bcs bound

{ @snowdrenched | here

candy apples were something they had done every year for as long as ned could remember. his mother started it but after she died, it only lasted for another year. after that, they hadn’t touched the candy apples. within recent years, since rickon was old enough to help, they began making them again. sometimes the others joined in, sometimes it was just ned and arya. with hallowe'en right around the corner, ned figured it would be a good thing to pull out again.

it would give genevieve, micah, and their two boys something to do for the holidays. he was quiet sure hallowe'en hadn’t really been taken into consideration with everything going on. already bran, arya, and rickon had declared what they were going to be. when ned had asked genevieve if she wanted to help him, she seemed all too eager, a sight he was more than happy to see. it’d been too long since he’d seen her so eager.

“your hair is stuck,” ned laughed, shaking his head. he was not surprised as he pulled the frizzy hair from the caramel. “it takes a little bit to get use to the whole process and the stickiness of it. maybe you should wash your hands and pull your hair back. that way we don’t find little hairs all over the apples.”

I can’t wait to wake up tomorrow to an isakyaki update featuring a picture of a snoring Isak buried so far under his comforter that all you see is a pile of blond curls, captioned “now he can buy his own beer ❤️”

anonymous asked:

What are the pros and cons of a government job?

Pros: benefits
Cons: everyone thinks you believe everything your boss does and/or you can pull these imaginary strings to do whatever it is they want. You can’t Bc your literally bound by laws.

In reality a government job is just like any other office job. You just work for someone elected. And the county/state/federal government pays your salary. I know this from experience. -Mandie

snow white took every apple
in the kingdom and threw them
into the river / she cut down trees
with a saw-blade so sharp
it sent shivers down her spine.
she remembers
how it felt to choke, like a hand
had wrapped itself around
her throat / she remembers
the feeling of falling to the
floor, whisper weak and fading.
she took her trauma
and shaped it into a weapon / a way
to fight back against the ghost of a queen
who was already dead.
—  l.s. | AN APPLE A DAY © 2016

haaa so do i get a job i don’t want at a place that will make me miserable with people i already know and hate for the promise that financial independence will come sooner?

something else that made me feel happy !! i was looking through my design sketchbooks and its like super clear that all my designs go really well together like they could all be part of a collection!! it just made me happy bc i think i found my style, i’m sure my design style will change bc creativity has no bounds but all of my designs have like a certain element (,,,,,corny) that makes them just fit together 

Neuro Pharmacology: Remember!!!

Anticonvulsants

  • Barbiturates INDUCE lipid soluble drugs metabolism, meaning, its effect last less than normal. Example of lipid soluble drugs: Oral Contraceptives (OCP), warfarin, phenytoin, carbamazepine.
  • OCP DECREASES BZD metabolism.
  • Anticonvulsants DECREASES OCP efficacy, bc of Cyt p450 induction, eg: Phenytoin, Carbamazepine, Phenobarbital.
  • Women & Anticonvulsants: if pt wants to get pregnant, change to Phenobarbital (safest bc >protein bound); if pt don’t wanna get pregnant and is taking OCP, change to Valproic Acid (bc is a Cyt p450 inhibitor!)
  • Avoid abrupt withdrawal of Anticonvulsants bc it can precipitate seizures and increases risk of status epilepticus!!!
  • Carbamazepine SE: increased ADH secretion & Steven Johnson Sd.
  • Phenytoin SE:

  • Valproic Acid SE:

  • Valproic Acid & Ethosuximide: abscense seizures.

Anesthetics

  • Atracurium, Mivacurium: drugs used in anesthesia as muscle relaxants, Nicotinic Antagonists, non depolarizing competitive drugs.
  • Laudanosine is a metabolite of Atracurium (spontaneous inactivation) crosses BBB and can cause seizures.
  • Halothene SE: malignant hyperthermia, hepatitis, <3 arrythmias
  • Ketamine: dissociative anesthesia (pt is aware of pain, but gives zero fucks about it) stimulates CV function (good for elders with <3 problems)
  • Ketamine SE: vivid nightmares, increase ICP 

  • Succynilcholine SE: Malginant hyperthermia, hyperkalemia, atypical pseudocholinesterase.
  • Dantrolene: tx for malignant hyperthermia, Neuroleptic Malignant Sd (NMS)

