Kamagra repose sur le sildénafil comme principe actif, avec un mode d’action identique à celui du Viagra. La forme galénique en gel oral permet une absorption plus rapide et une concentration plasmatique maximale plus précoce que les comprimés. Le mécanisme implique l’inhibition compétitive de la PDE5, entraînant une relaxation musculaire lisse locale et une vasodilatation ciblée. La demi-vie courte, environ 4 heures, limite la durée d’action. L’élimination se fait après métabolisme hépatique, impliquant majoritairement le CYP3A4. L’incidence d’effets indésirables comprend céphalées, rougeurs et congestion nasale, de façon transitoire. Dans les comparatifs pharmacologiques, acheter kamagra sans ordonnance est associé aux présentations galéniques alternatives disponibles.
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University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION GLP-1 ANALOGS DRUG NAME BYDUREON STEP THERAPY CRITERIA PRIOR CLAIM FOR EITHER METFORMIN, METFORMIN ER, A SULFONYLUREA AGENT (E.G. GLYBURIDE, GLIPIZIDE), COMBINATION OF A SULFONYLUREA AND METFORMIN, A THIAZOLIDINEDIONE (E.G. PIOGLITAZONE, ROSIGLITAZONE), OR A COMBINATION THIAZOLIDINEDIONE AND METFORMIN WITHIN THE PAST 120 DAYS. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION ROTIGOTINE DRUG NAME NEUPRO STEP THERAPY CRITERIA PRIOR CLAIM FOR IMMEDIATE RELEASE PRAMIPEXOLE OR IMMEDIATE RELEASE ROPINIROLE WITHIN THE PAST 120 DAYS. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION ALZHEIMER'S DRUGS DRUG NAME EXELON STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): DONEPEZIL HCL, GALANTAMINE HYDROBROMIDE, GALANTAMINE HBR, RIVASTIGMINE. STEP 2 DRUG(S): EXELON ORAL SOLUTION, EXELON PATCH. AUTHORIZATION MAY BE GIVEN FOR A STEP 2 DRUG IF THE PATIENT IS CURRENTLY TAKING (OR HAS TAKEN IN THE PAST) THE REQUESTED AGENT. AUTHORIZATION FOR EXELON PATCH MAY BE GIVEN IF THE PATIENT HAS DIFFICULTY SWALLOWING OR CANNOT SWALLOW. THIS STEP THERAPY PROGRAM APPLIES TO NEW UTILIZERS ONLY. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION ANTIDEPRESSANTS- SSRI DRUG NAME PAXIL | VIIBRYD STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED TWO STEP 1 DRUGS, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): CITALOPRAM, CITALOPRAM HBR, FLUOXETINE DR, ESCITALOPRAM, FLUOXETINE HCL, FLUVOXAMINE MALEATE, PAROXETINE HCL, PAROXETINE ER, RAPIFLUX, SERTRALINE HCL. STEP 2 DRUG(S): VIIBRYD, PAXIL ORAL SUSPENSION. PATIENTS WHO HAVE TAKEN A STEP 2 SSRI AT ANY TIME IN THE PAST AND DISCONTINUED ITS USE MAY RECEIVE AUTHORIZATION TO RESTART THE STEP 2 SSRI (WHICHEVER THEY USED IN THE PAST). AUTHORIZATION MAY BE GIVEN FOR A STEP 2 SSRI IF THE PATIENT IS CURRENTLY TAKING THE REQUESTED AGENT. AUTHORIZATION MAY BE GIVEN FOR A STEP 2 DRUG IF THE PATIENT IS A CHILD OR ADOLESCENT AGED 18 YEARS OR LESS OR HAS SUICIDAL IDEATION. THIS STEP THERAPY PROGRAM APPLIES TO NEW UTILIZERS ONLY. