Smt. R. D. Gardi B. Pharmacy College, Nyara, Rajkot 360110
"Space medicine" is a broad clinical specialty that treats astronauts' health. This includes pre-mission screening to prevent disease, health restoration after missions, and the provision of medical care during missions. This can be accomplished through the development of compact human-centered systems and an integrated informatics capability with a range of space medical applications, combining new technology with traditional healthcare. This study highlights the main health hazards during space missions thereby discussing the intervention of space and medicine also space and pharmacist and physiology changes observed during short and long space mission, and brief discussion regarding research and technical advancements in space medicine.
When the spaceship starts orbiting the planet after the rocket engines are turned down, astronauts feel weightlessness for the first time. With a simple push off the walls, ceiling, or floor, crew members may move around the cabin after removing their seat straps and float out of their seats [5].
Approximately 400 kilometres above the ground, the International Space Station (ISS) is a massive, enclosed, living structure. A variety of life support systems maintain the circumstances necessary for people to function safely and effectively. Controlling air pressure, temperature, humidity, and contamination is essential [3].
The National Aeronautics and Space Administration (NASA) and its international partners must be able to provide a safe, efficient, and comprehensive pharmacy in order to preserve crew health and performance during long-duration spaceflight outside of low-Earth orbit (LEO). Extended mission durations, a lack of resupply capabilities, longer exposure to the space radiation environment, and the absence of emergency medical return capability are some of the key differences between long-duration exploration missions and missions in low Earth orbit [15].
During deep space missions, pharmaceuticals are an essential resource needed to treat high-probability or possibly serious medical disorders. As a result, drugs chosen for exploratory missions need to be stable for the duration of those trips. Over time, drug products deteriorate. Assuming co-reactants are readily available in excess, drug degradation is a chemical process that normally proceeds at a constant rate under a constant set of storage circumstances. When exposed to atmospheric variables (like oxygen or humidity), non-ionizing radiation (like ultraviolet light), or ionizing radiation (like gamma and alpha radiation), many active pharmaceutical ingredients (APIs) may degrade [14].
The health of astronauts may be considerably impacted by at least three aspects of space travel adaptation. First, the physiological adaptations made in reaction to space travel may eventually develop into pathologies. For example, long-term space travel causes astronauts to lose the mineral calcium. In addition to increasing the risk of fractures upon return to Earth, this adaptation may result in nephrolithiasis or worsen to the point where it causes pathological alterations in bone structure [4].
According to estimates, the likelihood of a significant medical emergency during space travel is 0.06 per person-year of flight, or one incident every 68 months [17]. A group of scientists from Université Laval (Québec, Canada) and Thales Research and Technology Canada were supported by the Canadian Space Agency (CSA) to create an evidence-based database for treating medical disorders in space in order to aid in the development of decision support systems. Relevant data on human medical issues, such as hazards, treatment and diagnostic tools, and prognosis data, will be included in the developing database. [22].
In a way, in a 1-G environment, the body gets rid of the extra blood volume it needs to resist hydrostatic forces. Cardiovascular deconditioning is an issue that arises during shuttle re-entry and the initial postflight phase. The lowered blood volume of astronauts is re-distributed into the legs' venous vasculature under the pull of gravity, which lowers the effective circulating blood volume. Blood pressure, cardiac output, and venous return all decline [5].
In addition, the astronauts experience nasal congestion, face fullness, and jugular vein distension. This is because blood and interstitial fluid from the lower body are redistributed to the brain. [5]
The stability of any medication for the length of a mission, the medication's efficacy in the particular space environment, and the availability of adequate and suitable medications to address the particular physiological and psychological difficulties the crew may encounter are some of the factors that determine whether a safe and efficient pharmacy can be provided to crews [25].
Human deep space missions will depend heavily on the prevention, diagnosis, and treatment of sickness as it is an essential aspect of life. Despite being used to diagnose, treat, cure, or prevent disease, pharmaceuticals are unstable on Earth and considerably more so in space [24].
Despite the astronaut corps' rigorous medical screening and physical condition, recorded medical in-flight emergencies have happened, and medical space flight emergencies can significantly impact a mission's results. The fact that crew medical officers (CMOs) can currently be either physicians or nonphysicians makes this issue much more troublesome. Furthermore, in order to fulfill mission requirements, deployed crews in the future will include a wider range of backgrounds, many of which will include CMOs who lack POCUS and healthcare professional training [1].
