DRUGSDRUGSinin

SPACESPACE

Joan Joan VernikosVernikos

WHAT, WHY, HOW & HOW MUCH?WHAT, WHY, HOW & HOW MUCH?

NaturalNatural or Sor SyntheticyntheticPreventPrevent

TreatTreatReduceReduce symptomssymptoms

DiagnoseDiagnose a health problem or diseasea health problem or diseaseReplaceReplace

Mimic Mimic InterfereInterfere

AntagoniseAntagoniseEffectiveness Effectiveness –– ToxicityToxicity

Need to KnowNeed to Know

Stability Stability –– shelf lifeshelf life

DoseDose –– EffectivenessEffectivenessDisadvantagesDisadvantagesAbsorptionAbsorptionDistributionDistributionMetabolismMetabolism

Action Action ––-- how it workshow it works

Interactions Interactions

Is the Dose You Need in Space the Is the Dose You Need in Space the Same as You Need on Earth?Same as You Need on Earth?

Body Changes Without G:Body Changes Without G:

Dehydration/ kidney stonesDehydration/ kidney stonesAnemiaAnemiaMuscle mass/ muscle strength/ backMuscle mass/ muscle strength/ back--painpainResistance to insulinResistance to insulinBone density loss/ Reduced Ca absorption/ Bone density loss/ Reduced Ca absorption/ decreased Vitamin Ddecreased Vitamin DSleep/ circadian rhythmsSleep/ circadian rhythmsImmune system/ reactivation of virusesImmune system/ reactivation of virusesBacterial infectionBacterial infectionAntibiotic absorption reduced/sensitivityAntibiotic absorption reduced/sensitivityWound healing/bone fracture repair delayedWound healing/bone fracture repair delayedHeart size & function/ Heart size & function/ baroreflexbaroreflex sensitivitysensitivity

On Return from FlightOn Return from Flight

Orthostatic HypotensionOrthostatic HypotensionNausea/ vomitingNausea/ vomitingAerobic stamina 25% reducedAerobic stamina 25% reducedDecreased muscle strengthDecreased muscle strengthBalance and Coordination ProblemsBalance and Coordination ProblemsAching joints, tender solesAching joints, tender solesBackacheBackache

Other Medical IssuesOther Medical Issues

EnvironmentEnvironment

Human FactorsHuman Factors

OccupationalOccupational

RadiationRadiation

Medical IncidentsMedical Incidents

Why would you Need Drugs in Why would you Need Drugs in Space?Space?

Countermeasures Countermeasures –– Preventive or CorrectivePreventive or Corrective

Rehabilitation after LandingRehabilitation after Landing

Medical SupportMedical Support

Emergency CareEmergency Care

MercuryMercury19611961--19631963

Private medical conferencesPrivate medical conferencesReliance on voice communicationReliance on voice communication

Vital function monitoringVital function monitoringHeart rateHeart rateRespirationRespirationEKG EKG

I.M. injectorsI.M. injectorsAntiAnti--motion sickness motion sickness medicationmedication

StimulantStimulant

VasoconstrictorVasoconstrictor

Mercury launchMercury launch

MercuryMercury19611961--19631963

Bill Douglas MD, does Bill Douglas MD, does preflight exam on preflight exam on ShepherdShepherd

Drugs made available for Drugs made available for emergency use onlyemergency use onlyInjectors made it possible for the Injectors made it possible for the astronaut to selfastronaut to self--administer drugs administer drugs through the pressure suitthrough the pressure suitFirst four missions these I.M. First four missions these I.M. drugs included drugs included

Pain relief (Anodyne)Pain relief (Anodyne)StimulantStimulantVasoconstrictor for treatment of Vasoconstrictor for treatment of shockshock

Later Changed to Later Changed to Tigan IM (antiTigan IM (anti--motionmotion--sickness)sickness)Demerol IMDemerol IMDextroDextro--amphetamine sulfate POamphetamine sulfate PO

