Request for Reconsideration afier Final Action
`
`Page 1 of 5
`
`PTO Form 1930 (Rev 9/2007)
`
`OMB No. 0651-0050 (Exp. 4/30/2009)
`
`Request for Reconsideration after Final Action
`
`The table below presents the data as entered.
`
`Input Field
`
`
`
`SERIAL NUMBER
`
`77507505
`
`LAW OFFICE ASSIGNED
`
`LAW OFFICE 117
`
`MARK SECTION (no change)
`
`http://tgate/PDF/RFR/2009/10/15/20091015102101023204-
`77507505—003_001/evi_2084615350—
`094659845_._Brochure__Reference_to_PediMugs_~
`_page1 1_.pdf
`
`
`
`—_——*——
`
`
`
`(1:()S3§1}J(IE’C(})RT8\IMAGEOUT8\775\075\775075Q5\xml1
`
`\\TICRS\EXPORT8\IMAGEOUT8\775\O75\77507505\xm11
`\IzF?Iu)o03.JPG
`\\TICRS\EXPORT8\IMAGEOUT8\775\075\77507505\.xm11
`\RFROO04.JPG
`
`
`
`\\TICRS\EXPORT8\IMAGEOUT8\775\075\77507505\xml1
`\RFR0005.JPG
`
`\\TIC RS \EXPORT8\IM AGEOUT8\775 \075\ 77 507 505\xm11
`\RFR0006.JPG
`
`\\TIC RS \EXPORT8\IM AGEOUT8\775\075\ 77 5 O7 5 05\xml1
`\RFR000 7. JPG
`
`\\TIC RS\EXPORT8\IMAGEOUT8\775\075\77507505\xm11
`\RFR0008.JPG
`
`\\TICRS\EXPORT8\IMAGEOUT8\775\075\77507505\xm11
`\RF ROO09.JPG
`
`
`
`
`
`file ://\\ticrs-ai s-0 1 \ticrsexport\HtmlToTifiInput\RFR000 1 2009_ 1 0_22_09_1 1_44_TTAB. ..
`
`10/2 2/200 9
`
`
`
`
`
`
`http://tgate/PDF/RFR/2009/10/15/20091015102101023204-
`77507505—0O3_O02/evi_2084615350-
`094659845_._samp1e_PediMUGs.pdf
`
`
`
`
`
`
`.
`
`
`
`
`EVIDENCE FILE NAME(S)
`
`ORIGINAL
`PDF FILE
`
`CONVERTED
`
`PDF mm)
`
`(1 page)
`
`ORIGINAL
`PDFFHF
`‘ ’
`
`1‘j1‘)’F£“;.’ErL‘If:‘(§“3)D
`(8 pages)
`
`

`
`Request for Reconsideration afier Final Action
`
`Page 2 of 5
`
`
`
`The first attachment is a marketing brochure clearly
`referenceing the PediMUGs tradmark (at the bottom of the
`
`
`page). The second attachment is a sample of the actual
`
`PediMUGs Guidelines handbook
`
`\\TICRS\EXPORT8\IMAGEOUT8\775\075\77507505\xml1
`\RFR00 1 0. JPG
`
`
`
`DESCRIPTION OF EVIDENCE FILE
`
`GOODS AND/OR SERVICES SECTION (current)
`
`
`
`
`
`INTERNATIONAL CLASS
`
`044
`
`DES CRIPTION
`Healthcare services, namely, integrated healthcare services with a network of international healthcare
`providers
`
`
`
`Section 1(a)
`
`FILING BASIS
`
`
`
`FIRST USE ANYWHERE DATE
`
`At least as early as 00/O0/2008
`
`FIRST USE IN COMMERCE DATE
`
`At least as early as 00/00/2008
`
`
`
`
`GOODS AN D/OR SERVICES SECTION (proposed)
`
`
`
`
`044
`INTERNATIONAL CLASS
`
` DES CRIPTION
`Healthcare services, namely, integrated healthcare services with a network of international healthcare
`providers
`
`
`
`
`
`
`
`
`FILING BASIS
`
`Section 1(a)
`
`FIRST UsE ANYWHERE DATE
`
`At least as early as 00/00/2008
`
`FIRST USE IN COMMERCE DATE
`
`At least as early as 00/00/2008
`
`ST
`
`ATEMENT TYPE
`
`"The specirnen(s) was in use in commerce as of the filing
`.
`.
`date ofthe application."
`
`
`
`
`
`
`
`
`
`
`
`http://tgate/PDF/RFR/2009/10/15/2009l01510210l023204-
`77507505—003_0O3/SPUO-2084615350-
`O94659845_._PediMUGs.pdf
`
`\\TICRS\EXPORT8\IMAGEOUT8\775\075\77507505\xm11
`\_R_Fg)m1.J1>G
`
`ORIGINAL
`PDF FILE
`
`§§FWVFHEgf§)D
`(1 page)
`
`The specimen contains a black & white rendering of the
`
`"PediMUGs"-
`
`SIGNATURE SECTION
`
`
`
`file://\\ticrs—ais—O1\1icrsexport\HtmlToTifiInput\RFROO0 12009__10_22_09_1 1_44_TTAB...
`
`10/22/2009
`
`
`
`
`

