Re: [Gnumed-devel] clin_medication

[J Busser]

At 1:31 PM +0200 10/18/04, Karsten Hilbert wrote:
>  > > > SR denotes "slow release". A more general case of CR (controlled
> >  >> release), which encompasses "slow release", has relevance because if
> >  >> it is controlled-release, it is specially-formulated and thus the
> >  >> tablet or capsule (usually but not always) cannot/should not be
> >  >> split, otherwise the release is disturbed.
> >  I am not sure I am proposing an "extra" field, I am wondering whether
> >  is_CR would be a more generally useful case than is_SR therefore to
> >  use is_CR *instead of* is_SR
>
> Would "gastric acid resistant capsule" also fall under is_CR ?

I would figure "yes", because to disrupt it (i.e. to disrupt the 
capsule) would interfere with the gastric acid resistance.

Does such information need to belong in the clin_medication table? 
Perhaps, if the reason is to identify which *particular* drug 
*is/was* the one used?

There may be no perfect distinction among is_SR and/or is_CR, and it 
may come down to what people believe to be the useful (if any) 
distinctions being drawn.

Considerations:

- if there is only one form of a drug available, then its dosing 
leaves no room for confusion with other forms, and so IMO the value 
of is_SR is only to distinguish it from non-SR forms, whose dosing 
schedule should be different

-drugs bearing name suffixes like "SR", "XL" "LA" are generally the 
pharmaceutical companies' means of extending patent protection and I 
wonder if it is sufficient and only meaningful to capture this in the 
drug's name

-  there are drugs (typically hormones, think insulins, 
progesterones, also depot forms of drugs) compounded with varying 
materials which require different dosing schedules but which do not 
bear one of the above suffixes

... also there are drugs which, at a lower dose (for example 
sulfonylurea hypoglycemics) may be given once daily whereas at higher 
doses may deserve to be split during the day
... and then there is this value I suggested, of a field to indicate 
whether the solid form can be split (but "CR" for "Controlled 
Release" is here imperfect, for example there are drugs whose 
granules are micro-encapsulated and which therefore may work properly 
even if the capsule holding them were to be divided
... but maybe some of this functions as a *guide* to prescribing and 
is better stored in some other table?