how long for iv labetalol to work

mg. Labetalol HCl administered as a continuous IV infusion, with a mean dose of 136 mg (27 to 300 mg) over a period of 2 to 3 hours (mean of 2 hours and 39 minutes), lowered the blood pressure by an average of 60/35 mm Hg.

DESCRIPTION

LABETALOL - labetalol hydrochloride injection Sagent Pharmaceuticals----------Labetalol Hydrochloride Injection, USP (For IV Use Only)SAGENT ® R x only DESCRIPTIONLabetalol hydrochloride injection, USP is an adrenergic receptor blocking agent that has both selective alpha 1 -adrenergic and nonselective beta-adrenergic receptor blocking actions in a single substance. Labetalol hydrochloride (HCl) is a racemate chemically designated as 2-hydroxy-5- [1-hydroxy-2- [ (1-methyl-3-phenylpropyl)amino]ethyl]benzamide monohydrochloride, and it has the following structure: Labetalol HCl has the molecular formula C 19 H 24 N 2 O 3 •HCl and a molecular weight of 364.9. It has two asymmetric centers and therefore exists as a molecular complex of two diastereoisomeric pairs. Dilevalol, the R,R' stereoisomer, makes up 25% of racemic labetalol. Labetalol HCl is a white or off-white powder, soluble in water. Labetalol hydrochloride injection is a clear, colorless to light yellow, aqueous, sterile, isotonic solution for intravenous (IV) injection. It has a p H range of 3.0 to 4.5. Each milliliter contains 5 mg of labetalol HCl, 45 mg of anhydrous dextrose, 0.1 mg of edetate disodium; 0.8 mg of methylparaben and 0.1 mg of propylparaben as preservatives; and anhydrous citric acid and sodium hydroxide, as necessary, to bring the solution into the p H range. CLINICAL PHARMACOLOGYLabetalol HCl combines both selective, competitive, alpha 1 -adrenergic blocking and nonselective, competitive, beta-adrenergic blocking activity in a single substance. In man, the ratios of alpha- to beta-blockade have been estimated to be approximately 1:3 and 1:7 following oral and IV administration, respectively. Beta 2 -agonist activity has been demonstrated in animals with minimal beta 1 -agonist (ISA) activity detected. In animals, at doses greater than those required for alpha- or beta-adrenergic blockade, a membrane stabilizing effect has been demonstrated. Pharmacodynamics The capacity of labetalol HCl to block alpha receptors in man has been demonstrated by attenuation of the pressor effect of phenylephrine and by a significant reduction of the pressor response caused by immersing the hand in ice-cold water (“cold-pressor test”). Labetalol HCl's beta 1 -receptor blockade in man was demonstrated by a small decrease in the resting heart rate, attenuation of tachycardia produced by isoproterenol or exercise, and by attenuation of the reflex tachycardia to the hypotension produced by amyl nitrite. Beta 2 -receptor blockade was demonstrated by inhibition of the isoproterenol-induced fall in diastolic blood pressure. Both the alpha- and beta-blocking actions of orally administered labetalol HCl contribute to a decrease in blood pressure in hypertensive patients. Labetalol HCl consistently, in dose-related fashion, blunted increases in exercise-induced blood pressure and heart rate, and in their double product. The pulmonary circulation during exercise was not affected by labetalol HCl dosing. Single oral doses of labetalol HCl administered to patients with coronary artery disease had no significant effect on sinus rate, intraventricular conduction, or QRS duration. The atrioventricular (A-V) conduction time was modestly prolonged in two of seven patients. In another study, IV labetalol HCl slightly prolonged A-V nodal conduction time and atrial effective refractory period with only small changes in heart rate. The effects on A-V nodal refractoriness were inconsistent. Labetalol HCl produces dose-related falls in blood pressure without reflex tachycardia and without significant reduction in heart rate, presumably through a mixture of its alpha- and beta-blocking effects. Hemodynamic effects are variable, with small, nonsignificant changes in cardiac output seen in some studies but not others, and small decreases in total peripheral resistance. Elevated plasma renins are reduced. Doses of labetalol HCl that controlled hypertension did not affect renal function in mildly to severely hypertensive patients with normal renal function. Due to the alpha 1 -receptor blocking activity of labetalol HCl, blood pressure is lowered more in the standing than in the supine position, and symptoms of postural hypotension can occur. During dosing with IV labetalol HCl, the contribution of the postural component should be considered when positioning the patient for treatment, and the patient should not be allowed to move to an erect position unmonitored until his ability to do so is established. In a clinical pharmacologic study in severe hypertensives, an initial 0.25 mg/kg injection of labetalol HCl administered to patients in the supine position decreased blood pressure by an average of 11/7 mm Hg. Additional injections of 0.5 mg/kg at 15-minute intervals up to a total cumulative dose of 1.75 mg/kg of labetalol HCl caused further dose-related decreases in blood pressure. Some patients required cumulative doses of up to 3.25 mg/kg. The maximal effect of each dose level occurred within 5 minutes. Following discontinuation of IV treatment with labetalol HCl, the blood pressure rose gradually and progressively, approaching pretreatment baseline values within an average of 16 to 18 hours in the majority of patients. Similar results were obtained in the treatment of patients with severe hypertension who required urgent blood pressure reduction with an initial dose of 20 mg (which corresponds to 0.25 mg/kg for an 80 kg patient) followed by additional doses of either 40 or 80 mg at 10-minute intervals to achieve the desired effect, or up to a cumulative dose of 300

