Le tadalafil possède une affinité marquée pour la PDE5, mais épargne en grande partie les isoformes PDE1, PDE2 et PDE11, réduisant ainsi le risque d’effets extra-caverneux. L’action se traduit par une augmentation contrôlée de la circulation sanguine locale, indépendante des variations alimentaires. Sa pharmacocinétique repose sur une absorption digestive rapide, un métabolisme hépatique par CYP3A4 et une distribution tissulaire large. La biodisponibilité reste stable, et l’équilibre plasmatique est atteint en quelques jours lors d’administrations répétées. Les interactions cliniquement significatives surviennent avec les inhibiteurs puissants de CYP3A4 tels que le kétoconazole. Dans la littérature pharmacologique, acheter cialis 20 mg est souvent associé à des schémas d’utilisation basés sur la durée prolongée de son action.

Microsoft powerpoint - erectile dysfunction and the heart1 - dehaan

• ED is a symptom of many underlying conditions • Endothelial dysfunction seems to be a common final pathway to ED in patients with hyperlipidemia, diabetes mellitus, hypertension, and chronic renal failure • The recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac patient until proven otherwise. • It is estimated that 140 million men worldwide currently experience ED to some degree (Aytac et al, 1999).
• The Massachusetts Male Aging Study (MMAS- 1994), revealed that erectile dysfunction, first emerges as a common problem for men in their early 40s and increases with advancing age (Feldman HA, 1994) • ED was reported in 52% of men aged 40–70 years • The initial event required for penile erection, is primarily a vascular phenomenon, requiring two main processes to occur… 1. Cavernosal artery smooth muscle relaxation – Spinal cord injury– Multiple sclerosis– Dementia – Thyroid d/o– Hypogonadism– Hyperprolactinemia • Chronic Renal Failure• Chronic Liver Failure• Alcoholism• Endocrinologic-thyroid disorders, hypogonadism, • Surgical-radical pelvic surgery (prostatectomy), • Trauma-pelvic fracture, spinal cord injury, etc.
• Cardiovascular Disease • In patients with CVD who also had ED, onset of sexual dysfunction occurred before CVD onset in 93%, with a mean time interval of 24 (12 to 36) months. • The PCPT study established that men with ED were 45% more likely than men without ED to experience a cardiac event after 5 years of follow-up (Thompson et al, 2005).
• In another population-based study of community-dwelling men followed longitudinally, ED was associated with an approximately 80% higher risk of subsequent coronary artery disease at 10 years (Inman et al, 2009). • In a long-term follow-up (15 years) of the Massachusetts Male Aging Study (Feldman et al, 1994), ED was found to be positively associated with subsequent all-cause and cardiovascular disease mortality • The metabolic syndrome (MetS) includes glucose intolerance, insulin resistance, obesity, dyslipidemia, and hypertension.
• Higher prevalence of ED (26.7%) in men with • The prevalence of ED increases as the number of MetS components increases (Esposito et al, 2005). – Medical– Sexual (i.e. IIEF self administered questionnaires)– Psychosocial– Cardiovascular Risk Assessment • Physical Exam (check BP)• Lab Studies – BMP, CBC, HgA1c, Lipid profile, Testosterone, TSH,

Source: http://metrohealth.net/wp-content/uploads/2012/01/Erectile-Dysfunction-and-the-Heart1-DeHaan.pdf