Authors: Ashley Bartels, MD and Destiny F. Chau, MD - Arkansas Children’s Hospital/University of Arkansas for Medical Sciences, Little Rock, AR


A 4-month-old female infant with pulmonary atresia, intact ventricular septum and right ventricle-dependent coronary circulation is listed for heart transplantation. In the interim, she remains mechanically ventilated while receiving dexmedetomidine, morphine, milrinone, and prostaglandin E₁ infusions. Though well-sedated, she appears irritable and has increasing swelling of the bilateral lower extremities. Bony radiographs demonstrate hyperostosis of the cortical bones. When administered on a long-term basis, which medication that the patient is currently receiving is MOST likely to cause cortical hyperostosis?