Using rxNorm with FHIR

Introduction

On this page, all the rules & semantics for using RxNorm with FHIR are defined.

All of these are defined in terms of the default mysql RxNorm database created (after fixes!) by the scripts provided with RxNorm. This does not imply that implementations are required to use it, only that this is a useful place from which to start

Basics

• Namespace is http://www.nlm.nih.gov/research/umls/rxnorm
• codes = CUIs, though AUIs may be used in the property filters
• The display name is

 select Str from rxnconso where RXCUI = :code and SAB = 'RXNORM'

Filter properties

to make the SQL filters work, the base SQL is

Select RXCUI from rxnconso where SAB = 'RXNORM'

Description	Property Name	Property Operators	Value	Comments	SQL clause for '=' operator
Semantic Type	STY	in/=	[column:]Value	if not column is specified, the default column is TUI	and RXCUI in (select RXCUI from rxnsty where :column = :value)
Source	SAB	in/=	Value	value comes from (select RSAB from rxnsab)	and RXCUI in (select RXCUI from rxnconso where SAB = :value)
Term Type	TTY	in/=	Value	value of TTY column in rxnconso	and TTY = :value
Relationship (A)	[REL]	in/=	Value	REL (:rel) is one of SY, SIB, RN, PAR, CHD, RB or RO, and Value is either a RXCUI or RXAUI (the relationship test traverses both AUI and CUI links	and (RXCUI in (select RXCUI from rxnconso where RXAUI in (select RXAUI1 from rxnrel where REL = :rel and RXAUI2 = :value)) or RXCUI in (select RXCUI1 from rxnrel where REL = :rel and RXCUI2 = :value))
Relationship (B)	[RELA]	in/=	Value	RELA (:rela) is one of the relationship types immediately below, and Value is either a RXCUI or RXAUI (the relationship test traverses both AUI and CUI links	and (RXCUI in (select RXCUI from rxnconso where RXAUI in (select RXAUI1 from rxnrel where RELA = :rela and RXAUI2 = :value)) or RXCUI in (select RXCUI1 from rxnrel where RELA = :rela and RXCUI2 = :value))

Relationship Types

• active_ingredient_of
• active_metabolites_of
• chemical_structure_of
• consists_of
• constitutes
• contained_in
• contains
• contraindicated_with_disease
• contraindicating_class_of
• contraindicating_mechanism_of_action_of
• contraindicating_physiologic_effect_of
• doseformgroup_of
• dose_form_of
• effect_may_be_inhibited_by
• entry_version_of
• form_of
• has_active_ingredient
• has_active_metabolites
• has_chemical_structure
• has_contraindicated_drug
• has_contraindicating_class
• has_contraindicating_mechanism_of_action
• has_contraindicating_physiologic_effect
• has_doseformgroup
• has_dose_form
• has_entry_version
• has_form
• has_ingredient
• has_ingredients
• has_mechanism_of_action
• has_member
• has_part
• has_participant
• has_permuted_term
• has_pharmacokinetics
• has_physiologic_effect
• has_precise_ingredient
• has_print_name
• has_product_component
• has_quantified_form
• has_sort_version
• has_therapeutic_class
• has_tradename
• included_in
• includes
• induced_by
• induces
• ingredients_of
• ingredient_of
• inverse_isa
• isa
• mapped_from
• mapped_to
• may_be_diagnosed_by
• may_be_prevented_by
• may_be_treated_by
• may_diagnose
• may_inhibit_effect_of
• may_prevent
• may_treat
• mechanism_of_action_of
• member_of
• metabolic_site_of
• participates_in
• part_of
• permuted_term_of
• pharmacokinetics_of
• physiologic_effect_of
• precise_ingredient_of
• print_name_of
• product_component_of
• quantified_form_of
• reformulated_to
• reformulation_of
• site_of_metabolism
• sort_version_of
• therapeutic_class_of
• tradename_of

RxNorm Term Types

RxNorm includes the following term types (TTY)