Exacerbation of angina and, in some cases, myocardial infarction and ventricular dysrhythmias have been reported after abrupt discontinuation of therapy with beta-adrenergic blocking agents in patients with coronary artery disease. Abrupt withdrawal of these agents in patients without coronary artery disease has resulted in transient symptoms, including tremulousness, sweating, palpitation, headache, and malaise. Several mechanisms have been proposed to explain these phenomena, among them increased sensitivity to catecholamines because of increased numbers of beta receptors. Although beta-adrenergic receptor blockade is useful in the treatment of angina and hypertension, there are also situations in which sympathetic stimulation is vital. For example, in patients with severely damaged hearts, adequate ventricular function may depend on sympathetic drive. Beta-adrenergic blockade may worsen A-V block by preventing the necessary facilitating effects of sympathetic activity on conduction. Beta 2 -adrenergic blockade results in passive bronchial constriction by interfering with endogenous adrenergic bronchodilator activity in patients subject to bronchospasm, and it may also interfere with exogenous bronchodilators in such patients. Pharmacokinetics and Metabolism Following IV infusion of labetalol, the elimination half-life is about 5.5 hours and the total body clearance is approximately 33 m L/min per kilogram. The plasma half-life of labetalol following oral administration is about 6 to 8 hours. In patients with decreased hepatic or renal function, the elimination halflife of labetalol is not altered; however, the relative bioavailability in hepatically impaired patients is increased due to decreased “first-pass” metabolism. The metabolism of labetalol is mainly through conjugation to glucuronide metabolites. The metabolites are present in plasma and are excreted in the urine and, via the bile, into the feces. Approximately 55% to 60% of a dose appears in the urine as conjugates or unchanged labetalol within the first 24 hours of dosing. Labetalol has been shown to cross the placental barrier in humans. Only negligible amounts of the drug crossed the blood-brain barrier in animal studies. Labetalol is approximately 50% protein bound. Neither hemodialysis nor peritoneal dialysis removes a significant amount of labetalol HCl from the general circulation (<1%). INDICATIONS AND USAGELabetalol hydrochloride injection is indicated for control of blood pressure in severe hypertension. CONTRAINDICATIONSLabetalol hydrochloride injection is contraindicated in bronchial asthma, overt cardiac failure, greater-than-first-degree heart block, cardiogenic shock, severe bradycardia, other conditions associated with severe and prolonged hypotension, and in patients with a history of hypersensitivity to any component of the product (see WARNINGS ). Beta-blockers, even those with apparent cardioselectivity, should not be used in patients with a history of obstructive airway disease, including asthma. WARNINGSHepatic Injury Severe hepatocellular injury, confirmed by rechallenge in at least one case, occurs rarely with labetalol therapy. The hepatic injury is usually reversible, but hepatic necrosis and death have been reported. Injury has occurred after both short- and long-term treatment and may be slowly progressive despite minimal symptomatology. Similar hepatic events have been reported with a related research compound, dilevalol HCl, including two deaths. Dilevalol HCl is one of the four isomers of labetalol HCl. Thus, for patients taking labetalol, periodic determination of suitable hepatic laboratory tests would be appropriate. Appropriate laboratory testing should be done at the first symptom/sign of liver dysfunction (e.g., pruritus, dark urine, persistent anorexia, jaundice, right upper quadrant tenderness, or unexplained “flulike” symptoms). If the patient has laboratory evidence of liver injury or jaundice, labetalol should be stopped and not restarted. Cardiac Failure Sympathetic stimulation is a vital component supporting circulatory function in congestive heart failure. Beta-blockade carries a potential hazard of further depressing myocardial contractility and precipitating more severe failure. Although beta-blockers should be avoided in overt congestive heart failure, if necessary, labetalol HCl can be used with caution in patients with a history of heart failure who are well compensated. Congestive heart failure has been observed in patients receiving labetalol HCl. Labetalol HCl does not abolish the inotropic action of digitalis on heart muscle. In Patients without a History of Cardiac Failure In patients with latent cardiac insufficiency, continued depression of the myocardium with beta-blocking agents over a period of time can, in some cases, lead to cardiac failure. At the first sign or symptom of impending cardiac failure, patients should be fully digitalized and/or be given a diuretic, and the response should be observed closely. If cardiac failure continues despite adequate digitalization and diuretic, therapy with labetalol hydrochloride should be withdrawn (gradually, if possible). Ischemic Heart Disease Angina pectoris has not been reported upon labetalol HCl discontinuation. However, following abrupt cessation of therapy with some beta-blocking agents in patients with coronary artery disease, exacerbations of angina pectoris and, in some cases, myocardial infarction have been reported. Therefore, such patients should be cautioned against interruption of therapy without the physician's advice. Even in the absence of overt angina pectoris, when discontinuation of labetalol hydrochloride injection is planned, the patient should be carefully observed and should be advised to limit physical activity. If angina markedly worsens or acute coronary insufficiency develops, administration of labetalol hydrochloride injection should be reinstituted promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Nonallergic Bronchospasm (e.g., Chronic Bronchitis and Emphysema)Since labetalol hydrochloride injection at the usual IV therapeutic doses has not been studied in patients with nonallergic bronchospastic disease, it should not be used in such patients. Pheochromocytoma Intravenous labetalol HCl has been shown to be effective in lowering blood pressure and relieving symptoms in patients with pheochromocytoma; higher than usual doses may be required. However, paradoxical hypertensive responses have been reported in a few patients with this tumor; therefore, use caution when administering labetalol HCl to patients with pheochromocytoma. Diabetes Mellitus and Hypoglycemia Beta-adrenergic blockade may prevent the appearance of premonitory signs and symptoms (e.g., tachycardia) of acute hypoglycemia. This is especially important with labile diabetics. Beta-blockade also reduces the release of insulin in response to hyperglycemia; it may therefore be necessary to adjust the dose of antidiabetic drugs. Major Surgery The necessity or desirability of withdrawing beta-blocking therapy before major surgery is controversial. Protracted severe hypotension and difficulty in restarting or maintaining a heartbeat have been reported with beta-blockers. The effect of labetalol HCl's alpha-adrenergic activity has not been evaluated in this setting. Several deaths have occurred when labetalol hydrochloride injection was used during surgery (including when used in cases to control bleeding). A synergism between labetalol HCl and halothane anesthesia has been shown (see PRECAUTIONS: Drug Interactions ). Rapid Decreases of Blood Pressure Caution must be observed when reducing severely elevated blood pressure. A number of adverse reactions, including cerebral infarction, optic nerve infarction, angina, and ischemic changes in the electrocardiogram, have been reported with other agents when severely elevated blood pressure was reduced over time courses of several hours to as long as 1 or 2 days. The desired blood pressure lowering should therefore be achieved over as long a period of time as is compatible with the patient's status. PRECAUTIONSGeneral Impaired Hepatic Function Labetalol hydrochloride injection should be used with caution in patients with impaired hepatic function since metabolism of the drug may be diminished. Hypotension Symptomatic postural hypotension (incidence, 58%) is likely to occur if patients are tilted or allowed to assume the upright position within 3 hours of receiving labetalol hydrochloride injection. Therefore, the patient's ability to tolerate an upright position should be established before permitting any ambulation. Following Coronary Artery Bypass Surgery In one uncontrolled study, patients with low cardiac indices and elevated systemic vascular resistance following intravenous labetalol HCl experienced significant declines in cardiac output with little change in systemic vascular resistance. One of these patients developed hypotension following labetalol treatment. Therefore, use of labetalol HCl should be avoided in such patients. High Dose Labetalol Administration of up to 3 g/d as an infusion for up to 2 to 3 days has been anecdotally reported; several patients have experienced hypotension or bradycardia. Jaundice or Hepatic Dysfunction (see WARNINGS ). Information for Patients The following information is intended to aid in the safe and effective