@erosolaraijs/cure 1.0.1 → 1.0.3

package/dist/safety/drugInteractions.js

@@ -0,0 +1,697 @@
+/**
+ * Drug Interaction and Safety Checking System
+ *
+ * Provides comprehensive drug safety checks:
+ * - Drug-drug interactions
+ * - Contraindication checking
+ * - Dosing validation
+ * - Allergy cross-reactivity
+ * - Organ function-based adjustments
+ * - Pregnancy/lactation safety
+ * - QT prolongation risk assessment
+ * - CYP450 interaction analysis
+ *
+ * Data sources would include:
+ * - FDA drug labels
+ * - DrugBank
+ * - PharmGKB
+ * - Clinical Pharmacology databases
+ */
+import { EventEmitter } from 'events';
+// ═══════════════════════════════════════════════════════════════════════════════
+// DRUG SAFETY SERVICE
+// ═══════════════════════════════════════════════════════════════════════════════
+export class DrugSafetyService extends EventEmitter {
+    interactionDatabase = new Map();
+    contraindicationDatabase = new Map();
+    dosingGuidelines = new Map();
+    allergenCrossReactivity = new Map();
+    qtProlongingDrugs = new Set();
+    blackBoxWarnings = new Map();
+    constructor() {
+        super();
+        this.initializeDatabases();
+    }
+    /**
+     * Perform comprehensive safety check
+     */
+    async performSafetyCheck(patient, proposedDrugs) {
+        const alerts = [];
+        const recommendations = [];
+        // Get all drugs (current + proposed)
+        const allDrugs = [
+            ...patient.currentMedications.map(m => m.drug),
+            ...proposedDrugs.map(d => d.drug)
+        ];
+        // 1. Check drug-drug interactions
+        const interactionAlerts = await this.checkDrugInteractions(allDrugs);
+        alerts.push(...interactionAlerts);
+        // 2. Check contraindications based on patient conditions
+        const contraindicationAlerts = await this.checkContraindications(proposedDrugs.map(d => d.drug), patient);
+        alerts.push(...contraindicationAlerts);
+        // 3. Check allergies and cross-reactivity
+        const allergyAlerts = await this.checkAllergies(proposedDrugs.map(d => d.drug), patient.allergies);
+        alerts.push(...allergyAlerts);
+        // 4. Check dosing based on organ function
+        const dosingAlerts = await this.checkDosing(proposedDrugs, patient);
+        alerts.push(...dosingAlerts);
+        // 5. Check QT prolongation risk
+        const qtAlerts = await this.checkQTProlongation(allDrugs, patient);
+        alerts.push(...qtAlerts);
+        // 6. Check pregnancy/lactation
+        if (patient.demographics.pregnant || patient.demographics.breastfeeding) {
+            const pregnancyAlerts = await this.checkPregnancySafety(proposedDrugs.map(d => d.drug), patient);
+            alerts.push(...pregnancyAlerts);
+        }
+        // 7. Check black box warnings
+        const blackBoxAlerts = await this.checkBlackBoxWarnings(proposedDrugs.map(d => d.drug));
+        alerts.push(...blackBoxAlerts);
+        // 8. Check pharmacogenomic considerations
+        if (patient.geneticFactors) {
+            const pgxAlerts = await this.checkPharmacogenomics(proposedDrugs.map(d => d.drug), patient.geneticFactors);
+            alerts.push(...pgxAlerts);
+        }
+        // Count alerts by severity
+        const criticalAlerts = alerts.filter(a => a.severity === 'critical').length;
+        const highAlerts = alerts.filter(a => a.severity === 'high').length;
+        const moderateAlerts = alerts.filter(a => a.severity === 'moderate').length;
+        const lowAlerts = alerts.filter(a => a.severity === 'low').length;
+        // Determine overall risk
+        let overallRisk;
+        if (criticalAlerts > 0)
+            overallRisk = 'critical';
+        else if (highAlerts > 0)
+            overallRisk = 'high';
+        else if (moderateAlerts > 0)
+            overallRisk = 'moderate';
+        else if (lowAlerts > 0)
+            overallRisk = 'low';
+        else
+            overallRisk = 'minimal';
+        // Generate recommendations
+        for (const alert of alerts.filter(a => a.severity === 'critical' || a.severity === 'high')) {
+            recommendations.push(alert.recommendation);
+        }
