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Two more creates the client replays out of its offline outbox ran the handler again on the replay. A titration step carries no natural key at all, so a lost success response left the medication with two dose changes on the same day and the runway estimate reading off the wrong one. A custom cycle symptom is unique on its label, so the replay did not duplicate — it answered the 409 that uniqueness raises, reporting a conflict the client cannot act on for a row it has no record of creating. Both wrap in `withIdempotency`, the composition their siblings already ship, and both operations publish the header and the in-flight 409 so a client generated against the contract can tell a retry is safe. The integration file that drives the medication creates twice against real Postgres gains the titration case: one dose-change row after the replay, and a replayed 201 carrying `X-Idempotent-Replay: true`. `POST /api/mcp/tokens` is deliberately not on this list. Its response carries a freshly minted `hlk_` credential, and the wrapper refuses to persist a secret-shaped body — publishing the header there would promise a replay the mechanism will never perform.