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    When a man is sexually excited, the penis rapidly fills with more blood than usual. With this extra flow of blood, the penis then expands and hardens. After the man is done having sex, this extra blood flows out of the penis back into the body. In an opposite extreme situation, if an erection lasts for a long time (more than 6 hours), it can permanently damage your penis. You should call a doctor immediately if you ever have a prolonged erection that lasts more than 4 hours. Therefore sexual activity may not be advisable for people who have heart problems. Before you start any treatment for erectile dysfunction, ask your doctor if your heart is healthy enough to handle the extra strain of having sex. If you have chest pains, dizziness or nausea during sex, stop having sex and immediately tell your doctor you have had this problem. This is called erectile dysfunction if it becomes a frequent problem. Erectile dysfunction is a serious problem that can affect both the young and the old, involving psychological causes in some cases. Among other treatments that are nowadays available for erectile dysfunction, Viagra was the first. Some conditions and medicines interfere with the natural erection process. Erectile dysfunction, defined today as the inability to attain and maintain an erect penis with sufficient rigidity for sexual intercourse, has become an increasingly common complaint that affects 140 million men worldwide. So Viagra stands out as the pioneer of drugs that treat erectile dysfunction, for twenty years. Sildenafil citrate was the first oral agent to be introduced for the treatment of erectile dysfunction, thanks to the researchers from Pfizer. Sildenafil is the active substance of Viagra, while Viagra is the commercial name. Teva’s generic Viagra has launched already in December 2017 in the United States. Risk factors for developing erectile dysfunction include age, diabetes, hypertension, obesity, lack of exercise, dyslipidemia, smoking, depression, lower urinary tract symptoms, and pelvic surgery. Sildenafil is a highly selective inhibitor of PDE type 5 and enhances NO-mediated relaxation of human corpus cavernosum. Pfizer recently started to sell the new generic version of Viagra. para que sirve la metformina Viagra is the trade name for a drug called Sildenafil. Viagra is one of a class of drugs known as PDE-5 (Phosphodiesterase type 5) inhibitors. Viagra and the other PDE-5 inhibitors can help men with erectile dysfunction (male impotence) by enhancing the erectile response when a man is sexually stimulated. Aside from Viagra, the other drugs in this class are Cialis (Tadalafil) and Levitra (Vardenafil). Viagra does not cause a man to be sexually aroused. Viagra is only effective if you are sexually aroused. To understand how it works you need to understand the mechanics of how a man gets an erection.

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    Viagra takes around 30 minutes to become effective and lasts about 4 hours. Cialis lasts much longer -- up to 36 hours in some cases. Stendra can start doing its thing in as little as 15 minutes. buy cialis 40 mg online Zdravotnický prostředek. Zdravotnickým prostředkem se rozumí nástroj, přístroj, pomůcka, zařízení, programové vybavení včetně programového vybavení určeného jeho výrobcem ke specifickému použití pro diagnostické nebo léčebné účely a nezbytného ke správnému použití zdravotnického prostředku, materiál nebo jiný předmět, určené výrobcem pro použití u. Order Viagra Online with satisfaction guaranteed. The Lowest Price. Free pills with every order. A tablet of Viagra, no doubt, is going to change your sexual life for ever.

    Sildenafil is a common medication used to stimulate erections in men with erectile dysfunction (ED) and treat certain heart conditions. Many factors can influence how long Viagra takes to start working. In general, Viagra takes about 30 minutes to produce noticeable effects. But your diet, your overall health, the medications you’re taking, underlying conditions, and much more can all affect the amount of time Viagra takes to work in your body and how long it lasts. An erection happens when nerves in your penis are stimulated. Then, muscles around two cylinder-shaped chambers of spongy material along your penis, known as the corpus cavernosa, relax and allow blood to flow in, causing an erection. With ED, your nerves don’t communicate properly with your brain and blood doesn’t flow properly into the corpus cavernosa. Taking Viagra relaxes the walls of your blood vessels and lets blood flow more easily into the parts of your penis that cause an erection. You’ll still need to feel sexually aroused to get an erection. This medication is used to treat erectile dysfunction (ED). One of the more common side effects is flushing, or redness. While it helps you temporarily maintain an erection so you can have sex, it does not cure ED. You still need mental or physical stimulation to get an erection.5 Common Causes of Impotence »Viagra is available only with a doctor’s prescription. This medication can cause a decrease in blood pressure, particularly one to two hours after taking it. Within the penis are two chambers called the corpora cavernosa. If you already have low blood pressure, discuss the pros and cons of Viagra with your doctor. Nitric oxide (NO) is released in the chambers during sexual stimulation. That increases levels of cyclic guanosine monophosphate (c GMP), which causes muscles to relax. For most people, sexual activity is good for cardiovascular health. However, if you have cardiovascular disease, you should ask your doctor if it’s safe for you to take Viagra. You should also avoid Viagra if your doctor advised you not to have sex. You should not take Viagra if you have had a stroke, heart attack, or have unstable angina.

