Which of the following are symptoms of cholinesterase inhibition?

• A. Headache, dizziness, nausea, muscle twitching, pinpoint pupils, drooling
• B. Hair loss and dry skin
• C. Increased appetite
• D. Elevated blood pressure only

Answer: (A)

Cholinesterase inhibitors cause acetylcholine to build up at nerve endings, overstimulating both muscarinic and nicotinic receptors. This leads to a mix of symptoms such as excessive secretions, pupil constriction, and muscle activity changes. The combination described—headache, dizziness, nausea, muscle twitching, pinpoint pupils, and drooling—fits this cholinergic overdrive: the pinpoint pupils reflect muscarinic stimulation of the eyes, and the drooling and muscle twitching reflect increased secretions and nicotinic effects. The other options describe effects not typical of cholinesterase inhibition (hair loss and dry skin; increased appetite; elevated blood pressure only), so they don’t align with the characteristic cholinergic symptoms.