Palliative Care Community Pharmacy Updates

Case studies and resources to assist with skill development 

The South Australian Palliative Care Community Pharmacy Update is a monthly bulletin for community pharmacists involved in the delivery of services to palliative care patients and their families.

These updates are intended to provide a practical up to date and factual information relating to pharmacy and medicines management in the setting of Palliative Care and are based on critical review of available evidence. Individual patient circumstances must be considered when applying this information.

We hope that is will be a useful tool to enhance your interaction with other health providers, palliative patients and their families.

Please feel free to distribute these updates further to interested colleagues.

Follow this link to sign up for regular Pharmacy Updates.

For more information

Contact the Advanced Practice Pharmacists in the relevant service:

• Michaela del Campo, Central: michaela.delcampo@sa.gov.au
• Lana Rinchen, Southern: lana.rinchen@sa.gov.au
• Safwat Gergis, Northern: safwat.gergis@sa.gov.au
  

Case studies

2023

• Jurnista® discontinuation in Australia – Summer 2023 (189kb pdf)

2022

• Opioid Induced Hyperalgesia Fact Sheet - May 2022 (172kb pdf)

2021

• Palliative care during COVID - December 2021 (206kb pdf)
• Ketamine Fact Sheet - November 2021 (196kb pdf)
• ScriptCheckSA - September 2021 (202kb pdf)
• HYDROmorphone Fact Sheet - August 2021 (176kb pdf)
• Medications and PEG tube Case Study - July 2021(173kb pdf)
• Medications and PEG tube - June 2021(219kb pdf)
• Case 27 Drug and Alcohol Problems. - February 2021 (206kb pdf)
• Case 26 Drug and Alcohol Problems. - January 2021 (206kb pdf)

2020

• Case 25 Methadone can be a useful add-on therapy for managing neuropathic pain. - December 2020 (428kb pdf)
• Case 24 (Part 2) Patients approach pain and its management in different ways. - November 2020 (374kb pdf)
• Case 24 (Part 1) Managing Pain in Palliative Care. - October 2020 (171kb pdf)
• SA Health Palliative Care Medicines Information Decision Grid. - September 2020 (153kb pdf)
• Immunotherapy for cancer (Part3). - August 2020 (193kb pdf)
• Immunotherapy for cancer (Part2). - July 2020 (196kb pdf)
• Immunotherapy for cancer (Part1). - June 2020 (196kb pdf)
• Case 22 (part 3) Carers may need stronger supports in the home to help in managing medicines. - May 2020 (170kb pdf)
• Case 22 (part 2) Carers may need some guidance in managing medicines for their loved ones, as they approach the end of life. - April 2020 (204kb pdf)
• Case 22 (part 1) Carers offer support around the home for people with palliative care needs. Sometimes the carer is new to the role and needs assistance in managing the medications. - February 2020 (171kb pdf)
• Case 21 (part 2) Corticosteroids are used for a number of indications in people with palliative care needs. The previous update discussed Anthony's concerns about the use of corticosteroids. - January 2020 (215kb pdf)

