Gravitate Health FHIR Implementation Guide
0.1.0 - CI Build

Gravitate Health FHIR Implementation Guide, published by Gravitate Health Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/joofio/test-epi-composition/ and changes regularly. See the Directory of published versions

: ePI document Bundle for sugammadex Package Leaflet for language en - TTL Representation

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@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 -------------------------------------------------------------------

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<Composition/composition-en-16018c8f310d03d6a566ded2f2a2880a> a fhir:Composition ;
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  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><a name=\"Composition_composition-en-16018c8f310d03d6a566ded2f2a2880a\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Composition composition-en-16018c8f310d03d6a566ded2f2a2880a</b></p><a name=\"composition-en-16018c8f310d03d6a566ded2f2a2880a\"> </a><a name=\"hccomposition-en-16018c8f310d03d6a566ded2f2a2880a\"> </a><a name=\"composition-en-16018c8f310d03d6a566ded2f2a2880a-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"https://build.fhir.org/ig/HL7/emedicinal-product-info/StructureDefinition-Composition-uv-epi.html\">Composition (ePI)</a></p></div><p><b>identifier</b>: <code>http://ema.europa.eu/identifier</code>/EU/1/23/1739/001</p><p><b>status</b>: Final</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/rmswi/ 100000155538}\">Package Leaflet</span></p><p><b>category</b>: <span title=\"Codes:{http://hl7.eu/fhir/ig/gravitate-health/CodeSystem/epicategory-cs R}\">Raw</span></p><p><b>date</b>: 2022-02-16 13:28:17+0000</p><p><b>author</b>: <a href=\"Organization-mah-ema.html\">Organization ACME industry</a></p><p><b>title</b>: TEST PURPOSES ONLY - sugammadex</p><h3>Attesters</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Mode</b></td><td><b>Time</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://hl7.org/fhir/composition-attestation-mode official}\">Official</span></td><td>2022-02-16 13:28:17+0000</td></tr></table></div>"
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  fhir:title [ fhir:v "TEST PURPOSES ONLY - sugammadex"] ; # 
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fhir:title [ fhir:v "B. Package Leaflet" ] ;
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fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"></div>"       ]     ] [
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fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>What is in this leaflet</p><ol type=\"1\"><li>What Sugammadex Piramal is and what it is used for</li><li>What you need to know before Sugammadex Piramal is given</li><li>How Sugammadex Piramal is given</li><li>Possible side effects</li><li>How to store Sugammadex Piramal</li><li>Contents of the pack and other information</li></ol></div>"       ]     ] [
fhir:title [ fhir:v "1. What sugammadex is and what it is used for" ] ;
fhir:code [
        ( fhir:coding [
fhir:system [ fhir:v "https://spor.ema.europa.eu/rmswi/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "100000155538" ]         ] ) ;
fhir:text [ fhir:v "1. What sugammadex is and what it is used for" ]       ] ;
fhir:text [
fhir:status [ fhir:v "additional" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>What Sugammadex Piramal is Sugammadex Piramal contains the active substance sugammadex. Sugammadex Piramal is considered to be a selective relaxant binding agent since it only works with specific muscle relaxants, rocuronium bromide or vecuronium bromide.</p><p>What Sugammadex Piramal is used for</p><p>When you have some types of operations, your muscles must be completely relaxed. This makes it easier for the surgeon to do the operation. For this, the general anaesthetic you are given includes medicines to make your muscles relax. These are called muscle relaxants, and examples include rocuronium bromide and vecuronium bromide. Because these medicines also make your breathing muscles relax, you need help to breathe (artificial ventilation) during and after your operation until you can breathe on your own again. Sugammadex Piramal is used to speed up the recovery of your muscles after an operation to allow you to breathe on your own again earlier. It does this by combining with the rocuronium bromide or vecuronium bromide in your body. It can be used in adults whenever rocuronium bromide or vecuronium bromide is used and in children and adolescents (aged 2 to 17 years) when rocuronium bromide is used for a moderate level of relaxation.</p></div>"       ]     ] [
