**Question:** Operation Rajkishor was given pilocarpine. All of the following can be the features seen in him except

A. Hypertension
B. Hyperglycemia
C. Increased lacrimation
D. Increased salivation

**Core Concept:**

Pilocarpine is a cholinergic drug that belongs to the category of anticholinergic agents. It acts as a selective M3 muscarinic receptor agonist, thereby increasing saliva production (hypersalivation) and stimulating the lacrimal glands to produce more tears (increased lacrimation). These actions are part of pilocarpine's therapeutic uses, such as in the treatment of glaucoma and mydriasis (dilation of the pupil) for surgical procedures.

**Why the Correct Answer is Right:**

Hypertension and hyperglycemia are not direct side effects of pilocarpine administration. While pilocarpine can cause an increase in heart rate and blood pressure due to its action on the M3 receptor in the cardiovascular system, these changes are usually transient and mild. Hypertension and hyperglycemia are severe and persistent conditions, which are not expected from pilocarpine.

**Why Each Wrong Option is Incorrect:**

A. Hypertension: Pilocarpine does increase heart rate and blood pressure by stimulating M3 receptors, but the changes are usually mild and transient. Hypertension is a severe and persistent condition that is not expected from pilocarpine administration.

B. Hyperglycemia: Pilocarpine does not cause hyperglycemia as it does not directly impact glucose homeostasis or insulin secretion. It primarily affects the cardiovascular system.

C. Reduced lacrimation: Pilocarpine increases lacrimation (tears) by stimulating the lacrimal glands. Therefore, decreased lacrimation is not a feature of pilocarpine administration.

D. Reduced salivation: While pilocarpine does increase saliva production, it does not decrease it. Instead, pilocarpine stimulates the salivary glands to secrete more saliva.

**Correct Answer:**

**Correct Answer: C - Reduced lacrimation**

**Clinical Pearls:**

Pilocarpine is primarily used to decrease intraocular pressure in patients with glaucoma and to facilitate mydriasis (widening of the pupil) for surgery or examination. It acts by stimulating the parasympathetic nervous system through the release of acetylcholine, which activates M3 muscarinic receptors on lacrimal, salivary, and secretory glands. This stimulation results in increased tear production (lacrimation) and saliva secretion (salivation).

**Explanation of Reduced Lacrimation (Option C):**

Pilocarpine, a cholinergic drug, has a specific effect on the lacrimal glands. It stimulates the parasympathetic nervous system through the release of acetylcholine, which activates M3 muscarinic receptors on the lacrimal glands. This stimulation