<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 59-year-old healthy woman presents to her primary care physicians office six weeks after undergoing an elective breast augmentation procedure in the Dominican Republic. She was told by her surgeon to establish post-operative care once back in the United States. Today she is bothered by nausea and early satiety. Her past medical history is significant only for GERD for which she takes ranitidine. Since the surgery, she has also taken an unknown opioid pain medication that was given to her by the surgeon. She reports that she has been taking approximately ten pills a day. On examination she is afebrile with normal vital signs and her surgical incisions are healing well. Her abdomen is distended and tympanitic. The patient refuses to stop her pain medicine and laxatives are not effective; what medication could be prescribed to ameliorate her gastrointestinal symptoms?? A: Metoclopramide, B: Pantoprazole, C: Senna, D: Naloxegol, E: Naproxen,  <response>: This is a clinical vignette about a 59-year-old woman who underwent breast augmentation surgery 6 weeks ago and is now experiencing nausea and early satiety. She has a history of GERD and has been taking an unknown opioid pain medication prescribed by her surgeon at a high dose of 10 pills per day. On exam she has a distended, tympanitic abdomen. The key findings here are: 1 Recent breast augmentation surgery 2 Taking high dose opioids 3 Symptoms of nausea and early satiety 4 Distended, tympanitic abdomen5 Laxatives ineffectiveBased on these findings, the likely diagnosis is opioid-induced constipation causing her gastrointestinal symptoms. The best medication to treat this would be a peripherally-acting mu-opioid receptor antagonist like naloxegol to reverse the constipating effects of the opioids.D: Naloxegol 