Gaps and Goals: Getting to The Joint Commission's Advanced Certification in Palliative Care (TH311)

classes with complementary receptor activity can relieve refractory nausea and vomiting. By virtue of acting on a number of key receptor sites, olanzapine as a single agent has a distinct advantage over antiemetics combinations because of improved compliance and reduced drug interactions. Antiemetics, anticholinergics, octreotide, and dexamethasone are used in combination to treat bowel obstruction. By systematic review, there is little difference in response using etiologic guidelines compared to empiric single agent therapy. The greatest evidence is for metoclopramide and tropisetron. Nonpharmacologic interventions (mechanical stents and percutaneous endoscopic gastrostomy tubes) work when nausea is refractory to medical management and in bowel obstruction. The current evidence supports an empiric approach.