43.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines <br>Combination SSRI or SNRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g1"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Start an SSRI or SNRI, initiated at lowest dose dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_gad_inadequate === false) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Start an SSRI or SNRI, initiated at lowest dose dose<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_gad_inadequate === true) && (first_gad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g1"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Trial a different SSRI or SNRI<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === false) && (patient_age === \'Adult\')","title":"","uid":"39","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g3"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine (SOR B)","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_gad_inadequate === true) && (first_gad_partial === false) && (mirtazapine_inadequate  === true) && (patient_age === \'Adult\')","title":"","uid":"40","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g3"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA). (SOR C)<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(partum === \'None\')","uid":"40.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines ","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (mirtazapine_inadequate  === false) && (mirtazapine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g2"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"Continue SSRI or SNRI and augment with Mirtazapine <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (mirtazapine_inadequate  === false) && (mirtazapine_partial === true) && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g2"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"Continue SSRI or SNRI and Mirtazapine and trial TCA (Imipramine most studied TCA). (SOR C)<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(partum === \'None\')","uid":"42.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines <br>Combination SSRI or SNRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_gad_partial === true) && (mirtazapine_inadequate  === true) && (mirtazapine_partial === false) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Panic Disorder","figure":["Panic-Disorder_g2"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"<discontinue>Continue SSRI or SNRI and trial TCA (Imipramine most studied TCA). (SOR C)<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(partum === \'None\')","uid":"43.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines <br>Combination SSRI or SNRI and TCA therapy requires careful patient selection, education, shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":true,"title":"","uid":"43","state":"recommendation","branch":"Panic Disorder","figure":[""],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation","meds":[],"therapies":[]}]}]}')},2915:function(e){"use strict";e.exports=JSON.parse('{"variables":{"severity":"","underlying":"","medication_history":"No","medication_sertraline":false,"medication_escitalopram":false,"medication_fluoxetine":false,"medication_citalopram":false,"medication_other_ssri":false,"medication_duloxetine":false,"medication_desvenlafaxine":false,"medication_venlafaxine":false,"medication_drospirenone_and_ethinyl_estradiol":false,"medication_drospirenone":false,"medication_leuprolide_acetate":false,"sertraline_current":false,"escitalopram_current":false,"fluoxetine_current":false,"citalopram_current":false,"other_ssri_current":false,"duloxetine_current":false,"desvenlafaxine_current":false,"venlafaxine_current":false,"drospirenone_and_ethinyl_estradiol_current":false,"drospirenone_current":false,"leuprolide_acetate_current ":false,"sertraline_inadequate":false,"escitalopram_inadequate":false,"fluoxetine_inadequate":false,"citalopram_inadequate":false,"other_ssri_inadequate":false,"duloxetine_inadequate":false,"desvenlafaxine_inadequate":false,"venlafaxine_inadequate":false,"drospirenone_and_ethinyl_estradiol_inadequate":false,"drospirenone_inadequate":false,"leuprolide_acetate_inadequate ":false,"sertraline_successful":false,"escitalopram_successful":false,"fluoxetine_successful":false,"citalopram_successful":false,"other_ssri_successful":false,"duloxetine_successful":false,"desvenlafaxine_successful":false,"venlafaxine_successful":false,"drospirenone_and_ethinyl_estradiol_successful":false,"drospirenone_successful":false,"leuprolide_acetate_successful":false,"unsuccessful_oc":false,"unsuccessful_ssri_1":false,"unsuccessful_ssri_snri_2":false,"unsuccessful_ssri_snri_3":false,"successful_alt_meds":false,"prior_alt_successful_meds":false,"medCount":11},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","sertraline_inadequate":"medication_sertraline == true && sertraline_response === \'unsuccessful\'","fluoxetine_inadequate":"medication_fluoxetine == true && fluoxetine_response === \'unsuccessful\'","citalopram_inadequate":"medication_citalopram == true && citalopram_response === \'unsuccessful\'","other_ssri_inadequate":"medication_other_ssri == true && other_ssri_response === \'unsuccessful\'","duloxetine_inadequate":"medication_duloxetine == true && duloxetine_response === \'unsuccessful\'","escitalopram_inadequate":"medication_escitalopram == true && escitalopram_response === \'unsuccessful\'","desvenlafaxine_inadequate":"medication_desvenlafaxine == true && desvenlafaxine_response === \'unsuccessful\'","venlafaxine_inadequate":"medication_venlafaxine == true && venlafaxine_response === \'unsuccessful\'","drospirenone_and_ethinyl_estradiol_inadequate":"medication_drospirenone_and_ethinyl_estradiol == true && drospirenone_and_ethinyl_estradiol_response === \'unsuccessful\'","drospirenone_inadequate":"medication_drospirenone == true && drospirenone_response === \'unsuccessful\'","leuprolide_acetate_inadequate ":"medication_leuprolide_acetate == true && leuprolide_acetate_response === \'unsuccessful\'"},{"sertraline_successful":"medication_sertraline == true && sertraline_response === \'successful\'","fluoxetine_successful":"medication_fluoxetine == true && fluoxetine_response === \'successful\'","citalopram_successful":"medication_citalopram == true && citalopram_response === \'successful\'","other_ssri_successful":"medication_other_ssri == true && other_ssri_response === \'successful\'","duloxetine_successful":"medication_duloxetine == true && duloxetine_response === \'successful\'","escitalopram_successful":"medication_escitalopram == true && escitalopram_response === \'successful\'","desvenlafaxine_successful":"medication_desvenlafaxine == true && desvenlafaxine_response === \'successful\'","venlafaxine_successful":"medication_venlafaxine == true && venlafaxine_response === \'successful\'","drospirenone_and_ethinyl_estradiol_successful":"medication_drospirenone_and_ethinyl_estradiol == true && drospirenone_and_ethinyl_estradiol_response === \'successful\'","drospirenone_successful":"medication_drospirenone == true && drospirenone_response === \'successful\'","leuprolide_acetate_successful":"medication_leuprolide_acetate == true && leuprolide_acetate_response === \'successful\'"},{},{"unsuccessful_oc":"(drospirenone_inadequate ? 1 : 0) + (drospirenone_and_ethinyl_estradiol_inadequate ? 1 : 0) >= 1","unsuccessful_ssri_1":"(sertraline_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0) + (citalopram_inadequate ? 1 : 0) + (other_ssri_inadequate ? 1 : 0) + (escitalopram_inadequate ? 1 : 0) >= 1","unsuccessful_ssri_snri_2":"(sertraline_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0)  + (citalopram_inadequate ? 1 : 0)  + (other_ssri_inadequate ? 1 : 0)  + (duloxetine_inadequate ? 1 : 0)  + (escitalopram_inadequate ? 1 : 0)  + (desvenlafaxine_inadequate ? 1 : 0)  + (venlafaxine_inadequate ? 1 : 0) >= 2","unsuccessful_ssri_snri_3":"(sertraline_inadequate ? 1 : 0) + (fluoxetine_inadequate ? 1 : 0)  + (citalopram_inadequate ? 1 : 0)  + (other_ssri_inadequate ? 1 : 0)  + (duloxetine_inadequate ? 1 : 0)  + (escitalopram_inadequate ? 1 : 0)  + (desvenlafaxine_inadequate ? 1 : 0)  + (venlafaxine_inadequate ? 1 : 0) >= 3"},{"successful_meds":"(sertraline_current == \'current\' && sertraline_successful === true) || (fluoxetine_current == \'current\' && fluoxetine_successful === true) || (citalopram_current == \'current\' && citalopram_successful === true) || (other_ssri_current == \'current\' && other_ssri_successful === true) || (duloxetine_current == \'current\' && duloxetine_successful === true) || (escitalopram_current == \'current\' && escitalopram_successful === true) || (desvenlafaxine_current == \'current\' && desvenlafaxine_successful === true) || (venlafaxine_current == \'current\' && venlafaxine_successful === true)","prior_successful_meds":"(sertraline_current == \'prior\' && sertraline_successful === true) || (fluoxetine_current == \'prior\' && fluoxetine_successful === true) || (citalopram_current == \'prior\' && citalopram_successful === true) || (other_ssri_current == \'prior\' && other_ssri_successful === true) || (duloxetine_current == \'prior\' && duloxetine_successful === true) || (escitalopram_current == \'prior\' && escitalopram_successful === true) || (desvenlafaxine_current == \'prior\' && desvenlafaxine_successful === true) || (venlafaxine_current == \'prior\' && venlafaxine_successful === true)"},{"successful_alt_meds":"(drospirenone_and_ethinyl_estradiol_current == \'current\' && drospirenone_and_ethinyl_estradiol_successful === true) || (drospirenone_current == \'current\' && drospirenone_successful === true) || (leuprolide_acetate_current == \'current\' && leuprolide_acetate_successful === true)","prior_alt_successful_meds":"(drospirenone_and_ethinyl_estradiol_current == \'prior\' && drospirenone_and_ethinyl_estradiol_successful === true) || (drospirenone_current == \'prior\' && drospirenone_successful === true) || (leuprolide_acetate_current == \'prior\' && leuprolide_acetate_successful === true)"}],"sections":[{"valid":"true","title":"PMDD Medications","state":"medication","content":[{"visible":false,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat PMDD"}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"SSRI Antidepressants"}]},{"visible":"medication_history === \'Yes\'","id":"medication_sertraline","text":"Sertraline","type":"switch","groups":[{"visible":"medication_sertraline","id":"sertraline_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_sertraline && sertraline_current === \'current\'","id":"sertraline_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_sertraline && sertraline_current === \'prior\'","id":"sertraline_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_escitalopram","text":"Escitalopram","type":"switch","groups":[{"visible":"medication_escitalopram","id":"escitalopram_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_escitalopram && escitalopram_current === \'current\'","id":"escitalopram_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_escitalopram && escitalopram_current === \'prior\'","id":"escitalopram_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_fluoxetine","text":"Fluoxetine","type":"switch","groups":[{"visible":"medication_fluoxetine","id":"fluoxetine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_fluoxetine && fluoxetine_current === \'current\'","id":"fluoxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_fluoxetine && fluoxetine_current === \'prior\'","id":"fluoxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_citalopram","text":"Citalopram","type":"switch","groups":[{"visible":"medication_citalopram","id":"citalopram_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_citalopram && citalopram_current === \'current\'","id":"citalopram_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_citalopram && citalopram_current === \'prior\'","id":"citalopram_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_other_ssri","text":"Other SSRI","type":"switch","groups":[{"visible":"medication_other_ssri","id":"other_ssri_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_other_ssri && other_ssri_current === \'current\'","id":"other_ssri_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_other_ssri && other_ssri_current === \'prior\'","id":"other_ssri_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"SNRI Antidepressants"}]},{"visible":"medication_history === \'Yes\'","id":"medication_duloxetine","text":"Duloxetine","type":"switch","groups":[{"visible":"medication_duloxetine","id":"duloxetine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_duloxetine && duloxetine_current === \'current\'","id":"duloxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_duloxetine && duloxetine_current === \'prior\'","id":"duloxetine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_desvenlafaxine","text":"Desvenlafaxine","type":"switch","groups":[{"visible":"medication_desvenlafaxine","id":"desvenlafaxine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_desvenlafaxine && desvenlafaxine_current === \'current\'","id":"desvenlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_desvenlafaxine && desvenlafaxine_current === \'prior\'","id":"desvenlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_venlafaxine","text":"Venlafaxine","type":"switch","groups":[{"visible":"medication_venlafaxine","id":"venlafaxine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_venlafaxine && venlafaxine_current === \'current\'","id":"venlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_venlafaxine && venlafaxine_current === \'prior\'","id":"venlafaxine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"Hormonal contraceptive agents"}]},{"visible":"medication_history === \'Yes\'","id":"medication_drospirenone_and_ethinyl_estradiol","text":"Combined Oral Contraceptives","type":"switch","groups":[{"visible":"medication_drospirenone_and_ethinyl_estradiol","id":"drospirenone_and_ethinyl_estradiol_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_drospirenone_and_ethinyl_estradiol && drospirenone_and_ethinyl_estradiol_current === \'current\'","id":"drospirenone_and_ethinyl_estradiol_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_drospirenone_and_ethinyl_estradiol && drospirenone_and_ethinyl_estradiol_current === \'prior\'","id":"drospirenone_and_ethinyl_estradiol_response","type":"choice","choices":[{"text":"Successful response","value":"successful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_drospirenone","text":"Drospirenone","type":"switch","groups":[{"visible":"medication_drospirenone","id":"drospirenone_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_drospirenone && drospirenone_current === \'current\'","id":"drospirenone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_drospirenone && drospirenone_current === \'prior\'","id":"drospirenone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"}]}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"GnRH Agonist"}]},{"visible":"medication_history === \'Yes\'","id":"medication_leuprolide_acetate","text":"Leuprolide acetate","type":"switch","groups":[{"visible":"medication_leuprolide_acetate","id":"leuprolide_acetate_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_leuprolide_acetate && leuprolide_acetate_current === \'current\'","id":"leuprolide_acetate_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_leuprolide_acetate && leuprolide_acetate_current === \'prior\'","id":"leuprolide_acetate_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"PMDD","state":"intro","content":[{"id":"drsp","visible":"true","type":"overlay","choices":[{"text":""}],"text":"Diagnosis confirmed by documentation of symptoms prospectively over 2 cycles using Daily Record of Severity of Problems (DRSP)"},{"id":"underlying","visible":"true","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is there an underlying mood disorder?"},{"id":"severity","visible":"underlying == \'No\'","type":"radio","choices":"Mild, Moderate/Severe","text":"Severity of symptoms","groups":[{"id":"severity","type":"choice","choices":[{"text":"Mild","value":"Mild"},{"text":"Moderate/Severe","value":"Moderate/Severe"}]}]}]},{"valid":"(medication_history === \'Yes\') && (successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p8"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose. If applicable, continue SSRI/SNRI for minimum one year.","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p8"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart effective treatment. If applicable, continue SSRI/SNRI for minimum one year.","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (successful_alt_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective dose. ","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (prior_alt_successful_meds === true) && (patient_age === \'Adult\')","title":"","uid":"0","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p9"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart effective treatment. ","meds":[],"therapies":[]}]},{"valid":"(underlying === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p2"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Maximize treatment of underlying mood disorder:</b><br><br>- See corresponding decision support tool<br>- Premenstrual Exacerbation of mood disorder: consider dose increase of primary pharmacotherapy during luteal phase<br>- If mood disorder medically optimized and premenstrual symptoms persist, consider evaluation for treatment of PMDD","meds":[],"therapies":[]}]},{"valid":"(severity === \'Mild\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Lifestyle Interventions:</b><br>- Exercise<br>- Relaxation techniques","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'No\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p3"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- SSRI or hormonal contraception<br>- Evaluate patient\'s desire and CDC Medical Eligibility Criteria for Hormonal Contraception<br>- SSRI: Sertraline or Fluoxetine (may be taken continuously, during luteal phase, or symptom triggered)<br>- Hormonal Contraception: combined oral contraception (COC) or progesterone only contraception (POC)","meds":["Fluoxetine","Sertraline","Drospirenone","Drospirenone and Ethinyl Estradiol"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === false) && (unsuccessful_ssri_1 === false) && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p3"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- SSRI or hormonal contraception<br>- Evaluate patient\'s desire and CDC Medical Eligibility Criteria for Hormonal Contraception<br>- SSRI: Sertraline or Fluoxetine (may be taken continuously, during luteal phase, or symptom triggered)<br>- Hormonal Contraception: combined oral contraception (COC) or progesterone only contraception (POC)","meds":["Fluoxetine","Sertraline","Drospirenone","Drospirenone and Ethinyl Estradiol"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"4.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === true) && (unsuccessful_ssri_1 === false) && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p4"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Augment combined oral contraception (COC) or progesterone only contraception (POC) with an SSRI","meds":["Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"5.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === true) && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === false) && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p5"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Change to a different SSRI or SNRI","meds":["Fluoxetine","Sertraline","Escitalopram","Duloxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"6.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- - Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === true) && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (unsuccessful_ssri_snri_3 === false) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p7"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Consider third SSRI/SNRI trial<br>- Increase dose as needed each cycle","meds":["Fluoxetine","Sertraline","Escitalopram","Duloxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"7.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === true) && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (unsuccessful_ssri_snri_3 === true) && (leuprolide_acetate_inadequate  === false) && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p6"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Discontinue prior ineffective SSRI/SNRI<br>- GnRH agonist with low dose estrogen-progesterone \\"add back\\" therapy<br>- Symptom targeted augmentation<br>- See corresponding decision support tool (e.g. MDD, GAD)","meds":["Leuprolide acetate"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"8.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === true) && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (unsuccessful_ssri_snri_3 === true) && (leuprolide_acetate_inadequate  === true) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p6"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Assess patients guideline defined appropriateness for last resort surgical bilateral salpingo-oophorectomy","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === false) && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p5"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Change to a different SSRI or SNRI<br>- Increase dose as needed each cycle","meds":["Fluoxetine","Sertraline","Escitalopram","Duloxetine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"10.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"10.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === false) && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (unsuccessful_ssri_snri_3 === false) && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p7"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Consider third SSRI/SNRI trial and reconsider OCP desire/appropriateness in combination with SSRI/SNRI<br>- Increase dose as needed each cycle","meds":["Fluoxetine","Sertraline","Escitalopram","Duloxetine","Drospirenone","Drospirenone and Ethinyl Estradiol"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"11.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"11.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === false) && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (unsuccessful_ssri_snri_3 === true) && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p7"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Reconsider OCP desire/appropriateness in combination with SSRI/SNRI<br>- Increase dose as needed each cycle","meds":["Fluoxetine","Sertraline","Escitalopram","Duloxetine","Drospirenone","Drospirenone and Ethinyl Estradiol"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"12.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"12.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === true) && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (unsuccessful_ssri_snri_3 === true) && (leuprolide_acetate_inadequate  === false) && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p6"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- GnRH agonist with low dose estrogen-progesterone \\"add back\\" therapy<br>- Symptom targeted augmentation<br>- See corresponding decision support tool (e.g. MDD, GAD)","meds":["Leuprolide acetate"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"13.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"13.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":"(severity === \'Moderate/Severe\') && (underlying === \'No\') && (medication_history === \'Yes\') && (unsuccessful_oc === true) && (unsuccessful_ssri_1 === true) && (unsuccessful_ssri_snri_2 === true) && (unsuccessful_ssri_snri_3 === true) && (leuprolide_acetate_inadequate  === true) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":["pmdd_p6"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Combination lifestyle interventions, psychotherapy, pharmacotherapy:</b><br>- Exercise<br>- Relaxation techniques<br><br><b>Psychotherapy:</b><br>- CBT if available<br><br><b>Pharmacotherapy:</b><br>- Assess patients guideline defined appropriateness for last resort surgical bilateral salpingo-oopherectomy","meds":[],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"14.1","type":"collapse","title":"SSRI administration guidance","text":"Continuous and luteal administration phase equivalent efficacy<br><br><b>Continuous:</b><br>- Convenient/simple<br>- Benefit for non-premenstrual symptoms<br><br><b>Luteal:</b><br>- Potentially more affordable and fewer side effect potential<br>- Start day 14 of cycle and end at onset of menses or few days after<br><br><b>Symptom triggered:</b><br>- Preferred if symptoms are brief and predictable","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"14.2","type":"collapse","title":"Hormonal Contraception administration guidance","text":"Review oral agents in <a href=\'https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf\'>CDC Medical Eligibility Criteria for Hormonal Contraception</a><br><br>- Drospirenone containing combined oral contraception (COC) most studied for PMDD<br>- Drospirenone only option if progesterone only contraception (POC) desired<br>- If inadequate response to COC, Increase estrogen dose to 30mcg equivalent<br>- If inadequate response to POC, consider addition of estrogen if eligible or augment with SSRI","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Premenstrual Dysphoric Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},6210:function(e){"use strict";e.exports=JSON.parse('{"variables":{"psychotic":"","medication_history":"No","medication_mirtazapine":false,"medication_quetiapine":false,"medication_aripiprazole":false,"medication_olanzapine":false,"medication_risperidone":false,"medication_other_atypical":false,"medication_trifluoperazine":false,"medication_perphenazine":false,"medication_benztropine":false,"medication_amitriptyline":false,"medication_imipramine":false,"medication_desipramine":false,"medication_lithium":false,"mirtazapine_current":false,"quetiapine_current":false,"olanzapine_current":false,"aripiprazole_current":false,"risperidone_current":false,"other_atypical_current":false,"trifluoperazine_current":false,"perphenazine_current":false,"benztropine_current":false,"lithium_current":false,"mirtazapine_successful":false,"quetiapine_successful":false,"olanzapine_successful":false,"aripiprazole_successful":false,"risperidone_successful":false,"other_atypical_successful":false,"trifluoperazine_successful":false,"perphenazine_successful":false,"benztropine_successful":false,"lithium_successful":false,"on_aa_1":false,"on_aa_2":false,"aa_failed_1":false,"aa_failed_2":false,"aa_partial_ise_1":false,"aa_partial_ise_2":false,"psychotic_or_other":false,"other_symptoms":"","other_symptoms_postpartum":"","medCount":6},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","psychotic_or_other":"psychotic === \'Yes\' || other_symptoms === \'Yes\' || partum === \'Postpartum\'","postpartum_evaluation":"other_symptoms_postpartum === \'Yes\'","aripiprazole_inadequate_cur":"medication_aripiprazole == true && (aripiprazole_response == \'unsuccessful\' || aripiprazole_response == \'partial due to intolerable side effects\') && aripiprazole_current == \'current\'","aripiprazole_inadequate":"medication_aripiprazole == true && (aripiprazole_response == \'unsuccessful\' || aripiprazole_response == \'partial due to intolerable side effects\')","aripiprazole_partial":"medication_aripiprazole == true && aripiprazole_response == \'partial\'","aripiprazole_partial_ise":"medication_aripiprazole == true && aripiprazole_response == \'partial due to intolerable side effects\'","quetiapine_inadequate":"medication_quetiapine == true && (quetiapine_response == \'unsuccessful\' || quetiapine_response == \'partial due to intolerable side effects\')","quetiapine_partial":"medication_quetiapine == true && quetiapine_response == \'partial\'","risperidone_inadequate":"medication_risperidone == true && (risperidone_response == \'unsuccessful\' || risperidone_response == \'partial due to intolerable side effects\')","risperidone_inadequate_cur":"medication_risperidone == true && (risperidone_response == \'unsuccessful\' || risperidone_response == \'partial due to intolerable side effects\') && risperidone_current == \'current\'","risperidone_partial":"medication_risperidone == true && risperidone_response == \'partial\'","risperidone_partial_ise":"medication_risperidone == true && risperidone_response == \'partial due to intolerable side effects\'","olanzapine_inadequate":"medication_olanzapine == true && (olanzapine_response == \'unsuccessful\' || olanzapine_response == \'partial due to intolerable side effects\')","olanzapine_partial":"medication_olanzapine == true && olanzapine_response == \'partial\'","olanzapine_partial_ise":"medication_olanzapine == true && olanzapine_response == \'partial due to intolerable side effects\'","other_atypical_inadequate":"medication_other_atypical == true && (other_atypical_response == \'unsuccessful\' || other_atypical_response == \'partial due to intolerable side effects\')","other_atypical_partial":"medication_other_atypical == true && other_atypical_response == \'partial\'","other_atypical_partial_ise":"medication_other_atypical == true && other_atypical_response == \'partial due to intolerable side effects\'","trifluoperazine_inadequate":"medication_trifluoperazine == true && trifluoperazine_response == \'unsuccessful\'","perphenazine_inadequate":"medication_perphenazine == true && perphenazine_response == \'unsuccessful\'","benztropine_inadequate":"medication_benztropine == true && benztropine_response == \'unsuccessful\'","lithium_inadequate":"medication_lithium == true && lithium_response == \'unsuccessful\'","olanzapine_successful":"medication_olanzapine == true && olanzapine_response == \'successful\'","amitriptyline_successful":"medication_amitriptyline == true && amitriptyline_response == \'successful\'","imipramine_successful":"medication_imipramine == true && imipramine_response == \'successful\'","quetiapine_successful":"medication_quetiapine == true && quetiapine_response == \'successful\'","desipramine_successful":"medication_desipramine == true && desipramine_response == \'successful\'","aripiprazole_successful":"medication_aripiprazole == true && aripiprazole_response == \'successful\'","risperidone_successful":"medication_risperidone == true && risperidone_response == \'successful\'","other_atypical_successful":"medication_other_atypical == true && other_atypical_response == \'successful\'","trifluoperazine_successful":"medication_trifluoperazine == true && trifluoperazine_response == \'successful\'","perphenazine_successful":"medication_perphenazine == true && perphenazine_response == \'successful\'","benztropine_successful":"medication_benztropine == true && benztropine_response == \'successful\'","lithium_successful":"medication_lithium == true && lithium_response == \'successful\'"},{},{"on_aa_1":"(medication_aripiprazole ? 