+        // Determine if safe to proceed
+        const safe = criticalAlerts === 0 && !alerts.some(a => !a.overridable);
+        // Emit event
+        this.emit('safety-check-completed', { patientId: patient.patientId, safe, alertCount: alerts.length });
+        return {
+            safe,
+            alerts: alerts.sort((a, b) => {
+                const severityOrder = { critical: 0, high: 1, moderate: 2, low: 3 };
+                return severityOrder[a.severity] - severityOrder[b.severity];
+            }),
+            summary: {
+                criticalAlerts,
+                highAlerts,
+                moderateAlerts,
+                lowAlerts,
+                overallRisk
+            },
+            recommendations
+        };
+    }
+    /**
+     * Check drug-drug interactions
+     */
+    async checkDrugInteractions(drugs) {
+        const alerts = [];
+        const checkedPairs = new Set();
+        for (let i = 0; i < drugs.length; i++) {
+            for (let j = i + 1; j < drugs.length; j++) {
+                const drug1 = drugs[i].toLowerCase();
+                const drug2 = drugs[j].toLowerCase();
+                const pairKey = [drug1, drug2].sort().join('|');
+                if (checkedPairs.has(pairKey))
+                    continue;
+                checkedPairs.add(pairKey);
+                const interaction = this.findInteraction(drug1, drug2);
+                if (interaction) {
+                    alerts.push({
+                        id: `DDI-${Date.now()}-${i}-${j}`,
+                        type: 'interaction',
+                        severity: this.mapInteractionSeverity(interaction.severity),
+                        title: `Drug Interaction: ${drugs[i]} + ${drugs[j]}`,
+                        description: interaction.clinicalEffect,
+                        affectedDrugs: [drugs[i], drugs[j]],
+                        recommendation: interaction.management,
+                        overridable: interaction.severity !== 'contraindicated',
+                        requiresDocumentation: interaction.severity === 'major' || interaction.severity === 'contraindicated',
+                        references: interaction.references
+                    });
+                }
+            }
+        }
+        return alerts;
+    }
+    /**
+     * Check contraindications
+     */
+    async checkContraindications(drugs, patient) {
+        const alerts = [];
+        // Check renal contraindications
+        if (patient.renalFunction.gfr < 30) {
+            const renalContraindicated = ['metformin', 'nsaids', 'lithium', 'gadolinium'];
+            for (const drug of drugs) {
+                if (renalContraindicated.some(c => drug.toLowerCase().includes(c))) {
+                    alerts.push({
+                        id: `CI-RENAL-${Date.now()}`,
+                        type: 'contraindication',
+                        severity: patient.renalFunction.gfr < 15 ? 'critical' : 'high',
+                        title: `Renal Contraindication: ${drug}`,
+                        description: `${drug} is contraindicated or requires significant dose adjustment with GFR ${patient.renalFunction.gfr} mL/min`,
+                        affectedDrugs: [drug],
+                        recommendation: `Consider alternative therapy or significant dose reduction. Consult nephrology if essential.`,
+                        overridable: patient.renalFunction.gfr >= 15,
+                        requiresDocumentation: true
+                    });
+                }
+            }
+        }
+        // Check hepatic contraindications
+        if (patient.hepaticFunction.childPughClass === 'C') {
+            const hepaticContraindicated = ['methotrexate', 'valproic-acid', 'isoniazid', 'ketoconazole'];
+            for (const drug of drugs) {
+                if (hepaticContraindicated.some(c => drug.toLowerCase().includes(c))) {
+                    alerts.push({
+                        id: `CI-HEPATIC-${Date.now()}`,
+                        type: 'contraindication',
+                        severity: 'critical',
+                        title: `Hepatic Contraindication: ${drug}`,