use of this medication. It is not a disclosure of all possible adverse or intended effects. During and immediately following (for up to 3 hours) labetalol hydrochloride injection, the patient should remain supine. Subsequently, the patient should be advised on how to proceed gradually to become ambulatory and should be observed at the time of first ambulation. When the patient is started on labetalol hydrochloride tablets following adequate control of blood pressure with labetalol hydrochloride injection, appropriate directions for titration of dosage should be provided (see DOSAGE AND ADMINISTRATION ). As with all drugs with beta-blocking activity, certain advice to patients being treated with labetalol HCl is warranted. While no incident of the abrupt withdrawal phenomenon (exacerbation of angina pectoris) has been reported with labetalol HCl, dosing with labetalol hydrochloride tablets should not be interrupted or discontinued without a physician's advice. Patients being treated with labetalol hydrochloride tablets should consult a physician at any signs or symptoms of impending cardiac failure or hepatic dysfunction (see WARNINGS ). Also, transient scalp tingling may occur, usually when treatment with labetalol hydrochloride tablets is initiated (see ADVERSE REACTIONS ). Laboratory Tests Routine laboratory tests are ordinarily not required before or after IV labetalol HCl. In patients with concomitant illnesses, such as impaired renal function, appropriate tests should be done to monitor these conditions. Drug Interactions Since labetalol hydrochloride injection may be administered to patients already being treated with other medications, including other antihypertensive agents, careful monitoring of these patients is necessary to detect and treat promptly any undesired effect from concomitant administration. In one survey, 2.3% of patients taking labetalol HCl orally in combination with tricyclic antidepressants experienced tremor as compared to 0.7% reported to occur with labetalol HCl alone. The contribution of each of the treatments to this adverse reaction is unknown, but the possibility of a drug interaction cannot be excluded. Drugs possessing beta-blocking properties can blunt the bronchodilator effect of beta-receptor agonist drugs in patients with bronchospasm; therefore, doses greater than the normal antiasthmatic dose of beta-agonist bronchodilator drugs may be required. Cimetidine has been shown to increase the bioavailability of labetalol HCl administered orally. Since this could be explained either by enhanced absorption or by an alteration of hepatic metabolism of labetalol HCl, special care should be used in establishing the dose required for blood pressure control in such patients. Synergism has been shown between halothane anesthesia and intravenously administered labetalol HCl. During controlled hypotensive anesthesia using labetalol HCl in association with halothane, high concentrations (3% or above) of halothane should not be used because the degree of hypotension will be increased and because of the possibility of a large reduction in cardiac output and an increase in central venous pressure. The anesthesiologist should be informed when a patient is receiving labetalol HCl. Labetalol HCl blunts the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effect. If labetalol HCl is used with nitroglycerin in patients with angina pectoris, additional antihypertensive effects may occur. Care should be taken if labetalol is used concomitantly with calcium antagonists of the verapamil type. Risk of Anaphylactic Reaction While taking beta-blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. Drug/Laboratory Test Interactions The presence of labetalol metabolites in the urine may result in falsely elevated levels of urinary catecholamines, metanephrine, normetanephrine, and vanillylmandelic acid when measured by fluorimetric or photometric methods. In screening patients suspected of having a pheochromocytoma and being treated with labetalol HCl, a specific method, such as a high performance liquid chromatographic assay with solid phase extraction (e.g., J Chromatogr 385:241,1987) should be employed in determining levels of catecholamines. Labetalol HCl has also been reported to produce a false-positive test for amphetamine when screening urine for the presence of drugs using the commercially available assay methods Toxi-Lab A ® (thin-layer chromatographic assay) and Emit-d.a.u. ® (radioenzymatic assay). When patients being treated with labetalol have a positive urine test for amphetamine using these techniques, confirmation should be made by using more specific methods, such as a gas chromatographic-mass spectrometer technique. Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term oral dosing studies with labetalol HCl for 18 months in mice and for 2 years in rats showed no evidence of carcinogenesis. Studies with labetalol HCl using dominant lethal assays in rats and mice and exposing microorganisms according to modified Ames tests showed no evidence of mutagenesis. Pregnancy Teratogenic Effects - Pregnancy Category CTeratogenic studies were performed with labetalol in rats and rabbits at oral doses up to approximately six and four times the maximum recommended human dose (MRHD), respectively. No reproducible evidence of fetal malformations was observed. Increased fetal resorptions were seen in both species at doses approximating the MRHD. A teratology study performed with labetalol in rabbits at IV doses up to 1.7 times the MRHD revealed no evidence of drug-related harm to the fetus. There are no adequate and well-controlled studies in pregnant women. Labetalol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Nonteratogenic Effects Hypotension, bradycardia, hypoglycemia, and respiratory depression have been reported in infants of mothers who were treated with labetalol HCl for hypertension during pregnancy. Oral administration of labetalol to rats during late gestation through weaning at doses of two to four times the MRHD caused a decrease in neonatal survival. Labor and Delivery Labetalol HCl given to pregnant women with hypertension did not appear to affect the usual course of labor and delivery. Nursing Mothers Small amounts of labetalol (approximately 0.004% of the maternal dose) are excreted in human milk. Caution should be exercised when labetalol hydrochloride injection is administered to a nursing woman. Pediatric Use Safety and effectiveness in pediatric patients have not been established. ADVERSE REACTIONSLabetalol hydrochloride injection is usually well tolerated. Most adverse effects have been mild and transient and, in controlled trials involving 92 patients, did not require labetalol HCl withdrawal. Symptomatic postural hypotension (incidence, 58%) is likely to occur if patients are tilted or allowed to assume the upright position within 3 hours of receiving labetalol hydrochloride injection. Moderate hypotension occurred in 1 of 100 patients while supine. Increased sweating was noted in 4 of 100 patients, and flushing occurred in 1 of 100 patients. The following also were reported with labetalol hydrochloride injection with the incidence per 100 patients as noted: Cardiovascular System Ventricular arrhythmia in 1. Central and Peripheral Nervous Systems Dizziness in 9, tingling of the scalp/skin in 7, hypoesthesia (numbness) and vertigo in 1 each. Gastrointestinal System Nausea in 13, vomiting in 4, dyspepsia and taste distortion in 1 each. Metabolic Disorders Transient increases in blood urea nitrogen and serum creatinine levels occurred in 8 of 100 patients; these were associated with drops in blood pressure, generally in patients with prior renal insufficiency. Psychiatric Disorders Somnolence/yawning in 3. Respiratory System Wheezing in 1. Skin Pruritus in 1. The incidence of adverse reactions depends upon the dose of labetalol HCl. The largest experience is with oral labetalol HCl (see labetalol HCl tablet product information for details). Certain of the side effects increased with increasing oral dose, as shown in the following table that depicts the entire U. S. therapeutic trials data base for adverse reactions that are clearly or possibly dose related. Labetalol HCl Daily Dose (mg) 200 300 400 600 800 900 1200 1600 2400Number of patients 522 181 606 608 503 117 411 242 175Dizziness (%) 2 3 3 3 5 1 9 13 16Fatigue 2 1 4 4 5 3 7 6 10Nausea <1 0 1 2 4 0 7 11 19Vomiting 0 0 <1 <1 <1 0 1 2 3Dyspepsia 1 0 2 1 1 0 2 2 4Paresthesia 2 0 2 2 1 1 2 5 5Nasal stuffiness 1 1 2 2 2 2 4 5 6Ejaculation failure 0 2 1 2 3 0 4 3 5Impotence 1 1 1 1 2 4 3 4 3Edema 1 0 1 1 1 0 1 2 2In addition, a number of other less common adverse events have been reported: Cardiovascular Hypotension, and rarely, syncope, bradycardia, heart block. Liver and Biliary System Hepatic necrosis, hepatitis, cholestatic jaundice, elevated liver function tests. Hypersensitivity Rare reports of hypersensitivity (e.g., rash, urticaria, pruritus, angioedema, dyspnea) and anaphylactoid reactions. The oculomucocutaneous syndrome associated with the beta-blocker practolol has not been reported with labetalol HCl during investigational use and extensive foreign marketing experience. Clinical Laboratory Tests Among patients dosed with labetalol hydrochloride tablets, there have been reversible increases of serum transaminases in 4% of patients tested and, more