Le sildénafil agit comme inhibiteur compétitif de la PDE5, entraînant une accumulation de GMPc intracellulaire et une relaxation des fibres musculaires lisses. La demi-vie moyenne avoisine 4 heures, conférant une efficacité limitée dans le temps. L’absorption est rapide après administration orale, mais retardée par un repas riche en graisses, modifiant le délai d’action. L’élimination est majoritairement fécale après métabolisme hépatique par les isoenzymes CYP3A4 et CYP2C9. Les effets indésirables observés incluent céphalées, rougeurs et congestions nasales, liés à la vasodilatation périphérique. Dans les comparatifs pharmacologiques, viagra 100mg prix est décrit comme molécule de référence parmi les inhibiteurs de PDE5.

Hartzells.com

300 American Street, Catasauqua, PA 18032610-264-5471 or 1-800-325-6856Email: [email protected] Today’s Date: / / Date of Birth: / / ☐ Male ☐ Female TRAVEL SPECIFICS
Purpose of trip: ☐ School related study/ work What school? ☐ ☐ Visiting ONLY urban areas? If no, explain: ☐ ☐ Staying ONLY in hotels? If no, explain: ☐ ☐ Visiting friends and family?☐ ☐ Ascending to high altitudes (>7,000ft or 2,300 meters) in the mountains? ☐ ☐ Working in the medical or dental field with exposure to Does your program require the completion of a medical form by a ☐ ☐ Working with exposure to animals? ☐ ☐ Potentially having sex with new partners? Are you currently enrolled in a health insurance plan that covers you while overseas?. ☐ Yes ☐ No ALLERGIES
What insurance coverage do you currently have? ☐ No known DRUG allergies ☐ No known FOOD allergies Have you had an allergic reaction to any of the following? (please check all Departure: Date and U.S. City departing from United States: Return: Date and U.S. City entering upon return date to United States: (wheezing, rash, trouble breathing, etc.) If you have a detailed itinerary, please attach it so that we can review the full details ☐ Antibiotics (e.g. Neomycin, Streptomycin)☐ Sulfa drugs (e.g. Bactrim, Septra, Gantrisin)☐ Chrysanthemums☐ Pyrimethamine☐ Quinines (Chloroquine [Aralen], Mefloquine [Lariam], Hydroxychloroquine [Plaquenil], Primaquine) A. Have you travelled outside of the United States before? ☐ Yes ☐ No 300 American Street, Catasauqua, PA 18032610-264-5471 or 1-800-325-6856Email: [email protected] MEDICAL HISTORY
Are you using steroids, receiving radiation therapy, or other immunosuppressive chemotherapy? ☐ Yes ☐ No List your current prescription medications and medical condition (include birth control pills). If you need additional space, please attach a separate List regularly used non-prescription medications (over-the-counter, herbals, vitamins, homeopathic). If you need additional space, please attach a separate sheet to this form: Have you been told that you have any of the following medical conditions? (list any others on the back) 300 American Street, Catasauqua, PA 18032610-264-5471 or 1-800-325-6856Email: [email protected] For Women Only:
Last normal menstrual period:
Are you or could you be pregnant? ☐ Yes ☐ No
Are you currently breast-feeding or will you be on the trip? ☐ Yes ☐ No
Please attach a current vaccine record to this sheet. If you do not have an updated vaccination record, please complete a Release of Records
form so that we may contact your other health care providers to obtain the necessary information. Vaccine record attached: ☐ Yes ☐ No
Are there any specific concerns or questions you have about your travel that you would like answered during the consultation? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________(patient name), grant Hartzell’s Pharmacy permission to contact my physician to obtain any necessary health information that would be relevant for this travel health consultation. I acknowledge that I have completed this form to the best of my abilities. I am aware that the Travel Health Consultation will be based on the information provided herein. I am aware that a non-refundable deposit of $30.00 (CPT 99605) will be charged up front and applied to the first 15 minutes of the consultation.

Source: http://www.hartzells.com/Assets/thc_intake_sheet.pdf