Mode of action- nasya.pptx

Probable mode of action of nasal drug administration

1. NASYA - MODE OF ACTION Dr.A.Binitha MD(Ay) Professor Dept. of Panchakarma VPSV Ayurveda College Kottakkal 1

2. The best of Nasya Panchakarma for Urdhwa jatru vikaras / Shiras ( Uttamanga ) Indicated for daily practice Indicated for all ages Easy administration Wide range of application(cosmetic, pumsavana , menstrual disorders…) 2

3. Vishalyakarani Nasya 3

4. 4 Nasya in common clinical practice

5. Ksheerabala taila Sudhabala taila Karpasathyadi taila Ardita , Pakshaghata 5

6. Ksheerabala taila Narayana taila Mashadi taila Jyothishmati taila Shadbindu taila Madhuyashtyadi taila Yashtimadhu taila Rasna dasamoola ghrta Baladi ksheera kashaya Parkinsonism Multiple sclerosis Motor neurone disease Dystonias Cerebellar diseases Myasthenia gravis Post Herpetic neuralgia Trigeminal neuralgia 6

7. Karpasasthyadi taila Maharaja prasarinee taila Khuda manjari ksheera Cervical spondylosis Frozen shoulder 7

8. Anutaila Tulasi swarasa Pippalyadi ch Nimbasava & Sigrubeeja Ardhanareeswara rasa Sinusitis 8

9. Shuntyaditaila Rhinitis Nasa pratinaha Baladi ghrta Goghrta 9

10. Diabetic retinopathy Abhishyanda Retinitis pigmentosa Refractive errors Jeevaneeya ghrta / Jeevanthyadi ghrta (VP) Siterandadi taila ( VK) Durva swarasa & Ksheera / Honey Agastya swarasa sidha taila Ksheerabala 10

11. Rasna dasamoola ghrta Dhanwantara taila Eranda sigruadi taila Badhirya Karna naada Erandadi taila 11

12. Tuvaraka taila Seborrhoeic dermatitis Scalp Psoriasis 12

13. Nimba taila Bhringaraja taila Alopecia Premature greying Melasma Kumkumadi taila 13

14. Baladi ghrta Dhanwatara taila Ksheerabala taila Avarti taila Nasika choorna Rasnadi choorna Schizophrenia Seizures Dementia Depression Insomnia 14

15. Rasnadi choorna Brahmi swarasa / Ksheera kashaya Mandukaparni swarasa / ksheera kashaya Autism ADHD 15

16. Ksheerabala taila Ksheera ks Satahwadi taila Dysmenorrhoea Pumsavana PCOD Infertility Hypothyroidism 16

17. Devadaali phalarasa Jaundice 17

18. Vilwadi gulika Lasuna swarasa Sunti choorna Sarpa visha 18

19. Jwara Shirasoola Arkadi nasya Sannipata jwara Hidhma Kushmanda swarasa nasya Chandana nasya 19

20. Chikitsamanjari Mridweekadi nasya Lohitaandadi taila Krikavaku pureesha taila Marichadi taila Devadarvyadi taila Indraani taila Sannipata jwara 20

21. Nasal route 21

22. Nasal route - advantages A non invasive drug administration route Rapid attainment of therapeutic bloodlevels,Quicker onset of pharmacological activity Large surface area, high vascularity, enables dose reduction Used for both local and systemic drug delivery Avoidance of hepatic first pass metabolism and gut wall metabolism 22

23. Nasal route- advantages A favorable way to bypass the obstacles for blood-brain barrier (BBB) allowing the direct drug delivery to central nervous system Fewer side effects Convenient & good patient compliance Can be used even in unconscious patients and other vulnerable people 23

24. Nasal route - Limitations Nasal irritation Mucosal damage due to frequent use Nasal congestion interferes with drug delivery Histological toxicity of drugs not yet studied Small absorption surface area compared to GIT& Mucosal barrier 24

25. Nasya karmukata नास हि शिरसो द्वारम् | तत्र अवसेचितं औषधम् स्रोत शृङ्गाटकं प्राप्य व्याप्य च मूर्धानं नेत्र श्रोत्र कण्टादी सिरामुखानि च मुञ्चदीषिकामिवासक्तां ऊर्ध्वजत्रुगताम् वैकारिकीमशेषमाशु दोषसंहतिं उत्तमाङ्गदपकर्षति| (AS 29/2) 25

26. MODE OF ACTION 26

27. ANATOMY & PHYSIOLOGY OF NOSE 27 ‘ Nasaa hi Shiraso dwaaram ….’.

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29. Prime purpose Protect the lungs 29

