Das pharmakologische Profil von Sildenafil zeigt neben der PDE5-Inhibition auch eine geringe Aktivität an der PDE6 in der Retina. Dies erklärt visuelle Nebenwirkungen wie Farbsehstörungen, die gelegentlich auftreten. Die orale Bioverfügbarkeit beträgt etwa 40 %, mit einer hohen Bindung an Plasmaproteine. Das Verteilungsvolumen ist groß, sodass die Substanz rasch in verschiedene Gewebe gelangt. Die Metabolisierung erfolgt hepatisch und produziert einen aktiven Metaboliten, der die pharmakologische Wirkung ergänzt. Nebenwirkungen sind dosisabhängig und umfassen Kopfschmerzen, Hautrötung und Dyspepsie. Bei Vergleichen innerhalb der Wirkstoffklasse wird viagra original regelmäßig als Beispiel für eine Substanz mit schneller, aber kurzzeitiger Wirkung aufgeführt.

Newbeginningsbirthcenter.com

First Name_______________________ Middle Name______________________ Last Name_______________________ Prefers to be Called____________________________ Maiden Name__________________ DOB___________________ SS#_____________________________ State/Province of Birth_______________________ Age____________________ Level of Education:  8th Grade or Less  Some High School  High School Graduate  Some College, No Degree  Associates Degree  Bachelor’s Degree  Master’s Degree  Doctorate or Professional Degree Street Address______________________________________________ Apt#__________ Within City Limits?  Y  N State_______ Zip Code___________ County___________________ E-Mail Address______________________________ Home Phone______________________Cell Phone______________________ Work Phone_______________________ Religious Preference________________________ Marital Status:  Married  Single  Unmarried Couple  Separated Employer____________________________________ Occupation____________________________________________ Race:  White  Black/African American American Indian or Alaskan Native, Name of Tribe_________________  Asian Indian Chinese  Filipino  Japanese Korean  Vietnamese  Native Hawaiian  Samoan  Guamanian or Chamorro  Other Pacific Islander______________________  Other Asian_______________________  Other__________________________ Are you:  Hispanic/Latina? If yes,  Mexican/Mexican American/Chicana  Puerto Rican  Cuban  Other______________________ First Name_______________________ Middle Name______________________ Last Name_______________________ Prefers to be Called____________________________ DOB___________________ SS#_____________________________ State/Province of Birth_______________________ Age____________________ Level of Education:  8th Grade or Less  Some High School  High School Graduate  Some College, No Degree  Associates Degree  Bachelor’s Degree  Master’s Degree  Doctorate or Professional Degree Street Address______________________________________________ Apt#__________ Within City Limits?  Y  N State_______ Zip Code___________ County___________________ E-Mail Address______________________________ Home Phone______________________Cell Phone______________________ Work Phone_______________________ Religious Preference________________________ Employer____________________________________ Occupation____________________________________________ Race:  White  Black/African American American Indian or Alaskan Native, Name of Tribe_________________  Asian Indian Chinese  Filipino  Japanese Korean  Vietnamese  Native Hawaiian  Samoan  Guamanian or Chamorro  Other Pacific Islander______________________  Other Asian_______________________  Other__________________________ Are you:  Hispanic/Latina? If yes,  Mexican/Mexican American/Chicana  Puerto Rican  Cuban  Other______________________  On Medicaid #____________________________ Primary Insurance___________________________ Policy#_____________________ Group#______________________ Insurance is through:  Other______________________________________ Have you seen any other providers (i.e. a doctor or another midwife) for this pregnancy?  Yes  No If yes, Please Describe: Provider___________________________ Date of First Visit___________ # of Visits with This Provider______ 1) What forms of birth control have you used?  Pill or Mini Pill  IUD  Diaphragm  Cervical Cap  Breastfeeding  Condoms  Norplant  Natural Family Planning or Rhythm Method  NuvaRing  Depo  Withdrawal Method 2) Did you have any difficulty conceiving this baby?  