Table 8 shows categorical changes in fasting lipids values. Dyslipidemia Patients should be counseled that dyslipidemia has occurred during treatment fluoxetine with fluoxetine symbyax. Risk of fluoxetine 20 mg fluoxetine developing tardive dyskinesia and olanzapine likelihood that it will become irreversible are believed to increase fluoxetine as treatment duration and fluoxetine the fluoxetine total cumulative dose of antipsychotic drugs fluoxetine administered to the patient increase. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients fluoxetine is olanzapine not clear. FDA Warning regarding off-label use for dementia in elderly. See also: Ingrezza, fluoxetine is an antidepressant in a group of drugs called selective serotonin olanzapine reuptake inhibitors sSRIs ). More severe and/or acute cases have been associated with fluoxetine hallucination, syncope, seizure, coma, respiratory arrest, olanzapine and fluoxetine death see warnings AND precautions. Table 14: Weight Gain with olanzapine Olanzapine Use in Adolescents from 4 Placebo-Controlled Trials Mean change in body weight from baseline (median exposure 3 weeks) Olanzapine-treated patients Placebo-treated patients.6 kg (10.1 lb).3 kg (0.7 lb) Percentage. Tell your doctor fluoxetine right away fluoxetine if you have any serious fluoxetine high side effects, including: unusual or fluoxetine severe mental/mood changes (e.g., olanzapine confusion, nervousness, trouble concentrating, rare thoughts of suicide swelling hands/ ankles /feet, restlessness, shaking (tremor inability to keep still, fluoxetine decreased. Olanzapine was administered to mice in two 78-week studies at doses of 3, 10, and fluoxetine 30/20 mg/kg/day equivalent.8 to 5 times the maximum recommended human daily dose (mrhd) on a mg/m2 basis and.25, 2, and. For females, this rare increase in prolactin levels may result in unwanted breast milk, fluoxetine olanzapine irregular/stopped menstrual periods, or difficulty becoming pregnant. Oral administration fluoxetine of fluoxetine to rats from weaning postnatal day 21 through adulthood day 90 at 3, 10, or 30 mg/kg/day was associated with testicular degeneration and necrosis, epididymal vacuolation and hypospermia (at 30 mg/kg/day corresponding to plasma fluoxetine exposures. The safety and effectiveness of symbyax for the treatment of bipolar I depression in patients under 10 years of age have not been established. Discuss the risks and benefits of treatment with your doctor. Discontinue symbyax if dress is suspected see patient information. Get medical help right away if any of these rare but seriousfainting, severe headache, seizures, eye pain /swelling/redness, widened pupils, vision changes (such as seeing olanzapine rainbows around lights at night, blurred vision ). As with other CNS-active drugs, symbyax should be used fluoxetine with caution fluoxetine in elderly patients with dementia. Hyperprolactinemia may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotropin secretion. Although olanzapine the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. Among adolescent patients, mean weight gain by baseline BMI category was.5 kg (25.3.1 kg (26.6 lb and.7 kg (27.9 lb respectively, for normal (N106 overweight (N26) and obese (N17). Disruption olanzapine of bodys ability to reduce core body temperature has been attributed to antipsychotic drugs. Consider ECG assessment and periodic ECG monitoring if initiating treatment with symbyax in patients with risk factors for QT prolongation and ventricular arrhythmia. Drug reaction with eosinophilia and systemic symptoms (dress) reported with olanzapine exposure; dress may present with a cutaneous reaction (eg, rash or exfoliative dermatitis eosinophilia, fever, and/or lymphadenopathy with systemic complications such as hepatitis, nephritis, pneumonitis, myocarditis, and/or pericarditis; discontinue treatment if dress is suspected. Patients should be advised that they should not alter their dosing regimen, or stop taking symbyax, without consulting their physician see warnings AND precautions. Labor And Delivery symbyax The effect of symbyax on labor and delivery in humans is unknown. Table 10: Changes in Fasting olanzapine Lipids Values from Adolescent Olanzapine Monotherapy Studies Laboratory Analyte olanzapine Category Change (at least olanzapine once) from Baseline Treatment olanzapine