2019

• Case 21 (part 1) Corticosteroids are used for a number of indications in people with palliative care needs. - December 2019 (172kb pdf)
• Fact Sheet: Project Resources. To support health care professionals in assisting people with palliative care needs to remain in their home, the Australian government has funded a number of projects. This fact sheet examines three projects. - November 2019 (189kb pdf)
• Fact Sheet: Web-based Palliative Care Resources. This fact sheet looks at three Australian websites with resources to support the delivery of pharmacist advice in store, to GPs and aged care. - October 2019 (205kb pdf)
• Fact Sheet: Smartphone Applications. This fact sheet examines three smartphone applications relevant to the provision of palliative care. - September 2019 (172kb pdf)
• Case 20 Psychoactive medicines are commonly used throughout the disease journey including the last days of life. - August 2019 (411kb pdf)
• Fact Sheet: Antipsychotics. Psychoactive medicines are commonly used throughout the disease journey including the last days of life. This update reviews antipsychotic use in palliative care. - July 2019 (327kb pdf)
• Fact Sheet: Benzodiazepines. Psychoactive medicines are commonly used throughout the disease journey including the last days of life. This update is the first of three to discuss benzodiazepine and antipsychotic use in palliative care. - July 2019 (253kb pdf)
• Case 19 Palliative Care Services offer a broad range of support which aims to provide a seamless patient journey with smooth and timely transitions from one service to another, and where possible, for patients to die in their place of choice. - May 2019 (216kb pdf)
• Case 18 (part 3) Most people might only care for someone who is dying a handful of times; they may approach their pharmacist to identify how to seek bereavement supports.  - April 2019 (220kb pdf)
• Case 18 (part 2) Medicines used in the last days of life (terminal phase) may need to be administered by untrained carers. An Australian resource has been developed to teach carers to administer subcutaneous medicines for breakthrough symptoms.  - March 2019 (222kb pdf)
• Case 18 (part 1) Medicines used in the last days of life (terminal phase) may need combining within a syringe, when administered over 24 hours. Identifying compatibility issues is an important role for pharmacists.  - February 2019 (151kb pdf)
• Case 17 (part 3) Medications that were good then, might not be the best choice now. Community pharmacists can lead deprescribing conversations with GPs and support patients.  - January 2019 (223kb pdf)

2018

• Thank you for being part of our Palliative Care Pharmacy Community. - December 2018 (270kb pdf)
• Case 17 (part 2) Community pharmacists can lead deprescribing conversations with their patients and support GPs. - November 2018 (269kb pdf)
• Case 17 (part 1) Medications that were good then, might not be the best choice now. Community pharmacists can lead deprescribing conversations with their patients and support GPs. - October 2018 (306kb pdf)
• Case 16 (part III) Being accessible, community pharmacists will often be the first to hear of swallowing concerns and are well placed to provide advice. - September 2018 (266kb pdf)
• Case 16 (part II) While troublesome side effects associated with chemotherapy or radiotherapy calls for prompt Specialist referral, pharmacists are well placed to reinforce pain relief options as well as effective oral hygiene strategies. - August 2018 (75kb pdf)
• Case 16 (part I) Chemotherapy and radiotherapy can continue in palliative care. The pharmacist may become aware of troublesome side effects where Specialist referral is vital. - July 2018 (173kb pdf)
• Case 15 (part II) Cancer is a major risk factor for developing venous thromboembolism and the use of Direct-Acting Oral Anticoagulants in these patients differs from patients without cancer. - June 2018 (264kb pdf)
• Case 15 (part I) Cancer is a major risk factor for developing venous thromboembolism and management of this risk differs from patients without cancer. - May 2018 (267kb pdf)
• A range of resources is available to guide pharmacists as they engage with patients, carers and other health professionals when relating to palliative care issues. - April 2018 (270kb pdf)
• The Community Pharmacy Update distribution list has grown and now reaches a multidisciplinary audience. - March 2018 (232kb pdf)
• Case 14 (part III) Expressions of grief can vary widely from person to person and it may be the community pharmacist that recognises a carer’s difficulty in coping with the death of a loved one. - February 2018 (119kb pdf)
• Case 14 (part II) Given the complexity of medicines management in the last days of life, pharmacists have opportunities to assist carers to have confidence in managing subcutaneous medicines, despite a lack of formal training. - January 2018 (223kb pdf)