30. The rigidity of bones and cartilages avoid collapse of nasal mucosa during inhalation of medicine 30

31. Nasal Valve N arrow triangular-shaped slit A cts as a dynamic valve to modify the rate and direction of the airflow during respiration 31

32. Prevent collapse of nasal valve during inhalation of medicine Dialator nasi muscle Nasalis muscle Apicis nasi muscle 32

33. Nose Depth : 120-140 mm Total surface area : 160cm 2 T otal volume : 16-19 ml 33 Anatomical and Histological Factors Affecting Intranasal Drug and Vaccine Delivery; Current Drug Delivery, 2012, Vol. 9, No. 6 567

34. Increase surface area Increase resistance to airflow Increase contact time at absorption site 34

35. Vestibular (Stratified squamous epithelium) Turbinate / Respiratory (Pseudo stratified columnar epithelium) (optimal drug absorption) Olfactory Non ciliated pseudo stratified columnar epithelium Epithelium is covered by numerous microvilli which increase the surface area Functional zones 35

36. . Mucus is hydrophilic The submucosal layer is highly vascularised and the venous blood drain into the systemic circulation and avoids loss of drug by hepatic metabolism 36

37. Olfactory area 2.5 cm 2 in each cavity Only site in the body where CNS is in direct contact with the outer surface 37

38. Openings into Nasal cavity 7 openings Most of it opens into Middle meatus, area of maximum absorption 38

39. Blood Supply to the Nasal Cavity Arteries Branch of sphenopalatine artery. Branches of Ophthalmic artery Branches of the maxillary artery(branch of the external carotid artery.) Facial artery Fenestrated capillaries and porosity of endothelial basement membrane is characteristic of nasal blood vessels 39

40. Blood Supply to the Nasal Cavity Sphenopalatine a. Maxillary a. 40

41. Blood Supply to the Nasal Cavity Veins Veins in nose are valve less Form plexus in infr . meatus and drain into Pterygoid plexus Ethmoidal veins join opthalmic plexus and proceed to Cavernous plexus Vascular bed is high in density over the lower part of septum and Infr . conchae , providing promising condition for drug absorption 41

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43. Lymphatic drainage of the Nasal Cavity Lymphatics The nose associated lymphoid system around nose & bucccal cavity is called Waldeyer’s ring Lymphatics guard the entrance from nose to brain Anatomical relationship between the olfactory nerves and the extra cranial lymphatics in the Olfactory region CSF drain into nasal lymphatics Absorb lipids and lipid soluble compounds from the tissues and convey to circulation 43

44. Nerve Supply of the Nasal Cavity Trigeminal nerve, the largest cranial nerve supports the nasal cavity The olfactory nerves ( over septum & Supr. concha) Parasympathetic fibres from the facial nerve The olfactory nerves are non medullated 44

45. Nerve Supply of the Nasal Cavity CN I – Olfactory Nerves (SVA) Anterior ethmoidal branch of V 1 Posterior nasal branches of V 2 Cut nasopalatine branch of V 2 to septum 45

46. NERVE SUPPLY 46

47. Chemo receptors & Glands Vomeronasal organ is a chemo receptor in the nasal cavity Connected to Brain thru Vomeronasal terminalis nerve Runs parallel to olfactory bulb and tract to end in Lamina propria in the Hypothalamus I nfluence the onset of puberty, the oestrus cycle, gestation, maternal behaviour and social behaviour 90000 glands in the nasal cavity producing watery secretions Function as a trap and solvent. 47

48. 48 The arachnoid villi penetrate the Lamina cribrosa and ended in Nasal Submucosal tissue The Nasal Route of Cerebrospinal Fluid Drainage in Man. A Light-Microscope Study P Löwhagen   1 ,  B B Johansson ,  C Nordborg Mastulungaagama ….

49. Role of Sringataka marma 49

50. Sringataka marma घ्राणादि इन्द्रिय चतुश्क तर्पणिनाम् सिराणम् सिरमुखानाम् सन्निपात सम्योगस्थानम् Junction of several siras Siramarma and sadyopranahara 50

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52. Cavernous sinus A collection of thin walled veins creating a cavity bordered by the temporal bone  and the sphenoid The pituitary gland lies between the two paired cavernous sinuses. They communicate freely with each other via the intercavernous sinuses Only anatomical location in which artery passes through venous structure 52

53. Internal carotid arteries & its small branches Carotid plexus of sympathetic nerve Abducens nerve (CN VI) Maxillary nerve (CN V 2 ) Oculomotor nerve (CN III) Ophthalmic nerve (CN V 1 ) Trochlear nerve (CN IV) Contents 53

