1. Drug Forms Jim Cimino

2. 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?

3. Clincial Drug Review Active ingredients –Chemical –Form Strength Strength amount Strength units Volume Volume units Dosage form

4. Focus on Dosage Form 3982 comparisons 111 synonyms 72% match rate What went wrong?

5. 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

6. 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^^

7. Near Misses and the Hierarchy A Sodium Fluoride 1.1 MG Chewable Tablet B C D Tablet Chewable Tablet is-a Sodium Fluoride 1.1 MG Tablet

8. 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^^

9. Example of 100% Agreement A: LOTION: 1: LOTION| B: LOTION: 1: LOTION| C: LOTION: 1: LOTION| D: LOTION: 1: LOTION| E: LOTION: 1: LOTION|

10. Example of 100% Agreement A: TABLET CR: 14: TAB E REL|TAB FC ER B: TABLET CR: 6: TAB FC ER|TAB SUG CO| C: TABLET CR: 9: TAB FC ER|TAB E REL| D: TABLET CR: 14: TAB E REL|TAB FC ER|TAB FC| E: TABLET CR: 7: TAB FC ER|TAB E REL|

11. Example of <100% Agreement A: AEROSOL: 2: INHALANT|AEROSL SPR| B: AEROSOL: 1: INHALANT| C: AEROSOL: 1: INHALANT| SPRAY, TOPICAL, DERMAL: 1: AEROSL SPR| D: AEROSOL: 2: INHALANT|AEROSL SPR| E: AEROSOL: 1: INHALANT|

12. Handling Ambiguity Aerosol Inhaled Aerosol is-a Dermal Aerosol A Triamcinolone Acetonide 0.147mg/GM Aerosol A Terbutaline Sulfate 0.2mg/ACT Aerosol D Terbutaline Sulfate 0.2mg/ACT Inhaled Aerosol C E B C Triamcinolone Acetonide 0.147mg/GM Dermal Aerosol is-a

13. 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)

14. No Solution for Solution AMPUL DROPS INFUS. BTL INJECTION IRRIGATION SOLUTION IV SOLN. KIT PIGGYBACK PLAST. BAG SKIN TEST SOLUTION SYRUP VIAL ELIXIR INJ REPOSITORY INJECTION INJECTION TYPE INJECTION IVPB KIT LIQUID SOLUTION SUSPENSION DROPS, OPHTHALMIC (NON-SYSTEMIC) INJECTION IRRIGATION SOLUTION KIT, INJECTION (SYSTEMIC) SOLUTION FOR DROPS, OTIC SOLUTION FOR INHALATION... SOLUTION OPHTMALMIC… SOLUTION, ORAL (SYSTEMIC) SOLUTION, OTIC SOLUTION, TOPICAL, DERMAL SYRUP CONCENTRATE INJECTION KIT NEBU OIL SOLUTION SYRUP

15. Hierarchy Thus Far Capsule (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)

16. Liquid/Solution Hierarchy Oral (Systemic) Liquid/Solution Oral Concentrate Oral Suspension Powder for Oral (Systemic) Suspension Controlled Release Suspension Syrup Elixir Concentrate Oral Concentrate Irrigation Solution Drops Drops Suspension Suspension for Ophthalmic Drops Ophthalmic Drops Solution for Otic Drops Dermal Topical Liquid/Solution Gel Oil Powder for Reconstitution Solution for Oral Inhalation Nebulizer Solution for Oral Mucous Membranes Ophthalmic Solution Ophthalmic Drops Suspension for Ophthalmic Drops Otic Solution Solution for Otic Drops Vial Injection Ampule Infusion Bottle Repository Injection Intravenous Solution IV Piggyback Intraperitoneal Solution Injection Kit Plastic Bag Powder for Injection Skin Test Suspension Oral Suspension Powder for Oral (Systemic) Suspension Controlled Release Suspension 12 Hour Controlled Release Suspension Drops Suspension Suspension for Ophthalmic Drops Suspension for Reconstitution

17. Other Hierarchy Kit Injection Kit Miscellaneous Routes Kit Powder Powder for Injection Powder for Reconstitution Powder for Oral (Systemic) Suspension

18. 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?