rarely, reversible increases in blood urea. OVERDOSAGEOverdosage with labetalol HCl causes excessive hypotension that is posture sensitive and, sometimes, excessive bradycardia. Patients should be placed supine and their legs raised if necessary to improve the blood supply to the brain. If overdosage with labetalol HCl follows oral ingestion, gastric lavage or pharmacologically induced emesis (using syrup of ipecac) may be useful for removal of the drug shortly after ingestion. The following additional measures should be employed if necessary: Excessive bradycardia —administer atropine or epinephrine. Cardiac failure —administer a digitalis glycoside and a diuretic. Dopamine or dobutamine may also be useful. Hypotension —administer vasopressors, e.g., norepinephrine. There is pharmacologic evidence that norepinephrine may be the drug of choice. Bronchospasm —administer epinephrine and/or an aerosolized beta 2 -agonist. Seizures—administer diazepam. In severe beta-blocker overdose resulting in hypotension and/or bradycardia, glucagon has been shown to be effective when administered in large doses (5 to 10 mg rapidly over 30 seconds, followed by continuous infusion of 5 mg/h that can be reduced as the patient improves). Neither hemodialysis nor peritoneal dialysis removes a significant amount of labetalol from the general circulation (<1%). The oral LD 50 value of labetalol HCl in the mouse is approximately 600 mg/kg and in the rat is greater than 2 g/kg. The IV LD 50 in these species is 50 to 60 mg/kg. DOSAGE AND ADMINISTRATIONLabetalol hydrochloride injection is intended for IV use in hospitalized patients. DOSAGE MUST BE INDIVIDUALIZED depending upon the severity of hypertension and the response of the patient during dosing. Patients should always be kept in a supine position during the period of IV drug administration. A substantial fall in blood pressure on standing should be expected in these patients. The patient's ability to tolerate an upright position should be established before permitting any ambulation, such as using toilet facilities. Either of two methods of administration of labetalol hydrochloride injection may be used: a) repeated IV injection, or b) slow continuous infusion. Repeated Intravenous Injection Initially, labetalol hydrochloride injection should be given in a 20 mg dose (which corresponds to 0.25 mg/kg for an 80 kg patient) by slow IV injection over a 2-minute period. Immediately before the injection and at 5 and 10 minutes after injection, supine blood pressure should be measured to evaluate response. Additional injections of 40 or 80 mg can be given at 10-minute intervals until a desired supine blood pressure is achieved or a total of 300 mg of labetalol HCl has been injected. The maximum effect usually occurs within 5 minutes of each injection. Slow Continuous Infusion Labetalol hydrochloride injection is prepared for continuous IV infusion by diluting the vial contents with commonly used IV fluids (see below). Examples of two methods of preparing the infusion solution are: Add 40 m L of labetalol hydrochloride injection to 160 m L of a commonly used IV fluid such that the resultant 200 m L of solution contains 200 mg of labetalol HCl, 1 mg/m L. The diluted solution should be administered at a rate of 2 m L/min to deliver 2 mg/min. Alternatively, add 40 m L of labetalol hydrochloride injection to 250 m L of a commonly used IV fluid. The resultant solution will contain 200 mg of labetalol HCl, approximately 2 mg/3 m L. The diluted solution should be administered at a rate of 3 m L/min to deliver approximately 2 mg/min. The rate of infusion of the diluted solution may be adjusted according to the blood pressure response, at the discretion of the physician. To facilitate a desired rate of infusion, the diluted solution can be infused using a controlled administration mechanism, e.g., graduated burette or mechanically driven infusion pump. Since the half-life of labetalol is 5 to 8 hours, steady-state blood levels (in the face of a constant rate of infusion) would not be reached during the usual infusion time period. The infusion should be continued until a satisfactory response is obtained and should then be stopped and oral labetalol HCl started (see below). The effective IV dose is usually in the range of 50 to 200 mg. A total dose of up to 300 mg may be required in some patients. Blood Pressure Monitoring The blood pressure should be monitored during and after completion of the infusion or IV injection. Rapid or excessive falls in either systolic or diastolic blood pressure during IV treatment should be avoided. In patients with excessive systolic hypertension, the decrease in systolic pressure should be used as an indicator of effectiveness in addition to the response of the diastolic pressure. Initiation of Dosing with Labetalol Tablets Subsequent oral dosing with labetalol tablets should begin when it has been established that the supine diastolic blood pressure has begun to rise. The recommended initial dose is 200 mg, followed in 6 to 12 hours by an additional dose of 200 or 400 mg, depending on the blood pressure response. Thereafter, inpatient titration with labetalol tablets may proceed as follows: Inpatient Titration Instructions* If needed, the total daily dose may be given in three divided doses. Regimen Daily Dose *200 mg b.i.d. 400 mg400 mg b.i.d. 800 mg800 mg b.i.d. 1600 mg1200 mg b.i.d. 2400 mg The dosage of labetalol tablets used in the hospital may be increased at 1-day intervals to achieve the desired blood pressure reduction. For subsequent outpatient titration or maintenance dosing, see DOSAGE AND ADMINISTRATION in the labetalol tablets Product Information for additional recommendations. Compatibility with Commonly Used Intravenous Fluids Parenteral drug products should be inspected visually for particulate matter and discoloration before administration whenever solution and container permit. Labetalol hydrochloride injection was tested for compatibility with commonly used IV fluids at final concentrations of 1.25 to 3.75 mg of labetalol HCl per milliliter of the mixture. Labetalol hydrochloride injection was found to be compatible with and stable (for 24 hours refrigerated or at room temperature) in mixtures with the following solutions: ringer's injection, USP; lactated ringer's injection, USP; 5% dextrose and ringer's injection; 5% lactated ringer's and 5% dextrose injection; 5% dextrose injection, USP; 0.9% sodium chloride injection, USP; 5% dextrose and 0.2% sodium chloride injection, USP; 2.5% dextrose and 0.45% sodium chloride injection, USP; 5% dextrose and 0.9% sodium chloride injection, USP; and 5% dextrose and 0.33% sodium chloride injection, USP. Labetalol hydrochloride injection was NOT compatible with 5% sodium bicarbonate injection, USP. Care should be taken when administering alkaline drugs, including furosemide, in combination with labetalol. Compatibility should be assured prior to administering these drugs together. HOW SUPPLIEDLabetalol Hydrochloride Injection, USP, is supplied as follows: NDC Labetalol Hydrochloride Injection, USP (5 mg per m L) Package Factor25021-300-20 100 mg in a 20 m L Multi-Dose Vial 1 vial per carton25021-300-40 200 mg in a 40 m L Multi-Dose Vial 1 vial per carton Storage Conditions Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature. ]Protect from freezing and light. Retain in carton until time of use. LATEX-FREESterile, Nonpyrogenic. SAGENT ®Mfd. for SAGENT Pharmaceuticals Schaumburg, IL 60195 (USA) Made in India ©2009 Sagent Pharmaceuticals, Inc. Rev. : April 2009PACKAGE LABEL – PRINCIPAL DISPLAY PANEL – VIAL LABELNDC 25021-300-20PROFESSIONAL SAMPLE – NOT FOR SALERx only Labetalol Hydrochloride Injection, USP 100 mg per 20 m LPACKAGE LABEL – PRINCIPAL DISPLAY PANEL – CARTONNDC 25021-300-20PROFESSIONAL SAMPLE – NOT FOR SALERx only Labetalol Hydrochloride Injection, USP 100 mg per 20 m LPACKAGE LABEL – PRINCIPAL DISPLAY PANEL – VIAL LABELNDC 25021-300-40PROFESSIONAL SAMPLE – NOT FOR SALERx only Labetalol Hydrochloride Injection, USP 200 mg per 40 m LPACKAGE LABEL – PRINCIPAL DISPLAY PANEL – CARTONNDC 25021-300-40PROFESSIONAL SAMPLE – NOT FOR SALERx only Labetalol Hydrochloride Injection, USP 200 mg per 40 m LLABETALOLlabetalol hydrochloride injection Product Information Product Type HUMAN PRESCRIPTION DRUG NDC Product Code (Source) 25021-300Route of Administration INTRAVENOUS DEA Schedule Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength Labetalol Hydrochloride (Labetalol) Labetalol Hydrochloride 5 mg in 1 m LInactive Ingredients Ingredient Name Strength Anhydrous Dextrose 45 mg in 1 m LEdetate Disodium 0.10 mg in 1 m LMethylparaben 0.80 mg in 1 m LPropylparaben 0.10 mg in 1 m LCitric Acid Monohydrate Sodium Hydroxide Product Characteristics Color Score Shape Size Flavor Imprint Code Contains Packaging# NDC Package Description Multilevel Packaging1 25021-300-20 1 VIAL In 1 CARTON contains a VIAL1 20 m L In 1 VIAL This package is contained within the CARTON (25021-300-20)2 25021-300-40 1 VIAL In 1 CARTON contains a VIAL2 40 m L In 1 VIAL This package is contained within the CARTON (25021-300-40)Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date ANDA ANDA079134 02/17/2010Labeler - Sagent Pharmaceuticals (796852890)Establishment Name Address ID/FEI Operations Strides Arco Limited 676199117 MANUFACTURERevised: 02/2010 Sagent Pharmaceuticals


