Transition Metals

Question 1

Describe copper use in the human body

Answer 1

50% absorbed in GI tract

Processed in liver, transported to peripheral tissue

Binds to glycoproteins and albumin

Excessive copper is excreted via bile and faeces

Enzymatic approaches

Question 2

What is a cuproenzyme and an example of it

Answer 2

Copper dependent enzyme

Example:
Lysyl oxidase- cross linking collagen and elastin (formation of blood vessels and heart)

Question 3

What is wilson’s disease

Answer 3

Inherited, genetic disorder due to build up of excessive copper stored in liver, brain

Question 4

How do you treat Wilson disease

Answer 4

Chelation Therapy
Zinc supplementation
Liver transplant

Question 5

What is GHK-Cu (II)

Answer 5

An anti-inflammatory that protects tissue from oxidative injury after damage

Activator for wound healing- activates after tissue remodelling

Question 6

What can silver be used for based on its antibacterial properties

Answer 6

Disinfection of water

Silver nitrate- water treatment

Silver (I) sulfadiazine- antiseptic

Question 7

How is silver used in wart treatment

Answer 7

API- silver nitrate 40%

Treatment destroys the tissue infected with papillovirus

Question 8

How is silver used in wound healing

Answer 8

API- silver (I) sulfadiazine

Used primarily on second and third degree burns

Prevents growth of bacteria and yeast on damaged skin

Question 9

What is the oligodynamic effect used in silver

Answer 9

Silver damages irreversibly key enzymes

Enzymes precipitate and inactivate (only bacteria, not viruses)

Silver reacts with thiol groups to form silver sulphides

Question 10

How do silver dressings work

Answer 10

Silver ions bind to DNA of bacteria and bacterial spores to reduce ability for it to replicate

Question 11

What is Chrysotherapy

Answer 11

Use of gold for the treatment of rheumatoid arthritis such as Auranofin

Question 12

What is the main toxicity of sodium aurothiomalate and side effects

Answer 12

Toxicity:
Myelosuppression

Side effects:
Mouth ulcers
Skin reactions 
Proteinuria
Peripheral nephritis
Pulmonary fibrosis
Hepatotoxicity
Alopeca

Question 13

What is the clinically monitoring required in sodium aurothiomalate

Answer 13

Full blood counts (FBC)

Urine tests before each dose

Question 14

What is the dose for sodium aurothiomalate and when do you start to see an effect

Answer 14

Dose:
10mg test dose (exclude hypersensitivity)

50mg intramuscular injection
(benefit not seen until 300 to 500mg given between 6-10 weeks)

Question 15

What are the side effects of gold injections

Answer 15

Discolouration of skin

Nausea and vomiting

Metallic taste

Mouth sores

Itching and rash

kidney damage and decreased white blood cell count

Question 16

What is the brand of auranofin

Answer 16

Ridaura

Question 17

What is the mode of action of auranofin

Answer 17

1. In blood stream, Au drugs form a complex with albumin (Au drugs thiol groups exchange with cysteine-34 of albumin)
2. Au (I)- albumin complex formation
3. Au (I)/albumin complex arrive at site of action (SYNOVIAL CAVITY)
4. Au (I) can enter cell via second thiol exchange reaction with membrane transport protein
5. Once absorbed into cell, Au (I) can interact with mitochondria to induce apoptosis