+                        description: `${drug} is contraindicated in Child-Pugh Class C liver disease`,
+                        affectedDrugs: [drug],
+                        recommendation: `Avoid use. Consider alternative therapy.`,
+                        overridable: false,
+                        requiresDocumentation: true
+                    });
+                }
+            }
+        }
+        // Check cardiac contraindications
+        if (patient.cardiacStatus.lvef && patient.cardiacStatus.lvef < 40) {
+            const cardiacCaution = ['anthracycline', 'trastuzumab', 'sunitinib', 'sorafenib'];
+            for (const drug of drugs) {
+                if (cardiacCaution.some(c => drug.toLowerCase().includes(c))) {
+                    alerts.push({
+                        id: `CI-CARDIAC-${Date.now()}`,
+                        type: 'contraindication',
+                        severity: 'high',
+                        title: `Cardiac Caution: ${drug}`,
+                        description: `${drug} has cardiotoxicity risk. Patient LVEF is ${patient.cardiacStatus.lvef}%`,
+                        affectedDrugs: [drug],
+                        recommendation: `Baseline and serial cardiac monitoring required. Consider cardiology consultation.`,
+                        overridable: true,
+                        requiresDocumentation: true
+                    });
+                }
+            }
+        }
+        return alerts;
+    }
+    /**
+     * Check allergy cross-reactivity
+     */
+    async checkAllergies(drugs, allergies) {
+        const alerts = [];
+        for (const allergy of allergies) {
+            for (const drug of drugs) {
+                const crossReactivity = this.checkCrossReactivity(allergy.allergen, drug);
+                if (crossReactivity.crossReactivity) {
+                    const severity = allergy.severity === 'severe' && crossReactivity.riskLevel === 'high'
+                        ? 'critical'
+                        : allergy.severity === 'severe' || crossReactivity.riskLevel === 'high'
+                            ? 'high'
+                            : 'moderate';
+                    alerts.push({
+                        id: `ALLERGY-${Date.now()}`,
+                        type: 'allergy',
+                        severity,
+                        title: `Allergy Alert: ${drug}`,
+                        description: `Patient allergic to ${allergy.allergen}. ${drug} has ${crossReactivity.riskLevel} cross-reactivity risk.`,
+                        affectedDrugs: [drug],
+                        recommendation: crossReactivity.recommendation,
+                        overridable: allergy.severity !== 'severe' || crossReactivity.riskLevel !== 'high',
+                        requiresDocumentation: true
+                    });
+                }
+            }
+        }
+        return alerts;
+    }
+    /**
+     * Check dosing based on organ function
+     */
+    async checkDosing(drugs, patient) {
+        const alerts = [];
+        for (const drugOrder of drugs) {
+            const guidelines = this.dosingGuidelines.get(drugOrder.drug.toLowerCase());
+            if (!guidelines)
+                continue;
+            for (const guideline of guidelines) {
+                // Check renal adjustment
+                if (guideline.renalAdjustment) {
+                    for (const adj of guideline.renalAdjustment) {
+                        if (patient.renalFunction.gfr < adj.gfrThreshold) {
+                            alerts.push({
+                                id: `DOSE-RENAL-${Date.now()}`,
+                                type: 'dosing',
+                                severity: 'moderate',
+                                title: `Dose Adjustment Required: ${drugOrder.drug}`,
+                                description: `Patient GFR ${patient.renalFunction.gfr} requires dose adjustment`,
+                                affectedDrugs: [drugOrder.drug],
+                                recommendation: adj.adjustment,
+                                overridable: true,
+                                requiresDocumentation: true
