La tétracycline, connue sous le nom commercial Sumycin, agit en bloquant la fixation de l’ARNt sur la sous-unité 30S ribosomale, interrompant l’élongation de la chaîne protéique bactérienne. Ce mécanisme confère une activité sur un spectre large, incluant bactéries Gram positives, Gram négatives, rickettsies et spirochètes. Sa biodisponibilité digestive varie selon la prise alimentaire et les interactions avec les ions divalents comme calcium et magnésium. Sa diffusion tissulaire est importante, notamment dans les voies respiratoires et génito-urinaires. L’élimination se fait par voie rénale et biliaire. Les effets indésirables incluent photosensibilisation, troubles digestifs et coloration dentaire en cas d’administration précoce. Les guides thérapeutiques mentionnent sumycin prix, en soulignant la nécessité de restreindre son utilisation afin de limiter les résistances acquises.

Microsoft word - important checklist to be completed before your appointment - 8.12

FORM 4, PATIENT INFORMATION FORM
Tri-City Cardiology Consultants, P.C.
Dobson Baywood Mtn Vista S. Gilbert Ironwood Patient Name: ___________________________________________________________ Date of Visit:________________ Date of Birth: ________________ Age:___________ Sex:__________ Height:____________ Weight:____________lbs.
Referring Doctor:___________________________________ Primary Care Doctor:_________________________________ Reason for Visit (current symptoms today):___________________________________________________________________ Recent hospitalization? If yes, please explain:_________________________________________________________________ Drug/Food Allergies
Are you allergic to any medications:
Other allergies (food, adhesive tape, iodine, latex, etc.):
Current Medications (please list all prescription, non-prescription, vitamins and nutritional supplements)
Local Pharmacy (name & crossroads):_____________________________________ Phone: ( )________-____________ Mail Order Pharmacy:___________________________________________________ Fax: ( )_________-____________ Risk Factors
Do You Use Tobacco: Current Former Never If former, Year Quit:_______________
If Yes, Type: Chewing Cigarettes Pipe Smokeless
Packs/day______________
Have you ever been diagnosed or are taking medications for the following conditions:
Diabetes: Yes No
Unknown If Yes, Type: Type 1 (Juvenile) Type 2 (Adult onset) Year diagnosed____________
High Cholesterol: Yes No Unknown
If Yes, Type: Cholesterol Triglycerides Cholesterol+Triglycerides Low HDL Syndrome
High Blood Pressure: Yes No Unknown Year diagnosed______________
Family History of Heart Disease(CAD) prior to age 55: Yes No Unknown Adopted (No Fam Hx Unknown)
Peripheral Vascular Disease (poor circulation in legs): Yes No Unknown
Social History
Marital Status: Divorced Married Single Widowed Life Partner Other:_________________________
Do you have children: No Yes If Yes, Number of sons:_____________ Number of daughters:______________
White Black/African American Hispanic/Latino American Indian/Alaska Native Asian Pacific Islander/Native Hawaiian Other __________________________ Refused (declined) Do you follow a specific Diet: (check all that apply)
Diabetic Low Carb Low Fat, Low Chol Low Salt No Added Salt No specific diet Regular Renal Vegetarian Weight loss Other:________________________ Activity Level (exercise): Sedentary Occasional Regular Active Life Style Physically Unable to Exercise
Exercise Type: (check all that apply)
Frequency:_________________(times per week)
Aerobics Cycling Dancing Elliptical Jogging Physical Therapy Running Swimming Team Sports Walking Weight lifting Other:_______________________________________ Do you consume Alcohol: Yes No Former If Yes, What Type: Beer Wine Liquor
If Yes, Frequency: Rarely Frequently Social Occasional Daily Drinks per week:______________
Do you consume Caffeine on a daily basis: Yes No Cups per day:___________________
If Yes, What type: Chocolate Coffee Energy Drink Soda Tablets Tea Other:_____________________
Drug use/Abuse: Yes No Former If Yes, What type:_________________________________
Advanced Directives: None DNR HC Proxy Living Will
Primary Language: English Spanish Other:__________________________________
Family History
Unknown- (Unknown)Family Hx
Place a check mark in the box for any conditions below that apply: Adopted - (Unknown)Family Hx
RELATIONSHIP
TO PATIENT:
_________
CURRENT AGE:
AGE AT DEATH:
HEART ATTACK:
ARRHYTHMIA:
HEART FAILURE:
ANEURYSM:
STROKE(CVA):
HIGH BLOOD
PRESSURE:
CHOLESTEROL:
DIABETES:
LUNG DISEASE:
RENAL DISEASE:
Type:____________
Other pertinent family history:
Past Medical History
Place a check mark in the box for any of the conditions that apply: Respiratory: COPD Pulmonary Embolus Pulmonary Hypertension Sleep Apnea Other:______________________
Renal: End Stage Renal Disease Renal Artery Stenosis Renal Insufficiency Other:__________________________
Endocrine: Hyperthyroidism Hypothyroidism Obesity Other:_______________________________________
Oncology: Breast Cancer Skin Cancer Lung Cancer Prostate Cancer Other:________________________
Chemotherapy Radiation Other:_________________________________________________________ Cardiac: Arrhythmias Congestive Heart Failure CAD Heart Attack (MI) Valvular Heart Disease
CABG (Bypass) Coronary Stent ICD Pacemaker PTCA (Angioplasty) Other:___________________________ Vascular: Abdominal Aneurysm Peripheral Arterial Disease Carotid Disease DVT Thoracic Aneurysm
Varicose Veins Amputation Aneurysm Repair Vein Stripping Other:____________________________ List any other medical conditions:
List any other surgeries:
Cardiac Testing
Echo (ultrasound):
Electrophysiology:
Cath Lab:
Vascular:
Stress Test:
Other:
___________________________
Any other cardiac testing:
Review of Symptoms
Check only the problems you are currently experiencing: Cardiac:
Vascular:
Constitutional:
Respiratory:
Gastrointestinal:
Genitourinary:
Neurology:
Psychiatric:
Hematologic:
Endocrine:
Derm(Skin):
Musculoskeletal:
Any additional symptoms you are experiencing:
Patient Name (printed):

Important checklist to be completed before your appointment - 8.12

Form 1 Directions and Maps - 5.12

FORM 2 Communication Tips - 3.12

FORM 3 Important message about your visit - 3.12

Form 5 Important Message Regarding Our Financial Policy Signature Line - 8.12

FORM 6 Authorization to Release Health Information - 5.12

FORM 7 Authority to Release Private Health Information - 5.12

Notice of Privacy Practices 2013

FORM 10 Peripheral Vascular Health Screening Questionnaire - 11.10

FORM 11 Important message about managing your medications - 11.10

Source: http://www.tricitycardiology.com/wp-content/uploads/2013/09/PatientInformationForm.pdf