advancedvalproatehepatotoxicityliver enzymesammoniabipolar Imedication monitoring
A 48-year-old male presents for psychiatric evaluation after his PCP identified elevated liver enzymes (AST 85, ALT 102). The PCP noted the patient is on multiple psychotropic medications prescribed by a previous psychiatrist: valproate 1000 mg, quetiapine 300 mg, and sertraline 150 mg. The patient has diagnoses of bipolar I disorder and GAD. What should the PMHNP assess FIRST?