Tadalafil entfaltet seine Wirkung über eine selektive Hemmung der PDE5, wodurch die Konzentration von cGMP im glatten Muskelgewebe stabil bleibt. Diese biochemische Modulation resultiert in einer langanhaltenden Relaxation der Gefäßwände. Der Wirkstoff wird nach oraler Einnahme effizient resorbiert, mit einer Bioverfügbarkeit von rund 80 %. Seine Halbwertszeit von bis zu 36 Stunden ist innerhalb dieser Substanzklasse außergewöhnlich. Abgebaut wird er in der Leber, hauptsächlich durch CYP3A4, mit anschließender biliärer Exkretion. Typische unerwünschte Wirkungen entstehen durch eine verstärkte Vasodilatation, etwa Kopfschmerzen oder Flush. Pharmakologisch wird cialis generika vor allem durch die verlängerte Wirkungsdauer charakterisiert.

Dear general practitioner

LEGIONNAIRES' DISEASE ALERT
Information for GPs, respiratory & ID physicians & EDs
Please distribute to all clinicians in your practice Key points
Visitors to Sydney Olympic Park in August may be at risk of Legionnaires’ disease
Consider Legionnaires' disease in people presenting with pneumonia
If the diagnosis is suspected, collect urine for Legionella urinary antigen testing

An investigation following two recent cases of Legionnaires' disease who had visited Sydney
Olympic Park has found an air conditioning cooling tower in the area was contaminated with
Legionella pneumophila serogroup 1. This raises suspicion that it could have been the source of
infection. The tower has been shut down and disinfected today. These cases may be unrelated and
have occurred coincidentally. However if the tower was the source, it is possible that other people
have been exposed and could develop Legionnaires' disease.
Note that Legionnaires' disease is also sometimes diagnosed in overseas travellers and a small
number of interstate cases have recently been identified in people who visited Bali.
Who is at risk?
 The incubation period of Legionnaires' disease is 2 to 10 days.
 Particularly suspect the diagnosis in anyone with pneumonia who reports visiting Sydney Olympic Park in August or who has recently returned from Bali.  Older adults who smoke or have chronic diseases or immunosuppression are most at risk of How does Legionnaires' disease present?
 Common symptoms are fever, chills, cough and breathlessness. Some people have systemic
symptoms such as myalgia, headache, abdominal pain, diarrhoea and fatigue.  Significant respiratory compromise occurs with some cases.
 CXR may show focal or patchy areas of consolidation that can be bilateral.
How should I manage suspected Legionnaires' disease cases?
 In people with consistent clinical and radiological findings obtain urine for Legionella urinary
antigen testing. This detects infection due to Legionella pneumophila serogroup 1 only. Other Legionella infections are usually diagnosed serologically.  Hospitalised cases should have sputum collected for Legionella culture, DFA or PCR. This should be requested on the pathology form.  The antibiotic of first choice for Legionnaires' disease includes one of azithromycin, doxycycline or erythromycin. See Therapeutic Guidelines: Antibiotic for more information.  Legionnaires' disease is not transmitted person-to-person.  Please ring your local public health unit to notify patients who present with pneumonia and who visited Sydney Olympic Park during August.
For more information, please call your local public health unit
02 4734 2022 Broken Hill 08 8080 1499 Newcastle 02 6841 5569 Port Macquarie 02 6588 2750 Please visit our website: www.health.nsw.gov.au/infect/diseases.html


Dr Jeremy McAnulty
A/Director, Health Protection 1 September 2010

Source: http://www.nsgpn.org.au/lp%20alert_010910_final.pdf