November 29, 2022

Ivabradine is an ion channel blocker that reduces pacemaker activity resulting in a decrease in heart rate. This drug block funny ion channels (If) which are activated by hyperpolarization and gated by cyclic nucleotides such as cAMP. In patients with stable chronic heart failure this drug can be used to prevent deterioration of heart failure.

Hi everyone today in this video we are going to discuss about iva braden what is this drag iowa branding from the name of this tag we can get few of the important information about this drive here we can find the term brad within the name of this drug which indicates this drug produce the bradycardia resulting in slowing of the heart rate by reducing the heart

Rate it reduce the cardiac work that’s why this drug is useful in the treatment of heart failure so iowa braiding is one of the drug which reduce the heart rate and it is useful in the treatment of heart failure similarly we can find another term i at the starting of this track name here the letter i indicates this drug acts on ion channels particularly this direct

Blocks if channels these are the funny ion channels which are permeable to two different ions such as sodium as well as potassium and these ion channels are also called as hcn ion channels so here hcn indicates hyperpolation activated cyclic nucleotide gated ion channels so these ion channels are blocked by iowa braden so iva bradin is a ion channel blocker

And it produces the bradycardia thereby it is useful in the treatment of stable chronic heart failure similarly we can find other letters within the name of this drug here the letter v indicates this drug produce some visual side effects similarly a indicates it produce atrial fibrillation so along with the bradycardia this drug produce visual effects as well as

Atrial fibrillation these are the three important side effects produced by iva braden so today in this video we are going to discuss about this iowa branding how this drug acts what are the important precautions drug interactions contraindications and important side effects as well as clinical use of this drug we will discuss in this video so we have seen that

Ivabradine is useful in the patients with stable chronic heart failure in these patients because of heart failure the cardiac output is somewhat reduced so when the heart is going to contract it is going to eject the blood and whatever the fraction of the blood that is going to be ejected out of the left ventricles can be denoted as left ventricular ejection

Fraction and when this lvf is less than or equal to 35 percent it indicates a serious heart failure in the patients this condition in the patients may stimulate fear of the pathways resulting in the stimulation of sympathetic system as well as increase the automaticity so by this mechanism static elements are released and they can act on the heart thereby heart

Rate is going to be increased so in these patients with left ventricular ejection fraction less than or equal to 35 percent we can observe increased heart rate irregular heartbeats as well as cardiac arrest in the patients so in order to control these complications iowa braiding can be used which can act on the pacemaker cells thereby to reduce the heart rate

Preventing irregular heartbeats as well as cardiac arrest in the patients so iobridine is useful in the patients who are having stable chronic heart failure so ivy bladden can be used in these patients which reduce the risk of unstable heart failure as well as sudden cardiac arrest in the patients particularly this drug is useful in the patients who are having

Left ventricular ejection fraction less than or equal to 35 percent and the patients with sinus rhythm greater than or equal to 70 beats per minute where the heart rate is increased and in those patients where the beta blockers are ineffective for instance if a patient is given with the beta blockers and the maximum dose is achieved but still heart rate is not

Controlled in such patients iowa braiding can be given and finally this drug can also be given in the patients who are contraindicated with beta blockers for instance beta blockers at a high dose they produce bronchospasm and they are contraindicated in osmotic patients so in such patients or in any other contraindication of beta blockers iowa braiding can be given

In order to control the heart rate in the patients this drug can also be used in the pediatric patients with greater than six months in these pediatrics we can observe one of the condition dilated cardiomyopathy dcm so this is a condition the patients which leads to symptomatic heart failure and in these patients we can observe elevated heart rate which is again

Controlled by iowa braden now that is the chemical nature of this drug so this is the structure of iowa braden and here we can observe one of the heterocyclic ring system a seven member ring system with one nitrogen is fused with benzene so this is nothing but benzepine let us give the numbering to this benzene pine so this is one two three four five six seven

Eight nine now nitrogen is present at the third position and ketone group is present at the fourth position so this ring is nothing but one h three benja g pine four ohm that is the ring system present in iowa branding so iowa brandon is a benji pine derby too now let us see how this truck acts just we have discussed that ioba bradin is going to reduce the heart

Rate in the patients thereby reduce the cardiac work and improve the symptoms of heart failure all these actions of ayurvedin are attributed to its action on one of the ion channel hyperpolarization activated cyclic nucleotide gated ion channels they are commonly known as hcn they are also called as funny ion channels because through the same ion channel two

Different ions such as sodium as well as potassium are permeable among these hcn ion channels one of the ion channel that is more expressed in the cardiac pacemaker cells is the hcn4 and these ion channels are actuated under hyperpolarization so during the diastole the pacemaker potential is going to be developed and an inward current is generated through these ion

