Family Nurse Practitioner Exam

All of the following are signs of anticholinergic drug overdose except:

1. Dilated pupils

2. Flushing and tachycardia

3. Hypertension

4. Confusion

The correct answer is: Hypertension

Anticholinergic drug overdose often presents with a characteristic set of symptoms related to the inhibition of acetylcholine, which is a neurotransmitter associated with many bodily functions, particularly in the parasympathetic nervous system. In cases of overdose, one can typically expect to see signs such as dilated pupils (mydriasis), which result from the inhibition of the iris sphincter muscle; flushing and tachycardia as a result of increased sympathetic activity; and confusion due to central nervous system effects, which may also include agitation and hallucinations. Hypertension does not typically present as a direct sign of anticholinergic drug overdose. While some patients may experience elevated blood pressure due to increased sympathetic activity, it is not a classic sign associated with anticholinergic toxicity. Most often, the focus is on the triad of symptoms—dry skin, flushed face, and dilated pupils—along with confusion. Therefore, recognizing hypertension as a less definitive sign helps clarify that it does not belong to the core symptoms expected in cases of anticholinergic overdose.