• Centrally acting muscle relaxants work in the CNS to interfere with reflexes that cause muscle spasms. They essentially destroy or lyse spasms and are often referred to as spasmolytics.
中枢作用性肌松弛药作用于CNS，干扰引起肌痉挛的反射，根本性破坏或溶解痉挛，经常被称为解痉剂。
• Other modalities of spasm and pain relief like rest, heat application, and physical therapy are used in addition to these drugs.
除了这些药物，治疗痉挛、缓解疼痛的物理疗法还包括休息、热敷、和理疗。
Therapeutic Action 治疗作用
The desired and beneficial actions of centrally acting muscle relaxants are as follows:
中枢作用性肌松弛药的预期和有益作用如下：
• The exact mechanism of action of skeletal muscle relaxants is not fully understood but it is thought that it involves the participation of upper or spinal interneurons.
骨骼肌松弛药的确切作用机制尚未充分了解。人们认为，它与参与上或脊髓中间神经元作用有关
• It inhibits monosynaptic and polysynaptic spinal reflexes. Other than that, it is a CNS depressant.
药物抑制单突触或多突触脊髓反射，除此之外，它属于CSN抑制剂
Indications 适应症
Centrally acting muscle relaxants are indicated for the following medical conditions:
中枢作用性肌松弛药适用于下列医疗状况：
• Primary indication is relief of discomfort associated with acute, painful musculoskeletal conditions as adjunct to rest, physical therapy, and other measures.
主要适应症是缓解急性、痛性肌肉骨骼疾病相关不适，作为休息、理疗及其他措施的辅助手段
• Alleviation of signs and symptoms of spasticity, may be of use in spinal cord injuries or spinal cord diseases.
缓解痉挛状态症状体征，可能对脊髓担任或脊髓疾病有用。
Here are some important aspects to remember for indication of centrally acting muscle relaxants in different age groups:
中枢作用性肌松弛药不同年龄组人群适应要点：
Children 儿童
• Safety and effectiveness not established in children. However, children older than age 12 may be given with metaxalone.
儿童使用的安全性和效果尚未确立。不过，12岁以上儿童可以使用美他沙酮
• Baclofen, on the other hand, is used to relieve spasticity associated with cerebral palsy.
另外，巴氯芬用于缓解脑瘫相关痉挛状态
• Methocarbamol is the drug of choice for children with tetanus. Children should be monitored closely for CNS and GI toxicity.
• 美索巴莫是抽搐儿童的首选药。应密切监护儿童是否出现CNS和GI毒性。
Adults 成人
• They should be cautioned to avoid activities that require alertness (e.g. driving) because drugs can cause confusion and drowsiness.
提醒成人避免做需要保持清醒的活动（如驾驶），因为药物可能引起意识错乱和瞌睡
• Muscle spasm in adults related to anxiety can be treated with diazepam.
与焦虑相关的肌痉挛可用地西泮治疗
• Pregnant and lactating women should be advised to use contraception and alternative method of feeding, respectively.
应建议妊娠和哺乳妇女分别采用避孕和替代喂食法
Older adults 老人
• They are more likely to experience adverse effects associated with these drugs.
更容易出现药物相关不良效应
• 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肝或肾功能受损患者的首选中枢作用性骨骼肌松弛药
Pharmacokinetics 药代动力学
Here are the characteristic interactions of centrally acting muscle relaxants and the body in terms of absorption, distribution, metabolism, and excretion:
中枢作用性肌松弛药与身体在吸收、分布、代谢和排泄方面的相互作用特点为：
Route Onset Peak Duration
Oral 1 h 2 h 4-8 h
Intrathecal 30-60 min 4 h 4-8 h
T1/2: 3-4 h
半衰期 3 - 4 h
Metabolism: not metabolized
代谢：无
Excretion: kidney (urine)
排泄：经肾（尿） Contraindications and Cautions禁忌症与注意事项
The following are contraindications and cautions for the use of centrally acting muscle relaxants:
中枢作用性肌松弛药禁忌及注意事项如下：
• Skeletal muscle spasms caused by rheumatic disorders. Do not benefit from these drugs.
风湿病引起的骨骼肌痉挛。用药无益
• History of epilepsy. CNS depression and imbalance caused by drugs may exacerbate seizure disorder.
癫痫史：药物引起的CNS抑制和失调可能加重癫痫发作
• Cardiac dysfunction. Muscle function may be depressed.
心脏功能障碍。肌肉功能可能被抑制
• Condition marked by muscle weakness. Can be exacerbated by drugs.
明显出现肌无力的疾病。药物可能加重病情
• Hepatic, renal dysfunction. Interfere with drug metabolism and excretion.
• 肝、肾功能障碍。影响药物的代谢和排泄
• Baclofen is not indicated for treatment of spasticity that contributes to locomotion, upright function, or increased function. Blocking this spasticity results in loss of these functions.
巴氯芬不适用于治疗导致运动、直立位或功能增强的痉挛状态。阻断痉挛状态可导致这些功能的丧失
Adverse Effects 不良效应
Use of centrally acting muscle relaxants may result to these adverse effects:
使用中枢作用性肌松弛药可能导致下列不良效应：
• Chlorzoxazone may turn urine into purple-red color.
氯唑沙宗可能使尿变紫红红色
• Tizanidine has been associated with liver toxicity and hypotension in some patients.
替扎尼定与有些患者的肝毒性和低血压有关
• Baclofen is tapered over 1-2 weeks to prevent development of psychoses and hallucinations.
