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.

Supported living referral

REQUEST FOR PROPOSAL
All TDD Nursing Providers
Michelle Lindrose, Service and Support Administrator
Denise Scott, Service and Support Administrator Supervisor
October 17, 2013
Client: # 437
This person is a 30 year old male with tuberous sclerosis, seizures, mild mental
retardation, and visual issues who requires up to 24 hours supervision. He
resides with his mother and father in a family home in Painesville.

DEADLINE
TO RESPOND:
RFP (Responses due by 10/22/2013.) To be considered for an interview, please
respond no later than the end of business day on Tuesday, by email
be sure to include the referral (RFP) number,
and your contact information on the email.
FUNDING
SOURCE:
TDD waiver
SERVICE
HOURS NEEDED:
October 29, 30 and 31, 2013 from 6:00am – 4:00pm


DIAGNOSES:
Tuberous Sclerosis, Seizures, Mild Retardation, Asthma, Esophageal Reflux,
Visually Impaired, Diaphragmatic Hernia, Joint pain, CVA.

CURRENT
MEDICATION:
Melatonin 3mg for sleep
Albuterol 2-4 puffs every 4-6hours for asthma
Trazedone 100mg for sleep
Flovent 1 puff BID for asthma
Glycolax 17 grams for constipation
Tranxene 7.5mg BID and 3.75 mg daily for seizures
Tegretol XL 400mg in am/800mg HS for seizures
Spirnolactone 25mg BID to assist with lasix
Lyrica 200mg BID for seizures
Lasix 20mg BID for edema
Urea 40% 1x/day for foot fungal infection
Ondensetron HCL 8-24mg in 24 hr period for vomiting
Prevacid 30mg BID for reflux
Ketoconazole shampoo 2% daily for eczema
Ketoconazole cream 2% BID eczema
Gloves in a bottle lotion for eczema
Tylenol 500-650mg PRN for pain
GUARDIANSHIP:
Individual’s mother and father are his guardians.

PROVIDER
REQUIREMENT:
Provider would need to be able to provide services as identified in ISP.
Provider would need to be able to help lift individual. Provider will need to
administer medication to individual during the shift.

SERVICE AREAS:
Transportation, Community Membership, Safety, Health, ADL’s, Social Skills.

CHOICE &
OPTIONS:
Individual enjoys accessing the community. Individual enjoys riding his
stationary bike. He is friendly and enjoys giving hugs. He can walk a little with
assistance. Individual enjoys swimming, listen to baseball and music daily. He
also enjoys fishing, playing bocce ball, basketball and hockey. He has a low
sodium diet due to his cholesterol.

PERSONAL
INCOME:
Individual’s mother manages his finances.

HOUSING:
This individual lives with his mother and father.

COMMUNITY
MEMBERSHIP:
Provide opportunities for social outings in the community. This individual
enjoys outdoor activities.
Total assistance in the event of an actual emergency due to physical disability.
Individual’s mother schedules medical appointments. Staff may be required to
assist mom with transporting individual to appointments. Individual requires
physical assistance with his ADL’s. Individual does not self-medicate, and
provider will monitor for seizure activity.

Source: http://www.lakemrdd.org/services/documents/437TDDoctober172013.pdf