drug forms jim cimino. a modest goal mapping actual drugs to clinical drug terms exchanging clinical...

Drug Forms

Jim Cimino

A Modest Goal

• Mapping actual drugs to Clinical Drug terms

• Exchanging Clinical Drug terms sufficient for a variety of purposes

• Question:– Will some loss of information be acceptable?– Does decision support care about pill vs. capsule?

Clincial Drug Review

• Active ingredients– Chemical

– Form Strength• Strength amount

• Strength units

• Volume

• Volume units

• Dosage form

Focus on Dosage Form

• 3982 comparisons

• 111 synonyms

• 72% match rate

• What went wrong?

Examination of Dosage Forms

• Compare use of each form, in each source, with use in other sources for corresponding medications

• Look for irregularities in source

• Look for 100% agreement

• When not 100% agreement, look at hierarchical subsumption

Irregularities in Sources

NDC: 0000153144|FLUORITAB TABLETS CHEWABLE CHERRY|1.1|MG| TAB CHEW|100|BOT:

A:: |FLUORITAB 0.5MG TABLET CHEW^SODIUM FLUORIDE| CHEWABLE TABLET|SODIUM FLUORIDE^00000000.500^MG ^0000.000^

B: |FLUORITAB CHERRY TABS CHEW, 0.5MG|CHEWABLE TABLET| SODIUM FLUORIDE^1.100000^MG^^

C: |SODIUM FLUORIDE CHEW TAB 1.1 MG (0.5MG F)|CHEWABLE TABLET|SODIUM FLUORIDE^1.1000^MG^^

D: ||TABLET|SODIUM FLUORIDE^0.5^MG^^

Near Misses and the Hierarchy

ASodium Fluoride1.1 MGChewable TabletB

C

D

Tablet

ChewableTablet

is-a

is-a

Sodium Fluoride1.1 MGTablet

Irregularities in Sources

NDC: 0000014889|PROPRANOLOL HYDROCHLORIDE EXTENDED RELEASE CAPSULES|80|MG|CAP ER|100|BOT

A: ||CAPSULE CR|PROPRANOLOL HYDROCHLORIDE^80^MG^^

B: |PROPRANOLOL 80MG CAPSULE SA^PROPRANOLOL HCL| CAPSULE CR|PROPRANOLOL HCL^00000080.000^MG^0000.000^

C:: |PROPRANOLOL HCL CAP CR 80 MG|CAPSULE CR| PROPRANOLOL HYDROCHLORIDE^80.0000^MG^^

D:: |PROPRANOLOL HYDROCHLORIDE^80 MG|CAPSULE CR| PROPRANOLOL HYDROCHLORIDE^80^MILLIGRAM(S)^1^EACH

E:: |PROPRANOLOL HCL TABS CR, 80MG|TABLET CR|PROPRANOLOL HYDROCHLORIDE^80.000000^MG^^

Handling Ambiguity

Aerosol

InhaledAerosol

is-a

DermalAerosol

A

Triamcinolone Acetonide0.147mg/GMAerosol

A

Terbutaline Sulfate0.2mg/ACTAerosol

D

Terbutaline Sulfate0.2mg/ACTInhaled Aerosol

C

E

B

C

Triamcinolone Acetonide0.147mg/GMDermal Aerosol

is-a is-a

Example of Subsumption

Aerosol ():A(AEROSOL) D(AEROSOL)

Inhaled Aerosol (INHALENT):B(AEROSOL) C(AEROSOL)

E(AEROSOL)

Dermal Aerosol (AEROSL SPR): C(SPRAY TOPICAL, DERMAL)

No Solution for SolutionAMPULDROPSINFUS. BTLINJECTIONIRRIGATION SOLUTIONIV SOLN.KITPIGGYBACKPLAST. BAGSKIN TESTSOLUTIONSYRUPVIAL

ELIXIRINJ REPOSITORYINJECTIONINJECTION TYPEINJECTION IVPBKITLIQUIDSOLUTIONSUSPENSION

DROPS, OPHTHALMIC (NON-SYSTEMIC)INJECTIONIRRIGATION SOLUTIONKIT, INJECTION (SYSTEMIC)SOLUTION FOR DROPS, OTICSOLUTION FOR INHALATION...SOLUTION OPHTMALMIC…SOLUTION, ORAL (SYSTEMIC)SOLUTION, OTICSOLUTION, TOPICAL, DERMALSYRUP

CONCENTRATEINJECTIONKITNEBUOILSOLUTIONSYRUP

Hierarchy Thus FarCapsule (CAPSULE, CAP GEL CO) Capsule EC (CAP DR PEL) Capsule CR (CAP ER) Capsule CR 12 HR (CAP ER) Capsule CR 24 HR (CAP ER)

Aerosol () Inhaled Aerosol (INHALENT) Dermal Aerosol (AEROSL SPR)Cream (CREAM)Lotion (LOTION) Shampoo (SHAMPOO)Ointment (OINTMENT) Dressing (OINTMENT)Patch (): 24 Hour Patch TD24 (FILM ER) Biweekly Patch (PATCH ER)Rectal Suppository (SUPP)Topical Dermal Powder (POWDER)

Tablet (TABLET) Chewable Tablet (TAB CHEW) Sublingual Tablet (TABLET) Tablet Ultra MCR (TABLET) Tablet CR (TAB FC, TAB FC ER, TAB E REL, TAB SUG CO) Tablet CR 12HR (TAB FC ER, TAB E REL) Tablet CR 24HR (TAB FC, TAB E REL, TAB SUG CO) Coated Tablet (TAB COAT) Enteric Coated Tablet (TAB D REL) Tablet SA OSM (TAB E REL)

Liquid/Solution HierarchyOral (Systemic) Liquid/Solution Oral Concentrate Oral Suspension Powder for Oral (Systemic) Suspension Controlled Release Suspension Syrup Elixir

Concentrate Oral ConcentrateIrrigation SolutionDrops Drops Suspension Suspension for Ophthalmic Drops Ophthalmic Drops Solution for Otic DropsDermal Topical Liquid/SolutionGelOilPowder for ReconstitutionSolution for Oral Inhalation NebulizerSolution for Oral Mucous MembranesOphthalmic Solution Ophthalmic Drops Suspension for Ophthalmic DropsOtic Solution Solution for Otic DropsVial

Injection Ampule Infusion Bottle Repository Injection Intravenous Solution IV Piggyback Intraperitoneal Solution Injection Kit Plastic Bag Powder for Injection Skin TestSuspension Oral Suspension Powder for Oral (Systemic) Suspension Controlled Release Suspension 12 Hour Controlled Release Suspension Drops Suspension Suspension for Ophthalmic Drops Suspension for Reconstitution

Other HierarchyKit Injection Kit Miscellaneous Routes KitPowder Powder for Injection Powder for Reconstitution Powder for Oral (Systemic) Suspension

Where Do We Go From Here?

• Work thus far is based on previous sample

• Can a complete hierarchy be developed?

• Will changes in editorial policy be needed?

• If it should be done, who will do it?

drug forms jim cimino. a modest goal mapping actual drugs to clinical drug terms exchanging clinical...

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