Channels and these ion channels are also controlled by cyclic nucleotides such as cyclic amp now within the heart the cyclic mp can increase the acute of hcn4 thereby can increase the chronotropic activity here sympatic system mainly activates the cyclic amp through beta-1 receptors thereby increase the heart rate as well as force of contraction that’s why beta

Blockers can be used to reduce the heart rate but when these beta blockers are contraindicated in the patients or they are not tolerated in such conditions iowa branding can be used to control the heart rate so now let us see the pacemaker potential at the sc node and how these ion channels are involved so this is the different phases of action potential within

The pacemaker cells at the pacemaker cells the resting membrane potential is somewhat less negative value compared with the non-pacemaker cells so around minus 50 millivolts to minus 60 millivolts will be the resting membrane potential at the pacemaker cells and this is the other potential minus 40 millivolts which is the threshold potential where voltage-gated

Calcium channels are open to produce depolarization but here the important thing is the development of pacemaker potential pacemaker potential is initiated by one of the ion channels if funny ion channels which are going to produce inward sodium current and they are activated by hyper polarization of the membrane the entry of sodium produces a small increase

In the membrane potential which is then followed by opening of t type calcium channels which produce influx of a small amount of the calcium further raising the membrane potential and finally the next role is going to be taken by l-type calcium channels which produce another influx of calcium ions thereby they produce a depolarization and the membrane potential

Crosses to the positive values resulting in the complete depolation of the pacemaker cells and after the depolation potassium channels are opened thereby again membrane potential decreases to the negative values in this way pacemaker potential is going to be developed during the diastole where the inward sodium current is initiating the development of pacemaker

Potential now iowa branding can block these if channels thereby to reduce the pacemaker potential which results in the slowing of the heart rate and we can observe a curve like this so this is the sca node at the ac node three important ion channels are present one is the if channels which are the funny ion channels and second one is the t type calcium channels

And then the one is the l-type calcium channels now sodium ions as well as potassium ions can enter into the membrane through these if channels and calcium can enter through both t type as well as l-type calcium channels when the sca myocytes are under hyperpolyzation they allow entry of sodium and a small amount of the potassium through these if channels so this

Produces a small raise in the membrane potential suppose the resting membrane potential is minus 50 millivolts then potential of the membrane is slowly raised which activates the t-type calcium channels these t-type calcium channels are called as pacemaker calcium channels now a small amount of calcium can enter into the membrane which further raises the membrane

Potential and when this membrane potential achieves to the threshold potential the l-type calcium channels are actuated and they can allow the entry of calcium leading to further elevation of the membrane potential and complete depolarization so these three type of ion channels are involved in the development of pacemaker potential but the initiation is produced

By hcn channels or if channels now iowa branding can block these if channels thereby inhibit the entry of sodium ions into the membrane which inhibits the development of pacemaker potential thereby to reduce the heart rate in the patients now that is the precautions of iowa braiding one of the important precaution of fiber brightening is that this tech produce

The bradycardia and the patients we have seen that term brad within the name of this drug indicates that this drug produces a bradycardia and iowa branding can produce some sinus node dysfunction which reduce the atrioventricular conduction and when this atrial ventricular conduction is significantly reduced it can produce some conduction block in the patients so

It may lead to first degree heart block where there is a delay in the av conduction otherwise it can lead to the second degree heart block where there is further suppression of conduction in the patients so iva brian may increase the risk of hot block in the patients so in the patients who are having the first degree or second degree heart block this drug should

Be carefully given similarly bradycardia produced by iva bradin may result in fear of the cardiac arrhythmias so it can increase the acute interval within the ecg which may precipitate one of the fatal cardiac arrhythmias such as torso dependence and when this iva briden is given with other drugs like calcium channel blockers such as diltiazem varapamil which is

Going to act on the heart and reduce the heart rate and class 3 antiarrhythmic drugs like emaderone as well as sotalol cardiotonics like disoxy all these drugs can reduce the heart rate and they can further increase the bradycardia produced by ivabradine similarly calcium channel blockers like diltiazem and varap mill they can increase the levels of fibroblading

Which may further increase the risk of bradycardia in the patients another important precaution of fibrobridene is that this drug can increase the risk of atrial fibrillation the patients at the pulmonary venous myocardium particularly hcn4 channels are important now iowa branding can block these hcn4 ion channels which reduce the if current and because of reduction

Of if current it may stimulate other pathways resulting in the increased atrial fibrillation so ioabridine can precipitate atrial fibrillation in the patients so case should be taken and any symptoms of atrial fibrillation are observed in the patients then ibradine should be stopped in order to avoid a certain cardiac arrest in the patients similarly iowa branding

