Advertise on podcast: Prescribe or Pass: The PoP Pod

Does your ADHD medication seem to work brilliantly for most of the month and then suddenly feel less effective before your period? In this bonus episode of Prescribe or Pass: The PoP Pod, pharmacist Kate Thomas explores the fascinating and still under-researched relationship between ADHD, stimulant medication and female hormones. We look at how oestrogen and progesterone may interact with dopamine, why ADHD symptoms can worsen during the luteal phase, what happens during perimenopause, and the emerging evidence around adjusting stimulant doses at different points in the menstrual cycle. We also unpack an important question: can you actually have different Vyvanse doses across the month? There’s plausible biology, growing clinical experience and some intriguing early research but there are also major gaps in the evidence. Plus, we discuss how to distinguish worsening ADHD symptoms from PMS or PMDD, why tracking symptoms across several cycles can be incredibly useful, and what to take to your prescriber if you notice a consistent pattern. For clinicians, people taking ADHD medication, and anyone interested in why the same medication can sometimes feel very different depending on where you are in your hormonal life. Educational information only. Do not change your stimulant dose without discussing it with your prescriber. Support the show

Nausea and vomiting are common in palliative care but they are not diagnoses in themselves. In this episode, we look at how to work backwards from the symptom and ask what is actually causing it. Gastric stasis, opioids, constipation, metabolic disturbances, vestibular problems, raised intracranial pressure and bowel obstruction can all cause nausea and they do not all need the same treatment. We unpack where commonly used antiemetics such as metoclopramide, haloperidol, ondansetron, prochlorperazine and cyclizine fit, why metoclopramide can be helpful in gastric stasis but problematic in complete bowel obstruction, and why route of administration matters when oral medicines are no longer reliable. As always, we finish with reflective questions for clinicians using the episode as part of their CPD. Support the show

Why can someone feel profoundly breathless even when their oxygen levels are normal? And why might morphine help more than oxygen? In Episode 4 of our palliative care series, we unpack the difference between breathlessness and hypoxaemia, why oxygen is not always the answer, and how low-dose opioids can reduce the distress and sensation of struggling to breathe. We also cover reversible causes of breathlessness, the surprisingly useful role of a handheld fan, non-drug strategies, COPD and carbon dioxide retention, benzodiazepines, oxygen in the final days of life, and one of the biggest fears families have: does giving morphine for breathlessness hasten death? For clinicians, pharmacists and anyone wanting a deeper understanding of palliative medicines, with reflective questions at the end to support CPD. Support the show

Opioids are some of the most important medicines in palliative care and some of the most misunderstood. In this episode, we take a practical deep dive into morphine, oxycodone, hydromorphone, fentanyl, buprenorphine and methadone, including how their potency differs, what changes in renal impairment, and why opioid conversion is never just simple arithmetic. We also look at opioid rotation, breakthrough dosing, fentanyl and buprenorphine patches, rapid-onset fentanyl products such as Abstral and Actiq, and the important safety distinction between morphine and the much more potent hydromorphone. Plus, we unpack the difference between tolerance, physical dependence and addiction and why fear of opioids can sometimes become a barrier to good symptom control. A practical episode for clinicians who want to prescribe, supply and discuss opioids with more confidence. Support the show

Pain in palliative care is rarely as simple as “give more morphine.” In this episode of Prescribe or Pass: The PoP Pod, we start with the most important step: working out what kind of pain the patient is actually experiencing. We explore nociceptive, neuropathic, visceral and bone pain, and how the likely mechanism should guide treatment. We also look at where paracetamol, NSAIDs, opioids and adjuvant medicines fit, and why radiotherapy, positioning, treating constipation or addressing other reversible causes can sometimes do more than another analgesic dose. The key message: assess the pain first, then match the treatment to the mechanism and the patient’s goals. Plus, reflective questions to help turn the episode into CPD. Next up in Episode 3: a deeper dive into opioids including morphine, oxycodone, hydromorphone, fentanyl, buprenorphine and methadone, opioid rotation, equianalgesia, breakthrough dosing, renal impairment and common opioid myths. Support the show

