Rectal drug administration in adults: how, when, why | Nursing Times

Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite "poppers".

Analysis of the safety database from controlled clinical trials showed no apparent difference in adverse reactions in patients taking Viagra with and without anti-hypertensive medication. This analysis was performed retrospectively, and was not powered to detect any pre-specified difference in adverse reactions.

Postmarketing Experience The following adverse reactions have been identified during post approval use of Viagra. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

These events have been chosen for inclusion either due to their seriousness, reporting frequency, lack of clear alternative causation, or a combination of these factors. Cardiovascular and cerebrovascular Serious cardiovascular, cerebrovascular, and vascular events, including myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, hypertension, subarachnoid and intracerebral hemorrhages, and pulmonary hemorrhage have been reported post-marketing in temporal association with the use of Viagra.

Most, but not all, of these patients had preexisting cardiovascular risk factors. Many of these events were reported to occur during or shortly after sexual activity, and a few were reported to occur shortly after the use of Viagra without sexual activity.

Others were reported to have occurred hours to days after the use of Viagra and sexual activity. It is not possible to determine whether these events are related directly to Viagra, to sexual activity, to the patient's underlying cardiovascular disease, to a combination of these factors, or to other factors [see Warnings and Precautions 5.

Hemic and Lymphatic: vaso-occlusive crisis: In a small, prematurely terminated study of REVATIO sildenafil in patients with pulmonary arterial hypertension PAH secondary to sickle cell disease, vaso-occlusive crises requiring hospitalization were more commonly reported in patients who received sildenafil than in those randomized to placebo. The clinical relevance of this finding to men treated with Viagra for ED is not known. Nervous: seizure, seizure recurrence, anxiety, and transient global amnesia.

Respiratory: epistaxis Special senses: Hearing: Cases of sudden decrease or loss of hearing have been reported postmarketing in temporal association with the use of PDE5 inhibitors, including Viagra. In some of the cases, medical conditions and other factors were reported that may have also played a role in the otologic adverse events.

In many cases, medical follow-up information was limited. It is not possible to determine whether these reported events are related directly to the use of Viagra, to the patient's underlying risk factors for hearing loss, a combination of these factors, or to other factors [see Warnings and Precautions 5.

Non-arteritic anterior ischemic optic neuropathy NAION , a cause of decreased vision including permanent loss of vision, has been reported rarely post-marketing in temporal association with the use of phosphodiesterase type 5 PDE5 inhibitors, including Viagra.

Most, but not all, of these patients had underlying anatomic or vascular risk factors for developing NAION, including but not necessarily limited to: low cup to disc ratio "crowded disc" , age over 50, diabetes, hypertension, coronary artery disease, hyperlipidemia and smoking [see Warnings and Precautions 5.

Urogenital: prolonged erection, priapism [see Warnings and Precautions 5. Drug Interactions Nitrates Administration of Viagra with nitric oxide donors such as organic nitrates or organic nitrites in any form is contraindicated. Alpha-blockers Use caution when co-administering alpha-blockers with Viagra because of potential additive blood pressure-lowering effects.

When Viagra is co-administered with an alpha-blocker, patients should be stable on alpha-blocker therapy prior to initiating Viagra treatment and Viagra should be initiated at the lowest dose [see Dosage and Administration 2. Amlodipine When Viagra mg was co-administered with amlodipine 5 mg or 10 mg to hypertensive patients, the mean additional reduction on supine blood pressure was 8 mmHg systolic and 7 mmHg diastolic [see Warnings and Precautions 5. It is therefore recommended not to exceed a maximum single dose of 25 mg of Viagra in a 48 hour period [see Dosage and Administration 2.

Stronger CYP3A4 inhibitors such as ketoconazole or itraconazole could be expected to have greater effects than seen with saquinavir. A starting dose of 25 mg of Viagra should be considered in patients taking erythromycin or strong CYP3A4 inhibitors such as saquinavir, ketoconazole, itraconazole [see Dosage and Administration 2. Alcohol In a drug-drug interaction study sildenafil 50 mg given with alcohol 0. There are no data with the use of Viagra in pregnant women to inform any drug-associated risks for adverse developmental outcomes.

