Medicinalproductinteraction-example.ttl

Example of medicinalproductinteraction

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/MedicinalProductClinicals/example> a fhir:MedicinalProductClinicals;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "example"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: example</p><h3>UndesirableEffects</h3><table><tr><td>-</td><td><b>SymptomConditionEffect</b></td><td><b>Classification</b></td><td><b>FrequencyOfOccurrence</b></td></tr><tr><td>*</td><td>Prevention of\\nVTE in adult\\npatients who have\\nundergone\\nelective hip or\\nknee replacement\\nsurgery (VTEp) <span>(Details : {http://ema.europa.eu/example/undesirableeffectassymptom-condition-effect code 'Anaemia' = 'Anaemia)</span></td><td>Bloodandlymphaticsystemdisorders <span>(Details : {http://ema.europa.eu/example/symptom-condition-effectclassification code 'Bloodandlymphaticsystemdisorders' = 'Bloodandlymphaticsystemdisorders)</span></td><td>Common <span>(Details : {http://ema.europa.eu/example/frequencyofoccurrence code 'Common' = 'Common)</span></td></tr></table><blockquote><p><b>therapeuticIndication</b></p><p><b>diseaseSymptomProcedure</b>: Prevention of venous thromboembolic events (VTE) in adult patients who have undergone elective hip\\nor knee replacement surgery.\\nPrevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation\\n(NVAF), with one or more risk factors, such as prior stroke or transient ischaemic attack (TIA); age\\n≥ 75 years; hypertension; diabetes mellitus; symptomatic heart failure (NYHA Class ≥ II).\\nTreatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent\\nDVT and PE in adults (see section 4.4 for haemodynamically unstable PE patients). <span>(Details : {http://ema.europa.eu/example/indicationasdisease-symptom-procedure code 'Venousthromboembolismprophylaxis' = 'Venousthromboembolismprophylaxis)</span></p><p><b>comorbidity</b>: Hipsurgery <span>(Details : {http://ema.europa.eu/example/comorbidity code 'Hipsurgery' = 'Hipsurgery)</span></p><p><b>intendedEffect</b>: PRYLX <span>(Details : {http://ema.europa.eu/example/intendedeffect code 'PRYLX' = 'PRYLX)</span></p><h3>Populations</h3><table><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><h3>Contraindications</h3><table><tr><td>-</td><td><b>Disease</b></td><td><b>Comorbidity</b></td></tr><tr><td>*</td><td>Hepatic disease associated with coagulopathy and clinically relevant bleeding risk <span>(Details : {http://ema.europa.eu/example/contraindicationsasdisease-symptom-procedure code 'Coagulopathiesandbleedingdiatheses(exclthrombocytopenic)' = 'Coagulopathiesandbleedingdiatheses(exclthrombocytopenic))</span></td><td>Hepaticdisease <span>(Details : {http://ema.europa.eu/example/comorbidity code 'Hepaticdisease' = 'Hepaticdisease)</span></td></tr></table><h3>Interactions</h3><table><tr><td>-</td><td><b>Interaction</b></td><td><b>Interactant</b></td><td><b>Type</b></td><td><b>Effect</b></td><td><b>Management</b></td></tr><tr><td>*</td><td>Inhibitors of CYP3A4 and P-gp\\nCoadministration of equixaban with ketoconazole (400 mg once a day), a strong inhibitor of both\\nCYP3A4 and P-gp, led to a 2-fold increase in mean equixaban AUC and a 1.6-fold increase in mean\\nequixaban Cmax.\\nThe use of Eliquis is not recommended in patients receiving concomitant systemic treatment with\\nstrong inhibitors of both CYP3A4 and P-gp, such as azole-antimycotics (e.g., ketoconazole,\\nitraconazole, voriconazole and posaconazole) and HIV protease inhibitors (e.g., ritonavir) (see\\nsection 4.4).