2017

• Case 14 (part I) Carers are an important resource in supporting people with palliative needs to remain in their homes. Given the complexity of medicines management, pharmacists play a primary role in helping carers to anticipate and solve problems that may arise. - December 2017 (233kb pdf)
• Case 13 (part III) End-stage Parkinson’s Disease (PD) can present unique issues for medication prescribing. Pharmacists can help assist with specific recommendations in this setting. - November 2017 (273kb pdf)
• Case 13 (part II) Later-stage Parkinson’s Disease (PD) can lead to worsening symptoms and complex medication regimes. Pharmacists can partner with patients and carers to provide assistance. - October 2017 (274kb pdf)
• Case 13 (part I) Parkinson’s Disease (PD) is a degenerative brain disorder that is progressive and unpredictable. Pharmacists can play an important role in supporting patients with PD. - September 2017 (273kb pdf)
• Case 12 (part III) With the legalisation of medicinal cannabis, pharmacists must be aware of the current access pathways. - August 2017 (226kb pdf)
• Case 12 (part II) Under changes to Federal Legislation, medicinal cannabis products will be made available to patients. There are increasing requests from patients for these products. - July 2017 (219kb pdf)
• Case 12 (part I) Under changes to Federal Legislation, medicinal cannabis products will be made available to patients. There are increasing requests from patients for these products. - June 2017 (224kb pdf)
• Case 11 (part II) Having a strategy to manage impromptu requests for subcutaneous medicines is an important way to minimise pharmacy staff stress. - May 2017 (219kb pdf)
• Case 11 (part I) Advance Care Directives are a means for adults to document their preference for future healthcare. Community pharmacists may be asked to be an authorised witness. - April 2017 (218kb pdf)
• Case 10 (part II) Saliva problems are common amongst neurodegenerative disorders such as Motor Neuron Disease, Parkinsons Disease and Multiple Sclerosis for which pharmacists may play a role in the treatment. - March 2017 (218kb pdf)
• Case 10 (part I) Saliva problems are common amongst neurodegenerative disorders such as Motor Neuron Disease, Parkinsons Disease and Multiple Sclerosis for which pharmacists may play a role in the treatment. - February 2017 (219kb pdf)
• Case 9 (part II) “Depressive disorders are important potentially reversible causes of suffering for palliative care patients, and while sadness and distress can be understandable, depressive disorders are not a normal part of dying”. (Therapeutic Guidelines (palliative care) 4th Ed). - January 2017 (222kb pdf)

2016

• Case 9 (part I) Being diagnosed with a life limiting illness can have a significant effect on a person’s mental health. This can lead to further functional impairments including the ability to manage medicines appropriately. - December 2016 (136kb pdf)
• Case 8 (part III) While syringe drivers are a useful way to administer subcutaneous medicines, in the terminal phase, problems can arise when adding more than one item into the same syringe. - November 2016 (135kb pdf)
• Case 8 (part II) Research shows that community pharmacists struggle to anticipate which medicines to stock to support timely symptom control in the last days of life (terminal phase). - October 2016 (136kb pdf)
• Case 8 (part I) Enabling palliative patients to receive care in their home environment in the terminal phase is good public health practice. Pharmacists play a valuable role, within the multidisciplinary palliative care team, in facilitating good care in the home environment. - September 2016 (136kb pdf)
• Case 7 (part III) Ensuring stability and compatibilities of medications administered via a Continuous Subcutaneous Infusion (CSCI) is essential to safeguard symptom management and safety of the patient. - August 2016 (135kb pdf)
• Case 7 (part II) Pharmacists may provide advice when converting between opioid formulations. - July 2016 (136kb pdf)
• Case 7 (part I) Often palliative patients experience breakthrough cancer pain, usually managed with short acting opioids. Pharmacist advice may be needed regarding formulations of fentanyl designed for trans-mucosal absorption. - June 2016 (129kb pdf)
• Case 6 (part II) Patients with a malignancy will often require opioids to manage their pain. While this may represent appropriate therapeutic use, there is also a risk of addiction and diversion. - May 2016 (136kb pdf)
• Case 6 (part I) Pharmacists can offer advice for managing medications for palliative care patients with swallowing difficulties. - April 2016 (132kb pdf)
• Case 5 (part III) Caregivers may need a range of programs and services to support the emotional and physical burden of caring for someone. - March 2016 (129kb pdf)
• Case 5 (part II) Pharmacists may become privy to the caregiver’s social and financial situation and thus be able to guide them to organisations where further support is available. - February 2016 (129kb pdf)
• Case 5 (part I) In recognising the carer’s role and the additional stresses that this may cause, pharmacists can be a reliable resource for this valuable population. - January 2016 (134kb pdf)

