DrVirgo
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A 32 year old female presents with amenorrhea for the past several months. She also states that there is a "watery secretion" coming from both her nipples. On examination, there is a non-puerperal, watery secretion that does not contain white or red blood cells. Laboratory examination reveals elevated serum prolactin levels. Which of the following medications most likely caused this patient's signs and symptoms?
A. Captopril
B. Hydrochlorothiazide
C. Indomethacin
D. Nortriptyline
E. Warfarin
Please explain what this woman has and which drug she was given and the mechanism by which this drug causes this side effect...
Thanks. 
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| robin082006
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D
TCAs--> causes decrease in Dopamine---> loss of hihibition of Dopamine on Prolactin secretion--> increase Prolactin--> Galactorrhea and Amenorrhea
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| DrVirgo
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Agree about the mechanism, but in depression there is already a decrease of Dopamine...
Why would TCA's be given to further decrease dopamine?
I have only read that TCA affect NE and Seratonin however this was a Q is q-bank! 
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| Cedrick
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Wow just read it hard question
the explination is right found it on the web
antipsychotics in the wikipedia page
I am very surprised !
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| mjl1717
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i was under the impression that TCAs inhibit the reuptake of NE and catecholamine, leaving more at the synaptic cleft.
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| waqastariq
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TCAs have effect on multiple receptors. Nortriptyline is notorious for blocking Dopaminergic D 1 receptors more so when they are blocked in pituitary, dopamine doesnt act on pituitary causing release of Prolactin that explains prolactinemia, which leads to enlargement of acinus and production of watery milky fluid that is expressed as a result...
thanks
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| waqastariq
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amenorrhea is also a side effect of this drug...
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| HILFIGER
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D. I don't think this was a hard question, because other drugs named are not related to CNS
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| drpkaur
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It's D for sure.
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| DrVirgo
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Waq,
Can you please tell me where you read about Nortryptyline and D1 Receptorsj because I can't find it in my reading kap or goljan.
Thanks.
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