Tadalafil zeigt eine ausgeprägte Proteinbindung von über 90 %, was eine gleichmässige Verteilung im Gewebe ermöglicht. Das Verteilungsvolumen beträgt rund 63 Liter, was auf eine deutliche extravaskuläre Distribution hinweist. Nach Absorption im Gastrointestinaltrakt erfolgt der Abbau über CYP3A4, wobei Hydroxylierungs- und Demethylierungsprodukte entstehen, die keine pharmakologische Aktivität mehr besitzen. Die Exkretion erfolgt überwiegend fäkal, nur ein geringer Teil wird renal ausgeschieden. Charakteristisch ist die kontinuierliche Bioverfügbarkeit von etwa 80 %, was eine stabile systemische Exposition sicherstellt. Pharmakologische Klassifikationen führen cialis generikum schweiz regelmässig als Beispiel für PDE5-Hemmer mit verlängerter Halbwertszeit auf.

Microsoft word - 2012-10-09-guidesmaster for website pdfs.doc

This is an example practice guide excerpted from one of the 800-page
Practice Guide books p - 180 -
d by Acute Care Horizons, LLC.
For info on this book go to: http://www.acutecarehorizons.com
FLANK PAIN PRACTICE GUIDE
When using any Practice Guide, always follow the Guidelines of Proper Use (page 16). Differential Diagnosis
● Renal colic ● Biliary colic ● Aortic aneurysm ● Mechanical back pain ● Herpes zoster ● Pyelonephritis ● Renal vein thrombosis ● Retroperitoneal bleeding ● Appendicitis Considerations
● Renal colic is most common misdiagnosis of ruptured ● Aortic disease cause more frequent in elderly ● No hematuria on U/A with 10–15% of kidney stones ● Flank ecchymosis indicative of intra-abdominal Evaluation
● Detailed abdomen, back, flank, and neurovascular Musculoskeletal suspected as cause
● No tests unless blunt injury occurred ● Blunt trauma consider x-ray ● CBC and U/A as indicated Kidney stone suspected
CT abdominal/pelvis scan considered
● Aortic cause suspected ● Inadequate response to pain medications D-dimer
● Can be used as screening test to rule out aortic ● Coumadin (warfarin) can cause false negative D- ● Elderly have a positive D-dimer > 50% of the U/A
● UTI symptoms ● Obtain urine C&S if pyelonephritis suspected or a Treatment Options
● Toradol (ketorolac) 30 mg IV with or without Dilaudid (hydromorphone) 0.5–1 mg IV (or other equipotent narcotic) and Phenergan (promethazine) 6.25 mg or Zofran (ondansetron) 4 mg IV for suspected renal ● Do not use Toradol (ketorolac) if creatinine is ● Musculoskeletal can be treated with Tylenol, OTC medication, NSAID or short narcotic course ● Narcotic short course prn on discharge for renal colic pain, with or without Toradol (ketorolac) ● Phenergan (promethazine) prn ● Flomax (tamsulosin) 0.4 mg PO every day for 2-4 ● Simple UTI: Septra DS, cephalosporin or quinolone for ● Pyridium: 200 mg TID prn urinary symptoms — do not ● Pyelonephritis: 10–14 days of simple UTI antibiotic ● IV Rocephin (ceftriaxone) or Levaquin (levofloxacin) × 1 can be given initially Discharge Criteria
● Renal colic controlled ● Simple cystitis ● Pyelonephritis in nontoxic patient and able to hold Discharge instructions
● Flank pain aftercare instructions ● Refer to primary care provider or urologist as Consult Criteria
● Unknown cause of moderate to severe flank pain ● Unable to hold oral fluids down at home ● Heart rate ≥ 110, hypotension or relative hypotension (SBP < 105 with history of hypertension) ● Suspected vascular cause of flank pain ● Toxic UTI patient ● Unable to hold down medications at home ● WBC ≥ 15,000 ● Bandemia ≥ 15% ● New onset anemia ● Inadequate renal colic relief ● Age ≥ 60 without firm diagnosis ● New onset renal insufficiency or worsening renal ● Solitary kidney with ureteral calculus ● Pyelonephritis with ureteral calculus Notes _____________________________________ _____________________________________ _____________________________________

Source: http://www.clinician1.com/images/book_guide_pdfs/Flank_Pain.pdf