+                            });
+                            break;
+                        }
+                    }
+                }
+                // Check hepatic adjustment
+                if (guideline.hepaticAdjustment && patient.hepaticFunction.childPughClass) {
+                    const adj = guideline.hepaticAdjustment.find(a => a.childPughClass === patient.hepaticFunction.childPughClass);
+                    if (adj) {
+                        alerts.push({
+                            id: `DOSE-HEPATIC-${Date.now()}`,
+                            type: 'dosing',
+                            severity: patient.hepaticFunction.childPughClass === 'C' ? 'high' : 'moderate',
+                            title: `Hepatic Dose Adjustment: ${drugOrder.drug}`,
+                            description: `Child-Pugh Class ${patient.hepaticFunction.childPughClass} requires dose adjustment`,
+                            affectedDrugs: [drugOrder.drug],
+                            recommendation: adj.adjustment,
+                            overridable: patient.hepaticFunction.childPughClass !== 'C',
+                            requiresDocumentation: true
+                        });
+                    }
+                }
+                // Check age-based adjustment
+                if (guideline.ageAdjustment) {
+                    for (const adj of guideline.ageAdjustment) {
+                        if (patient.demographics.age >= adj.ageThreshold) {
+                            alerts.push({
+                                id: `DOSE-AGE-${Date.now()}`,
+                                type: 'dosing',
+                                severity: 'low',
+                                title: `Age-Based Consideration: ${drugOrder.drug}`,
+                                description: `Patient age ${patient.demographics.age} may require adjustment`,
+                                affectedDrugs: [drugOrder.drug],
+                                recommendation: adj.adjustment,
+                                overridable: true,
+                                requiresDocumentation: false
+                            });
+                            break;
+                        }
+                    }
+                }
+            }
+        }
+        return alerts;
+    }
+    /**
+     * Check QT prolongation risk
+     */
+    async checkQTProlongation(drugs, patient) {
+        const alerts = [];
+        const qtDrugs = drugs.filter(d => this.qtProlongingDrugs.has(d.toLowerCase()));
+        if (qtDrugs.length > 0) {
+            // Check baseline QTc
+            const baselineQTc = patient.cardiacStatus.qtcInterval;
+            let riskLevel = 'moderate';
+            if (baselineQTc && baselineQTc > 500) {
+                riskLevel = 'critical';
+            }
+            else if (baselineQTc && baselineQTc > 470) {
+                riskLevel = 'high';
+            }
+            else if (qtDrugs.length >= 2) {
+                riskLevel = 'high';
+            }
+            // Check for additional risk factors
+            const riskFactors = [];
+            if (patient.demographics.gender === 'female')
+                riskFactors.push('Female gender');
+            if (patient.demographics.age > 65)
+                riskFactors.push('Age > 65');
+            if (patient.cardiacStatus.arrhythmiaHistory)
+                riskFactors.push('Arrhythmia history');
+            // Would also check electrolytes (K, Mg) if available
+            if (qtDrugs.length >= 2 || riskLevel === 'critical' || riskLevel === 'high') {
+                alerts.push({
+                    id: `QT-${Date.now()}`,
+                    type: 'qt-prolongation',
+                    severity: riskLevel,
+                    title: `QT Prolongation Risk: ${qtDrugs.join(', ')}`,
+                    description: `${qtDrugs.length} QT-prolonging drug(s) ordered. ${riskFactors.length > 0 ? 'Risk factors: ' + riskFactors.join(', ') : ''}`,
+                    affectedDrugs: qtDrugs,
+                    recommendation: `Monitor QTc. Consider ECG at baseline and after steady state. Avoid if QTc > 500ms.`,