1 : 0) + (medication_olanzapine? 1 : 0) + (medication_quetiapine? 1 : 0) + (medication_risperidone ? 1 : 0) + (medication_other_atypical ? 1 : 0) >= 1","on_aa_2":"(medication_aripiprazole ? 1 : 0) + (medication_olanzapine? 1 : 0) + (medication_quetiapine? 1 : 0) + (medication_risperidone ? 1 : 0) + (medication_other_atypical ? 1 : 0) >= 2","aa_failed_1":"(aripiprazole_inadequate ? 1 : 0) + (olanzapine_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (risperidone_inadequate ? 1 : 0) + (other_atypical_inadequate ? 1 : 0) >= 1","aa_failed_2":"(aripiprazole_inadequate ? 1 : 0) + (olanzapine_inadequate ? 1 : 0) + (quetiapine_inadequate ? 1 : 0) + (risperidone_inadequate ? 1 : 0) + (other_atypical_inadequate ? 1 : 0) >= 2","aa_partial_1":"(aripiprazole_partial ? 1 : 0) + (olanzapine_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (risperidone_partial ? 1 : 0) + (other_atypical_partial ? 1 : 0) >= 1","aa_partial_2":"(aripiprazole_partial ? 1 : 0) + (olanzapine_partial ? 1 : 0) + (quetiapine_partial ? 1 : 0) + (risperidone_partial ? 1 : 0) + (other_atypical_partial ? 1 : 0) >= 2","successful_aa":"(aripiprazole_current == \'current\' && aripiprazole_successful === true) || (olanzapine_current == \'current\' && olanzapine_successful === true) || (quetiapine_current == \'current\' && quetiapine_successful === true) || (risperidone_current == \'current\' && risperidone_successful === true) || (lithium_current == \'current\' && lithium_successful === true) || (other_atypical_current == \'current\' && other_atypical_successful === true) || (mirtazapine_current == \'current\' && mirtazapine_successful === true)","prior_successful_aa":"(aripiprazole_current == \'prior\' && aripiprazole_successful === true) || (olanzapine_current == \'prior\' && olanzapine_successful === true) || (quetiapine_current == \'prior\' && quetiapine_successful === true) || (risperidone_current == \'prior\' && risperidone_successful === true) || (lithium_current == \'prior\' && lithium_successful === true) || (other_atypical_current == \'prior\' && other_atypical_successful === true) || (mirtazapine_current == \'prior\' && mirtazapine_successful === true)","symptoms":"psychotic_or_other ? \'medicated\' : \'unmedicated\'"}],"sections":[{"valid":"true","title":"Psychosis Disorder Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":"Adequate pharmacotherapy trial: minimum 3 weeks at maximum clinically indicated and tolerable dose."},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Psychosis Disorder"}]},{"visible":"medication_history === \'Yes\'","type":"title","text":[{"visible":"true","text":"Atypical (SGA) Antipsychotics"}]},{"visible":"medication_history === \'Yes\'","id":"medication_aripiprazole","text":"Aripiprazole","type":"switch","groups":[{"visible":"medication_aripiprazole","id":"aripiprazole_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_aripiprazole && aripiprazole_current === \'current\' && !((patient_age != \'Pediatric\'))","id":"aripiprazole_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_aripiprazole && aripiprazole_current === \'prior\' || medication_aripiprazole && aripiprazole_current === \'current\' && (patient_age != \'Pediatric\')","id":"aripiprazole_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_olanzapine","text":"Olanzapine","type":"switch","groups":[{"visible":"medication_olanzapine","id":"olanzapine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_olanzapine && olanzapine_current === \'current\' && !((patient_age != \'Pediatric\'))","id":"olanzapine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_olanzapine && olanzapine_current === \'prior\' || medication_olanzapine && olanzapine_current === \'current\' && (patient_age != \'Pediatric\')","id":"olanzapine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_quetiapine","text":"Quetiapine","type":"switch","groups":[{"visible":"medication_quetiapine","id":"quetiapine_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_quetiapine && quetiapine_current === \'current\' && !((patient_age != \'Pediatric\'))","id":"quetiapine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_quetiapine && quetiapine_current === \'prior\' || medication_quetiapine && quetiapine_current === \'current\' && (patient_age != \'Pediatric\')","id":"quetiapine_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_risperidone","text":"Risperidone","type":"switch","groups":[{"visible":"medication_risperidone","id":"risperidone_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_risperidone && risperidone_current === \'current\' && !((patient_age != \'Pediatric\'))","id":"risperidone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_risperidone && risperidone_current === \'prior\' || medication_risperidone && risperidone_current === \'current\' && (patient_age != \'Pediatric\')","id":"risperidone_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\'","id":"medication_other_atypical","text":"Other Atypical Antipsychotics","type":"switch","groups":[{"visible":"medication_other_atypical","id":"other_atypical_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_other_atypical && other_atypical_current === \'current\' && !((patient_age != \'Pediatric\'))","id":"other_atypical_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_other_atypical && other_atypical_current === \'prior\' || medication_other_atypical && other_atypical_current === \'current\' && (patient_age != \'Pediatric\')","id":"other_atypical_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && patient_age != \'Pediatric\' &&  patient_age != \'Adolescent\'","type":"title","text":[{"visible":"true","text":"Mood Stabilizer"}]},{"visible":"medication_history === \'Yes\' && patient_age != \'Pediatric\' && patient_age != \'Adolescent\'","id":"medication_lithium","text":"Lithium","type":"switch","groups":[{"visible":"medication_lithium","id":"lithium_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_lithium && lithium_current === \'current\' && !((patient_age != \'Pediatric\'))","id":"lithium_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_lithium && lithium_current === \'prior\' || medication_lithium && lithium_current === \'current\' && (patient_age != \'Pediatric\')","id":"lithium_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Unsuccessful response","value":"unsuccessful"}]}]}]},{"valid":true,"title":"Psychosis Disorder","state":"intro","content":[{"id":"pediatric","visible":"patient_age == \'Pediatric\'","type":"overlay","choices":[{"text":""}],"text":"&#x2022; Rule out alternative etiology (e.g., substance abuse, medication effects, delirium)<br>&#x2022; Pediatric schizophrenia is rare; strongly consider other causes of psychosis and agitation (e.g., bipolar, ASD, substance abuse)<br>&#x2022; Assess for SI/HI, aggressive behavior, psychosis. If present, send to ER for hospitalization assessment. "},{"id":"adolescent","visible":"patient_age == \'Adolescent\'","type":"overlay","choices":[{"text":""}],"text":"&#x2022; Rule out alternative etiology (e.g., substance abuse, medication effects, delirium)<br>&#x2022; Pediatric/Adolescent schizophrenia is rare; strongly consider other causes of psychosis and agitation (e.g., bipolar, ASD, substance abuse)<br>&#x2022; Assess for SI/HI, aggressive behavior, psychosis. If present, send to ER for hospitalization assessment. "},{"id":"postpartum","visible":"partum === \'Postpartum\'","type":"overlay","choices":[{"text":""}],"text":"- Psychiatric emergency with risk for suicide and infanticide <br>- Most often seen in women who have or will be diagnosed with bipolar disorder, but can also occur with MDD with psychosis, schizophrenia, or schizoaffective disorder. <br>- 5% are isolated cases"},{"id":"psychotic","visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Actively psychotic?"},{"id":"other_symptoms","visible":"psychotic == \'No\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"If not actively psychotic, is patient experiencing intrusive symptoms or decreased function?"},{"id":"other_symptoms_postpartum","visible":"partum === \'Postpartum\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Does the patient have any of the following: <br>-Catatonia<br>-Severe agitation<br>-MDD with psychotic features<br>-Refusal to eat or drink?"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (successful_aa === true) && (patient_age === \'Pediatric\')","title":"","uid":"98","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_5"],"content":[{"visible":true,"uid":"98.0","type":"overlay","title":"Recommendation","text":"<b>Maintenance/ Relapse Prevention</b> Continue treatment that produced adequate response. <br><br> Monitor for metabolic side effects and tardive dyskinesia <br><br> Long Acting Injectable Form: use only in cases of extreme nonadherence\\n","meds":[],"therapies":[]},{"visible":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\')","uid":"98.1","type":"overlay","title":"Recommendation","text":"<b>Treatment length</b> <br> Minimum 6 months; consider psychiatry referral for dose reduction or discontinuation","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (successful_aa === false) && (prior_successful_aa === true) && (patient_age === \'Pediatric\')","title":"","uid":"99","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_5"],"content":[{"visible":true,"uid":"99.0","type":"overlay","title":"Recommendation","text":"<b>Maintenance/ Relapse Prevention</b> Use previous successful treatment that produced adequate response. <br><br> Monitor for metabolic side effects and tardive dyskinesia <br><br> Long Acting Injectable Form: use only in cases of extreme nonadherence\\n","meds":[],"therapies":[]},{"visible":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\')","uid":"99.1","type":"overlay","title":"Recommendation","text":"<b> Taper based on treatment length</b> <br> Gradual onset / Mild symptoms: Consider taper < 6 months with close observation <br><br> Faster onset / Severe symptoms: taper > 6 months (Consider consultation with Psychiatry if indefinite therapy considered)","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === false) && (psychotic === \'No\') && (other_symptoms === \'No\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"101","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_2"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"Consider frequent monitoring and follow up; <br>Consider psychiatry referral","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Pediatric\')","title":"","uid":"102","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_1"],"content":[{"visible":true,"uid":"102.0","type":"overlay","title":"Recommendation","text":"<discontinue>Psychiatry Referral (if available) <br><br>Start Aripiprazole ","meds":["Aripiprazole"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"110","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_1"],"content":[{"visible":true,"uid":"110.0","type":"overlay","title":"Recommendation","text":"<discontinue>Psychiatry Referral (if available) <br><br>Start Aripiprazole ","meds":["Aripiprazole"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"111","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_1"],"content":[{"visible":true,"uid":"111.0","type":"overlay","title":"Recommendation","text":"<discontinue>Psychiatry Referral (if available) <br><br>Start Aripiprazole ","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate_cur === true) && (risperidone_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"103","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_1"],"content":[{"visible":true,"uid":"103.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral (if available) <br><br>If no response to Aripiprazole at max dose for 2-4 weeks, cross taper to Risperidone","meds":["Risperidone"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"103","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_1"],"content":[{"visible":true,"uid":"103.0","type":"overlay","title":"Recommendation","text":"<discontinue>Psychiatry Referral (if available) <br><br>Start Risperidone","meds":["Risperidone"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === true) && (olanzapine_inadequate === false) && (quetiapine_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"104","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_3"],"content":[{"visible":true,"uid":"104.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation/ referral. <br><br> <b>Third Choice Options:</B> Quetiapine, Olanzapine, or other lower intensity antipsychotics may be reasonable in special circumstances.","meds":["Quetiapine","Olanzapine"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === true) && (olanzapine_inadequate === false) && (quetiapine_inadequate === true) && (patient_age === \'Pediatric\')","title":"","uid":"105","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_3"],"content":[{"visible":true,"uid":"105.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation/ referral. <br><br> <b>Third Choice Options:</B> Olanzapine or other lower intensity antipsychotics may be reasonable in special circumstances.","meds":["Olanzapine"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === true) && (olanzapine_inadequate === true) && (quetiapine_inadequate === false) && (patient_age === \'Pediatric\')","title":"","uid":"106","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_3"],"content":[{"visible":true,"uid":"106.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation/ referral. <br><br> <b>Third Choice Options:</B> Quetiapine or other lower intensity antipsychotics may be reasonable in special circumstances.","meds":["Quetiapine"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === true) && (olanzapine_inadequate === true) && (quetiapine_inadequate === true) && (patient_age === \'Pediatric\')","title":"","uid":"107","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-pediatric_3"],"content":[{"visible":true,"uid":"107.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation/ referral ","meds":[],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (successful_aa === true) && (patient_age === \'Adolescent\')","title":"","uid":"108","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_5"],"content":[{"visible":true,"uid":"108.0","type":"overlay","title":"Recommendation","text":"<b>Maintenance/ Relapse Prevention</b> Continue treatment that produced adequate response. <br><br> If concern for metabolic complications, consider cross taper to weight-neutral atypical antipsychotic once stable for 3-6 months<br><br>Consider long acting injectable form if:<br>&#x2022; established tolerability to oral agent<br>&#x2022; patient/parental prefernce<br>&#x2022; adherence concerns<br><br>Monitor for metabolic side effects and tardive dyskinesia","meds":[],"therapies":[]},{"visible":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\')","uid":"108.1","type":"overlay","title":"Recommendation","text":"<b>Treatment length</b><br>Minimum 12 months; strongly consider psychiatry consultation for dose reduction or discontinuation","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (successful_aa === false) && (prior_successful_aa === true) && (patient_age === \'Adolescent\')","title":"","uid":"110","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_5"],"content":[{"visible":true,"uid":"110.0","type":"overlay","title":"Recommendation","text":"<b>Maintenance/ Relapse Prevention</b> Use previous successful treatment that produced adequate response.<br><br> If concern for metabolic complications, consider cross taper to weight-neutral atypical antipsychotic once stable for 3-6 months<br><br>Consider long acting injectable form if:<br>&#x2022; established tolerability to oral agent<br>&#x2022; patient/parental prefernce<br>&#x2022; adherence concerns<br><br>Monitor for metabolic side effects and tardive dyskinesia","meds":[],"therapies":[]},{"visible":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\')","uid":"110.1","type":"overlay","title":"Recommendation","text":"<b>Treatment length</b><br>Minimum 12 months; strongly consider psychiatry consultation for dose reduction or discontinuation","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === false) && (psychotic === \'No\') && (other_symptoms === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"112","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_2"],"content":[{"visible":true,"uid":"112.0","type":"overlay","title":"Recommendation","text":"Consider frequent monitoring and follow up; <br>Consider psychiatry referral","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"113","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_1"],"content":[{"visible":true,"uid":"113.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral (if available) <br><br>Start Aripiprazole or Risperidone","meds":["Aripiprazole","Risperidone"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_2","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. BMI<br>2. Labs (CBC, fasting glucose or A1C, lipids, CMP, drug screen)<br>3. ECG (if personal history of syncope/arrhythmias or family history of early sudden death or long-QT syndrome)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === false) && (risperidone_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"114","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_1"],"content":[{"visible":true,"uid":"114.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral (if available) <br><br>Start Aripiprazole or Risperidone","meds":["Aripiprazole","Risperidone"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_2","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. BMI<br>2. Labs (CBC, fasting glucose or A1C, lipids, CMP, drug screen)<br>3. ECG (if personal history of syncope/arrhythmias or family history of early sudden death or long-QT syndrome)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === false) && (risperidone_inadequate_cur === true) && (patient_age === \'Adolescent\')","title":"","uid":"115","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_1"],"content":[{"visible":true,"uid":"115.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral (if available) <br><br>If no response to Risperidone at max dose for 2-4 weeks, cross taper to Aripiprazole","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === false) && (risperidone_inadequate === true) && (patient_age === \'Adolescent\')","title":"","uid":"116","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_1"],"content":[{"visible":true,"uid":"116.0","type":"overlay","title":"Recommendation","text":"<discontinue>Psychiatry Referral (if available) <br><br>Start Aripiprazole","meds":["Aripiprazole"],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate_cur === true) && (risperidone_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"117","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_1"],"content":[{"visible":true,"uid":"117.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral (if available) <br><br>If no response to Aripiprazole at max dose for 2-4 weeks, cross taper to Risperidone","meds":["Risperidone"],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"118","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_1"],"content":[{"visible":true,"uid":"118.0","type":"overlay","title":"Recommendation","text":"<discontinue>Psychiatry Referral (if available) <br><br>Start Risperidone","meds":["Risperidone"],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === true) && (olanzapine_inadequate === false) && (quetiapine_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"119","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_3"],"content":[{"visible":true,"uid":"119.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation/ referral. <br><br> <b>Third Choice Options:</B> Quetiapine, Olanzapine, or other lower intensity antipsychotics may be reasonable in special circumstances.","meds":["Quetiapine","Olanzapine"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_2","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. BMI<br>2. Labs (CBC, fasting glucose or A1C, lipids, CMP, drug screen)<br>3. ECG (if personal history of syncope/arrhythmias or family history of early sudden death or long-QT syndrome)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === true) && (olanzapine_inadequate === false) && (quetiapine_inadequate === true) && (patient_age === \'Adolescent\')","title":"","uid":"120","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_3"],"content":[{"visible":true,"uid":"120.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation/ referral. <br><br> <b>Third Choice Options:</B> Olanzapine or other lower intensity antipsychotics may be reasonable in special circumstances.","meds":["Olanzapine"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_2","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. BMI<br>2. Labs (CBC, fasting glucose or A1C, lipids, CMP, drug screen)<br>3. ECG (if personal history of syncope/arrhythmias or family history of early sudden death or long-QT syndrome)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === true) && (olanzapine_inadequate === true) && (quetiapine_inadequate === false) && (patient_age === \'Adolescent\')","title":"","uid":"121","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_3"],"content":[{"visible":true,"uid":"121.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation/ referral. <br><br> <b>Third Choice Options:</B> Quetiapine or other lower intensity antipsychotics may be reasonable in special circumstances.","meds":["Quetiapine"],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"},{"visible":"true","uid":"G_2","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. BMI<br>2. Labs (CBC, fasting glucose or A1C, lipids, CMP, drug screen)<br>3. ECG (if personal history of syncope/arrhythmias or family history of early sudden death or long-QT syndrome)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aripiprazole_inadequate === true) && (risperidone_inadequate === true) && (olanzapine_inadequate === true) && (quetiapine_inadequate === true) && (patient_age === \'Adolescent\')","title":"","uid":"122","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-adolescent_3"],"content":[{"visible":true,"uid":"122.0","type":"overlay","title":"Recommendation","text":"Psychiatry consultation/ referral ","meds":[],"therapies":[]},{"visible":"patient_age == \'Pediatric\' || patient_age == \'Adolescent\'","uid":"G_2","type":"overlay","text":"Avoid antidepressants","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === true) && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"202","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_1"],"content":[{"visible":true,"uid":"202.0","type":"overlay","title":"Recommendation","text":"<b>If symptoms include catatonia, severe agitation, MDD with psychotic features, or refusal to eat or drink:</b><br><b>Strongly recommend inpatient psychiatric evaluation (involuntary if necessary)</b> <br><br> Nearly all patients with postpartum psychosis should be treated inpatient","meds":["Lithium","Olanzapine","Aripiprazole","Quetiapine"],"therapies":[]},{"visible":true,"uid":"202.1","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === false) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (successful_aa === true) && (olanzapine_successful === true) && (patient_age === \'Adult\')","title":"","uid":"208","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_6"],"content":[{"visible":true,"uid":"208.0","type":"overlay","title":"Recommendation","text":"<b>No psychotic symptoms for minimum 8-12 weeks</b> <br><br>If taking olanzapine and no psychotic symptoms for minimum 8-12 weeks, may consider cautious cross taper to aripiprazole or quetiapine. <br><br>If aripiprazole or quetiapine unsuccessful, return to olanzapine.","meds":[],"therapies":[]},{"visible":true,"uid":"208.1","type":"overlay","title":"Recommendation","text":"Maintenance therapy: minimum 9 months <br><br>Underlying mood disorder likely; consider prolonged therapy","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (prior_successful_aa === true) && (olanzapine_successful === true) && (patient_age === \'Adult\')","title":"","uid":"209","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_6"],"content":[{"visible":true,"uid":"209.0","type":"overlay","title":"Recommendation","text":"<b>No psychotic symptoms for minimum 8-12 weeks</b> <br><br>If taking olanzapine and no psychotic symptoms for minimum 8-12 weeks, may consider cautious cross taper to aripiprazole or quetiapine. <br><br>If aripiprazole or quetiapine unsuccessful, return to olanzapine.","meds":[],"therapies":[]},{"visible":true,"uid":"209.1","type":"overlay","title":"Recommendation","text":"Maintenance therapy: minimum 9 months <br><br>Underlying mood disorder likely; consider prolonged therapy","meds":[],"therapies":[]},{"visible":true,"uid":"209.2","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === false) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (successful_aa === true) && (patient_age === \'Adult\')","title":"","uid":"208","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_5"],"content":[{"visible":true,"uid":"208.0","type":"overlay","title":"Recommendation","text":"Maintenance therapy: minimum 9 months <br><br>Underlying mood disorder likely; consider prolonged therapy","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (prior_successful_aa === true) && (patient_age === \'Adult\')","title":"","uid":"209","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_5"],"content":[{"visible":true,"uid":"209.0","type":"overlay","title":"Recommendation","text":"Maintenance therapy: minimum 9 months <br><br>Underlying mood disorder likely; consider prolonged therapy","meds":[],"therapies":[]},{"visible":true,"uid":"209.1","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === false) && (medication_history === \'No\') && (partum === \'Postpartum\') && (patient_age === \'Adult\')","title":"","uid":"203","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_1"],"content":[{"visible":true,"uid":"203.0","type":"overlay","title":"Recommendation","text":"<b>Strongly recommend inpatient psychiatric evaluation (involuntary if necessary)</b> <br><br> Nearly all patients with postpartum psychosis should be treated inpatient","meds":["Lithium","Olanzapine","Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"true","uid":"G_3","type":"overlay","text":"H&P, including detailed neuro exam; lab: CBC, CMP, TSH, free T4, TPO antibodies, ammonia, UDS, UA","meds":[],"priority":"false"},{"visible":true,"uid":"203.1","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]},{"visible":true,"uid":"203.