fluoxetine Arm Up to 6 weeks exposure At least fluoxetine 24 weeks exposure N Patients N Patients Fasting Triglycerides. Patients starting treatment with symbyax should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. In olanzapine female rats, the precoital period was increased and the mating index reduced at 5 mg/kg/day (2.5 times the mrhd on a mg/m2 basis). Human Data There are no adequate and well-controlled clinical studies with symbyax, olanzapine or fluoxetine in pregnant women. Fluoxetine is primarily metabolized by CYP2D6 see contraindications, adverse reactions, drug interactions, overdose, and clinical pharmacology. Skip the missed dose if it is almost time for your next scheduled dose. Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system pathology. The following data are based on findings in studies performed olanzapine with the individual components, therefore all dose multiples (based on body surface area) reflect the maximum recommended human dose (mrhd) of 20 mg olanzapine, or 80 mg fluoxetine, when each drug is administered separately. Fluoxetine and olanzapine side effects Get emergency medical help if you have signs of an allergic reaction: skin rash or hives ; difficulty breathing; swelling of your face, lips, tongue, or throat. An increase in mammary gland neoplasms has been found in rodents after chronic administration of other antipsychotic drugs and is considered to be prolactin-mediated. In long-term olanzapine olanzapine studies (at least 24 weeks adolescents had increases from baseline in mean fasting total cholesterol, fluoxetine LDL cholesterol, and triglycerides.5 mg/dL,.4 mg/dL, and.5 mg/dL, respectively, and a mean decrease in fasting HDL cholesterol.5 mg/dL. Report any new or worsening symptoms to your doctor. Such adverse reactions were not often the basis for study discontinuations; symbyax should be used with caution olanzapine in patients with clinically significant prostatic hypertrophy, angle-closure glaucoma, a history of paralytic ileus, fluoxetine 40 mg or related conditions. May cause somnolence, postural hypotension, fluoxetine motor and sensory instability, which may lead to falls and, consequently, fractures or other injuries; for patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating antipsychotic treatment. Since the introduction of fluoxetine, systemic reactions, possibly related to vasculitis, have developed in patients with rash. Cerner Multum, what is fluoxetine and olanzapine? Dress may present with a cutaneous reaction (such as rash or exfoliative dermatitis eosinophilia, fever, and/or lymphadenopathy with systemic complications such as hepatitis, nephritis, pneumonitis, myocarditis, and/or pericarditis. Among the cases of rash and/or urticaria reported in premarketing clinical studies, almost a third were withdrawn from treatment because of the rash and/or systemic signs or symptoms associated with the rash. Do not use this medicine fluoxetine if you have taken. Fluoxetine In oral embryo-fetal development studies in rats and rabbits, there was no evidence of teratogenicity following administration of fluoxetine at doses up.5 and 15 mg/kg/day, respectively (1.5 and.6 times, respectively, the mrhd of 80 mg/day on a mg/m basis) throughout organogenesis. In fluoxetine US clinical studies, 7 of 10,782 fluoxetine-treated patients developed various types of rashes and/or urticaria. Table 9: Changes in Fasting Lipids Values from a Single Pediatric symbyax Study in Bipolar Depression Laboratory Analyte Category Change (at least once) from Baseline Treatment fluoxetine Arm Up to 8 weeks exposure N Patients Fasting Triglycerides Increase. Activation Of Mania/Hypomania A major depressive episode may be the initial presentation of Bipolar Disorder. The infants plasma drug levels were 340 ng/mL of fluoxetine and 208/mL of norfluoxetine on the 2nd day of feeding. You may take fluoxetine and olanzapine with or without food. Dizziness and lightheadedness can increase the risk of falling. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia ) in nature. Decreased ovary weight, and corpora luteal depletion and uterine atrophy were observed to a greater extent in the females receiving the high-dose combination than in females receiving either olanzapine or fluoxetine alone. What happens if I miss a dose? There may be circumstances when it is necessary to initiate treatment with an maoi such as linezolid or intravenous methylene blue in a patient taking symbyax. Fluoxetine and olanzapine is a combination medicine used to treat depression caused by bipolar disorder (manic depression). There was a decrease in bone mineralization and density at both doses, but the overall growth (body weight gain or femur length) was not affected. Adults Sedation-related adverse reactions were commonly reported with symbyax treatment occurring at an incidence.6 in symbyax-treated patients compared with.9 in placebo-treated patients. Olanzapine The effect of olanzapine on labor and delivery in humans is unknown. Table 13 olanzapine depicts olanzapine weight gain observed in the pediatric symbyax study. Controlled olanzapine fasting glucose data is limited for symbyax; however, in an analysis of 5 placebo-controlled olanzapine monotherapy studies with treatment duration up to 12 olanzapine weeks, olanzapine was associated with a greater mean change in fasting glucose levels compared to placebo (2.76 mg/dL. A specific effect on bone development was reported in juvenile mice administered fluoxetine by the intraperitoneal route to 4 week old mice for 4 weeks at doses.5 and 2 times the oral mrhd of 20 mg/day on mg/m2 basis. The frequency of weight gain 7, and the magnitude and frequency of increases in lipids, hepatic analytes, and prolactin in children and adolescents treated with symbyax were similar to those observed in adolescents treated with olanzapine monotherapy. Several olanzapine recent epidemiologic studies suggest a positive statistical association between ssri (including fluoxetine) olanzapine use in pregnancy and pphn. Patients should be advised to call their doctor if they experience any increased or unusual bruising or bleeding while taking symbyax. No seizures occurred in the controlled symbyax studies. Abnormal Bleeding Patients should be cautioned about the concomitant use of symbyax and nsaids, aspirin, warfarin, or other drugs that affect coagulation since the combined use of psychotropic drugs that interfere with serotonin reuptake and these agents have been. Ask your doctor before taking a nonsteroidal anti-inflammatory drug (nsaid including aspirin, ibuprofen ( Advil, Motrin naproxen ( Aleve celecoxib ( Celebrex diclofenac, indomethacin, meloxicam, and others. Fluoxetine and olanzapine is sometimes used after at least 2 other medications have been tried without success. Pulmonary reactions, including inflammatory processes of varying histopathology and/or fibrosis, have been reported rarely. The mean change in fasting glucose for olanzapine-treated patients exposed at least 48 weeks was.2 mg/dL (N487). Table 9 shows categorical changes in fasting lipids values from the pediatric symbyax study. Patients should also be advised to inform their physicians if they plan to discontinue any medications they are taking while taking symbyax, as stopping a medication may also impact the overall blood level of symbyax see warnings AND precautions. Hyperglycemia, in some cases extreme and associated with ketoacidosis olanzapine or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics, including olanzapine alone, as well as olanzapine taken concomitantly with fluoxetine. Do not use this medicine if you have taken an MAO inhibitor in the past 14 days. Your family or other caregivers should also be alert to changes in your mood or symptoms. Abnormal Bleeding snris and ssris, including fluoxetine, may increase the risk of bleeding reactions. Olanzapine is not approved for the treatment of patients with dementia-related psychosis see BOX warning, dosage AND administration, and warnings AND precautions. What should I avoid while taking fluoxetine and olanzapine? Upon the appearance of rash or of other possible allergic phenomena for which an alternative etiology cannot be identified, symbyax should be discontinued. Pre-existing glaucoma is almost always open-angle glaucoma because angle-closure glaucoma, when diagnosed, can be treated definitively with iridectomy. All reports with methylene blue that provided information on the route of administration involved intravenous administration in the dose range of 1 mg/kg to 8 mg/kg. Cerebrovascular Adverse Events (cvae Including Stroke Cerebrovascular adverse events (e.g., stroke, transient ischemic attack including fatalities, were reported in