+                    overridable: riskLevel !== 'critical',
+                    requiresDocumentation: true
+                });
+            }
+        }
+        return alerts;
+    }
+    /**
+     * Check pregnancy and lactation safety
+     */
+    async checkPregnancySafety(drugs, patient) {
+        const alerts = [];
+        // Known teratogenic drugs
+        const categoryX = [
+            'methotrexate', 'thalidomide', 'lenalidomide', 'pomalidomide',
+            'isotretinoin', 'warfarin', 'ribavirin', 'leflunomide'
+        ];
+        const categoryD = [
+            'doxorubicin', 'cyclophosphamide', 'imatinib', 'tamoxifen',
+            'carbamazepine', 'phenytoin', 'valproic acid', 'lithium'
+        ];
+        for (const drug of drugs) {
+            const drugLower = drug.toLowerCase();
+            if (categoryX.some(x => drugLower.includes(x))) {
+                alerts.push({
+                    id: `PREG-X-${Date.now()}`,
+                    type: 'pregnancy',
+                    severity: 'critical',
+                    title: `Pregnancy Contraindication: ${drug}`,
+                    description: `${drug} is absolutely contraindicated in pregnancy (Category X equivalent)`,
+                    affectedDrugs: [drug],
+                    recommendation: `Do not use. Use alternative therapy. Ensure contraception.`,
+                    overridable: false,
+                    requiresDocumentation: true
+                });
+            }
+            else if (categoryD.some(d => drugLower.includes(d))) {
+                alerts.push({
+                    id: `PREG-D-${Date.now()}`,
+                    type: 'pregnancy',
+                    severity: 'high',
+                    title: `Pregnancy Risk: ${drug}`,
+                    description: `${drug} has evidence of fetal risk but may be used if benefit outweighs risk`,
+                    affectedDrugs: [drug],
+                    recommendation: `Document informed consent. Discuss risks with patient. Consider alternatives.`,
+                    overridable: true,
+                    requiresDocumentation: true
+                });
+            }
+        }
+        return alerts;
+    }
+    /**
+     * Check black box warnings
+     */
+    async checkBlackBoxWarnings(drugs) {
+        const alerts = [];
+        for (const drug of drugs) {
+            const warnings = this.blackBoxWarnings.get(drug.toLowerCase());
+            if (warnings && warnings.length > 0) {
+                alerts.push({
+                    id: `BBW-${Date.now()}`,
+                    type: 'black-box',
+                    severity: 'high',
+                    title: `Black Box Warning: ${drug}`,
+                    description: warnings.join('; '),
+                    affectedDrugs: [drug],
+                    recommendation: `Ensure appropriate monitoring and patient education. Document informed consent.`,
+                    overridable: true,
+                    requiresDocumentation: true
+                });
+            }
+        }
+        return alerts;
+    }
+    /**
+     * Check pharmacogenomic considerations
+     */
+    async checkPharmacogenomics(drugs, genetics) {
+        const alerts = [];
+        // DPYD and fluoropyrimidines
+        if (genetics.dpyd && genetics.dpyd !== 'normal') {
+            const fluoropyrimidines = ['5-fu', 'fluorouracil', 'capecitabine'];
+            const affected = drugs.filter(d => fluoropyrimidines.some(f => d.toLowerCase().includes(f)));
+            if (affected.length > 0) {
+                const severity = genetics.dpyd === 'deficient' ? 'critical' : 'high';
+                alerts.push({
+                    id: `PGX-DPYD-${Date.now()}`,
+                    type: 'organ-function',
+                    severity,
+                    title: `DPYD Deficiency: ${affected.join(', ')}`,
+                    description: `Patient is DPYD ${genetics.dpyd}. High risk of severe/fatal toxicity with fluoropyrimidines.`,
+                    affectedDrugs: affected,
+                    recommendation: genetics.dpyd === 'deficient'
+                        ? 'Contraindicated. Use alternative therapy.'
