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Nikki Dyer
Student Academic Support Services & Inclusion
July 2016
 A 26-year-old woman has been on antidepressant therapy for several months.
Today she complains of missing her period and having what is eventually
determined to be galactorrhea. Your careful assessment reveals that she has
developed some dyskinesias not unlike those you would typically associate with a
phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy
tests are negative. What drug is most likely to have caused these findings?
 A.
Amoxapine
 B.
Citalopram
 C.
Fluoxetine
 D.
Sertraline
 E.
Tranylcypromine
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion
 A 26-year-old woman has been on antidepressant therapy for several months.
Today she complains of missing her period and having what is eventually
determined to be galactorrhea. Your careful assessment reveals that she has
developed some dyskinesias not unlike those you would typically associate with a
phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy
tests are negative. What drug is most likely to have caused these findings?
 A.
 B.
 C.
 D.
 E.
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion
 A 26-year-old woman has been on antidepressant therapy for several months.
Today she complains of missing her period and having what is eventually
determined to be galactorrhea. Your careful assessment reveals that she has
developed some dyskinesias not unlike those you would typically associate with a
phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy
tests are negative. What drug is most likely to have caused these findings?
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion
 A 26-year-old woman has been on antidepressant therapy for several months.
Today she complains of missing her period and having what is eventually
determined to be galactorrhea. Your careful assessment reveals that she has
developed some dyskinesias not unlike those you would typically associate with
a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug.
Pregnancy tests are negative. What drug is most likely to have caused these
findings?
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion
 A 26-year-old woman has been on antidepressant therapy for several months.
Today she complains of missing her period and having what is eventually
determined to be galactorrhea. Your careful assessment reveals that she has
developed some dyskinesias not unlike those you would typically associate with
a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug.
Pregnancy tests are negative. What drug is most likely to have caused these
findings?
 A.
Amoxapine
 B.
Citalopram
 C.
Fluoxetine
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion
 A 26-year-old woman has been on antidepressant therapy for several months.
Today she complains of missing her period and having what is eventually
determined to be galactorrhea. Your careful assessment reveals that she has
developed some dyskinesias not unlike those you would typically associate with
a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug.
Pregnancy tests are negative. What drug is most likely to have caused these
findings?
 A.
Amoxapine
 B.
Citalopram
 C.
Fluoxetine
 D.
Sertraline
 E.
Tranylcypromine
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion
 A 26-year-old woman has been on antidepressant therapy for several months.
Today she complains of missing her period and having what is eventually
determined to be galactorrhea. Your careful assessment reveals that she has
developed some dyskinesias not unlike those you would typically associate with
a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug.
Pregnancy tests are negative. What drug is most likely to have caused these
findings?
 A.
Amoxapine (Acts on dopamine receptors)
 B.
Citalopram
 C.
Fluoxetine
 D.
Sertraline (CNS agent)
 E.
Tranylcypromine
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion
 A 26-year-old woman has been on antidepressant therapy for several months.
Today she complains of missing her period and having what is eventually
determined to be galactorrhea. Your careful assessment reveals that she has
developed some dyskinesias not unlike those you would typically associate with
a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug.
Pregnancy tests are negative. What drug is most likely to have caused these
findings?
 A.
Amoxapine (Acts on dopamine receptors)
 B.
Citalopram
 C.
Fluoxetine
 D.
Sertraline (CNS agent)
 E.
Tranylcypromine
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion
 The mention of menstrual irregularities, galactorrhea, and what appears to be extrapyramidal side
effects, should be a tip-off that we are dealing with a drug that interacts with dopamine receptorsspecifically D2, by blocking them. Amoxapine, the correct answer, is a tricyclic antidepressant
(secondary amine). It is rather unique among all the tricyclics (other secondary amines, and
tertiary amines such as the more familiar amitriptyline and imipramine) in several respects. For one
thing it inhibits neuronal dopamine and NE reuptake (the others affect mainly NE and serotonin).
That however, does not readily explain the amenorrhea-galactorrhea and extrapyramidal side
effects. What provides the explanation or mechanism relates to another rather unique property of
amoxapine: one of its metabolites is a strong dopamine receptor antagonist, an action not shared by
any of the other tricyclics; by the SSRIs( eg, citalopram, fluoxentine, sertraline; answers b, c, and d);
or by the monoamine oxidase inhibitors (eg, tranylcypromine, e; or phenelzine).
 You should recall that such antipsychotic drugs such as the phenothiazines and haloperidol may
also cause amenorrhea-galactorrhea and extrapyramidal side effects, by the same dopaminergic
receptor-blocking mechanism. Conversely, drugs that activate dopamine receptors in one way or
another (eg bromocriptine) can be used to manage these endocrine dysfunctions. Amoxapine’s
dopamine receptor blockade also seems to account for why the drug exerts some antipsychotic
properties, theoretically making it useful for patients with both psychosis and depression.
Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & 178
July 2016
Nikki Dyer, Student Academic Support Services & Inclusion