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    Edema associated with congestive heart failure (CHF), liver cirrhosis, and renal disease, including nephrotic syndrome 20-80 mg PO once daily; may be increased by 20-40 mg q6-8hr; not to exceed 600 mg/day Alternative: 20-40 mg IV/IM once; may be increased by 20 mg q2hr; individual dose not to exceed 200 mg/dose Refractory CHF may necessitate larger doses Excessive diuresis may cause dehydration and electrolyte loss in elderly; lower initial dosages and more gradual adjustments are recommended (eg, 10 mg/day PO)Increase in blood urea nitrogen (BUN) and loss of sodium may cause confusion in elderly; monitor renal function and electrolytes Anaphylaxis Anemia Anorexia Diarrhea Dizziness Glucose intolerance Glycosuria Headache Hearing impairment Hyperuricemia Hypocalcemia Hypokalemia Hypomagnesemia Hypotension Increased patent ductus arteriosus during neonatal period Muscle cramps Nausea Photosensitivity Rash Restlessness Tinnitus Urinary frequency Urticaria Vertigo Weakness Toxic epidermal necrolysis, Stevens-Johnson Syndrome, erythema multiforme, drug rash with eosinophila and systemic symptoms, acute generalized exanthematous pustulosis, exfoliative dermatitis, bullous pemphigoid purpura, pruritus Agent is potent diuretic that, if given in excessive amounts, may lead to profound diuresis with water and electrolyte depletion Careful medical supervision is required; dosing must be adjusted to patient's needs Use caution in systemic lupus erythematosus, liver disease, renal impairment Concomitant ethacrynic acid therapy (increases risk of ototoxicity) Risks of fluid or electrolyte imbalance (including causing hyperglycemia, hyperuricemia, gout), hypotension, metabolic alkalosis, severe hyponatremia, severe hypokalemia, hepatic coma and precoma, hypovolemia (with or without hypotension) Do not commence therapy in hepatic coma and in electrolyte depletion until improvement is noted IV route twice as potent as PO Food delays absorption but not diuretic response May exacerbate lupus Possibility of skin sensitivity to sunlight Prolonged use in premature neonates may cause nephrocalcinosis Efficacy is diminished and risk of ototoxicity increased in patients with hypoproteinemia (associated with nephrotic syndrome); ototoxicity is associated with rapid injection, severe renal impairment, use of higher than recommended doses, concomitant therapy with aminoglycoside antibiotics, ethacrynic acid, or other ototoxic drugs To prevent oliguria, reversible increases in BUN and creatinine, and azotemia, monitor fluid status and renal function; discontinue therapy if azotemia and oliguria occur during treatment of severe progressive renal disease FDA-approved product labeling for many medications have included a broad contraindication in patients with a prior allregic reaction to sulfonamides; however, recent studies have suggested that crossreactivity between antibiotic sulfonamides and nonantibiotic sulfonamides is unlikely to occur In cirrhosis, electrolyte and acid/base imbalances may lead to hepatic encephalopathy; prior to initiation of therapy, correct electrolyte and acid/base imbalances, when hepatic coma is present High doses ( 80 mg) of furosemide may inhibit binding of thyroid hormones to carrier proteins and result in transient increase in free thyroid hormones, followed by overall decrease in total thyroid hormone levels In patients at high risk for radiocontrast nephropathy furosemide can lead to higher incidence of deterioration in renal function after receiving radiocontrast compared to high-risk patients who received only intravenous hydration prior to receiving radiocontrast Observe patients regularly for possible occurrence of blood dyscrasias, liver or kidney damage, or other idiosyncratic reactions Cases of tinnitus and