USMLE Step 3 - Question 31

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

Liver function tests were normal 1 year ago. Which of the following is the most appropriate course of action?

A. Discontinue simvastatin

B. Reduce simvastatin dose

C. Discontinue amlodipine

D. Observation

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