Direct-acting skeletal muscle relaxants enter the muscle to prevent muscle contraction directly.
直接作用性骨骼肌松弛药进入肌肉，直接阻止肌肉收缩。
B. Therapeutic Action 治疗作用
The desired and beneficial actions of direct-acting skeletal muscle relaxants are as follows:
直接作用的骨骼肌松弛药的预期和有益作用如下：
Dantrolene acts within skeletal muscle fibers and interfere with calcium ion release from the muscle tubules. Therefore, the fibers are prevented from contracting. It does not interfere with neuromuscular transmission and does not affect skeletal muscle surface membrane.
Here are some important aspects to remember for indication of direct-acting skeletal muscle relaxants in different age groups:
直接作用的骨骼肌松弛药部分适应症如下：
1. Children 儿童
Safety and effectiveness not established in children.
儿童使用的安全性和效果尚未确立
Dantrolene is used to treat upper motor neuron spasticity in children.
丹曲林用于治疗儿童上运动神经元痉挛状态
Dose should be accurately calculated based on body weight and it increases over time.
应根据体重正确计算剂量，并随使用时间增加
Children are at increased risk of CNS and GI toxicity.
用药儿童CNS和GI毒性风险增加
2. Adult 成人
They should be cautioned to avoid activities that require alertness (e.g. driving) because drugs can cause confusion and drowsiness.
应提醒成人避免需要保持清醒的工作（如驾驶），因为药物可能引起意识模糊和瞌睡
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采取避孕措施和其他喂养方式
Premenopausal women are at increased risk for hepatotoxicity in association with use of dantrolene.
绝经前妇女的丹曲林使用相关肝毒性然危险增加
3. 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性不良效应
Older women who are receiving hormone replacement therapy have the same risk for hepatotoxicity with premenopausal women in association with use of dantrolene.
进行激素替代疗法的老年妇女与绝经前妇女的丹曲林使用相关肝毒性危险相同
D. Pharmacokinetics 药代动力学
Here are the characteristic interactions of direct-acting skeletal muscle relaxants and the body in terms of absorption, distribution, metabolism, and excretion:
直接作用的骨骼肌松弛药与身体吸收、分布、代谢及排泄的相互作用如下：
Route Onset Peak Duration
Oral Slow 4-6 h 8-10 h
IV Rapid 5 h 6-8 h
T1/2: 9 h (oral), 4-8 h (IV) T1/2：9 h(口服)，4 – 8 h（IV）
Metabolism:N/A
代谢：N/A
Excretion: kidney (urine)
排泄：肾（尿）
E. Contraindications and Cautions 禁忌与注意事项
The following are contraindications and cautions for the use of direct-acting skeletal muscle relaxants:
直接作用的骨骼肌松弛药使用禁忌及注意事项如下：
Allergy to direct-acting skeletal muscle relaxants. Prevent hypersensitivity reactions
对直接作用的骨骼肌松弛药过敏；防止超敏反应
Spasticity that contributes to locomotion, upright position, increased function. These functions will be lost if spasticity were blocked
有助于行进、直立位及增强功能的痉挛状态。痉挛状态阻断后，这些功能就会丧失
Active hepatic disease. Interfere with metabolism of drug
活跃期肝病。干扰药物的代谢
Pregnancy. Potential adverse effects to the fetus
妊娠。对胎儿潜在的不良效应
Lactation. May cross breast milk and may cause adverse effects in the infant
哺乳。可能穿越母乳，可能引起婴儿的不良效应
Women and patients older than age 35. Caution is applied because of increased risk of potentially fatal hepatocellular disease
妇女和35岁以上患者。谨慎使用，因为潜在的致命性肝细胞病危险增加
History of liver disease or previous dysfunction. Increases liver’s susceptibility to cellular toxicity
肝病病史或既往功能障碍。肝对细胞毒性易感性增加
Respiratory depression. Exacerbated by muscular weakness
呼吸抑制。肌无力可加重病情
Cardiac disease. Cardiac muscle depression may be a risk
心脏病。有心肌抑制危险
F. Adverse Effects 不良效应
Use of direct-acting skeletal muscle relaxants may result to these adverse effects:
使用直接作用的骨骼肌松弛药可能导致下列不良效应：
Dantrolene can cause direct hepatocellular damage and potentially fatal hepatitis
丹曲林可能引起直接的肝细胞破坏及潜在的致命性肝炎
Botulinom toxins are associated with anaphylactic reactions characterized by headache, dizziness, muscle pain, paralysis
肉毒毒素与以头痛、头晕、肌痛、麻痹为特征的过敏反应存在相关性
G. Interactions 相互作用
The following are drug-drug interactions involved in the use of direct-acting skeletal muscle relaxants:
下列药-药相互作用涉及直接作用性骨骼肌松弛药的使用：
Estrogens: increased incidence of hepatocellular toxicity if used with dantrolene
雌激素类：与丹曲林一起使用可增加肝细胞毒性发生率
Here are important nursing considerations when administering this drug:
给药时的重要护理考虑：
1. Nursing Assessment 护理评估
These are the important things the nurse should include in conducting assessment, history taking, and examination:
实施评估、收集病史、检查时，护士应纳入下列重要内容：
Assess for mentioned contraindications and cautions (e.g. drug allergy, cardiac depression, rheumatic disorder, pregnancy and lactation, etc.) to prevent untoward complications.
