Tadalafil gehört zur Gruppe der PDE5-Hemmer und wirkt über eine hochselektive Blockade des Enzyms Phosphodiesterase Typ 5. Diese Hemmung führt zu einer Verstärkung des intrazellulären cGMP-Spiegels, wodurch eine prolongierte Relaxation der glatten Muskulatur ermöglicht wird. Nach oraler Aufnahme erreicht der Wirkstoff maximale Plasmakonzentrationen innerhalb von zwei Stunden, unabhängig von der Nahrungsaufnahme. Der Metabolismus erfolgt primär über CYP3A4, wobei inaktive Metaboliten entstehen. Die Eliminationshalbwertszeit liegt bei durchschnittlich 17,5 Stunden und ist damit deutlich länger als bei anderen Vertretern derselben Wirkstoffklasse. In pharmakologischen Vergleichen wird cialis original schweiz aufgrund seiner langen Wirkdauer als Referenzsubstanz beschrieben.

A4 leaflet

Flow Chart
Five A’s
sk and document tobacco use
Ex-Smoker
Non-smoker
Current Smoker
Set dental recall appropriate
to level of confi dence.
Assess motivation and confi dence to quit,
Assess - Any slips?
Advise/Assist
Advise/Assist
Advise/Assist
Affi rm decision to quit. Set a quit date and develop plan. Offer Quitine card or Quit and acknowledge their right to choose.
Assess nicotine dependence, recommend pharmacotherapy if required. appointment, QUITLINE
Follow-up appointment with GP/Pharmacist/ 131 848.
QUITLINE 131 848 and set dental recall time.
SYMPTOMS OF QUITTING
Effect on body
Coping strategy
Circulation improves, increased gingival Consider pharmacotherapy. Brief distractions eg: 4D’s: drink water, deep breathe, do some- thing else, delay urge to smoke. Ring the Worse initially, body clearing respiratory tract. Start regular exercise program. Eat sensibly, but no serious dieting until a less stressful period. Moderate alcohol consumption.
Sleep patterns altered, insomnia or tiredness. Refl ections of grief and (mainly) nicotine handle stress, eg: talk to a friend. Transient For further information go to: www.quitsa.org.au
Health Benefi ts of Quitting
Health Benefi ts of Quitting
Dental Benefi ts of Quitting
20 minutes
Blood pressure and pulse rate returns to normal.
• Improved gingival and oral tissue health.
Temperature of hands and feet increases to normal.
• Improved taste sensation after 48 hours.
Carbon monoxide and oxygen level in blood returns to • Smokers’ palate disappears shortly after cessation of Immediate risk of heart attack starts to fall.
14 days
•
• Reduced risk of periodontal disease and tooth loss.
Energy and fi tness level improves.
Lung function increases by up to 30%.
Most nicotine withdrawal symptoms disappear.
3 months
•
- Restorative and aesthetic dentistry.
Cilia regrow in lungs, increase in their ability to handle • Smokers’ melanosis in heavy smokers reverses after mucus, clean themselves and reduce infection.
a year and gingival colour returns to normal.
• Oral leukoplakia may regress or disappear following Risk of coronary heart disease is half that of smoker.
• Diminished risk of mouth, throat and oesophagus Risk of lung cancer is 30-50% that of continuing cancer to half that of a smoker after 5 years.
15 years
•
DOLLARS SAVED BY QUITTING
Risk of coronary heart disease same as a non smoker.
HELP WITH QUITTING
Advice from health professional,
pharmacotherapy and ongoing support eg
Quitline call-back program
Pharmacotherapy eg nicotine patches, gum
and Zyban ? (and ongoing support)
Advice from health professionals (at least
two sessions)
Self help ( Quit book, video)
PHARMACOTHERAPY FOR SMOKING CESSATION
SUITABLE ONLY FOR PATIENTS SMOKING 10 + CIGARETTES PER DAY TYPES OF THERAPY

Source: http://www.adelaide.edu.au/arcpoh/dperu/special/smoking/SmokingFlowchartA4.pdf