`
`Request for Reconsideration after Final Action
`
`Page 3 of 5
`
` SIGNATORY‘S NAME
`
`Catherine Woods
`General Counsel
` SIGNATORY‘S POSITION
`DATE SIGNED
`10/15/2009
`
`RESPONSE SIGNATURE
`/Catherine Woods/
`
`
`
`Thu Oct 15 10:21:01 EDT 2009
`
`
`
`
`
`
`USPTO/RFR-208.46. 153 . 50-2
`009 10 15102101023204-77507
`505-460541f99ec6f4986defc
`cf81227af1e7-N/A-N/A-2009
`1015094659845307
`
`SUBMIT DATE
`
`TEAS STAM1’
`
`
`
`PTO Form 1930 (Rev 9/2007)
`
`OMB No. 0651-0050 (Exp. 4/30/2009)
`
`Request for Reconsideration after Final Action
`
`To the Commissioner for Trademarks:
`
`Application serial no. 77507505 has been amended as follows:
`
`EVIDENCE
`Evidence in the nature of The first attachment is a marketing brochure clearly referenceing the
`PediMUGs tradmark (at the bottom of the page). The second attachment is a sample of the actual
`PediMUGs Guidelines handbook. has been attached.
`
`Original PDF file:
`http://tgate/PDF/RFR/2009/10/15/20091015102101023204-77507505-003_001/evi_2084615350-
`09 4659845_._Brochure_Referenc e_to_PediMugs_-_page1 1_.pdf
`Converted PDF file(s) (1 page)
`Evidenc e- 1
`
`Original PDF file:
`http://tgate/PDF/RFR/2009/10/15/20091015102101023204—77507505-003_002/evi_2084615350-
`094659845_._samp1e_PediMUGs.pdf
`Converted PDF file(s) (8 pages)
`
`file://\\ticrs—ais—O1\ticrs export\Htm1TOTifi'Input\RFR000 12009_1 0_22_09_1 1_44_TTAB . ..
`
`10/22/2009
`
`
`
`SIGNATORY'S NAME
`
`Catherine Woods
`
`SIGNATORY‘S POSITION
`
`General Counsel
`
`DATE SIGNED
`
`10/15/2009
`
`AUTHORIZED SIGNATORY
`
`YES
`
`CONCURRENT APPEAL NOTICE FILED YES
`
`FILING INFORMATION SECTION
`
`

