Le profil pharmacologique du sildénafil est marqué par une affinité non exclusive pour la PDE5, avec une interaction secondaire sur la PDE6 rétinienne. Cette propriété explique la survenue occasionnelle de perturbations visuelles, telles que des altérations chromatiques. Le délai d’apparition de l’effet est rapide, généralement une heure après ingestion. Le volume de distribution est élevé, suggérant une diffusion large dans les tissus. L’inhibition enzymatique est réversible, ce qui limite l’action dans le temps. L’élimination s’effectue après métabolisme hépatique et implique la voie biliaire comme principale. Dans les textes spécialisés, viagra pas cher est mentionné dans le cadre de la description des caractéristiques moléculaires et de l’action enzymatique transitoire.

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Name: __________________________________________________ Today’s Date: _______________ Date of Birth: _______________________ Social Security #: ___________________________________ Street address: _________________________________________________________________________ City: __________________________________________ State: ______________ Zip:_____________ Phone numbers: Home _____________________________ Cell______________________________ Do you have an email address you can share with us?________________________________________ We would like to stay in contact with you at all times. Please provide us with a summer residence location if you have one: ________________________________________________________________ Patient employed by: __________________________________________________________________ Business address: _____________________________________________________________________ Business phone: ______________________________________________________________________ Marital status: (please circle) Married Divorced Single Widow Living with Sig. Other Spouse’s Name: ______________________________________________________________________ Spouse’s date of birth: _______________________ Social Security #: _________________________ Spouse employed by: __________________________ Business phone:_________________________ In case of emergency, whom should we notify? _________________________________________ Phone number(s): _________________________________________________________________ Signature: _____________________________________________ Date: __________________________ y? f it is a problem, please describe the symptoms & be specifi c: _______________________________________________________________________ ______________________________________________________________________________
OB HISTORY
1. How many times have you been pregnant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________2. How many miscarriages have you had? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________3. How many abortions have you had? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________4. Have you had any Tubal/Ectopic pregnancies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________5. How many vaginal deliveries have you had? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________6. How many Cesarean Sections have you had? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________7. Have you had any premature deliveries? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________8. Have you had any babies weighing less than 5 lb 8 oz at birth? . . . . . . . . . . . . ____________9. How many full term deliveries? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________10. Have you had any twin births? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________11. Did you have any complications with your pregnancies? ❏ YES ❏ NO If yes, list: __________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ GYN HISTORY
3. What type of contraception are you currently using? (CIRCLE BELOW) Pills Tubal Ligation Condoms Withdrawal Depo Provera IUD Foam Vasectomy Diaphragm Implants Other __________________4. What type of contraception have you used in the past? (CIRCLE BELOW) Pills Tubal Ligation Condoms Withdrawal Depo Provera IUD Foam Vasectomy Diaphragm Implants Other __________________5. Are you having any problems with your method of Birth Control? ❏ YES ❏ NO6. Have you ever had any vaginal, cervical and/or tubal infection? If yes, please check below: ❏ Yeast ❏ Gardnerella ❏ Syphllis ❏ Condyloma ❏ Bacterial Vaginitis ❏ PID ❏ Herpes ❏ Trichomonas ❏ Chlamydia ❏ Gonorrhea ❏ Warts ❏ Other _________7. Date of last pap smear? ________________________________________________________8. Have you ever had an abnormal pap smear? If yes, how was it treated? Please check below: ❏ Repeated Pap Smear ❏ Colposcopy ❏ Laser Surgery ❏ Cone Biopsy ❏ Cryosurgery (freezing) ❏ Hysterectomy ❏ Loop Excision9. Do you have trouble leaking urine? 10. Do you have any breast lumps, tenderness or discharge? Date of last mammogram ____________________________________________________11. Do you do breast self exams? If yes, any treatment?________________________________________________________13. Do you have any hot fl ashes or menopausal symptoms? 15. Do you have a history of infertility? 16. Do you have a history of DES exposure? MENSTRUAL HISTORY
1. If you no longer have periods, please state reason: __________________________________2. First day of last period: ________________________________________________________3. How many days does your period last? ___________________________________________4. Are your periods regular? 5. How many days from the start of one period to the start of the next period? _____________6. Has the fl ow changed in any way? ___________ If so, how? ___________________________7. Do you have any bleeding between periods? 8. Do you have any cramping with your periods? If yes, circle one: mild moderate severe9. Medicine taken for cramps? ____________________________________________________ SOCIAL HISTORY
If yes, # per day? _________________________ Number of years? ____________________2. Do you use street drugs? If yes, how much per day?______________________________________________________ PAST MEDICAL HISTORY
6. Have you ever been treated for psychiatric problems? 9. Have you ever had a urinary tract infection? 10. Have you ever had hepatitis/liver disease? 11. Have you ever had varicosities/phlebitis? 14. Have you ever had any blood transfusions? If yes, please list:_____________________________________________________________17. Please list any GYN surgeries:______________________________________________________________________________ ______________________________________________________________________________18. Please list any other operations/hospitalizations (include year & reason):______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________19. Have you had any anesthesia complications? If yes, please list:_____________________________________________________________20. Have you ever been anemic? 21. Do you have an Internist or Family doctor? Please list name, phone number:______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________22. Are you currently on any medications? If yes, please list with dosage: __________________________________________________23. Have you had your cholesterol checked? If yes, date last checked: ______________________________________________________ Was it normal? If yes, what type? ____________________________________________________________25. Do you have Lupus, Scleroderma or similar diseases? If yes, please describe: ________________________________________________________ FAMILY HISTORY
1. Do you have a family history of breast cancer? If yes, whom?_______________________________________________________________2. Do you have a family history of colon cancer? If yes, whom?_______________________________________________________________3. Do you have a family history of ovarian cancer? If yes, whom?_______________________________________________________________4. Do you have a family history of osteoporosis? If yes, whom?_______________________________________________________________5. Do you have a family history of diabetes? If yes, whom?_______________________________________________________________6. Do you have a family history of hypertension? If yes, whom?_______________________________________________________________7. Do you have a family history of heart disease? If yes, whom?_______________________________________________________________8. Do you have a family history of kidney disease? If yes, whom?_______________________________________________________________

Source: http://www.icambartissmd.com/forms/cert_female_assessment_form.pdf