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.

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Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding R
Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding • Any bleeding defined as postmenopausal bleeding (PMB) • Bleeding in women on hormone replacement therapy (HRT) • Non-menstrual bleeding in premenopausal women • PMB is defined as an episode of bleeding in a women at least 12 months after her last period • PMB is any breakthrough bleeding in a woman receiving cyclical HRT, or breakthrough bleeding while receiving continuous HRT (after first 6 months, or after full amenorrhoea has been established) • PMB should be considered as a sign of uterine cancer until the diagnosis is excluded • Main risk factors are age and HRT use • 1% risk of cancer for those on combined HRT with PMB • 0.1% risk of cancer for patients under age 50 years with PMB • 1.5% risk of cancer for patients over age 60 years with PMB • Women presenting with PMB who are also taking tamoxifen have more than a 10% risk of having uterine cancer and require 2 Patient leaflets and documents relating to this pathway Quick info:Please see local info tab for patient information.
If there is no local info tab at the top of this box, there is no patient information attached at this time. 3 Joint Formulary relating to this pathway • nature of the bleeding – timing, quantity, duration • precipitating events, e.g. trauma, postcoital • origin of bleeding (could this be arising from urinary tract, vulva or rectum?) • Associated symptoms – pain, unplanned weight loss, fever, bowel or bladder symptoms • Past medical history – especially thyroid, renal or hepatic problems Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding • Distinguish whether bleeding is postmenopausal (PMB) or that related to hormone replacement therapy (HRT), enquire about: • possible HRT drug interaction or malabsorption • whether bleeding occurs in progestogen phase or oestrogen phase of HRT cycle • possible underlying disease, e.g. hypothyroidism • Action: patient taking HRT should have 6 week treatment break.
• Look for signs of systemic disease, e.g. bruising for coagulopathy, weight loss • An abdominal examination and bimanual palpation of the pelvic area • A speculum examination of the vagina and cervix • Transvaginal ultrasound is required. If a referral is made via the 2 week wait process the ultrasound will be done at this time.
• While bleeding from the genital area is normally from a uterine source, other anatomical sources should be considered • Causes of postmenopausal bleeding (PMB) include: • benign growths, e.g. polyps or fibroids • breakthrough bleeding in relation to hormone replacement therapy (HRT) Quick info:Stop HRT for 6 weeks and review patient.
Quick info:Review HRT prescriptions.
Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding Please see Joint Formulary for further information:-
Quick info:Please see local info tab for Choose and Book service.
• All patients with suspected cancer should be seen within 2 weeks Service: Two Week Wait Gynaecology-RDE-RH8 Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.
Post Menopausal BleedingObstetrics and Gynaecology > Gynaecology > Abnormal vaginal bleeding Published: 15-Apr-2011 Valid until: 16-Mar-2012 Printed on: 18-Apr-2011 Map of Medicine LtdThis pathway was published by Exeter. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.

Source: http://www.supportingchoiceintorbay.nhs.uk/reports/pathways/gynae/pmb.pdf