Implementation of a dexmedetomidine stewardship program at a tertiary academic medical center.

Background: Brigham and Women's Hospital implemented a dexmedetomidine stewardship program in October 2010 beginning with an institution-specific prescribing guideline. To ensure continued adherence to the prescribing guideline, a pharmacist-driven quality assurance program was implemented in November 2011.

Objective: The primary objective of this study is to describe the role and impact of a dexmedetomidine stewardship program on dexmedetomidine use at a tertiary academic medical center.

Impact of an immunoglobulin G-specific enzyme-linked immunosorbent assay on the management of heparin-induced thrombocytopenia.

Study Objective: To evaluate whether using an immunoglobulin G (IgG)-specific platelet factor 4 (PF4) test reduces the rate of positive PF4 results and has an impact on prescribing practices of nonheparin anticoagulants (direct thrombin inhibitors and fondaparinux) in patients assessed for heparin-induced thrombocytopenia (HIT).

Design: Single-center prospective cohort study with a historical control group.

Setting: Large academic medical center.

Neurologic adverse effects of ranolazine in an elderly patient with renal impairment.

Ranolazine, an antianginal agent, has activity at muscle and neuronal sodium channels. Congenital genetic mutations to sodium channels in humans and supratherapeutic ranolazine concentrations in animal models have produced similar neurologic adverse reactions. We describe a case of neurologic adverse effects in an 81-year-old woman with coronary artery disease, renal impairment, and mild neurologic disease who received ranolazine for symptomatic control of a non-ST-segment elevation myocardial infarction.