2015

• Case 4 (part II) Targin® (oxycodone/naloxone) safety and experiences - December 2015 (509kb pdf)
• Case 4 (part I) Targin® (oxycodone/naloxone) evidence and experiences - November 2015 (494kb pdf)
• Case 3 (part II) Opioid allergy - October 2015 (127kb pdf)
• Case 3 (part I) Opioid allergy - September 2015 (270kb pdf)
• Case 2 (part III) Deprescribing - August 2015 (375kb pdf)
• Case 2 (part II) Deprescribing - July 2015 (155kb pdf)
• Case 2 (part I) Deprescribing - June 2015 (177kb pdf)
• Case 1 (part II) Opioid Conversion - May 2015 (385kb pdf)
• Case 1 (part 1) 24 Hr Infusion Devices - April 2015 (302kb pdf)

Newsletters

2015

• Issue 34 - Skeletal related events (SREs) - February 2015 (210kb pdf)
• Issue 33 - SIADH - January 2015 (239kb pdf)

2014

• Issue 32 - Depression - December 2014 (209kb pdf)
• Issue 31 - Pathological Cough - November 2014 (206kb pdf)
• Issue 30 - Mouth Care in Palliative Care - October 2014 (207kb pdf)
• Issue 29 - Anticholinergic Agents - September 2014 (157kb pdf)
• Issue 28 - Identifying Potentially Inappropriate Medications - August 2014 (300kb pdf)
• Issue 27 - Advance Care Directives - July 2014 (298kb pdf)
• Issue 26 - Deprescribing in palliative care - June 2014 (590kb pdf)
• Issue 25 - Carers - May 2014 (590kb pdf)
• Issue 24 - State-wide referral form - April 2014 (301kb pdf)
• Issue 23 - Clinical research - March 2014 (590kb pdf)
• Issue 22 - Off label prescribing - February 2014 (278kb pdf)
• Issue 21 - Advanced care planning - January 2014 (589kb pdf)

2013

• Issue 20 - Palliative Emergencies - December 2013 (313kb pdf)
• Issue 19 - Bowel management - November 2013 (597kb pdf)
• Issue 18 - Cachexia and fatigue - October 2013 (300kb pdf)
• Issue 17 - Drug compatibility - September 2013 (586kb pdf)
• Issue 16 - Polypharmacy - August 2013 (587kb pdf)
• Issue 15 - Switching Opioids - July 2013 (303kb pdf)
• Issue 14 - Antipsychotics - June 2013 (585kb pdf)
• Issue 13 - Useful Resources - May 2013 (344kb pdf)
• Issue 12 - Core medicines list - April 2013 (348kb pdf)
• Issue 11 - Terminal Agitation and delirium - March 2013 (592kb pdf)
• Issue 10 - Treatment of breakthrough/incident pain - February 2013 (344kb pdf)
• Issue 9 - Treatment of neuropathic pain - January 2013 (337kb pdf)

2012

• Issue 8 - Treatment of nociceptive pain - December 2012 (337kb pdf)
• Issue 7 - Pain - November 2012 (344kb pdf)
• Issue 6 - Nausea and vomiting - October 2012 (346kb pdf)
• Issue 5 - Noisy Breathing - September 2012 (305kb pdf)
• Issue 4 - Dyspnoea - August 2012 (343kb pdf)
• Issue 3 - Syringe Drivers - July 2012 (344kb pdf)
• Issue 2 - End of Life Care - June 2012 (337kb pdf)
• Issue 1 - SA Palliative Care - May 2012 (343kb pdf)

Other documents

• How Can Palliative Care Services Support Community Pharmacies (1.04MB pdf)

Last updated 02 March 2023