Use of Skeletal Muscle Relaxants Across the Lifespan
骨骼肌松弛药使用
Children 儿童
The safety and effectiveness of most of these drugs have not been established in children. If a child older than 12 years of age requires a skeletal muscle relaxant after an injury, metaxalone has an established pediatric dosage. Other agents have been used, with adjustments to the adult dosage based on the child’s age and weight.
Baclofen is often used to relieve the muscle spasticity associated with cerebral palsy. A caregiver needs intensive education in the use of the intrathecal infusion pump and how to monitor the child for therapeutic as well as adverse effects.
Methocarbamol is the drug of choice if a child needs to be treated for tetanus.
美索巴莫是需要进行破伤风治疗的儿童的首选药物。
Dantrolene is used to treat upper motor neuron spasticity in children. The dosage is based on body weight and increases over time. The child should be screened regularly for CNS and GI (including hepatic) toxicity.
Botulinum toxins are not approved for use in children. The use of these neurotoxins in children has been associated with the development of botulism.
肉毒毒素类未获准用于儿童。儿童使用这些神经毒素都与肉毒中毒存在相关性。
Adults 成人
Adults being treated for acute musculoskeletal pain should be cautioned to avoid driving and to take safety precautions against injury because of the related CNS effects, including dizziness and drowsiness. Rest of the muscle, heat, massage, physical therapy are key components to recovery from any muscular injury or pain.
Adults complaining of muscle spasm pain that may be related to anxiety often respond very effectively to diazepam, which is a muscle relaxant and anxiolytic.
成人主诉肌肉痉挛痛可能与焦虑相关时，地西泮的效果通常极佳。地西泮为肌肉松弛和抗焦虑药。
Women of childbearing age should be advised to use contraception when they are taking these drugs. If a pregnancy does occur, or is desired, they need counseling about the potential for adverse effects. Women who are nursing should be encouraged to find another method of feeding the baby because of the potential for adverse drug effects on the baby.
Premenopausal women are also at increased risk for the hepatotoxicity associated with dantrolene and should be monitored very closely for any change in hepatic function and given written information about the prodrome syndrome that often occurs with the hepatic toxicity.
Older patients are more likely to experience the adverse effects associated with these drugs—CNS, GI, and cardiovascular. Because older patients often also have renal or hepatic impairment, they are also more likely to have toxic levels of the drug related to changes in metabolism and excretion.
Carisoprodol is the centrally acting skeletal muscle relaxant of choice for older patients and for those with hepatic or renal impairment.
卡立普多是老年患者及有肝或肾损害患者的首选中枢作用性骨骼肌松弛药。
If dantrolene is required for an older patient, lower doses and more frequent monitoring are needed to assess for potential cardiac, respiratory, and liver toxicity.
如果老人需要使用丹曲林，就必须减少剂量，增加监护次数，评估潜在的心脏、呼吸和肝毒性。
Older women who are receiving hormone replacement therapy are at the same risk for development of hepatotoxicity as premenopausal women and should be monitored accordingly.
接受激素替代疗法的老年妇女跟绝经前妇女一样同样会有肝毒性危险，应进行相应的监护。
★Video ★
Muscle Relaxants
★Test ★
1. What is the centrally acting muscle relaxant of choice for children with tetanus?
A. botulinum toxin type B
B. Dantrium
C. Baclofen
D. Methocarbamol
2. A patient who had a dose of botulinum toxin type A complained of headache and dizziness. What is the most appropriate nursing response?
A. Provide comfort measures.
B. Institute safety measures.
C. Assess for possible anaphylactic reactions
D. Both A and B
奥医教育“在线自测”正式上线，复习练习、效果检验，奥医NCLEX-RN/ISPN题库一站完成
答案 Answers 1. D. Methocarbamol. Rationale: Both botulinum toxin type B and Dantrium are direct-acting skeletal muscle relaxants. Baclofen is indicated for relief of spasticity in children with cerebral palsy. 2. C. Assess for possible anaphylactic reactions. Rationale: Botulinom toxins are associated with anaphylactic reactions characterized by headache, dizziness, muscle pain, paralysis
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