Explore every episode of the 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.

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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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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.

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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.

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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.

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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?

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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.

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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.

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ADHD is overdiagnosed. Everyone is a little ADHD. Stimulants are addictive. Medication changes personality. Children grow out of it. Sugar, phones, or even the gut microbiome, cause ADHD.

In the final episode of this eight-part series, pharmacist Kate Thomas examines some of the most common myths surrounding ADHD and its treatment.

We look at what the evidence actually tells us about diagnosis, stimulant dependence, adult ADHD, intelligence, diet, screen use, probiotics and the idea that ADHD medication changes who someone is.

This episode also brings together the key lessons from the entire series. From how ADHD medicines are selected and titrated to the differences between methylphenidate, dexamphetamine, lisdexamfetamine and non-stimulant treatments.

Designed for pharmacists, pharmacy students and other clinicians, this episode encourages listeners to challenge misinformation while responding to patients with accuracy, empathy and respect.

Reflective questions:

Which ADHD myth do you hear most often in practice?

Have any of your own beliefs changed during this series?

How can you correct misinformation without making a patient feel dismissed or embarrassed?

This concludes the eight-part ADHD medicines series from Prescribe or Pass: The PoP Pod.

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What happens if a patient forgets their ADHD medicine?

Should they take weekends off?

Can they exercise? Drive? What about pregnancy, university, shift work, appetite, weight loss or the ongoing medicine shortages?

In this practical episode of Prescribe or Pass: The PoP Pod, we move beyond pharmacology and into the real-world questions pharmacists, doctors and other clinicians are asked every day.

We discuss:

• What to do after a missed dose
• Drug holidays: when they may (and may not) be appropriate
• Managing appetite suppression and weight loss
• Sleep and exercise
• Nutrition and growth in children
• Shift work and university life
• Pregnancy and shared decision-making
• Driving and roadside drug testing
• PBS restrictions and ADHD medicine shortages
• When treatment should be reviewed, and why growing bigger doesn’t automatically mean needing a higher stimulant dose

This episode is designed for pharmacists, pharmacy students and other health professionals wanting a practical, evidence-based understanding of ADHD medicines that extends well beyond the Product Information.

Whether you’re counselling a patient collecting their first prescription or supporting someone who’s been taking these medicines for years, this episode is packed with practical clinical pearls you can use in everyday practice.

Learning objectives

By the end of this episode, you should be able to:

• Counsel patients on the practical management of ADHD medicines in everyday life.
• Discuss common issues including missed doses, appetite, sleep, exercise and driving.
• Recognise situations where treatment review or referral may be appropriate.
• Provide evidence-based advice on common questions encountered in pharmacy practice.

Prescribe or Pass: The PoP Pod is a clinician education podcast created by pharmacist Kate Thomas, providing evidence-based learning for continuing professional development (CPD) in medicines and therapeutics. Whether you’re a pharmacist, pharmacy student, doctor, nurse practitioner or other prescribing clinician, join us as we explore the science behind medicines, and the practical conversations that improve patient care.

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Stimulant medicines like methylphenidate and Vyvanse often dominate conversations about ADHD, but they’re only part of the story.

In this episode of Prescribe or Pass: The PoP Pod, we take a deep dive into the three main non-stimulant medicines used to treat ADHD: atomoxetine, guanfacine and clonidine.

You’ll learn how these medicines work, why they’re prescribed, who they’re best suited for, and why they shouldn’t simply be thought of as “second-line” treatments. We explore the fascinating neuroscience behind alpha-2 adrenergic agonists, why atomoxetine takes weeks to reach its full effect, how guanfacine helps the brain’s executive networks function more efficiently, and why clonidine can improve ADHD symptoms while also causing drowsiness.

We also discuss:

• When non-stimulants may be preferred over stimulants
• Common side effects and counselling points
• Monitoring blood pressure, heart rate and mood
• Combination therapy with stimulant medicines
• Practical expectations for patients and families

As always, we finish with reflective CPD questions to help translate today’s learning into clinical practice.

Prescribe or Pass: The PoP Pod is an independent clinical education podcast designed for pharmacists, pharmacy students and other healthcare professionals. 

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If Vyvanse is converted into dexamphetamine… why do the two medicines feel so different?

In Episode 5 of our ADHD medicines series, we unpack the science behind the amphetamine family and explain one of the most fascinating concepts in pharmacology: the prodrug.

Learn how lisdexamfetamine (Vyvanse) is converted into active dexamphetamine inside red blood cells, why this creates a smoother and longer-lasting effect, and why the capsule itself isn’t actually slow release.

In this episode, you’ll learn:

• The difference between dexamphetamine and lisdexamfetamine (Vyvanse)
• What a prodrug is and why it matters
• How red blood cells gradually convert Vyvanse into dexamphetamine
• Why Vyvanse often lasts longer than immediate-release dexamphetamine
• Why some people are prescribed both Vyvanse and dexamphetamine
• The evidence behind common advice about food and protein
• The truth about vitamin C and whether it really affects ADHD medicines
• Practical counselling points and monitoring considerations for pharmacists and other clinicians

Whether you’re a pharmacist, pharmacy student, prescriber or another healthcare professional, this episode will help you understand not just what these medicines do, but why they behave so differently in clinical practice.