Palliative care is often misunderstood as the point where active treatment stops and “nothing more can be done.” But that is not what modern palliative care looks like. In this first episode of our new palliative care series, we unpack what palliative care actually is, when it should begin, how it can sit alongside disease-directed treatment, and why referral does not mean giving up. We also look at who provides palliative care and where it can happen; at home, in hospital, in dedicated palliative care units, in residential aged care, and through outpatient or virtual care. This episode sets the foundation for the rest of the series, where we’ll dive into opioids, breathlessness, nausea, constipation, delirium, anticipatory medicines, syringe drivers, the last days of life, and more. As always, there are reflective questions at the end for clinicians who want to use the episode to support CPD documentation or for anyone who wants to think a little more deeply about what good care looks like when cure is not the only goal. Support the show

In the final episode of our MHT series, we look beyond hormones and into the booming menopause wellness market. Do phytoestrogens, soy isoflavones, red clover, wild yam, black cohosh, magnesium, collagen and creatine actually help, and how do they compare with prescribed MHT? We also unpack the difference between soy foods and concentrated phytoestrogen supplements, why wild yam cream is not progesterone, what to consider in women with a history of hormone-sensitive breast cancer, and why “natural” does not mean biologically inactive. Then we step back from the supplement aisle altogether and look at the things that may matter most for long-term health: adequate protein, fruit and vegetables, strength training, bone health, cardiovascular risk, calcium, vitamin D and maintaining physical independence as we age. Because there is no universal menopause stack. There is a person. And next, we move into a very different, but equally important, series: palliative care. Support the show

MHT is often discussed as either “safe” or “dangerous” but the real clinical picture is far more nuanced. In Episode 7 of our menopause series, we unpack the major risks associated with menopausal hormone therapy, including breast cancer, venous thromboembolism, stroke and cardiovascular disease, and explore how age, timing, route of administration and the specific hormone regimen all influence risk. We revisit the Women’s Health Initiative and why its findings changed menopause prescribing for a generation, while also explaining why those results cannot simply be applied to every woman using contemporary MHT. We also cover complex clinical situations including migraine, hypertension, liver disease, previous cancer, unscheduled bleeding and starting or continuing MHT later in life. And for women who cannot or do not want to use hormone therapy, we look at non-hormonal options including fezolinetant (Veoza), its mechanism of action and the important liver-monitoring requirements clinicians need to know. This episode is about moving beyond blanket reassurance or blanket fear, and towards individualised, evidence-based risk assessment and shared decision-making. Support the show

Just when we thought the ADHD series was finished, the FDA approved a brand-new ADHD medication. Centanafadine, FDA approved in the US as Simtriyo, is a once-daily triple reuptake inhibitor that affects dopamine, noradrenaline and serotonin, giving it a mechanism unlike the ADHD medicines we currently use. In this bonus episode, we look at how centanafadine works, why serotonin is part of the picture, whether it should be considered a stimulant or non-stimulant, what the Phase 3 trials actually showed, and the key safety issues including cardiovascular effects, serotonin syndrome, abuse potential and the paediatric suicidality warning. We also ask the important question: does a novel mechanism mean a better medication? And for Australian listeners, we cover what we currently know about TGA approval and whether Simtriyo could eventually become available here. A concise, clinician-focused update on one of the most interesting new developments in ADHD pharmacotherapy. Support the show

Genitourinary syndrome of menopause, or GSM, is common, chronic and often under-recognised. In this episode, we look at how declining oestrogen affects the vulva, vagina, urethra and bladder and why symptoms can include much more than vaginal dryness. We explore the role of low-dose vaginal oestrogen, including how it restores the vaginal epithelium, glycogen, Lactobacillus populations and an acidic vaginal environment. We also discuss intravaginal prasterone, its intracrine conversion to oestrogens and androgens within vaginal cells, and where it may fit into treatment. Plus: recurrent UTIs, moisturisers and lubricants, using vaginal oestrogen alongside systemic MHT, whether progesterone is required, considerations after breast cancer, red flags, and the practical counselling points clinicians need to know. Next episode: MHT risks, contraindications and complex clinical situations, including a closer look at the Women’s Health Initiative and how it changed the menopause conversation. Support the show

