A 66-year-old woman with metastatic breast cancer presents with hard, difficult-to-pass stools.

Comprehensive and Detailed Explanation:

Opioid-induced constipation is best managed with stimulant laxatives like senna or bisacodyl. Stool softeners such as docusate are insufficient as monotherapy. Senna stimulates peristalsis, making it more effective.

Toronto Notes 2023 – Palliative Care:

“Opioid-induced constipation requires stimulant laxatives such as senna. Stool softeners alone are not adequate.”

MCCQE1 Objectives (Palliative Care > 92-1: Symptom Management):

“Candidates must treat opioid-related side effects appropriately, including use of stimulant laxatives for constipation.”

Bulk agents (C) can worsen symptoms. Reducing morphine (D) may compromise pain control. Activity (E) helps but is insufficient as first-line management.

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