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>Lithium or Olanzapine (Combination in severe disease) <br><br>Lithium potentially more efficacious; combination Lithium and Olanzapine beneficial in severe disease <br><br>Aripiprazole or Quetiapine are other reasonable antipsychotic options; however, Olanzapine is preferred","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === false) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (aripiprazole_inadequate === false) && (risperidone_inadequate === false) && (olanzapine_inadequate === false) && (quetiapine_inadequate === false) && (lithium_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"204","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_1"],"content":[{"visible":true,"uid":"204.0","type":"overlay","title":"Recommendation","text":"<b>Strongly recommend inpatient psychiatric evaluation (involuntary if necessary)</b> <br><br> Nearly all patients with postpartum psychosis should be treated inpatient","meds":["Lithium","Olanzapine","Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"true","uid":"G_3","type":"overlay","text":"H&P, including detailed neuro exam; lab: CBC, CMP, TSH, free T4, TPO antibodies, ammonia, UDS, UA","meds":[],"priority":"false"},{"visible":true,"uid":"204.1","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]},{"visible":true,"uid":"204.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>Lithium or Olanzapine (Combination in severe disease) <br><br>Lithium potentially more efficacious; combination Lithium and Olanzapine beneficial in severe disease <br><br>Aripiprazole or Quetiapine are other reasonable antipsychotic optionss; however, Olanzapine is preferred","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === false) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (aa_failed_1 === false) && (aa_failed_2 === false) && (lithium_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"205","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_3"],"content":[{"visible":true,"uid":"205.0","type":"overlay","title":"Recommendation","text":"<b>Strongly recommend inpatient psychiatric evaluation (involuntary if necessary)</b> <br><br> Nearly all patients with postpartum psychosis should be treated inpatient","meds":["Lithium","Olanzapine","Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"true","uid":"G_3","type":"overlay","text":"H&P, including detailed neuro exam; lab: CBC, CMP, TSH, free T4, TPO antibodies, ammonia, UDS, UA","meds":[],"priority":"false"},{"visible":true,"uid":"205.1","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]},{"visible":true,"uid":"205.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>Combination Lithium and atypical antipsychotic <br><br>Aripiprazole or Quetiapine are other reasonable antipsychotic options; however, Olanzapine is preferred","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === false) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (aa_failed_1 === true) && (aa_failed_2 === false) && (lithium_inadequate === false) && (patient_age === \'Adult\')","title":"","uid":"206","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_3"],"content":[{"visible":true,"uid":"206.0","type":"overlay","title":"Recommendation","text":"<b>Strongly recommend inpatient psychiatric evaluation (involuntary if necessary)</b> <br><br> Nearly all patients with postpartum psychosis should be treated inpatient<br><br>If patient declines inpatient evaluation and involuntary admission assessment unavailable, recommend combination pharmacotherapy with Lithium and Olanzapine","meds":["Lithium","Olanzapine","Aripiprazole","Quetiapine"],"therapies":[]},{"visible":"true","uid":"G_3","type":"overlay","text":"H&P, including detailed neuro exam; lab: CBC, CMP, TSH, free T4, TPO antibodies, ammonia, UDS, UA","meds":[],"priority":"false"},{"visible":true,"uid":"206.1","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]},{"visible":true,"uid":"206.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>Combination Lithium and atypical antipsychotic.","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === false) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (aa_failed_1 === true) && (aa_failed_2 === false) && (olanzapine_inadequate === false) && (lithium_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"207","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_3"],"content":[{"visible":true,"uid":"207.0","type":"overlay","title":"Recommendation","text":"<b>Strongly recommend inpatient psychiatric evaluation (involuntary if necessary)</b> <br><br> Nearly all patients with postpartum psychosis should be treated inpatient<br><br>If patient declines inpatient evaluation and involuntary admission assessment unavailable, recommend combination pharmacotherapy with Lithium and Olanzapine","meds":["Olanzapine"],"therapies":[]},{"visible":true,"uid":"207.1","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]},{"visible":true,"uid":"207.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br><br>Change atypical antipsychotic to Olanzapine.","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (postpartum_evaluation === false) && (medication_history === \'Yes\') && (partum === \'Postpartum\') && (aa_failed_1 === true) && (olanzapine_inadequate === true) && (lithium_inadequate === true) && (patient_age === \'Adult\')","title":"","uid":"207","state":"recommendation","branch":"Psychosis Disorder","figure":["Psychosis-postpartum_3"],"content":[{"visible":true,"uid":"207.0","type":"overlay","title":"Recommendation","text":"<b>Strongly recommend inpatient psychiatric evaluation (involuntary if necessary)</b> <br><br> Nearly all patients with postpartum psychosis should be treated inpatient<br><br>If patient declines inpatient evaluation and involuntary admission assessment unavailable, recommend combination pharmacotherapy with Lithium and Olanzapine","meds":["Lithium","Olanzapine","Aripiprazole","Quetiapine"],"therapies":[]},{"visible":true,"uid":"207.1","type":"overlay","title":"Recommendation","text":"<b>Establish safety for mom and infant</b> <br><br>Do not leave mom/infant unsupervised <br>Screen for infanticidal ideation<br>Screen for suicidal ideation","meds":[],"therapies":[]},{"visible":true,"uid":"207.2","type":"overlay","title":"Recommendation","text":"Recommend inpatient psychiatric evaluation","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"300","state":"recommendation","branch":"Psychosis Disorder","figure":[""],"content":[{"visible":true,"uid":"300.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},1569:function(e){"use strict";e.exports=JSON.parse('{"variables":{"medication_history":"No","medication_fluoxetine":false,"medication_paroxetine":false,"medication_sertraline":false,"medication_escitalopram":false,"medication_citalopram":false,"medication_other_ssri":false,"medication_desvenlafaxine":false,"medication_duloxetine":false,"medication_venlafaxine":false,"medication_trazodone":false,"medication_prazosin":false,"medication_mirtazapine":false,"medication_hydroxyzine":false,"medication_amitriptyline":false,"medication_imipramine":false,"medication_quetiapine":false,"medication_desipramine":false,"medication_aripiprazole":false,"medication_risperidone":false,"medication_other_atypical":false,"medication_lamotrigine":false,"medication_clonidine":false,"medication_guanfacine":false,"medication_propranolol":false,"fluoxetine_current":false,"paroxetine_current":false,"sertraline_current":false,"escitalopram_current":false,"citalopram_current":false,"other_ssri_current":false,"desvenlafaxine_current":false,"duloxetine_current":false,"venlafaxine_current":false,"trazodone_current":false,"prazosin_current":false,"mirtazapine_current":false,"hydroxyzine_current":false,"amitriptyline_current":false,"imipramine_current":false,"quetiapine_current":false,"desipramine_current":false,"aripiprazole_current":false,"risperidone_current":false,"other_atypical_current":false,"lamotrigine_current":false,"clonidine_current":false,"guanfacine_current":false,"propranolol_current":false,"fluoxetine_successful":false,"paroxetine_successful":false,"sertraline_successful":false,"escitalopram_successful":false,"other_ssri_successful":false,"desvenlafaxine_successful":false,"duloxetine_successful":false,"venlafaxine_successful":false,"trazodone_successful":false,"prazosin_successful":false,"mirtazapine_successful":false,"hydroxyzine_successful":false,"amitriptyline_successful":false,"imipramine_successful":false,"quetiapine_successful":false,"desipramine_successful":false,"aripiprazole_successful":false,"risperidone_successful":false,"other_atypical_successful":false,"lamotrigine_successful":false,"clonidine_successful":false,"guanfacine_successful":false,"propranolol_successful":false,"trazodone_unsuccessful":false,"prazosin_unsuccessful":false,"ssri_failed_1":false,"ssri_failed_2":false,"hall_ssri_venflaxine_failed":false,"hall_ssri_venflaxine_partial_avoid":false,"hall_ssri_venflaxine_partial_hyper":false,"hall_ssri_venflaxine_partial_xp":false,"hall_ssri_partial_avoid":false,"hall_ssri_partial_hyper":false,"hall_ssri_partial_xp":false,"hall_atypical_failed_1":false,"third_failed_1":false,"third_failed_2":false,"hall_third_failed_2":false,"sleep_failed":false,"sleep_failed_cardiac":false,"sleep_failed_hep_ob":false,"mirtazapine_unsuccessful":false,"ssri_venflaxine_failed":false,"ssri_venflaxine_partial_avoid":false,"ssri_venflaxine_partial_hyper":false,"ssri_venflaxine_partial_xp":false,"ssri_partial_avoid":false,"ssri_partial_hyper":false,"ssri_partial_xp":false,"tca_failed":false,"disturbance_Sleep_initiation_insomnia":false,"disturbance_Midsleep_wakening_or_nightmares":false,"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea":false,"medBranch":"","hallucinations":"","medCount":24,"fluoxetine_response":"","paroxetine_response":"","sertraline_response":"","escitalopram_response":"","citalopram_response":"","other_ssri_response":"","desvenlafaxine_response":"","duloxetine_response":"","venlafaxine_response":"","trazodone_response":"","prazosin_response":"","hydroxyzine_response":"","mirtazapine_response":"","amitriptyline_response":"","desipramine_response":"","imipramine_response":"","aripiprazole_response":"","quetiapine_response":"","risperidone_response":"","other_atypical_response":"","lamotrigine_response":"","clonidine_response":"","guanfacine_response":"","propranolol_response":""},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","fluoxetine_inadequate":"medication_fluoxetine == true && fluoxetine_response === \'unsuccessful\'","fluoxetine_partial_avoid":"medication_fluoxetine == true && fluoxetine_response === \'partial with avoidance symptoms\'","fluoxetine_partial_hyper":"medication_fluoxetine == true && fluoxetine_response === \'partial with hyperarousal symptoms\'","fluoxetine_partial_xp":"medication_fluoxetine == true && fluoxetine_response === \'partial with re-experiencing symptoms\'","paroxetine_inadequate":"medication_paroxetine == true && paroxetine_response === \'unsuccessful\'","paroxetine_partial_avoid":"medication_paroxetine == true && paroxetine_response === \'partial with avoidance symptoms\'","paroxetine_partial_hyper":"medication_paroxetine == true && paroxetine_response === \'partial with hyperarousal symptoms\'","paroxetine_partial_xp":"medication_paroxetine == true && paroxetine_response === \'partial with re-experiencing symptoms\'","sertraline_inadequate":"medication_sertraline == true && sertraline_response == \'unsuccessful\'","sertraline_partial_avoid":"medication_sertraline == true && sertraline_response == \'partial with avoidance symptoms\'","sertraline_partial_hyper":"medication_sertraline == true && sertraline_response == \'partial with hyperarousal symptoms\'","sertraline_partial_xp":"medication_sertraline == true && sertraline_response == \'partial with re-experiencing symptoms\'","escitalopram_inadequate":"medication_escitalopram == true && escitalopram_response == \'unsuccessful\'","escitalopram_partial_avoid":"medication_escitalopram == true && escitalopram_response == \'partial with avoidance symptoms\'","escitalopram_partial_hyper":"medication_escitalopram == true && escitalopram_response == \'partial with hyperarousal symptoms\'","escitalopram_partial_xp":"medication_escitalopram == true && escitalopram_response == \'partial with re-experiencing symptoms\'","citalopram_inadequate":"medication_citalopram == true && citalopram_response == \'unsuccessful\'","citalopram_partial_avoid":"medication_citalopram == true && citalopram_response == \'partial with avoidance symptoms\'","citalopram_partial_hyper":"medication_citalopram == true && citalopram_response == \'partial with hyperarousal symptoms\'","citalopram_partial_xp":"medication_citalopram == true && citalopram_response == \'partial with re-experiencing symptoms\'","other_ssri_inadequate":"medication_other_ssri == true && other_ssri_response == \'unsuccessful\'","other_ssri_partial_avoid":"medication_other_ssri == true && other_ssri_response == \'partial with avoidance symptoms\'","other_ssri_partial_hyper":"medication_other_ssri == true && other_ssri_response == \'partial with hyperarousal symptoms\'","other_ssri_partial_xp":"medication_other_ssri == true && other_ssri_response == \'partial with re-experiencing symptoms\'","desvenlafaxine_inadequate":"medication_desvenlafaxine == true && desvenlafaxine_response == \'unsuccessful\'","desvenlafaxine_partial":"medication_desvenlafaxine == true && desvenlafaxine_response == \'partial with avoidance symptoms\'","desvenlafaxine_partial_hyper":"medication_desvenlafaxine == true && desvenlafaxine_response == \'partial with hyperarousal symptoms\'","desvenlafaxine_partial_xp":"medication_desvenlafaxine == true && desvenlafaxine_response == \'partial with re-experiencing symptoms\'","duloxetine_inadequate":"medication_duloxetine == true && duloxetine_response == \'unsuccessful\'","duloxetine_partial_avoid":"medication_duloxetine == true && duloxetine_response == \'partial with avoidance symptoms\'","duloxetine_partial_hyper":"medication_duloxetine == true && duloxetine_response == \'partial with hyperarousal symptoms\'","duloxetine_partial_xp":"medication_duloxetine == true && duloxetine_response == \'partial with re-experiencing symptoms\'","venlafaxine_inadequate":"medication_venlafaxine == true && venlafaxine_response == \'unsuccessful\'","venlafaxine_partial_avoid":"medication_venlafaxine == true && venlafaxine_response == \'partial with avoidance symptoms\'","venlafaxine_partial_hyper":"medication_venlafaxine == true && venlafaxine_response == \'partial with hyperarousal symptoms\'","venlafaxine_partial_xp":"medication_venlafaxine == true && venlafaxine_response == \'partial with re-experiencing symptoms\'","trazodone_inadequate":"medication_trazodone == true && trazodone_response == \'unsuccessful\'","trazodone_partial_avoid":"medication_trazodone == true && trazodone_response == \'partial with avoidance symptoms\'","trazodone_partial_hyper":"medication_trazodone == true && trazodone_response == \'partial with hyperarousal symptoms\'","trazodone_partial_xp":"medication_trazodone == true && trazodone_response == \'partial with re-experiencing symptoms\'","prazosin_inadequate":"medication_prazosin == true && prazosin_response == \'unsuccessful\'","prazosin_partial_avoid":"medication_prazosin == true && prazosin_response == \'partial with avoidance symptoms\'","prazosin_partial_hyper":"medication_prazosin == true && prazosin_response == \'partial with hyperarousal symptoms\'","prazosin_partial_xp":"medication_prazosin == true && prazosin_response == \'partial with re-experiencing symptoms\'","hydroxyzine_inadequate":"medication_hydroxyzine == true && hydroxyzine_response == \'unsuccessful\'","hydroxyzine_partial_avoid":"medication_hydroxyzine == true && hydroxyzine_response == \'partial with avoidance symptoms\'","hydroxyzine_partial_hyper":"medication_hydroxyzine == true && 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== \'partial with hyperarousal symptoms\'","amitriptyline_partial_xp":"medication_amitriptyline == true && amitriptyline_response == \'partial with re-experiencing symptoms\'","imipramine_inadequate":"medication_imipramine == true && imipramine_response == \'unsuccessful\'","imipramine_partial_avoid":"medication_imipramine == true && imipramine_response == \'partial with avoidance symptoms\'","imipramine_partial_hyper":"medication_imipramine == true && imipramine_response == \'partial with hyperarousal symptoms\'","imipramine_partial_xp":"medication_imipramine == true && imipramine_response == \'partial with re-experiencing symptoms\'","desipramine_inadequate":"medication_desipramine == true && desipramine_response == \'unsuccessful\'","desipramine_partial_avoid":"medication_desipramine == true && desipramine_response == \'partial with avoidance symptoms\'","desipramine_partial_hyper":"medication_desipramine == true && desipramine_response == \'partial with hyperarousal 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Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Paroxetine","Venlafaxine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"hallucinations == \'Yes\'","uid":"G_71","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"13.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Geriatric\')","title":"","uid":"14","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-geriatric_p1"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<discontinue>Try an alternative SSRI or SNRI not previously trialed <br><br>Start an SSRI/SNRI<br><br>1. Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Paroxetine","Venlafaxine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"hallucinations == \'Yes\'","uid":"G_71","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"14.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"15","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-geriatric_p3"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"<b>Third choice options:</b> <br><discontinue>Try an alternative SSRI not previously trialed or Mirtazapine","meds":["Escitalopram","Citalopram","Fluoxetine","Paroxetine","Mirtazapine","Imipramine","Amitriptyline","Desipramine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_1200","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"hallucinations == \'Yes\'","uid":"G_71","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"15.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === true) && (third_failed_2 === false) && (patient_age === \'Geriatric\')","title":"","uid":"16","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-geriatric_p3"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"16.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (paroxetine_inadequate === true) && (third_failed_2 === false) && (patient_age === \'Geriatric\')","title":"","uid":"17","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-geriatric_p3"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"17.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (third_failed_2 === true) && (patient_age === \'Geriatric\')","title":"","uid":"18","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-geriatric_p3"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"Psychiatric Consultation if available","meds":[],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"hallucinations == \'Yes\'","uid":"G_71","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":true,"uid":"18.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_partial_avoid === true) && (patient_age === \'Geriatric\')","title":"","uid":"19","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-geriatric_p2"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole.<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Aripiprazole","Lamotrigine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"19.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_partial_hyper === true) && (patient_age === \'Geriatric\')","title":"","uid":"20","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-geriatric_p2"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Clonidine XR, Guanfacine ER, or Propranolol. Alternatively consider Quetiapine<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Clonidine XR","Guanfacine ER","Propranolol","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"20.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_partial_xp === true) && (patient_age === \'Geriatric\')","title":"","uid":"21","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-geriatric_p2"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole, Risperidone, or Quetiapine<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Lamotrigine","Aripiprazole","Risperidone","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_19","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone or Mirtazapine","meds":["Trazodone","Mirtazapine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_20","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazapine","meds":["Mirtazapine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_70","type":"overlay","text":"<caution><b>Geriatric Black Box Warning</b><br><br>Atypical antipsychotics carry a black box warning for patients with neuropsychiatric dementia","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"21.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"22","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p1"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"Start an SSRI/SNRI<br><br>1. Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Paroxetine","Venlafaxine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"22.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_failed === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"23","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p1"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"Start an SSRI/SNRI<br><br>1. Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Paroxetine","Venlafaxine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"23.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"24","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p1"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"<discontinue>Try an alternative SSRI not previously trialed <br><br>Start an SSRI/SNRI<br><br>1. Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Paroxetine","Venlafaxine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"24.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === false) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"25","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p3"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"<b>Third choice options:</b> <br><discontinue>Try an alternative SSRI not previously trialed, Mirtazapine, or TCA","meds":["Escitalopram","Citalopram","Fluoxetine","Paroxetine","Mirtazapine","Imipramine","Amitriptyline","Desipramine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_1200","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"25.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (paroxetine_inadequate === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p3"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"26.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (tca_failed === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p3"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"27.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p3"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"28.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (third_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p3"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"Psychiatric Consultation if available","meds":[],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"29.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_partial_avoid === true) && (patient_age === \'Adult\')","title":"","uid":"30","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p2"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole.<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Aripiprazole","Lamotrigine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"30.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_partial_hyper === true) && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p2"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Clonidine XR, Guanfacine ER, or Propranolol. Alternatively consider Quetiapine<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Clonidine XR","Guanfacine ER","Propranolol","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"31.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_venflaxine_partial_xp === true) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-hepatic_p2"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole, Risperidone, or Quetiapine<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Lamotrigine","Aripiprazole","Risperidone","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == false && sleep_disturbance == \'Yes\'","uid":"G_21","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_failed_hep_ob  == true && sleep_disturbance == \'Yes\'","uid":"G_22","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"32.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p1"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"<b>First choice:</b> <br>Start Sertraline or Venlafaxine<br><br><b>Second choice:</b><br>Start Paroxetine","meds":["Sertraline","Paroxetine","Venlafaxine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"33.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_failed === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p1"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"<b>First choice:</b> <br>Start Sertraline or Venlafaxine<br><br><b>Second choice:</b><br>Start Paroxetine","meds":["Sertraline","Paroxetine","Venlafaxine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"34.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p1"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"<discontinue>Try an alternative SSRI or SNRI not previously trialed <br><br><b>First choice:</b> <br>Start Sertraline or Venlafaxine<br><br><b>Second choice:</b><br>Start Paroxetine","meds":["Sertraline","Paroxetine","Venlafaxine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_11","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"35.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === false) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p3"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"<b>Third choice options:</b> <br><discontinue>Try an alternative SSRI not previously trialed, Mirtazapine, or TCA","meds":["Escitalopram","Citalopram","Fluoxetine","Paroxetine","Mirtazapine","Imipramine","Amitriptyline","Desipramine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Fluoxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"36.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (paroxetine_inadequate === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p3","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<discontinue><b>First choice (due to lower metabolic risk):</b><br>Aripiprazole<br><br><b>Second choice (due to higher metabolic risk):</b><br> Start Quetiapine or Risperidone","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"37.