Testosterone has become one of the most talked-about hormones in menopause care, but its evidence-based role is more specific than the hype sometimes suggests. In Episode 5 of our MHT series, we look at what testosterone actually does in women, how levels change with age and menopause, and the one clear evidence-based indication for treatment: hypoactive sexual desire disorder, or HSDD. We discuss how HSDD is assessed, the difference between spontaneous and responsive desire, why a blood testosterone level cannot diagnose the condition, and the importance of considering factors such as vaginal symptoms, sleep, medicines, mental health and relationships before prescribing. We also cover AndroFeme 1 in Australia, dosing and application, monitoring, adverse effects, and why pellets, injections and supraphysiological testosterone dosing should be approached with caution. And importantly, we separate the evidence from the enthusiasm around claims that testosterone treats fatigue, brain fog, weight gain, low mood, muscle loss or general “anti-ageing”. P!nk has an important place in our hormonal girl band, but she doesn’t need to sing on every track. Next episode: Vaginal Oestrogen and Genitourinary Syndrome of Menopause. Support the show

Oestrogen may get most of the attention in menopausal hormone therapy, but if a uterus is present, progesterone, or another progestogen, has a crucial role to play. In Episode 4 of our MHT series, we look at why endometrial protection matters, the difference between progesterone, progestogens and progestins, and how cyclic and continuous combined MHT regimens work. We also cover micronised progesterone, synthetic progestogens, Mirena as part of MHT, progestogen intolerance, vaginal progesterone, compounded progesterone creams, and why adherence matters when systemic oestrogen is being used. Plus: when oral micronised progesterone may occasionally be used alongside a Mirena, and which bleeding patterns should prompt further assessment. If oestrogen is Beyoncé, progesterone is Adele: perhaps a little less flashy, but absolutely essential to keeping the whole performance safe. Support the show

Oestrogen is the headline act in menopausal hormone therapy, but the way it is delivered matters. In this episode, we explore the differences between oral and transdermal oestrogen, including patches, gels and tablets. We look at absorption, first-pass metabolism, clotting risk, practical counselling points, dose considerations and why one formulation may suit a patient better than another. Using our hormone girl-band analogy, Beyoncé is oestrogen, but whether she arrives through the front door or the stage door changes what happens backstage. We also discuss body-identical oestradiol, when transdermal therapy may be preferred, common application errors and why patients with a uterus usually need adequate endometrial protection alongside systemic oestrogen. This episode is designed for pharmacists and other clinicians wanting a practical, evidence-based overview of oestrogen prescribing and counselling in menopause. Support the show

Menopausal hormone therapy can be transformative, but it is not a cure-all. In this episode, we look at the symptoms MHT treats most effectively, including hot flushes, night sweats and genitourinary symptoms, as well as the areas where the benefits are less predictable, such as sleep, mood, brain fog, joint pain and sexual function. We also unpack what MHT should not be expected to do. It is not a weight-loss treatment, it is not contraception, and it should not be prescribed solely to prevent dementia or cardiovascular disease. The key question is not simply, “Does MHT work?” It is, “What are we asking it to do?” Plus, we introduce the three members of our hormone girl band: Beyoncé as oestrogen, Adele as progesterone and P!nk as testosterone, before Beyoncé takes centre stage in the next episode. Support the show

What is actually happening to hormones during perimenopause, and why can symptoms feel so unpredictable? In the first episode of our new eight-part series on menopausal hormone therapy, pharmacist Kate Thomas explains the physiology behind the menopausal transition, including changes in oestrogen, progesterone, FSH, ovulation and ovarian reserve. We also look at why hormone blood tests are often unhelpful in women over 45 with a typical clinical presentation, why perimenopause is not simply a steady decline in oestrogen, and how fluctuating hormones can affect bleeding, sleep, mood, cognition, hot flushes and genitourinary symptoms. This episode also introduces genitourinary syndrome of menopause, or GSM, and why symptoms such as urinary urgency, recurrent UTIs and nocturia should not be dismissed as minor inconveniences. Reflective questions are included at the end to support continuing professional development. In Episode 2, we will ask an essential clinical question: what can menopausal hormone therapy actually treat and what can’t it? Support the show