2026 05 15 The Role of the Compounding Pharmacist in Hospice and Palliative Care

This lecture by Dr. David Miller, a compounding pharmacist, addresses the challenges of administering medications to hospice and palliative care patients who do not fit standard pharmaceutical profiles. He emphasizes the need for creative, site-directed drug delivery methods when commercial products are inadequate. The talk covers various routes of administration including oral, nasal, sublingual, buccal, rectal, vaginal, inhalation, and transdermal, along with dosage forms like troches, suppositories, nasal sprays, and topical creams. Real-life case examples illustrate the application of these methods, such as using inhaled morphine for a patient with collapsed veins and rectal delivery for a child with gut shutdown. Dr. Miller discusses the pharmacokinetics of rectal and nasal drug absorption, highlighting the avoidance of first-pass metabolism. He also mentions specific formulations like the Heliad bandage for oral wounds and rectal rockets for prolonged rectal drug delivery. The lecture includes practical advice on dosing conversions and the use of compounded medications for conditions like thick secretions and fungal infections. Overall, it provides a comprehensive overview of the compounding pharmacist’s role in optimizing drug delivery for patients at the end of life.