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MCQ 14: Opioid-Induced ConstipationA 70-year-old man on regular morphine for cancer pain develops severe constipation. Which of the following is the most appropriate first-line laxative?A. LactuloseB. Senna C. Docusate sodiumD. Glycerin suppositoriesE. Polyethylene glycol (Macrogol)Answer: SennaExplanation: For opioid-induced constipation, a stimulant laxative like senna is typically recommended as first-line treatment. It directly stimulates peristalsis, counteracting the constipating effects of opioids. Lactulose and polyethylene glycol are osmotic laxatives that can cause bloating and are generally second-line. Docusate sodium, a stool softener, is often insufficient alone for opioidinduced constipation. Glycerin suppositories may be helpful but are usually used in combination with oral laxatives or for impacted stool.