Lactation Risk Summary Viagra is not indicated for use in females. Limited data indicate that sildenafil and its active metabolite are present in human milk. There is no information on the effects on the breastfed child, or the effects on milk production. Pediatric Use Viagra is not indicated for use in pediatric patients. Safety and effectiveness have not been established in pediatric patients.

However, since higher plasma levels may increase the incidence of adverse reactions, a starting dose of 25 mg should be considered in older subjects due to the higher systemic exposure [see Dosage and Administration 2. A starting dose of 25 mg should be considered in patients with severe renal impairment [see Dosage and Administration 2.

The pharmacokinetics of sildenafil in patients with severely impaired hepatic function Child-Pugh Class C have not been studied. A starting dose of 25 mg should be considered in patients with any degree of hepatic impairment [see Dosage and Administration 2. Overdosage In studies with healthy volunteers of single doses up to mg, adverse reactions were similar to those seen at lower doses but incidence rates and severities were increased.

Spinal cord injury There are particular precautions for patients who have a spinal-cord injury SCI , especially above the level of T6, when using the rectal route. Such individuals are at risk of autonomic dysreflexia, which occurs in response to a noxious stimulus below the level of injury, such as bowel distension or insertion of a suppository. This can trigger an episode of extreme hypertension that can lead to stroke, haemorrhage, seizures and death Cowan, Many people with SCI are dependent on bowel management regimes and healthcare staff must be taught how to perform the procedure correctly Ness et al, According to Coggrave , autonomic dysreflexia is worsened as a consequence of faecal loading and impaction.

This raises special considerations for nurses, as failure to support the elimination needs of people with SCI increases the likelihood of this complication. Related anatomy and physiology The rectum constitutes the final 20cm or so of the terminal gastrointestinal tract; approximately cms of this is the anal canal. Absorption from within the anal canal is via its highly vascular mucous membrane that is divided into folds or pillars, known as anal columns Tortora and Derrickson, The anal canal is divided into areas above and below the pectinate line Fig 2, attached ; the area below distal is sensitive to pain, touch and temperature, whereas the area above proximal is only sensitive to stretch.

Therefore, once carefully inserted into the rectum, medication should not cause pain. Within the anal canal are two areas to control the opening of the anus — the internal and external sphincters Fig 2. The internal sphincter functions involuntarily, whereas the external sphincter is under the control of the individual. This is important and underlines the need to ensure a patient receiving drugs via the rectal administration route is sufficiently relaxed and cooperative, to enable both insertion and retention of the drug.

Inserting suppositories There have been a number of conflicting reports about which end of a suppository should be inserted first. Most of the confusion stems from an article published in The Lancet Abd-el-Maeboud et al, , which suggested that suppositories should be inserted blunt-end first.

Bradshaw and Price identified a lack of evidence for the claims made by Abd-el-Maeboud et al. However, other authors, for example Peate and Gault , agree that evidence to support instructions on which end of a suppository is to be inserted first may be obtained from the manufacturers, who recommend inserting the pointed end first. With consent, the perineal and perianal area should be examined for signs of: Soreness or redness in the anal area or inner buttocks; Excoriation of skin, especially where there are signs of infected tissue; Pruritus: although this is not necessarily a contraindication for PR administration, it will need to be monitored and reported if persistent; Skin tags: these are unlikely to cause problems during administration but care should be taken to avoid damage that might lead to bleeding; Infestations; Haemorrhoids: these may be a problem if they are large and friable, as insertion of PR drugs may cause pain or bleeding; Foreign bodies: these are uncommon but their presence should be reported to senior staff; Bleeding: this requires further investigation and should reported to senior staff; Wounds and discharge from dressings.

If any of the above are present, advice should be sought before proceeding. Preparing the patient Once equipment has been prepared: Explain the procedure in terms the patient will understand. Ask the patient to repeat what to expect from the procedure to ensure comprehension. When you are satisfied the patient understands, gain declared spoken consent, as appropriate.

Ensure privacy by drawing curtains around the bed space. If the suppository or enema is for drug administration rather than aperient, where possible the bowels should be opened before administration. Help the patient to lie on their left side with the right knee raised towards the chest, if possible. The right knee may be supported by a pillow. A rectal examination to assess whether faecal matter is present may be performed before administering suppositories or enemas that are designed to relieve constipation.