fhir:title [ fhir:v "2. What you need to know before you take sugammadex" ] ;
fhir:code [
        ( fhir:coding [
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fhir:text [ fhir:v "2. What you need to know before you take sugammadex" ]       ] ;
fhir:text [
fhir:status [ fhir:v "additional" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>You should not be given Sugammadex Piramal</p><ul><li>if you are allergic to sugammadex or any of the other ingredients of this medicine (listed in section 6). Tell your anaesthetist if this applies to you.</li></ul><p>Warnings and precautions</p><p>Talk to your anaesthetist before Sugammadex Piramal is given</p><ul><li>if you have kidney disease or had in the past. This is important as this medicine is removed from</li><li>your body by the kidneys.</li><li>if you have liver disease or have had it in the past.</li><li>if you have fluid retention (oedema).</li><li>if you have diseases which are known to give an increased risk of bleeding (disturbances of blood clotting) or anticoagulation medicine.</li></ul><p>Children and adolescents</p><p>This medicine is not recommended for infants less than 2 years of age.</p><p>Other medicines and Sugammadex Piramal</p><p>Tell your anaesthetist if you are taking, have recently taken or might take any other medicines. Sugammadex Piramal may affect other medicines or be affected by them.</p><p>Some medicines reduce the effect of Sugammadex Piramal</p><p>It is especially important that you tell your anaesthetist if you have recently taken:</p><ul><li>toremifene (used to treat breast cancer).</li><li>fusidic acid (an antibiotic).</li></ul><p>Sugammadex Piramal can affect hormonal contraceptives</p><p>Sugammadex Piramal can make hormonal contraceptives - including the Pill , vaginal ring, implants or a hormonal Intra Uterine System (IUS) - less effective because it reduces how much you get of the progestogen hormone. The amount of progestogen lost by using Sugammadex Piramal is about the same as missing one oral contraceptive Pill. If you are taking the Pill on the same day as Sugammadex Piramal is given to you, follow the instructions for a missed dose in the Pill s package leaflet. If you are using other hormonal contraceptives (for example a vaginal ring, implant or IUS) you should use an additional non-hormonal contraceptive method (such as a condom) for the next 7 days and follow the advice in the package leaflet.</p><p>Effects on blood tests</p><p>In general, Sugammadex Piramal does not have an effect on laboratory tests. However, it may affect the results of a blood test for a hormone called progesterone. Talk to your doctor if your progesterone levels need to be tested on the same day you receive Sugammadex Piramal.</p><p>Pregnancy and breast-feeding</p><p>Tell your anaesthetist if you are pregnant or might be pregnant or if you are breast-feeding. You may still be given Sugammadex Piramal, but you need to discuss it first. It is not known whether sugammadex can pass into breast milk. Your anaesthetist will help you decide whether to stop breast-feeding, or whether to abstain from sugammadex therapy, considering the benefit of breast-feeding to the baby and the benefit of Sugammadex Piramal to the mother.</p><p>Driving and using machines</p><p>Sugammadex Piramal has no known influence on your ability to drive and use machines.</p><p>Sugammadex Piramal contains sodium</p><p>This medicine contains up to 9.7 mg sodium (main component of cooking / table salt) in each mL. This is equivalent to 0.5 % of the recommended maximum daily dietary intake of sodium for an adult.</p></div>"       ]     ] [
fhir:title [ fhir:v "3. How to take sugammadex" ] ;
fhir:code [
        ( fhir:coding [
fhir:system [ fhir:v "https://spor.ema.europa.eu/rmswi/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "100000155538" ]         ] ) ;
fhir:text [ fhir:v "3. How to take sugammadex" ]       ] ;