patients in trials of olanzapine in elderly patients with dementia-related psychosis. QT Prolongation Patients should be advised that QT interval prolongation and ventricular arrhythmia including Torsade de Pointes have been reported in patients treated with fluoxetine. Caution is advised when using symbyax in patients with diseases or conditions that could affect its metabolism see dosage AND administration and clinical pharmacology. A number of published epidemiological studies assessing the risk of fluoxetine exposure during the first trimester of pregnancy have demonstrated inconsistent results. Table 7 shows the categorical changes in fasting lipids see Clinical Studies. Your doctor may need to adjust your diabetes medication, exercise program, or diet when you start or stop this medication. Hyperglycemia And Diabetes Mellitus Adults Physicians should consider the risks and benefits when prescribing fluoxetine dosage symbyax to patients with an established diagnosis of diabetes mellitus, or having borderline increased blood glucose level (fasting 100-126 mg/dL, nonfasting 140-200 mg/dL). Table 3 shows the categorical changes in fasting glucose see Clinical Studies. Olanzapine may rarely cause a condition known as tardive dyskinesia. Brand Name: Symbyax, medically reviewed by m on Sep 27, 2017 Written. Anaphylactoid reactions (eg, bronchospasm, angioedema, and urticaria) alone and in combination, reported. In some cases, olanzapine this condition may be permanent. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. Neither clinical studies nor epidemiologic studies conducted to date have shown an association between chronic administration of this class of drugs and tumorigenesis in humans; the available evidence is considered too limited to be conclusive at this time. Tell your doctor about all your current medicines and any you start or stop using, especially: any other antidepressant;. Subsequently, the physician may continue decreasing the dose but at a more fluoxetine gradual rate. While these reactions are generally self-limiting, there have been reports of serious discontinuation symptoms. Your doctor may occasionally change your dose. Fasting lipid data is limited for symbyax; however, in an analysis of 5 placebo-controlled olanzapine monotherapy studies with treatment duration up to 12 weeks, olanzapine-treated patients had increases from baseline in mean fasting total cholesterol, LDL cholesterol, and triglycerides. Symbyax should also not be started in a patient who is being treated with maois such as linezolid or intravenous methylene blue. Hyperglycemia/diabetes, increased risk of hyperglycemia and diabetes; in some cases, hyperglycemia concomitant with use of atypical antipsychotics (of which olanzapine is a member) has been associated with ketoacidosis, hyperosmolar coma, or death. 2 Based on a search of the following terms: anorgasmia, delayed ejaculation, erectile dysfunction, decreased libido, loss of libido, abnormal orgasm, and sexual dysfunction. Patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that symbyax therapy does not affect them adversely fluoxetine fluoxetine see warnings AND precautions. Use In Specific Populations. Tell your doctor about all your current medicines and any you start or stop using. The management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, 2) intensive symptomatic treatment and medical monitoring, and 3) treatment of any concomitant serious medical problems for which specific treatments are available. Caution should be exercised when prescribing these medications concomitantly with symbyax see overdose. Tell your doctor right away if you have symptoms of high blood sugar such as increased thirst/urination. In rare cases, this medication may increase your blood level of a certain hormone ( prolactin ). Meta-Analysis Of Antipsychotic Use In Dementia Related Psychosis Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Symbyax is not approved for the treatment of patients with dementia-related psychosis see BOX warning, Use In Patients With Concomitant Illness, and patient information. Elderly patients with dementia-related psychosis treated with olanzapine are at an increased risk of death compared to placebo. Body Temperature Dysregulation Disruption of the bodys ability to reduce core body temperature has been attributed to antipsychotic drugs.
