wonderland 2

6

Historically accurate(?) Disney Princesses part 3

I based them off of google images so accuracy is questionable

part 1  part 2

Anti-epileptics/Anti-convulsants Made Incredibly Easy

TREATMENT STRATEGIES:

  • Start therapy after the second seizure; first ONLY if recurrence is high = MRI abnormal, EEG abnormal, or status epilepticus.
  • Monotherapy until seizures are controlled.
  • If failed: titrate up to maximum tolerated dose –> shift to alternative drug –> use drug combination –> VNS, DBS.
  • Full drug therapy for 2 – 3 years after the last fit.
  • Gradual withdrawal over at least 6 months.

Rx Profile:

(Drawings are courtesy of @mynotes4usmle​)

Carbamazepine

  • Mainly for generalized tonic-clonic seizures
  • Trigeminal neuralgia
  • Bipolar disorders (with depressive predomince) - mood stabelizier
  • NEVER in abscence seizures
  • SE:

Lamotrigine

  • Safer profile, with minimal interactions.
  • Bipolar disorders (with depressive predominance) - mood stabilizer  
  • SE: maculopapular rash; SJS

Topiramate

  • Broad spectrum anti-seizure; used in migraine.
  • SE of TopIRamate: enzyme Inhibitor + Renal stones.

TREATMENT PROTOCOL:

Green: first line; Yellow: second line; Orange: third line; Red: contraindications. (Graph reproduced from Oxford Handbook of Clinical Medicine)

Epilepsy & Pregnancy:

  • Non-enzyme-inducing AEDS have no effect on the pill. Enzyme inhibitors prolong the half life of OCP (=Valproate) so better for birth control , and vice versa.
  • Most of AEDs are teratogenic; Category D
  • Therapy not stopped; uncontrolled seizure is risky to fetus & mother. Give lowest effective dose.
  • Avoid phenytoin, valproate and barbiturates (use Lamotrigine)
  • Most AEDs cause folate deficiency …. Folic acid (prior to or early in conception)
  • Most AEDs are competitive inhibitors of vit. K-dependent clotting factor: Vit. K to mother 10 days before labor & to newborn.
  • Most except carbamazepine and valproate are present in breast milk. Lamotrigine is safe on infants.

Status Epilepticus:

  • WHAT? Seizures lasting for >30min, OR repeated seizures without intervening consciousness.
  • Things to be done:
  1. Bedside glucose, the following tests can be done once Rx has started: lab glucose, ABG, U&E, Ca2+, FBC, ECG.
  2. Consider anticonvulsant levels, toxicology screen, LP, cultures, EEG, CT, CO level.
  3. Pulse oximetry, cardiac monitor.
  • How to treat?

THE END

Originally posted by disneypixar

Person A of OTP #1 is surprisingly talented in playing the guitar and doesn’t mention it to person B. One day person B takes A out on a date to the woods where it is a winter wonderland. OTP #2 stashed a guitar case in a log near where person A makes B sit down.

They take it out and start playing Feliz Navidad to them, while OTP #2 dance and sing vocals in the background. Person B’s focus is mainly A but is surprised about persons C and D.

Bonus: they all hold hands on the way home.

Things to talk about: 

Everyone driving a dragon is STANDING - which means this is kind of like DRAGON SURFING more than anything else

Kurogane is VERY MUCH DEDICATED TO COMING IN FIRST

It doesn’t matter if they’re not racing. It doesn’t matter that they’re all kind of in the same place. KUROGANE IS THE DRAGON MASTER AND HE WILL BE THE FASTEST OK. 

And Sakura is sitting sidesaddle like a freaking lady.