Space's microgravity environment can also interfere with a number of bodily processes. For instance, the deterioration of bones and muscles can result in osteoporosis and other issues; the kidneys' increased filtration rate can cause kidney stones; the body's fluid redistribution can cause puffy faces and "chicken legs"; and the cardiovascular systems can be severely stressed [7].
In astronauts, syncope occurs when the lower effective circulation blood volume cannot be compensated for. In order to reduce the severity of the deconditioning, astronauts frequently use countermeasures. One liter of saline (156 mEq of sodium) is consumed just before to shuttle de-orbit in order to aid in plasma volume replenishment. The astronaut may also choose to inflate an antigravity suit if necessary. To reduce the accumulation of bodily fluids in the legs, the bladders built into the suit exert extreme pressure on the legs and lower abdomen. While the cardiovascular system readjusts to the I-G gravitational field, these techniques help the astronaut in the early postflight phase [5].
1. Short space flights:
Space motion sickness, which affects over 40% of all astronauts, is the most dangerous issue with short-duration flights. Malaise, pallor, cold sweats, nausea, and, in the worst situations, vomiting are typical symptoms. After three days in space, the majority of the impacted astronauts felt better. Nonetheless, it might be a major safety concern and a waste of time if many crew members are absent and performing below their capacity for three days of a normal seven-day shuttle trip [5].
2. Long space flights:
In preparation for long-duration space missions (>210 days), the current NASA standard has instituted a crew medical of officers (CMO) training program that consists of 40 to 70 hours of medical training during the 18 months prior to a flight. Regardless of medical education, an exploratory space flight CMO's proficiency in performing and interpreting point-of-care ultrasonography will be essential for crew member health and mission success. POCUS [POINT OF CORE ULTRASOUND] has shown promise in treating pulmonary pathologies (e.g., pneumonia, pleural effusion, and appendicitis), musculoskeletal trauma, genitourinary traumas, deep vein thrombosis, ocular health, and abdominopelvic emergencies (e.g., appendicitis, cholelithiasis, cholecystitis, ectopic pregnancy, and ovarian torsion) [1].
Long-duration missions may cause adaptive physiological changes that impact the pathophysiology of illness in addition to making people more vulnerable to damage [4].
Long-term Soviet and American astronauts have reported having a negative calcium balance, most likely as a result of disuse bone atrophy. After an 84-day trip, one American astronaut's calcaneal bone density dropped by about 8%. There is a concerning chance that bone demineralization might increase with spaceflight time and that not all of the calcium is recovered upon returning to Earth's gravitational pull. Therefore, following long space missions, astronauts' bones may become brittle and susceptible to pathologic fractures upon returning to Earth [5].
Figure 1: Effect of Space fight
SPACE STATION AND MEDICAL SUPPORT
When space agencies and commercial enterprises are ready for extended space missions to the Moon, Mars, and beyond, complex medical concerns must be taken into account. Crews on exploratory missions will have to put up with longer travel times, greater distances, slower communication, and greater levels of isolation and confinement. Higher degrees of medical autonomy will be required when it becomes more difficult to return to Earth in a timely way due to logistical and distance issues. Despite their lack of medical expertise, crew members must be equipped to manage medical situations [22].
In order to assist astronaut teams in managing mission-critical situations, resources such as diagnostic and decision-aid systems will be crucial. Planning, the advancement of medical technology, and the availability of vital resources will all be aided by efficient systems that will assist monitor crewmember health throughout missions [22].
Motion sickness, upper respiratory tract infections, and mild injuries are just a few of the issues that may be predicted and require medical care. However, the danger of occupational hazards would rise due to the increased scope of activities and the constant presence of several individuals. Given that it might take up to 28 days to prepare for a space shuttle rescue mission, it is imperative that there be the capacity to diagnose and treat serious diseases on board. The patient's health may also be jeopardized by the physiological strains connected to shuttle re-entry. Intravenous treatment, cardiac and ventilatory support, minor surgery, and local and regional anesthesia are among the therapeutic capabilities that space stations will have [5].
