Advair Diskus

Isabel Filges, M.D.

• Medical Genetics
• University Hospital Basel
• Switzerland

Hoechst Marion Roussel asthma ventolin order advair diskus 250 mcg on-line, the claim in question specified only "[a] pharmaceutical composition comprising a therapeutically effective amount of human erythropoietin and a pharmaceutically acceptable diluent asthma symptoms in 7 year old generic 100 mcg advair diskus fast delivery, adjuvant or carrier asthma exacerbation symptoms discount advair diskus 250 mcg fast delivery, wherein said erythropoietin is purified from mammalian cells grown in culture asthma 504 forms for school effective advair diskus 100 mcg. In that case, Amgen argued that a "therapeutically effective amount" meant that there would be an increase in hematocrit as well as any or all of the biological effects previously attributed to the natural version of the patented product. Amgen argues only that "effective amount" must be an amount effective to provide therapy to a mammal. The center of the dispute regarding this claim term is on the phrase "effective amount. Alternatively, Defendants assert that the term should be construed as "an amount sufficient to stop or significantly reduce [restenosis or cell proliferation]. Claims that are "not amenable to construction" or "insolubly ambiguous" are indefinite. As recently noted by the Federal Circuit, "because claim construction frequently poses difficult questions over which reasonable minds may disagree, proof of indefiniteness must meet an exacting standard. Consequently, to show indefiniteness, an accused infringer is required to "demonstrate by clear and convincing evidence that one of ordinary skill in the relevant art could not discern the boundaries of the claim based on the claim language, the specification, the prosecution history, and the knowledge in the relevant art. Defendantsargue that the claim term "effective amount" is indefinite because the patents fail to provide any benchmark for what amount of rapamycin provides an effective reduction in restenosis or proliferation. But Defendants simply have not shown by clear and convincing evidence that a person of ordinary skill in the art would be unable to determine the specific amounts without undue experimentation. Nigel Buller, a cardiologist experienced in the field of stents and restenosis, who notes that the specification of the Morris patents explains how an effective amount of rapamycin can be determined: by starting "with small dosages," and increasing the dose "until the optimum effect under the circumstances is reached. Buller explains that by using the teachings in the specification, a person of ordinary skill could determine an effective amount by employing different amounts of rapamycin and measuring the results using standard angiographic and sonographic techniques. When construing a patent claim, the Court must first analyze "the intrinsic evidence of record - the claims and written description of the patent itself, and, if in evidence, the prosecution history. Andrx Pharmaceuticals, - 828 - Jump to: A­ B­ C­ D­ E ­ F­ G­ H­ I­ J­ K­ L­ M­ N­ O­ P­ Q­ R­ S­T­ U­V­W­ X­Y­ Z Inc. As discussed above, a patentee may limit the scope of its claims through statements made in the specification. The nutrientindicator actively participates in the growth of the target microbes by serving as the preferred or primary nutrient source. The target microbes can grow, metabolize and multiply into log phase because they, and substantially only they, can use the indicator as their primary nutrient. Because microbes other than the target microbes are prevented from growing, metabolizing or multiplying substantially into log phase, the medium is so specific that it does not have to be sterilized before use. The accelerant is present in a small amount so as to be dissipated by the time the microbes enter log phase of growth. The nutrient used will be one that the target microbes greatly prefer over any other nutrients, and also, one for which other microbes in the sample have little or no preference, and cannot significantly assimilate. The patent specification further states: In general, with respect to this invention, after the specific medium has been added to the sample, during the lag phase while the microbes are adjusting to the presence of the medium no substantial microbial metabolism will occur with either the target or non-target microbes. At the beginning of the log phase, all of the microbes will begin to metabolite [sic] the vitamin and mineral components of the medium, but only the target microbes will also metabolize the specific nutrient component of the medium. This specific nutrient is the only ingredient in the medium which will allow substantial growth, i. Plaintiffs thus expressly represented, and the patent examiner expressly relied on the fact that the claimed invention would permit log-phase reproductive growth of only the target microbe. Accordingly, plaintiffs cannot now "obtain, through litigation, coverage of subject matter relinquished during prosecution. According to Defendants, such short-term and periodic treatment cannot be considered "chronic. However, according to Plaintiffs, treatment with doxercalciferol results in few incidents of hypercalcemia, such that treatment must be suspended only infrequently. Therefore, the Court declines to construe claim 7 as requiring chronic administration. Moreover, the Court finds that the claim term "effective" is not ambiguous in the context of claim 7. Low Incidenceof Hypercalcemia Finally, Plaintiffs contend that the scope of claim 7 should be limited to methods that result in a "low incidence of hypercalcemia. And there is a "heavy presumption" that a claim term carries its ordinary and customary meaning. Here, claim 7 does not explicitly recite a "low incidence of hypercalcemia" limitation, nor is that phrase included in the "ordinary and customary meaning" of the claim term "effective.