\\nActive substances which are not considered strong inhibitors of both CYP3A4 and P-gp,\\n(e.g., diltiazem, naproxen, amiodarone, verapamil, quinidine) are expected to increase equixaban\\nplasma concentration to a lesser extent. Diltiazem (360 mg once a day), for instance, considered a moderate CYP3A4 and a weak P-gp inhibitor, led to a 1.4-fold increase in mean equixaban AUC and a 1.3-fold increase in Cmax. Naproxen (500 mg, single dose) an inhibitor of P-gp but not an inhibitor of CYP3A4, led to a 1.5-fold and 1.6-fold increase in mean equixaban AUC and Cmax, respectively. No dose adjustment for equixaban is required when coadministered with less potent inhibitors of CYP3A4 and/or P-gp.</td><td>ketoconazole <span>(Details : {http://ema.europa.eu/example/interactant code 'ketoconazole' = 'ketoconazole)</span></td><td>StrongInhibitorofCYP3A4 <span>(Details : {http://ema.europa.eu/example/interactionsType code 'StrongInhibitorofCYP3A4' = 'StrongInhibitorofCYP3A4)</span></td><td>Increasedplasmaconcentrations <span>(Details : {http://ema.europa.eu/example/interactionseffect code 'Increasedplasmaconcentrations' = 'Increasedplasmaconcentrations)</span></td><td>CoadministrationnotrecommendedinpatientsreceivingconcomitantsystemictreatmentstronginhibitorsofbothCYP3A4andP-gp <span>(Details : {http://ema.europa.eu/example/managementactions code 'CoadministrationnotrecommendedinpatientsreceivingconcomitantsystemictreatmentstronginhibitorsofbothCYP3A4andP-gp' = 'CoadministrationnotrecommendedinpatientsreceivingconcomitantsystemictreatmentstronginhibitorsofbothCYP3A4andP-gp)</span></td></tr></table></div>"
  ];
  fhir:MedicinalProductClinicals.undesirableEffects [
     fhir:index 0;
     fhir:MedicinalProductClinicals.undesirableEffects.symptomConditionEffect [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/undesirableeffectassymptom-condition-effect" ];
         fhir:Coding.code [ fhir:value "Anaemia" ]
       ];
       fhir:CodeableConcept.text [ fhir:value "Prevention of\\nVTE in adult\\npatients who have\\nundergone\\nelective hip or\\nknee replacement\\nsurgery (VTEp)" ]
     ];
     fhir:MedicinalProductClinicals.undesirableEffects.classification [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/symptom-condition-effectclassification" ];
         fhir:Coding.code [ fhir:value "Bloodandlymphaticsystemdisorders" ]
       ]
     ];
     fhir:MedicinalProductClinicals.undesirableEffects.frequencyOfOccurrence [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/frequencyofoccurrence" ];
         fhir:Coding.code [ fhir:value "Common" ]
       ]
     ]
  ];
  fhir:MedicinalProductClinicals.therapeuticIndication [
     fhir:index 0;
     fhir:MedicinalProductClinicals.therapeuticIndication.diseaseSymptomProcedure [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/indicationasdisease-symptom-procedure" ];
         fhir:Coding.code [ fhir:value "Venousthromboembolismprophylaxis" ]
       ];
       fhir:CodeableConcept.text [ fhir:value "Prevention of venous thromboembolic events (VTE) in adult patients who have undergone elective hip\\nor knee replacement surgery.\\nPrevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation\\n(NVAF), with one or more risk factors, such as prior stroke or transient ischaemic attack (TIA); age\\n≥ 75 years; hypertension; diabetes mellitus; symptomatic heart failure (NYHA Class ≥ II).\\nTreatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent\\nDVT and PE in adults (see section 4.4 for haemodynamically unstable PE patients)." ]
     ];
     fhir:MedicinalProductClinicals.therapeuticIndication.comorbidity [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/comorbidity" ];
         fhir:Coding.code [ fhir:value "Hipsurgery" ]
       ]
     ];
     fhir:MedicinalProductClinicals.therapeuticIndication.intendedEffect [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/intendedeffect" ];
         fhir:Coding.code [ fhir:value "PRYLX" ]
       ]
     ];
     fhir:MedicinalProductClinicals.therapeuticIndication.population [
       fhir:index 0;