The Antarctic Concordia Station and isolation facilities like the Mars500 facility, the Hawai’i Space Exploration Analog and Simulation isolation habitat, and an inflatable lunar/Mars analog habitat have been constructed to replicate the circumstances of spaceflight. The Mars500 project modelled a 520-day return trip to Mars with a crew [3].
DEFINING A MEDICAL FOUNDRY FOR SPACE EXPLORATION:
In order to identify trends in exposure and health outcomes, the NASA Lifetime Surveillance of Astronaut Health (LSAH) program proactively gathers data on astronaut medical care and workplace exposures, particularly those that take place in training and spaceflight environments. It then performs operational and health care analyses. In order to provide a more complete reference database for analysis, NASA's Life Sciences Data Archive also contains data from analog research and human participants from previous and ongoing spaceflights [10].
In order to inform ISS and other PRA-based mission evaluations, NASA created the Integrated Medical Model (IMM), a Probabilistic Risk Assessment (PRA) Monte-Carlo simulation tool. NASA began developing the IMM in 2008, and it went into service in 2017. The IMM provides mission planners with useful information by modelling 100 medical conditions and incorporating data from Apollo, Skylab, Mir, and Space Shuttle programs, as well as evidence from all ISS missions, to evaluate the impact of resource depletion or limitation on the successful treatment of medical conditions [10].
"Space medicine" is a vast clinical field that looks after the health of astronauts. This covers health care delivery during missions, long-term rehabilitation and health restoration after missions, and pre-mission screening to avoid disease. The goal of countermeasures is to shield astronauts' health from the negative consequences of space travel. Examples include reducing radiation exposure by planning trips during times when the sun isn't as active and perhaps using medications as radiation shields [17].
A study headed by Karen McDonald, a professor of chemical engineering at the University of California, was given a two-year, USD 800,000 funding by TRISH in January 2020 to investigate the possibility of genetically modifying lettuce to make medications in this manner [12].
McDonald is leading a project that would allow crews to respond to the detrimental effects of extended zero-gravity conditions on bone density by genetically modifying the plant to make parathyroid hormone, an authorized medication for treating osteoporosis. [12]
Figure 2: Five hazards of human spaceflight
To ensure astronaut health, future space exploration medical systems will need to be redesigned. The three sub-systems that make up the NASA-provided ISS crew health care system (CHeCS) are the modern standard [16]:
Pharmaceuticals will be a crucial product class, and a space medical foundry will enable the mission to produce high-value medical products. This is especially crucial for long-term exploration and habitation of alien planets like the Moon and Mars. Within a basic, closed loop, a space foundry, of which a medical foundry is a subset, must be able to create a large range of outputs using a small number of inputs (preferably in situ resources with minimum flown resources) [16].
WHAT IS THE NEED OF ASTRO PHARMACY
The area of astropharmacy, which combines space science, pharmacy, and medicine, is relatively young. Addressing the particular pharmacological difficulties that arise in space conditions is the main goal of this new multidisciplinary subject. To guarantee the safe and efficient use of pharmaceuticals during space missions, it integrates aspects of biotechnology, aerospace medicine, and pharmacology [9].
A dedicated flight surgeon, often referred to as a crew surgeon, and a deputy surgeon are in charge of an astronaut's health throughout a particular mission. Due to the ISS's extremely restricted medical capabilities, it is not only necessary for astronauts to be in perfect condition before departure, but also for their health to be closely monitored while in space. [18]
A new area called "astropharmacy" seeks to solve the particular problems that pharmaceuticals encounter in space. Specialized pharmaceutical treatment is becoming more and more necessary to support astronaut health and safety as human space exploration progresses, from low-Earth orbit missions to possible deep-space travel and habitation. Conventional medicine formulations and pharmacological models are predicated on Earth's gravity, atmosphere, and radiation levels, all of which are very different from those found in space. The stability, pharmacokinetics, pharmacodynamics, and delivery of medications are severely hampered by spaceship limitations, cosmic radiation, and microgravity. A new framework is required to direct research and guarantee the creation of dependable, efficient pharmaceutical solutions designed especially for space missions in light of these difficulties. [9]
Medications may deteriorate more quickly in space because of exposure to cosmic radiation, temperature changes, and the particulars of microgravity [9]. Both pharmacodynamics and pharmacokinetics are Drug absorption, distribution, metabolism, and excretion in the body are altered in a zero-gravity setting. Drug safety and efficacy may be impacted by these differences [9].