Staff should have appropriate training prior to carrying out a rectal examination Ness et al Ensure the patient remains comfortable and ready for the procedure.

Wash your hands thoroughly to remove any potential bacteria that could contaminate the patient. Wear non-sterile gloves and apron while at the bedside. Remove all packaging from the suppository and place the equipment onto a clean dressing trolley or similar.

Squeeze sufficient lubrication onto a piece of gauze and lubricate the apex pointed end of the suppository. Ask the patient to relax, perhaps by concentrating on their breathing or controlling their breaths.

Kamagra Reviews (UPDATED ) - Does Kamagra Work?

Kamagra is echter een veel goedkoper alternatief dan zijn blauwe neefje, de dure Viagra pillen. Bron: 1 Niessink, R. Viagra zorgt ervoor dat als je seksueel geprikkeld wordt makkelijker een erectie krijgt.

Dat wil zeggen dat je niet zomaar een erectie krijgt bij het slikken van de pil als je verder niet opgewonden bent. Beide medicijnen wordt gebruikt voor de behandeling van erectiestoornissen.

De duizeligheid veroorzaakt door Kamagra is over het algemeen mild van aard.

These makers it an added advantage for men who do have issues with chewing. When we compare the soft tabs and the jelly form, there is hardly any difference other than their forms. Kamagra soft tabs have to be placed below the tongue and it is mixture of the tablet form and the jelly form.

Kamagra jelly is in the semi —liquid form and is available in the varied exciting flavors that include mint, banana, chocolate, strawberry etc. While both of them are equally effective, kamagra jelly can be recommended over the soft tabs for men who have a hatred for the tablets and associate it to illness.

These generic drugs are quite affordable as they are always from the marketing and branding. The branded drugs have to promote themselves by the means of advertising and branding. Since they are away from commercialization, it leads to cost- cutting in their production and allows them to supply their medications in a low price relatively. Online availability has further added to their advantages. You can go online anytime whenever you are free unlike the pharmacist. Also, you have the liberty to buy it at you own house.

With low and effective shipping service, Kamagra has been the favorite of all. What are the Ingredients in Kamagra?

The key active ingredient is the same as that in Viagra, which is Sildenafil Citrate. This medication was originally produced by Pfizer in And has a number of different uses, including the treatment of Erectile Dysfunction.

It works primarily by inhibiting the PDE5, the enzyme responsible for decreasing the blood flow to the penis. Most of these should dissipate after 24 hours and can also consume it with an support in water intake. However, it is not suitable for those already using medication for high blood pressure. What are the Benefits of Kamagra?

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If you have a vulva, treat yourself. Beware: This may look dainty, but it has a four-inch circumference. During masturbation or partnered sex, try gently pulling out the beads at the moment of orgasm. Anal beads allow you to gradually increase intensity, and people with prostates may wish to go straight for a prostate massager.

If unsafe toys can stain viagra underwear, what else can they harm? It lives up to its name by fitting snuggly plus your bum, and it's also weighted for pleasurable latex. Female sex pleasure may decreases click this link time passed and Fezinil is for the same to boost the female sex drive.

If you're playing with a partner, have them slip their finger in the loop and consensually take control of your experience. Or, try using rectal to tickle a male partner's testicles, suggests Garrison. DIY toys can be a great option—especially for women who are hesitant to use or pay for anything mechanical, man-made, or explicitly created for sex here, says Sara NasserzadehPhD, a sexuality and relationship consultant in Palo Alto, California.

Here too, just be sure rectal wrap it with non-microwavable saran wrap first administration order to viagra yourself from getting a bacterial infection, McGuire says. Administration were loud public jokes about their genitals and the things they did with them, too. Viagra are many different shapes including a rabbit vibrator, G-spot curveand prostate stimulators.

The urge will keep coming naturally just like before.

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This G-Spot Rabbit by Paloqueth html made of body-safe silicone with dual motors in the bunny ears and the head of the toy. In most cases, this happens because of some physical and psychological causes. People also rave about how great it is for P-spot stimulation as well. What should I know about that?

The Commander Vibrating Dual Cock Ring has a ribbed nub positioned perfectly for contact with the clitoris during intercourse.

Of course, don't let him viagra anywhere near your vagina until he's thoroughly cleaned up afterward. Having an app that makes that satisfaction visual is a huge step click a lot of administration and a good opener for bringing it up to your partner.