+                        : 'Reduce dose by 50%. Consider alternative.',
+                    overridable: genetics.dpyd !== 'deficient',
+                    requiresDocumentation: true
+                });
+            }
+        }
+        // UGT1A1 and irinotecan
+        if (genetics.ugt1a1 === '*28/*28') {
+            const irinotecan = drugs.filter(d => d.toLowerCase().includes('irinotecan'));
+            if (irinotecan.length > 0) {
+                alerts.push({
+                    id: `PGX-UGT1A1-${Date.now()}`,
+                    type: 'organ-function',
+                    severity: 'high',
+                    title: `UGT1A1 Polymorphism: Irinotecan`,
+                    description: `Patient is UGT1A1*28/*28. Increased risk of severe neutropenia and diarrhea.`,
+                    affectedDrugs: irinotecan,
+                    recommendation: `Reduce initial dose by 1 level. Monitor closely.`,
+                    overridable: true,
+                    requiresDocumentation: true
+                });
+            }
+        }
+        // TPMT and thiopurines
+        if (genetics.tpmt && genetics.tpmt !== 'normal') {
+            const thiopurines = ['azathioprine', '6-mercaptopurine', 'thioguanine'];
+            const affected = drugs.filter(d => thiopurines.some(t => d.toLowerCase().includes(t)));
+            if (affected.length > 0) {
+                const severity = genetics.tpmt === 'poor' ? 'critical' : 'high';
+                alerts.push({
+                    id: `PGX-TPMT-${Date.now()}`,
+                    type: 'organ-function',
+                    severity,
+                    title: `TPMT Deficiency: ${affected.join(', ')}`,
+                    description: `Patient is TPMT ${genetics.tpmt} metabolizer. Risk of severe myelosuppression.`,
+                    affectedDrugs: affected,
+                    recommendation: genetics.tpmt === 'poor'
+                        ? 'Reduce dose by 90% or use alternative.'
+                        : 'Reduce dose by 50%. Monitor CBC closely.',
+                    overridable: genetics.tpmt !== 'poor',
+                    requiresDocumentation: true
+                });
+            }
+        }
+        return alerts;
+    }
+    /**
+     * Get recommended alternatives for a contraindicated drug
+     */
+    getAlternatives(drug, reason, patientProfile) {
+        const alternatives = [];
+        // Drug class-based alternatives
+        const alternativeMap = {
+            // Chemotherapy
+            'cisplatin': ['carboplatin', 'oxaliplatin'],
+            'doxorubicin': ['liposomal doxorubicin', 'epirubicin'],
+            'ifosfamide': ['cyclophosphamide'],
+            // Targeted therapy
+            'osimertinib': ['afatinib', 'erlotinib', 'gefitinib'],
+            'alectinib': ['brigatinib', 'lorlatinib', 'crizotinib'],
+            // Immunotherapy (generally fewer direct alternatives)
+            'pembrolizumab': ['nivolumab', 'atezolizumab'],
+            'nivolumab': ['pembrolizumab', 'atezolizumab'],
+            // Supportive care
+            'ondansetron': ['granisetron', 'palonosetron'],
+            'metoclopramide': ['prochlorperazine', 'promethazine']
+        };
+        const drugLower = drug.toLowerCase();
+        for (const [key, alts] of Object.entries(alternativeMap)) {
+            if (drugLower.includes(key)) {
+                alternatives.push(...alts);
+                break;
+            }
+        }
+        // Filter alternatives based on patient's contraindications
+        return alternatives.filter(alt => {
+            const interaction = this.findInteraction(alt, drug);
+            if (interaction?.severity === 'contraindicated')
+                return false;
+            return true;
+        });
+    }
+    // ═══════════════════════════════════════════════════════════════════════════════
+    // HELPER METHODS
+    // ═══════════════════════════════════════════════════════════════════════════════
+    initializeDatabases() {