As always, the episode concludes with reflective questions to support your Continuing Professional Development (CPD).

Next episode: We leave stimulant medicines behind and explore the often-overlooked world of non-stimulant ADHD treatments, including atomoxetine, guanfacine and clonidine. Who they’re for, how they work, and where they fit into ADHD management.

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Ritalin, Ritalin LA and Concerta all contain methylphenidate but they are not interchangeable versions of the same medicine.

In this episode, we compare immediate-release methylphenidate, Ritalin LA and Concerta, including how each formulation releases the medicine, how long it may last, and why the same number of milligrams can feel very different.

We also cover switching between formulations, Australian generic brands, PBS substitution, common brand myths, and the key counselling points pharmacists need to know.

By the end of the episode, you should have a clearer understanding of:

● immediate-release, dual-release and OROS delivery systems

● the different release patterns of Ritalin, Ritalin LA and Concerta

● why Ritalin LA and Concerta are not direct substitutes

● how to counsel patients about swallowing, food, missed doses and tablet remnants

● when generic brands may be substituted and when they cannot

● how to respond when a patient says a different brand does not feel the same

This is Episode 4 of the eight-part ADHD medicines series from Prescribe or Pass: The PoP Pod, created for pharmacists, pharmacy students and clinicians who want to understand not only what is prescribed, but why.

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Methylphenidate is one of the most commonly used medicines for ADHD, but understanding it requires more than knowing a list of brand names.

In this episode of Prescribe or Pass: The PoP Pod, pharmacist Kate Thomas explains how methylphenidate works, why immediate-release and modified-release products behave differently, and what patients may realistically notice when treatment is effective.

She also covers common adverse effects, including reduced appetite and sleep disturbance, practical counselling points, and the monitoring that should accompany treatment.

By the end of the episode, you should have a clearer understanding of:

• how methylphenidate affects dopamine and noradrenaline signalling
 • the difference between immediate-release and modified-release treatment
 • what a useful clinical response may look like
 • how to counsel about appetite, sleep and dosing
 • what should be monitored during treatment

The episode finishes with reflective questions and suggested wording to support pharmacists documenting their continuing professional development.

This is Episode 3 of an eight-part series on ADHD medicines. Next, we compare the different methylphenidate formulations and why products containing the same active ingredient may not feel the same in practice.

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Why is one patient prescribed Ritalin while another receives Vyvanse? Is one medication “stronger” than the other? Does it mean their ADHD is more severe?

In this episode of PoP Pod, we explore the clinical reasoning behind ADHD medication selection and explain why there is no one-size-fits-all approach.

You’ll learn how clinicians individualise treatment by considering factors such as symptom profile, age, daily routine, duration of symptom control required, co-existing medical conditions, previous treatment response, side effects and patient preferences. We’ll also discuss why medication choice is a shared decision-making process and why finding the right treatment sometimes involves careful adjustment over time.

Whether you’re a pharmacy student, pharmacist, doctor or another clinician who works with medicines, this episode will give you a practical framework for understanding how ADHD medications are chosen, and why two patients with the same diagnosis may receive completely different treatments.

Learning objectives

By the end of this episode, you should be able to:

• Explain why ADHD medication selection is not based on the “severity” of ADHD alone.
• Describe the key factors clinicians consider when choosing an ADHD medication.
• Understand the importance of individualising treatment to suit the patient’s needs, lifestyle and goals.
• Recognise the role of shared decision making in ADHD management.
• Appreciate the importance of considering a patient’s complete medication history, including over-the-counter and complementary medicines, when reviewing ADHD treatment.

As always, we’ll finish with reflective CPD questions to help translate today’s learning into your own clinical practice.

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ADHD is one of the most talked about and misunderstood conditions in healthcare.

In the first episode of our ADHD series, we start with the foundations.

What actually is ADHD? Why is it considered a disorder of executive function rather than simply a problem with attention? What roles do dopamine and noradrenaline play? How is ADHD diagnosed in Australia, and why is there no blood test or brain scan that can confirm it?

We’ll also explore how ADHD is treated, from psychoeducation and behavioural strategies through to stimulant and non-stimulant medications, before discussing the pharmacist’s role as part of the multidisciplinary team.

Whether you’re a pharmacist, pharmacy student or another clinician who works with medicines, this episode provides the framework for everything that follows in the series.

In this episode you’ll learn:

• What ADHD is and what it isn’t
• Why “attention deficit” is a misleading name
• Executive function and why it matters
• The roles of dopamine and noradrenaline
• How ADHD is diagnosed in Australia
• The broad approaches to treatment
• The main classes of ADHD medications
• The pharmacist’s role in supporting people with ADHD

This episode concludes with a reflective question to support your continuing professional development.

Next episode: Why might one person with ADHD be prescribed methylphenidate while another receives an amphetamine? We’ll explore how clinicians choose between the two major stimulant families and why the answer is much more nuanced than many people realise.

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