Common adverse effects of cholinesterase inhibitors include which of the following?

• A. Nausea, vomiting, dyspepsia, diarrhea, dizziness, headache, bradycardia, and weight loss
• B. Hyperactivity and hypertension
• C. Cough and wheezing
• D. Rash and photosensitivity

Answer: (A)

When a cholinesterase inhibitor is given, it increases acetylcholine at parasympathetic (muscarinic) receptors, leading to heightened cholinergic activity. This commonly shows up in the GI tract as increased motility and secretions, producing nausea, vomiting, dyspepsia, and diarrhea. The heart is slowed by enhanced vagal tone, which explains bradycardia. Dizziness and headache can accompany these systemic effects, and weight loss may occur due to GI upset and reduced appetite. These patterns of adverse effects reflect the predictable muscarinic stimulation from these drugs and are the ones most often observed in clinical practice.

Hyperactivity and hypertension are not characteristic of cholinergic overstimulation; cough and wheezing can occur with airway constriction but are less typical as common adverse effects. Rash and photosensitivity are not the hallmark adverse effects associated with cholinesterase inhibitors.