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (tca_failed === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p3","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"<discontinue><b>First choice (due to lower metabolic risk):</b><br>Aripiprazole<br><br><b>Second choice (due to higher metabolic risk):</b><br> Start Quetiapine or Risperidone","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"38.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"39","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p3","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"<discontinue><b>First choice (due to lower metabolic risk):</b><br>Aripiprazole<br><br><b>Second choice (due to higher metabolic risk):</b><br> Start Quetiapine or Risperidone","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"39.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (third_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"40","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p3","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"Psychiatric Consultation if available","meds":[],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_28","type":"overlay","text":"<b>Obesity</b><br><br>Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"priority":"false"},{"visible":true,"uid":"40.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_partial_avoid === true) && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p2","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole.<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Aripiprazole","Lamotrigine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_28","type":"overlay","text":"<b>Obesity</b><br><br>Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"priority":"false"},{"visible":true,"uid":"41.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_partial_hyper === true) && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p2","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Clonidine XR, Guanfacine ER, or Propranolol. Alternatively consider Quetiapine<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Clonidine XR","Guanfacine ER","Propranolol","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_28","type":"overlay","text":"<b>Obesity</b><br><br>Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"42.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (ssri_venflaxine_partial_xp === true) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-obesity_p2","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole, Risperidone, or Quetiapine<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Lamotrigine","Aripiprazole","Risperidone","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_12","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic. First choice due to lower metabolic risk is Aripiprazole. Second choices are Quetiapine or Risperidone","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_23","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, or Hydroxyzine","meds":["Trazodone","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_24","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA or Hydroxyzine","meds":["Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_28","type":"overlay","text":"<b>Obesity</b><br><br>Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"43.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"44","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p1"],"content":[{"visible":true,"uid":"44.0","type":"overlay","title":"Recommendation","text":"Start an SSRI/SNRI<br><br>1. Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Venlafaxine","Paroxetine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"44.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_failed === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p1"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"Start an SSRI/SNRI<br><br>1. Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Venlafaxine","Paroxetine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"45.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p1"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"<discontinue>Try an alternative SSRI or SNRI not previously trialed<br><br>1. Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Venlafaxine","Paroxetine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"46.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === false) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p3"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"<b>Third choice options:</b> <br><discontinue>Try an alternative SSRI not previously trialed, Mirtazapine, or TCA","meds":["Escitalopram","Citalopram","Fluoxetine","Paroxetine","Mirtazapine","Imipramine","Amitriptyline","Desipramine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_1200","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"47.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (paroxetine_inadequate === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"48","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p3"],"content":[{"visible":true,"uid":"48.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"48.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (tca_failed === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"49","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p3"],"content":[{"visible":true,"uid":"49.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"49.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"50","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p3"],"content":[{"visible":true,"uid":"50.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"50.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (third_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p3"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"Psychiatric Consultation if available","meds":[],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"51.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_partial_avoid === true) && (patient_age === \'Adult\')","title":"","uid":"52","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p2"],"content":[{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole.<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Aripiprazole","Lamotrigine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"52.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_partial_hyper === true) && (patient_age === \'Adult\')","title":"","uid":"53","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p2"],"content":[{"visible":true,"uid":"53.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Clonidine XR, Guanfacine ER, or Propranolol. Alternatively consider Quetiapine<br><br>Mixed evidence for antipsychotic\\naugmentation","meds":["Clonidine XR","Guanfacine ER","Propranolol","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"53.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (ssri_venflaxine_partial_xp === true) && (patient_age === \'Adult\')","title":"","uid":"54","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD-renal_p2"],"content":[{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole, Risperidone, or Quetiapine<br><br>Mixed evidence for antipsychotic\\r\\naugmentation","meds":["Lamotrigine","Aripiprazole","Risperidone","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_16","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, Mirtazpine, or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_17","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start Mirtazpine or Hydroxyzine. TCA\u2019s may be reasonable after careful review","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_27","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":"true","uid":"G_7","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":true,"uid":"54.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'No\') && (partum === \'None\') && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"55","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p1"],"content":[{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"Start an SSRI/SNRI (SOR A) <br><br>1. Sertraline or Venlafaxine<br><br>2. Paroxetine","meds":["Sertraline","Venlafaxine","Paroxetine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"55.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (ssri_venflaxine_failed === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"56","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p1"],"content":[{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"Start an SSRI/SNRI (SOR A) <br><br>1. Sertraline or Venlafaxine<br><br>2. Paroxetine","meds":["Sertraline","Venlafaxine","Paroxetine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"56.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p1"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"<discontinue>Try an alternative SSRI or SNRI not previously trialed<br><br>1. Sertraline or Venlafaxine<br>2. Paroxetine","meds":["Sertraline","Venlafaxine","Paroxetine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_8","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"57.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === false) && (tca_failed === false) && (patient_age === \'Adult\')","title":"","uid":"58","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p3"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"<b>Third choice options:</b> <br><discontinue>Try an alternative SSRI not previously trialed, Mirtazapine, or TCA (SOR B)","meds":["Escitalopram","Citalopram","Fluoxetine","Paroxetine","Mirtazapine","Imipramine","Amitriptyline","Desipramine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_1200","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"58.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (paroxetine_inadequate === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p3"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic (SOR B)","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"59.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (tca_failed === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p3"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic (SOR B)","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"60.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_failed_3 === false) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (mirtazapine_unsuccessful === true) && (third_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"61","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p3"],"content":[{"visible":true,"uid":"61.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start an Atypical Antipsychotic (SOR B)","meds":["Aripiprazole","Quetiapine","Risperidone"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"61.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_failed === true) && (ssri_venflaxine_failed_2 === true) && (ssri_venflaxine_partial_avoid === false) && (ssri_venflaxine_partial_hyper === false) && (ssri_venflaxine_partial_xp === false) && (third_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"62","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p3"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"Psychiatric Consultation if available","meds":[],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"62.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_partial_avoid === true) && (patient_age === \'Adult\')","title":"","uid":"63","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p2"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole. <br><br>Mixed evidence for antipsychotic\\r\\naugmentation (SOR B)","meds":["Aripiprazole","Lamotrigine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"63.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_partial_hyper === true) && (patient_age === \'Adult\')","title":"","uid":"64","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p2"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Clonidine XR, Guanfacine ER, or Propranolol. Alternatively consider Quetiapine<br><br>Mixed evidence for antipsychotic\\r\\naugmentation (SOR B)","meds":["Clonidine XR","Guanfacine ER","Propranolol","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"64.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":"(partum === \'None\') && (ssri_venflaxine_partial_xp === true) && (patient_age === \'Adult\')","title":"","uid":"65","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p2"],"content":[{"visible":true,"uid":"65.0","type":"overlay","title":"Recommendation","text":"Augment current medication with Lamotrigine. Alternatively consider Aripiprazole, Risperidone, or Quetiapine<br><br>Mixed evidence for antipsychotic\\r\\naugmentation (SOR B)","meds":["Lamotrigine","Aripiprazole","Risperidone","Quetiapine"],"therapies":["Recommended","Consider"]},{"visible":"hallucinations == \'Yes\'","uid":"G_9","type":"overlay","text":"<b>Hallucinations:</b><br>Start SSRI and an Atypical Antipsychotic.","meds":["Fluoxetine","Paroxetine","Sertraline","Aripiprazole","Quetiapine","Risperidone"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && sleep_disturbance == \'Yes\'","uid":"G_14","type":"overlay","text":"<b>Sleep initiation insomnia first choice:</b><br>Start Trazodone, a TCA, Mirtazapine, or Hydroxyzine","meds":["Trazodone","Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Sleep_initiation_insomnia == true && trazodone_unsuccessful == true && sleep_disturbance == \'Yes\'","uid":"G_15","type":"overlay","text":"<b>Sleep initiation insomnia second choice:</b><br>Discontinue Trazodone and start a TCA, Mirtazapine, or Hydroxyzine","meds":["Mirtazapine","Hydroxyzine"],"priority":"false"},{"visible":"disturbance_Midsleep_wakening_or_nightmares == true && sleep_disturbance == \'Yes\'","uid":"G_25","type":"overlay","text":"<b>Midsleep wakening or nightmares:</b><br>Start Prazosin","meds":["Prazosin"],"priority":"false"},{"visible":"disturbance_Positive_screen_for_Obstructive_Sleep_Apnea == true && sleep_disturbance == \'Yes\'","uid":"G_26","type":"overlay","text":"<b>Positive screen for Obstructive Sleep Apnea:</b><br>Polysomnography","meds":[],"priority":"false"},{"visible":true,"uid":"65.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"66","state":"recommendation","branch":"Posttraumatic Stress Disorder","figure":["PTSD_p1"],"content":[{"visible":true,"uid":"66.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]},{"visible":true,"uid":"66.1","type":"overlay","title":"Recommendation","text":"Recommend trauma focused psychotherapy (SOR A)<br><br>Alternatively consider Brief Written Exposure in primary care settings","meds":[],"therapies":[]}]}]}')},4601:function(e){"use strict";e.exports=JSON.parse('{"variables":{"on_ssri_snri_1":false,"on_ssri_snri_2":false,"ssri_partial_1":false,"augment_unsuccessful":false,"ssri_inadequate_partum_1":false,"ssri_inadequate_partum_2":false,"ssri_inadequate_1":false,"ssri_inadequate_2":false,"snri_inadequate_1":false,"snri_inadequate_2":false,"ssri_partial_partum_1":false,"first_gad_inadequate":false,"first_gad_partial":false,"second_gad_unsuccessful_1":false,"second_gad_unsuccessful_2 ":false,"ssri_inadequate_ad_3":false,"anticonvulsant_unsuccessful_1":false,"quet_mirtaz_1":false,"quet_mirtaz_2":false,"mirtazapine_unsuccessful":false,"medBranch":null,"medication_history":"No","medication_escitalopram":false,"medication_fluoxetine":false,"medication_sertraline":false,"medication_citalopram":false,"medication_clonazepam":false,"medication_duloxetine":false,"medication_venlafaxine":false,"medication_buspirone":false,"medication_mirtazapine":false,"medication_propranolol":false,"medication_pregabalin":false,"medication_gabapentin":false,"medication_imipramine":false,"medication_lorazepam":false,"medication_other_ssri":false,"medication_other_snri":false,"medication_desvenlafaxine":false,"other_ssri_inadequate":false,"other_ssri_partial":false,"other_snri_inadequate":false,"other_snri_partial":false,"escitalopram_current":false,"fluoxetine_current":false,"sertraline_current":false,"citalopram_current":false,"clonazepam_current":false,"buspirone_current":false,"duloxetine_current":false,"desvenlafaxine_current":false,"venlafaxine_current":false,"mirtazapine_current":false,"propranolol_current":false,"pregabalin_current":false,"gabapentin_current":false,"imipramine_current":false,"lorazepam_current":false,"other_atypical_current":false,"other_ssri_current":false,"escitalopram_successful":false,"fluoxetine_successful":false,"sertraline_successful":false,"citalopram_successful":false,"clonazepam_successful":false,"buspirone_successful":false,"duloxetine_successful":false,"desvenlafaxine_successful":false,"venlafaxine_successful":false,"mirtazapine_successful":false,"propranolol_successful":false,"pregabalin_successful":false,"gabapentin_successful":false,"imipramine_successful":false,"lorazepam_successful":false,"other_atypical_successful":false,"other_ssri_successful":false,"successful_ssri_snri":false,"prior_successful_ssri_snri":false,"severity":"","is_performance":"","medCount":14},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'","escitalopram_inadequate":"medication_escitalopram == true && escitalopram_response === \'unsuccessful\'","escitalopram_partial":"medication_escitalopram == true && escitalopram_response === \'partial\'","fluoxetine_inadequate":"medication_fluoxetine == true && fluoxetine_response === \'unsuccessful\'","fluoxetine_partial":"medication_fluoxetine == true && fluoxetine_response === \'partial\'","sertraline_inadequate":"medication_sertraline == true && sertraline_response == \'unsuccessful\'","sertraline_partial":"medication_sertraline == true && sertraline_response == \'partial\'","citalopram_inadequate":"medication_citalopram == true && citalopram_response == \'unsuccessful\'","citalopram_partial":"medication_citalopram == true && citalopram_response == \'partial\'","clonazepam_inadequate":"medication_clonazepam == true && clonazepam_response == \'unsuccessful\'","clonazepam_partial":"medication_clonazepam == true && clonazepam_response == \'partial\'","other_ssri_inadequate":"medication_other_ssri == true && other_ssri_response == \'unsuccessful\'","other_ssri_partial":"medication_other_ssri == true && other_ssri_response == \'partial\'","duloxetine_inadequate":"medication_duloxetine == true && duloxetine_response == \'unsuccessful\'","duloxetine_partial":"medication_duloxetine == true && duloxetine_response == \'partial\'","desvenlafaxine_inadequate":"medication_desvenlafaxine == true && desvenlafaxine_response == \'unsuccessful\'","desvenlafaxine_partial":"medication_desvenlafaxine == true && desvenlafaxine_response == \'partial\'","venlafaxine_inadequate":"medication_venlafaxine == true && venlafaxine_response == \'unsuccessful\'","venlafaxine_partial":"medication_venlafaxine == true && venlafaxine_response == \'partial\'","other_snri_inadequate":"medication_other_snri == true && other_snri_response == \'unsuccessful\'","other_snri_partial":"medication_other_snri == true && other_snri_response == \'partial\'","buspirone_inadequate":"medication_buspirone == true && buspirone_response == \'unsuccessful\'","buspirone_partial":"medication_buspirone == true && buspirone_response == \'partial\'","mirtazapine_inadequate":"medication_mirtazapine == true && mirtazapine_response == \'unsuccessful\'","mirtazapine_partial":"medication_mirtazapine == true && mirtazapine_response == \'partial\'","propranolol_inadequate":"medication_propranolol == true && propranolol_response == \'unsuccessful\'","propranolol_partial":"medication_propranolol == true && propranolol_response == \'partial\'","pregabalin_inadequate":"medication_pregabalin == true && pregabalin_response == \'unsuccessful\'","pregabalin_partial":"medication_pregabalin == true && pregabalin_response == \'partial\'","gabapentin_inadequate":"medication_gabapentin == true && gabapentin_response == \'unsuccessful\'","gabapentin_partial":"medication_gabapentin == true && gabapentin_response == \'partial\'","imipramine_inadequate":"medication_imipramine == true && imipramine_response == \'unsuccessful\'","imipramine_partial":"medication_imipramine == true && imipramine_response == \'partial\'","lorazepam_inadequate":"medication_lorazepam == true && lorazepam_response == \'unsuccessful\'","lorazepam_partial":"medication_lorazepam == true && lorazepam_response == \'partial\'","escitalopram_successful":"medication_escitalopram == true && escitalopram_response === \'successful\'","fluoxetine_successful":"medication_fluoxetine == true && fluoxetine_response === 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response","value":"unsuccessful"}]}]},{"visible":"medication_history === \'Yes\' && !(patient_age == \'Adolescent\' && is_performance == \'Yes\') && severity != \'Mild\'","id":"medication_other_ssri","text":"Other SSRI","type":"switch","groups":[{"visible":"medication_other_ssri","id":"other_ssri_current","type":"choice","choices":[{"text":"Current medication","value":"current"},{"text":"Prior medication","value":"prior"}]},{"visible":"true && medication_other_ssri && other_ssri_current === \'current\' && !((patient_age == \'Adolescent\'))","id":"other_ssri_response","type":"choice","choices":[{"text":"Successful response","value":"successful"},{"text":"Partial response","value":"partial"},{"text":"Unsuccessful response","value":"unsuccessful"}]},{"visible":"true && medication_other_ssri && other_ssri_current === \'prior\' || medication_other_ssri && other_ssri_current === \'current\' && (patient_age == 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&& (comorbidities === \'cardiac\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Geriatric\')","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'hepatic\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'obesity\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (comorbidities === \'renal\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum 6-12 months; Consider taper after symptom free for 1 year ","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true) && (patient_age === \'Adolescent\')","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum 6-12 months; Consider taper after symptom free for 1 year ","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (prior_successful_ssri_snri === true)","title":"","uid":"0","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g5"],"content":[{"visible":true,"uid":"0.0","type":"overlay","title":"Recommendation","text":"Restart prior successful medication. Maintain effective pharmacotherapy for minimum of 12 months; if asymptomatic for 4-6 months, consider slow taper.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g4"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"In rare cases, consider adding a benzodiazepine as needed, such as Clonazepam or Lorazepam, ideally &lt;4 weeks.","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start SSRI (first choice) or SNRI (second choice)<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (first_sad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g2"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g2"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g1"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone or SSRI (first choice) or SNRI (second choice)<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g1"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>1. Start an SSRI <br>2. Start an SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g1"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>1. Start Buspirone or SSRI<br>2. Start an SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'cardiac\') && (patient_age === \'Adult\')","uid":"5.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g1"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_sad_inadequate === true) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g1"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different first choice medication <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g3"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"9","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g3"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"10","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g3"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(partum === \'None\') && (comorbidities === \'cardiac\')","uid":"10.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_sad_partial === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"11","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g2"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"12","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g2"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with First choice:SSRI or Second choice:SNRI ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_sad_partial === true) && (mirtazapine_unsuccessful === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"13","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g3"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g3"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g3"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(partum === \'None\') && (comorbidities === \'cardiac\')","uid":"15.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"14","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g3"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'cardiac\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"15","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-cardiac_g3"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"(partum === \'None\') && (comorbidities === \'cardiac\')","uid":"15.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (propranolol_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"16","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g4"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start as needed Beta Blocker such as Propranolol","meds":["Propranolol"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (propranolol_unsuccessful === true) && (patient_age === \'Geriatric\')","title":"","uid":"17","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g1"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"Consider adjunctive as needed Benzodiazepine like Lorazepam, ideally &lt;4 weeks","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (first_sad_partial === true) && (patient_age === \'Geriatric\')","title":"","uid":"27","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g2"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Geriatric\')","title":"","uid":"28","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g2"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"18","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g1"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Geriatric\')","title":"","uid":"19","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g1"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Geriatric\')","uid":"19.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"20","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"21","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g1"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Geriatric\')","uid":"21.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"22","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g1"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_sad_inadequate === true) && (first_sad_partial === false) && (patient_age === \'Geriatric\')","title":"","uid":"23","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g1"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different first choice medication <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Geriatric\')","title":"","uid":"24","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g3"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Geriatric\')","title":"","uid":"25","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g3"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Geriatric\')","title":"","uid":"26","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g3"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"26.