Yes  No If Yes, Please Describe:_____________________ 3) Was this a planned pregnancy?  Yes  No 4) When was your last PAP smear? Month and Year______________ 5) What was the result?  Normal  Irregular If Irregular, Please Describe:_______________________________ 6) How often (how many days) do you have your period? (i.e. every 28 - 32 days)_______________days 7) How long do you bleed during your period?_________________days 8) Are your periods regular?  Yes  No If No, Please Describe:_______________________________________ 9) What was the first day of your last menstrual period (LMP)?__________________________ 10) Was this period normal for you?  Yes  No If No, Please Describe:____________________________________ 11) Are you certain about the first day of your last menstrual period?  Yes  No 12) Do you know your date of conception?  Yes  No If Yes, Please Give the Date:________________________ 13) Have you had any ultrasounds this pregnancy?  Yes  No If Yes, Please Fill in the Table Below: 14) Date_______________ Week of Pregnancy_____________ Due Date Given Based on Ultrasound_______________ 15) Date_______________ Week of Pregnancy_____________ Due Date Given Based on Ultrasound_______________ 16) Has another provider given you a due date?  Yes  No If Yes, Please Give the Date:_____________________ Please Select All That Apply (current or past):  Yes  No Chronic Hypertension (High Blood Pressure)  Yes  No Diabetes (Non-Gestational)  Yes  No Seizures/Epilepsy requiring Rx  Yes  No Gastrointestinal Disorders  Yes  No Depression or Psychiatric Disease  Yes  No Family History of Genetic Disorders  Yes  No Thyroid Disease requiring Rx  Yes  No Cervical Surgery (i.e. LEEP)  Yes  No Abnormal Cervical Cytology (PAP results)  Yes  No Prior Chemotherapy or Radiation  Yes  No Previous Bariatric Surgery  Yes  No Major Surgery of the Pulmonary System,  Yes  No Sexually Transmitted Infections/Diseases  Yes  No Alcohol or Prescription Drug Abuse  Yes  No Allergies to Medications If Yes, Please List:___________________________________________________ Please indicate if your mother or father have a history of any of the following: High Blood Pressure 1) Is this your first pregnancy?  Yes  No If No, how many times have you been pregnant before (including miscarriages, abortions or stillbirths)?___________________ 2) Have you ever had a miscarriage?  Yes  No If Yes, how many?___________ 3) Have you ever had an abortion?  Yes  No If Yes, how many?____________ 4) Have you ever had a c-section?  Yes  No If Yes, how many?_____________ 5) What was the date of your c-section?______________ What type of incision did you have?___________________ 6) Have you ever had a Vaginal Birth After Cesarean (VBAC)?  Yes  No 7) What was your pre pregnant weight for this current pregnancy?________________ 8) What is your height?____________ 9) May we have your permission to post a discreet announcement on our Facebook Group after your birth? (i.e. “A beautiful waterbirth this morning!”)  Yes  No 10) May we use modest/discreet photos of you on our website or Facebook page? (i.e. photo of midwife holding baby at postpartum check-up)  Yes  No Please Select All That Apply to Your History:  Yes  No D&C for Miscarriage or Abortion  Yes  No Cervical Incompetence/Insufficiency  Yes  No Hyperemesis  Yes  No Gestational Diabetes  Yes  No Intrauterine Growth Restriction (IUGR)  Yes  No Neonatal Death  Yes  No Placenta Previa or Placental Abruption  Yes  No Pyelonephritis (Kidney Infection)  Yes  No Rh or other Blood Group or Platelet Sensitization, Hematological or Coagulation Disorders  Yes  No Vacuum or Forceps Use  Yes  No Congenital Anomalies or Genetic Disease  Yes  No Large for Gestational Age (LGA) Baby  Yes  No Pregnancy Induced Hypertension (PIH, High Blood Pressure in Pregnancy)  Yes  No Preterm Birth (<37 weeks) or Post term Birth (>42 weeks)  Yes  No Pre-Eclampsia, Eclampsia or HELLP Syndrome  Yes  No Group B Strep (GBS) Positive Status  Yes  No Shoulder Dystocia  Yes  No Postpartum Hemorrhage Yes  No Retained Placenta or Manual Removal of Placenta  Yes  No Postpartum Depression

Source: http://www.newbeginningsbirthcenter.com/wp-content/uploads/2012/07/NBBC-Intake-Form-Revised.pdf