`
`Request for Reconsideration after Final Action
`
`Page 4 of 5
`
`Evid_ence—1
`Evidence—2
`E\:idS{{6e3
`E_vi_d_ence-4
`Eviden_ce-S
`Evid9t1_c_e-_6
`Evidenc e-7
`
`E_vi_d§nce—8
`
`CLASSIFICATION AND LISTING OF GOODS/SERVICES
`Applicant proposes to amend the following class of goods/services in the application:
`Current: Class 044 for Healthcare services, namely, integrated healthcare services with a network of
`international healthcare providers
`Original Filing Basis:
`Filing Basis: Section 1(a), Use in Commerce: The applicant is using the mark in commerce, or the
`applicant's related company or licensee is using the mark in commerce, on or in connection with the
`identified goods and/or services. 15 U.S.C. Section lO51(a), as amended. The mark was first used at
`least as early as 00/00/2008 and first used in commerce at least as early as 00/00/2008, and is now in use
`in such commerce.
`
`Proposed: Class 044 for Healthcare services, namely, integrated healthcare services with a network of
`international healthcare providers
`Filing Basis: Section 1(a), Use in- Commerce: The applicant is using the mark in commerce, or the
`applicant's related company or licensee is using the mark in commerce, on or in connection with the
`identified goods and/or services. 15 U.S.C. Section 1051(a), as amended. The mark was first used at
`least as early as 00/00/2008 and first used in commerce at least as early as 00/00/2008, and is now in use
`in such commerce.
`Applicant hereby submits a new specimen for Class 044. The specimen(s) submitted consists of The
`specimen contains a black & white rendering of the Trademark "PediMUGs"..
`For an application based on 1(a), Use in Commerce, "The substitute specimen(s) was in use in
`commerce as of the filing date of the application."
`Original PDF file:
`http://tgate/PDF/RFR/2009/10/15/20091015102101023204-77507505-003_003/SPUO-2084615350-
`O94659845_.gPediMUGs.pdf
`Converted PDF file(s) (1 page)
`Sgggimen Filel
`
`SIGNATURE(S)
`Declaration Signature
`Ifthe applicant is seeking registration under Section 1(b) and/or Section 44 of the Trademark Act, the
`applicant has had a bona fide intention to use or use through the applicant's related company or licensee
`the mark in commerce on or in connection with the identified goods and/or services as of the filing date
`of the application. 37 C.F.R. Secs. 2.34(a)(2)(i); 2.34 (a)(3)(i); and 2.34(a)(4)(ii); and/or the applicant
`has had a bona fide intention to exercise legitimate control over the use of the mark in commerce by its
`members. 37 C.F. R. Sec. 2.44. Ifthe applicant is seeking registration under Section 1(a) of the
`Trademark Act, the mark was in use in commerce on or in connection with the goods and/or services
`listed in the application as ofthe application filing date or as of the date of any submitted allegation of
`use. 37 C.F.R. Secs. 2.34(a)(1)(i); and/or the applicant has exercised legitimate control over the use of
`the mark in commerce by its members. 37 C.F.R. Sec. 244. The undersigned, being hereby warned that
`willful false statements and the like so made are punishable by fine or imprisonment, or both, under 18
`U.S.C. Sectionl001, and that such willful false statements may jeopardize the validity of the application
`
`file://\\ticrs-ais—01\ticrsexport\HtmlToTifiInput\RFR00012009_10_22_09_1 l_44_TTAB...
`
`10/22/2009
`
`

`
`Request for Reconsideration afier Final Action
`
`Page 5 of 5
`
`or any resulting registration, declares that he/she is properly authorized to execute this application on
`behalf of the applicant; he/she believes the applicant to be the owner of the trademark/service mark
`sought to be registered, or, if the application is being filed under 15 U.S.C. Sectionl051(b), he/she
`believes applicant to be entitled to use such mark in commerce; to the best of his/her knowledge and
`belief no other person, firm, corporation, or association has the right to use the mark in commerce, either
`in the identical form thereof or in such near resemblance thereto as to be likely, when used on or in
`connection with the goods!services of such other person, to cause confusion, or to cause mistake, or to
`deceive; that if the original application was submitted unsigned, that all statements in the original
`application and this submission made of the declaration signer's knowledge are true; and all statements
`in the original application and this submission made on information and belief are believed to be true.
`
`Date: 10/15/2009
`Signature: /Catherine Woods,’
`Signatory‘s Name: Catherine Woods
`Signatory‘s Position: General Counsel
`
`Request for Reconsideration Signature
`Signature: /Catherine Woodsl Date: 10/15/2009
`Signatory‘s Name: Catherine Woods
`Signatory‘s Position: General Counsel
`
`The signatory has confirmed that he/she is an attorney who is a member in good standing of the bar of
`the highest court of a U.S. state, which includes the District of Columbia, Puerto Rico, and other federal
`territories and possessions; and he/she is currently the applicant's attorney or an associate thereof; and to
`the best of his/her knowledge, if prior to his/her appointment another US. attorney or a Canadian
`attorney/agent not currently associated with his/her company/finn previously represented the applicant
`in this matter: (1) the applicant has filed or is concurrently filing a signed revocation of or substitute
`power of attomey with the USPTO; (2) the USPTO has granted the request of the prior representative to
`withdraw; (3) the applicant has filed a power of attorney appointing him/her in this matter; or (4) the
`applicant's appointed U.S. attorney or Canadian attomey/agent has filed a power of attorney appointing
`him/her as an associate attorney in this matter.
`
`The applicant is filing a Notice of Appeal in conjunction with this Request for Reconsideration.
`
`Serial Number: 77507505
`Internet Transmission Date: Thu Oct 15 10:21:01 EDT 2009
`
`TEAS Stamp: USPTO/RFR-208.46. 15350-200910 15 10210102
`3204-77507505-46054lt99ec6f4986defccf812
`27af1e7-N/A—N/A-20091015094659845307
`
`file://\\ticrs-ais—01\ticrsexport\HtmlToTifiTnput\RFR000l2009_10_22_09_l l_44_TTAB...
`
`10/22/2009
`
`

