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Exam Review

Key Facts: Israel Pharmacist Licensing Exam Exam

120

Questions in the Official Paper

Ministry of Health — pharmacy licensing page

3.5 h

Duration, No Break

Ministry of Health — pharmacy licensing page

60

Pass Mark (50-59 May Appeal)

Ministry of Health appeal procedure for the health professions

2 / year

Sittings (13.05.2026, 28.10.2026)

Ministry of Health — pharmacy licensing page

2017

Israeli Graduates Exempt Since 16.01.2017

Ministry of Health — pharmacy licensing page

100

Practice Questions

OpenExamPrep Bank

The Israeli government pharmacy licensing examination is a 120-question multiple-choice paper sat over 3.5 hours with no break at Binyanei Ha'uma in Jerusalem, twice a year, and delivered on laptops from May 2026. It is taken by graduates of recognised foreign pharmacy programmes - Israeli graduates have been exempt since January 2017 - and the pass mark is 60, with an appeal right for scores of 50-59. This 100-question set is independent English-language practice by OpenExamPrep covering therapeutics, pharmaceutics, medicinal chemistry, calculations and Israeli pharmacy law.

Sample Israel Pharmacist Licensing Exam Practice Questions

Try these sample questions to review concepts for the Israel Pharmacist Licensing Exam exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old diabetic patient with stage 3 chronic kidney disease (eGFR 42 mL/min/1.73 m²) and persistent albuminuria (UACR 380 mg/g) is prescribed enalapril. What is the primary hemodynamic mechanism by which ACE inhibitors provide renoprotection in diabetic nephropathy?
A.Preferential dilation of the efferent renal arteriole, reducing intraglomerular hydrostatic pressure.
B.Constriction of the afferent arteriole, reducing hyperfiltration and blood flow to the nephron.
C.Direct inhibition of tubular sodium-glucose co-transporters in the proximal convoluted tubule.
D.Systemic venodilation resulting in reflex activation of the sympathetic renal plexus.
Explanation: Angiotensin II preferentially constricts the efferent arteriole of the renal glomerulus. By blocking the synthesis of angiotensin II, ACE inhibitors like enalapril cause preferential vasodilation of the efferent arteriole, which lowers intraglomerular capillary hydrostatic pressure and decreases albuminuria, mitigating long-term renal damage.
2A 58-year-old male with heart failure with reduced ejection fraction (HFrEF, LVEF 28%) is being initiated on beta-blocker therapy alongside guideline-directed medical therapy. Which of the following beta-blockers has demonstrated a mortality reduction benefit in randomized clinical trials of HFrEF?
A.Atenolol
B.Bisoprolol
C.Propranolol
D.Labetalol
Explanation: Only three beta-blockers are proven to reduce all-cause mortality in HFrEF clinical trials: bisoprolol (CIBIS-II), carvedilol (COPERNICUS), and extended-release metoprolol succinate (MERIT-HF). Atenolol, propranolol, and labetalol have not demonstrated mortality reduction in clinical trials for HFrEF.
3A patient with refractory atrial fibrillation receives long-term oral amiodarone therapy. Which organ toxicity requires routine baseline and periodic pulmonary function tests (including DLCO) due to the risk of irreversible fibrotic changes?
A.Hepatocellular necrosis
B.Thyroid follicular hyperplasia
C.Pulmonary interstitial toxicity
D.Corneal microdeposits
Explanation: Amiodarone contains iodine and lipophilic structural moieties that cause phospholipidosis and hypersensitivity pneumonitis, progressing to pulmonary fibrosis in up to 5-15% of patients. Annual chest radiography and pulmonary function testing with diffusion capacity of carbon monoxide (DLCO) are recommended to detect subclinical toxicity early.
4A 71-year-old female receiving apixaban 5 mg twice daily for non-valvular atrial fibrillation presents to the emergency department with life-threatening intracranial hemorrhage. Which specific reversal agent is approved to rapidly bind and neutralize oral factor Xa inhibitors like apixaban and rivaroxaban?
A.Idarucizumab
B.Protamine sulfate
C.Andexanet alfa
D.Phytomenadione (Vitamin K1)
Explanation: Andexanet alfa is a recombinant modified human factor Xa decoy protein that binds oral direct factor Xa inhibitors (apixaban and rivaroxaban) with high affinity, sequestering them and rapidly restoring endogenous thrombin generation.
5A 66-year-old patient established on simvastatin 40 mg daily is diagnosed with severe atypical pneumonia and prescribed clarithromycin. What major pharmacokinetic interaction and clinical complication is this patient at imminent risk of developing?
A.Inhibition of CYP3A4 leading to dramatically elevated simvastatin levels and rhabdomyolysis.
B.Induction of CYP2D6 causing subtherapeutic simvastatin levels and loss of lipid control.
C.Competition for renal organic anion transporters resulting in crystalline nephropathy.
D.Displacement of clarithromycin from albumin leading to acute macrolide ototoxicity.
Explanation: Simvastatin is a sensitive substrate of CYP3A4. Clarithromycin is a potent mechanism-based CYP3A4 inhibitor that markedly increases simvastatin plasma concentrations (AUC increases over 10-fold), creating a severe risk of statin-induced myopathy, myoglobinuria, and fatal rhabdomyolysis.
6Regarding the renal handling of electrolytes, how do thiazide diuretics (e.g., hydrochlorothiazide) differ fundamentally from loop diuretics (e.g., furosemide) in their effect on urinary calcium excretion?
A.Thiazides decrease urinary calcium excretion, whereas loop diuretics increase urinary calcium excretion.
B.Thiazides increase urinary calcium excretion, whereas loop diuretics decrease urinary calcium excretion.
C.Both drug classes produce equimolar wasting of calcium and magnesium in the collecting duct.
D.Thiazides cause calcium precipitation in the macula densa, whereas loop diuretics spare all divalent cations.
Explanation: Thiazide diuretics inhibit the Na+/Cl- cotransporter in the distal convoluted tubule, which enhances passive proximal and active distal paracellular calcium reabsorption, thereby decreasing urinary calcium excretion (hypocalciuria). Conversely, loop diuretics inhibit the Na+/K+/2Cl- cotransporter in the thick ascending limb of the loop of Henle, eliminating the transepithelial positive potential and increasing urinary excretion of both calcium and magnesium.
7A patient with a documented history of severe IgE-mediated anaphylaxis to amoxicillin (laryngeal edema and bronchospasm) requires antibiotic therapy. Which of these cephalosporins carries the highest risk of allergic cross-reactivity because its C-7 side chain is closest to that of the aminopenicillins?
A.Cefazolin
B.Cephalexin
C.Ceftriaxone
D.Ceftazidime
Explanation: Cross-reactivity between penicillins and cephalosporins is driven mainly by similarity of the C-7/C-6 side chain rather than by the shared beta-lactam ring. Cephalexin carries the alpha-aminobenzyl (phenylglycine) side chain that is identical to ampicillin's and differs from amoxicillin's only by the para-hydroxyl group, so among the options it is the agent most likely to cross-react in an aminopenicillin-allergic patient. (Cefadroxil and cefprozil, which carry the p-hydroxyphenylglycine side chain identical to amoxicillin's, are the closest structural matches of all and should likewise be avoided.)
8According to contemporary consensus guidelines for therapeutic drug monitoring (TDM) of vancomycin in serious MRSA infections, what is the preferred pharmacokinetic-pharmacodynamic (PK/PD) target index for optimizing clinical efficacy while minimizing nephrotoxicity?
A.Trough serum concentration maintained strictly between 25 and 30 mcg/mL
B.24-hour Area Under the Curve to MIC ratio (AUC24/MIC) of 400 to 600 mg·h/L
C.Peak serum concentration maintained above 80 mcg/mL at 1 hour post-infusion
D.Time above MIC (T > MIC) exceeding 90% of the dosing interval
Explanation: Current ASHP/IDSA/PIDS consensus guidelines recommend Bayesian-guided dosing targeting an AUC24/MIC ratio of 400 to 600 mg·h/L (assuming an MIC of 1 mg/L) for serious MRSA infections. This approach ensures maximal bacterial eradication while significantly reducing the incidence of acute kidney injury compared to sustained high trough concentrations.
9A hospitalized neutropenic fever patient requires immediate empiric coverage against Pseudomonas aeruginosa. Which of the following antimicrobial regimens lacks reliable intrinsic activity against Pseudomonas aeruginosa?
A.Ceftriaxone
B.Piperacillin-tazobactam
C.Cefepime
D.Meropenem
Explanation: Ceftriaxone is a third-generation cephalosporin that lacks intrinsic activity against Pseudomonas aeruginosa. Antipseudomonal beta-lactams include piperacillin-tazobactam, cefepime, ceftazidime, meropenem, and imipenem-cilastatin.
10A 24-year-old female receiving oral ciprofloxacin for pyelonephritis reports to the pharmacy that she routinely takes calcium carbonate and ferrous sulfate supplements. What counseling advice must the pharmacist provide regarding this co-administration?
A.Ciprofloxacin forms insoluble chelates with polyvalent cations, reducing its bioavailability; separate administration by at least 2 hours before or 4 to 6 hours after.
B.Calcium and iron induce hepatic CYP1A2, speeding the degradation of ciprofloxacin; double the antibiotic dose.
C.Polyvalent cations increase the gastrointestinal absorption of ciprofloxacin, increasing the risk of tendon rupture.
D.Take all tablets together with a large glass of orange juice to enhance gastric acidification and tablet disintegration.
Explanation: Fluoroquinolones possess a 4-keto and 3-carboxyl structural grouping that forms stable, insoluble chelates with polyvalent metal ions (Ca²⁺, Fe²⁺, Mg²⁺, Al³⁺). This physical chelation drastically impairs oral bioavailability by up to 90%, requiring dosing separation by at least 2 hours before or 4-6 hours after cation ingestion.