54. Intrenal Carotid Artery-   Cincinnati Classification ( Bouthillier et. al., 1996). C1 – Cervical Segment -Cervical part (neck ) - Kanta C2 – Petrous Segment Petrous part (temporal bone) C3 –  Lacerum Segment ( srotra ) C4 – Cavernous Segment - Cavernous part (cavernous sinus) C5 –  Clinoid Segment C6 – Ophthalmic Segment Intercranial ( Netra ) part C7 – Communicating Segment 54

55. PROCEDURE 55

56. Poorvakarma Abhyanga & Ooshma sweda Vasodilation Momentary hyparaemia Drug absorption 56 Cushing’s reaction

57. Poorvakarma Prayogika dhoompana Reduce mucus secretion Dry nasal cavity Drug absorption 57

58. P osture Lie supine with extended hands & legs ( प्रसारित करचरणं नरं ) Legs in elevated position than head ( उत्तान शीर्षं ईषतुन्नत पादं ) Head lowered slightly ( किञ्चित् प्रलम्बित शिरस:)

59. Posture 15 Slanting 60 Angulation of entry is altered Flowspeed increased from 2-3 m/s Pooling of blood 59

60. Paschatkarma Post nasya massage Carotid sinus (Baroreceptors) Cerebral arterial pressure Drug absorption 60

61. 61 Resting in supine posture allows for increased rate of drug absorption

62. PHARMACOLOGICAL ACTION 62

63. Nasal drug delivery Systemic circulation Olfactory & Trigeminal pathway Nasal cavity Brain tissue & CSF Organs & tissues 63

64. Mechanism of drug absorption Para cellular Aqueous route of transport Trans cellular ( lipoidal route) responsible for the transport of lipophilic drugs 64

65. OSMOTIC GRADIENT “HYPEROSMOTIC ENVIRONMENT” Vascular absorption of active ingredients into capillaries 65

66. Formulation factors affecting nasal bioavailability Lipophilicity Molecular size Mucosal contact Concentration Solution PH 66

67. Gokarna Nasal drops Syringe Mode of administration The mode of administration could influence the distribution of drug in the nasal cavity, which in turns determines the efficacy of its absorption . Constant dose Uniform distribution on nasal mucosa 67

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69. T aila or ghrta Types- Snehana , Sodhana Navana nasya 69

70. Validation of Samyak nasya lakshana and effect of karpasathyadi taila nasya in Viswachi w.s.r .t Snehapaaka - A Randomized Double blind clinical trial (Dr Devi R Nair (2015)) Clinical study – the efficacy of marsa nasya with mridu , madhyama & kharapaka of karpasasthyadi taila at OP level was equally effective in all 3 gps of 30 pts each. Experimental study – ( R & D division , Oushadhi , Trissur; AVS, Kottakkal ; CMPR, Kottakkal ) Mridu paka – more saponification value, more hydrophilic constituents Madhyama paka – more active ingredients ( HPTLC) Kharapaka - more active ingredients, more lipophilic constituents 70

71. MR’DU PAAKA Taila with more iodine value More unsaturated Carbon atoms Less H+ ions Low molecular fatty acids More active ingredient absorption Fluid pass directly to capillaries without penetrating muco – ciliary membrane 71

72. Avapida nasya S warasa , kwatha , kalka etc. Types- sodhana , stambhana Avapeeda nasya 72

73. Fine powders of drugs administered through nose. Nadi yantra ( 6 angula ) Dhmapana nasya Pradhamana nasya 73

74. Inhalation of medicated dhooma by nasal route and elimination by oral route Dhuma Nasya 74

75. Nasal drops disperse a drug solution throughout the length of the nasal cavity from atrium to nasopharynx , offering a relatively large area for immediate absorption. 75

76. Excretory Stimulatory Absorptive Errhine therapy 76

77. 77 Excretory action Local irritation More permeability More nasal discharge

78. 78 Absorptive action Vascular & Lymphatic path Systemic circulation Intracranial pooling

79. 79 Stimulative action Chemo receptors & Olfactory nerves Hypothalamo – Pituitary axis Neurological & Endocrinal stimulation

80. 80 Summary The structure of nose plays a vital role in Nasya karmukata The pre and post procedures of Nasya facilitate drug absorption The nature of the drug and the mode of administration determines the efficiency of nasal drug delivery More researches in Ayurveda required to understand Nasya karmukata

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82. Thank you all 82