did eric holder ever recuse himself

s WASHINGTON — Attorney General Eric Holder did not recuse himself from the 2010 search warrant for emails from a Fox News reporter’s personal account, a Justice Department official said Monday evening.

James Rosen Warrant Doesnât Suggest Charges Against Fox News Reporter, DOJ Says

POLITICS 05/20/2013 10:05 pm ET Updated May 26, 2013James Rosen Warrant Doesn’t Suggest Charges Against Fox News Reporter, DOJ Says By Ryan J. Reilly Getty Image

DOJ regulations require the attorney general to approve charges against a journalist or the search warrant for journalist phone records, but that regulation does not appear to apply to journalist emails. The DOJ official, who spoke on the condition of anonymity, said no charges against Rosen were anticipated. Language used by an FBI agent requesting a search warrant made Rosen’s reporting activities out to be part of a criminal conspiracy.“To our knowledge, the Department of Justice has never prosecuted a reporter,” the Justice Department official told The Huffington Post. “No reporter has ever been charged by the Department of Justice simply for publishing information obtained through an illegal leak of classified information by a government official. At this time, we do not anticipate bringing any additional charges in this matter.”Holder, during testimony before the House Judiciary Committee last week, said that targeting journalists had not “fared well in American history” and suggested there was a high bar for prosecutions. The focus, he said, “should be on those people who break their oath and put the American people at risk, not the reporters who gather the information.”CORRECTION: This article has been edited to note that Rosen’s emails were searched as a result of a search warrant, not a subpoena. Do you have information you want to share with Huff Post? Here’s how. BEFORE YOU GOPHOTO GALLERYEric Holder In The Hot Seat Ryan J. Reilly Justice Reporter, The Huffington Post Suggest a correction MORE: Leak Prosecutions James Rosen Subpoena Doj James Rosen Doj Fox News


what time is the mavericks game

The Cleveland Cavaliers vs. Dallas Mavericks game is scheduled for an 8:30 p.m. Eastern Time start. To watch tonight’s game, fans have a variety of options. In the Cleveland viewing region, television coverage comes through Fox Sports Ohio. In the Dallas region, TV coverage is available on Fox Sports South West (FSSW).

November 11, 2017Watch Cavs Vs. Mavericks 2017 Online: Live Streaming, TV Channel, Time, And Odds Basketball Matt Couden Basketball fans will watch the Cavs vs. Mavericks game live streaming online and on television as Cleveland tries to move closer to .500 this season. The team has had its early struggles en route to a 5-7 record, but will take on a team doing even worse. The Dallas Mavericks have won just twice in their first 12 games of the NBA season, but the Mavs feature promising young rookie Dennis Smith, Jr. on the roster, along with longtime star Dirk Nowitzki. Here’s tonight’s game preview with the point spread, points total, TV channels, start time, and Cavs vs. Mavs live streaming online options. In what may be surprising to NBA fans, Cleveland is nowhere near the top of the Eastern Conference after their first dozen games. The team is banged up with Isaiah Thomas out until midseason and Derrick Rose recently sidelined. As ESPN reported in their preview of tonight’s game, the Cavaliers’ early-season issues have also come on the defensive side of things. The team has lost six of their last eight games, including a road loss to Houston on Thursday, ahead of this next away game at Dallas. The Cavs have given up 112 points or more in their last 10 games, showing their inabilities to stop opponents from putting up points against them. Luckily, they’ll take on a team that has trouble scoring, as the Mavericks are averaging just 99.2 points per game this season. Dallas is just 2-10 overall so far this season with a 1-5 home record. Most recently, they picked up that second win of the season on the road, with a 113-99 victory over John Wall and the Washington Wizards. Harrison Barnes led the way with 31 points on 11-for-18 shooting, while rookie Dennis Smith, Jr. added 22 points, eight assists, and eight rebounds. So far, Smith has showcased why he’s among the early possible candidates for at least NBA Rookie First team and possibly 2017-18 NBA Rookie of the Year. As Odds Shark indicated in their betting preview, the Cleveland Cavaliers are six-point favorites on the road tonight. The Dallas Mavs are +195 to +205 underdogs while the Cavs will be -235 favorites at several sportsbooks. For the over/under, bettors are looking at a total of 215.5 points for the consensus, as of this report. Neither team has done well against the spread over their first 12 games of the season. The Cavs are just 3-8-1 ATS, while Dallas is 3-9 ATS. The Mavs are also 5-7 for the over/under, while the Cavs are 8-4 against the number in their games this season. Le Bron James Best Play From Every Career 50-Point Game Your browser does not currently recognize any of the video formats available. Click here to visit our frequently asked questions about HTML5 video.0:00 / 2:15

Live streaming is available for cable and satellite subscribers in these regions on the Fox Sports Go website or compatible apps. Tonight’s Cavs vs. Mavs game is also live streaming through NBA League Pass. The subscription service is available for a starting price of $17.99 for a season pass. In addition, the game can be purchased individually for $6.99 tonight. More details are available at the NBA League Pass site. [Featured Image by LM Otero/AP Images]


what does screaming mean

Dictionary entry overview: What does screaming mean?• SCREAMING (noun) The noun SCREAMING has 2 senses:1. sharp piercing cry 2. a high-pitched noise resembling a human cry Familiarity information: SCREAMING used as a noun is rare.• SCREAMING (adjective) The adjective SCREAMING has 4 senses:1. loud and sustained; shrill and piercing 2. so extremely intense as to evoke screams 3. resembling a scream in effect

SCREAMING

"Audio English.org » Dictionary » S » Scraper ... Screw-pine Family SCREAMINGPronunciation (US):

4. marked by or causing boisterous merriment or convulsive laughter Familiarity information: SCREAMING used as an adjective is uncommon. Dictionary entry details• SCREAMING (noun)Sense 1 screaming [BACK TO TOP]Meaning: Sharp piercing cry Classified under: Nouns denoting communicative processes and contents Synonyms:scream; shrieking; shriek; screaming; screeching; screech Context example:her screaming attracted the neighbors Hypernyms (""screaming"" is a kind of...):call; cry; outcry; shout; vociferation; yell (a loud utterance; often in protest or opposition)Sense 2 screaming [BACK TO TOP]Meaning: A high-pitched noise resembling a human cry Classified under: Nouns denoting natural events Synonyms:screech; screeching; shrieking; shriek; screaming; scream Context examples:he ducked at the screechings of shells / he heard the scream of the brakes Hypernyms (""screaming"" is a kind of...):noise (sound of any kind (especially unintelligible or dissonant sound))• SCREAMING (adjective)Sense 1 screaming [BACK TO TOP]Meaning: Loud and sustained; shrill and piercing Synonyms:screaming; screeching; shrieking Context examples:hordes of screaming fans / a screaming jet plane / a screaming fury of sound / a screeching parrot / screeching brakes / a horde of shrieking fans / shrieking winds Similar:noisy (full of or characterized by loud and nonmusical sounds)Sense 2 screaming [BACK TO TOP]Meaning: So extremely intense as to evoke screams Context examples:in screaming agony / a screaming rage Similar:intense (in an extreme degree)Sense 3 screaming [BACK TO TOP]Meaning: Resembling a scream in effect Context examples:screaming headlines / screaming colors and designs Similar:sensational (causing intense interest, curiosity, or emotion)Sense 4 screaming [BACK TO TOP]Meaning: Marked by or causing boisterous merriment or convulsive laughter Synonyms:hilarious; uproarious; screaming Context examples:hilarious broad comedy / a screaming farce / uproarious stories Similar:humorous; humourous (full of or characterized by humor)Learn English with... Proverbs of the week""The early bird gets the worm, but the second mouse gets the cheese."" (English proverb) ""Who starts making the dough, will also cook."" (Albanian proverb) ""Never give advice in a crowd."" (Arabic proverb) ""Haste and speed are rarely good"" (Dutch proverb)SCREAMING: related words searches» call: pronunciation in phonetic transcription » Meaning of outcry » yell: pronunciation in phonetic transcription » What does noise mean? » humorous meaning SCREAKYSCREAMSCREAMERSCREAMINGSCREAMING MEEMIESSCREAMINGLYSCREESCREECHSCREECH OWLSCREECHEREnglish learning courses About Practical English About Telephone English About Accounting English Learn English Free English Language Dictionary British and American English pronunciation Other popular searches:» what does tentative mean » plane figure » what does hinder mean » ceylon » what does crank that mean Page delivered in 0.119 seconds "


what is ginrou

2Ginrou ( ギンロウ, Ginrou?) is an AGI-type player in the VRMMORPG, Gun Gale Online. He is a member of Dyne 's Pv P (anti-personnel) squad that targets weaker, low-risk opponents. Ginrou's evasion skills in face-to-face combat is known to be above average.