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fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Sugammadex Piramal will be given to you by your anaesthetist, or under the care of your anaesthetist.</p><p>The dose</p><p>Your anaesthetist will work out the dose of Sugammadex Piramal you need based on:</p><ul><li>your weight</li><li>how much the muscle relaxant medicine is still affecting you. The usual dose is 2-4 mg per kg body weight for adults and for children and adolescents between 2- 17 years old. A dose of 16 mg/kg can be used in adults if urgent recovery from muscle relaxation is needed.</li></ul><p>How Sugammadex Piramal is given</p><p>Sugammadex Piramal will be given to you by your anaesthetist. It is given as a single injection through an intravenous line.</p><p>If more Sugammadex Piramal is given to you than recommended</p><p>As your anaesthetist will be monitoring your condition carefully, it is unlikely that you will be given too much Sugammadex Piramal. But even if this happens, it is unlikely to cause any problems.</p><p>If you have any further questions on the use of this medicine, ask your anaesthetist or other doctor.</p></div>"       ]     ] [
fhir:title [ fhir:v "4. Possible side effects" ] ;
fhir:code [
        ( fhir:coding [
fhir:system [ fhir:v "https://spor.ema.europa.eu/rmswi/"^^xsd:anyURI ] ;
fhir:code [ fhir:v "100000155538" ]         ] ) ;
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fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Like all medicines, this medicine can cause side effects, although not everybody gets them. If these side effects occur while you are under anaesthesia, they will be seen and treated by your anaesthetist.</p><p>Common side effects (may affect up to 1 in 10 people)</p><ul><li>Cough</li><li>Airway difficulties that may include coughing or moving as if you are waking or taking a breath</li><li>Light anaesthesia - you may start to come out of deep sleep, so need more anaesthesia. This might cause you to move or cough at the end of the operation</li><li>Complications during your procedure such as changes in heart rate, coughing or moving</li><li>Decreased blood pressure due to the surgical procedure</li></ul><p>Uncommon side effects (may affect up to 1 in 100 people)</p><ul><li>Shortness of breath due to muscle cramps of the airways (bronchospasm) occurred in patients with a history of lung problems</li><li>Allergic (drug hypersensitivity) reactions - such as a rash, red skin, swelling of your tongue and/or throat, shortness of breath, changes in blood pressure or heart rate, sometimes resulting in a serious decrease of blood pressure. Severe allergic or allergic-like reactions can be life threatening. Allergic reactions were reported more commonly in healthy, conscious volunteers</li><li>Return of muscle relaxation after the operation</li></ul><p>Not known (frequency cannot be estimated from the available data)</p><ul><li>Severe slowing of the heart and slowing of the heart up to cardiac arrest may occur when Sugammadex Piramal is administered Reporting of side effects</li></ul><p>If you get any side effects, talk to your anaesthetist or other doctor. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system<br/>listed in Appendix V. By reporting side effects you can help provide more information on the safety of this medicine.</p></div>"       ]     ] [
fhir:title [ fhir:v "5. How to store sugammadex" ] ;
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fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Storage will be handled by healthcare professionals. Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton and on the label after EXP . The expiry date refers to the last day of that month.</p><p>Keep the vial in the outer carton in order to protect from light. After first opening and dilution, store at 2 to 8 C and use within 48 hours.</p></div>"       ]     ] [
fhir:title [ fhir:v "6. Contents of the pack and other information" ] ;
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fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>What Sugammadex Piramal contains</p><ul><li><p>The active substance is sugammadex. 1 mL solution for injection contains sugammadex sodium equivalent to 100 mg sugammadex. Each vial of 2 mL contains sugammadex sodium equivalent to 200 mg sugammadex. Each vial of 5 mL contains sugammadex sodium equivalent to 500 mg sugammadex.</p></li><li><p>The other ingredients are water for injections, hydrochloric acid and/or sodium hydroxide (for pH adjustment). (see section 2 Sugammadex Piramal contains sodium).</p></li></ul><p>What Sugammadex Piramal looks like and contents of the pack</p><p>Sugammadex Piramal is a clear and colourless to slightly yellow brown solution for injection. It comes in two different pack sizes, containing either 10 vials with 2 mL or 10 vials with 5 mL solution for injection. Not all pack sizes may be marketed.</p><p>Marketing Authorisation Holder and Manufacturer</p><p>Piramal Critical Care B.V Rouboslaan 32, 2252 TR Voorschoten The Netherlands</p><p>This leaflet was last revised in June 2Detailed information on this medicine is available on the European Medicines Agency web site:</p></div>"       ]     ] )
