Which two medications can be added to a PN solution by pharmacy services?

In parenteral nutrition (PN), certain medications can be safely added to the PN solution to manage specific patient needs. The addition of insulin and heparin is appropriate because both can be used to manage metabolic and thrombotic conditions in patients receiving PN.

Insulin is commonly added to PN solutions to help control blood glucose levels in patients who may develop hyperglycemia, which is a common concern in individuals receiving nutritional support. Heparin, on the other hand, is an anticoagulant that can be included to reduce the risk of thrombosis associated with central venous catheters used for PN administration.

The other combinations of medications listed do not align with safe practices in PN. For example, warfarin is not typically included in a PN solution due to concerns about its interaction with nutrients and other drugs, and acetaminophen is also not intended for addition to PN since it has a different route of administration and therapeutic goals compared to the medications that are suitable for PN admixture. Antibiotics can sometimes be used in PN, but their compatibility with specific formulations, timing of administration, and potential for interactions with other nutrients makes them a less predictable choice compared to insulin and heparin.