+        // Initialize drug interactions (simplified - production would have comprehensive database)
+        this.addInteraction({
+            drug1: 'pembrolizumab',
+            drug2: 'corticosteroids',
+            severity: 'moderate',
+            type: 'pharmacodynamic',
+            mechanism: 'High-dose corticosteroids may reduce immunotherapy efficacy',
+            clinicalEffect: 'Reduced antitumor immune response',
+            management: 'Use lowest effective steroid dose. Consider steroid-sparing agents for irAE management.',
+            documentation: 'established'
+        });
+        this.addInteraction({
+            drug1: 'warfarin',
+            drug2: 'capecitabine',
+            severity: 'major',
+            type: 'pharmacokinetic',
+            mechanism: 'Capecitabine inhibits CYP2C9, increasing warfarin effect',
+            clinicalEffect: 'Increased INR and bleeding risk',
+            management: 'Monitor INR closely. Consider LMWH alternative.',
+            documentation: 'established'
+        });
+        this.addInteraction({
+            drug1: 'osimertinib',
+            drug2: 'strong cyp3a4 inducers',
+            severity: 'major',
+            type: 'pharmacokinetic',
+            mechanism: 'CYP3A4 inducers decrease osimertinib exposure',
+            clinicalEffect: 'Reduced efficacy',
+            management: 'Avoid concomitant use with strong CYP3A4 inducers',
+            documentation: 'established'
+        });
+        // Initialize QT-prolonging drugs
+        const qtDrugs = [
+            'ondansetron', 'granisetron', 'haloperidol', 'droperidol',
+            'methadone', 'sotalol', 'amiodarone', 'dofetilide',
+            'ibutilide', 'quinidine', 'procainamide', 'disopyramide',
+            'arsenic trioxide', 'crizotinib', 'lapatinib', 'nilotinib',
+            'pazopanib', 'sunitinib', 'vandetanib', 'vemurafenib'
+        ];
+        qtDrugs.forEach(d => this.qtProlongingDrugs.add(d.toLowerCase()));
+        // Initialize black box warnings
+        this.blackBoxWarnings.set('pembrolizumab', [
+            'Immune-mediated adverse reactions can be severe and fatal',
+            'Monitor for immune-mediated pneumonitis, colitis, hepatitis, endocrinopathies, nephritis, and dermatologic reactions'
+        ]);
+        this.blackBoxWarnings.set('trastuzumab', [
+            'Cardiomyopathy: Evaluate LVEF prior to and during treatment',
+            'Infusion reactions including fatal cases'
+        ]);
+        this.blackBoxWarnings.set('bevacizumab', [
+            'Gastrointestinal perforation',
+            'Surgery and wound healing complications',
+            'Hemorrhage'
+        ]);
+        // Initialize allergy cross-reactivity
+        this.allergenCrossReactivity.set('penicillin', ['amoxicillin', 'ampicillin', 'piperacillin', 'cephalosporins']);
+        this.allergenCrossReactivity.set('sulfa', ['sulfamethoxazole', 'sulfasalazine', 'celecoxib', 'furosemide']);
+        this.allergenCrossReactivity.set('platinum', ['cisplatin', 'carboplatin', 'oxaliplatin']);
+        // Initialize dosing guidelines
+        this.dosingGuidelines.set('carboplatin', [{
+                drug: 'carboplatin',
+                indication: 'solid tumors',
+                standardDose: 'AUC 5-6 (Calvert formula)',
+                renalAdjustment: [
+                    { gfrThreshold: 60, adjustment: 'Use Calvert formula with measured or estimated GFR' },
+                    { gfrThreshold: 30, adjustment: 'Reduce target AUC. Consider nephrology consult' },
+                    { gfrThreshold: 15, adjustment: 'Avoid or significant dose reduction' }
+                ],
+                weightBasedDosing: {
+                    formula: 'Dose (mg) = Target AUC × (GFR + 25)',
+                    maxDose: 'Cap GFR at 125 mL/min'
+                }
+            }]);
+        this.dosingGuidelines.set('cisplatin', [{
+                drug: 'cisplatin',
+                indication: 'solid tumors',
+                standardDose: '75-100 mg/m²',