`
`FEATURES OF VALUE IN ALL
`
`AREAS OF CARE
`
`\)'/e are proud to provide our partners with one—of-;1—l<ind service oiierings. Hl”s
`
`offerings have heen developed through recognition ofour hospice partner's needs
`
`and a fulfillment of unacknowledged gaps in service previously overlooked.
`
`COM FORTPAKS
`. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..................................................................
`
`I-iP’s Conifortlhks address the most common symptoms at the end oflife, and the
`
`most urgent problem for hospices: immediate access to the appropriate medica-
`
`tions. There nre currently Four different HP Paks: the Comfortpak, a C:trdiacI’ak,
`
`SeizurePak, and a Pediatric ComfortPak.
`
`HP WOUNDCARE
`. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............................................
`
`HP is proud to he the only hospice pharmacy service company to offer wound care
`
`assessment, Care planning, and select products for the management of wounds at
`
`the end oi: lite. Services include comprehensive. peer—reviewed Hi’ \X/oundCare
`
`‘X-’\~"c2w t/mt we /.2am2 access
`
`(HP\X/C) Guidelines, access to consultation with HP's wound care certified spe-
`
`II) f//1656’ great Cn;n_fort1"’rIk;
`
`cialists, metrics and outcomes tracking. HP WouttdCare consultation and the
`
`zuir/;I
`
`;~r.Iez{ia'zz‘z'0715 tlrzzt zw‘
`
`Hi’W'C Guidelines are included in Hlrs per diem pricing. Wound care products
`
`are offered to our clients under a fee—for—service model. W/e support hospice staff
`
`to suggest the most cost—effective solutions for hospices.
`
`PEDIATRICS
`
`HP's recognition of the crucial difference and distinctiveness in pediatric care,
`
`use ezIeryc[zzy,
`
`five’
`
`/ma.’ «me
`
`umzve re/I rrze t/mt it’: mt
`
`clown
`
`an
`
`/Ber
`
`pl1}*51'c'im1
`
`/>/Jam’ 471/It
`
`£2): 75 9/62.’
`
`717:’
`
`Caiivzfinz‘/’zI/95 1‘Ii‘é‘
`
`i'7c'rzt:/}1z!‘rz/
`
`and of the need for nurse education on such, prompted the development of the
`
`rzrzazl Slit’//7 :1 time’ .~7£z21'22f5. ”
`
`Pediatric ivlediczttion Use Guidelines (Peclii\/IUGS) as well as the Pediatric Com-
`
`fortPak. Hospices benefit from the knowledge of our pediatric palliative care
`
`trained pharrnacists with expertise in specialized care planning and dosing for the
`
`special populations.
`
`Janet Champoux, Hospice
`
`Clinical Manager, Mercy Medical
`
`Center Hospice
`
`Hzasvltii‘. F’HARMA<:‘tA -~ 53tIPi>«i)Rtiw;. Pi«U.’.)'vi'N. Pi%;t‘;-:t.ssi<3.\-‘M.
`
`I
`
`ll
`
`

