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Example diagrams for MP (containing)
Stated template view:
Figure 1012: Medicinal Product (containing) stated template view
Example: single active ingredient product: stated view (including therapeutic role) followed by the inferred view that shows the grouper concepts concept associated with the product:
Figure 1113: Medicinal Product (containing) example stated view
Figure 1214: Medicinal Product (containing) example inferred view
Example: multiple active ingredient product: stated view followed by the inferred view that shows the grouper concepts associated with the single active ingredient MP concepts that are the proximal parent concepts for the multiple active ingredient product:
Figure 1315: Medicinal Product (containing) example stated view - multi-ingredient concept
Figure 1416: Medicinal Product (containing) example inferred view - multi-ingredient concept
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| Semantic tag | (medicinal product) | |||||||||||
| Definition status |
Exceptions
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| Role Group | Attribute
| Range
Cardinality
Notes
This attribute describes the set of active ingredient substances that the concept minimally contains. A set set of active ingredient substances may well have only one member. | ||||||||||
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The main use case for describing products containing some active ingredient substance(s), is for analysis; as an aggregation concept for use in research. Details of further use cases will be added as they become available.
Availability of MP (containing) concepts in the international
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edition
This class forms part of the medicinal product content provided in the international releaseedition.
IDMP Compatibility for MP (containing)
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Example diagrams for MP (only)
Stated template view:
Figure 1517: Medicinal Product (only) stated template view
Example: single active ingredient product: stated view followed by the inferred view that shows the grouper concepts proximal parent MP concept associated with the product:
Figure 1618: Medicinal Product (only) example stated view
Example inferred view:
Figure 1719: Medicinal Product (only) example inferred view
Example: multiple active ingredient product: stated view followed by the inferred view that shows the proximal parent MP ( containing ) parent concept associated with the product:
Figure 1820: Medicinal Product (only) example stated view - multi-ingredient concept
Figure 1921: Medicinal Product (only) example inferred view - multi-ingredient concept
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- In national extensions; where it is useful for various clinical purposes, such as prescribing scenarios (so called "abstract" or "non-product-based" prescribing) and in medication history and in Medication Profilesmedication profiles
- Internationally and nationally in decision support and in protocols and treatment guidelines
- Internationally and nationally for interoperability of patient medication information such as in patient summaries
- Internationally and nationally for recording adverse events and/or sensitivities to medication, particularly for multi-ingredient preparations where there will be no appropriate single substance concept and it is not possible to say which particular active ingredient is responsible for the issue
- In pharmacovigilance, especially for description of concomitant medications where less information may be available (see also below in IDMP Compatibility)
- In analysis and research
- As a supporting attribute for other concepts elsewhere in SNOMED CT
Availability of MP (only) concepts in the international
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edition
This class forms part of the medicinal product content provided in the international releaseedition.
IDMP Compatibility
The MP (only) concept might be directly compatible with the ISO 11616 concept of a level 1 Pharmaceutical Product (PhPID_SUB_L1), where the "active substance set" comprises the definition of this concept. However, the granularity of description of substance for the PhP1 is not completely clear, but may be more granular than that used for the MP (only) concept. The MP (only) concept is defined by "only and exclusively the active ingredient substance(s) that it contains but regardless of any modification of those active ingredient substance(s)" whereas the PhP1 will likely use a substance description that includes any modification, including when there are multiple modifications (e.g. a solvated salt modification). See also the MP (precisely) concept below.
Note that, in IDMP, for products using adjuvants it is probable that the adjuvant would be included as part of the "active substance set" and its role explicitly identified. For example aluminium hydroxide is used as an adjuvant in several vaccine products (e.g. hepatitis A, hepatitis B) in addition to the antigen itself to enhance the immune response; it is not an active ingredient per se and it is not an inactive ingredient, it is explicitly an "adjuvant". However, this type of detail of the implementation of the abstract model of ISO 11616 remains unclear, and in its first implementation, vaccines are out of scope for the Medicinal Product hierarchy model in SNOMED CTthe modelling of adjuvants in the vaccine content in the SNOMED CT international edition has not been finalised.
Medicinal Product (MP precisely) (closed world view) - optional concept class - not populated in the
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international edition
Definition of MP (precisely)
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A Medicinal Product (MP precisely) concept may be created in national extensions when use case(s) require this (see below) and for those national extensions where products exist such that the Active Ingredient Count active ingredient count attribute for the MP precisely has a different value from the Active Ingredient Count the active ingredient count of the parent Medicinal Product (MP only) concept. It is described here for completeness and to acknowledge that this is a key issue for many national terminologies. For further details and examples, see the Ingredient Count attribute section below.
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Example: product with a "multiple modified" active ingredient substance (dexamethasone phosphate is the modified concept that has a further modification to give dexamethasone sodium phosphate): stated view, showing both the count of the base active ingredient and the count of base and modification pair are present, as the substance has a multiple modification (dexamethasone phosphate is the modified concept that has a further modification to give dexamethasone sodium phosphate) and there are multi-ingredient concepts that contain this multiple modified substance and at least one other modified ingredient substance that shares the same base substance (dexamethasone) (see next examples). The multi-ingredient concept is "dexamethasone sodium phosphate and dexamethasone acetate". As described in the MRCM rules, the additional ingredient count attributes have to be applied iteratively. The following inferred view shows the correct dexamethasone moiety MP (only) parent concept.
Figure 2022: Single Ingredient Medicinal Product (precisely) example stated view
Figure 2123: Single Ingredient Medicinal Product (precisely) example inferred view
Example: multi-ingredient concept, where both precise active ingredient substances share the same base moiety substance, showing requirement for two ingredient count attributes; note that because these attributes must be applied iteratively, the MP precisely concepts exist for each single ingredient product
Figure 2224: Medicinal Product (precisely) example stated view - multi-ingredient concept
Figure 2325: Medicinal Product (precisely) example inferred view - multi-ingredient concept
The count of base and modification pair ensures that this multi-ingredient product does not incorrectly subsume under either of the single ingredient products, since they have a base and modification pair count of one and this has a base and modification pair count of two. It can subsume under the parent "Product containing only dexamethasone" as shown in the diagram above, as "Product containing only Dexamethasonedexamethasone" has a Count count of base of active ingredient of 1, and that one is dexamethasone (substance), which is the same as for the "Product containing only Dexamethasone dexamethasone acetate and Dexamethasone dexamethasone sodium phosphate".
The requirement for all the three ingredient count attributes depends significantly on how the substance hierarchy is modelled. For example, with calcium products (calcium lactate and calcium lactate gluconate) if both are considered modifications of "calcium (substance)" then for multi-ingredient products containing both, the three ingredient counts would be required to obtain correct classification for MP only and MP precisely concepts.
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In national extensions using the MP precisely concept where there is no MP precisely concept in the international edition and where CD concepts do not have multiple ingredient counts so may mean that classification results are not as expected, it may be necessary to override the international definition of some concepts in the sub-hierarchy in the national extension (e.g. if a CD containing one of the precise ingredient substances has only one count attribute in the international, but requires two or three count attributes in the national in order to get correct classification into an MP precisely concept).
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