Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH)

Question 1

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH) Drug Names

Answer 1

Ivabradine

Question 2

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH) Therapeutic Actions

Answer 2

• Blocking the HCNs slows the heart’s pacemaker, the sinus node, in repolarizing phase of the action potential

Question 3

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH) Indications

Answer 3

• Chronic HF

Question 4

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH)

Answer 4

Contraindication:
• Allergy
• Active, decompensated HF; hypotension; sick sinus syndrome of AV block; resting heart rate under 60; patients completely dependent on a pacemaker and severe hepatic impairment

Caution:
• Atrial fibrillation or moderate heart block

Question 5

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH) DDI

Answer 5

DDI:
• CYP3A4 inhibitors or inducers
• Negative chronotropic drugs (digoxin & betablockers)

Question 6

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH) Adverse Effects

Answer 6

• Arrhythmias
• Hypotension
• Nausea, vomiting
• Thrombocytopenia (decreased platelet count)
• Pericarditis
• Pleuritis
• Fever
• Chest Pain
• Burning in injection site

Question 7

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH):
Assessment

Answer 7

Assess:
Hx: allergy, AV block, decompensated HF, dependence of a pacemaker, resting HR <60 bpm, hypotension, hepatic impairment
Physical: vital signs, weight, heart & lung sounds, skin, perfusion(pulses), cardiac status and heart sounds(baseline)
Labs: ECG, and liver test

Question 8

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH):
Diagnosis

Answer 8

Dx:

• Decreased cardiac output related to the development of arrhythmias or hypotension
• Risk for injury related to visual or CV effects
• ineffective tissue perfusion related to hypotension or bradycardia
• Deficient knowledge

Question 9

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH):
Implmentation

Answer 9

Implementation:
• Monitor heart rate and blood pressure regularly
• Monitor input and output and record daily weight
• Provide safety measures if visual disturbances occur
• Provide thorough patient teaching

Question 10

Hyperpolarization- Activated Cyclic Nucleotide- Gated Channel Blocker (NCH):
Evaluation

Answer 10

Eval:
Response to the drug
Adverse effects 
Effectiveness of comfort measures Compliance with the regimen
Effectiveness of the teaching plan