Improving Online Access to Drug-related Information

Acknowledgements

Jiao Li, Ph.D., Ritu Khare, Ph.D., Zhiyong Lu, Ph.D.

National Center for Biotechnology Information (NCBI)

National Library of Medicine, National Institutes of Health

Linking drug monographs to diseases of interest Introduction

Drug Monographs

• Each monograph is subject to a drug’s

generic name/active ingredient (e.g.,

‘Ibuprofen’) rather than its specific drug

product (e.g., ‘Advil®’)

• Drugs with same ingredients but

different dosage forms may be

described in different monographs.

Diclofenac (Transdermal)

Diclofenac (Ophthalmic)

Diclofenac (Topical)

Brand name vs. Ingredient name

• When searching for drug information,

consumers use brand names rather

than generic names.

Seeking drug-related information is one of the major activities of today’s

online health consumers. In this work, our goals are:

(1) To facilitate health consumers to access trustworthy drug information online

(2) To provide consumers with integrated access to other health resources

Fig 1. Health consumers’ behaviors of seeking drug-related information

Fig 3. Resources containing

drug-disease relationships

References 1. Islamaj DR, Murray GC, Neveol A, and Lu Z: Understanding PubMed user search behavior through

log analysis. Database (Oxford) 2009, 2009:bap018.

2. Li J. and Lu Z. Automatic Identification and Normalization of Dosage Forms in Drug Monographs.

BMC Medical Informatics and Decision Making 2012, 12:9.

3. Li J. and Lu Z. Assigning Brand Names to Drug Monographs in PubMed Health. The AMIA 2011

Annual Symposium. 2011. Washington DC, USA

4. MedlinPlus® http://www.nlm.nih.gov/medlineplus/

5. American Hospital Formulary Service® (AHFS) drug information

http://www.ahfsdruginformation.com/

6. A.D.A.M. Medical Encyclopedia http://www.adam.com/MutlimediaEncyclopedia.aspx

7. RxNorm http://www.nlm.nih.gov/research/umls/rxnorm/

8. PubMed® http://www.ncbi.nlm.nih.gov/pubmed/

9. PubMed Health http://www.ncbi.nlm.nih.gov/pubmedhealth/

Enriching drug monographs

by automatically assigning brand names

Fig 2. Flowchart for determining brand names

Conclusions

RxNorm

• A standardized

nomenclature

for clinical drugs

• Drug brand

related concepts

in RxNorm

Assigning brand names to a given

drug monograph

Assignment Result

• Our method is applicable to 957 drug

monographs (1095 in total).

• Our method can help human editors update

and revise drug information.

Identifying diseases of

interest from drug monographs

Ranking diseases of interest

θ s g = α ∗ pM s g + β ∗ pF s g + γ ∗ pQ s g + 𝛿 ∗ 𝑝𝐿(𝑠|𝑔)

= 𝛼 ∗𝑛𝑀 𝑔,𝑠

𝑛𝑀 𝑔+ 𝛽 ∗

𝑛𝐹 𝑔,𝑠

𝑛𝐹 𝑔+ 𝛾 ∗

𝑛𝑄 𝑔,𝑠

𝑛𝑄 𝑔+ 𝛿 ∗

𝑛𝐿 𝑔,𝑠

𝑛𝐿 𝑔

𝜏 𝑠 𝑔 =𝑞 𝑠 𝑔

𝑞 𝑠=

𝑓 𝑔, 𝑠𝑓 𝑔

𝑓 𝑠𝑁

=𝑓 𝑔, 𝑠 ∗ 𝑁

𝑓 𝑔 ∗ 𝑓 𝑠

• Search trends

• Evidence confidence

𝑟 𝑠|𝑔 = 𝜃 𝑠 𝑔 ∗ 𝑒𝜏 𝑠|𝑔

• Relevant score

s: Disease

g: Drug

𝒑𝑀 𝑠 𝑔 : drug-disease in disease

monographs

𝒑𝑭 𝑠 𝑔 : drug-disease in drug monographs

𝒑𝑸 𝑠 𝑔 : drug-disease searched by users

𝒑𝑳 𝑠 𝑔 : drug-disease in scientific literature

where,

Filtering drug-disease

relationships

Statistics-based filter:

Hypergeometric p-value is used to

measure the significance of relationships

identified from queries and literature.

Domain knowledge based filter:

Drugs in specific physical forms should be

applied in specific categories of diseases.

Drug dose form Disease category

Ophthalmic Cream Ophthalmology

Otic Solution Otolaryngology

Vaginal Cream Obstetrics & Gynecology

Our study has several practical implications in real-world medical informatics:

• Facilitating consumers to access drug information through brand name search

• Facilitating consumers to access drug-related disease monographs, and ranking

diseases based on evidence confidence and user interest

• Helping drug monograph editors update drug information such as brand names

• Accurately characterizing monographs using features like ingredients & dosage forms

Results Input: a drug

monograph Enlarged prostate

Prostatitis - bacterial

chronic

Prostatitis - nonbacterial

- chronic

Cataract

Output: ranked

diseases of interest

Search query

Q_ID Q_Term

Q831368 flomax cataract

Q1129241 tamsulosin cataract

Q952568 flomax and cataract

surgery

Q235052 flomax cataract

surgery

Literature

Health Consumer

· Search drug names

§ Active ingredients

( e.g., Ibuprofen)

§ Brand names

(e.g., Advil, Motrin)

(1)

Drug monograph

Disease

Compound

Gene

Protein

Literature

Clinical Trial

(2)

Advil

Brand Name (BN)

Ibuprofen

Ingredient (IN)

Advil 100 MG Oral Tablet

[Obsolete=N]

[Veterinary=N]

Branded Drug or Package (SBD)

Oral Tablet

Dosage Form (DF)

has_ingredient

ingredient_of

has_dose_form

dose_form_of

has_tradename tradename_of

Allfen

Brand Name (BN)

Guaifenesin

Ingredient (IN)

Allfen Reformulated Mar 2007

Brand Name (BN)

has_ingredient

ingredient_of

has_ingredient

ingredient_of Guaifenesin

Guaiacolsulfonate

Ingredient (IN)

reformulation_of has reformulation

Input: A full-text drug monograph

Identify ingredients and dosage forms

Map to RxNorm [2]

Identify brand names in RxNorm

(1) Ingredient Consistency

(2) Dosage Form Consistency

(3) Obsolescence

(4) Reformulation

(5) Veterinary

Output: Brand Names

Resources containing drug-disease relationships

Literature

e.g., study [Drug] in [Disease]

Drug monograph

e.g., the [Drug] is used for treating [Disease]

Disease monograph

e.g., the [Disease] can be treated by [Drug]

Search query

e.g., [Drug] [Disease]

LL0.01 L0.05L0.1

M

F

Q Q0.01Q0.05Q0.1

Tamsulosin(tam soo' loe sin)

Why is this medication prescribed?Tamsulosin is used in men to treat the symptoms of an enlarged prostate (benign prostatic hyperplasia or BPH) which include difficulty urinating (hesitation, dribbling, weak stream, and incomplete bladder emptying), painful urination, and urinary frequency and urgency. Tamsulosin is in a class of medications called alpha blockers. It works by relaxing the muscles in the prostate and bladder so that urine can flow easily.

This research was supported by the Intramural Research Program of the National Institutes of Health,

National Library of Medicine. We would like to thank our colleagues Dr. Stuart J. Nelson, Dr. John

Kilbourne, and Dr. Olivier Bodenreider for discussing the meaningful use of RxNorm.