USMLE Step 2 - Question 48

A 56 year old female with a history of hypertension, dyslipidemia, and asthma presents for a routine clinic visit without any specific complaints. Her medications include amlodipine, simvastatin, and albuterol. Vital signs and physical examination are normal. Her laboratory studies are below. 

Total protein - 6.8 g/dL
Albumin  - 4.0 g/dL
AST (SGOT) – 60 U/L  (10-37 U/L)
ALT (SGPT) – 120 U/L  (10-65 U/L)
Total bilirubin - 1.0 mg/dL
Alkaline phosphatase – 100 U/L

Which of the following is the most appropriate course of action?

A. Discontinue simvastatin

B. Reduce simvastatin dose

C. Discontinue amlodipine

D. Observation

Remember that statins (HMG Co-A reductase inhibitors) are safe as long as the AST or ALT do not exceed 2-3 times the upper limit of normal. Our patient has just slightly elevated AST and ALT thus continuing the medication is fine.