Use prednisolone eye for drops or eye ointment exactly as directed. Specific situation such as being in or on If you are to dogs have surgery, propranolol should public transportation, tunnels, bridges, be withdrawn 24 hours before as it may lifts, planes, cars, or enclosed spaces) interfere with response to stress. Although it's legal for a doctor to prescribe drugs for off-label purposes, it's illegal for a drug manufacturer to actively promote any dogs off-label use. The idea of prescreening patients to determine whether patients respond to the medication is something physicians should consider. Doxycycline Article Continues on Next Page. Availability of Generic Plavix, generic Plavix (like the brand-name version) is available in just one strength - Clopidogrel 75 mg for tablets. Nifedipine, nisoldipine, nicardipine, isradipine or lacidipine drugs used to treat diabetes including insulin. Some drugs may have another patient information leaflet. Stop using Seroquel and call your for doctor at once if you have the following symptoms: very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, uncontrolled muscle movements, feeling light-headed, blurred vision, eye pain, increased thirst and urination. Plavix is a brand name of clopidogrel, approved by the FDA in the following formulation(s plavix (clopidogrel bisulfate - tablet;oral manufacturer: sanofi aventis US, approval date: November 17, 1997. Shake the bottle well if the label says that you should. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your for doctor the benefits and risks of using this medication during pregnancy. Read More, generic : Escitalopram oxalate PPD Drug Class: Central Nervous System Drugs (CNS Psychotropic Drugs/ Antidepressants/ Selective Serotonin Reuptake Inhibitors (ssri) Needs dogs a Prescription: Yes Indications: Listed in Dosage. Tell your doctor if you have ever had: an dogs ulcer in your stomach or intestines ; or a bleeding disorder or blood fluoxetine clotting disorder. If you suffer from acne, you are not alone and many treatment options are. It is made by several different manufacturers, including but not limited to: Aurobindo Pharma, Limited, greenstone LLC. Discuss the risks and benefits with your is unknown if this drug passes into breast milk. Antibiotic Doxycycline demonstrates dogs dogs a wide range of action. Unwanted effects often for improve as your body adjusts to a new medicine but speak with your doctor or pharmacist if any of the following continue or become troublesome. Patients on such drugs may continue with high heart attack and stroke risk if they take clopidogrel. Breastfeeding while using Plavix is not recommended. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: severe rash, itching fluoxetine /swelling (especially of the face/tongue/throat severe dizziness, trouble breathing.This is not a complete list of possible side effects. Overdoses with pills are often a very painful experience - like paracetamol whereby the person will come too after passing out and be dying slowly. This course uses 60 succinct, high-yield videos and brief comprehension quizzes to help you develop a rock-solid understanding of the top 250 medications.
Call high Chapters Capistrano Today for more Information. Medical Disclaimer Next Side Effects Add fluoxetine to My Med List). I begin casually talking to people and get to know some people from my classes. Nervous System Frequent: emotional lability ; Infrequent: akathisia, ataxia, balance disorder1, bruxism 1, buccoglossa1 syndrome, depersonalization, euphoria, hypertonia, libido increased, myoclonus, paranoid reaction; Rare: delusions. Some medicines can interact with fluoxetine and cause a high serious condition called serotonin syndrome. However, the fluoxetine numbers are so low we might high as high well attribute the euphoria to other unseen variables. What should high I avoid while taking fluoxetine? The time of the day is fluoxetine also important in fluoxetine Prozac dosing. Not only did the drug not work, it made some patients worse. This combination fluoxetine is also used to treat depression after at least 2 other medications have been tried without successful treatment of symptoms. The overall profile of adverse reactions was generally similar to that seen in adult studies, as shown in Tables 4 and. Then, the agency found more studies with conflicting findings and released another warning in 2011. This can include having repetitive thought patterns. A reaction was considered treatment-emergent if it occurred for the first time or worsened while receiving therapy following baseline evaluation. It is the third most prescribed antidepressant in the.S. What does Prozac Treat? Prozac and Weight Gain high Weight gain is a side effect of many antidepressants, high including Prozac. As to the remaining questions, as another user said there may be "brain zaps which are hard to explain to someone who's never experienced them, and just general apathy; on ssris you might not be depressed but. Copyright Cerner Multum, Inc. Prozac may increase suicidal thoughts or actions in children, teenagers, fluoxetine and young adults high within the first several months of treatment or after a change in dose. It takes its name from the black border that surrounds the warning information on the drugs packaging. Call your doctor at once if you have: blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights; high levels of serotonin in the body-agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss. An FDA black box warning is the most stringent precaution high a drug can carry before it is pulled from the shelves. A study published in 2014 in the journal jama Psychiatry found that people taking Prozac and other ssris gained one to two pounds over the course of a year; weight gain varied, depending on the ssri used. Click on "Free Coupon" below and sign up to get your free SingleCare pharmacy savings card.
