[Verse 1]
Morphine hits the liver, glucuronidation's the lane
M6G builds up when kidneys can't flush the drain
Renal failure patients catch the brunt of that ride
Codeine needs CYP2D6 to flip to morphine inside
Ultra-rapid metabolizers — toxic surge, no guide
Meperidine normeperidine accumulates with glee
Seizure risk in elderly, renally compromised, you see
Fentanyl runs through CYP3A4, lipophilic and clean
But watch hepatic blood flow, context-sensitive morphine machine
[Chorus]
Acetaminophen, NSAIDs, opioids in line
Conozca sus límites — where the ceiling is defined
LAST in your pocket, lipid emulsion on deck
Evalúa al paciente — or you'll wind up a wreck
Metabolize it, memorize it, metabolize it right
Dosis por dosis, keep your pharmacology tight
[Verse 2]
Now acetaminophen, four grams is the healthy cap
But chronic alcohol thins the glutathione map
Malnourished bodies, low reserves can't quench the blaze
Hepatic disease shrinks that ceiling into a haze
Two grams daily — that's the prudent dose you'll praise
Fasting state depletes the cofactors overnight
CYP2E1 upregulation amplifies the blight
So alcoholics, cirrhotic patients, underweight — beware
That extra dose becomes a necrotic snare
[Chorus]
Acetaminophen, NSAIDs, opioids in line
Conozca sus límites — where the ceiling is defined
LAST in your pocket, lipid emulsion on deck
Evalúa al paciente — or you'll wind up a wreck
Metabolize it, memorize it, metabolize it right
Dosis por dosis, keep your pharmacology tight
[Verse 3]
Now lisinopril blocks angiotensin, drops efferent tone
Furosemide depletes the volume, kidneys on their own
CKD three-b means GFR already frail
NSAIDs block prostaglandins — renal perfusion derails
That triple threat — the nephrotoxic bermuda gale
Prostaglandins dilate afferent arterioles with care
Remove that dilation, tubular necrosis waits right there
Hyperkalemia spikes, sodium retention compounds the mess
Contraindication absolute — no exceptions, reassess
[Bridge]
Here's a rare word — iatrogenic — physician-caused harm
Every drug decision either treats or springs the alarm
Catecholamine cascade fuels LAST — the toxidrome unfurled
Local anesthetic systemic toxicity — lipid rescue hurled
Twenty percent intralipid bolus, one-point-five per kilo fast
Then infusion runs at point-two-five until the seizure's past
Benzodiazepines for convulsions, avoid propofol if you can
Cardiovascular collapse — ACLS but modified plan
[Chorus]
Acetaminophen, NSAIDs, opioids in line
Conozca sus límites — where the ceiling is defined
LAST in your pocket, lipid emulsion on deck
Evalúa al paciente — or you'll wind up a wreck
Metabolize it, memorize it, metabolize it right
Dosis por dosis, keep your pharmacology tight
[Outro]
Morfina, codeína, fentanilo — know the route
Glutathione, prostaglandins — never brush them out
LAST sequence tattooed in the cortex of your mind
La farmacología del dolor — the sharpest discipline you'll find