INTERVENTION OF HUMAN PHYSIOLOGY AND SPACE ENVIRONMENT:
The environment that humans are used to on Earth is not the same as that of spaceflight. Due mostly to the impacts of space radiation and the lack of convection, buoyancy, sedimentation, hydrostatic pressure, and gravitational loading, it alters most physiological processes to some extent. Changes in pharmacokinetics, including drug absorption, distribution, metabolism, and excretion, as well as pharmacodynamics in space environments, are not well understood. It seems sense that the effects of medications may alter during spaceflight since the human body experiences major physiological and metabolic changes [7].
NASA is actively investigating two possibilities about the cause of space motion sickness. One of these may be widely included in what has been referred to as the sensory conflict hypothesis of motion sickness, even though it was not caused by manned space flight. The Skylab Program served as the catalyst for the second idea, which has been dubbed the fluid shift theory. The observed redistribution of bodily fluids during prolonged exposure to zero-g serves as the foundation for this notion. There is no disagreement between the fluid shift and sensory conflict hypotheses of space motion sickness [2].
Drug absorption, distribution, metabolism, and excretion may also be impacted by changes in renal blood flow, serum albumin levels, and variable protein expression. However, observational reports and analog studies have been the main sources of research on how spaceflight-induced physiological changes affect pharmacological action [7].
According to a study, Acetaminophen was given orally to five astronauts from three shuttle missions in a limited trial (650 mg as two 325-mg tablets). The drug's pharmacokinetics were assessed both during ground-based testing and during flight using saliva samples rather than blood samples. A consistently lower maximum salivary concentration (Cmax) and a longer time to attain peak concentration (Tmax) in the test group indicated a decrease in acetaminophen absorption in space as compared to ground-based testing. Furthermore, over the course of many flight days, individual astronauts' salivary acetaminophen concentrations fluctuated significantly; the causes of this are unknown, but potential causes include variations in gastrointestinal motility, gut absorption, and space motion sickness [7].
Microgravity may potentially have an impact on medication excretion through the skin, kidneys, or lungs. According to research on antiorthostatic bed rest, it may also have an impact on medication metabolism in the liver because of changes in perfusion brought on by blood redistribution. There is no information on the metabolism of drugs in the human liver in space. However, a number of metabolic alterations have been noted during human spaceflight, which may suggest that enzymatic activity is changed in space due to the effect of variables such variations in the levels of antidiuretic hormone, thyrotropin, plasma renin activity, and plasma adrenocorticotropic hormone [7].
Long-duration missions are significantly impacted by the effects of space flight on the immune, hematological, and endocrine systems. Red blood cell mass has been found to have significantly decreased in the Gemini, Apollo, Skylab, and Soyuz projects. Even with ongoing exposure to microgravity, there is a noticeable recovery in red cell mass after 30 to 60 days. During flight, electrolyte loss persists along with morphological and white blood cell alterations. Space travel causes complicated and poorly understood neuroendocrine alterations. These alterations might be linked to gastrointestinal issues or heart arrhythmias. Loss of liquids, lean body mass, and fat reserves causes the body weight to decrease during flight [21].
Deep space travel presents unique obstacles to the crew's mental well-being. According to a 2001 National Academy of Sciences-commissioned assessment, one of the biggest hazards to crew members on a Mars trip is psychological health. Crew members will encounter a variety of stressors during such missions, such as prolonged social isolation and close quarters confinement, ongoing stress from performing high-caliber work, handling unforeseen emergencies without much assistance from the ground, and structural brain changes brought on by ionizing radiation and microgravity [23].