TTY	Name	Description	Example
IN	Ingredient	A compound or moiety that gives the drug its distinctive clinical properties. Ingredients generally use the United States Adopted Name (USAN).	Fluoxetine
PIN	Precise Ingredient	A specified form of the ingredient that may or may not be clinically active. Most precise ingredients are salt or isomer forms.	Fluoxetine Hydrochloride
MIN	Multiple Ingredients	Two or more ingredients appearing together in a single drug preparation, created from SCDF. In rare cases when IN/PIN or PIN/PIN combinations of the same base ingredient exist, created from SCD.	Fluoxetine / Olanzapine
DF	Dose Form		Oral Solution
DFG	Dose Form Group		Oral Liquid
SCDC	Semantic Clinical Drug Component	Ingredient + Strength	Fluoxetine 4 MG/ML
SCDF	Semantic Clinical Drug Form	Ingredient + Dose Form	Fluoxetine Oral Solution
SCDG	Semantic Clinical Dose Form Group	Ingredient + Dose Form Group	Fluoxetine Oral Product
SCD	Semantic Clinical Drug	Ingredient + Strength + Dose Form	Fluoxetine 4 MG/ML Oral Solution
BN	Brand Name	A proprietary name for a family of products containing a specific active ingredient.	Prozac
SBDC	Semantic Branded Drug Component	Ingredient + Strength + Brand Name	Fluoxetine 4 MG/ML [Prozac]
SBDF	Semantic Branded Drug Form	Ingredient + Dose Form + Brand Name	Fluoxetine Oral Solution [Prozac]
SBDG	Semantic Branded Dose Form Group	Brand Name + Dose Form Group	Prozac Pill
SBD	Semantic Branded Drug	Ingredient + Strength + Dose Form + Brand Name	Fluoxetine 4 MG/ML Oral Solution [Prozac]
PSN	Prescribable Name	Synonym of another TTY, given for clarity and for display purposes in electronic prescribing applications. Only one PSN per concept.	Leena 28 Day Pack
SY	Synonym	Synonym of another TTY, given for clarity.	Prozac 4 MG/ML Oral Solution
TMSY	Tall Man Lettering Synonym	Tall Man Lettering synonym of another TTY, given to distinguish between commonly confused drugs.	FLUoxetine 10 MG Oral Capsule [PROzac]
BPCK	Brand Name Pack	{# (Ingredient Strength Dose Form) / # (Ingredient Strength Dose Form)} Pack [Brand Name]	{12 (Ethinyl Estradiol 0.035 MG / Norethindrone 0.5 MG Oral Tablet) / 9 (Ethinyl Estradiol 0.035 MG / Norethindrone 1 MG Oral Tablet) / 7 (Inert Ingredients 1 MG Oral Tablet) } Pack [Leena 28 Day]
GPCK	Generic Pack	{# (Ingredient + Strength + Dose Form) / # (Ingredient + Strength + Dose Form)} Pack	{11 (varenicline 0.5 MG Oral Tablet) / 42 (varenicline 1 MG Oral Tablet) } Pack

RxNorm Relationships

RxNorm relationships

This graph represents relationships between term types (TTY), in terms of a small set of relationships (RELA). The green arcs represent connection from the first (leftmost) TTY to the relationship, and the yellow arcs represent the connection from the relationship to the rightmost TTY. Thus, for example, the relationship of {PIN, precise_ingredient_of, BN} (precise ingredient name (PIN) is a precise_ingredient_of a brand name (BN)), there is a green arc from PIN to precise_ingredient_of, and a yellow arc from precise_ingredient_of to BN.

The complete set of RxNorm relationships includes the following:

Name	From	To
consists_of	SBD, SCD	SBDC, SCDC
constitutes	SBDC, SCDC	SBD, SCD
contained_in	SBD, SCD	BPCK, GPCK
contains	BPCK, GPCK	SBD, SCD
dose_form_of	DF	BPCK, GPCK, SBD, SBDF, SCD, SCDF
has_dose_form	BPCK, GPCK, SBD, SBDF, SCD, SCDF	DF
doseformgroup_of	DFG	SBDG, SCDG
has_doseformgroup	SBDG, SCDG	DFG
form_of	PIN	IN
has_form	IN	PIN
ingredient_of	BN, IN	SBD, SBDC, SBDF, SBDG, SCDC, SCDF, SCDG
ingredients_of	MIN	SCD
has_ingredient	SBD, SBDC, SBDF, SBDG, SCDC, SCDF, SCDG, SCD	BN, IN, MIN
part_of	IN, PIN	MIN
has_part	MIN	IN, PIN
precise_ingredient_of	PIN	BN, SCDC
has_precise_ingredient	BN, SCDC	PIN
quantified_form_of	SBD, SCD	SBD, SCD
has_quantified_form	SBD, SCD	SBD, SCD
tradename_of	BN, BPCK, SBD, SBDC, SBDF, SBDG	IN, GPCK, SCD, SCDC, SCDF, SCDG
has_tradename	GPCK, IN, SCD, SCDC, SCDF, SCDG	BPCK, BN, SBD, SBDC, SBDF, SBDG
isa	DF, SBD, SBDF, SCD, SCDF	DFG, SBDF, SBDG, SCDF, SCDG
inverse_isa	DFG, SBDF, SBDG, SCDF, SCDG	DF, SBD, SBDF, SCD, SCDF
reformulated_to	BN	BN
reformulation_of	BN	BN

or, put differently, the following ten and their inverses:

• consists of
• contains
• dose form group of
• dose form of
• form of
• ingredient(s) of
• is a
• part of
• precise ingredient of
• quantified form of
• tradename of