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.

Rxpg.com

Pinta (skin disease) is caused by Treponema carateum

2. Symmetrical normoaesthetic macules are seen in-
1.
Lepromatous leprosy-------------------ans Discussion-

Leprosy- (P-264 Park)
Cardinal signs-
•
Anesthetic--> first goes temperature (cold first) Enlargement of nerve--> ulnar nerve--> claw hand BI*- Bacteriological Index (Used for classification) MI- Morphological Index (Live bacilli--> therapeutic response) Paucibacillary: 1-5 skin lesion : BI < 2 : TT, BT Multibacillary: >5 skin lesion: BI > 2 : BB, BL, LL Ridley Jopling classification- Depending on CMI- TT--> Anesthetic + anhidrosis + complete loss of hair, saucer right way up lesions BT--> Satellite lesions
BB--> Inverted saucer, Punched out, Swiss cheese, Lepromin test -ve BL--> Onion peel/cut onion--> Nerve LL--> Leonine fascies, Glove+Stocking, BI 6+, globi, Genz zone (cell free zone below Indian classification- Madr id classification + Pure neuritic form High immunity (TT,BT)
Low immunity (LL,BL)
immunity--> higher loss), AFB -/less, Plaques Prevalence of leprosy--> 0.6 (1.34 per 10,000 › Ck PARK P-265) Generation time › 12-14 days (longest) Nerves involved in 100% cases--> Ulnar, Radial, Facial(in that order) Leprosy affects everything except--> CVS, CNS, Ovary (affects uterus)--> ck C/F--> Intermediate Leprosy (M/C INDIA)--> Facial les ions, no nerve thickening, smear negative Histoid leprosy- Seen in INDIA--> Cause--> dapsone monotherapy resistence. Dome shaped nodes on normal skin, linear elongated bacilli. Lazar ine leprosy--> Synonym for Lucio's leprosy › Malnutrition, HIV--> Severe skin destruction
Leprosy treatment-
•
MB- R/D/C 1 Yr
(FDT- Fixed duration therapy--> earlier MDT) Leprosy is only disease where I+D not done--> nerve damage will occur Harr ison is good for all except leprosy.
Lepra reaction-
1.
Type I(Reversal reaction)- BT/BB, Type IV HS, IL-1,2; IFN-gamma, Neuritis› Steroid Type II(ENL)- BL/LL—> TNF-alpha --> Thalidomide(inhibits TNF-alpha so DOC)-->other

9. A young man aged 19 years developed a painless penile ulcer 9 days after sexual intercourse
with a professional sex worker; likely diagnosis is:
1.
Discussion- if in place of sex worker there is normal married male with painful ulcer then-->4

25. A case with bilateral inguinal swelling comes to the STD clinic what organism will you
provisionally treat-
1.
LGV-------------------ans (Inguinal bubo- LGV and chancroid)
45. DOC for tertiary syphilis-
1.
Discussion: Congenital/Neuro Syphilis--> Crystalline pennicillin

49. All are seen in Lepromatous Leprosy except-
1.
Inflammatory reaction is sparse---------------------ans Surface of the skin lesions is smooth and shiny
58. What is the time period required for the MI of a patient on treatment to become 0 on MDT-
1.
67. A case of Urethral discharge comes and the smear shows Intracellular Diplococci with PMN.
How will you treat this case-
1.
Doxycycline 100 mg orally twice a day for 7 days NGU- Scanty, Mucoid, Odourless, >5 PMN, M/C Chlamydia (McCoy cell line) Rx: GU- Profuse, yellow, foul smelling, >5 PMN + Intracellular diplococci, Culture-BA; Rx: Gonorrhoea- Cefixime 400mg, Ceftriaxone 250 mg stat
68. Persistent painless bleeding ulcer that spreads by inoculation is seen in-
1.

69. In HIV positive patient of syphilis what treatment will you give in early syphilis-
1.
Benzathine penicillin G, 2.4 million units IM--------------ans Benzathine penicillin G, 2.4 million units IM one dose weekly for 3 weeks Doxycycline, 100 mg PO, twice daily for 15 days Doxycycline, 100 mg PO, twice daily for 30 days Discussion- H/17 P-1044; Option 2--> late

71. How will you treat a case of chancroid with HIV-
1.
Doxycycline 100 mg orally twice a day for 7 days Erythromycin 500 mg QID for 7 days-------------------ans Discussion- 1 gm Azithromycin or 250 mg i. m. Ceftriaxone. In HIV 500 mg oral erythromycin 4 times per day for seven days

Source: http://www.rxpg.com/files/leox/15.%20Venerology.pdf