By: Kimberly Lapierre, PharmD Candidate c/o 2017

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Since its inception in 2003, the Johnson Space Center Pharmacy has taken giant leaps to advance the field of pharmacy on Earth and in space. Under the direction of pharmacist Tina Bayuse, the pharmacy is responsible for preparing medication kits for astronauts at the International Space Station, creatively approaching medication challenges that come with the extraterrestrial territory, and providing ambulatory care for the Flight Medicine and Occupational Medicine clinics.¹ The pharmacy packages two types of medication kits: convenience kits and contingency kits. Convenience kits include any medications a person on earth has on hand, whereas contingency kits are comprised of drugs that are needed in more advanced situations, such as infection or cardiac arrest.

The contents of these kits address any predicable or unpredictable medical complications an astronaut may encounter. The medication supply is tremendously important given the effects space travel has on the body. For example, osteopenia is a common side effect of spaceflight as weight bearing bones and muscles deteriorate. A decrease in gravity leads to lack of stress-induced bone remodeling and increased bone resorption. In an attempt to combat bone loss, astronauts may take bisphosphonates, like zolendronate or risedronate, or hormonal therapy, including selective estrogen receptor modulators (SERMs).² Secondly, astronauts experience decreased immune system functioning as a result of poorly reproducing T cells. This is further complicated by the existence of microbes with increased virulence due to adaption to the space environment.³ Therefore, topical and systemic antifungals, antivirals, and antibiotics are included in the medication kits. Lastly, like any type of long term travel, space travel wreaks havoc on astronauts’ sleep wake cycles, with the majority of astronauts using sleeping pills and stimulants. An observational study from 2012 that examined sleep habits of astronauts from 80 space shuttle missions found that 78% of crew members took sleep promoting drugs, mostly zolpidem, on 52% of nights.⁴

In addition to considering the needs of the astronauts when preparing the kits, the pharmacy must stock drugs with space appropriate dosage forms. The volume of the drugs is taken into consideration when first time fliers or doctors are making requests. Furthermore, how medications are prepared can be an obstacle. Tina Bayuse cites that managing alcohol levels in medicines and the ability to take drugs while wearing a space suit are among the challenges.¹ Moreover, the dosage forms of medications can affect their stabilities, which is an important point to consider for long term missions.

The “Stability of Pharmacotherapeutic and Nutritional Compounds” study analyzed the stability of 35 different medications of various dosage forms such as liquids, tablets, and capsules. Multiple stability kits were launched into space in July 2006 and each returned for testing at various time intervals from June 2007 to November 2008.⁵ The medications were tested for degradation and compared against a control kit that stayed on the ground. The results showed that the space kit medications degraded more rapidly than the ground control kits, with Augmentin® (amoxicillin/clavulanate) being the most unstable due to the clavulanate component degrading by almost 50%. These results justify the space center’s current policy of short dating the medications to expire six months before the manufacturers given date. Moreover, drugs that were repackaged were even more susceptible to degradation than if kept in their original packaging.⁶ The decreased stability of medications in space contributes to another barrier: the need for more frequent resupply, which may not be possible on longer missions. Therefore, contingency kits that contain medications for emergency situations are not repackaged in order to preserve the shelf lives of its drugs.

Like prescribing and dispensing medications on Earth, space pharmacy comes with high stakes. Therefore, three different pharmacists check each medication kit before it goes into orbit. Also, astronauts are encouraged to undergo drug tolerance testing, or trial runs, to ensure that unwanted side effects do not occur when taking a medication for the first time.¹ These precautions minimize the inherent risk of taking medication in space. Although space pharmacy can be problematic, the Johnson Space Center Pharmacy team approaches each challenge with ingenuity and expertise to ensure the safety of each and every one of its astronauts.

 

SOURCES:

1. Page E. How Tina Bayuse became the first pharmacist at NASA. The Pharmaceutical Journal. Published 02/05/2016.
2. Ohshima H. Preventing bone loss in space flight with prophylactic use of bisphosphonate: health promotion of the elderly by space medicine technologies. https://www.nasa.gov/mission_pages/station/research/benefits/bone_loss.html. Published 02/29/2012.
3. Kim W, Tengra FK, Young Z, Shong J, Marchand N, et al. Spaceflight promotes biofilm formation by Pseudomonas aeruginosa. PLoS One. 2013;84.e62437. doi: 10.1371/journal.pone.0062437.
4. Painter K. Sleeping pills in space: astronauts are regular users. USA Today. http://www.usatoday.com/story/news/nation/2014/08/07/sleeping-pill-astronauts/13737819/. Published 08/07/2014.
5. Barger LK, Flynn-Evans EE, Kubey A, et al. Prevalence of sleep deficiency and use of hypnotic drugs in astronauts before, during, and after spaceflight: an observational study. Lancet Neurol. 2014;13(9):904-12. doi:10.1016/S1474-4422(14)70122-X.
6. Nimon J. Preparing to stock the medicine cabinet for long-duration missions. NASA’s Johnson Space Center. http://www.nasa.gov/mission_pages/station/research/news/Medication_ISS.html. Published 11/08/2011. Updated 12/09/2011.

 

Published by Rho Chi Post