CHALLENGES ASSOCIATED WITH HEALTH IN SPACE:
Rethinking human health for deep space missions[6]:
As space organizations and businesses worldwide strive to create fresh plans to increase human presence further into the cosmos, humanity has collectively turned its attention back to the stars. We must go from Earth-reliant to Earth-independent mission architecture in order to get there. For Earth-reliant human space missions, organizations like as the European Space Agency (ESA) and the National Aeronautics and Space Administration (NASA) have created outstanding life support systems. A livable environment for astronauts on the International Space Station (ISS) is maintained by carefully designed medicine, food, and environmental control re-supply shuttles that collaborate with on-board environmental control and life support systems [6].
There have been reports of cardiac arrhythmias in the Soviet and American projects (Skylab, Apollo, and Shuttle); one astronaut was sent down to Earth after 175 days of a 324-day mission due to a cardiac arrhythmia [21]. While postifight studies show weight loss, decreased exercise capacity, and a decline in muscular strength and motor coordination, inflight findings include anthropometric and postural abnormalities. Data from the 1987 Mir flights of 160-, 175-, and 326-day missions indicated muscle loss in the range of 25-40 percent postflight, whereas data from Skylab showed 20-25 percent loss in leg strength despite countermeasures [21].
Regular resupplies for life support systems will grow more difficult, though, as space missions get longer and go farther into the solar system, including to the Moon, Mars, and beyond. The likelihood of a low probability medical issue grows with mission time. It is crucial for astronauts to be medically independent while they are on Mars and the nearest hospital or medical supplies is at least 200 days distant via interplanetary travel [6].
In addition, the recent literature notes that the limited fidelity of current ground analog models, the in-flight instability of drug formulations, and the biased and underreported historical data of in-flight pharmaceutical use and efficacy are systemic vulnerabilities in space-flown pharmaceutical life support [6].
Particular Health Risks During Spaceflight[6]:
A number of negative health impacts might arise from spaceflight-related factors. These may include hypokinesis, which causes a decrease of muscle mass and bone density, or substantial fluid redistribution, which alters heart function. Long-term radiation exposure raises the risk of cancer. Stress, solitude, changed diet, and/or irregular circadian rhythms can all contribute to immunological changes in crew members. Additionally, crew members can be exposed to certain environmental risks such chemical exposures and potentially more virulent infections [6].
During and After Spaceflight Health Monitoring:
After being assigned to a space mission, the astronaut takes part in the necessary medical laboratory tests. According to NASA medical requirement MEDB 2.1, certain tests are regularly conducted on all astronauts prior to flight. These tests include a CBC with differential, a clinical chemistry evaluation, CRP, TSH, bone markers, an iron profile, and a urinalysis. From routine ISS maintenance (filter changes, monitoring systems, etc.) to conducting fascinating research for researchers around the world to the increased anticipation and preparation for spacewalks, the crew surgeon and deputy crew surgeon oversee every astronaut's daily activities after launch to the ISS.Throughout the six-month mission, the crew surgeon meets with each astronaut individually once a week to address schedule concerns, medication use (such as analgesics or dry skin treatments), and any medical concerns. For crew support, each astronaut and family is also allocated a dedicated ground-based behavioural health team [18].
A high-gravity re-entry and re-adaptation to terrestrial gravity after extended physical deconditioning during flight make the return from space a risky and unpleasant experience. Following landing, a thorough medical and laboratory evaluation of any damage sustained during the mission is conducted. Similar to pre-flight testing, post-flight laboratory testing is conducted, and values are tracked to confirm the return to pre-mission baselines while the astronaut recovers from any negative health consequences [18].
The first six weeks after flying and, to a lesser extent, the following few months are dedicated to astronaut rehabilitation, which includes exercises to increase strength and balance. Additionally, the astronaut takes part in several experiments that examine the physiological changes that occur during the six months spent in microgravity. The astronaut will return to their regular duties within the astronaut corps and wait for their next spaceflight assignment once their health has returned to its baseline level. [18]
DISEASES OBSERVED IN SPACE ENVIRONMENT:
Zero-G sickness:
Like motion sickness on Earth, which occurs during airline and sea travel, this condition is caused by an imbalance in the part of the brain that controls spatial orientation. It can produce nausea and a strong sense of unwellness that can linger for many days. An astronaut had this issue in 1968 while on the Apollo 8 mission to the Moon [7].
Mental health:
A prolonged period of confinement with just a small window providing a restricted view into the darkness may have a negative effect on a human subject's thoughts, feelings, and mental health, which might compromise the mission [7].
