Pituitary drugs: dopamine agonists: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Pituitary drugs: dopamine agonists

Sample item

A 28-year-old woman with amenorrhoea, galactorrhoea and a serum prolactin of 150 ng/mL has a pituitary microadenoma. Which first-line drug and notable safety concern with high cumulative doses fit?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Cabergoline; cardiac valvular fibrosis

Dopamine acts on D2 receptors of lactotrophs to inhibit prolactin release, so dopamine agonists such as cabergoline shrink prolactinomas and restore menses. Cabergoline is a 5-HT2B agonist, so high doses (as used in Parkinson disease) are linked with valvular heart disease, and echocardiography is advised with prolonged high dosing.

Option by option

  • A. Metoclopramide; extrapyramidal symptoms

    Metoclopramide blocks D2 receptors and raises prolactin.

  • B. Levodopa; dyskinesia

    Levodopa is used in Parkinson disease and is not a treatment for prolactinoma.

  • C. Octreotide; gallstones

    Octreotide is a somatostatin analogue used in acromegaly and does not treat prolactinoma.

  • D. Cabergoline; cardiac valvular fibrosis (correct)

    Correct. D2 agonism suppresses prolactin, with valvulopathy a concern at high doses.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Cabergoline; cardiac valvular fibrosis. Dopamine acts on D2 receptors of lactotrophs to inhibit prolactin release, so dopamine agonists such as cabergoline shrink prolactinomas and restore menses.

Why is "Metoclopramide; extrapyramidal symptoms" not the answer?

Metoclopramide blocks D2 receptors and raises prolactin.

Why is "Levodopa; dyskinesia" not the answer?

Levodopa is used in Parkinson disease and is not a treatment for prolactinoma.

Why is "Octreotide; gallstones" not the answer?

Octreotide is a somatostatin analogue used in acromegaly and does not treat prolactinoma.

What concept does this question test?

It tests Pituitary drugs: dopamine agonists in Pharmacology. Cabergoline is a 5-HT2B agonist, so high doses (as used in Parkinson disease) are linked with valvular heart disease, and echocardiography is advised with prolonged high dosing.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pituitary drugs: dopamine agonists?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.