Ginrou

Spoiler Alert: This article or section contains details about plotlines not covered in the anime. Do not proceed unless you wish to be spoiled. Ginrou Personal Information Avatar Name (Japanese) [? ]ギンロウ (Ginrou)System Name [? ]Ginrou Gender Male VR World (s)Gun Gale Online Media Voiced By Katsu Anri [1] ( 勝 杏里)Voiced By (English)Ben Diskin [2]First Appearance Novel Volume 5 Chapter 3Manga Phantom Bullet Chapter 1Anime SII Episode 0

[3]Contents [ show]Appearance Edit Ginrou has mohawk-style light brown hair. [4] He wears a tight, dark top, green trousers, brown boots, black fingerless gloves and white goggles [4] Ginrou's weapon of choice is a live ammo type «H&K UMP» sub-machine gun. [3]Personality Edit Ginrou is a cocky player, as he underestimates the power of his opponents and believes that he can easily keep them occupied at close range to stall for time. [4] Ginrou is also a person who tries to hit on women, though has never succeeded in both the virtual world, nor the real world. Chronology Edit Phantom Bullet Arc Edit While waiting for the Mob hunting party to show up, he attempted to invite Sinon for a cup of tea, but was rejected, because Sinon thought that he was not worth remembering. Ginrou later leads a group of 3 attackers from the squadron against the Mob hunting party, but is the first one to be killed by Behemoth 's Minigun fire. Gallery Edit Ginrou's design from the OS Production Book Ginrou showing off. Ginrou under fire by Behemoth. References Edit↑ SII Episode 2 credits↑ https://twitter.com/Benjamin Diskin/status/584551454624460800↑ 3.0 3.1 Volume 5, Chapter 3↑ 4.0 4.1 4.2 SII Episode 02Navigation Edit [ v e] Characters Major Characters Alice Zuberg - Asada Shino (Sinon) - Ayano Keiko (Silica) - Eugeo - Kayaba Akihiko - Kikuoka Seijirou - Kirigaya Kazuto (Kirito) - Kirigaya Suguha (Leafa) - Shinozaki Rika (Lisbeth) - Tsuboi Ryoutarou (Klein) - Yui - Yuuki Asuna (Asuna)SAO Players Aincrad Liberation Force /ALS Hokkaiikura - Joe - Kibaou - Kobatz - Liten - Melonmask - Okotan - Schinkenspeck - Thinker - Yulier - Yakumo Divine Dragon Alliance /DKBHafner - Lind - Morte - Schmitt - Shivata - Yamata Fuumaningun Isuke - Kotaru Fuurinkazan Dale - Dynamm - Harry One - Issin - Klein - Kunimttz Golden Apple Caynz - Grimlock - Griselda - Schmitt - Yolko Knights of the Blood Asuna - Daizen - Godfree - Heathcliff - Kirito - Kuradeel - Nautilus Laughing Coffin Johnny Black - Kuradeel - Po H - Xa Xa Legend Braves Beowulf - Cu Chulainn - Enkidu - Gilgamesh - Nezha - Orlando Moonlit Black Cats Ducker - Keita - Kirito - Sachi - Sasamaru - Tetsuo Titan's Hand Rosalia Agil's guild Agil - Wolfgang Others Argo - Ashley - Ceba - Coper - Diavel - Gin - Gwen - Kein - Lisbeth - Lux - Mina - Nishida - Rossa - Ryufior - Sasha - Silica - Yuna Beta-Tester Argo - Coper - Diavel - Isuke - Kotaru - Morte - Kirito NPC Angel - Kizmel - Lion - NPC Orchestra - Pina - Ruru - Scarecrow - Tilnel - Tin - Toto - Yui Non-Canon Aaaa - Alberich - Leafa - Philia - Rain - Sinon - Strea - Yuuki ALO Players Cait Sith Alicia Rue - Silica - Sinon Gnome Agil - Tecchi Imp Yuuki Leprechaun Lisbeth - Ceba - Talken Pooka Sasha Salamander Eugene - fastuosa - Gtacs - Jun - Kagemune - Klein - Mortimer - Uxper XJSpriggan Kirito - Kuro - Nori Sylph Erika - Fukaziroh - Leafa - Lux - Recon - Sakuya - Sigurd Undine Asuna - Chrysheight - Siune - Thinker - Yulier NPC / Navigation Pixie Angel - Emely - Hraesvelg - Leviathan - Nerakk - NPC Orchestra - Pina - Skuld - Thiazi - Thor - Thrym - Tonky - Urðr - Verðandi - Yui Others/Unknown Ashley - Fairy King Oberon - Gwen - Marinca - Saitou Shouichi - Slug Researchers Non-Canon Alice Zuberg - Argo - Black Lotus - Eugeo - Heathcliff - Philia - Rain - Sachi - Seven - Strea - Sumeragi - Yuna GGO Players Dyne's Squadron Arashi - Dyne - Ginrou - Jin - Miso - Sinon Bo B Participants Blackwood - Colonel Liberty - DA*LU - David - Dyne - E. J. - Fernil - Garrett - huuka - Jack Reacher - JIGEN - Kakouton - kaeeeede - Kakameposu the II - Keith - Kirito - Lion King Richie - Masaya - Musketeer X - No-No - Pale Rider - Pancho - Raiden - Licoco - Setsugekka - Shishigane - Sinon - Sterben - Stinger - Subtilizer - Ten-Q - Uemaru - Usujio Tarako - Yamikaze - Xe Xee D - XYZDeath Gun Victims Garrett - Pale Rider - Usujio Tarako - Xe Xee DSquad Jam Participants LPFM Fukaziroh - LLENN - M - Pitohui SH-NC Anna - Eva - Rosa - Sophie - Tanya - Tohma MMTM Bolt - David - Jake - Lax KKHC Shirley ZAT Benjamin - Casa - Frost - Koenig - Yamada - Let's Play Host Others Clarence Others Behemoth - Spiegel Underworld Resident Human Empire Rulid Village Algu - Alice Zuberg - Bercouli - Donetti - Doyke - Eugeo - Garitta - Gasupht Zuberg - Ivenda - Jaina - Jink - Kirito - Nigel Balbossa - Orick - Ridack - Sadina Zuberg - Selka Zuberg - Sister Azariya - Sulinea Zakkaria Banou Wolde - Egome Zakkalight - Kelgam Zakkalight - Telin Wolde - Telulu Wolde - Toriza Wolde Centoria Azurika - Cardinal - Quinella - Sadore Sword Mastery Academy Azurika - Eugeo - Frenica Szeski - Gorgolosso Baltoh - Humbert Zizek - Kirito - Raios Antinous - Ronye Arabel - Sortiliena Serlut - Tiese Shtolienen - Uolo Levanteinn - Zobun Central Cathedral Cardinal - Charlotte - Chudelkin - Elevating Operator - Fizel - Linel - Quinella Integrity Knight Alice Zuberg - Bercouli - Dakira - Deusolbert - Eldrie Woolsburg - Eugeo - Fanatio - Fizel - Giro - Hobren - Jeis - Linel - Renri - Scheta Dragons Himawari - Hinageshi - Hoshigami - Kazenui - Shimosaki - Takiguri - Tsukigake - Yoiyobi Others Almera Woolsburg - Eschdol Woolsburg Dark Territory Black Iums D. I. L - Dampe - Fu Za - Iskahn - Lengil Gira Scobo - Lipia Zankale - Viksul Ur Shasta - Yotte Orcs Fulgrr - Renju - Rilpirin Giants Sigrosig Goblins Aburi - Hagashi - Kubiri - Oroi - Shibori - Ugachi Underworld Visitors Agil - Alicia Rue - Asuna - Eugene - Gabriel Miller - Hirono Takashi - Jun - Kirito - Klein - Leafa - Lisbeth - Moonphase - Nori - Sakuya - Silica - Sinon - Siune - Tecchi - Vassago Asuka Empire Players Players Clevel - Koyomi - Merida - Nayuta - Ran - Yanagi - Yuuki NPC Kitsune-masked child Reality/Other Games Rath Aki Natsuki - Higa Takeru - Hiraki - Ichiemom - Kikuoka Seijirou - Koujiro Rinko - Nakanishi - Niemom - Yanai Others Alicia Klingerman - Cel - Clovis - Critter - Doctor Kurahashi - Eiji - Endou - Fujita Shin - Kirigaya Midori - Okano Kouji - Sada Akiyo - Satou Rei - Shigemura Tetsuhiro - Yuna - Yuuki Kouichirou - Yuuki Kyouko - Yuuki Shouzou Non-Canon Genesis - Premiere - Richter - Tia Categories: Characters Male GGO Players Players Add category Languages: Español Русский