Muscle weakness:
One of the health issues that might be anticipated during space flight is muscle weakness, which can be reduced by doing daily workouts in a spaceship gym room while strapped to an exercise machine [7].
Visual deterioration:
According to NASA, space battles lasting more than six months affect eye function because they alter the anatomy of the eye. Under zero-G, eye targeting and object position identification may be compromised [7].
Bone Issue:
Extended periods of weightlessness can cause human bones to deteriorate [7].
Congestion in the head:
A fluid shift that takes place under zero-G conditions causes bodily fluid to accumulate in the skull, giving the astronaut a puffy face [7].
Reduced immune system effectiveness:
In addition to oversensitization in certain cosmonauts, which shows up as hypersensitivity symptoms, human exposure to a wide range of stressors throughout the spaceflight mission may also lead to immune system malfunction. [7]
Radiation risks:
People on Earth and low-orbiting space shuttles or stations are shielded from radiation by the Earth's magnetic field. However, cosmonauts in deep space are subjected to a variety of dangerous radiations, including ionizing (solar energetic particles, trapped particles, and galactic cosmic radiation) and non-ionizing UV radiation [7].
Medical emergency:
There are many emergency cases, and many situations, including trauma, fractures, injuries, and bleeding, may occur in space [7].
Emergency Medicine Simulation: To have pharmacists ready to handle medical crises in zero gravity, training programs should include simulated emergency scenarios. Pharmacists can gain the skills and decision-making abilities required in emergency scenarios by using virtual reality or simulation technology, which can offer realistic experiences. [8]
INTERVENTION OF PHARMACIST AND SPACE:
While the literature has addressed the role of space medicine physicians, far less attention has been paid to the role of pharmacists in relation to space participants' health [7].
Even though just a tiny percentage of pharmacists actively support the health of space participants, their position has considerably more potential because it is largely focused on reviewing astronauts' pharmaceutical usage at the ISS. The first pharmacist to work for NASA was Tina Bayuse. Preparing "convenience" and "contingency" medical kits for astronauts aboard the International Space Station is the primary responsibility of pharmacists at NASA. The primary distinction between the two kits is that the contingency kit is prepared for emergencies and includes supplies like cardiac life support and antibiotics, whilst the convenience pack includes medications that one would typically bring on a vacation. After deciding what should be included, pharmacists pack the flight kits. [7]
Furthermore, pharmacists may contribute significantly to both pharmaceutical research and treatment. medicine management included creating customized medicine, conducting pre- and post-flight medication evaluations, and providing medication guidance (digital Astro telepharmacy information services during spaceflight) in order to protect the health of space travelers, similar to space tourists. Novel drug creation, creative manufacturing, and comprehending clinical applications of the PK-PD variations of pharmaceuticals in space were all included in medication research [7], [13].
Historically, pharmacists have been essential to healthcare because they make sure that drugs are used safely and effectively. Their duties broaden in the space setting to tackle the particular difficulties brought on by radiation, microgravity, few resources, and extended isolation [7].
Pharmacists with specific expertise in space medicine and medicines may be needed if the number of space exploration missions that include extended stays in zero gravity increases. Private space firms and agencies like NASA may be able to shed light on their expected mission needs [9].
For research and development, pharmacists with experience in zero gravity settings would be needed. They could aid in the creation of medications, drug delivery methods, and space-suitable medical procedures. [8]
In ten years, a sizable, permanently inhabited space station will orbit the planet. Large solar arrays, astronomical observatories, tiny factories, astronaut living quarters, labs, and a garage for spaceship maintenance and repair will all be part of the station [5].
CONCLUSIONS
Furthermore, new communications technology will be needed by exploration teams in order to track and respond to elements that impact the environmental, system, and human components of their mission. In order to do this, new technologies and conventional healthcare will come together to develop small human-centered systems and an integrated informatics capacity with a variety of space medical applications.
REFERENCES
SahilKumar Khunt, Kajal Pradhan, Need and Prospects for Innovation in Space Pharmaceutical: A Comprehensive Overview, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 10, 408-420. https://doi.org/10.5281/zenodo.17265556
10.5281/zenodo.17265556