`
`PEDIMUGS
`
`ii
`
`i’*"§ES!CATiON USE GUIDELINES
`
`SAl\/IPLE
`CYSTLIC FIBROSIS PROTOCOL’
`
`hospice pharmacia
`
`a service ofexczllekx, Inc.
`
`1601 Cherry Street, Suite I700 - ?hi!ade|phia, W6.
`
`|9E02 - 877.882.7822 - www.ho5picepharmacia.com
`Capyright © 2098 excefIeRx, inc,
`
`

`
`l-lP’s Pediatric Medication Use Guidelines (Pedil"lUGs) provide
`
`25 evidencebased protocols that comprise the most comprehensive
`
`pediatric symptom management tool in the hospice industry. ln addition,
`
`they highlight the important principles unique to medication therapy in
`
`the pediatric population.
`
`The PediMUGs and l-lP's pharmacists help hospices to provide
`
`consistent, standardized, high—quality palliative care for patients—while
`
`controlling medication costs.
`
`To learn more about the Pediatric Medication Use Guidelines or the
`
`medication management services offered by Hospice Pharmacia, please
`
`call 877-882-7822. PediMUGs are offered free—of-charge, exclusively to
`
`Hospice Pharmacia partnering hospices.
`
`Hospice Pharmacla Medication Use Guidelines and Wound Care
`Guidelines are also available.
`
`Copyright © 2008, excellefix, lnc.. All rights reserved. Medication Use Guidelines (MUGS), and all Xerls products and services and their
`respective logos are trademarks of excallefix, Inc. MUGs“ and Xena“ are registered trademarks of excelleRx, lnc. No part of the information
`contained herein may be reproduced, duplicated, or copied without permission. Please inquire if you are not sure.
`
`

`
`INCLUSION CODE: 0
`
`CYSTIC FEBROSIS
`
`Cystic fibrosis (CF) is a hereditary disease that causes certain glands to produce abnormal
`secretions, resulting in several symptoms, the most important of which affect the digestive
`tract and the lungs. In some glands, such as the pancreas and those in the intestines, the
`secretions are thick or solid and may block the gland completely.The mucus-producing glands
`in the airways of the lungs produce abnormal secretions that clog the airways and allow
`bacteria to multiply.The sweat glands, parotid glands, and small salivary glands secrete fluids
`containing more salt than normal. Recurrent bronchitis and pneumonia gradually destroy the
`lungs. Death usually results from a combination of respiratory failure and a failing heart caused
`by the underlying lung disease.A small number, however, will expire clue to liver disease,
`bleeding into the airway, or complications of surgery.
`
`Non-pharmacologic therapy
`' Nutrition
`
`- Vitamin suppiementation (A, D, E, and lQ.
`' Percussion and postural drainage
`
`Pharmacologic therapy
`
`A
`Meconium ileus
`Meconium ileus, a form of intestinal obstruction in newborns, occurs in almost 20% of those
`with CF. Meconium, the dark green substance that emerges as the newborn's first stool, is
`thick and passes more slowly than normal. if the meconium is too thick, it blocks the intestine.
`Lactulose can be used for the prevention of intestinal obstruction.
`
`LACTULOSE
`
`miL/"24 h in 3 or 4 divided doses
`
`Pancreatic insufficiency
`A pancreas affected by CF does not produce enough enzymes to digest proteins and fats.
`Without the appropriate digestive enzymes, the body loses too much protein and fat in the
`stools, resulting in malnutrition and slowed growth. Stools are bulky and often foul smelling.
`
`PANCRELIPASE CAPSULES OR TABLETS:
`
`
`
`
`i000 units of lipasellcg/meal
`I
`‘Cit?
`”‘S
` Maximum dose:
`2500 units/kg/meal
`
`
`
`CYSTIC FIBROSES
`
`

