Medication Summary
Antihypertensive agents, vasoactive drugs, colloids, or diuretics may be needed to control hypertension, to treat shock, or to induce diuresis, respectively. Antibiotics have not had any benefit during the course of illness. Although intravenous ribavirin initiated within 4 days of illness reduces the morbidity and mortality associated with the disease, in the setting of adequate supportive measures and dialysis, ribavirin is not needed; at present, it is not approved for use in United States.
Antihypertensive agents
Class Summary
These agents are used to treat hypertension. Pharmacotherapy may include numerous drug classes that have antihypertensive effects, such as beta-blockers, calcium-channel blockers, ACE inhibitors, alpha-blockers, and angiotensin II–receptor antagonists. The antihypertensive regimen is customized to the population, with attention on ways to enhance compliance and to improve the patient's ability to tolerate treatment. For additional information see the eMedicine pediatric topic Hypertension.
Nifedipine (Adalat, Procardia)
Relaxes coronary smooth muscle, produces coronary vasodilation and improves myocardial oxygen delivery. Sublingual administration generally safe despite theoretic concerns.
Atenolol (Tenormin)
Selectively blocks beta1-receptors with little or no effect on beta2 types.
Captopril (Capoten)
Prevents conversion of angiotensin I to angiotensin II, potent vasoconstrictor, lowering aldosterone secretion.
Diuretic agents
Class Summary
These agents are used for the treatment of hypertension, oliguria, or edema. They promote the excretion of water and electrolytes by the kidneys. Diuretics are also used to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention has resulted in edema or ascites. They may be used as monotherapy or combination to treat hypertension.
Furosemide (Lasix)
Increases excretion of water by interfering with chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule. Individualize dose. Depending on response, administer at increments of 20-40 mg, no sooner than 6-8 h after previous dose, until desired diuresis occurs. In infants, titrate with 1-mg/kg/dose increments until satisfactory effect achieved.
Colloids
Class Summary
These agents are used for volume expansion to treat shock. They are preferred over crystalloids because the excessive administration of fluids can lead to extravasation caused by vascular leak, especially during the febrile and hypotensive stages.
Albumin (Albuminar, Albunex, Albumisol, Buminate, Albutein)
For certain types of shock or impending shock. Useful for plasma volume expansion and maintenance of cardiac output. Although theoretically attractive, benefit of colloid resuscitation over isotonic crystalloids not proven.
Vasopressors
Class Summary
Vasopressors are used for the treatment of hypotension. Dopamine is unique among other catecholamines; unlike norepinephrine, epinephrine, and isoproterenol, low doses of dopamine increase renal blood flow without increasing the patient's heart rate or systemic arterial pressure. It is an effective vasopressor for treating shock and hypotension in persons unresponsive to plasma volume expansion (ie, crystalloids or colloids). It also dilates the mesenteric and renal blood vessels, which improves renal blood flow and increases the glomerular filtration rate, sodium excretion, and urine output. However, dosages of more than 20 mcg/kg/min may decrease renal blood flow secondary to a reversal of the dopaminergic vasodilation.
Dopamine (Intropin)
Stimulates both adrenergic and dopaminergic receptors. Hemodynamic effect depends on dose. Low doses predominantly stimulate dopaminergic receptors, which, in turn, produce renal and mesenteric vasodilation. High doses produce cardiac stimulation and renal vasodilation. After initiating therapy, increase by 1-4 mcg/kg/min q10-30min until optimal response obtained. Maintenance at < 20 mcg/kg/min satisfactory in >50% of patients.
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Distribution of Hantavirus pulmonary syndrome cases in the United States by virus type. Courtesy of the Centers for Disease Control and Prevention.
