 Welcome back to our USMLE question of the week. As always, we will begin reading this question at the last sentence so that we know what this question is looking for. Which of the following drugs would be considered first-line treatment for her illness? A 28-year-old female presents to her primary care physician complaining of overwhelming fear and apprehension. The patient states that for the past nine months, she has been feeling anxious and worried about many things on almost a daily basis. She states that she sometimes feels like her heart is racing, but her pulse is never above 100. She has difficulty concentrating and difficulty sleeping because she can't shut her brain off. She also says she often feels tense and restless. She denies past substance abuse. Which of the following drugs would be considered first-line treatment for her illness? So right off the bat, all of these symptoms are telling me this patient is likely dealing with generalized anxiety disorder. We're seeing the fear and apprehension on a nine-month scale, feeling anxious and worried, can't shut their brain off, hearts racing, but they're not tachycardic. So we're dealing with generalized anxiety. We need to find a first-line treatment for generalized anxiety. Amitriptyline is a tricyclic antidepressant that is not first-line for anxiety. Busprone, while it is a possible treatment for anxiety, I don't believe that's a first-line treatment. That's usually often a second-line treatment. So I'm going to mark that one out as well. Sertraline, also known as Zoloft, that definitely is a first-line treatment for anxiety. Flumazanil is a treatment for benzodiazepine overdose, but not for anxiety. So we will rule that out. And then medazolam. Medazolam is a benzodiazepine. However, this is a short-acting benzodiazepine, so we don't use this as a first-line treatment for generalized anxiety disorder, as it does have a high risk of dependency and rebound anxiety. Therefore, my answer would be C. Sertraline or Zoloft. C is the correct answer. This patient is suffering from generalized anxiety, which is marked by several key factors that you must know. First and foremost, this anxiety and worry must be present for most days for greater than or equal to six months of a patient's life. It must affect multiple areas of their life, including work, school, family. And then we also have to have at least three of the following for adult patients. Restlessness, irritability, sleep disturbances, fatigue, muscle tension, and difficulty concentrating. Our first-line treatments include CBT or cognitive behavioral therapy, and our first-line medical treatments is SSRIs and SNRIs. And I know that sertraline is an SSRI, so we would treat sertraline as our first-line medication treatment. I will note that Busebarone and other tricyclic antidepressants like amitripline or benzodiazepines are second-line treatments for generalized anxiety, but we would not use these first.