A patient is newly diagnosed with atrial fibrillation and is being discharged home today. Their heart rate is controlled at 88 bpm and BP is 121/68. They deny dizziness or fatigue. What medication do we expect this patient will be discharged home with?

Choice A reason:
Amoxicillin is an antibiotic used to treat bacterial infections. It has no role in the management of atrial fibrillation, which is a cardiac rhythm disorder. Antibiotics do not address the prevention of thromboembolism or the control of heart rate or rhythm.

Choice B reason:
Reglan (metoclopramide) is a medication used to treat gastroesophageal reflux disease (GERD) and gastroparesis. It does not have any indication for use in atrial fibrillation. The management of atrial fibrillation focuses on rate or rhythm control and anticoagulation.

Choice C reason:
Rivaroxaban (Xarelto) is an anticoagulant that is commonly prescribed for patients with atrial fibrillation to prevent stroke and systemic embolism. Since atrial fibrillation increases the risk of thromboembolism, anticoagulation is a crucial component of the treatment plan to reduce the risk of stroke.

Choice D reason:
Omeprazole is a proton pump inhibitor used to treat acid-related stomach issues such as GERD. It is not relevant to the management of atrial fibrillation. The primary concerns in managing atrial fibrillation are controlling the heart rate and preventing thromboembolism, which omeprazole does not address.

Choice A reason:
Pulmonary embolism is not a typical complication of a peptic ulcer. While serious, pulmonary embolism is unrelated to the gastrointestinal tract and would not arise from ulceration of the stomach or duodenum. It is therefore not the correct answer to the question posed.
Choice B reason:
Bleeding is the primary clinical manifestation of greatest concern with a peptic ulcer. Ulcers can erode into blood vessels, leading to gastrointestinal hemorrhage, which may present as hematemesis (vomiting blood) or melena (black, tarry stools). Severe bleeding can result in hypovolemic shock and requires immediate medical intervention, such as endoscopic hemostasis, blood transfusions, or surgery. This makes bleeding the most critical concern among the options listed.
Choice C reason:
Bowel obstruction can occur as a complication of peptic ulcer disease but is less common compared to bleeding. It arises from scarring or swelling near the pylorus, leading to gastric outlet obstruction. While serious, it is not the most frequent or immediate concern in the context of peptic ulcers.
Choice D reason:
Hepatomegaly, or enlargement of the liver, is unrelated to peptic ulcer disease. This symptom is typically associated with liver conditions such as cirrhosis, hepatitis, or cancer, and does not result from ulcer pathology.