On January 21, 2004, David Ibarra-Viernes fell asleep while operating his motor vehicle on U.S. Highway 189. The vehicle crossed the center line and collided with another vehicle, killing Richard Black (decedent). Peggy Ann Cook Black (Black), individually and as personal representative of the estate of her late husband filed a wrongful death action against Ibarra-Viernes`s employer, William Insulation Company, Inc. (WIC), alleging that it negligently required Ibarra-Viernes to commute long distances and work long hours without providing proper training or safeguards, breaching a duty to the public to prevent its employees from traveling to or from when exhausted and tired. The district court granted WIC`s motion for summary judgment concluding that there was no duty owed by WIC to the decedent under the circumstances.
12. What are the CNS and peripheral effects of the opioids? (See notes)
– The main effect on CNS is to inhibit neurotransmitter release. Effects include analgesia, mood changes and an activation of the reward center which can lead to drug abuse.
Among the peripheral effects are: inflammation reducing effects in the joints or healing wounds.
13. Describe the differences between the strong opioids, mild to moderate opioids and mixed agonist-antagonists in terms of efficacy and potential for addiction.
– Codeine is an opioid used for mild to moderate pain relief, but the side effects are very serious (nausea and constipation) and are not used for long term.
Morphine is a stronger opioid used for management of moderate to severe pain. Frequent side effects include nausea, vomiting and feelings of euphoria
Methadone has a longer duration of action than morphine.
Fentanyl is known to be a fast acting opioid, 50-100 times stronger than morphine, but is known to be highly addictive also.
14. Define the terms tolerance, withdrawal, addiction and pseudoaddiction.
– Tolerance is a state of adaptation in which the dose of the opioid needs to be increased to achieve recommended level of analgesia.
Withdrawal is a group of symptoms that occur with the abrupt discontinuation of a drug that has the capability of producing physical dependence.
Addiction is a chronic, neurobiological disease characterized by behaviors such as no control over drug use, compulsive use, continued use despite harm and craving (American society of Addiction Medicine, 2001)
Pseudoaddiction is a behavior of seeking additional medication of the patients