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_sad_partial === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Geriatric\')","title":"","uid":"27","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g2"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Geriatric\')","title":"","uid":"28","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g2"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_sad_partial === true) && (mirtazapine_unsuccessful === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Geriatric\')","title":"","uid":"29","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g3"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Geriatric\')","title":"","uid":"30","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g3"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Geriatric\')","title":"","uid":"31","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g3"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"31.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Geriatric\')","title":"","uid":"30","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g3"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Geriatric\')","title":"","uid":"31","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-geriatric_g3"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation <br><discontinue>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"31.1","type":"overlay","title":"Recommendation","text":"Note: Consider psychiatry referral prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (propranolol_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g4"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start as needed Beta Blocker such as Propranolol","meds":["Propranolol"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (propranolol_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g1"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"Consider adjunctive as needed Benzodiazepine like Lorazepam, ideally &lt;4 weeks","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g2"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"44","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g2"],"content":[{"visible":true,"uid":"44.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g1"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g1"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone or SSRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\') && (patient_age === \'Adult\')","uid":"35.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === false) && (ssri_inadequate_2 === false) && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g1"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === false) && (ssri_inadequate_2 === false) && (medication_buspirone === false) && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g1"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone or SSRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (patient_age === \'Adult\')","uid":"37.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === false) && (ssri_inadequate_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g1"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (ssri_inadequate_1 === true) && (ssri_inadequate_2 === false) && (patient_age === \'Adult\')","title":"","uid":"39","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g1"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different first choice medication <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_2 === true) && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"40","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g3"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_2 === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g3"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_inadequate_2 === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g3"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"42.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g2"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"44","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g2"],"content":[{"visible":true,"uid":"44.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (mirtazapine_unsuccessful === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g3"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"Continue SSRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"45.1","type":"overlay","title":"Recommendation","text":"Note: Combination SSRI/SNRI and TCA therapy requires careful patient selection, education,  shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g3"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g3"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"47.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g3"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'hepatic\') && (ssri_partial_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-hepatic_g3"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\') && (comorbidities === \'hepatic\')","uid":"47.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (propranolol_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"48","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g4"],"content":[{"visible":true,"uid":"48.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start as needed Beta Blocker such as Propranolol","meds":["Propranolol"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (propranolol_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"49","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g1"],"content":[{"visible":true,"uid":"49.0","type":"overlay","title":"Recommendation","text":"Consider adjunctive as needed Benzodiazepine like  Clonazepam or Lorazepam, ideally &lt;4 weeks","meds":["Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (first_sad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g2"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Pregabalin/Gabapentin<br>&#x2800;&#x2800;b. Second Choice: Mirtazapine or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Pregabalin/Gabapentin<br>&#x2800;&#x2800;b. Second Choice: Mirtazapine or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Clonazepam","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g2"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Pregabalin/Gabapentin<br>&#x2800;&#x2800;b. Second Choice: Mirtazapine or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Pregabalin/Gabapentin<br>&#x2800;&#x2800;b. Second Choice: Mirtazapine or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Clonazepam","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"50","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g1"],"content":[{"visible":true,"uid":"50.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","title":"","uid":"51","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g1"],"content":[{"visible":true,"uid":"51.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"51.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"52","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g1"],"content":[{"visible":true,"uid":"52.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"53","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g1"],"content":[{"visible":true,"uid":"53.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\') && (patient_age === \'Adult\')","uid":"53.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"54","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g1"],"content":[{"visible":true,"uid":"54.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_sad_inadequate === true) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"55","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g1"],"content":[{"visible":true,"uid":"55.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different first choice medication <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"56","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g3"],"content":[{"visible":true,"uid":"56.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === false) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"57","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g3"],"content":[{"visible":true,"uid":"57.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"58","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g3"],"content":[{"visible":true,"uid":"58.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Clonazepam","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"58.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_sad_partial === true) && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"59","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g2"],"content":[{"visible":true,"uid":"59.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === false) && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"60","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g2"],"content":[{"visible":true,"uid":"60.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_sad_partial === true) && (anticonvulsant_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"61","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g3"],"content":[{"visible":true,"uid":"61.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_1","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks).","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"61.1","type":"overlay","title":"Recommendation","text":"Note: Combination SSRI/SNRI and TCA therapy requires careful patient selection, education,  shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"62","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g3"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"63","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g3"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Clonazepam","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"63.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"62","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g3"],"content":[{"visible":true,"uid":"62.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'obesity\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (anticonvulsant_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"63","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-obesity_g3"],"content":[{"visible":true,"uid":"63.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Clonazepam","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'obesity\')","uid":"63.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (propranolol_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"64","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g4"],"content":[{"visible":true,"uid":"64.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start as needed Beta Blocker such as Propranolol","meds":["Propranolol"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (propranolol_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"65","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g1"],"content":[{"visible":true,"uid":"65.0","type":"overlay","title":"Recommendation","text":"Consider adjunctive as needed Benzodiazepine like Lorazepam, ideally &lt;4 weeks","meds":["Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (first_sad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"75","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g2"],"content":[{"visible":true,"uid":"75.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"76","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g2"],"content":[{"visible":true,"uid":"76.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"66","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g1"],"content":[{"visible":true,"uid":"66.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"67","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g1"],"content":[{"visible":true,"uid":"67.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"67.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"68","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g1"],"content":[{"visible":true,"uid":"68.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"69","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g1"],"content":[{"visible":true,"uid":"69.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone, SSRI, or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","uid":"69.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"70","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g1"],"content":[{"visible":true,"uid":"70.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_sad_inadequate === true) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"71","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g1"],"content":[{"visible":true,"uid":"71.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different first choice medication <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"72","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"72.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"73","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"73.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"74","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"74.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\')","uid":"74.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === false) && (first_sad_partial === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"75","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g2"],"content":[{"visible":true,"uid":"75.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"76","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g2"],"content":[{"visible":true,"uid":"76.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_sad_partial === true) && (mirtazapine_unsuccessful === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"77","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"77.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Mirtazapine","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\')","uid":"77.1","type":"overlay","title":"Recommendation","text":"Note: Combination SSRI/SNRI and TCA therapy requires careful patient selection, education,  shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"78","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"78.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"79","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"79.0","type":"overlay","title":"Recommendation","text":"Trial a different medication","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"80","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"80.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"78","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"78.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"79","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"79.0","type":"overlay","title":"Recommendation","text":"Trial a different medication","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_2","type":"overlay","text":"In some rare/severe cases consider adding lorazepam (ideally less than 4 weeks)","meds":["Lorazepam"],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(partum === \'None\') && (comorbidities === \'renal\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"80","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-renal_g3"],"content":[{"visible":true,"uid":"80.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as lorazepam","meds":["Lorazepam","Imipramine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"},{"visible":"(partum === \'None\') && (comorbidities === \'renal\')","uid":"80.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to Lorazepam","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (propranolol_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"81","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g4"],"content":[{"visible":true,"uid":"81.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start as needed Beta Blocker such as Propranolol","meds":["Propranolol"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (first_sad_partial === true) && (patient_age === \'Adult\')","title":"","uid":"92","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g2"],"content":[{"visible":true,"uid":"92.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (medication_buspirone === true) && (buspirone_response === \'partial\') && (patient_age === \'Adult\')","title":"","uid":"93","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g2"],"content":[{"visible":true,"uid":"93.0","type":"overlay","title":"Recommendation","text":"<b>If SSRI/SNRI is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue SSRI/SNRI and augment with Buspirone. If unsuccessful/partial then<br><br>&#x2800;2. Discontinue both SSRI/SNRI and Buspirone and trial different SSRI/SNRI. If continued partial response then<br><br>&#x2800;3. Continue SSRI/SNRI and consider further augmentation therapy options:<br><br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)<br><br><b>If Buspirone is primary pharmacotherapy, consider the following steps:</b><br><br>&#x2800;1. Continue Buspirone and augment with SSRI/SNRI. If unsuccessful/partial then<br><br>&#x2800;2. Continue Buspirone, discontinue current SSRI/SNRI, and trial different SSRI/SNRI. If continued partial response then<br>&#x2800;<br>3. Continue Buspirone, discontinue new SSRI/SNRI, and consider further augmentation therapy options:<br>&#x2800;&#x2800;a. First Choice: Mirtazapine<br>&#x2800;&#x2800;b. Second Choice: Pregabalin/Gabapentin or Quetiapine<br>&#x2800;&#x2800;c. Third Choice: TCA (avoid if taking SSRI/SNRI)","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine","Buspirone","Mirtazapine","Gabapentin","Pregabalin","Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (propranolol_unsuccessful === true) && (patient_age === \'Adult\')","title":"","uid":"82","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g1"],"content":[{"visible":true,"uid":"82.0","type":"overlay","title":"Recommendation","text":"Consider adjunctive as needed Benzodiazepine like  Clonazepam or Lorazepam, ideally &lt;4 weeks","meds":["Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"83","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g1"],"content":[{"visible":true,"uid":"83.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"84","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g1"],"content":[{"visible":true,"uid":"84.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone (SOR C), SSRI or SNRI (SOR A)<br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"84.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_comorbid === \'Yes\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"85","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g1"],"content":[{"visible":true,"uid":"85.0","type":"overlay","title":"Recommendation","text":"<b>First choice option (SOR A)</b> <br>Start an SSRI or SNRI <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(is_comorbid === \'No\') && (medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === false) && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"86","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g1"],"content":[{"visible":true,"uid":"86.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start Buspirone (SOR C), SSRI or SNRI (SOR A) <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\') && (patient_age === \'Adult\')","uid":"86.1","type":"overlay","title":"Recommendation","text":"Note: Buspirone offers more benign SE profile and is less effective with history of benzodiazepine use","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === false) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_inadequate === false) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"87","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g1"],"content":[{"visible":true,"uid":"87.0","type":"overlay","title":"Recommendation","text":"Switch to SSRI or SNRI (SOR A)  <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (medication_buspirone === false) && (first_sad_partial === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"92","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g2"],"content":[{"visible":true,"uid":"92.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and augment with Buspirone","meds":["Buspirone"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"93","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g2"],"content":[{"visible":true,"uid":"93.0","type":"overlay","title":"Recommendation","text":"Continue Buspirone and augment with SSRI/SNRI ","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g2"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"<b>For SSRI/SNRI primary therapy:</b><br>Discontinue both SSRI/SNRI and Buspirone<br><br>Trial a different SSRI/SNRI<br><br><b>For Buspirone primary therapy:</b><br>Discontinue SSRI/SNRI augmentation therapy.<br><br>Continue Buspirone and trial a different SSRI/SNRI","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_2 === false) && (medication_buspirone === true) && (first_sad_partial === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"94","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g2"],"content":[{"visible":true,"uid":"94.0","type":"overlay","title":"Recommendation","text":"<b>For SSRI/SNRI primary therapy:</b><br>Discontinue both SSRI/SNRI and Buspirone<br><br>Trial a different SSRI/SNRI<br><br><b>For Buspirone primary therapy:</b><br>Discontinue SSRI/SNRI augmentation therapy.<br><br>Continue Buspirone and trial a different SSRI/SNRI","meds":["Buspirone","Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"95","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g2"],"content":[{"visible":true,"uid":"95.0","type":"overlay","title":"Recommendation","text":"Discontinue ineffective augmentation therapy.<br><br>Prior to trialing other augmentation options ensure minimum of two SSRI/SNRI trials<br><br>Further augmentation therapy options:<br>First Choice: Mirtazapine<br>Second Choice: Pregabalin/Gabapentin<br>Third Choice: TCA (aboid if taking SSRI/SNRI)","meds":["Mirtazapine","Gabapentin","Pregabalin","Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_2 === true) && (medication_buspirone === true) && (first_sad_partial === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"96","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g2"],"content":[{"visible":true,"uid":"96.0","type":"overlay","title":"Recommendation","text":"Discontinue ineffective augmentation therapy.<br><br>Prior to trialing other augmentation options ensure minimum of two SSRI/SNRI trials<br><br>Further augmentation therapy options:<br>First Choice: Mirtazapine<br>Second Choice: Pregabalin/Gabapentin<br>Third Choice: TCA (aboid if taking SSRI/SNRI)","meds":["Mirtazapine","Gabapentin","Pregabalin","Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_1 === true) && (on_ssri_snri_2 === false) && (first_sad_inadequate === true) && (first_sad_partial === false) && (patient_age === \'Adult\')","title":"","uid":"88","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g1"],"content":[{"visible":true,"uid":"88.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Trial a different first choice medication <br> <br>Follow up and titrate dose as appropriate every 1-2 weeks for active medication management","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Duloxetine","Venlafaxine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === false) && (patient_age === \'Adult\')","title":"","uid":"89","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g3"],"content":[{"visible":true,"uid":"89.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start Mirtazapine (SOR B)","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"90","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g3"],"content":[{"visible":true,"uid":"90.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin (SOR A)","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'None\') && (on_ssri_snri_2 === true) && (first_sad_inadequate === true) && (first_sad_partial === false) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"91","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g3"],"content":[{"visible":true,"uid":"91.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"91.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (first_sad_partial === true) && (mirtazapine_unsuccessful === false) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"97","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g3"],"content":[{"visible":true,"uid":"97.0","type":"overlay","title":"Recommendation","text":"Continue SSRI/SNRI and Buspirone <br> <br>Start Mirtazapine (SOR B)","meds":["Mirtazapine"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"},{"visible":"(partum === \'None\')","uid":"97.1","type":"overlay","title":"Recommendation","text":"Note: Combination SSRI/SNRI and TCA therapy requires careful patient selection, education,  shared decision making, and monitoring","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"98","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g3"],"content":[{"visible":true,"uid":"98.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin (SOR A)","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'partial\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"99","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g3"],"content":[{"visible":true,"uid":"99.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === false) && (patient_age === \'Adult\')","title":"","uid":"100","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g3"],"content":[{"visible":true,"uid":"100.0","type":"overlay","title":"Recommendation","text":"<discontinue>Start either Pregabalin or Gabapentin (SOR A)","meds":["Gabapentin","Pregabalin"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"true","uid":"G_6","type":"overlay","text":"In some rare/severe cases consider adding a benzodiazepine such as clonazepam or lorazepam (ideally less than 4 weeks). (SOR A)","meds":["Clonazepam","Lorazepam"],"priority":"false"}]},{"valid":"(partum === \'None\') && (on_ssri_snri_1 === true) && (medication_buspirone === true) && (buspirone_response === \'unsuccessful\') && (first_sad_partial === true) && (mirtazapine_unsuccessful === true) && (second_sad_unsuccessful_1 === true) && (patient_age === \'Adult\')","title":"","uid":"101","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD_g3"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"<discontinue>Trial TCA (Imipramine most studied TCA).<br>OR<br>Consider a benzodiazepine such as clonazepam or lorazepam","meds":["Imipramine","Clonazepam","Lorazepam"],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]},{"visible":"(partum === \'None\')","uid":"101.1","type":"overlay","title":"Recommendation","text":"Note: Consider TCA prior to chronic benzodiazepines","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]},{"valid":"(is_performance === \'Yes\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"97","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g1"],"content":[{"visible":true,"uid":"97.0","type":"overlay","title":"Recommendation","text":"Use propranolol as needed prior to performance/activity","meds":["Propranolol"],"therapies":[]}]},{"valid":"(severity === \'Mild\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"173","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g1"],"content":[{"visible":true,"uid":"173.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Cognitive Behavioral Therapy (CBT) (if available in community)","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(severity === \'Severe\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"99","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g1"],"content":[{"visible":true,"uid":"99.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start combination Cognitive Behavioral Therapy with pharmacotherapy","meds":["Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(severity === \'Severe\') && (medication_history === \'Yes\') && (partum === \'None\') && (ssri_inadequate_1 === false) && (patient_age === \'Adolescent\')","title":"","uid":"100","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g1"],"content":[{"visible":true,"uid":"100.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Start combination Cognitive Behavioral Therapy with pharmacotherapy","meds":["Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(severity === \'Moderate\') && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adolescent\')","title":"","uid":"101","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g1"],"content":[{"visible":true,"uid":"101.