reversible or irreversible hearing impairment and deafness reported Hearing loss in neonates has been associated with use of furosemide injection; in premature neonates with respiratory distress syndrome, diuretic treatment with furosemide in the first few weeks of life may increase risk of persistent patent ductus arteriosus (PDA), possibly through a prostaglandin-E-mediated process Excessive diuresis may cause dehydration and blood volume reduction with circulatory collapse and possibly vascular thrombosis and embolism, particularly in elderly patients Increases in blood glucose and alterations in glucose tolerance tests (with abnormalities of fasting and 2 hour postprandial sugar) have been observed, and rarely, precipitation of diabetes mellitus reported Patients with severe symptoms of urinary retention (because of bladder emptying disorders, prostatic hyperplasia, urethral narrowing), the administration of furosemide can cause acute urinary retention related to increased production and retention of urine; these patients require careful monitoring, especially during initial stages of treatment Hypokalemia may develop with furosemide, especially with brisk diuresis, inadequate oral electrolyte intake, when cirrhosis is present, or during concomitant use of corticosteroids, ACTH, licorice in large amounts, or prolonged use of laxatives Pregnancy category: C; treatment during pregnancy necessitates monitoring of fetal growth because of risk for higher fetal birth weights Lactation: Drug excreted into breast milk; use with caution; may inhibit lactation Loop diuretic; inhibits reabsorption of sodium and chloride ions at proximal and distal renal tubules and loop of Henle; by interfering with chloride-binding cotransport system, causes increases in water, calcium, magnesium, sodium, and chloride Solution: Fructose10W, invert sugar 10% in multiple electrolyte #2 Additive: Amiodarone (at high concentrations of both drugs), buprenorphine, chlorpromazine, diazepam, dobutamine, eptifibatide, erythromycin lactobionate, gentamicin(? ), isoproterenol, meperidine, metoclopramide, netilmicin, papaveretum, prochlorperazine, promethazine Syringe: Caffeine, doxapram, doxorubicin, eptifibatide, metoclopramide, milrinone, droperidol, vinblastine, vincristine Y-site: Alatrofloxacin, amiodarone (incompatible at furosemide 10 mg/m L; possibly compatible at 1 mg/m L), chlorpromazine, ciprofloxacin, cisatracurium (incompatible at cisatracurium 2 mg/m L; possibly compatible at 0.1 mg/m L), clarithromycin, diltiazem, diphenhydramine, dobutamine, dopamine, doxorubicin (incompatible at furosemide 10 mg/m L and doxorubicin 2 mg/m L; possibly compatible at furosemide 3 mg/m L and doxorubicin 0.2 mg/m L), droperidol, eptifibatide, esmolol, famotidine(? ), fenoldopam, gatifloxacin, gemcitabine, gentamicin(? ), hydralazine, idarubicin, labetalol, levofloxacin, meperidine, metoclopramide, midazolam, milrinone, morphine, netilmicin, nicardipine, ondansetron, quinidine, thiopental, vecuronium, vinblastine, vincristine, vinorelbine Not specified: Tetracycline Additive: Cimetidine, epinephrine, heparin, nitroglycerin, potassium chloride, verapamil Syringe: Heparin Y-site: Epinephrine, fentanyl, heparin, norepinephrine, nitroglycerin, potassium chloride, verapamil(? ), vitamins B and C Injection: Inject directly or into tubing of actively running IV over 1-2 minutes Administer undiluted IV injections at rate of 20-40 mg/min; not to exceed 4 mg/min for short-term intermittent infusion; in children, give 0.5 mg/kg/min, titrated to effect Use infusion solution within 24 hours The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. Hypokalemia NCLEX Review Notes propecia blood donation CV Pharmacology Diuretics Hyperkalemia & Hypokalemia – Online Surgery Course
     
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