评估上述禁忌与注意事项（如，药物过敏史、心脏抑制、风湿疾病、妊娠哺乳，等），以预防意外并发症
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.
实施彻底的体格检查（体温、皮肤颜色与损伤、CNS定向力、情感、反射、双手握力、痉挛状态评价、肠鸣音、尿排量），获取基线资料
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
2. 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
I. Implementation with Rationale 实施及说明
These are vital nursing interventions done in patients who are taking direct-acting skeletal muscle relaxants:
直接作用的骨骼肌松弛药患者的重要护理措施如下：
Assess area before administering botulinum toxins because area with active infection will be exacerbated by injection.
使用肉毒毒素前评估相关部位，因为注射可加重活动性感染部位病情
Monitor intravenous access sites of dantrolene for potential extravasation because drug is alkaline and very irritating to tissues.
监护丹曲林静脉入径部位有无潜在的外渗和，因为药物为碱性，对组织刺激性强
Periodically discontinue dantrolene for 2-4 days as ordered to monitor therapeutic effectiveness.
按处方，周期性停用丹曲林2-4小时，监测治疗效果
Discontinue drug at any sign of liver dysfunction to prevent adverse effects.
发现肝功能障碍体征时停药，预防不良效应
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（如照明充足、抬高床栏，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，促进了解和依从性
J. Evaluation评价
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
需要评价以确定药物疗法效果的一些护理情况：
Monitor patient response to therapy (improvement in spasticity, movement and activities).
监测患者的治疗反应（痉挛状态、运动、活动等的改善）
Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
要求患者说出药物、适应症及需要注意的不良效应，以评价患者对药物疗法的了解程度
Monitor patient compliance to drug therapy.
监测患者对药物疗法的依从性
★Vocabulary★
desired – a. 想得到的，渴望的
beneficial – a. 有益的，有用的
muscle fiber – 肌纤维
caution – v. n. 提醒，警告，小心
premenopausal – a. 绝经前的
locomotion – n. 行进，移动
neuromuscular junction – 神经肌肉接点
lincosamides – n. 林可胺类
quinidine – n. 奎尼丁
magnesium sulphate – n. 硫酸镁
anticholinesterase – n. 抗胆碱酯酶
succinylcholine – n. 琥珀酰胆碱
polymyxin – n. 多粘菌素
aminoglycosides – n. 氨基糖苷类
1. A patient comes to the clinic to receive a Botox injection in her forehead. The patient has adult acne across her forehead. What is the nurses priority action?
A. Hold the injection and consult the health care provider.
B. Cleanse the area well with an antibacterial soap.
C. Apply a topical antibiotic after administering the Botox.
D. Provide patient information about post-Botox injection care. 2. Which muscle relaxant was found to be embryotoxic in animal studies?
A. Carisoprodol (Soma)
B. Botulinum toxin A (Botox)
C. Cyclobenzaprine (Flexeril)
D. Dantrolene (Dantrium)
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. A. Hold the injection and consult the health care provider Rationale: Botulinum toxins should not be injected into any area with an active infection because of the risk of exacerbation of the infection. As a result, the nurse would hold the injection and consult with the physician, with the expectation the medication would be held until the acne resolved. Cleansing the area well, applying a topical antibiotic, and providing information about postinjection care would not resolve the problem and are not indicated. 2. D. Dantrolene (Dantrium) Rationale: Dantrolene crosses the placenta and was found to be embryotoxic in animal studies. Botulinum toxin A, carisoprodol, and cyclobenzaprine are not known to be embryotoxic.
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