what is the difference between a medical doctor and a doctor of osteopathic

MD is short for Medical Doctor. This type of doctor has an allopathic degree. DO stands for Doctor of Osteopathic Medicine. This type of doctor has an osteopathic degree. Like an MD, a Doctor of Osteopathic Medicine (DO) is licensed to practice medicine in any field they choose to specialize in. For example, I practice family medicine, but a DO can be anything from a family doctor or internist to a general surgeon, orthopedic surgeon, neurosurgeon or psychiatrist.

What is the difference between a DO and an MD?

Andrew R. Robinson, DO on behalf of Lone Peak Hospital Family Medicine An MD and DO are different types of doctors.

DO and MD doctors are alike in that they both use scientifically-accepted methods to diagnose and treat you. This may include using prescription drugs and surgery. Here's how they are different. Unlike an MD, a DO follows a universal approach to practicing medicine. That means he sees you as a whole -- not just your symptoms or injuries. This approach believes that all the body systems are interconnected. It also thinks your muscles, bones, and supporting structures (musculoskeletal system) play an important role in the condition of all the other systems. There are currently more MDs working than DOs. However, more than 30% of doctors graduating from medical school today are from osteopathic schools. This is likely to go up as the need for doctors -- and the recognition of DOs -- grows. This content originally appeared on http://blog.mountainstar.com/Shelley Webb Nursing The difference between a DO (Doctor of Osteopathic Medicine) and an MD (Doctor of Medicine) is really a difference in philosophy. While medical doctors (which are based on allopathic medicine) evaluate the disease within their patient in terms of how it affects only certain parts of the body, the osteopathic doctor evaluates the disease within the body as a complex related network. Both types of doctors are licensed to practice medicine, write prescriptions and perform surgery. Both require 4 years of undergraduate study in either pre-medicine or a related science. Both require 4 additional years of medical training before being allowed to take their medical exams (which are comparably difficult but yet not quite the same). Both a medical doctor and a doctor of osteopathic medicine may elect to choose a specialty which would require between 2 and 6 years of additional training. Continue Learning about Osteopathic Medicine Related to Osteopathic Medicine Chiropractic Treatment Massage Therapy Energy Work & Reiki Physical Therapy Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs. Trending on Sharecare


what are hcp

HCP, Inc. is a real estate investment trust which invests primarily in real estate serving the healthcare industry in the United States. It acquires, develops, leases, sells and manages healthcare real estate and provides mortgage and other financing to healthcare providers.

HCP Inc.