Last Mercury flight Last Mercury flight Note: First use of medication on Note: First use of medication on U.S flightU.S flight

Project GeminiProject Gemini1965 1965 ––1966 1966 Medical goalMedical goal

Study the Study the ““long term effectslong term effects”” of space flight of space flight and EVA (intervals long enough to complete and EVA (intervals long enough to complete a lunar mission)a lunar mission)

Medical strategyMedical strategyVoice communicationVoice communicationVital sign monitoring Vital sign monitoring Augmented medical kitAugmented medical kit

Medical findingsMedical findings (longest orbital flight, (longest orbital flight, 14 days) 14 days)

Mild dehydrationMild dehydrationTransient orthostatic intoleranceTransient orthostatic intoleranceReduced red cell mass and plasma volumeReduced red cell mass and plasma volumeBone mineral lossBone mineral lossReduced postflight exercise toleranceReduced postflight exercise tolerance

Charles Conrad has heart rate checked by Dr. Howie Minners

Gemini VII Medical KitGemini VII Medical KitMedicationMedication DoseDose LabelLabel QuantityQuantityOral Merizine Oral Merizine 50mg.50mg. Motion SicknessMotion Sickness #8#8Parenteral MerizineParenteral Merizine 45 mg.45 mg. Motion sicknessMotion sickness #2#2dd--Amphetamine sulfateAmphetamine sulfate 5mg.5mg. StimulantStimulant #8#8APCAPC APCAPC #16#16Oral Meperidine HClOral Meperidine HCl 100mg.100mg. DecongestantDecongestant #16#16Parenteral MeperidineParenteral Meperidine 90 mg.90 mg. PainPain #2#2ActifedActifed 2.5mg.2.5mg. DecongestantDecongestant #16#16SudafedSudafed 60mg. 60mg. DecongestantDecongestant #16#16LomotilLomotil 2.5mg.2.5mg. DiarrheaDiarrhea #16#16Tetracycline HClTetracycline HCl 250mg.250mg. AntibioticAntibiotic #16#16Methyl cellulose Sol.Methyl cellulose Sol. 15cc15cc’’ss Eye dropsEye drops #1#1

Augmentations

Project Apollo

Project Apollo Project Apollo Medical goalMedical goal

Complete a lunar mission and bring the crew safely back to Complete a lunar mission and bring the crew safely back to EarthEarth

Medical strategyMedical strategyVoice communication Voice communication Physiologic monitoring Physiologic monitoring Augmented Apollo medical kitAugmented Apollo medical kitLunar module medical kitLunar module medical kit

Medical findingsMedical findingsMild dehydrationMild dehydrationTransient orthostatic intoleranceTransient orthostatic intoleranceReduced red cell massReduced red cell massBone mineral lossBone mineral lossReduced postflight exercise toleranceReduced postflight exercise toleranceSpace motion sicknessSpace motion sicknessTransient cardiac arrhythmiaTransient cardiac arrhythmia

Project Apollo Project Apollo Medical goalMedical goal

Complete a lunar mission and bring the crew safely back to Complete a lunar mission and bring the crew safely back to EarthEarth

Medical strategyMedical strategyVoice communication Voice communication Physiologic monitoring Physiologic monitoring AugmentedAugmented Apollo medical kitApollo medical kitLunar module medical kitLunar module medical kit

Medical findingsMedical findingsMild dehydrationMild dehydrationTransient orthostatic intoleranceTransient orthostatic intoleranceReduced red cell massReduced red cell massBone mineral lossBone mineral lossReduced postflight exercise toleranceReduced postflight exercise toleranceSpace motion sicknessSpace motion sicknessTransient cardiac arrhythmiaTransient cardiac arrhythmia

Medication Use Apollo Medication Use Apollo (Continued)(Continued)

Apollo 15Apollo 15 ExerciseExercise--induced induced musculomusculo--skeletalskeletalpain in right shoulderpain in right shoulder ASAASATransient arrhythmiaTransient arrhythmia No treatment availableNo treatment available

Self prescribed decongestant Self prescribed decongestant prior to entry prior to entry

Apollo 16Apollo 16 Difficulty with sleep Difficulty with sleep SeconalSeconal Cap. Cap.