`
`CYSTIC Fnaaosisi INCLUSION come: 0
`
`Product
`
`lmmediaterelease tablet
`
`Amylase
`(Units)
`
`Protease
`(Units)
`
`30,000
`
`
`Capsules, enteric—coated 4 Creon 5 SR
`i
`5.000
`l6,600
`l8,75O
`““”"‘“‘°r°SPl“3'“*°-5
`Creon :0 SR
`10.000
`33,220
`37,500
`Creon 20 SR
`20,000
`66,400
`
`
`
`Capsules, enteriocoatecl
`“"“°5Pl‘e"‘”-SW” '°‘°a"
`bonate buffer
`
`Pancrecarb l"lS—4
`Pancrecanb MS-8
`
`4,000
`8,000
`
`25,000
`40,000
`
`25,000
`45,000
`
`0
`
`Pancrecarb MS- l 6
`
`-
`
`l 6,000
`
`52,000
`
`52,000
`
`Adapted from: Ferrone /l/l, Raimonclo /l/1,Sc0lapio jS. Pancreatic Enzyme Phormacotherapy. Phannacother
`2007.‘2 7(6):‘? l 0-920.
`
`Clinical Notes:
`
`—
`
`- The capsule beads are not stable when placed in breast milk or formula.The current
`recommendation is to open the capsule(s) and place the beads on a spoon containing a
`small amount of applesauce, infant rice cereal, banana, or sweet potato baby food.
`— The baby should be given this enzyme—food mixture before the liquid feeding.The mouth
`should be checked to make sure that all the beads have been swallowed.
`lf retained in the mouth, the beads may irritate the mucous membranes. Feeding can
`commence once the beads are swallowed. One suggested method is the place the beads
`in the cheek and immediately offer fluids.
`— As infants learn to chew, be sure they do not chew the beads.
`- The pancreatic enzymes are acid labile, and if introduced into the stomach without the
`protection of a coating, they will be degraded in the acid medium of the stomach.
`- Caregivers can “hide the beads" in yogurt, applesauce, ice cream, or pudding (low pH
`foods). Feeclings that are high in fat may require additional enzyme supplementation.
`Feedings of fruits or vegetables may not require any enzyme supplementation.
`- Snack doses are approximately half of meal closes but may vary depending on the food
`consumed.
`
`4
`
`l CYSTIC FEBROSIS
`
`

`
`INCLUSION CODE:O I CYSTIC FIBROSIS
`
`Dyspepsia
`
`RANITIDINE
`
`> I month—I 6 years of age:
`
`2~4 mg/kg/24 h PO divided q8——I Zh
`Maximum close: 300 mg/Z4 h
`
`Clinical Notes:
`
`- Dosage needs to be adjusted for patients with renal impairment.
`° Ranitidine may decrease absorption of some medications requiring an acidic gastric envi—
`ronment for absorption (e.g., ketoconazole, some cephalosporins, cyciosporine).
`° Some patients may not tolerate the peppermint flavor of the oral syrup preparation.
`
`FAMOTIDINE
`
`l~l6 years of age:
`
`Clinical Notes:
`
`0.5 —I mg/kg/24 h PO divided q I 2h
`Maximum close: 40 mg/24 h
`
`- Dosage needs to be adjusted for patients with renal impairment.
`- Famotidine may decrease absorption of some medications requiring an acidic gastric
`environment for absorption (ketoconazole. some cephalosporins, cyciosporine).
`
`OMEPRAZOLE
`
`PC:
`
`I mg/kg/24 h administered daily or bid
`Effective range: 0.3-3.3 mg/kg/24 h
`
`Clinical Notes:
`
`- Administer all doses before meals.
`
`- To administer dose, the capsules may be opened and the intact pellets administered in an
`acidic beverage (apple/cranberry juice) or applesauce.
`° An extemporaneously compounded oral suspension is available. However, this preparation
`may be less bioavailable due to loss of omeprazoles enteric coating.
`- Omeprazole may decrease absorption of some medications requiring an acidic gastric
`environment for absorption (e.g., ketoconazole, some cephalosporins, cyciosporine).
`- Omeprazole is a substrate and inhibitor of CYP45O ZCI9 and induces CYP45O IAZ; its
`metabolism may be altered by medications that share these pathways.
`
`CYSTIC FIBROSIS
`
`5
`
`

