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.
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Pre-Filled OR Syringes from PharMEDium Services, LLC By Dennis Roberts, DPh
The Regional Medical Center at Memphis is a critical Acceptance From Anesthesia
access teaching hospital, affiliated with the University
Anesthesia has quickly accepted the new cefazolin push syringes,
of Tennessee and operating eight centers of excel-
since they can be administered in two to three minutes, versus the
lence, including burns, level 1 trauma, high-risk obstet-
30 minutes needed for cefazolin piggybacks. The shorter adminis-
rics, wound care, newborn, adult special care, sickle
tration time also made it easier to comply with the Centers for
cell, and bariatric care. We are licensed for 355 beds and 25% Medicare and Medicaid Services (CMS) core measures for surgicalto 30% of our patient population is indigent or self pay.
infection prophylaxis, which require the medication to be adminis-
To ensure the proper labeling and beyond-use dating for our OR
tered within the hour prior to surgery. Our anesthesiologists also
ucts on a daily basis for use in our four
Since using pre-filled syringes, the Regional Medical Center has witnessed a reduction in cefazolin costs and Benefits waste, as well as simplified inventory control for a variety of drugs used in the OR.
security, and 45-day beyond-use dating.
our cefazolin, phenylephrine, ephedrine, and succinylcholine to
well in advance of their expected use. We have also noted a sig-
PharMEDium as a beta site for their OR syringes.
nificant reduction in costs and waste associated with cefazolinsince switching from piggybacks to PharMEDium’s push
Cost Considerations
syringes, due to the elimination of the tubing. In addition, inven-
The cost of a PharMEDium syringe is considerably higher than the
tory control has been simplified. Our buyer places a weekly
cost of preparing a product in-house, even with the associated labor
order, and we currently stock five boxes of 25 cefazolin syringes
reduction. However, with just 24-hour dating on products com-
and two boxes of 25 each of the other products. Because of the
pounded in-house and the syringe quantities anesthesia required to
success of this program, we have asked PharMEDium to consid-
be on-hand, we were destroying 60-plus syringes daily. This made the
er compounding additional syringes, such as ceftriaxone with
premium PharMEDium charges for its syringes financially feasible
lidocaine for IM injections given in the emergency department ■
for our organization, as we stood to waste fewer syringes with theirextended beyond-use dating. Furthermore, in using PharMEDium’s
Dennis E. Roberts, DPh, is the assistant director of pharmacy oper-
cefazolin syringes as a push, we eliminated the cost of piggyback tub-
ations at the Regional Medical Center in Memphis. He is a gradu-
ing, which is actually more expensive than the drug itself.
ate of the University of Tennessee School of Pharmacy.
Reprinted with permission from Pharmacy Purchasing & Products, Vol. 5 #7. 2008 Ridgewood Medical Media, LLC, Ho-Ho-Kus, NJ. All rights reserved.
Journal of Attention Disorders Current Literature in ADHD Abikoff, H., McGough, J., Vitiello, B., McCracken, J.,less access to print media than their nonreferred peers. Davies, M., Walkup, J., et al. (2005). SequentialNonreferred children whose homes had the same type ofpharmacotherapy for children with comorbid atten-media environment as children with ADHD watched astion deficit/hyper
Prefeitura Municipal de Joinville Processo Seletivo para Médico Residente 2009/2010 Medicina Intensiva Dia: 24 de novembro de 2009 • Horário: das 14 às 17 h Duração: 3 horas, incluído o tempo para o preenchimento do cartão-resposta. Confira o número que você obteve no ato da inscrição com o que está indicado no cartão-resposta. Instruções Atenção! Não é per