[Verse 1]
Azoles and macrolides, they throttle CYP three-four
Inhibit the enzyme, opioids stack up more
Fluconazole creeping, methadone levels soar
Rifampin's an inducer, strips the plasma to the floor
Carbamazepine, St. John's wort — induction in disguise
Fentanyl and oxycodone metabolized and gone — surprise
The substrate drug don't know the enzyme's been rewritten
You prescribe a standard dose and now the patient's smitten
With toxicity or failure — both extremes will leave you bitten
[Chorus]
CYP, QT, serotonin catastrophe
CNS depression, additive opacity
NSAID bleeding, acetaminophen and warfarin's synergy
Pharmacokinetic treachery — memorize the pedigree
CYP, QT, check every drug you write
Interactions ambuscade you in the pharmacology fight
Ambuscade — an ambush lying hidden in the weeds
Know the mechanism cold before a patient bleeds
[Verse 2]
Tramadol and SSRIs — serotonin starts to flood
Meperidine plus MAOIs, agitation in the blood
Tremors, hyperthermia, myoclonus in the mix
Linezolid's a MAOI, weak but still it kicks
Methadone and fentanyl got serotonergic pull
Add an SNRI on top and now the synapse is too full
Hunter criteria: clonus, diaphoresis, the shakes
One wrong combination and the hypothalamus breaks
Autonomic conflagration — that's the syndrome that it makes
[Chorus]
CYP, QT, serotonin catastrophe
CNS depression, additive opacity
NSAID bleeding, acetaminophen and warfarin's synergy
Pharmacokinetic treachery — memorize the pedigree
CYP, QT, check every drug you write
Interactions ambuscade you in the pharmacology fight
[Verse 3]
Benzodiazepines plus gabapentin — respiratory debt
Z-drugs, antihistamines, opioids — a suffocating net
Every CNS depressant stacks the apnea toll
Alcohol compounds the sediment inside your brainstem's soul
QT prolongation — methadone stretches out the wave
Ondansetron plus antipsychotics digging torsades' grave
Macrolides extend it too — azithromycin's quiet cost
ECG before you dose, or cardiac rhythm's lost
Prolonged QT, torsades de pointes — ventricular tempest tossed
[Bridge]
NSAIDs block prostaglandins in the kidney's soft terrain
Anticoagulants plus NSAIDs — GI hemorrhage is the refrain
Lithium rises, methotrexate lingers in the marrow deep
Antihypertensive blunting — pressure climbing while you sleep
SSRIs with NSAIDs — platelet aggregation stripped
Acetaminophen and warfarin — INR gets quietly flipped
Enzyme inducers shred the Tylenol, glucuronidation lost
Hepatotoxic metabolite — NAPQI counts the cost
Alcohol depletes glutathione — pay the oxidative frost
[Chorus]
CYP, QT, serotonin catastrophe
CNS depression, additive opacity
NSAID bleeding, acetaminophen and warfarin's synergy
Pharmacokinetic treachery — memorize the pedigree
CYP, QT, check every drug you write
Interactions ambuscade you in the pharmacology fight