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Cognitive Behavioral Therapy (CBT) alone or combination therapy (CBT + pharmacotherapy)","meds":["Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(severity === \'Moderate\') && (medication_history === \'Yes\') && (partum === \'None\') && (ssri_inadequate_1 === false) && (patient_age === \'Adolescent\')","title":"","uid":"102","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g1"],"content":[{"visible":true,"uid":"102.0","type":"overlay","title":"Recommendation","text":"<b>First choice option:</b> <br>Cognitive Behavioral Therapy (CBT) alone or combination therapy (CBT + pharmacotherapy)","meds":["Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ssri_inadequate_1 === true) && (ssri_inadequate_2 === false) && (patient_age === \'Adolescent\')","title":"","uid":"103","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g2"],"content":[{"visible":true,"uid":"103.0","type":"overlay","title":"Recommendation","text":"<b>Second choice option:</b> <br>Trial a different SSRI","meds":["Escitalopram","Fluoxetine","Sertraline"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ssri_inadequate_1 === true) && (ssri_inadequate_2 === true) && (ssri_inadequate_ad_3 === false) && (patient_age === \'Adolescent\')","title":"","uid":"104","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g2"],"content":[{"visible":true,"uid":"104.0","type":"overlay","title":"Recommendation","text":"<b>Third choice option:</b> <br>Trial Venlafaxine or Duloxetine","meds":["Venlafaxine","Duloxetine"],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":"(partum === \'None\') && (ssri_inadequate_1 === true) && (ssri_inadequate_2 === true) && (ssri_inadequate_ad_3 === true) && (patient_age === \'Adolescent\')","title":"","uid":"105","state":"recommendation","branch":"Social Anxiety Disorder","figure":["SAD-adolescent_g2"],"content":[{"visible":true,"uid":"105.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy"]}]},{"valid":true,"title":"","uid":"106","state":"recommendation","branch":"Social Anxiety Disorder","figure":[""],"content":[{"visible":true,"uid":"106.0","type":"overlay","title":"Recommendation","text":"Consider psychiatry consultation","meds":[],"therapies":["Cognitive Behavioral Therapy","Acceptance and Commitment Therapy"]}]}]}')},6556:function(e){"use 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(Higher metabolic risk) <br> Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. 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Either additional atypical antipsychotic or typical antipsychotic: Trifluoperazine or Perphenazine.<br><br>For insomnia: see insomnia decision support","meds":["Mirtazapine","Aripiprazole","Olanzapine","Quetiapine","Risperidone","Trifluoperazine","Perphenazine"],"therapies":[]},{"visible":"true","uid":"G_7","type":"overlay","text":"<b>Obesity</b><br><br>Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (aa_failed_1 === true) && (aa_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"23","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-obesity_s3","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"Cross taper to another antipsychotic and titrate to max dose. <br><br><b>First Choice:</b><br>Aripiprazole (lower metabolic risk; non sedating)<br><br><b>Second Choice:</b><br>Start Quetiapine, Risperidone, or Olanzapine. (Higher metabolic risk) <br><br> Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"},{"visible":"true","uid":"G_7","type":"overlay","text":"<b>Obesity</b><br><br>Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"priority":"false"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'obesity\') && (aa_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"24","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-obesity_s3","Antipsychotic-Metabolic_b1"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral","meds":[],"therapies":[]},{"visible":"true","uid":"G_7","type":"overlay","text":"<b>Obesity</b><br><br>Refer to Antipsychotic Side Effect Management Decision Support for recommendations on mitigating metabolic effects of atypical antipsychotics","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === false) && (psychotic === \'No\') && (other_symptoms === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"25","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-renal_s1"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"Consider frequent monitoring and follow up","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'No\') && (partum === \'None\') && (comorbidities === \'renal\') && (patient_age === \'Adult\')","title":"","uid":"26","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-renal_s1"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Antipsychotics</b><br>Start Aripiprazole, Olanzapine, Quetiapine, or Risperidone<br><br> Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (aa_failed_1 === false) && (aa_partial_1 === false) && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-renal_s1"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<b>First Choice Antipsychotics</b><br>Start Aripiprazole, Olanzapine, Quetiapine, or Risperidone<br><br> Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (aa_failed_1 === false) && (aa_failed_2 === false) && (aa_partial_1 === true) && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-renal_s2"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<b>Adjunctive treatment</b><br><br>For decreased appetite: start Mirtazapine. <br><br>For agitation or ongoing psychosis: Cautious introduction of additional antipsychotic. Either additional atypical antipsychotic or typical antipsychotic: Trifluoperazine or Perphenazine.<br><br>For insomnia: see insomnia decision support","meds":["Mirtazapine","Aripiprazole","Olanzapine","Quetiapine","Risperidone","Trifluoperazine","Perphenazine"],"therapies":[]},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (aa_failed_1 === true) && (aa_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-renal_s3"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"Cross taper to another antipsychotic such as Aripiprazole, Olanzapine, Quetiapine, or Risperidone, and titrate to max dose. <br><br> Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"},{"visible":"true","uid":"G_5","type":"overlay","text":"<caution>Please see medication details for guidance","meds":[],"priority":"false"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (comorbidities === \'renal\') && (aa_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"30","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-renal_s3"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'No\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-antepartum_s1"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"<b>First Choice:</b><br>Start Aripiprazole, Lurasidone, or Quetiapine<br><br><b>Second Choice:</b><br>Start Olanzapine or Risperidone. Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (aa_failed_1 === false) && (aa_partial_1 === false) && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-antepartum_s1"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"<b>First Choice:</b><br>Start Aripiprazole, Lurasidone, or Quetiapine<br><br><b>Second Choice:</b><br>Start Olanzapine or Risperidone. Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (aa_failed_1 === false) && (aa_failed_2 === false) && (aa_partial_1 === true) && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-antepartum_s2"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"<b>Adjunctive treatment</b><br><br>For agitation: Consider medium acting benzodiazepine such as Clonazepam or Lorazepam. <br><br>For insomnia:See insomnia decision support. Consider Doxylamine or Diphenhydramine","meds":["Clonazepam","Lorazepam","Doxylamine","Diphenhydramine"],"therapies":[]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (aa_failed_1 === true) && (aa_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-antepartum_s3"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"Cross taper to another antipsychotic and titrate to max dose.<br><br><b>First Choice:</b><br>Start Aripiprazole, Lurasidone, or Quetiapine<br><br><b>Second Choice:</b><br>Start Olanzapine or Risperidone. <br><br> Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Antepartum\') && (aa_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-antepartum_s3"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral","meds":[],"therapies":[]}]},{"valid":"(medication_history === \'No\') && (partum === \'Preconception\') && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-preconception_s1"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"<b>First Choice:</b><br>Start Aripiprazole, Lurasidone, or Quetiapine<br><br><b>Second Choice:</b><br>Start Olanzapine or Risperidone. Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Risperidone"],"therapies":["Preconception counseling"]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (aa_failed_1 === false) && (aa_partial_1 === false) && (patient_age === \'Adult\')","title":"","uid":"39","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-preconception_s1"],"content":[{"visible":true,"uid":"39.0","type":"overlay","title":"Recommendation","text":"<b>First Choice:</b><br>Start Aripiprazole, Lurasidone, or Quetiapine<br><br><b>Second Choice:</b><br>Start Olanzapine or Risperidone. Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Risperidone"],"therapies":["Preconception counseling"]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (aa_failed_1 === false) && (aa_failed_2 === false) && (aa_partial_1 === true) && (patient_age === \'Adult\')","title":"","uid":"40","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-preconception_s2"],"content":[{"visible":true,"uid":"40.0","type":"overlay","title":"Recommendation","text":"<b>Adjunctive treatment</b><br><br>For agitation: Consider medium acting benzodiazepine such as Clonazepam or Lorazepam. <br><br>For insomnia:See insomnia decision support. Consider Doxylamine or Diphenhydramine.","meds":["Clonazepam","Lorazepam","Doxylamine","Diphenhydramine"],"therapies":["Preconception counseling"]}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (aa_failed_1 === true) && (aa_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"41","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-preconception_s3"],"content":[{"visible":true,"uid":"41.0","type":"overlay","title":"Recommendation","text":"Cross taper to another antipsychotic and titrate to max dose. <br><br><b>First Choice:</b><br>Start Aripiprazole, Lurasidone, or Quetiapine<br><br><b>Second Choice:</b><br>Start Olanzapine or Risperidone.<br><br> Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Lurasidone","Quetiapine","Olanzapine","Risperidone"],"therapies":["Preconception counseling"]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(medication_history === \'Yes\') && (partum === \'Preconception\') && (aa_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"42","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia-preconception_s3"],"content":[{"visible":true,"uid":"42.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral","meds":[],"therapies":["Preconception counseling"]}]},{"valid":"(psychotic_or_other === false) && (psychotic === \'No\') && (other_symptoms === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"43","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia_s1"],"content":[{"visible":true,"uid":"43.0","type":"overlay","title":"Recommendation","text":"Consider frequent monitoring and follow up","meds":[],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'No\') && (partum === \'None\') && (patient_age === \'Adult\')","title":"","uid":"44","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia_s1"],"content":[{"visible":true,"uid":"44.0","type":"overlay","title":"Recommendation","text":"<b>Antipsychotic Treatment (SOR A)</b><br>Start Aripiprazole, Olanzapine, Quetiapine, or Risperidone<br> <br>Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aa_failed_1 === false) && (aa_partial_1 === false) && (patient_age === \'Adult\')","title":"","uid":"45","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia_s1"],"content":[{"visible":true,"uid":"45.0","type":"overlay","title":"Recommendation","text":"<b>Antipsychotic Treatment (SOR A)</b><br>Start Aripiprazole, Olanzapine, Quetiapine, or Risperidone<br> <br>Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aa_failed_1 === false) && (aa_failed_2 === false) && (aa_partial_1 === true) && (patient_age === \'Adult\')","title":"","uid":"46","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia_s2"],"content":[{"visible":true,"uid":"46.0","type":"overlay","title":"Recommendation","text":"<b>Adjunctive treatment (SOR C)</b><br><br>For decreased appetite: start Mirtazapine. <br><br>For agitation or ongoing psychosis: Cautious introduction of additional antipsychotic. Either additional atypical antipsychotic or typical antipsychotic: Trifluoperazine or Perphenazine. <br><br>For insomnia: see insomnia decision support","meds":["Mirtazapine","Aripiprazole","Olanzapine","Quetiapine","Risperidone","Trifluoperazine","Perphenazine"],"therapies":[]}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aa_failed_1 === true) && (aa_failed_2 === false) && (patient_age === \'Adult\')","title":"","uid":"47","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia_s3"],"content":[{"visible":true,"uid":"47.0","type":"overlay","title":"Recommendation","text":"Cross taper to another antipsychotic such as Aripiprazole, Olanzapine, Quetiapine, or Risperidone, and titrate to max dose. <br><br> Other antipsychotics may be reasonable in special circumstances.","meds":["Aripiprazole","Olanzapine","Quetiapine","Risperidone"],"therapies":[]},{"visible":"true","uid":"G_1","title":"Pretreatment assessment","type":"collapse","text":"Pretreatment assessment: <br>1. ECG <br>2. BMI <br>3. Labs (CBC, fasting glucose, lipids, CMP)"}]},{"valid":"(psychotic_or_other === true) && (medication_history === \'Yes\') && (partum === \'None\') && (aa_failed_2 === true) && (patient_age === \'Adult\')","title":"","uid":"48","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia_s3"],"content":[{"visible":true,"uid":"48.0","type":"overlay","title":"Recommendation","text":"Psychiatry Referral","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"49","state":"recommendation","branch":"Schizophrenia Disorder","figure":["Schizophrenia_s1"],"content":[{"visible":true,"uid":"49.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},5348:function(e){"use strict";e.exports=JSON.parse('{"variables":{"phase":"","is_comorbid":"","medication_history":"","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'"}],"sections":[{"valid":"true","title":"Somatic Symptom Disorder Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Somatic Symptom Disorder"}]}]},{"valid":true,"title":"Somatic Symptom Disorder","state":"intro","content":[{"id":"is_comorbid","visible":"true","type":"radio","choices":"Yes, No","text":"Is a comorbid disorder present?","groups":[{"id":"is_comorbid","type":"choice","choices":[{"text":"Yes","value":"Yes"},{"text":"No","value":"No"}]}]}]},{"valid":"(is_comorbid === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"Somatic Symptom Disorder","figure":["ssd_b1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Medical and Psychiatric Evaluation:</b><br>Perform history and physical with family corroboration and prior records if available<br><br><b>Explain Somatic Symptom Disorder (SSD Diagnosis)</b><br>- Acknowledge patient\'s suffering<br>- Emphasize that somatic symptoms are valid<br>- SSD is common, with scientific support, yet etiology is unclear<br>- Avoid debate over cause of symptoms","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Amitriptyline","Desipramine","Nortriptyline"],"therapies":["Relaxation training","Mindfulness based therapy","Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"1.1","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.2","type":"overlay","title":"Initial Treatment","text":"<b>Non-pharmacologic Interventions</b><br>- Goal: Maximize occupational and social functioning<br>- Regularly scheduled office visits (every 4-8 weeks) regardless of patient symptoms<br>- Manage physical symptoms conservatively<br>- Reassure the patient will receive appropriate evaluation<br><br><b>Pharmacologic Interventions</b><br>Consider deprescribing unnecessary or ineffective medications","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.3","type":"overlay","title":"Recommendation","text":"<b>Subsequent Treatment if Inadequate response to Initial Treatment)</b><br>Combination Psychotherapy and Pharmacotherapy<br><br><b>Psychotherapy:</b><br>- Relaxation training<br>- Mindfulness based therapy or CBT if available<br><br><b>Pharmacotherapy:</b><br>- SSRI or TCA at low doses (if not already prescribed for other indication)<br>- SSRIs: Consider Sertraline or Citalopram (Other SSRIs may be reasonable alternatives)<br>- TCAs: Consider Nortriptyline or Desipramine (activating) (Other TCAs may be reasonable alternatives)<br><br><b>If continued Inadequate response to above:</b><br>- Consider psychiatry referral<br>- Titrate medication towards max effective and tolerable dose<br>- Consider second trial of SSRI or TCA if first trial unresponsive at max effective and tolerable dose for 6-8 weeks","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'No\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"Somatic Symptom Disorder","figure":["ssd_b1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Medical and Psychiatric Evaluation:</b><br>Perform history and physical with family corroboration and prior records if available<br><br><b>Explain Somatic Symptom Disorder (SSD Diagnosis)</b><br>- Acknowledge patient\'s suffering<br>- Emphasize that somatic symptoms are valid<br>- SSD is common, with scientific support, yet etiology is unclear<br>- Avoid debate over cause of symptoms","meds":["Citalopram","Escitalopram","Fluoxetine","Sertraline","Amitriptyline","Desipramine","Nortriptyline"],"therapies":["Relaxation training","Mindfulness based therapy","Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"2.1","type":"overlay","title":"Initial Treatment","text":"<b>Non-pharmacologic Interventions</b><br>- Goal: Maximize occupational and social functioning<br>- Regularly scheduled office visits (every 4-8 weeks) regardless of patient symptoms<br>- Manage physical symptoms conservatively<br>- Reassure the patient will receive appropriate evaluation<br><br><b>Pharmacologic Interventions</b><br>Consider deprescribing unnecessary or ineffective medications","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.2","type":"overlay","title":"Recommendation","text":"<b>Subsequent Treatment if Inadequate response to Initial Treatment)</b><br>Combination Psychotherapy and Pharmacotherapy<br><br><b>Psychotherapy:</b><br>- Relaxation training<br>- Mindfulness based therapy or CBT if available<br><br><b>Pharmacotherapy:</b><br>- SSRI or TCA at low doses (if not already prescribed for other indication)<br>- SSRIs: Consider Sertraline or Citalopram (Other SSRIs may be reasonable alternatives)<br>- TCAs: Consider Nortriptyline or Desipramine (activating) (Other TCAs may be reasonable alternatives)<br><br><b>If continued Inadequate response to above:</b><br>- Consider psychiatry referral<br>- Titrate medication towards max effective and tolerable dose<br>- Consider second trial of SSRI or TCA if first trial unresponsive at max effective and tolerable dose for 6-8 weeks","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Somatic Symptom Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},1396:function(e){"use strict";e.exports=JSON.parse('{"variables":{"is_comorbid":"","is_special":"","psychic":"","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'"}],"sections":[{"valid":"true","title":"SSRI Sex Dysfunction Medications","state":"medication","content":[{"visible":false,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat SSRI Sex Dysfunction"}]}]},{"valid":true,"title":"SSRI Sex Dysfunction","state":"intro","content":[{"id":"dysfunction","visible":"true","type":"radio","choices":"Female- Low Libido, Female- Orgasmic Disorder, Male- Erectile Dysfunction","text":"Sexual dysfunction","groups":[{"id":"dysfunction","type":"choice","choices":[{"text":"Female- Low Libido","value":"Female- Low Libido"},{"text":"Female- Orgasmic Disorder","value":"Female- Orgasmic Disorder"},{"text":"Male- Erectile Dysfunction","value":"Male- Erectile Dysfunction"}]}]},{"id":"severity","visible":"dysfunction != \'\'","type":"radio","choices":"Mild/Moderate, Severe","text":"Severity of sexual dysfunction","groups":[{"id":"severity","type":"choice","choices":[{"text":"Mild/Moderate","value":"Mild/Moderate"},{"text":"Severe","value":"Severe"}]}]},{"id":"effective","visible":"severity != \'\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Is current SSRI effective in the treatment of intended disorder?"}]},{"valid":"(severity === \'Severe\') && (effective === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"1","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":["ssri_s1"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Nonpharmacologic Treatments:</b><br>Psychotherapy<br>Behavioral Modification<br><br><b>Pharmacotherapy</b><br>Switch to other non SSRI/SNRI medication per corresponding decision support (i.e Bupropion, Mirtazapine)<br><br>Some SSRI\'s (Escitalopram/Citalopram),Serotonin Modulators (Vortioxetine, Vilazodone) or SNRI\'s may have lower incidence of  sexual side effects","meds":["Bupropion","Mirtazapine","Escitalopram","Citalopram","Vortioxetine","Vilazodone"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.1","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"1.2","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(severity === \'Severe\') && (effective === \'No\') && (patient_age === \'Adult\')","title":"","uid":"2","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":["ssri_s1"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"<b>Nonpharmacologic Treatments:</b><br>Psychotherapy<br>Behavioral Modification<br><br><b>Pharmacotherapy</b><br>Switch to other non SSRI/SNRI medication per corresponding decision support (i.e Bupropion, Mirtazapine)<br><br>Some SSRI\'s (Escitalopram/Citalopram),Serotonin Modulators (Vortioxetine, Vilazodone) or SNRI\'s may have lower incidence of  sexual side effects","meds":["Bupropion","Mirtazapine","Escitalopram","Citalopram","Vortioxetine","Vilazodone"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.1","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"2.2","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(dysfunction === \'Female- Low Libido\') && (severity === \'Mild/Moderate\') && (effective === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"3","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":["ssri_s2"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Individual Tailored Intervention:</b><br>Watchful Waiting x 2-3 months<br>Psychotherapy<br>Behavioral Modification<br><br><b>Pharmacotherapy</b><br>If inadequate response, consider decreasing/maintaining SSRI dose to lowest effective dose<br><br>If after dose decrease symptoms continue, consider dysfunction targeted pharmacotherapy","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"<b>Targeted pharmacotherapy for Female- Low Libido: </b><br>Add bupropion XL, titrate as appropriate to 300mg/day","meds":["Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"3.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(dysfunction === \'Female- Low Libido\') && (severity === \'Mild/Moderate\') && (effective === \'No\') && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":["ssri_s1"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Nonpharmacologic Treatments:</b><br>Psychotherapy<br>Behavioral Modification<br><br><b>Pharmacotherapy</b><br>Switch to other non SSRI/SNRI medication per corresponding decision support (i.e Bupropion, Mirtazapine)<br><br>Some SSRI\'s (Escitalopram/Citalopram),Serotonin Modulators (Vortioxetine, Vilazodone) or SNRI\'s may have lower incidence of  sexual side effects","meds":["Bupropion","Mirtazapine","Escitalopram","Citalopram","Vortioxetine","Vilazodone"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"4.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(dysfunction === \'Female- Orgasmic Disorder\') && (severity === \'Mild/Moderate\') && (effective === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":["ssri_s2"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>Individual Tailored Intervention:</b><br>Watchful Waiting x 2-3 months<br>Psychotherapy<br>Behavioral Modification<br><br><b>Pharmacotherapy</b><br>If inadequate response, consider decreasing/maintaining SSRI dose to lowest effective dose<br><br>If after dose decrease symptoms continue, consider dysfunction targeted pharmacotherapy","meds":["Sildenafil"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.1","type":"overlay","title":"Recommendation","text":"<b>Targeted pharmacotherapy for Female- Orgasmic Disorder:</b><br>Add PDE5-i (Sildenafil)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"5.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(dysfunction === \'Female- Orgasmic Disorder\') && (severity === \'Mild/Moderate\') && (effective === \'No\') && (patient_age === \'Adult\')","title":"","uid":"6","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":["ssri_s1"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>Nonpharmacologic Treatments:</b><br>Psychotherapy<br>Behavioral Modification<br><br><b>Pharmacotherapy</b><br>Switch to other non SSRI/SNRI medication per corresponding decision support (i.e Bupropion, Mirtazapine)<br><br>Some SSRI\'s (Escitalopram/Citalopram),Serotonin Modulators (Vortioxetine, Vilazodone) or SNRI\'s may have lower incidence of  sexual side effects","meds":["Bupropion","Mirtazapine","Escitalopram","Citalopram","Vortioxetine","Vilazodone"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"6.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(dysfunction === \'Male- Erectile Dysfunction\') && (severity === \'Mild/Moderate\') && (effective === \'Yes\') && (patient_age === \'Adult\')","title":"","uid":"7","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":["ssri_s2"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Individual Tailored Intervention:</b><br>Watchful Waiting x 2-3 months<br>Psychotherapy<br>Behavioral Modification<br><br><b>Pharmacotherapy</b><br>If inadequate response, consider decreasing/maintaining SSRI dose to lowest effective dose<br><br>If after dose decrease symptoms continue, consider dysfunction targeted pharmacotherapy","meds":["Sildenafil","Tadalafil"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"<b>Targeted pharmacotherapy for Male- erectile dysfunction:</b><br>Add PDE5-i (Sildenafil Tadalafil)","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"7.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":"(dysfunction === \'Male- Erectile Dysfunction\') && (severity === \'Mild/Moderate\') && (effective === \'No\') && (patient_age === \'Adult\')","title":"","uid":"8","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":["ssri_s1"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Nonpharmacologic Treatments:</b><br>Psychotherapy<br>Behavioral Modification<br><br><b>Pharmacotherapy</b><br>Switch to other non SSRI/SNRI medication per corresponding decision support (i.e Bupropion, Mirtazapine)<br><br>Some SSRI\'s (Escitalopram/Citalopram),Serotonin Modulators (Vortioxetine, Vilazodone) or SNRI\'s may have lower incidence of  sexual side effects","meds":["Bupropion","Mirtazapine","Escitalopram","Citalopram","Vortioxetine","Vilazodone"],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.2","type":"collapse","title":"Psychotherapy","text":"- Sexual therapy<br>- Couples therapy<br>- Mindfulness","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adult\')","uid":"8.3","type":"collapse","title":"Behavior Modification","text":"- Lifestyle changes<br>- Body image<br>- Sleep hygiene<br>- Stress Reduction<br>- Pelvic therapy<br>- Relationship building<br>- Sexual Novelty","meds":[],"therapies":[]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"SSRI-Induced Sexual Dysfunction","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},9659:function(e){"use strict";e.exports=JSON.parse('{"variables":{"is_comorbid":"","severity":"","stimulant":"","medCount":0},"derived":[{"population":"(partum != \'None\') ? partum.toLowerCase() : comorbidities == \'renal\' ? \'renal\' : comorbidities == \'cardiac\' ? \'cardiac\' : comorbidities == \'obesity\' ? \'obesity\' : comorbidities == \'hepatic\' ? \'hepatic\' : patient_age === \'Geriatric\' ? \'geriatric\' : patient_age === \'Pediatric\' ? \'pediatric\' : patient_age === \'Adolescent\' ? \'adolescent\' : \'adult\'"}],"sections":[{"valid":"true","title":"Stimulant Use Disorder Medications","state":"medication","content":[{"visible":true,"type":"overlay","text":""},{"visible":"true","text":"Medication History","type":"switch","id":"medication_history","choices":[{"text":"Currently or has previously taken medication to treat Stimulant Use Disorder"}]}]},{"valid":true,"title":"Stimulant Use Disorder","state":"intro","content":[{"id":"is_comorbid","visible":"true && patient_age == \'Adult\'","type":"radio","choices":"Yes, No","text":"Is a comorbid disorder (such as bipolar disorder or ADHD) present?","groups":[{"id":"is_comorbid","type":"choice","choices":[{"text":"Yes","value":"Yes"},{"text":"No","value":"No"}]}]},{"id":"is_comorbid_adolescent","visible":"true && patient_age == \'Adolescent\'","type":"radio","choices":"Yes, No","text":"Comorbidities present?