+                renalAdjustment: [
+                    { gfrThreshold: 60, adjustment: 'Standard dose with aggressive hydration' },
+                    { gfrThreshold: 45, adjustment: 'Reduce dose 25-50%' },
+                    { gfrThreshold: 30, adjustment: 'Avoid - use carboplatin alternative' }
+                ]
+            }]);
+    }
+    addInteraction(interaction) {
+        const key1 = interaction.drug1.toLowerCase();
+        const key2 = interaction.drug2.toLowerCase();
+        if (!this.interactionDatabase.has(key1)) {
+            this.interactionDatabase.set(key1, []);
+        }
+        if (!this.interactionDatabase.has(key2)) {
+            this.interactionDatabase.set(key2, []);
+        }
+        this.interactionDatabase.get(key1).push(interaction);
+        this.interactionDatabase.get(key2).push(interaction);
+    }
+    findInteraction(drug1, drug2) {
+        const interactions = this.interactionDatabase.get(drug1.toLowerCase());
+        if (!interactions)
+            return null;
+        return interactions.find(i => i.drug2.toLowerCase() === drug2.toLowerCase() ||
+            i.drug1.toLowerCase() === drug2.toLowerCase()) || null;
+    }
+    mapInteractionSeverity(severity) {
+        switch (severity) {
+            case 'contraindicated': return 'critical';
+            case 'major': return 'high';
+            case 'moderate': return 'moderate';
+            case 'minor': return 'low';
+        }
+    }
+    checkCrossReactivity(allergen, drug) {
+        const relatedAllergens = this.allergenCrossReactivity.get(allergen.toLowerCase()) || [];
+        const crossReacts = relatedAllergens.some(a => drug.toLowerCase().includes(a));
+        let riskLevel = 'none';
+        if (crossReacts) {
+            // Platinum cross-reactivity is high
+            if (allergen.toLowerCase().includes('platinum')) {
+                riskLevel = 'high';
+            }
+            // Penicillin-cephalosporin is lower risk
+            else if (allergen.toLowerCase().includes('penicillin') && drug.toLowerCase().includes('cephalosporin')) {
+                riskLevel = 'low'; // ~2% cross-reactivity
+            }
+            else {
+                riskLevel = 'moderate';
+            }
+        }
+        return {
+            reportedAllergy: allergen,
+            drugToCheck: drug,
+            crossReactivity: crossReacts,
+            riskLevel,
+            relatedAllergens,
+            recommendation: crossReacts
+                ? `Consider alternative. If essential, administer with caution and monitor.`
+                : `No known cross-reactivity. Standard precautions.`
+        };
+    }
+    /**
+     * Generate a medication reconciliation report
+     */
+    async generateMedicationReconciliation(patient) {
+        const currentMeds = patient.currentMedications.map(m => m.drug);
+        const interactionAlerts = await this.checkDrugInteractions(currentMeds);
+        const interactions = [];
+        for (let i = 0; i < currentMeds.length; i++) {
+            for (let j = i + 1; j < currentMeds.length; j++) {
+                const int = this.findInteraction(currentMeds[i], currentMeds[j]);
+                if (int)
+                    interactions.push(int);
+            }
+        }
+        const recommendations = [];
+        for (const int of interactions.filter(i => i.severity === 'major' || i.severity === 'contraindicated')) {
+            recommendations.push(int.management);
+        }
+        return {
+            currentMedications: currentMeds,
+            interactions,
+            recommendations,
+            summary: interactions.length > 0
+                ? `Found ${interactions.length} drug interaction(s), including ${interactions.filter(i => i.severity === 'major' || i.severity === 'contraindicated').length} major interaction(s).`
+                : 'No significant drug interactions identified.'
+        };
+    }
+}
+export default DrugSafetyService;
+//# sourceMappingURL=drugInteractions.js.map