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION DRUG NAME AZOR | BENICAR | BENICAR HCT | DIOVAN | EXFORGE | EXFORGE HCT | MICARDIS | MICARDIS HCT | TRIBENZOR | TWYNSTA STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): AMLODIPINE BESYLATE-BENAZEPRIL, BENAZEPRIL HCL, BENAZEPRIL-HYDROCHLOROTHIAZIDE, CANDESARTAN- HYDROCHLOROTHIAZIDE, CAPTOPRIL, CAPTOPRIL-HYDROCHLOROTHIAZIDE, ENALAPRIL MALEATE, ENALAPRIL-HYDROCHLOROTHIAZIDE, EPROSARTAN, FOSINOPRIL SODIUM, FOSINOPRIL-HYDROCHLOROTHIAZIDE, IRBESARTAN, IRBESARTAN-HYDROCHLOROTHIAZIDE, LISINOPRIL, LISINOPRIL- HYDROCHLOROTHIAZIDE, LOSARTAN POTASSIUM, LOSARTAN- HYDROCHLOROTHIAZIDE, MOEXIPRIL HCL, MOEXIPRIL- HYDROCHLOROTHIAZIDE, PERINDOPRIL ERBUMINE, QUINAPRIL HCL, QUINAPRIL- HYDROCHLOROTHIAZIDE, RAMIPRIL, TRANDOLAPRIL. STEP 2 DRUG(S): AZOR, BENICAR, BENICAR HCT, DIOVAN, EXFORGE, EXFORGE HCT, MICARDIS, MICARDIS HCT, TRIBENZOR, TWYNSTA. AUTHORIZATION MAY BE GIVEN FOR A STEP 2 PRODUCT, WITHOUT A TRIAL OF A STEP 1 AGENT, IF THE PATIENT WAS RECENTLY HOSPITALIZED AND DISCHARGED WITHIN THE PREVIOUS 30 DAYS FOR A CARDIOVASCULAR EVENT (E.G., MYOCARDIAL INFARCTION, HYPERTENSIVE EMERGENCY, DECOMPENSATED HEART FAILURE) AND HAS ALREADY BEEN STARTED AND STABILIZED ON THE AGENT. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION BISPHOSPHONATES ORAL DRUG NAME BONIVA STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): ALENDRONATE SODIUM, IBANDRONATE SODIUM. STEP 2 DRUG(S): BONIVA. AUTHORIZATION MAY BE GIVEN FOR BONIVA, IF THE PATIENT HAS TRIED ALENDRONATE SODIUM (BRAND OR GENERIC) OR IBANDRONATE SODIUM. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION BRAND NSAIDS DRUG NAME VOLTAREN STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED TWO STEP 1 DRUGS, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): DICLOFENAC POTASSIUM, DICLOFENAC SODIUM, ETODOLAC, FENOPROFEN CALCIUM, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN, KETOPROFEN, KETOROLAC TROMETHAMINE, MECLOFENAMATE SODIUM, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN, NAPROXEN SODIUM, OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN SODIUM. STEP 2 DRUG(S): VOLTAREN GEL. AUTHORIZATION MAY BE GIVEN FOR VOLTAREN GEL FOR PATIENTS WITH DIFFICULTY SWALLOWING OR CANNOT SWALLOW. AUTHORIZATION MAY BE GIVEN FOR VOLTAREN GEL FOR PATIENTS WITH A CHRONIC MUSCULOSKELETAL PAIN CONDITION (EG, OSTEOARTHRITIS) IN 3 OR FEWER JOINTS/SITES (IE, HAND, WRIST, ELBOW, KNEE, ANKLE, OR FOOT EACH COUNT AS 1 JOINT/SITE) WHO ARE AT RISK OF NSAID-ASSOCIATED TOXICITY (EG, PREVIOUS GASTROINTESTINAL [GI] BLEED, HISTORY OF PEPTIC ULCER DISEASE, IMPAIRED RENAL FUNCTION, CARDIOVASCULAR DISEASE, HYPERTENSION, HEART FAILURE, ELDERLY PATIENTS WITH IMPAIRED HEPATIC FUNCTION, OR THOSE TAKING CONCOMITANT ANTICOAGULANTS). University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION DRUG NAME CELEBREX STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED TWO STEP 1 DRUGS, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): DICLOFENAC POTASSIUM, DICLOFENAC SODIUM, ETODOLAC, FENOPROFEN CALCIUM, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN, KETOPROFEN, KETOROLAC TROMETHAMINE, MECLOFENAMATE SODIUM, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN, NAPROXEN