The reaction is regioselective asthma treatment over the counter effective 250 mcg advair diskus, and occurs via the most stable carbocation intermediate asthma xolair purchase 250 mcg advair diskus free shipping. Hydrogen halides can be added to alkynes just like alkenes asthma emergency treatment best advair diskus 250 mcg, to form first the vinyl halide asthma treatment dulera advair diskus 500 mcg without prescription, and then the geminal alkyl dihalide. The vinyl cation is more stable with positive charge on the more substituted carbon, because a secondary vinylic cation is more stable than a primary vinylic cation. When the internal alkyne has identical groups attached to the sp carbons, only one geminal-dihalide is produced. The free radical initiators change the mechanism of addition from an electrophilic addition to a free radical addition. Bromine radical Alkoxy radicals Propagation the bromine radical is electron deficient and electrophilic. The reversal of regiochemistry through the use of peroxides is called the peroxide effect. This is called acid-catalysed hydration of alkenes, which is the reverse of the acid-catalysed dehydration of an alcohol. The reaction proceeds via protonation to give the more stable tertiary carbocation intermediate. Addition of water by oxymercuration­reduction or hydroboration­oxidation has two advantages over the acid-catalysed addition of water. These procedures do not require acidic condition, and carbocation rearrangements never occur. Oxymercuration­reduction of alkenes: preparation of alcohols Addition of water to alkenes by oxymercuration­reduction produces alcohols via Markovnikov addition. The electrophilic mercury of mercuric acetate adds to the double bond, and forms a cyclic mercurinium ion intermediate rather than a planer carbocation. In the next step, water attacks the most substituted carbon of the mercurinium ion to yield the addition product. In the addition reaction, borane bonds to the less substituted carbon, and hydrogen to the more substituted carbon of the double bond. When the internal alkyne has identical groups attached to the sp carbons, only one ketone is obtained. For example, 2-butyne reacts with water in the presence of acid catalyst to yield 2-butanone. For example, 2-pentyne reacts with water in the presence of acid catalyst to yield 3-pentanone and 2-pentanone. Addition of water to acetylene gives acetaldehyde, and all other terminal alkynes give ketones. Oxygen loses a proton to form a mercuric enol, which under work-up produces enol (vinyl alcohol). Terminal alkynes are converted to aldehydes, and all other alkynes are converted to ketones. A sterically hindered dialkylborane must be used to prevent the addition of two borane molecules. A vinyl borane is produced with anti-Markovnikov orientation, which is oxidized by basic hydrogen peroxide to an enol. The addition of alcohols in the presence of an acid catalyst, most commonly aqueous 5. The reaction proceeds via protonation to give the more stable carbocation intermediate. The reaction mechanism is exactly the same as the oxymercuration­reduction of alkenes. This reaction is used as a test for unsaturation (p bonds), because the red colour of the bromine reagent disappears when an alkene or alkyne is present. The negative part of bromine is the nucleophile, which attacks the less substituted carbon to open up the cyclic bromonium ion and forms 1,2-dibromoethane (vicinal-dihalide).

Instruct and educate the patient how to perform monthly breast selfexamination and emphasize asthma treatment with herbs cheap advair diskus 500 mcg on line, as appropriate asthma definition images purchase 100 mcg advair diskus mastercard, the importance of having a mammogram performed annually asthma treatment advair discount 250 mcg advair diskus with amex. Encourage the patient to review corresponding literature provided by a pharmacist asthmatic bronchitis quotes buy generic advair diskus 500 mcg online. The cervical biopsy is used to assist in confirmation of cancer when screening tests are positive. Cervical biopsy is obtained using an instrument that punches into the tissue and retrieves a tissue sample. Inform the patient that the test is used to establish a diagnosis of cervical disease. Address concerns about pain and explain that a sedative and/or analgesia will be administered to promote relaxation and reduce discomfort prior to the percutaneous biopsy; general anesthesia will be administered prior to the open biopsy. General: Make sure a written and informed consent has been signed prior to the procedure and before administering any medications. Direct the patient to breathe normally and to avoid unnecessary movement during the local or general anesthetic and the procedure. The diseased tissue is removed along with a small amount of healthy tissue along the margins of the biopsy to ensure that no diseased tissue is left in the cervix after the procedure. Instruct the patient to expect a gray-green vaginal discharge for several days, some vaginal bleeding may occur for up to 1 wk but should not be heavier than a normal menses, and some pelvic pain may occur. The advantage over amniocentesis is that it can be performed as early as the 8th wk of pregnancy, permitting earlier decisions regarding termination of pregnancy. Generally, the laboratory provides detailed interpretive information regarding the specific chromosome abnormality detected. Inform the patient that the test is used to establish a diagnosis of in utero genetic disorders. Record the date of the last menstrual period and determine that the pregnancy is in the first trimester between the 10th and 12th wk. Obtain a history of intravenous drug use, high-risk sexual activity, or occupational exposure. Assure the patient that precautions to avoid injury to the fetus will be taken by locating the fetus with ultrasound. Explain that, during the transabdominal procedure, any discomfort with a needle biopsy will be minimized with local anesthetics. Explain that, during the transvaginal procedure, some cramping may be experienced as the catheter is guided through the cervix. Instruct the patient to drink a glass of water about 30 min prior to testing so that the bladder is full. Transabdominal: Assist the patient into a supine position on the exam table with abdomen exposed. Transvaginal: Assist the patient into a lithotomy position on a gynecologic examination table (with feet in stirrups). Transabdominal Biopsy: Assess the position of the amniotic fluid, fetus, and placenta using ultrasound. A needle is inserted through the abdomen into the uterus, avoiding contact with the fetus. A syringe is connected to the needle and the specimen of chorionic villus cells is withdrawn from the uteroplacental area. Transvaginal Biopsy: Assess the position of the fetus and placenta using ultrasound. A speculum is inserted into the vagina and is opened to gently spread apart the vagina for inspection of the cervix. A catheter is inserted through the cervix into the uterus, avoiding contact with the fetus. A syringe is connected to the catheter and the specimen of chorionic villus cells is withdrawn from the uteroplacental area. After the procedure, the patient is placed in the left side-lying position, and both maternal and fetal vital signs are monitored for at least 30 min.