<br>Note: Consider a diagnosis of ADHD if no prior diagnosis based on reported symptoms; use validated assessment instruments as needed","groups":[{"id":"is_comorbid_adolescent","type":"choice","choices":[{"text":"Yes","value":"Yes"},{"text":"No","value":"No"}]}]},{"id":"is_comorbid_adhd","visible":"false","type":"radio","choices":"Yes, No","text":"Is comorbid ADHD present?","groups":[{"id":"is_comorbid_adhd","type":"choice","choices":[{"text":"Yes","value":"Yes"},{"text":"No","value":"No"}]}]},{"id":"severity","visible":"true && patient_age == \'Adult\'","type":"radio","choices":"Mild, Moderate/Severe","text":"Severity of stimulant use disorder?","groups":[{"id":"severity","type":"choice","choices":[{"text":"Mild","value":"Mild"},{"text":"Moderate/Severe","value":"Moderate/Severe"}]}]},{"id":"severity_adolescent","visible":"true && patient_age == \'Adolescent\'","type":"radio","choices":"Non-medical or Risky Use, Mild Stimulant Use Disorder, Moderate/Severe Stimulant Use Disorder","text":"Severity of stimulant use?","groups":[{"id":"severity_adolescent","type":"choice","choices":[{"text":"Non-medical or Risky Use","value":"Non-medical or Risky Use"},{"text":"Mild Stimulant Use Disorder","value":"Mild Stimulant Use Disorder"},{"text":"Moderate/Severe Stimulant Use Disorder","value":"Moderate/Severe Stimulant Use Disorder"}]}]},{"id":"stimulant","visible":"true && patient_age == \'Adult\' || patient_age == \'Adolescent\' && severity_adolescent == \'Mild Stimulant Use Disorder\' || severity_adolescent == \'Moderate/Severe Stimulant Use Disorder\'","type":"choice","choices":[{"text":"Cocaine"},{"text":"Methamphetamine"},{"text":"Prescription Stimulant"}],"text":"Type of Stimulant"},{"id":"opioid_concern","visible":"patient_age == \'Adolescent\' && stimulant == \'Methamphetamine\' && severity_adolescent != \'Non-medical or Risky Use\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Concern for: Use of opioids (either prescribed or illicit)"},{"id":"insom_concern","visible":"patient_age == \'Adolescent\' && stimulant == \'Methamphetamine\' && severity_adolescent != \'Non-medical or Risky Use\'","type":"choice","choices":[{"text":"Yes"},{"text":"No"}],"text":"Concern for: Prominent insomnia/weight loss"}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Non-medical or Risky Use\') && (patient_age === \'Adolescent\')","title":"","uid":"1","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s9"],"content":[{"visible":true,"uid":"1.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"1.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"1.2","type":"overlay","title":"Recommendation","text":"Brief Intervention with the Brief Negotiated Interview and interval follow-up assessment.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Non-medical or Risky Use\') && (patient_age === \'Adolescent\')","title":"","uid":"2","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s9"],"content":[{"visible":true,"uid":"2.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"2.1","type":"overlay","title":"Recommendation","text":"Brief Intervention with the Brief Negotiated Interview and interval follow-up assessment.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Cocaine\') && (patient_age === \'Adolescent\')","title":"","uid":"3","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s2"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Topiramate","Modafinil"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"3.4","type":"overlay","title":"Recommendation","text":"<b>Mild Cocaine Use Disorder</b><br>Start Topiramate<br><br>If inadequate response, consider trial of Modafinil. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., amphetamines).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'No\') && (insom_concern === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"4","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s3"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Bupropion","Naltrexone","Topiramate","Mirtazapine"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"4.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"4.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"4.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"4.4","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Start Bupropion + Naltrexone.<br><br><b>Pharmacotherapy</b><br>Use pharmacotherapy based on comorbidity or specific indication<br><br>If inadequate response, trial Topiramate or Mirtazapine if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'Yes\') && (insom_concern === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"5","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s4"],"content":[{"visible":true,"uid":"5.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Topiramate","Mirtazapine","Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"5.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"5.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"5.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"5.4","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Pharmacotherapy Options:<br>1. Topiramate<br>2. Mirtazapine<br>3. Bupropion<br><br>If inadequate response, trial an alternate medication(if no contraindications). If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'No\') && (insom_concern === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"6","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s5"],"content":[{"visible":true,"uid":"6.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Mirtazapine","Topiramate","Bupropion","Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"6.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"6.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"6.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"6.4","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Start Mirtazapine.<br><br>If inadequate response, trial Topiramate or Bupropion with Naltrexone if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'Yes\') && (insom_concern === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"7","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s5"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Mirtazapine","Topiramate","Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"7.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"7.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"7.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"7.4","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Start Mirtazapine.<br><br>If inadequate response, trial Topiramate or Bupropion if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Prescription Stimulant\') && (patient_age === \'Adolescent\')","title":"","uid":"8","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s1"],"content":[{"visible":true,"uid":"8.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"8.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"8.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"8.3","type":"overlay","title":"Recommendation","text":"<b>Mild Prescription Stimulant Use Disorder</b><br>Consider monitored supply of a long-acting prescription stimulant","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Cocaine\') && (patient_age === \'Adolescent\')","title":"","uid":"9","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s2"],"content":[{"visible":true,"uid":"9.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Topiramate","Modafinil"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"9.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"9.2","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"9.3","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"9.4","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Cocaine Use Disorder</b><br>Start Topiramate<br><br>If inadequate response, consider trial of Modafinil. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., amphetamines).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'No\') && (insom_concern === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"10","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s3"],"content":[{"visible":true,"uid":"10.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Bupropion","Naltrexone","Topiramate","Mirtazapine"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"10.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"10.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"10.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"10.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Start Bupropion + Naltrexone.<br><br><b>Pharmacotherapy</b><br>Use pharmacotherapy based on comorbidity or specific indication<br><br>If inadequate response, trial Topiramate or Mirtazapine (if no contraindications). If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'Yes\') && (insom_concern === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"11","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s4"],"content":[{"visible":true,"uid":"11.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Topiramate","Mirtazapine","Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"11.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"11.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"11.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"11.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Pharmacotherapy Options:<br>1. Topiramate<br>2. Mirtazapine<br>3. Bupropion<br><br>If inadequate response, trial an alternate medication if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'No\') && (insom_concern === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"12","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s5"],"content":[{"visible":true,"uid":"12.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Mirtazapine","Topiramate","Bupropion","Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"12.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"12.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"12.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"12.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Start Mirtazapine.<br><br>If inadequate response, trial Topiramate or Bupropion with Naltrexone if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'Yes\') && (insom_concern === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"13","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s5"],"content":[{"visible":true,"uid":"13.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":["Mirtazapine","Topiramate","Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"13.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"13.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"13.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"13.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Start Mirtazapine.<br><br>If inadequate response, trial Topiramate or Bupropion if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'Yes\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Prescription Stimulant\') && (patient_age === \'Adolescent\')","title":"","uid":"14","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s1"],"content":[{"visible":true,"uid":"14.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support. If substance use or cravings persistent despite treatment of comorbidities, continue with stimulant use disorder specific treatment.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"14.1","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"14.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"14.1","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Prescription Stimulant Use Disorder</b><br>Consider monitored supply of a long-acting prescription stimulant","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Cocaine\') && (patient_age === \'Adolescent\')","title":"","uid":"15","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s2"],"content":[{"visible":true,"uid":"15.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"15.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Topiramate","Modafinil"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"15.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"15.3","type":"overlay","title":"Recommendation","text":"<b>Mild Cocaine Use Disorder</b><br>Consider starting Topiramate<br><br>If inadequate response, consider trial of Modafinil. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., amphetamines).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'No\') && (insom_concern === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"16","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s3"],"content":[{"visible":true,"uid":"16.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"16.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Bupropion","Naltrexone","Topiramate","Mirtazapine"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"16.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"16.3","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Start Bupropion + Naltrexone.<br><br><b>Pharmacotherapy</b><br>Use pharmacotherapy based on comorbidity or specific indication<br><br>If inadequate response, trial Topiramate or Mirtazapine if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'Yes\') && (insom_concern === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"17","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s4"],"content":[{"visible":true,"uid":"17.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"17.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Topiramate","Mirtazapine","Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"17.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"17.3","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Pharmacotherapy Options:<br>1. Topiramate<br>2. Mirtazapine<br>3. Bupropion<br><br>If inadequate response, trial an alternate medication(if no contraindications). If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'No\') && (insom_concern === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"18","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s5"],"content":[{"visible":true,"uid":"18.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"18.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Mirtazapine","Topiramate","Bupropion","Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"18.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"18.3","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Start Mirtazapine.<br><br>If inadequate response, trial Topiramate or Bupropion with Naltrexone if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'Yes\') && (insom_concern === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"19","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s5"],"content":[{"visible":true,"uid":"19.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"19.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Mirtazapine","Topiramate","Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"19.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"19.3","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Start Mirtazapine.<br><br>If inadequate response, trial Topiramate or Bupropion if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Mild Stimulant Use Disorder\') && (stimulant === \'Prescription Stimulant\') && (patient_age === \'Adolescent\')","title":"","uid":"20","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s1"],"content":[{"visible":true,"uid":"20.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"20.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>If not previously started, add pharmacotherapy if inadequate response to behavioral interventions.<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"20.2","type":"overlay","title":"Recommendation","text":"<b>Mild Prescription Stimulant Use Disorder</b><br>Consider monitored supply of a long-acting prescription stimulant","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Cocaine\') && (patient_age === \'Adolescent\')","title":"","uid":"21","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s2"],"content":[{"visible":true,"uid":"21.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"21.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Topiramate","Modafinil"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"21.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"21.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Cocaine Use Disorder</b><br>Consider starting Topiramate<br><br>If inadequate response, consider trial of Modafinil. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., amphetamines).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'No\') && (insom_concern === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"22","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s3"],"content":[{"visible":true,"uid":"22.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"22.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Bupropion","Naltrexone","Topiramate","Mirtazapine"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"22.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"22.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Start Bupropion + Naltrexone.<br><br><b>Pharmacotherapy</b><br>Use pharmacotherapy based on comorbidity or specific indication<br><br>If inadequate response, trial Topiramate or Mirtazapine (if no contraindications). If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'Yes\') && (insom_concern === \'No\') && (patient_age === \'Adolescent\')","title":"","uid":"23","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s4"],"content":[{"visible":true,"uid":"23.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"23.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Topiramate","Mirtazapine","Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"23.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"23.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Pharmacotherapy Options:<br>1. Topiramate<br>2. Mirtazapine<br>3. Bupropion<br><br>If inadequate response, trial an alternate medication if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'No\') && (insom_concern === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"24","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s5"],"content":[{"visible":true,"uid":"24.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"24.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Mirtazapine","Topiramate","Bupropion","Naltrexone"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"24.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"24.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Start Mirtazapine.<br><br>If inadequate response, trial Topiramate or Bupropion with Naltrexone if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Methamphetamine\') && (opioid_concern === \'Yes\') && (insom_concern === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"25","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s5"],"content":[{"visible":true,"uid":"25.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"25.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":["Mirtazapine","Topiramate","Bupropion"],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"25.2","type":"overlay","title":"Recommendation","text":"<b>Pharmacotherapy</b><br>Consider pharmacotherapy for patients at any stage of change (e.g., contemplation).<br><br>Involve specialty addiction medicine especially for multi-substance use or higher complexity.","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"25.3","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Start Mirtazapine.<br><br>If inadequate response, trial Topiramate or Bupropion if no contraindications. If continued inadequate response, refer to psychiatry or addiction medicine and/or consider a monitored supply of a long-acting prescription stimulant (e.g., methylphenidate).","meds":[],"therapies":[]}]},{"valid":"(is_comorbid_adolescent === \'No\') && (severity_adolescent === \'Moderate/Severe Stimulant Use Disorder\') && (stimulant === \'Prescription Stimulant\') && (patient_age === \'Adolescent\')","title":"","uid":"26","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud-adolescent_s1"],"content":[{"visible":true,"uid":"26.0","type":"overlay","title":"Recommendation","text":"Consent of parent or guardian varies by state. See <a href=\'https://publications.aap.org/pediatrics/article/149/6/e2021053458/187003/State-by-State-Variability-in-Adolescent-Privacy\' target=\'blank\'>Sharko et al., Pediatrics 2022 article</a> for information regarding your state","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"26.1","type":"overlay","title":"Recommendation","text":"<b>Behavioral Interventions</b><br>Consider any of the following alone or in combination:<br>&#x2022; Brief Intervention with Brief Negotiated Interview<br>&#x2022; CBT for substance use<br>&#x2022; Peer/group support (i.e., 12-steps)<br>&#x2022; Contingency management (if available)<br><br>Involve parents or guardians during behavioral interventions, if possible.<br><br>Pharmacotherapy recommended in addition to behavioral interventions<br><br>Brief Negotiated Interview:<br><a href=\\"https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/\\" target=\\"blank\\">https://www.thenationalcouncil.org/resources/brief-negotiated-interview-and-active-referral-to-treatment-provider-training-algorithm/</a>","meds":[],"therapies":[]},{"visible":"(patient_age === \'Adolescent\')","uid":"26.2","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Prescription Stimulant Use Disorder</b><br>Consider monitored supply of a long-acting prescription stimulant","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (severity === \'Mild\') && (stimulant === \'Cocaine\') && (patient_age === \'Adult\')","title":"","uid":"27","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s2"],"content":[{"visible":true,"uid":"27.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. If substance use or cravings to use persist despite treatment, continue with stimulant use specific treatment.","meds":["Topiramate","Modafinil"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"27.1","type":"overlay","title":"Recommendation","text":"<b>Mild Cocaine Use Disorder</b><br>Recommend behavioral interventions for initial treatment. If inadequate response, consider addition of pharmacotherapy.<br><br><b>Pharmacotherapy</b><br>Start topiramate. If unsuccessful, consider a trial of modafinil.","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (severity === \'Mild\') && (stimulant === \'Methamphetamine\') && (patient_age === \'Adult\')","title":"","uid":"28","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s3"],"content":[{"visible":true,"uid":"28.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. If substance use or cravings to use persist despite treatment, continue with stimulant use specific treatment.","meds":["Bupropion","Naltrexone","Mirtazapine"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"28.1","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Recommend behavioral interventions for initial treatment. If inadequate response, consider addition of pharmacotherapy.<br><br><b>Pharmacotherapy</b><br>Use pharmacotherapy based on comorbidity or specific indication<br><b>None:</b> Bupropion + Naltrexone<br><b>Concurrent opioid use:</b><br>1. Mirtazapine<br>2. Bupropion<br><b>Prominent concern about low weight or insomnia:</b> Mirtazapine<br><br>If unsuccessful, consider a trial of an alternate medication if no contraindications.","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (severity === \'Mild\') && (stimulant === \'Prescription Stimulant\') && (patient_age === \'Adult\')","title":"","uid":"29","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s1"],"content":[{"visible":true,"uid":"29.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. If substance use or cravings to use persist despite treatment, continue with stimulant use specific treatment.","meds":["Vyvanse"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"29.1","type":"overlay","title":"Recommendation","text":"<b>Mild Prescription Stimulant Use Disorder</b><br>Recommend behavioral interventions for initial treatment. If inadequate response, consider addition of pharmacotherapy.<br><br><b>Pharmacotherapy</b><br>Consider monitored supply of a long-acting prescription stimulant such as Vyvanse for select patients.","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (severity === \'Moderate/Severe\') && (stimulant === \'Cocaine\') && (patient_age === \'Adult\')","title":"","uid":"30","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s2"],"content":[{"visible":true,"uid":"30.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. If substance use or cravings to use persist despite treatment, continue with stimulant use specific treatment.","meds":["Topiramate","Modafinil"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"30.1","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Cocaine Use Disorder</b><br>Recommend behavioral interventions and pharmacotherapy for initial treatment.<br><br><b>Pharmacotherapy</b><br>Start topiramate. If unsuccessful, consider a trial of modafinil.","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (severity === \'Moderate/Severe\') && (stimulant === \'Methamphetamine\') && (patient_age === \'Adult\')","title":"","uid":"31","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s3"],"content":[{"visible":true,"uid":"31.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. If substance use or cravings to use persist despite treatment, continue with stimulant use specific treatment.","meds":["Bupropion","Naltrexone","Mirtazapine"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"31.1","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Recommend behavioral interventions and pharmacotherapy for initial treatment.<br><br><b>Pharmacotherapy</b><br>Use pharmacotherapy based on comorbidity or specific indication<br><b>None:</b> Bupropion + Naltrexone<br><b>Concurrent opioid use:</b><br>1. Mirtazapine<br>2. Bupropion<br><b>Prominent concern about low weight or insomnia:</b> Mirtazapine<br><br>If unsuccessful, consider a trial of an alternate medication if no contraindications.","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Yes\') && (severity === \'Moderate/Severe\') && (stimulant === \'Prescription Stimulant\') && (patient_age === \'Adult\')","title":"","uid":"32","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s1"],"content":[{"visible":true,"uid":"32.0","type":"overlay","title":"Recommendation","text":"<b>Comorbid psychiatric disorder:</b><br>See corresponding decision support tool. If substance use or cravings to use persist despite treatment, continue with stimulant use specific treatment.","meds":["Vyvanse"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]},{"visible":"(patient_age === \'Adult\')","uid":"32.1","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Prescription Stimulant Use Disorder</b><br>Recommend behavioral interventions and pharmacotherapy for initial treatment.