SODIUM, OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN SODIUM. STEP 2 DRUG(S): CELEBREX. AUTHORIZATION FOR CELEBREX MAY BE GIVEN IF THE PATIENT HAS TRIED TWO ORAL PRESCRIPTION STRENGTH NSAIDS (BRAND OR GENERIC) FOR THE CURRENT CONDITION. THIS STEP THERAPY PROGRAM WILL EXCLUDE PARTICIPANTS WITH A CLAIMS HISTORY OF WARFARIN (COUMADIN) WITHIN THE LAST 130 DAYS. AUTHORIZATION FOR CELEBREX MAY BE GIVEN FOR PATIENTS WHO ARE CURRENTLY TAKING CHRONIC SYSTEMIC CORTICOSTEROID THERAPY, WARFARIN (COUMADIN), CLOPIDOGREL (PLAVIX), PRASUGREL (EFFIENT), TICAGRELOR (BRILINTA), RIVAROXABAN (XARELTO), DABIGATRAN (PRADAXA), CHRONIC ASPIRIN THERAPY, OR LOW MOLECULAR WEIGHT HEPARINS. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION FENOFIBRATE DRUG NAME LIPOFEN STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): FENOFIBRATE. STEP 2 DRUG(S): LIPOFEN. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION HMG RULE 1 DRUG NAME CRESTOR STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): ATORVASTATIN, FLUVASTATIN, LOVASTATIN, PRAVASTATIN SODIUM, SIMVASTATIN. STEP 2 DRUG(S): CRESTOR 5 MG. AUTHORIZATION MAY BE GIVEN FOR A STEP 2 DRUG, IF THE PATIENT HAS TRIED ATORVASTATIN (BRAND OR GENERIC), FLUVASTATIN (BRAND OR GENERIC), LOVASTATIN (BRAND OR GENERIC), PRAVASTATIN SODIUM (BRAND OR GENERIC), OR SIMVASTATIN (BRAND OR GENERIC). AUTHORIZATION FOR A STEP 2 DRUG WILL GIVEN ON AN INDIVIDUAL BASIS FOR DRUG-DRUG INTERACTIONS. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION LONG ACTING OPIOIDS DRUG NAME OPANA ER STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): MORPHINE SULFATE, MORPHINE SULFATE ER, OXYMORPHONE ER. STEP 2 DRUG(S): OPANA ER, OXYCONTIN. AUTHORIZATION MAY BE GIVEN FOR OXYCONTIN IF THE PATIENT IS UNABLE TO TOLERATE OR HAS A DRUG ALLERGY NOTED WITH MORPHINE SULFATE. AUTHORIZATION MAY BE GIVEN FOR OXYCONTIN IF THE PATIENT HAS RENAL INSUFFICIENCY. AUTHORIZATION MAY BE GIVEN FOR OXYCONTIN IF THE PATIENT IS PREGNANT. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION OPHTHALMIC PROSTAGLANDINS DRUG NAME TRAVATAN Z STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): LATANOPROST. STEP 2 DRUG(S): TRAVATAN Z. AUTHORIZATION FOR TRAVATAN Z MAY BE GIVEN IF THE PATIENT HAS A KNOWN BENZALKONIUM CHLORIDE (BAK) SENSITIVITY OR SENSITIVITY TO OTHER OPHTHALMIC PRESERVATIVES. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION OVERACTIVE BLADDER DRUG NAME ENABLEX | SANCTURA XR STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): OXYBUTYNIN CHLORIDE, OXYBUTYNIN CHLORIDE ER, TROSPIUM CHLORIDE. STEP 2 DRUG(S): ENABLEX, SANCTURA XR. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION PROTON PUMP INHIBITORS DRUG NAME NEXIUM STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): LANSOPRAZOLE, OMEPRAZOLE, OMEPRAZOLE-SODIUM BICARBONATE, PANTOPRAZOLE SODIUM. STEP 2 DRUG(S): NEXIUM. AUTHORIZATION FOR NEXIUM MAY BE GIVEN IN PATIENTS LESS THAN 1 YEAR OF AGE. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION SEDATIVE HYPNOTICS DRUG NAME ROZEREM STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): ZALEPLON, ZOLPIDEM TARTRATE. STEP 2 DRUG(S): ROZEREM. ROZEREM WILL BE COVERED FOR MEMBERS EQUAL TO OR OVER THE AGE OF 65 YEARS. FOR THOSE UNDER 65 YEARS OF AGE, THE STEP THERAPY WILL APPLY. AUTHORIZATION FOR ROZEREM MAY BE GIVEN IF THE PATIENT HAS A DOCUMENTED HISTORY OF ADDICTION TO CONTROLLED SUBSTANCES. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION TEKTURNA DRUG NAME AMTURNIDE | TEKAMLO | TEKTURNA | TEKTURNA HCT STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): AMLODIPINE BESYLATE-BENAZEPRIL, AZOR, BENICAR, BENICAR HCT, BENAZEPRIL HCL, BENAZEPRIL- HYDROCHLOROTHIAZIDE, CANDESARTAN-HYDROCHLOROTHIAZIDE, CAPTOPRIL, CAPTOPRIL-HYDROCHLOROTHIAZIDE, DIOVAN, ENALAPRIL MALEATE, ENALAPRIL-HYDROCHLOROTHIAZIDE, EPROSARTAN, EXFORGE, EXFORGE HCT, FOSINOPRIL SODIUM, FOSINOPRIL-HYDROCHLOROTHIAZIDE, IRBESARTAN, IRBESARTAN-HYDROCHLOROTHIAZIDE, LISINOPRIL, LISINOPRIL- HYDROCHLOROTHIAZIDE, LOSARTAN POTASSIUM, LOSARTAN- HYDROCHLOROTHIAZIDE, MICARDIS, MICARDIS HCT, MOEXIPRIL HCL, MOEXIPRIL-HYDROCHLOROTHIAZIDE, PERINDOPRIL ERBUMINE, QUINAPRIL HCL, QUINAPRIL-HYDROCHLOROTHIAZIDE, RAMIPRIL, TRANDOLAPRIL, TRIBENZOR, TWYNSTA. STEP 2 DRUG(S): AMTURNIDE, TEKAMLO, TEKTURNA, TEKTURNA HCT. AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN IF THE PATIENT TRIED AN ANGIOTENSIN CONVERTING ENZYME (ACE) INHIBITOR OR ACE INHIBITOR COMBINATION PRODUCT IN THE PAST. AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN IF THE PATIENT TRIED AN ANGIOTENSIN RECEPTOR BLOCKER (ARB) OR ARB COMBINATION PRODUCT IN THE PAST THEY ARE NOT REQUIRED TO HAVE A TRIAL WITH AN ACE INHIBITOR. University Care Advantage (HMO SNP) Step Therapy Webfile EFFECTIVE DATE: 04/01/2013 STEP THERAPY GROUP DESCRIPTION DRUG NAME ULORIC STEP THERAPY CRITERIA IF THE PATIENT HAS TRIED A STEP 1 DRUG, THEN AUTHORIZATION FOR A STEP 2 DRUG MAY BE GIVEN. STEP 1 DRUG(S): ALLOPURINOL. STEP 2 DRUG(S): ULORIC. AUTHORIZATION MAY BE GIVEN FOR ULORIC IF THE PATIENT HAS TRIED ALLOPURINOL (BRAND OR GENERIC) AT ANY TIME IN THE PAST. AUTHORIZATION MAY BE GIVEN FOR ULORIC IF THE PATIENT HAS RENAL INSUFFICIENCY OR DECREASED RENAL FUNCTION. AUTHORIZATION MAY BE GIVEN FOR ULORIC IF THE PATIENT IS RECEIVING CONCOMITANT MEDICATIONS THAT HAVE SIGNIFICANT DRUG-DRUG INTERACTIONS WITH ALLOPURINOL, WHICH ARE NOT NOTED WITH ULORIC (EG, CYCLOSPORINE, CHLORPROPAMIDE).
Treatment of Sudden Sensorineural Hearing Loss II. A Meta-analysis Anne Elizabeth Conlin, BA&Sc, MD; Lorne S. Parnes, MD, FRCSC Objective: To pool and meta-analyze the results of all 5 met inclusion criteria for meta-analysis. Pooling of datarandomized controlled trials (RCTs) on treatment of sud-from 2 RCTs that compared steroids with placebo showedden sensorineural hearing lo
IL MEDICO E L’IPERTENSIONE Burgarella Editore International Come si misura la pressione arteriosa Qual'è il più comune metodo di misurazione della pressione arteriosa Il più comune metodo di misurazione della pressione arteriosa è quello ascoltatorio, utilizzando lo sfigmomanometro. Nel monitoraggio pressorio e nella automisurazione si utilizza sempre più il metodo oscil