Precautions with Steroids

a)	They should be used with caution in patients with a previous history of stomach ulcers.
b)	Tuberculosis should be excluded before starting a patient on steroids.
c)	The patient's urine should be checked for sugar and the drug used with caution in diabetic patients.
d)	The patients' weight and blood pressure should be monitored regularly.
e)	The treatment with steroids should not be stopped abruptly.
f)	Any infection present should be treated simultaneously.
g)	If surgery is required or the patient develops an acute infection, the dose of the steroid may have to
	be increased.
h)	Topical steroids should be used with caution, especially those of the high potency group. Prolonged
	use should be avoided, especially on the face.

Misuse of Steroids

*	To produce a rapid relief of symptoms like fever, body ache, etc., in common infections - this is the most common type of misuse.
*	In the absence of a diagnosis, to produce symptomatic relief.
*	In the treatment of inflammatory conditions of the skin, when steroids are combined with antifungal agents or antibiotics in the same preparation, for example, betamethasone with neomycin.

Annexure 2

Poisoning and its Treatment

We discuss here about poisoning because of its relation to poisoning by drug intake.

Poisoning may be due to the ingestion of

-	Poisonous chemicals including overdose of high-danger drugs (see Box 12 below) or overdose of low-danger drugs in people highly allergic to them.
-	Poisonous plants
-	Contaminated food

Poisoning may occur intentionally (as a suicide attempt) or accidentally (especially in children and the elderly people).

How to Recognise Poisoning?

Occurrence of one or more of the following danger symptoms suggest poisoning:

-	Drowsiness or unconsciousness
-	Shallow, irregular or stopped breathing
-	Vomiting
-	Fits or convulsions

Always Remember (in all cases of poisoning)

-	A calm person should stay with the victim and observe him/her carefully, while others seek help.
-	Arrange for an ambulance to transport the victim to the hospital.
-	Call (phone) the doctor, give him/her details about the case (that is,. causative substance ingested and its amount, age of the victim), and follow his/her directions carefully.
-	Keep the leftover substance along with its container (if any) that caused poisoning.
-	Collect all evidence that will prove helpful in the correct diagnosis.
-	In case you have to treat the victim yourself before medical help arrives, follow the treatment chart.

Treatment of Poisoning

The chart presented below will help you to assess the situation and to determine your priorities. The instructions given here, apply to all types of poisoning and not only drug-poisoning. Also refer to the column 'Gross overdosage' in individual drug profiles (specific information on the symptoms likely to occur is given, where necessary, that is, in high-danger drugs).

TREATMENT CHART

Person is vomiting?——> Yes —> Box 1—> No	1) Preserve the vomit for detection of poison in the hospital. (2) Dilute the poison in stomach only if advised (Box 7) (3) Lay the victim on his back on a firm surface and clear his mouth of any vomit/foreign material, which would otherwise block the air ways. Remove false teeth. (4) Then lay the victim in the recovery position (Box 5) and get medical help.
Person is conscious?——> Yes —> Box 2—> No	1. In certain cases, it may be advisable to induce vomiting in the victim (Box 6). It must be attempted only when specifically advised. 2. Never induce vomiting if the victim is unconscious or if you suspect the poison to be a corrosive (acid or alkali) or a petroleum product. 3. Then follow steps 1 to 4 in Box 1.
Person is Breathing?——> Yes —> Box 3—>	1. Do not induce vomiting 2. Then follow steps 3 and 4 in Box 1.
No---------------------------------------->Box 4—>	1. Give artificial respiration (Box 6) and, if necessary, cardiac compression (Box 9). 2. Get medical help.