<br><br><b>Pharmacotherapy</b><br>Consider monitored supply of a long-acting prescription stimulant such as Vyvanse for select patients.","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'No\') && (severity === \'Mild\') && (stimulant === \'Cocaine\') && (patient_age === \'Adult\')","title":"","uid":"33","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s2"],"content":[{"visible":true,"uid":"33.0","type":"overlay","title":"Recommendation","text":"<b>Mild Cocaine Use Disorder</b><br>Recommend behavioral interventions for initial treatment. If inadequate response, consider addition of pharmacotherapy.<br><br><b>Pharmacotherapy</b><br>Start topiramate. If unsuccessful, consider a trial of modafinil.","meds":["Topiramate","Modafinil"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (severity === \'Mild\') && (stimulant === \'Methamphetamine\') && (patient_age === \'Adult\')","title":"","uid":"34","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s3"],"content":[{"visible":true,"uid":"34.0","type":"overlay","title":"Recommendation","text":"<b>Mild Methamphetamine Use Disorder</b><br>Recommend behavioral interventions for initial treatment. If inadequate response, consider addition of pharmacotherapy.<br><br><b>Pharmacotherapy</b><br>Use pharmacotherapy based on comorbidity or specific indication<br><b>None:</b> Bupropion + Naltrexone<br><b>Concurrent opioid use:</b><br>1. Mirtazapine<br>2. Bupropion<br><b>Prominent concern about low weight or insomnia:</b> Mirtazapine<br><br>If unsuccessful, consider a trial of an alternate medication if no contraindications.","meds":["Bupropion","Naltrexone","Mirtazapine"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (severity === \'Mild\') && (stimulant === \'Prescription Stimulant\') && (patient_age === \'Adult\')","title":"","uid":"35","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s1"],"content":[{"visible":true,"uid":"35.0","type":"overlay","title":"Recommendation","text":"<b>Mild Prescription Stimulant Use Disorder</b><br>Recommend behavioral interventions for initial treatment. If inadequate response, consider addition of pharmacotherapy.<br><br><b>Pharmacotherapy</b><br>Consider monitored supply of a long-acting prescription stimulant such as Vyvanse for select patients.","meds":["Vyvanse"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (severity === \'Moderate/Severe\') && (stimulant === \'Cocaine\') && (patient_age === \'Adult\')","title":"","uid":"36","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s2"],"content":[{"visible":true,"uid":"36.0","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Cocaine Use Disorder</b><br>Recommend behavioral interventions and pharmacotherapy for initial treatment.<br><br><b>Pharmacotherapy</b><br>Start topiramate. If unsuccessful, consider a trial of modafinil.","meds":["Topiramate","Modafinil"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (severity === \'Moderate/Severe\') && (stimulant === \'Methamphetamine\') && (patient_age === \'Adult\')","title":"","uid":"37","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s3"],"content":[{"visible":true,"uid":"37.0","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Methamphetamine Use Disorder</b><br>Recommend behavioral interventions and pharmacotherapy for initial treatment.<br><br><b>Pharmacotherapy</b><br>Use pharmacotherapy based on comorbidity or specific indication<br><b>None:</b> Bupropion + Naltrexone<br><b>Concurrent opioid use:</b><br>1. Mirtazapine<br>2. Bupropion<br><b>Prominent concern about low weight or insomnia:</b> Mirtazapine<br><br>If unsuccessful, consider a trial of an alternate medication if no contraindications.","meds":["Bupropion","Naltrexone","Mirtazapine"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]}]},{"valid":"(is_comorbid === \'No\') && (severity === \'Moderate/Severe\') && (stimulant === \'Prescription Stimulant\') && (patient_age === \'Adult\')","title":"","uid":"38","state":"recommendation","branch":"Stimulant Use Disorder","figure":["sud_s1"],"content":[{"visible":true,"uid":"38.0","type":"overlay","title":"Recommendation","text":"<b>Moderate/Severe Prescription Stimulant Use Disorder</b><br>Recommend behavioral interventions and pharmacotherapy for initial treatment.<br><br><b>Pharmacotherapy</b><br>Consider monitored supply of a long-acting prescription stimulant such as Vyvanse for select patients.","meds":["Vyvanse"],"therapies":["Peer support (12-step program)","Cognitive Behavioral Therapy"]}]},{"valid":true,"title":"","uid":"999","state":"recommendation","branch":"Stimulant Use Disorder","figure":[""],"content":[{"visible":true,"uid":"999.0","type":"overlay","title":"Recommendation","text":"Failed to find a recommendation with chosen parameters","meds":[],"therapies":[]}]}]}')},1820:function(e){"use strict";e.exports=JSON.parse('{"medications":["acetaZOLAMIDE","acetoHEXAMIDE","ALPRAZolam","aMILoride","amLODIPine","ARIPiprazole","AVINza","azaCITIDine","azaTHIOprine","buPROPion","busPIRone","carBAMazepine","CARBOplatin","ceFAZolin","cefoTEtan","cefOXitin","cefTAZidime","cefTRIAXone","CeleBREX","CeleXA","chlordiazePOXIDE","chlorproMAZINE","chlorproMAZINE","chlorproPAMIDE","CISplatin","cloBAZam","clomiPHENE","clomiPRAMINE","clonazePAM","cloNIDine","cloZAPine","cycloSERINE","cycloSPORINE","DACTINomycin","DAPTOmycin","DAUNOrubicin","DEPO-Medrol","diazePAM ","dilTIAZem","dimenhyDRINATE","diphenhydrAMINE","DOBUTamine","DOCEtaxel","DOPamine","DOXOrubicin","DOXOrubicin","DULoxetine","ePHEDrine","EPINEPHrine","epiRUBicin","eriBULin","fentaNYL","flavoxATE","FLUoxetine","fluPHENAZine","fluvoxaMINE","glipiZIDE","glyBURIDE","guaiFENesin","guanFACINE","HumaLOG","HumuLIN","hydrALAZINE","hydrALAZINE","hydroCHLOROthiazide","HYDROcodone","HYDROmorphone","HYDROmorphone","HYDROXYprogesterone","hydrOXYzine","hydrOXYzine","IDArubicin","idaruCIZUmab","inFLIXimab","INVanz","ISOtretinoin","KlonoPIN","LaMICtal","LamISIL","lamiVUDine","lamoTRIgine","levETIRAcetam","levOCARNitine","levoFLOXacin","LEVOleucovorin","LORazepam","medroxyPROGESTERone","metFORMIN","methazolAMIDE","methIMAzole","methylPREDNISolone","methylTESTOSTERone","metOLazone","metroNIDAZOLE","metyraPONE","metyroSINE","miFEPRIStone","miSOPROStol","mitoMYcin","mitoXANTRONE","mitoXANTRONE","NexAVAR","NexIUM","niCARdipine","niCARdipine","NIFEdipine","NIFEdipine","niMODipine","NovoLIN","NovoLOG","OLANZapine","OXcarbazepine","oxyCODONE","OxyCONTIN","oxyMORphone","PACLitaxel","PARoxetine","PAZOPanib","PEMEtrexed","penicillAMINE","PENTobarbital","PHENobarbital","PONATinib","PRALAtrexate","prednisoLONE","predniSONE","PriLOSEC","PROzac","QUEtiapine","quiNIDine","quiNINE","RABEprazole","raNITIdine","rifAMPin","rifAXIMin","riMANTAdine","RisperDAL","risperiDONE","risperiDONE","riTUXimab","romiDEPsin","romiPLOStim","rOPINIRole","rOPINIRole","SandIMMUNE","SandoSTATIN","sAXagliptin","SEROquel","SINEquan","SITagliptin","Solu-CORTEF","SOLU-Medrol","SORAfenib","SUFentanil","sulfADIAZINE","sulfADIAZINE","sulfaSALAzine","sulfiSOXAZOLE","SUMAtriptan","SUNItinib","TEGretol","tiaGABine","tiZANidine","TOLAZamide","TOLBUTamide","traMADol","traZODone","TRENtal","valACYclovir","valGANciclovir","vinBLAStine","vinCRIStine","ZOLMitriptan","ZyPREXA","ZyrTEC"]}')},6547:function(e){"use strict";e.exports=JSON.parse('[{"title":"Ryan Laschober, MD, FAAFP, Family Medicine","headshot":"Laschober_Ryan_headshot.jpg","biosketch":"Biosketch_Ryan_Laschober.pdf","profLink":"https://residency.wacofamilymedicine.org/our-family/faculty/","description":"<a target=\'_blank\' href=\'https://residency.wacofamilymedicine.org/our-family/faculty/\' className=\'teamLink\'><b>Ryan Laschober, MD, FAAFP</b></a> is the Editor-in-Chief of The Waco Guide and an Associate Program Director for Waco Family Medicine Residency. Dr. Laschober received a BS in Biochemistry from Baylor University and MD from University of Arkansas for Medical Sciences. He completed his family medicine residency at Waco Family Medicine Residency, during which time he served as chief resident. Dr. Laschober is invested in full spectrum family medicine with special interests in global health, mental health care, and care for the underserved. In addition to medicine, he is involved with his local church, foster care, and adoption community. He resides with his wife and four children blocks away from the federally qualified health center residency clinic where he practices."},{"title":"Lance Kelley, PhD, Clinical Psychology","headshot":"Kelley_Lance_headshot.jpg","biosketch":"Biosketch_Lance_Kelley.pdf","profLink":"https://residency.wacofamilymedicine.org/our-family/faculty/","description":"<a target=\'_blank\' href=\'https://residency.wacofamilymedicine.org/our-family/faculty/\' className=\'teamLink\'><b>Lance Kelley, PhD</b></a> is a clinical psychologist, Associate Editor of The Waco Guide, and Chief Behavioral Health Officer at Waco Family Medicine. Dr. Kelley pioneered the federally qualified health center\u2019s integrated behavioral health program and oversees the behavioral health training for Waco Family Medicine Residency. Dr. Kelley has published articles on PTSD, health anxiety, obesity, pediatric disruptive behavior, and the science of psychology and regularly presents at state and national conferences on primary care behavioral health and residency training. He also serves on the editorial board for Psychological Services, the board of directors for the Heart of Texas Behavioral Health Network, and the clinical committee for the Texas Association of Community Health Centers."},{"title":"Zachary Sartor, MD, Family Medicine","headshot":"Zach_Sartor_headshot.jpg","biosketch":"Biosketch_Zach_Sartor.pdf","profLink":"https://residency.wacofamilymedicine.org/our-family/faculty/","description":"<a target=\'_blank\' href=\'https://residency.wacofamilymedicine.org/our-family/faculty/\' className=\'teamLink\'><b>Zachary Sartor, MD, FAAFP</b></a> is Associate Editor of The Waco Guide and a family medicine faculty physician with Waco Family Medicine Residency, serving as Associate Program Director for Curriculum and Evaluation and Director for Primary Care Addiction Medicine. He received a BS in Chemistry from Baylor University and MD from Texas Tech University School of Medicine Health Science Center School of Medicine. Dr. Sartor also completed family medicine residency training at Waco Family Medicine and an academic development fellowship at the University of North Texas Health Sciences Center. His primary interests are medical education, including curriculum design and evaluation; primary care behavioral health, specifically involving system-level innovations targeted at improving the preparedness of primary care clinicians to address the behavioral health needs of communities; addiction medication in primary care; and health disparities and the impact of leveraging unique care models to improve health outcomes in communities. Dr. Sartor is also completing a MPH part-time through the Johns Hopkins Bloomberg School of Public Health where he is a Bloomberg American Health Initiative scholar in the Addiction and Overdose focus area."},{"title":"Jackson Griggs, MD, FAAFP, Family Medicine","headshot":"Griggs_Jackson_headshot.png","biosketch":"Biosketch_Jackson_Griggs.pdf","profLink":"https://www.doximity.com/pub/jackson-griggs-md","description":"<a target=\'_blank\' href=\'https://www.doximity.com/pub/jackson-griggs-md\' className=\'teamLink\'><b>Jackson Griggs, MD, FAAFP</b></a> is Associate Editor of The Waco Guide and the Chief Executive Officer of Waco Family Medicine, a fifteen-site federally qualified health center serving over 60,000 patients in Central Texas. Dr. Griggs is a family physician who has spent his career focused on families living in poverty. Before executive leadership, he trained over 150 resident physicians while on faculty of the Waco Family Medicine Residency Program. His research has covered topics in primary care, population health, and mental illness.  As a consensus committee member, Dr. Griggs contributed to the influential report by National Academies of Sciences Engineering and Medicine, Implementing High Quality Primary Care: Rebuilding the Foundation of Health Care."},{"title":"Susan Johnson, MD, Psychiatry","headshot":"Susan_Johnson_headshot.jpg","biosketch":"https://www.doximity.com/pub/susan-johnson-md-733ab1db","profLink":"https://www.doximity.com/pub/susan-johnson-md-733ab1db","description":"<b>Susan Johnson, MD</b> is Associate Editor of The Waco Guide and a board-certified psychiatrist. Dr. Johnson received a BA in Psychology from the University of Texas at Austin, an MD from the University of Texas Medical School at Houston (now McGovern Medical School at UT Health), and completed a residency in psychiatry at The University of Texas Medical School at Houston. Her psychiatric career as Assistant Professor of Psychiatry at The University of Texas Medical School at Houston focused primarily upon patient care in underserved populations, as well as education of medical students and residents. Dr. Johnson\u2019s research interests include psychopharmacology and psychotherapy. Now retired from active practice, Dr. Johnson lives with her husband, a retired family medicine physician and educator. Their daughter is a physician assistant, and their son is currently a medical student."}]')},7032:function(e){"use strict";e.exports=JSON.parse('[{"id":"1","name":"Cognitive Behavioral Therapy","class":"CBT","description":""},{"id":"2","name":"Acceptance and Commitment Therapy","class":"ACT","description":""},{"id":"3","name":"Recommended","class":"","description":"Prolonged Exposure <i>PE</i><br>Cognitive Processing Therapy <i>CPT</i><br>Cognitive Behavioral Therapy <i>CBT</i>"},{"id":"4","name":"Consider","class":"","description":"Eye Movement Desensitization and Reprocessing <i>EMDR</i><br>Cognitive Therapy <i>CT</i><br>Narrative Exposure Therapy <i>NET</i><br>Brief Eclectic Psychotherapy <i>BEP</i>"},{"id":"5","name":"Evidence-based psychotherapy in primary care","class":"","description":"<br>Cognitive Behavioral Therapy <i>CBT</i><br>Interpersonal Therapy <i>IPT</i><br>Problem Solving Therapy <i>PST</i><br>Behavioral Activation <i>BA</i>"},{"id":"6","name":"Preconception 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\'Adult\')","title":"","uid":"3","state":"recommendation","branch":"Tobacco Use Disorder","figure":["TUD-antepartum_t2"],"content":[{"visible":true,"uid":"3.0","type":"overlay","title":"Recommendation","text":"<b>Pre-contemplation:</b> <br>Continue to Ask and Advise on cessation using motivational interviewing","meds":[],"therapies":[]}]},{"valid":"(is_comorbid === \'Contemplation\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"4","state":"recommendation","branch":"Tobacco Use Disorder","figure":["TUD-antepartum_t2"],"content":[{"visible":true,"uid":"4.0","type":"overlay","title":"Recommendation","text":"<b>Contemplation:</b> <br>Continue to Ask and Advise on cessation using motivational interviewing","meds":[],"therapies":[]}]},{"valid":"(psychic === \'Yes\') && (partum === \'Antepartum\') && (patient_age === \'Adult\')","title":"","uid":"5","state":"recommendation","branch":"Tobacco Use 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to Resources (eg. 1-800-QUIT-NOW, smokefree.gov)<br>Smoking cessation counseling<br>Ideally set quit date<br><br>Shared decision making discussing psychotherapy alone or psychotherapy + pharmacotherapy<br><br>If using pharmacotherapy, use combination Nicotine Replacement Therapy (cNRT) or bupropion if 12wk gestational age","meds":["Bupropion","Nicotine Gum","Nicotine Inhaled","Nicotine Lozenge","Nicotine Nasal Spray","Nicotine Transdermal Patch"],"therapies":[]}]},{"valid":"(severity === \'Mild\') && (patient_age === \'Adolescent\')","title":"","uid":"7","state":"recommendation","branch":"Tobacco Use Disorder","figure":["TUD-adolescent_t1"],"content":[{"visible":true,"uid":"7.0","type":"overlay","title":"Recommendation","text":"<b>Mild:</b> <br>Behavioral interventions with regular follow-up","meds":[],"therapies":[]}]},{"valid":"(is_special === \'None\') && (aged === \'Yes\') && (patient_age === \'Adolescent\')","title":"","uid":"8","state":"recommendation","branch":"Tobacco Use 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e.createElement(Si.Provider,{value:this.childContext},this.renderMainLayer(),this.renderTextLayer(),this.renderAnnotationLayer(),t)}},{key:"renderContent",value:function(){var t=this.pageNumber,i=this.props.pdf,a=this.state.page;if(!t){var n=this.props.noData;return e.createElement(Ft,{type:"no-data"},"function"===typeof n?n():n)}if(null===i||null===a){var r=this.props.loading;return e.createElement(Ft,{type:"loading"},"function"===typeof r?r():r)}if(!1===i||!1===a){var o=this.props.error;return e.createElement(Ft,{type:"error"},"function"===typeof o?o():o)}return this.renderChildren()}},{key:"render",value:function(){var t=this.pageNumber,i=this.props,a=i.className,n=i.inputRef;return e.createElement("div",r({className:Rt("react-pdf__Page",a),"data-page-number":t,ref:wi(n,this.pageElement),style:{position:"relative",minWidth:"min-content",minHeight:"min-content"}},this.eventProps),this.renderContent())}}]),a}(e.PureComponent);qi.defaultProps={error:"Failed to load the 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t={url:"/assets/"+this.props.pdfName+".pdf"};this.props.pdfName!==e.pdfName&&this.setState({file:t})}},{key:"componentWillUnmount",value:function(){document.removeEventListener("mousedown",this.handleClickOutside)}},{key:"handleClickOutside",value:function(e){this.wrapperRef&&!this.wrapperRef.current.contains(e.target)&&"visible"==this.props.isHidden&&this.props.togglePDF()}},{key:"render",value:function(){return(0,ye.jsx)("div",{ref:this.wrapperRef,className:"floatingPDF",style:{width:Xi(),visibility:this.props.isHidden},children:(0,ye.jsxs)("div",{className:"card",style:{width:Xi(),padding:"30px 15px 0px 15px"},children:[(0,ye.jsx)("div",{style:{width:"100%"},children:(0,ye.jsx)("button",{className:"btn btn-primary",style:{width:"1%",float:"right",padding:"10px 30px 10px 20px"},onClick:this.props.togglePDF,children:"X"})}),(0,ye.jsx)("a",{target:"_blank",href:"/assets/"+this.props.pdfName+".pdf",children:(0,ye.jsx)(ui,{file:this.state.file,onLoadSuccess:function(){return 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d=r.comorbidities.indexOf("Cardiac")>=0,u=r.comorbidities.indexOf("Hepatic")>=0,p=r.comorbidities.indexOf("Renal")>=0,m=r.comorbidities.indexOf("Obesity")>=0;if(Se().setVariable("cardiac_enabled",d),Se().setVariable("hepatic_enabled",u),Se().setVariable("renal_enabled",p),Se().setVariable("obesity_enabled",m),Se().setVariable("comorbidities_enabled",d),"Adult"==t&&-1==r.category.indexOf("Adult")&&(o?Se().setVariable("comorbidities","childbearing"):Se().setVariable("comorbidities","cardiac")),o){r.pregnancy.indexOf(a)||(a="None"),Se().setVariable("reproductive_active",!0),Se().setVariable("childbearing_enabled",!0);var h=r.pregnancy.indexOf("Preconception")>=0,f=r.pregnancy.indexOf("Antepartum")>=0,y=r.pregnancy.indexOf("Postpartum")>=0;Se().setVariable("preconception_enabled",h),Se().setVariable("antepartum_enabled",f),Se().setVariable("postpartum_enabled",y),"None"==a&&(h?a="Preconception":f?a="Antepartum":y&&(a="Postpartum")),Se().setVariable("partum",a)}else Se().setVariable("reproductive_active",!1),Se().setVariable("childbearing_enabled",!1),Se().setVariable("preconception_enabled",!1),Se().setVariable("antepartum_enabled",!1),Se().setVariable("postpartum_enabled",!1),"childbearing"==i&&(Se().setVariable("comorbidities",""),Se().setVariable("comorbidities_childbearing",!1));-1==r.category.indexOf("Adult")&&(r.category.indexOf("Women")>=0?(Se().setVariable("comorbidities","childbearing"),Se().setVariable("patient_age","Adult")):r.comorbidities.length>0&&"Geriatric"!=r.comorbidities[0]?(Se().setVariable("comorbidities",r.comorbidities[0]),Se().setVariable("patient_age","Adult")):Se().setVariable("adult_enabled",!1));var b=Se().getVariable("patient_age")||"Adult";"Geriatric"!=b&&"Pediatric"!=b&&"Adolescent"!=b&&"childbearing"==i||Se().setVariable("partum","None");for(var g=0;g<Zi.length;g++)""!=i||"None"!=a?"childbearing"==i?("None"==a&&(n.state.pdf="none",n.state.currentAlgorithm=Zi[g]),Zi[g].diagnosis==r.name&&Zi[g].population==a&&(n.state.pdf=Zi[g].pdf,n.state.currentAlgorithm=Zi[g])):(Se().setVariable("partum","None"),Zi[g].diagnosis==r.name&&Zi[g].population.toLowerCase()==i&&(n.state.pdf=Zi[g].pdf,n.state.currentAlgorithm=Zi[g])):Zi[g].diagnosis==r.name&&Zi[g].population==b&&(n.state.pdf=Zi[g].pdf,n.state.currentAlgorithm=Zi[g])}},n.setVariable=function(e,t){Se().setVariable(e,t),"diagnosis"==e&&(Se().setVariable("_patient_age",""),Se().setVariable("sub_age","")),"Diagnosis"==n.state.page.title&&n.rebuildDiagnosisVariables();var i=Se().reevaluate(n.state.state);i.state=n.state.state,n.setState({page:i})},n.getVariable=function(e){return Se().getVariable(e)},n.goToNextPage=function(){window.scrollTo({top:0,left:0,behavior:"instant"});var e=n.state.page,t=e.variables.symptoms,i=e.variables.medCount;if("Diagnosis"==e.title){var a=e.content.find((function(e){return"diagnosis"==e.id})),r=n.getVariable("patient_age"),o=n.getVariable("comorbidities"),s=e.content.find((function(e){return"partum"==e.id}));n.state.currentDiagnosis=a.value,"None"!=s.value&&null!=s.value?n.state.currentComorbid=s.value:n.state.currentComorbid=""!=o?o.charAt(0).toUpperCase()+o.slice(1):r;for(var l=0;l<Zi.length;l++)if("None"!=s.value&&null!=s.value){if(Zi[l].diagnosis==a.value&&Zi[l].population==s){n.state.pdf=Zi[l].pdf,n.state.currentAlgorithm=Zi[l];break}}else if(""!=o){if(Zi[l].diagnosis==a.value&&Zi[l].population.toLowerCase()==o){n.state.pdf=Zi[l].pdf,n.state.currentAlgorithm=Zi[l];break}}else if(Zi[l].diagnosis==a.value&&Zi[l].population==r){n.state.pdf=Zi[l].pdf,n.state.currentAlgorithm=Zi[l];break}var c=n.state.diagnoses.find((function(e){return e.title===a.value}));if(!c)return;var d=__webpack_require__(6773)("./"+c.filename+".json");Se().setAlgorithm(d);var u=n.state.facts||{};n.setFacts(u);var p=(m=Se().reevaluate("intro")).content.length;m.state=h,n.setState({page:m,state:"intro"}),p>0?(n.state.state="intro",m.state=h,n.setState({page:m,state:"intro"})):(h=n.checkMedCount(m)<=1||"unmedicated"==t||"success"==t||0==i?"recommendation":"medication",(m=Se().reevaluate(h)).state=h,n.setState({page:m,state:h}))}else{if("medication"==n.state.state)return h="recommendation",(m=Se().reevaluate(h)).state=h,n.setState({page:m,state:h}),void(null!=m.figure&&(n.state.pdf=m.figure[0].split("_")[0]));var m,h=n.state.state;h="medication"!=n.state.state?n.checkMedCount(m)<=1||"unmedicated"==t||"success"==t||0==i?"recommendation":"medication":"recommendation",(m=Se().reevaluate(h)).state=h,null!=m.figure&&(n.state.pdf=m.figure[0].split("_")[0]),n.setState({page:m,state:h})}},n.goToPrevPage=function(){window.scrollTo({top:0,left:0,behavior:"instant"});var e=n.state.page,t=e.variables.symptoms,i=e.variables.medCount;if("recommendation"==e.state&&null!=n.state.currentAlgorithm&&(n.state.pdf=n.state.currentAlgorithm.pdf),"Diagnosis"==e.title){var a=e.content.find((function(e){return"diagnosis"==e.id})),r=n.getVariable("patient_age"),o=n.getVariable("comorbidities"),s=e.content.find((function(e){return"partum"==e.id}));n.state.currentDiagnosis=a.value,"None"!=s.value&&null!=s.value?n.state.currentComorbid=s.value:n.state.currentComorbid=""!=o?o.charAt(0).toUpperCase()+o.slice(1):r;for(var l=0;l<Zi.length;l++)if("None"!=s.value&&null!=s.value){if(Zi[l].diagnosis==a.value&&Zi[l].population==s){n.state.pdf=Zi[l].pdf;break}}else""!=o?Zi[l].diagnosis==a.value&&Zi[l].population.toLowerCase()==o&&(n.state.pdf=Zi[l].pdf):Zi[l].diagnosis==a.value&&Zi[l].population==r&&(n.state.pdf=Zi[l].pdf);var c=n.state.diagnoses.find((function(e){return e.title===a.value}));if(!c)return;var d=__webpack_require__(6773)("./"+c.filename+".json");Se().setAlgorithm(d);var u=(h=Se().reevaluate("intro")).content.length;h.state=f,n.setState({page:h,state:"intro",facts:{}}),u>0?(n.state.state="intro",h.state=f,n.setState({page:h,state:"intro",facts:{}})):(f=n.checkMedCount(h)<=1||"unmedicated"==t||"success"==t||0==i?"recommendation":"medication",(h=Se().reevaluate(f)).state=f,n.setState({page:h,state:f}))}else{var p=e.variables.symptoms;if("intro"==n.state.state)return n.reloadPage(),window.location.reload(!1),(0,ye.jsx)(g,{to:"/app/"});if("medication"==n.state.state){f="intro",(h=Se().reevaluate(f)).state=f,n.setState({page:h,state:f});var m=(h=Se().reevaluate("intro")).content.length;return h.state=f,n.setState({page:h,state:"intro",facts:{}}),0==m?(n.reloadPage(),window.location.reload(!1),(0,ye.jsx)(g,{to:"/app/"})):void 0}if("recommendation"==n.state.state)return f="medication",(h=Se().reevaluate(f)).state=f,n.checkMedCount(h)<=1||"unmedicated"==p||"success"==p||0==i?(f="intro",(h=Se().reevaluate(f)).state=f,h.content.length>0?void n.setState({page:h,state:f}):(n.reloadPage(),(0,ye.jsx)(g,{to:"/app/"}))):void n.setState({page:h,state:f});var h,f=n.state.state;f="medication"!=n.state.state?n.checkMedCount(h)<=1||"unmedicated"==p||"success"==p||0==i?"recommendation":"medication":"recommendation",(h=Se().reevaluate(f)).state=f,n.setState({page:h,state:f})}},n.togglePDF=function(e){null!=e&&"string"==typeof e&&n.setState({pdf:e}),"visible"==n.state.hidePDF?n.setState((function(e){return{hidePDF:"hidden"}})):n.setState((function(e){return{hidePDF:"visible"}}))},n.reloadPage=function(){Se().startOver(),n.state.currentDiagnosis="";var e=__webpack_require__(587),t=__webpack_require__(7091);console.log("g2"),Se().setAlgorithm(t);var i=Se().reevaluate("intro");i.state="intro",n.setState({page:i,diagnoses:e,state:"intro",facts:{}})},n.childRef=e.createRef(),n.state={location:n.props.locationData,page:{},diagnoses:[],facts:{},state:"intro",currentAlgorithm:null,currentDiagnosis:"",currentComorbid:"",hidePDF:"hidden",pdf:"",isCalc:!1},n.setVariable=n.setVariable.bind(ie(n)),n.getVariable=n.getVariable.bind(ie(n)),n.goToNextPage=n.goToNextPage.bind(ie(n)),n.goToPrevPage=n.goToPrevPage.bind(ie(n)),n.nextPageDelay=n.nextPageDelay.bind(ie(n)),n.togglePDF=n.togglePDF.bind(ie(n)),n.reloadPage=n.reloadPage.bind(ie(n)),null!=n.state.location&&(n.state.page=n.state.location,n.nextPageDelay()),n}return te(a,[{key:"checkMedCount",value:function(e){var t=Se().getVariable("medication_history");Se().setVariable("medication_history","Yes"),e=Se().reevaluate("medication");for(var i=0,a=0;a<e.content.length;a++)"switch"==e.content[a].type&&i++;return""==t&&(t="No"),Se().setVariable("medication_history",t),i}},{key:"componentDidUpdate",value:function(e){e.algo!==this.props.algo&&this.loadIt(this.props.algo)}},{key:"contextData",value:function(){var e=new URL(window.location.href).searchParams.get("context");if(e){var t=e.split(".");if(t.length>2){var i=atob(t[1]);return{context:e,data:JSON.parse(i)}}}return null}},{key:"loadIt",value:function(e){if(e){this.state.page;this.state.currentAlgorithm=e;var t,i=__webpack_require__(6773)("./"+e.algorithm+".json"),a=e.diagnosis,n=e.age,r=e.population,o=e.pregnancy;if("Geriatric"==r&&(n=r,r=""),""==o?o="None":r="childbearing",r=r.toLowerCase(),Se().setAlgorithm(i),Se().setVariable("comorbidities",r),Se().setVariable("patient_age",n),Se().setVariable("partum",o),Se().setVariable("diagnosis",a),this.state.currentDiagnosis=a,this.state.currentComorbid="None"!=o&&null!=o?o:""!=r?r.charAt(0).toUpperCase()+r.slice(1):n,this.state.pdf=e.pdf,(t=Se().reevaluate("intro")).state="intro",this.setState({page:t,state:"intro"}),0==t.content.length)if((t=Se().reevaluate("medication")).state="medication",this.checkMedCount(t)>1)this.setState({page:t,state:"medication"});else(t=Se().reevaluate("recommendation")).state="recommendation",this.setState({page:t,state:"recommendation"});console.log(window.location.href);var s=this.contextData();s&&this.fetchAndSetContext(s)}}},{key:"render",value:function(){var e,t=this,i="intro"==this.state.state||"medication"==this.state.state||"recommendation"==this.state.state?"current "+this.state.state:"",a="medication"==this.state.state||"recommendation"==this.state.state?"current "+("recommendation"==this.state.state?"recommendation":""):"",n="recommendation"==this.state.state?"current":"",r="intro"==this.state.state||"medication"==this.state.state||"recommendation"==this.state.state?st:lt,o="medication"==this.state.state||"recommendation"==this.state.state?ct:dt,s="recommendation"==this.state.state?ut:pt;this.getVariable("medication_history");return e=this.state.currentComorbid+" 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