Apollo 17Apollo 17 Difficulty with sleepDifficulty with sleep SeconalSeconal Cap.Cap.FlatulenceFlatulence Self prescribed Self prescribed SimethiconeSimethiconeLoose stoolsLoose stools LomotilLomotil

Prophylactic Prophylactic Scop/DexScop/Dex prior prior to entry to entry

SkylabSkylab19731973--19741974

First use of data downFirst use of data down--linking (12linking (12--24 hours after 24 hours after experiment)experiment)TelescienceTelescienceInflight medical kit & Inflight medical kit & exercise capabilityexercise capabilityEvacuation capability (crew Evacuation capability (crew return vehicle)return vehicle)Inflight medical support Inflight medical support system (IMSS)system (IMSS)First dental kitFirst dental kitFirst medical officerFirst medical officer

Dental kit and Dental kit and dental examdental exam

Shuttle Orbiter Medical SystemShuttle Orbiter Medical System(SOMS)(SOMS)

Adrenergic Agonist AgentsAdrenergic Agonist Agents (2)(2)Adrenalin (3 1ml syrs.)Adrenalin (3 1ml syrs.)EpiEpi--Pen (2 syrs.)Pen (2 syrs.)

AmphetaminesAmphetaminesDexedrine (#30 5mg tabs.)Dexedrine (#30 5mg tabs.)

Analgesic/AntipyreticAnalgesic/Antipyretic (2)(2)Tylenol (#60 325 mg tabs.)Tylenol (#60 325 mg tabs.)Ascriptin (#25 325mg tabs.) Ascriptin (#25 325mg tabs.)

Analgesic/Narcotic Analgesic/Narcotic (4)(4)MeperidineMeperidine (50mg/ml, 2 1ml syrs.)(50mg/ml, 2 1ml syrs.)Fentanyl (1 patch, 2.5mg)Fentanyl (1 patch, 2.5mg)Morphine sulfate (10mg/ml, 5 1ml Morphine sulfate (10mg/ml, 5 1ml syrs.)syrs.)Hydrocodone & Hydrocodone & Tylenol(10mg/660mg#20)Tylenol(10mg/660mg#20)

AntidiarrhealAntidiarrhealLomotil (#32, 2mg.)Lomotil (#32, 2mg.)PeptoPepto--Bismol (#24, 262mg tab)Bismol (#24, 262mg tab)

AnestheticsAnesthetics--Local Local (2)(2)Marcain (Bupivacaine) Marcain (Bupivacaine) with/without epinephrinewith/without epinephrineXylocaine (lidocaine with and Xylocaine (lidocaine with and without epinephrine)without epinephrine)

Antacid Antacid (Ca carbonate/Mg (Ca carbonate/Mg Sulphate, 700mg/300mg)Sulphate, 700mg/300mg)

Antimicrobials Antimicrobials (10)(10)AmikacinAmikacinMetronidazoneMetronidazoneImipnem/CilastatinImipnem/CilastatinCefadroxilCefadroxilAzithromycinAzithromycinAugmentinAugmentinCiprofloxcinCiprofloxcinBactrimBactrimFamciclovirFamciclovirFluconazoleFluconazole

SOMS SOMS (Cont.)(Cont.)