       fhir:MedicinalProductClinicals.undesirableEffects.population.ageRange [
         fhir:Range.low [
           fhir:Quantity.value [ fhir:value "18"^^xsd:decimal ];
           fhir:Quantity.unit [ fhir:value "a" ]
         ]
       ]
     ]
  ];
  fhir:MedicinalProductClinicals.contraindication [
     fhir:index 0;
     fhir:MedicinalProductClinicals.contraindication.disease [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/contraindicationsasdisease-symptom-procedure" ];
         fhir:Coding.code [ fhir:value "Coagulopathiesandbleedingdiatheses(exclthrombocytopenic)" ]
       ];
       fhir:CodeableConcept.text [ fhir:value "Hepatic disease associated with coagulopathy and clinically relevant bleeding risk" ]
     ];
     fhir:MedicinalProductClinicals.contraindication.comorbidity [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/comorbidity" ];
         fhir:Coding.code [ fhir:value "Hepaticdisease" ]
       ]
     ]
  ];
  fhir:MedicinalProductClinicals.interactions [
     fhir:index 0;
     fhir:MedicinalProductClinicals.interactions.interaction [ fhir:value "Inhibitors of CYP3A4 and P-gp\\nCoadministration of equixaban with ketoconazole (400 mg once a day), a strong inhibitor of both\\nCYP3A4 and P-gp, led to a 2-fold increase in mean equixaban AUC and a 1.6-fold increase in mean\\nequixaban Cmax.\\nThe use of Eliquis is not recommended in patients receiving concomitant systemic treatment with\\nstrong inhibitors of both CYP3A4 and P-gp, such as azole-antimycotics (e.g., ketoconazole,\\nitraconazole, voriconazole and posaconazole) and HIV protease inhibitors (e.g., ritonavir) (see\\nsection 4.4).\\nActive substances which are not considered strong inhibitors of both CYP3A4 and P-gp,\\n(e.g., diltiazem, naproxen, amiodarone, verapamil, quinidine) are expected to increase equixaban\\nplasma concentration to a lesser extent. Diltiazem (360 mg once a day), for instance, considered a moderate CYP3A4 and a weak P-gp inhibitor, led to a 1.4-fold increase in mean equixaban AUC and a 1.3-fold increase in Cmax. Naproxen (500 mg, single dose) an inhibitor of P-gp but not an inhibitor of CYP3A4, led to a 1.5-fold and 1.6-fold increase in mean equixaban AUC and Cmax, respectively. No dose adjustment for equixaban is required when coadministered with less potent inhibitors of CYP3A4 and/or P-gp." ];
     fhir:MedicinalProductClinicals.interactions.interactant [
       fhir:index 0;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/interactant" ];
         fhir:Coding.code [ fhir:value "ketoconazole" ]
       ]
     ], [
       fhir:index 1;
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/interactant" ];
         fhir:Coding.code [ fhir:value "itraconazole" ]
       ]
     ];
     fhir:MedicinalProductClinicals.interactions.type [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/interactionsType" ];
         fhir:Coding.code [ fhir:value "StrongInhibitorofCYP3A4" ]
       ]
     ];
     fhir:MedicinalProductClinicals.interactions.effect [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/interactionseffect" ];
         fhir:Coding.code [ fhir:value "Increasedplasmaconcentrations" ]
       ]
     ];
     fhir:MedicinalProductClinicals.interactions.management [
       fhir:CodeableConcept.coding [
         fhir:index 0;
         fhir:Coding.system [ fhir:value "http://ema.europa.eu/example/managementactions" ];
         fhir:Coding.code [ fhir:value "CoadministrationnotrecommendedinpatientsreceivingconcomitantsystemictreatmentstronginhibitorsofbothCYP3A4andP-gp" ]
       ]
     ]
  ] .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/MedicinalProductClinicals/example.ttl> a owl:Ontology;
  owl:imports fhir:fhir.ttl;
  owl:versionIRI <http://build.fhir.org/MedicinalProductClinicals/example.ttl> .

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