Syndromes

• Nasal congestion
• Diverticula of the colon
• You are afraid of close spaces (have claustrophobia). You may be given a medicine to help you relax and feel less anxious.
• Enlarged, mildly tender prostate
• Protein electrophoresis - serum
• Varicose veins are painful

The patent examiner objected to the specification because it "[F]ail[ed] to adequately define the manner of describing antiXa activity by employing a percentage asthma 4 month old baby advair diskus 250 mcg sale. Aventis also argues Novo Indus asthma lung cancer order advair diskus 500 mcg without a prescription, L P v Micro Molds Corp asthma symptoms not responding to treatment 100 mcg advair diskus buy amex, 350 F 3d 1348 (Fed Cir 2003) asthma treatment flow chart discount advair diskus 100 mcg free shipping, supports its argument that the court can correct its error. In Novo, the Federal Circuit held that "a district court can act to correct an error in a patent by interpretation of the patent where no certificate of correction has been issued only if (1) the correction is not subject to reasonable debate based on consideration of the claim language and the specification and (2) the prosecution history does not suggest a different interpretation of the claims" Id. Notwithstanding the first part of the Novo test, the second part precludes its application. As discussed above, the prosecution history explicitly advances an interpretation in international units. Thus, the prosecution history does suggest an interpretation different than what Aventis proposes. The patent history shows the patent examiner objected to percentages because of its lack of definition. As a result, the prosecuting patent attorney apparently agreed and affirmatively adopted international units. It does not imply indefiniteness or invalidity with respect to any claim as a whole or to any other part of the 618 patent. The specification provides examples of biodegradable materials with respect to spacers and plugs, such as processed collagen (catgut), Nylon or various other organic substances. The Court finds nothing in the Patent itself, the specification, or prosecution history that discusses the rate of breakdown or eventual elimination. Thus, the Court construes the term "biodegradable" as "capable of being broken down in the human body by the action of microorganisms. Indeed, even the dictionary definitions on which the Court relied do not so limit the term. As Plaintiffs point out, both of these definitions indicate that action by microorganisms is illustrative of only one method of biodegradation. Thus, the Court agrees with Plaintiffs that its original construction was too narrow and adopts instead the construction now advanced by Plaintiffs that includes other natural biological processes. On reconsideration, the term "biodegradable" in Claims 3 and 10 is construed as "capable of being broken down in the human body by natural biological processes. The Court has not considered this extrinsic evidence in its ruling on reconsideration and, therefore, need not rule on this issue raised by Defendant. They contend that this meaning is warranted by the specification language which establishes that the inventors expressly described their invention as a process for making non-edible articles, and also because the inventors added this language to the patent specification during patent prosecution in order to evade the prior art. Claim Language and Language Contained in the Specification the court begins with the words used in the claims themselves. Claims 1 and 24 disclose "biodegradable article[s]" without any reference to whether those articles are edible or non-edible. Defendants point out that the patent Abstract discloses "[a] method of forming solid, non-edible biodegradable, grain protein-based articles. The Field of the Invention states that "[t]he present invention is broadly concerned with a method of forming solid, nonedible biodegradable articles such as eating utensils, cups, plates, sheet items, packaging, and other convenience products. The Description of the Prior Art explains that "[p]etroleum-based synthetic resins have achieved widespread use in the fabrication of a multitude of products. The Summary of the Invention states that "[t]he present invention overcomes the problems outlined above and provides an improved method of forming biodegradable non-edible solid articles using essentially completely biodegradable starting materials and avoiding petroleum-based synthetic resin. The Preferred Embodiment discusses "solid biodegradable articles" without referring to those articles as non-edible, but it gives an example of a formulation for non-edible items. The claim terms (which do not contain the "non-edible" limitation) must of course be read in view of the specification (which does). But, at the same time, the Federal Circuit has repeatedly warned against importing limitations from the specification into the claims. Recognizing that the distinction between using the specification to interpret the meaning of a claim and importing limitations from the specification into the claim can be a difficult one to apply in practice, Phillips, 415 F. Absent a clear disavowal of claim scope, the patentee is entitled to the full scope of its claim language.

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