Antidote Antidote –– NarcoticsNarcoticsNarcan Narcan (0.4mg/ml, 2 ,1ml syrs)(0.4mg/ml, 2 ,1ml syrs)Antiemetic Antiemetic (P.O. & suppository)(P.O. & suppository)Promethazine Promethazine (25mg # 30 tabs /14 (25mg # 30 tabs /14 sup)sup)Promethazine (50mg/ml, 2 1ml syrs)Promethazine (50mg/ml, 2 1ml syrs)

AntihistaminesAntihistaminesSedatingSedating

Benadryl Benadryl (# 20 25mg caps.) (# 20 25mg caps.) Benadryl Benadryl (50mg/ml, 2, 1ml syrs)(50mg/ml, 2, 1ml syrs)

NonsedatingNonsedatingLoratiadine/Claritin Loratiadine/Claritin (#20 10mg (#20 10mg caps)caps)AntipsychoticAntipsychoticHaloperidol/Haldol Haloperidol/Haldol (5mg/ml, 2 (5mg/ml, 2 1ml syrs)1ml syrs)

AntitussiveAntitussiveDextromethorphan lozenges Dextromethorphan lozenges (#15, (#15, 5mg)5mg)

CardiotropicsCardiotropicsAdrenergicsAdrenergics

Adrenalin Adrenalin (1:10,000, 5 10ml syrs)(1:10,000, 5 10ml syrs)Nitroglycerin Nitroglycerin (tabs & patches)(tabs & patches)

AntiarrythmicsAntiarrythmicsAdenosine Adenosine (3mg/ml, 2 4ml syrs)(3mg/ml, 2 4ml syrs)

Lidocaine Lidocaine (20mg/ml, 2 5ml syrs)(20mg/ml, 2 5ml syrs)

Propranolol Propranolol (#24, 40mg tabs)(#24, 40mg tabs)

Verapamil Verapamil (2.5mg/ml, 2 2ml syrs)(2.5mg/ml, 2 2ml syrs)

Metoprolol Metoprolol (1mg/ml, 3 5ml syrs)(1mg/ml, 3 5ml syrs)

Procainamide Procainamide (100mg/ml, 1 10ml syrs)(100mg/ml, 1 10ml syrs)

Anticholinergic agentAnticholinergic agentAtropine Atropine (1mg/ml, 2 2ml syrs)(1mg/ml, 2 2ml syrs)

SOMS SOMS (Cont.)(Cont.) Dermatology medicationsDermatology medicationsAntibiotic Antibiotic –– topicaltopical

Bactroban (2%, 15gr tube)Bactroban (2%, 15gr tube)Neosporin/Lidocaine Neosporin/Lidocaine (40mg (40mg 0.5oz)0.5oz)Silvadene Silvadene (1%, 20gms)(1%, 20gms)Topicort Topicort (0.25%, 15gms)(0.25%, 15gms)

AntifungalAntifungal –– topicaltopicalLotriminLotrimin (1%, 15gm tube)(1%, 15gm tube)

Hormone therapy Hormone therapy –– femalefemaleOvral 21 Ovral 21 (#21 0.05mg & 0.5mg tabs)(#21 0.05mg & 0.5mg tabs)

Hypnotics/SedativesHypnotics/SedativesRestoril Restoril (#40 15mg tabs)(#40 15mg tabs)

Valium Valium (#30 5mg tabs)(#30 5mg tabs)

Versed Versed (1 mg/ml, 1 5ml syrs)(1 mg/ml, 1 5ml syrs)

Ambien Ambien (#75 10mg tabs)(#75 10mg tabs)

LaxativeLaxativeDulcolax Dulcolax (#30 5mg tabs)(#30 5mg tabs)

DulcolaxDulcolax (#5 10mg supp)

Electrolyte supplementsElectrolyte supplementsCa GluconateCa GluconateMg SulphateMg SulphatePotassium ChloridePotassium Chloride

CorticosteroidsCorticosteroidsDentalDental-- Kenalog in Orabase Kenalog in Orabase (5gm tube)(5gm tube)Rectal Rectal –– Anusol HCAnusol HC (6 (6 suppositories)suppositories)SystemicSystemicDecadron Decadron (10mg/ml, 2 1ml syrs)(10mg/ml, 2 1ml syrs)PrednisonePrednisone (#30, 20mg tabs)(#30, 20mg tabs)