  ] ) . # 

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fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MedicinalProductDefinition_mp16018c8f310d03d6a566ded2f2a2880a\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MedicinalProductDefinition mp16018c8f310d03d6a566ded2f2a2880a</b></p><a name=\"mp16018c8f310d03d6a566ded2f2a2880a\"> </a><a name=\"hcmp16018c8f310d03d6a566ded2f2a2880a\"> </a><a name=\"mp16018c8f310d03d6a566ded2f2a2880a-en-US\"> </a><p><b>identifier</b>: <code>http://ema.europa.eu/identifier</code>/EU/1/23/1739/001</p><p><b>type</b>: <span title=\"Codes:{http://hl7.org/fhir/medicinal-product-type MedicinalProduct}\">Medicinal Product</span></p><p><b>domain</b>: <span title=\"Codes:{http://hl7.org/fhir/medicinal-product-domain Human}\">Human use</span></p><p><b>status</b>: <span title=\"Codes:{http://hl7.org/fhir/publication-status active}\">active</span></p><p><b>legalStatusOfSupply</b>: <span title=\"Codes:{https://spor.ema.europa.eu/rmswi 100000072084}\">Medicinal product subject to medical prescription</span></p><blockquote><p><b>name</b></p><p><b>productName</b>: Sugammadex Piramal 100 mg/mL solution for injection</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000001}\">Full name</span></p><blockquote><p><b>part</b></p><p><b>part</b>: nan</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000002}\">Invented name part</span></p></blockquote><blockquote><p><b>part</b></p><p><b>part</b>: nan</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000003}\">Scientific name part</span></p></blockquote><blockquote><p><b>part</b></p><p><b>part</b>: nan</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000004}\">Strength part</span></p></blockquote><blockquote><p><b>part</b></p><p><b>part</b>: nan</p><p><b>type</b>: <span title=\"Codes:{https://spor.ema.europa.eu/lists/220000000000 220000000005}\">Pharmaceutical dose form part</span></p></blockquote><h3>Usages</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Country</b></td><td><b>Jurisdiction</b></td><td><b>Language</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{urn:iso:std:iso:3166 EU}\">EU</span></td><td><span title=\"Codes:{urn:iso:std:iso:3166 EU}\">EU</span></td><td><span title=\"Codes:{urn:ietf:bcp:47 en}\">en</span></td></tr></table></blockquote></div>"
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fhir:system [ fhir:v "https://spor.ema.europa.eu/lists/220000000000"^^xsd:anyURI ] ;
fhir:code [ fhir:v "220000000002" ] ;
fhir:display [ fhir:v "Invented name part" ]         ] )       ]     ] [
fhir:part [ fhir:v "nan" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "https://spor.ema.europa.eu/lists/220000000000"^^xsd:anyURI ] ;
fhir:code [ fhir:v "220000000003" ] ;
fhir:display [ fhir:v "Scientific name part" ]         ] )       ]     ] [
fhir:part [ fhir:v "nan" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "https://spor.ema.europa.eu/lists/220000000000"^^xsd:anyURI ] ;
fhir:code [ fhir:v "220000000004" ] ;
fhir:display [ fhir:v "Strength part" ]         ] )       ]     ] [
fhir:part [ fhir:v "nan" ] ;
fhir:type [
        ( fhir:coding [
fhir:system [ fhir:v "https://spor.ema.europa.eu/lists/220000000000"^^xsd:anyURI ] ;
fhir:code [ fhir:v "220000000005" ] ;
fhir:display [ fhir:v "Pharmaceutical dose form part" ]         ] )       ]     ] ) ;
    ( fhir:usage [
fhir:country [
        ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EU" ] ;
fhir:display [ fhir:v "EU" ]         ] )       ] ;
fhir:jurisdiction [
        ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "EU" ] ;
fhir:display [ fhir:v "EU" ]         ] )       ] ;
fhir:language [
        ( fhir:coding [
fhir:system [ fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ] ;
fhir:code [ fhir:v "en" ] ;
fhir:display [ fhir:v "en" ]         ] )       ]     ] )
  ] ) . #