`
`CYSTIC FIBROSIS l
`
`lNCLUSlON CODE:O
`
`METOCLOPRAMlDE
`
`PO/IVIIM:
`Infants and children:
`O. l—O.2 mg/kg/dose up to qid
`Maximum dose: 0.8 mg/kg/24 h
`
`
`Clinical Notes:
`
`- Avoid using in patients taking MAOls.
`-
`in higher doses, metoclopramide has the potential to cause EPS; premedicating with diphen~
`hydramine may reduce the incidence of EPS.
`° Metoclopramide is contraindicated in patients with a complete bowel obstruction and
`pheochromocytoma.
`- Relative contraindication exists for patients with a seizure history as metoclopramide can
`lower seizure thresholds.
`
`- Metoclopramide is a substrate of CYP45O lA2 and ZD6 enzymes; its metabolism may be
`altered by medications that share these pathways.
`
`Diabetes mellitus
`
`Diabetes mellitus (DM) is a common medical complication affecting CF patients. An increase
`in the number of insulin receptors occurs with a decreased affinity for insulin. leading to
`glucose intolerance.The incidence of DM ranges from less than 1% in CF patients who are
`younger than IO years of age to more than lO% in patients older than age 25.
`
`INSULIN, REGULAR
`
`Dosage is based on patient—specific factors.
`
`INSULIN, NPH
`
`Dosage is based on patient-specific factors.
`
`INSULIN. 70/30
`
`Dosage is based on patient—specific factors.
`
`Dyspnea
`
`Thick bronchial secretions eventually block the small airways, which then become inflamed.
`As the disease progresses, the bronchial walls thicken, the airways fill with infected secretions;
`areas of contact and the lymph nodes enlarge.All these changes reduce the lung's ability to
`transfer oxygen to the blood.
`
`See Dyspnea guideline for bronchodilator, corticosteroid. and respiratory sedative therapy
`options.
`
`Clinical Note:
`
`- Bioavailability oftheophylline may be decreased and clearance may be different in CF paflents.
`
`l CYSTIC HBROSIS
`
`

`
`lNCLUSlON CODE: 0
`
`CYSTIC FIBROSIS
`
`Respiratory tract infections
`Most CF infants have constant coughing, wheezing, and respiratory tract infections. CF patients
`typically do not clear their infections, as they become chronic colonizers of Pseudomonas
`aeruginosa. Coughing, the most notable symptom, is often accompanied by gagging, vomiting,
`and disturbed sleep.The most common pathogens found in the sputum include:
`' Staphylococcus aureus (prevalent in younger patients)
`- Pseudomonos aeruginosa
`- Haemophilus influenzae (prevalent in younger patients)
`- Burkholderia cepocia or Stenotrophamonas (more common in end-stage patients)
`
`See Infections guideline of the PediMUGs for therapy options.
`
`Cough/congestion
`
`- See Cough Guideline
`
`Anxiety
`
`- See Anxiety Guideline
`
`inflammation
`
`lBUPROFEN
`
`PO:
`
`Clinical Notes:
`
`Higher doses of 20—30 mg/kg/dose bid have been used for anti-
`inflammatory effects.
`
`ibuprofen inhibits the migration and activation of neutrophils.
`'
`- Greatest effect on lung function in clinical studies was seen in patients 5-13 years of age.
`- Ibuprofen requires regular monitoring of serum levels; peak plasma levels of 50—l 00 mcg/
`mL are desirable.
`
`- Long-term safety in CF patients is not known at this time.
`* Use with caution in patients allergic to aspirin; in patients with a history of hepatic or renal
`dysfunction, CHF, or Gl bleeding; or in patients taking anticoagulants.
`- Do not use in combination with other l\lSAlDs or in patients with bleeding diathesis.
`
`See Pain — Nociceptive guideline, Dyspnea guideline, and Corticosteroid closing section of the
`Pedil"lUGs for additional therapy options that may be useful in CF patients.
`
`CYSTKZ FIBROSV5
`
`7
`
`

`
`Hospice Pharmacia
`G sen/ice sf excelfefibc‘. ins.
`
`' Ph§Eaa:§s:iphia.¥’A l9%E}7.
`‘$21.;-'c€:t.SLsit.£2 Wififl
`«.!d.(.C>K’h
`- 877.88?.783?? -
`i:sf<;»@ihO.‘~;pi€esp?zs:r'rn;a{'i;a.<..0rn