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INTRODUCTION

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tadalafil (ta-daye-la-fil)

Cialis

Classification

Therapeutic: vasodilator

Pharmacologic: phosphodiesterase type 5 inhibitors

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Indications
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Erectile dysfunction.

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Action
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Increases cyclic guanosine monophosphate (cGMP) levels by inhibiting phosphodiesterase type 5 (PDE5), an enzyme responsible for the breakdown of cGMP. cGMP produces smooth muscle relaxation of the corpus cavernosum, which in turn promotes increased blood flow and subsequent erection. Therapeutic Effects: Enhanced blood flow to the corpus cavernosum and erection sufficient to allow sexual intercourse. Requires sexual stimulation.

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Adverse Reactions/Side Effects
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CNS: headache. EENT: HEARING LOSS, VISION LOSS, nasal congestion. CV: hypotension. GI: dyspepsia. GU: priapism. Derm: flushing. MS: back pain, limb pain, myalgia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for sudden loss of vision or hearing, and seek emergency care for any changes in vision or hearing.

  • Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

  • Assess any muscle, back, or limb pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

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Interventions
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  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

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Patient/Client-Related Instruction
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  • Instruct patient to notify health care professional promptly if erection lasts longer than 4 hr or if they experience a sudden decrease or loss of vision or hearing.

  • Instruct patient to report other bothersome side effects such as severe or prolonged headache, nasal congestion, skin flushing, or indigestion.

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Pharmacokinetics
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Absorption: Well absorbed following oral administration.

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Distribution: Extensive tissue distribution; penetrates semen.

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Protein Binding: 94%.

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Metabolism and Excretion: Mostly metabolized by the liver (mainly CYP3A4 enzyme system); metabolites are excreted in feces (61%) and urine (36%).

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Half-life: 17.5 hr.

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TIME/ACTION PROFILE (improved erectile function)

ROUTE ONSET PEAK DURATION
PO rapid 0.5–6 hr 36

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Concurrent use of nitrates; Unstable angina, recent history of stroke, life-threatening heart failure within 6 mo, uncontrolled hypertension, arrhythmias, stroke within 6 mo, or MI within 90 days; Any other cardiovascular pathology precluding sexual activity; Known hereditary degenerative retinal disorders; Severe hepatic impairment; Congenital or acquired QT prolongation or concurrent use of class IA or III antiarrhythmics; Pedi: Women, children, or newborns.

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Use Cautiously in: Left ventricular outflow obstruction; Penile deformity; Underlying conditions predisposing to priapism, including sickle cell anemia, multiple myeloma, or leukemia; Bleeding disorders or active peptic ulcer disease; Strong ...

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