Home Investing Quotes Stocks United States HCP Overview Compare Quotes Stock Screener Earnings Calendar Sectors NYSEHCP U. S.: NYSEHCP Inc. Watch list Create HCP Alert After Hours Last Updated: Nov 2, 2017 5:06 p.m. EDTDelayed quote$26.950.00 0.00%After Hours Volume: 35.6KClose Chg Chg %$26.95 0.93 3.57%Advanced Charting$ % Vol232.3% vs Avg. Volume: 8.2M 65 Day Avg. - 3.5MOpen: 26.97Close: 26.9526.71 Day Low/High 27.62Day Range25.09 52 Week Low/High 33.67Your Watchlist Customize Market Watch Have Watchlists? Log in to see them here or sign up to get started. Create Account… or Log In No Recent Tickers Visit a quote page and your recently viewed tickers will be displayed here. Search Tickers Overview Profile News Charts Financials Historical Quotes Analyst Estimates Options SEC Filings Insiders Key Data Open$26.97Day Range26.71 - 27.6252 Week Range25.09 - 33.67Market Cap$12.2BShares Outstanding468.96MPublic Float467.53MBeta0.64Rev. per Employee$11.41MP/E Ratio18.59EPS$1.45Yield5.49%Dividend$0.37Ex-Dividend Date Nov 3, 2017 12:00 a.m. ETShort Interest10.38M 10/13/17% of Float Shorted2.22%Average Volume3.52MPerformance5 Day5.40%1 Month0.11%3 Month-9.72%YTD-9.32%1 Year-8.71%Recent News Market Watch Other Dow Jones HCP Inc. downgraded to sell from neutral at UBSOct. 2, 2017 at 9:30 a.m. ET by Tomi Kilgore Here’s what will make real estate investing great again Aug. 28, 2017 at 4:35 p.m. ET by John Coumarianos HCP Inc. upgraded to outperform from underperform at Raymond James Jun. 14, 2017 at 8:29 a.m. ET by Tomi Kilgore A contrarian dividend stock play: Some retail REITs Apr. 20, 2017 at 8:07 a.m. ET by Philip van Doorn10 ‘Dividend Aristocrat’ stocks expected to rise up to 22% as you get paid to wait Feb. 2, 2017 at 11:21 a.m. ET by Philip van Doorn Opinion10 REITs that look like big winners for 2017Dec. 9, 2016 at 7:08 a.m. ET by Philip van Doorn HCP upgraded to sector perform from underperform at RBC Capital Nov. 4, 2016 at 6:58 a.m. ET by Tomi Kilgore HCP downgraded to neutral from long-term buy at Hilliard Lyons Nov. 2, 2016 at 9:02 a.m. ET by Tomi Kilgore HCP upgraded to hold from sell at Stifel Nicolaus Nov. 2, 2016 at 8:08 a.m. ET by Tomi Kilgore Opinion Six solid dividend stocks unfairly punished by investors Oct. 23, 2016 at 3:34 p.m. ET by Philip van Doorn‘Dividend Aristocrat’ stocks post almost double the returns of the S&P 500 in 2016Sep. 9, 2016 at 7:08 a.m. ET by Philip van Doorn Opinion REITs, boasting big outperformance, have earned their own sector Sep. 6, 2016 at 4:43 p.m. ET by Philip van Doorn Opinion It’s not too late to buy dividend stocks Aug. 31, 2016 at 9:32 a.m. ET by Philip van Doorn REIT stocks rocked by store closure fears Aug. 12, 2016 at 7:08 a.m. ET by Tomi Kilgore Opinion These 15 REITs beat low interest rates with dividend yields of up to 9.7%Jun. 18, 2016 at 7:39 a.m. ET by Philip van Doorn HCP upgraded to hold from underperform at Jefferies May. 10, 2016 at 8:05 a.m. ET by Tomi Kilgore This one-time event will give a boost to REITs May. 1, 2016 at 7:42 a.m. ET by Philip van Doorn Looking for income? These 23 dividend stocks provide it Apr. 30, 2016 at 10:14 a.m. ET by Philip van Doorn HCP downgraded to neutral from buy at UBSMar. 16, 2016 at 8:56 a.m. ET by Tomi Kilgore These ‘Dividend Aristocrat’ stocks have risen up to 24% a year for a decade Mar. 11, 2016 at 7:46 a.m. ET by Philip van Doorn Other News Press Releases HCP (HCP) Q3 2017 Results - Earnings Call Transcript Nov. 2, 2017 at 11:19 p.m. ET on Seeking Alpha Principal Financial Group Inc Buys Dow Du Pont Inc, Starwood Waypoint Homes, O'Reilly Automotive ... Nov. 2, 2017 at 9:38 p.m. ET on Guru Focus.com HCP Tops Q3 FFO, Guides Up, To Lower Brookdale Concentration Nov. 2, 2017 at 10:14 a.m. ET on Zacks.com HCP Inc (HCP) Q3 FFO and Revenues Beat Estimates Nov. 2, 2017 at 8:07 a.m. ET on Zacks.com HCP Is Making All the Right Moves Nov. 2, 2017 at 12:52 p.m. ET on Motley Fool Big session for REITs as earnings impress and rates pull back Nov. 2, 2017 at 12:19 p.m. ET on Seeking Alpha Brookdale Senior in deal with HCP to hopefully boost sale process Nov. 2, 2017 at 7:43 a.m. ET on Seeking Alpha10-Q: HCP, INC. Nov. 2, 2017 at 7:23 a.m. ET on Edgar Online - (EDG = 10Q, 10K)Notable earnings before Thursday’s open Nov. 1, 2017 at 5:30 p.m. ET on Seeking Alpha What's in the Offing for HCP Inc (HCP) This Earnings Season? Oct. 31, 2017 at 12:01 p.m. ET on Zacks.com Alexandria (ARE) Q3 FFO & Revenues Beat Estimates, Up Y/YOct. 31, 2017 at 10:23 a.m. ET on Zacks.com American Tower (AMT) Tops Earnings & Revenue Estimates in Q3Oct. 31, 2017 at 10:14 a.m. ET on Zacks.com Andra AP-fonden Buys Dow Du Pont Inc, Andeavor, 3M Co, Sells Reynolds American Inc, The ... Oct. 31, 2017 at 1:38 p.m. ET on Guru Focus.com3 Retiree Stocks You'll Want to Buy Now Oct. 31, 2017 at 6:13 a.m. ET on Motley Fool3 Top High-Dividend Stocks on Sale This Quarter Oct. 29, 2017 at 8:07 a.m. ET on Motley Fool Recent Stock Purchase October 2017Oct. 28, 2017 at 7:18 a.m. ET on Seeking Alpha Cousins Properties' (CUZ) Q3 FFO in Line, Revenues Beat Oct. 27, 2017 at 11:03 a.m. ET on Zacks.com AGNC Investment's (AGNC) Stock Down on Q3 Earnings Miss Oct. 27, 2017 at 11:04 a.m. ET on Zacks.com Ventas' (VTR) Q3 FFO In Line With Estimates, Revenues Beat Oct. 27, 2017 at 10:58 a.m. ET on Zacks.com Real Estate Management Services Llc Buys RLJ Lodging Trust, JBG SMITH Properties, HCP Inc, ... Oct. 26, 2017 at 5:38 p.m. ET on Guru Focus.com HCP Inc.

It operates through four segments: Senior Housing Triple-Net, Senior Housing Operating Portfolio, Life Science, and Medical Office. The Senior Housing Triple-Net & Operating Portfolio segments manage senior housing facilities, which include independent living, assisted living and memory care facilities, care homes and continuing care retirement communities by utilizing triple-net leases and RIDEA structures. The Life Science segment contains laboratory and office space primarily for biotechnology, medical device and pharmaceutical companies, scientific research institutions, government agencies and other organizations involved in the life science industry. The Medical Office segment includes pharmacies, hospital ancillary service space and outpatient services such as diagnostic centers, rehabilitation clinics and day-surgery operating rooms. The company was founded in March 1985 and is headquartered in Long Beach, CA. Analyst Ratings Sell Under Hold Over Buy Number of Ratings 21 Full Ratings HCP's Near-Term Outlook Is Worse Than You Think Oct. 2, 2017 at 11:08 a.m. ET on Benzinga.com Benzinga's Top Upgrades, Downgrades For September 25, 2017Sep. 25, 2017 at 9:01 a.m. ET on Benzinga.com Benzinga's Top Upgrades, Downgrades For June 14, 2017Jun. 14, 2017 at 9:19 a.m. ET on Benzinga.com Competitors Name Chg % Market Cap Ventas Inc. 1.22%$22.46BUniversal Health Realty Income Trust 0.59%$1.01BSabra Healthcare REIT Inc. -2.58%$3.59BPhysicians Realty Trust 0.81%$3.09BTiptree Inc. Cl A 3.05%$190.19MCompetitor Data Provided By


what is a student senate

What is Student Senate? The Student Senate is the Campus Student Organization as define by the Minnesota State Colleges and Universities (MNSCU) policy 2.1. The policy assigns the following duties to the Student Senate: That the Student Senate is the official representative for all students That the Senate has the sole authority to recommend the chartering of all clubs to the President of the College MNSCU Policy 2.3 and 2.3.1, and 2.8.1, that the Student Senate has the authority to appoint students, to all college committees, such as Finance, Policy, and Facilities.

STUDENT SENATE

STUDENT SENATEStudent Senate Executive Board Application Position Descriptions - Brooklyn Park Senate Position Descriptions - Eden Prairie Senate Washington DC Summit Application

The policies also require the administration to consult with the Student Senate. Student Senate 101As well as representing students, the Student Senate members are actively involved with the Minnesota State College Student Association. The Association serves to add the Student Senates as well as lobbying the Legislature and MNSCU. Read more on their webpage at www.mscsa.org. To become a voting member of the Student Senate, attend two consecutive meetings. Commonly asked questions: What is the Student Senate? The HTC Student Senate is the voice of the student body in matters affecting student activities. It exists to initiate consideration of student problems, and to communicate action or recommendation to the designated school authorities. Who can be a part of Student Senate? Any full-time or part-time students taking one credit at Hennepin Tech. Why should I join Student Senate? Getting involved in any club or organization can be one of the greatest, most rewarding experiences you will have while you are in college. By joining Student Senate you will have the opportunity to: Network and socialize with students, staff, faculty and administrators Build experience for your resume. Gain invaluable skills for future employment. Build social skills by interacting with people from different cultures and backgrounds. Enhance communication skills. Develop leadership skills by learning to take responsibility and manage challenges. Make friends and have fun!If you would like to be involved, please join us for a meeting on Wednesday’s at noon every other week or contact us: Eden Prairie Campus – studentsenate-epc@hennepintech.edu Brooklyn Park Campus – student.senate-bpc@hennepintech.edu Brooklyn Park Campus Student Senate Webpage Eden Prairie Campus Student Senate Webpage Student Senate Minutes Student Senate By-Laws MN State College Student Association Student Life & Career Development Main Page Last updated by bhucka : 2018-01-10 14:05:41