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.

Health care aspects

Session 6
• By administration of prophylaxis / anti-viral 1. Neuraminidase inhibitors
Oseltamivir* (Tamiflu)
Zanamivir (Relenza)
2. Adamantanes
Amantadine
Rimantadine
* Most relevant in treating human cases of avian influenza.
• Active against influenza A and B
– Against H5N1 and other AI viruses
• Oseltamivir: (Tami flu)
– Antiviral resistance may occur
– Antiviral for pandemic containment
– WHO has rapid response stockpile
Route of Administration
• Administer orally
For Treatment
• Administer within 48 hours of
symptom onset
For Prophylaxis
• Give to close contacts within
48 hours of exposure
Capsules 75 mg each
Liquid Suspension
– 10 capsules per box
– White powder mixed with
– Manufacturer: Roche
23 mL of drinking water
– Brand name—Tamiflu®
– Fruit flavored
– Store at room
– Refrigeration required
temperature (15 - 300C)
– Use within 10 days
– Oral dispenser included
Treatment with Oseltamivir
• Active against H5N1 viruses in the laboratory
and in experimental animals
• No proof of effectiveness against human
H5N1 disease
• Optimal dose and duration of treatment yet
to be determined
• Use Oseltamivir dosing for seasonal
influenza per WHO recommendations
Oseltamivir Treatment Regimen
• Adults: 75 mg two times a day for 5 days
• Not approved for children less than 1 year of
• Children > 1 year old:
<15 kg:
30 mg twice daily
15 - <23 kg:
45 mg twice daily
23 - <40 kg:
60 mg twice daily
> 40 kg:
75 mg twice daily
Patient Age
Prophylactic Dose
> 13 years
1 capsule (75 mg) once a day
1 to 12 years < 15 kg: 30 mg once a day
15-<23 kg: 45 mg once a day
23-<40 kg: 60 mg once a day
> 40 kg: 75 mg once a day
*Duration of prophylaxis depends on epidemiologic
setting. Post-exposure use is typically for 7 to 10 days.
• Headache (20%)*
• Nausea (10%)
• Vomiting (9%)
• Fatigue (8%)*
• Diarrhea (7%)
• Cough (6%)*
• Bronchitis, abdominal pain, dizziness (2%)
• Insomnia, vertigo (1%)
*In study of Oseltamivir as prophylaxis, treatment % is lower.
Serious Adverse Events*
Allergic reactions
Skin rash (sometimes severe)
Facial swelling
Dizziness
Hepatitis
*A causal relationship has not been established for
many of these
ƒ School closuresƒ Business and market ƒ Cancellation of eventsƒ Movement restrictions • Limited evidence to evaluate NPI for influenza • Tailor NPI to each locality’s situation • NP interventions likely useful in delaying spread of disease, and should be used in coordination with other interventions ƒ School closuresƒ Business and market ƒ Cancellation of eventsƒ Movement restrictions – Separation and restricted movement of ill persons – Often in a hospital setting– Primarily individual level – Separation and restricted movement of well – Often at home, may be designated residential – Applied at the individual or community level • Location of isolation (eg home, hospital) • Plan for large number of severe cases – Separation and restricted movement of ill persons – Often in a hospital setting– Primarily individual level – Separation and restricted movement of well – Often at home, may be designated residential – Applied at the individual or community level • Used when resources are available to – Provide essential services and care for those in • Used in combination with other interventions – Surveillance, diagnosis, treatment, and preventive • Does not have to be absolute to be effective • Implementation requires clear understanding of • Implementation requires coordinated planning – Public health authorities, health-care providers, emergency response teams, law enforcement, and transportation authorities • Implementation requires trust and participation – Effective risk communication, support and – Becomes difficult as case load increases – Essential during rapid response phase • Regular health monitoring is essential part – Conduct frequent health checks for high risk groups (e.g. household contacts of suspected cases) – Self-health monitoring and reporting – Fever telephone hotlines and clinics – Cleaning and disinfection of surfaces Infection Control Practices and Personal – Destroys the influenza (eg, H5N1) virus, when – Results in fewer upper respiratory infections – Hand washing stations in public places References: WHO Writing Group. Emerg Inf Dis 2006;12:88-94 *WHO SEARO: Simple public health interventions for Avian Influenza Infection Control Practices and Personal Infection Control Practices and Personal – Recommended for symptomatic persons and persons seeking care for respiratory illness in high risk areas (waiting rooms) – Consider use when caring for ill persons in the – Consider use among high risk populations, and exposed persons (poultry workers, market workers) • PPE should be used in health care facilities • Use household cleaning products such as alcohol • In hospitals clean rooms daily or more ƒ School closuresƒ Business and market ƒ Cancellation of eventsƒ Movement restrictions – Evidence or suspicion of human-to-human – Monitor for illness and provide essential services and – Barrier that restricts travel in and out of an area – Helpful in closed settings (military barracks, – Especially useful if high morbidity among – Access to and availability of necessities • Population measures to increase social – Discourage mass gatherings such as festivals • Another population measure to increase social – Restrictions on public transportation and public – Voluntary or involuntary work holidays – Effectiveness– Implementation– Alternative infrastructure • Early, rapid response may be key to successful • Health officials have legal authority – Review existing laws prior to pandemic – Under what conditions can authority be used? – How is quarantine/isolation enforced? Note: Please adapt this content to your country
• Administrative communication & coordination – Define who will make decisions about which NPI to – Define who will be responsible for implementation and – Rapid response teams, MOH and WHO should communicate regularly and coordinate activities Note: Please adapt this content to your country
– Compensation for mandatory isolation and Protocol for demobilization for RRT and
subsequent precautions
• Minimum of 7 days’ Quarantine for members of • Disinfection of bags, spectacles, cap, valet etc.

Source: http://nandurbar.nic.in/html_docs/animalhusb/birdflu/Important.pdf