DecongestantsDecongestantsOralOral

PseudoephedrinePseudoephedrine & Guaifensin & Guaifensin (#40, 120mg/600mg)(#40, 120mg/600mg)

NasalNasalAfrin Afrin (6 3ml containers) (#5 10mg supp)(6 3ml containers)

SOMS SOMS (Cont)(Cont)

OphthalmicsOphthalmics

Ophthalmic anesthetic, localOphthalmic anesthetic, localAlcaine (0.50%, 15ml)Alcaine (0.50%, 15ml)

Ophthalmic antibioticOphthalmic antibioticCiloxan 0.3%Ciloxan 0.3%CortisporinCortisporinGenoptic 0.3%Genoptic 0.3%

Ophthalmic antiviralOphthalmic antiviralViraVira--A 3.0%A 3.0%

Ophthalmic MydriaticOphthalmic MydriaticCyclogyl 1.0%Cyclogyl 1.0%

ISS MedicationsISS MedicationsRUSSIAN SEGMENTRUSSIAN SEGMENT

MedicationsMedicationsAntiAnti--Inflammatory AgentsInflammatory Agents

Kits 1,2,3 and 4Kits 1,2,3 and 4Atiseptic Remedies KitAtiseptic Remedies KitAspro Medical KitAspro Medical KitBurns and Wounds KitBurns and Wounds KitCardiovascular Remedies KitCardiovascular Remedies KitGastrointestinal and Urological KitGastrointestinal and Urological KitOintment KitOintment KitPreventive Remedies Preventive Remedies

Kits1,2,3 and 4Kits1,2,3 and 4

Psychotropic Remedies KitPsychotropic Remedies Kit

U.S. SEGMENTU.S. SEGMENTMedication Use Possible Side EffectsMedication Use Possible Side EffectsAcetaminophen (Tylenol)Acetaminophen (Tylenol)

.Acetazolamide (Diamox Oral).Acetazolamide (Diamox Oral)Altitude sickness (Minimal with shortAltitude sickness (Minimal with short--term term therapy)therapy)

Tingling sensation in Tingling sensation in extremities,extremities,Loss of appetite, increased Loss of appetite, increased urine urine

outputoutputOccasional drowsiness,Occasional drowsiness,confusionconfusion

.Acyclovir (Zovirax Ointment).Acyclovir (Zovirax Ointment)Antiviral ointment Antiviral ointment effective against herpes viruseseffective against herpes viruses

Mild burning or stinging, itchingMild burning or stinging, itching

Etc,etc,etcEtc,etc,etc…….24 pages .24 pages ……191 meds.191 meds.

PROGRESS FROM MERCURY TO PROGRESS FROM MERCURY TO ISSISS

3 MEDICATIONS TO 1913 MEDICATIONS TO 191

ORAL PREPARATIONSORAL PREPARATIONSI.M. INJECTIONSI.M. INJECTIONSSUPPOSITORIESSUPPOSITORIES

OPTHALMIC PREPARATIONSOPTHALMIC PREPARATIONS

CAPABILITY TO TREAT WIDE RANGE OF CAPABILITY TO TREAT WIDE RANGE OF CONDITIONSCONDITIONS

Medical Recommendations Medical Recommendations for Exploration Class Missionsfor Exploration Class Missions

Need more medication Need more medication shelf life datashelf life data

Need Need extensiveextensive pharmacokinetic studiespharmacokinetic studies

Need a more robust Need a more robust autonomous medical systemautonomous medical systemOn board physicianOn board physician with appropriate skill set and current with appropriate skill set and current medical practice experiencemedical practice experienceExpanded Expanded surgical capabilitysurgical capability

Better Better understanding of general anesthesia in understanding of general anesthesia in space and on returnspace and on returnOn board tutorial capabilityOn board tutorial capability to maintain physician to maintain physician currencycurrency

Project Apollo