Opioids

  • Opioid Acute Toxicity Classic Triad: CPR, Coma, Pinpoint pupils, Respiratory Depression 
  • Meperidine: is also antimuscarinic, pt won’t have miosis!!!!! (pt will also be tachycardic, no GI, GU gallblader spasm) Metabolized to Normeperidine (serotonin reuptake inhibitor, caution with Serotonin sd)
  • NEVER GIVE O2 WHEN GIVING OPIATES -UNLESS YOUR PT IS MECHANICALLY VENTILATED- BC YOU TAKE AWAY THE HYPOXIC DRIVE (that thing that tells the body: “hey dude, you gotta breathe more cause your O2 is falling”) AND SINCE PTS TAKING OPIATES HAVE A DECREASE RESPONSE TO ↑PCO2, YOU’LL LEAVE PT WITH NOTHING

  • When giving opiates as a long-term tx, it can cuase norepinephrine levels to decrease. As a response, the body makes more alpha1 & beta1 receptors. When long-term tx is stopped, a massive sympathetic response can happen, so, to prevent that, give clonidine (alpha2 agonist) that will decrease NE and cancel the sympathetic response.
  • Methylnaltrexone: for opioid induced contispation (cancer pts)

Parkinson Disease Drugs

  • Amantadine SE: livedo reticularis

Typical Antipsychotics: 

  • Thioridazine: cardiotoxicity (torsades), retinitis pigmentosa, ↓↓↓EPS

  • Droperidol: NMS, Tardive Dyskinesia
  • Fluphenazine: long acting injection (given e/ 2-3w), EPS.
  • Haloperidol: NMS, Tardive Dyskinesia, torsades
  • Chlorpromazine: NMS, corneal pigmentation, EPS

  • Loxapine: last to be given, antagonist D1 to D2
  • Tx for NMS: Bromocriptine, Dantrolene, Pergolide

Atypical Antipsychotics: 

  • Clozapine: AGRANULOCYTOSIS (weekly WBC), increased salivation (wet pillow syndrome)
  • Quetiapine: QT prolongation, drug monitoring
  • Ziprasidone: elders w/ dementia increased mortality, IM
  • Risperidone: Insomnia, PRL↑
  • Aripiprazole: partial agonist D2 & 5HT1, antagonist 5HT-2, adjunct tx for depression, akathisia

Antidepressants

  • MAO inhibitors SE: tx w/ Phentolamine (alpha1 antagonist) or Chlorpromazine (antipsychotic)
  • SSRI SE: anorgasmia :(, bruxism, weight loss 
  • Bupropion: DA reuptake inhibitor, associated w/ seizures, mimics drug addiction chemestry, bc increases DA in mesolimbic system.
  • Varenidine: partial Nicotinic receptor agonist (Mnemonic: “Vane & Nadine are trying to quit smoking”)
  • Both drugs are used in smoking cessation

    oh dear God! you are awful but I miss you so much 

  • SNRI: Venlafaxine (no ANS side effects, bc is a nonselective 5HT, NE reuptake blocker), Desvenlafaxine, Duloxetine.

Bipolar Disorder

  • Lithium: prevents recycling of inositol (decrease PIP2) and decrease cAMP; SE.. 

    Tx NDI with amiloride, triamterene (don’t give thiazides, it decreases Li clearance)
  • Never give Lithium to a pregnant women!!!!! If BD, change to Gabapentin & Clonazepam

ADHD

  • Methylphenidate: amphetamine-like
  • Atomoxetine: NE reuptake inhibitor
  • Do not stop this drugs abruptly! Withdrawal causes severe depression & suicide ideas

anonymous asked:

Gabbador activities in the summer ~ The Gabbador Fairy

Idk how to translate this but DEVONO ASSOLUTAMENTE FARE IL FALO’ DI FERRAGOSTO (15th August’s bonfire?? Does it exist in the rest of the world??)
Usually on 14th August you go by the beach with your friends, plant a tent and stay awake all night long near the bonfire watching the stars. You can do other things like cooking & eating stuff, singing and playing the guitar, or getting SO FUCKIN DRUNK

They do all of the stuff above- First of all, they eat. You don’t go anywhere in Italy if you don’t eat. Maybe just a light mezzo quartino con la salsiccia stracondito di salse?? Francesco is the one who cooks (during these social events, it is common belief that whoever stays at the bbq is endowed with a magical aura of sexyness. Maybe bc this person is bound to the very idea of food, idk)

Then they sing w/ all the crew, but only fine songs like Andiamo a Comandare, Senza Pagare, or Domani smetto. They also sing older songs, like Il Cielo è Sempre Più Blu and the entire discography of De Andrè, for Salvo’s sake, who was actually dying because of the earlier songs

Then– the drinking games. Then, they swim in the sea half drunk in the middle of the night and they make out on the rocks like the mermen they are