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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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