Need help for adding drug allergies (esp tirzepatide)

[Kevin Toppenberg]

The only part of the pharmacy system that we use in our office is entering DRUG ALLERGIES.  

I need to add tirzepatide into my system so I can list it as an allergy. 

I found this prior thread (https://groups.google.com/g/hardhats/c/vlOa-KO0oh4/m/7rcUZ7arshwJ) with a link to this page: https://vistapedia.net/index.php/Enter_A_Drug written by Sam Habiel.  

I tried to follow the instructions, but I think because there is no matching drug in multiple files that comprise the national drug file, I can't fully get it to work.  

I created this record:

Showing FILE: DRUG (#50)
 Entry #94724,
    .001-NUMBER : 94724
     .01-GENERIC NAME : TIRZEPATIDE
       1-AHFS NUMBER :   : 0.00
       2-VA CLASSIFICATION : HS500
       9-SYNONYM : <MULTIPLE-VALUED> SUBFILE #50.1
                        Entry #1
                           .01-SYNONYM : Mounjaro
                             1-INTENDED USE : TRADE NAME
                        Entry #2
                           .01-SYNONYM : Zepbound
                             1-INTENDED USE : TRADE NAME
                             2-NDC CODE : 00002-1152-01
      18-INV ORDER UNITS : 0.00
      25-NATIONAL DRUG CLASS : HS500 (`128 in #50.605)
      26-VA DRUG CLASS CODE : HS500  BLOOD GLUCOSE REGULATION AGENTS
      31-NDC : 00002-1152-01
      63-APPLICATION PACKAGES' USE : OX
      82-NCPDP DISPENSE UNIT : EACH
      83-NCPDP QUANTITY MULTIPLIER : 1
     900-OLD NAMES : <MULTIPLE-VALUED> SUBFILE #50.01
                         Entry #1
                            .01-OLD NAMES : tirzepatide
                            .02-DATE CHANGED : JUL 21, 2025
-------------------------------

But I still can't select the drug in the Add Allergy functionality of CPRS. 

I are a few years behind on our patches.  I looked in the PSN package for patches, and there are only 2 (SEQ#  556 - PSN*4.0*574, SEQ#  557 - PSN*4.0*57) and both of these seems to be bug fixes rather than file update. 

I traced through the RPC code from CPRS, ORWDAL32 ALLERGY MATCH, that searches for matches to user's entry.  It does not seem to support looking for entries in the local drug file.  Looking at the code, it seems that it used to, but then functionality was removed (incompletely).  

Question:
Can anyone give guidance on how to add ability to enter a drug allergy for tirzepatide?

Thanks

Kevin

[Benjamin Irwin]

This might help.  There are a number of files that is uses for the lookup listed in the text below.

STANDARD DATA DICTIONARY #120.8 -- PATIENT ALLERGIES FILE 6/27/25 PAGE 1

120.8,.02 REACTANT 0;2 FREE TEXT (Required) CAUSATIVE AGENT INPUT TRANSFORM: D EN^DDIOL("Editing not allowed!","","$C(7),!?4") K X LAST EDITED: AUG 13, 2004 HELP-PROMPT: Answer must be 3-30 characters in length. DESCRIPTION: This is the agent to which the patient had this reaction. This is the name of the reactant and will be the result of a look up on either the GMR Allergies (120.82), National Drug (50.6), Drug Ingredients (50.416), Local Drug (50) or VA Drug Class (50.605) files.

[Sam Habiel]

Can you see if you can still add an allergy from the Outpatient Pharmacy Package from the backend?

But otherwise, you will need to update your national drug files, which is a long long road. I can give you instructions, but expect that there will be hurdles on the way, and it may take you a couple of weeks.

--Sam

--
--
http://groups.google.com/group/Hardhats
To unsubscribe, send email to Hardhats+u...@googlegroups.com

---
You received this message because you are subscribed to the Google Groups "Hardhats" group.
To unsubscribe from this group and stop receiving emails from it, send an email to hardhats+u...@googlegroups.com.
To view this discussion visit https://groups.google.com/d/msgid/hardhats/15c8914a-9cbf-453e-ab55-535b61aa82c3n%40googlegroups.com.

[Kevin Toppenberg]

Thank you Ben and Sam.

I don't know how to add an allergy from the roll-and-scroll.  But I can add them for existing drugs in CPRS. 

I agree that I need to update the national drug files.  I discussed with Nancy, Dave, et al, on the support call last night.  They said that you had some code that would automate the loading and installation of the .DAT files.  Do you have instructions or guidance for that?

Thanks

Kevin

[Sam Habiel]

I gave this presentation back in the day.

https://smh101.com/presentations/20180424_SamHabiel_PPS-N-Final.pdf

A few notes:

1. The patches are now at https://github.com/shabiel/PSN-4-513/. Note that I have created patches post-OSEHRA. I keep the routines up to date with current VistA code but I don't make patches. So you have to look carefully and see what kind of collisions you have, as it depends on your current patch level.

2. You need to be very careful at the switch. Oddly, there is no checking code to see that you switched exactly at the right PSN patch. See the table in the presentation on when exactly you need to make the switch. There is a period where BOTH patches and dat files are being released.

3. Pharmacy dat files are here: https://foia-vista.worldvista.org/Patches_By_Application/PSN-NATIONAL%20DRUG%20FILE%20(NDF)/PPS_DATS/

4. You won't have a smooth experience installing the really early dat files (by and large I have had no problems in the last 2 years). I have had many problems where we crash with the drug interaction file because I think the original FOIA file released back in 2005 had problems in file 56. At this point, I don't know what I did to make it work... but basically I edited the data on the fly (killing, editing) to make sure that the dat file installed.

--Sam

To view this discussion visit https://groups.google.com/d/msgid/hardhats/de259cf1-40bc-48b4-a545-646e89a51877n%40googlegroups.com.

[Sam Habiel]

Correction: 1. The patches are now at https://github.com/shabiel/PSN-4-513/. Note that I have created patches post-OSEHRA. I keep the routines up to date with current VistA code but I don't make patches. So you have to look carefully and see what kind of collisions you have, as it depends on your current patch level.

I meant to say I have NOT created patches post-OSEHRA. The routines are kept up to date.

--Sam

[Kevin Toppenberg]

Thank you Sam and all.

I have a few other things on my plate right now, so I may have to come back to this a bit later.

Best wishes,

Kevin