Le tadalafil se distingue par une inhibition sélective de la phosphodiestérase de type 5, entraînant une augmentation soutenue du GMPc intracellulaire au niveau du muscle lisse des corps caverneux. Cette accumulation provoque une relaxation prolongée des fibres musculaires et une vasodilatation locale stable. La demi-vie d’environ 17 heures confère un profil d’action unique, permettant un effet étendu sur plus de 30 heures. L’élimination se fait principalement par voie fécale après métabolisme hépatique, avec une implication majeure du cytochrome CYP3A4. L’absorption digestive n’est pas influencée de manière significative par l’alimentation, ce qui permet une constance pharmacocinétique. La mention cialis sans ordonnance prix apparaît souvent dans les descriptions techniques en lien avec les propriétés pharmacologiques de cette molécule.
Ags_questionairrefinal
Arizona Glaucoma Specialists (www.azglaucomaspecialists.com) Tucson (520) 544-4393 Fax (520) 544-0098 Phoenix (480) 538-7075 Fax (480) 538-7952
Name:____________________________________ Date:___/___/____ Age/DOB:___________________________
Referred by:________________________________ Primary Care Physician:________________________________
Please fill out FRONT AND BACK of this page by checking or circling all that apply. Is there a family history of Glaucoma? Glaucoma Suspect? Y N (Mother, Father, Brother, Sister, Other________) EYE HEALTH QUESTIONS Details (Dates, Doctors, etc.) Decreased vision
Sharp – Dull – Constant – Intermittent – Upon awakening(morning) – Evening/Night
Constant – Intermittent – Upon awakening(morning) – Day - Night
Haloes around lights Floaters Flashes of light Fluctuating/Distorted vision Double vision Dryness/ Sandy feeling Itching/Burning Glare/Light Sensitivity Discharge/Infection Drooping eyelid Crossed eye/ Lazy eye Excess tearing/ watering Glaucoma
Suspect - Open Angle - Closed Angle – Steroid Related – Childhood – Injury Related – Pigmentary - Other
Glaucoma Surgery
Trabeculectomy w/ (Mitomycin, 5 FU) – Shunt – Other
Glaucoma Laser
Iridotomy – Laser Trabeculoplasty (ALT, SLT)
High eye pressure Cataract Cataract Surgery/YAG Laser Retinal detachment
Buckle – Laser Treatment – Cryo - Vitrectomy
Macular degeneration/ hole Diabetic eye disease Retinal Vein/Artery Occlusion Eye injury Corneal Transplant Glasses/Contact Lenses
Reading – Distance – Soft Lenses - RGP
CURRENT EYE MEDICINES # DROPS PER DAY Xalatan – Lumigan - Travatan(Z) Alphagan P (brimonidine) 0.1% 0.15% 0.2% Timoptic(XE) -Timolol(GFS) - Betimol - Optipranolol 0.25% 0.5% Betagan(levobunolol) - Betoptic S - Ocupress 0.25% 0.5 % Cosopt – Azopt - Trusopt Pilocarpine 0.5% 1% 2% 4% (gel) Diamox (Sequel) (acetazolamide) 250mg 500mg Neptazane (methazolamide) 25mg 50mg
Are there any glaucoma medications you have taken previously? Y N _____________________________________ Are there any glaucoma medications you could not tolerate (allergies)? Y N _______________________________ What have your highest eye pressures been? (Pre-Treatment, Post-Treatment) RT___ LT___ Date ________Unknown Please list all other medications you currently are using (prescription, over-the-counter, herbs, vitamins, supplements): 1_______________________4______________________7______________________10________________________2_______________________5______________________8______________________11________________________3_______________________6______________________9______________________12________________________ Please list all other past surgeries (from birth to present): 1_______________________4______________________7______________________10________________________2_______________________5______________________8______________________11________________________3_______________________6______________________9______________________12_______________________ List all allergies: __________________________________________________________________________________
MEDICAL HISTORY Diabetes (How many years?) Breathing Problems or Treatments Heart Problems or Treatments
Heart Attack – Arrhythmia – Irregular Heartbeat
Blood Pressure Problems or Treatments Stroke – Seizure, other Neurologic Problems Depression – Psychiatric Problems or Disorders Kidney Stones – other Genital/Urinary Disease Currently Pregnant Arthritis, Lupus, Thyroid, or Raynaud’s Disease Skin Cancer – other Skin Disease Sinus Problems – Ear/Nose/Throat problems Ulcers – other digestive problems Steroid Use
Inhalation – Oral Prednisone – Injection – Cream/Lotion
Blood Loss – Anemia – Blood Transfusion Migraine Social History
Occasional – 1/day – 2-3/day – 4+/day
Do you smoke? Quit? When? _______________
Occasional – 1/2pack/day – 1pack/day – 1+pack/day
The above information is true and correct to the best of my knowledge. Patient Signature: _________________________________________ Date: __________________ History Reviewed No Changes Additions as noted Technician Initials: _______ Doctor’s Signature: __________________________________________ Date: ___________________ TO BE FILLED OUT BY STAFF – Pulse_________ __________
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