Si necesitás el diseño de un logo, sitio web, papelería o material 3D, podés crear un concurso en la comunidad de Guerra Creativa y elegir entre las propuestas de miles de diseñadores que compiten por obtener el premio. Sin pagar de más, podés obtener la visión de diferentes profesionales, darles feedback y pedirles modificaciones hasta seleccionar el ganador.
Yo realicé un logo en esta comunidad y pagando USD 150, recibí más de 100 propuestas de diversos diseñadores, cuando al contratar un diseñador muchas veces debes elegir entre solamente 3 opciones.
Si bien he escuchado que a varios diseñadores no les parece bien que existan estas “guerras”, como usuarios es muy beneficioso poder tener tantos puntos de vista cuando estamos diseñando la imagen de nuestro negocio.
Aquí podés ver la presentación. Espero que les resulte útil!
Según las últimas estadísticas, el ranking de navegadores utilizados muestra el permanente crecimiento de Google Chrome, la disminución de usuarios de Internet Explorer (Microsoft) y el crecimiento equilibrado de Firefox (Mozilla).
Lo más interesante de las estadísticas es el crecimiento de Google Chrome. Poco después del lanzamiento, los usuarios de Internet que utilizan Chrome como su navegador predefinido ha crecido mucho y continúa avanzando. En Argentina más del 20% de los usuarios utilizan Chrome.
Estas son las estadísticas de utilización mundial a Enero del 2011:
Yo hace poco cambié de Explorer a Chrome y estoy contenta. Vos qué navegador utilizás?
Wix es un editor web online que te permite crear sitios Flash de forma muy fácil y rápida.
Ideal para quienes quieran crear su sitio web, el de su emprendimiento o negocio, sin tener que invertir en el desarrollo y logrando un aspecto profesional.
Simplemente tenés que seleccionar y arrastrar elementos de diseño – propios o de la extensa galería que proporciona Wix – hasta crear tu propio sitio web Flash. Las posibilidades son infinitas, los resultados super profesionales y el costo magnífico: ¡Gratis!
Además de poder crear tu sitio web desde cero, Wix te ofrece cientos de plantillas Flash que podés personalizar a tu gusto. También te permite tener tu carrito de compras y tienda online, aunque esta versión no es gratuita.
Con Wix se han realizado millones de sitios en el mundo y este mes han lanzado la plataforma en español, para llegar al público hispano.
Para todos los que quieran tener un sitio web de calidad sin el costo de contratar a profesionales, es una herramienta que les va a encantar. Manos a la obra!
La cantidad de blogs en el mundo sigue creciendo, se estima que existen unos 150 millones de blogs activos.
Para tener un blog no necesitás conocimientos técnicos, sólo ganas de empezar y de escribir. Es como un sitio web, pero no requiere de especialistas para realizarlo.
Para qué tener un blog?
Qué se necesita?
Vos ya tenés tu blog o querés empezar? Contanos!
Navegando la web encontré este video que me pareció muy interesante para los que recién comienzan a ver el tema y quieren entender de qué se trata el posicionamiento web o SEO .
También les recomiendo seguir leyendo cómo estar en los primeros puestos en Google.
El posicionamiento en buscadores (o SEO -Search Engine Optimization-) se convirtió en una de las herramientas más cotizadas para vender por Internet. Se trata de aparecer en las primeras posiciones en Google y es algo indispensable si querés generar tráfico hacia tu sitio web. Para esto, hay algunos trucos que podés utilizar sin ser una especialista en la materia, aunque debés saber que hay profesionales SEO que pueden ayudarte a realizar un trabajo más profesional.
Lo primero que hay que saber es que el buscador califica a los sitios, y para hacer que el tuyo sea muy atractivo para él debés tener en cuenta: