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Overdose concepts representing a substance base should be modeled using a Causative agent that is a descendant of 105590001 |Substance (substance)|.

Example:

• 295184007 |Morphine overdose (disorder)|

Expected classification:

• Classification results are expected to be consistent with the modeling of the concept selected as the Causative agent in the Substance hierarchy.

Overdose concepts representing a substance modification should be modeled using a Causative agent that is a descendant of 105590001 |Substance (substance)|. Concepts representing substance modifications are exceptions and may be included if the overdose profile is significantly different from the substance base.

Exception examples:

• Chemical element with multiple modifications (e.g. 422232005 |Calcium lactate gluconate (substance)|)
• Liposome or lipid complex substances (e.g. 412088006 |Amphotericin B liposome (substance)|, 426490000 |Vincristine liposome (substance)|)
• Pegylated substance (e.g. 385544005 |Pegfilgrastim (substance)|, 770965008 |Pegvaliase (substance)|)
• Salt forms (e.g. 412432007 |Metoprolol succinate (substance)|, 72770009 |Metoprolol tartrate (substance)|)

Example:

• 292389002 296213007 |Fluphenazine decanoate adverse reaction overdose (disorder)|
• 292390006 296217008 |Fluphenazine enanthate adverse reaction overdose (disorder)|

Expected classification:

• Classification results are expected to reflect that the concept modeled with the modified substance is a descendant of the concept modeled with the base substance (if such a concept exists (e.g. 292389002 |Fluphenazine decanoate adverse reaction (disorder)| has inferred parent 292392003 |Fluphenazine adverse reaction (disorder)|).

Adverse reaction concepts representing multiple substances should be modeled using a Causative agent that is a descendant of 105590001 |Substance (substance)|; preferentially modeling with the base rather than a modification unless the adverse reaction profile is significantly different from the substance base.

Example:

• 292984002 |Ampicillin and cloxacillin adverse reaction (disorder)|
• 292987009 |Piperacillin and tazobactam adverse reaction (disorder)|
• 292989007 |Ticarcillin and clavulanic acid adverse reaction (disorder)|

Expected classification (Agreed 21-Jan-2020):

• Classification results are expected to be consistent with the modeling of the concept selected as the Causative agent in the Substance hierarchy.

Adverse reaction concepts representing a disposition grouper should be modeled using a Causative agent that is a descendant of 105590001 |Substance (substance)|.

Example:

• 293432006 |3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitor adverse reaction (disorder)|
• 870376001 |Adverse reaction to dopamine receptor agonist (disorder)|
  

Expected classification results:

• Classification results are expected to reflect that the adverse reaction concepts are descendants of the appropriate disposition grouper based on the modeling of the 726542003 |Has disposition (attribute)| attribute in the substance hierarchy (e.g. 292113001 |Lansoprazole adverse reaction (disorder)| has inferred parent 292111004 |Proton pump inhibitor adverse reaction (disorder)|).

Adverse reaction concepts representing a role grouper should be modeled using a Causative agent that is a descendant of 105590001 |Substance (substance)|. Note that role groupers will be transitioned to the 763158003 |Medicinal product (product)| hierarchy in a future release.

Example:

• 430136001 |Adverse reaction caused by antiparkinsonism drug (disorder)|
• 292040004 |Analgesic adverse reaction (disorder)|

Expected classification results (Agreed 21-Jan-2020):

• Classification results are expected to reflect that the adverse reaction concepts are descendants of the appropriate disposition grouper based on the modeling of the 726542003 |Has disposition (attribute)| attribute in the substance hierarchy (e.g. 292113001 |Lansoprazole adverse reaction (disorder)| has inferred parent 292111004 |Proton pump inhibitor adverse reaction (disorder)|).
• 
  
• Classification results are expected to be consistent with the modeling in the Substance hierarchy for concepts modeled with an attribute value from the Substance hierarchy.

Adverse reaction concepts representing a structure grouper should be modeled using a Causative agent that is a descendant of 105590001 |Substance (substance)|.

Example:

• 218638005 |Adverse reaction caused by hydantoin derivative (disorder)|
  
• 419885006 |Beta lactam adverse reaction (disorder)|
  

Expected classification (Agreed 21-Jan-2020):

• Classification results are expected to be consistent with the modeling in the Substance hierarchy and with other existing concepts in the subhierarchy.