SNOMED CT Editorial Guide

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Modeling for concepts representing discrete dose forms

CD-precise concepts shall be are modeled using the proximal primitive modeling pattern.

CD-precise concepts representing discrete dose form (e.g. tablets, capsules, pessaries, suppositories,  sachetssachets, ampules or vials containing solid vials containing solid dose forms such as powders or granules, and metered dose delivery products such as inhalers and spray) will be are modeled using presentation strength attributes; concentration strength attributes are not allowed for these concepts in the International Release.

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When a product has a metered delivery, we will give the strength as is "per actuation" not as a concentration.

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  • Concepts with product strength that is "not equal to":
    • These concepts will be modeled Model as primitive, with attributes added as described in the following sections, except that strength numerator attributes will not be added.
    • These concepts will have the The appropriate Medicinal Product Form-only (MPF-only) concept will infer as an inferred a parent.
Stated parent concept

763158003 |Medicinal product (product)

Semantic tag(clinical drug)
Definition status

900000000000073002 |Sufficiently defined by necessary conditions definition status (core metadata concept)|

  • Exceptions:
    • Concepts with product strength that is "not equal to" (e.g. with product strength expressed as a range, greater than, or less than) will have definition status 900000000000074008 |Necessary but not sufficient concept definition status (core metadata concept)|.

Attribute:

Has manufactured dose form

Range:  736542009 <736542009 |Pharmaceutical dose form (dose form) - descendants only

      • NOTE: While the allowed range for this attribute is broader, the CD-precise discrete dose form concepts should only use descendants of 736542009 <736542009 |Pharmaceutical dose form (dose form), excluding grouper concepts based on intended site (e.g. 740596000 |Cutaneous dose form (dose form)|, 385268001 |Oral dose form (dose form)|)

Cardinality: 1..1

The attribute value should represent the manufactured dose form.

NotesNote:

  • Powder and granules for oral suspension, solution, etc. may be modeled using concentration strength and the administrable dose form (e.g. 1145409004 |Product containing precisely amoxicillin 25 milligram/1 milliliter and clavulanic acid (as clavulanate potassium) 6.25 milligram/1 milliliter conventional release oral suspension (clinical drug)|)
  • Clinical drug concepts in the International Release should are not be modeled using dose forms for “lyophilized powder”, because it is not a clinically relevant distinction at the Clinical drug level.
    • Pharmaceutical dose forms referring to “lyophilized powder” will be retained in the International Release but will not be used for modeling Clinical drug concepts; they can be used for modeling in national extensions.

Attribute:

Has unit of presentation

Range: 732935002 <732935002 |Unit of presentation (unit of presentation)| - descendants only

Cardinality: 1..1

Attribute:

Count of base of active ingredient (attribute)

Concrete Type: Integer

Range: >#0..

Cardinality: 1..1

Relationship groupOne relationship group containing one instance of each of the following attributes is required for each precise active ingredient.
  • Has precise active ingredient

Range: 105590001 <105590001 |Substance (substance)| - descendants only, excluding concepts representing structural groupers, dispositions, or combined substances

Cardinality: 1..1 per relationship group

NotesNote:

  • The PAI cannot be modeled as a substance hydrate or solvate unless the BoSS is expressed as a hydrate or solvate.
  • Concepts containing pancreatic enzymes will be are modeled based on the discrete enzymes; because of variability between real clinical drugs, synonyms representing a total amount in a particular product will not be included in the International Release.
  • Has basis of strength substance
  • Range: 105590001 <105590001 |Substance (substance)| - descendants only, excluding concepts representing structural groupers, dispositions, or combined substances
  • Cardinality: 1..1 per relationship group
  • Has presentation strength numerator value 

Concrete Type: Decimal

Range: >#0..

Cardinality: 1..1 per relationship group

Expression of product strength in metric units is preferred.

To avoid semantically equivalent concepts, product strength for metric units are normalized as follows:

    • Use milligram if value is <1000; if > then convert to gram
    • Use microgram if value is <1000; if > then convert to milligram
    • Use nanogram if value is <1000; if > then convert to microgram
    • Use picogram if value is <1000; if > then convert to nanogram

To avoid semantically equivalent concepts, product strength for units are normalized as follows:

    • Use million unit if value is >1000000 unit

The following units are not allowed unless specifically noted as an exception:

    • 408165007 |Mega u (qualifier value)|

Repeating decimals are rounded to three decimal places (with 5 and above rounded up and 4 and below rounded down).

  • Has presentation strength numerator unit

Range: 767524001 <767524001 |Unit of measure (qualifier value)| - descendants only 

Cardinality: 1..1 per relationship group

  • Has presentation strength denominator value

Concrete Type: Decimal

Range: >#0..

Cardinality: 1..1 per relationship group

For this pattern, the attribute value must be 38112003 |1 (qualifier value)|is 1.

Note: the denominator strength value is required for concepts in the International Release even if the value = 1 because including denominators for only some concepts negatively affects the classification results.

  • Has presentation strength denominator unit
  • Range: 767524001 <767524001 |Unit of measure (qualifier value)| - descendants only 
    • While the allowed range for this attribute is broader, the CD-precise concepts representing discrete dose forms should only use descendants of <732935002 |Unit of presentation (unit of presentation).
  • Cardinality: 1..1 per relationship group

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