Bromocriptine

Selegiline REF: KDT 6^th Ed p. 415

DRUGS USED FOR PARKINSONISM

Ans. is b and c i.e. Bromocriptine therapy for mother; and Ca breast

Contraindications to Breast feeding

• Mother on IV drug abuse/excess alcohol.
• Human T cell leukemia virus type 1 (HTLV – 1).
• In females undergoing treatment for breast cancer (Acog 2000)
• Mother on anticancer drugs or other teratogenic drugs.
• Active Herpes simplex lesions of the breast.
• Active pulmonary tuberculosis in mother.
• Galactosemia and congenital lactose intolerance in infant.
• HIV-positive mother if she can afford formula feeds.
• Mother with clinically infectious varicella. (Once the infant receives varicella zoster immune globulin and there are no skin lesions on the mother’s breast, she may provide expressed milk for the infant).

As far as Hepatitis B/C infections are concerned they are not contraindications to breast feeding.

Infants of seropositive hepatitis B mothers should be given He^patitis B Immunoglobulin MI within 12 hours of birth.

Also know The milk of nursing mother with cystic fibrosis, is high in sodium and places the infant at risk for hypernatremia.

Medications contraindicated during lactation.

Medication                              Reason

Bromocriptine                         Suppresses lactation; may be hazardous to the mother

Cocaine                                   Cocaine intoxication

Cyclophosphamide                 Possible immune suppression; unknown effect on growth or association with carcinogenesis; neutropenia

Cyclosporine                           Possible immune suppression; unknown effect on growth or association with carcinogenesis;

Doxorubicin                             Possible immune suppression; Unknown effect on growth or association with carcinogenesis;

Ergotamine                               Vomiting, diarrhea, convulsions (at doses used in migraine medications)

Lithium                                      Once third to one half of therapeutic blood concentration in infants

Methotrexate                           Possible immune suppression; unknown effect on growth or association with carcinogenesis;

Neutropenia Phencyclidine     Potent hallucinogen

Phenindione                             Anticoagulant; increased prothromboplastin and partial thromboplastin time in one infant; not used in United States

Radioactive iodine                   Contraindications to breast-feeding for various periods and other radiolabeled

& other radio                            elements labelled elements

Bromocriptine

Ans. is ‘b’ i.e., Increase prolactin release

• Bromocriptine is a potent dopamine agonist.

o The actions of bromocriptine is due to dopamine like effect (dopaminergic) on D2 and less common DI receptors.

1. Dopamine inhibits the secretion ofprolactin —› Bromocriptine does the same.
2. Dopamine increases the secretion of GH in normal individuals but decreases in acromegalics Bromocriptine also has ^r_.cone effect.
3. 3.     Dopamine stimulates CTZ and causes nausea, vomiting –> same is true with bromocriptine – Nausea & vomiting are the commonest adverse effects.
4. Dopamine decreases GI motility —> Bromocriptine has same effect.

Levodopa is an immediate precursor of dopamine so, bromocriptine also has levodopa like action in CNS.

Ans. is ‘b’ i.e., Prolactin deficiency

Bromocriptine is used in :-

i) Suppression of lactation in galactorrhea

ii) Cyclical mastalgia

iii)      Induction of ovulation in anovulatory infertility caused by hyperprolactinemia

iv)       Parkinsonism

v) Acromegaly due to small pitutary tumours

vi)       Hepatic coma

Recently, it has been approved for treatment of type 2 DM.

Ans. is ‘a’ i.e., Inhibits prolactin release

Ans. is ‘c’ i.e., Bromocriptine

Retroperitoneal fibrosis can be caused by ergot antiparkinsonism drugs (bromocriptine and pergolide).

Answer is D (Bromocriptine):

Secondary Amenorrhea and galactorrhea in a young women with evidence of microadenoma (tumor I Omm) in the pituitary fossa suggest a diagnosis of prolactinoma.

Oral dopamine agonists (Dopamine or Cabergoline) are the treatment of choice for patients with prolactinomas.

Ans. C: Bromocriptine

Dopamine agonists are the first line therapy for majority of the patients of prolcatinoma. Ergot derived dopamine agonists are preferred

Ans. is `d’ i.e., Hypoprolactinemia

Uses of Bromocriptive

• Bromocriptine is a powerful dopamine agonist. It suppresses prolactin secretion while promoting secretion of gonadotropins.
• Its therapeutic uses are:

1. Suppression of lactation in galactorrhea
2. Cyclical mastalgia
3. Induction of ovulation in anovulatory infertility caused by hyperprolactinemia
4. Parkinsonism
5. Acromegaly due to small pitutary tumours
6. Hepatic coma
7. Recently, it has been approved for treatment of type 2 DM.