Can increase the fetal toxicity so this diet can produce some fetal damage particularly fetal cardiac damage as well as some bradycardia in the fetus so this drug should not be given to the pregnant woman what are the drug interactions iv branding is mainly converted to metabolites by cytochrome p450 system and among them cyp3f4 is one of the important enzyme

Responsible for metabolism of iobridine so strong cyp3a4 inhibitors like azul anti-fungus such as itarazole ketoconazole similarly macrolides like telethromycin clarithromycin and protease inhibitors like return aware nelfina aware antidepressants like nephrodon all these drugs can block the cyp3a4 activity and they inhibit the metabolism of iowa ioba braiding

Resulting in the elevator levels of this track which leads to the toxicity in the patients so these drugs are contraindicated with hypoblading because this combination produces severe bradycardia in the patients similarly if you have the drugs like rifampicine barbiturates like phenobarbital and phenytoin saint john swat all these drugs can induce their cyp384

Activity thereby they can increase the metabolism of iowa brad in resulting in the loss of fkc of the strike beta blockers like metoprolol ethanol ac butyl and other beta blockers mainly act on the beta 1 receptors and they reduce the heart rate so these drugs can produce bradycardia as one of the important side effect so when these drugs are given along with iowa

Braiding this combination produce severe bradycardia in the patients so there is a significant drug interaction between beta blockers as well as ivabradine what are the contraindications since this drug acts on the pacemaker cells such as sc node so this drug is contraindicated in the sinus syndrome where there is decreased sinus rhythm and conduction and in the

Patients having third degree heart block where there is complete arrest of itreventricle conduction and in the patients with acute decompensated heart failure where this drug further complicates the heart failure and in the patient with severe hepatic impairment similarly the patients who are having significant bradycardia or patients who are using the pacemaker

And they are depending on the pacemaker activity and finally along with strong cyp3a4 inhibitors with all these iowa bride and is strictly contraindicated what are the side effects the important side effects of iowa braiding we have already discussed one of the important side effect is the bradycardia second one it can increase the blood pressure resulting in

The hypertension and it can also produce atrial fibrillation other side effects of this drug mainly include angioedema erythema and some vertigo uticaria skin rashes and proritas can be observed and the important side effect of eye vibrating is on the visual system this drug can produce phosphines in the patients this is one of the luminous phenomena that can

Be observed in the patients with use of iowa braden because this reckon block hyperpolation activated ion channels within the eye which produce increased brightness in the visual field the patients can observe an elevated brightness at the local areas of the visual field because of blocking of ih channels within the retina so this drug can produce some increased

Brightness as well as halos and image decomposition but this side effect is reversible whenever this drug is going to be stopped again the visual activity is going to be restored to the normal level how it is given this drug is available as tablet as well as oral solution and initial dose of the drug is given at 5 mg twice daily but the initial dose can also

Be reduced to 2 point fmg based on the conditions of the patient and the dose can be increased based on the control of heart rate in the patients the maximum dose that can be achieved is 7.5 mg given twice daily along with the four so this is the doses regimen in the adults but in the children with body weight less than 40 kg the dose of this drug is given as

0.05 mg per kg given twice daily along with the food so that’s about this drag iowa branding within the name i indicate this drag acts on the ion channel and it blocks the if channels which are also called as hcn hyper polarization activated cyclic nucleotide gated ion channels and another term brand indicates this drug produces bradycardia thereby to reduce

The heart rate which reduce the cardiac work in the patients and the letter v indicates visual effects this duck can produce phosphines in the patients increased brightness at the local areas of the visual field and indicates it produce atrial fibrillation so these three are the important precautions these trucks produce bradycardia atrial fibrillation as well

As phosphines in the patients and imbibing should be carefully given with other drugs which produce a bradycardia such as calcium channel blockers beta blockers class 3 anti-arthritic agents as well as cardiotonics like dissoxine and this drug can also produce some fatal damage so this drug is not preferred in the pregnant woman in the patients having cardiac

Conduction problems such as sinus syndrome third degree heart block or patients with severe bradycardia hypotension or in hepatic impairment in all these conditions this drug is contradicted this truck is available as a tablet as well as water solution the initial dose is started at 5 mg twice daily but the dose may be also reduced to 2.5 mg twice daily the

Maximum dose is 7.5 mg given twice daily but in the patients with body weight less than 40 kg the dose of the drug is given based on the body weight it is given at 0.05 mg per kg given twice daily along with the phone so that’s about this drag iowa braiding hope you have enjoyed this video if you like this video please subscribe to our channel share this video

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Transcribed from video
Ivabradine in Heart Failure – Mechanism, side effects, interactions & uses By egpat