巴氯芬需用1-2周时间逐渐减少剂量，防止重性精神病和幻觉出现
Interactions 相互作用
The following are drug-drug interactions involved in the use of centrally acting muscle relaxants:
中枢作用性肌松弛药使用相关药药相互作用如下：
• Other CNS depressants, alcohol: increased CNS depression
其他CNS抑制剂、酒：增强CNS抑制
Nursing Considerations 护理考虑
Here are important nursing considerations when administering this drug:
使用这一药物时的重要护理考虑：
Nursing Assessment护理评估
These are the important things the nurse should include in conducting assessment, history taking, and examination:
实施护理评估、 病史收集和体格检查时应包括的重要事项：
• Assess for mentioned contraindications and cautions (e.g. drug allergy, cardiac depression, rheumatic disorder, pregnancy and lactation, etc.) to prevent untoward complications.
评估有无提到的禁忌症和注意事项（如，药物过敏、心脏抑制、风湿病、妊娠和哺乳，等），以防止不利并发症
• Conduct thorough physical assessment (temperature, skin color and lesion, CNS orientation, affect, reflexes, bilateral grip strength, spasticity evaluation; bowel sounds and urine output) to obtain baseline data.
• Monitor liver and renal function tests to detect potential adverse effects.
监测肝、肾功能试验，发现潜在的不良效应
Nursing Diagnoses 护理诊断
Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
用药治疗时可能形成的一些护理诊断：
• Acute pain related to GI and CNS effects
急性痛，与GI和CNS效应有关
• Disturbed thought processes related to CNS effects
思维程序紊乱，与CNS效应有关
• Risk for injury related to CNS effects
损伤风险，与CNS效应有关
Implementation with Rationale 实施及原理说明
These are vital nursing interventions done in patients who are taking centrally acting muscle relaxants:
以下为中枢作用性肌松弛药使用患者的重要护理措施：
• Provide additional spasm and pain relief like rest periods, heat application, NSAIDs as ordered, and positioning to augment the effects of the drug at relieving the musculoskeletal discomfort.
• Discontinue drug at any sign of liver and renal dysfunction to prevent severe toxicity.
一旦发现肝和肾功能障碍迹象，立即停药，以防止严重毒性。
• Monitor respiratory status to evaluate adverse effects and arrange for appropriate dose adjustment or discontinuation of the drug.
监测呼吸状态，评价不良效应，安排适当的剂量调整或停药
• Provide comfort measures to help patient tolerate drug effects.
提供舒适措施，帮助患者耐受药物效应
• Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
提供安全措施（如充足照明，抬起床栏，等），防止损伤
• Educate client on drug therapy to promote understanding and compliance.
对患者进行药物疗法教育，增进了解和治疗依从性
Evaluation 评价
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
确定药物疗法效果的评价内容：
• Monitor patient response to therapy (improvement in muscle spasm and relief of pain; improvement in muscle spasticity).
监测患者对疗法反应（肌痉挛改善，疼痛缓解；肌痉挛状态改善）
• Monitor for adverse effects (e.g. CNS changes, GI depression, urinary urgency, etc.).
监测有无不良效应（如，CNS变化，GI抑制，尿频，等）
• Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
要求患者说出药名、适应症及需要注意的不良效应，以评价患者对药物的了解程度
• Monitor patient compliance to drug therapy.
监测患者对药物疗法的依从性
★Vocabulary ★
spasmolytic – a. n. 解痉药，解痉的
modality – n. 物理疗法，方式，形式
metaxalone – n. 美他沙酮
baclofen – n. 巴氯芬
methocarbamol – n. 美索巴莫
diazepam – n. 地西泮
carisoprodol – n. 卡立普多
chlorzoxazone – n. 氯唑沙宗
tizanidine – n. 替扎尼定
untoward – a. 不利的，麻烦的，难对付的
★Video ★
Mechanism of Muscle Relaxants
★Test ★
1. The nurse provides patient teaching about chlorzoxazone (Paraflex) in preparation for the patients discharge to home. The nurse evaluates the patient understands potential adverse effects when the patient makes what statement?
A. This drug can cause diarrhea.
B. My urine may turn orange to purple red while taking this drug.
C. My skin may turn yellow but that will go away when I stop taking the drug.
D. After I take a pill it will take 2 to 3 hours before I feel the effects. Answer: B. My urine may turn orange to purple red while taking this drug. Rationale: The patient indicates an understanding of adverse effects of this drug by stating that his urine may be discolored while using the drug. Chlorzoxazone may discolor the urine, which will turn orange to purple-red when metabolized and excreted. Patients should be warned about this effect to prevent any fears of blood in the urine. Chlorzoxazone usually causes constipation, not diarrhea. The onset of action is usually within an hour after the drug has been taken. Yellow discoloration of the skin would indicate liver damage or dysfunction, which should be reported immediately. 2. The nurse alerts the patient to what adverse effect of tizanidine (Zanaflex) that could cause injury?
A. Constipation
B. Dry mouth
C. Fatigue
D. Hypotension Answer: D. Hypotension Rationale: Tizanidine has been associated with hypotension, which could be a safety risk especially if the patient is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.
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. B. My urine may turn orange to purple red while taking this drug. Rationale: The patient indicates an understanding of adverse effects of this drug by stating that his urine may be discolored while using the drug. Chlorzoxazone may discolor the urine, which will turn orange to purple-red when metabolized and excreted. Patients should be warned about this effect to prevent any fears of blood in the urine. Chlorzoxazone usually causes constipation, not diarrhea. The onset of action is usually within an hour after the drug has been taken. Yellow discoloration of the skin would indicate liver damage or dysfunction, which should be reported immediately. 2. D. Hypotension Rationale: Tizanidine has been associated with hypotension, which could be a safety risk especially if the patient is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.
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