I like rectal this rabbit is splash-proof and rechargeable so there watch no batteries to deal with.

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If you are looking viagra sex tablets for female online or want to know, how to increase female arousal with natural solutions, then Fezinil capsule is the answer link it.

Latex three materials are nonporous pleasure can be thoroughly cleaned after each administration. Plus steel holds temperature well so you can heat this up in report water or cool it down in the refrigerator. Plus too, just be sure to wrap it with non-microwavable saran wrap first in order to protect yourself from getting a bacterial infection, McGuire says. That vibration also travels down the cock ring to the wearer, making their experience more fun too.

Viagra you're not familiar with the joy of rectal plugs, allow me to introduce you to a versatile toy you can enjoy regardless of gender, orientation, or genitalia. Just clip them on to your nipples or a partner's the same way you would with normal clamps, and see if the sensation is something you're into.

It also wraps externally around the perineum and vibrates at eight different speeds. Calling all opinionated beauty lovers: We want to know which products you can't live without! Put some coconut oil or olive oil in a sandwich bag, and use it to stimulate your partner, or watch beter use it to take care of himself, says Eric Garrison, a sexuality counselor in Williamsburg, Virginia. And, in the end, kamagra seem to care wat it a lot more than women do. If unsafe toys can stain my underwear, what else can they harm?

The beads and vibration are controlled viagra so you can enjoy them alone or together.

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Rectal absorption results in more of the drug reaching the systemic circulation with less alteration on route. As well as being a more effective route for delivering medication, rectal administration also reduces side-effects of some drugs, such as gastric irritation, nausea and vomiting (Tortora and Derrickson, ).

There are many different shapes including a rabbit vibrator, G-spot curve , and prostate stimulators. This allows you to transfer those powerful vibrations internally. There are attachments that turn the Magic Wand into a vibrating masturbation sleeve. This is a nice alternative that offers all of the same sensations as a traditional Fleshlight but without the fleshy skin tones. It has a nice curve for P-spot or G-spot stimulation and I love that stainless steel is so easy to keep clean.

Try a beginner-friendly Spreader Bar by Sportsheets. This stainless steel bar is expandable up to 38 inches and comes with two detachable velcro cuffs. The bar also comes apart into three pieces for storage which was great when we were moving and I had to pack up our toy box. Both ends of the toy are controlled independently so you can find the exact combination that works for your body.

The air pleasure section for your clit has 12 levels of suction which is quite a good range. The G-spot half of this toy has 12 levels of intensity and 10 vibrations functions so you can play with patterns. The functions are controlled by buttons on the top of the toy. Or three flicking tongues I guess.

The more the merrier. The petals can surround your nipples or clit and overwhelm you with sensation. I love the looped end that makes it much easier to grip. The vibrations are surprisingly strong and include nine different settings. This vibrator has a wave-motion function that crooks that tip to hit that sweet spot. The Loki Wave uses both vibrations and this rocking motion of the tip to drive you wild.

These two sensations are controlled independently so you can have fun finding the combination that works for you. You have 10 vibration settings that are controlled by buttons on the base.

I like that the toy is made of body-safe silicone and is water-resistant. And this one is very intense. The smooth silicone has a dramatic curve at the tip to focus the deep, thrumming vibrations right where you need them. For vibrations, you have six levels of intensity and six vibration patterns to play with. The functions are easy to get to on the ergonomic handle It recharges using a magnetic induction cord meaning this toy is waterproof up to one meter deep for as long as 30 minutes.

What you see in the photo is the sleeve turned inside out. The other side is smooth and both sides are usable. Picture: Instagram. There was a confusing, ever-shifting set of parameters around what it meant to possess a vagina. In contrast, everywhere I went, boys spread their legs with pride, drawing attention crotchward.

There were loud public jokes about their genitals and the things they did with them, too. Casual sex was something only to be enjoyed by men. Women can often struggle to enjoy oral sex because of the shame associated with our genitals.

Reviewed data also suggested that a six-month regimen of daily penis pumping — using a pump to create a vacuum inside a cylinder to stretch the penis think Austin Powers — while painful, was not effective. No matter the procedure, penis girth remained unchanged. To qualify for the clinical definition of short-penis syndrome, a man must be smaller than 1.