About the Israel Pharmacist Licensing Exam Exam

The Israel Pharmacy Licensing Examination (בחינת רישוי ממשלתית ברוקחות) is the mandatory statutory licensing examination conducted by the Medical Professions Licensing Department in coordination with the Pharmacy Division (אגף הרוקחות) of the Israeli Ministry of Health. Under the authority of the Pharmacists Ordinance [New Version], 5741-1981 (פקודת הרוקחים [נוסח חדש], התשמ"א-1981), passing this examination is required for pharmacy graduates—including all foreign-trained pharmacists and designated domestic cohorts—to obtain a government license to practice pharmacy in the State of Israel. The examination rigorously tests five foundational domains: pharmacology and therapeutics, pharmaceutics and compounding, medicinal chemistry, posology calculations, and Israeli pharmacy law and ethics. The official state examination is administered in Hebrew (and Arabic upon request). This question bank is an independent English-language MCQ study adaptation authored by OpenExamPrep to support candidates preparing for the exam; it is not an official government exam pool or official translation.

Exam sponsor: Ministry of Health (משרד הבריאות) — Pharmacy Division (אגף הרוקחות). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

120 multiple-choice ('American-style') questions over 3.5 hours with no break, sat on laptops at the International Convention Center (Binyanei Ha'uma), Jerusalem. Candidates may request a translation into English, Arabic, Russian, French or Spanish when they register, and approved candidates receive 25% extra time.

Time Limit

3.5 hours with no break

Passing Score

60 (a failing score of 50-59 carries the right to inspect the paper and appeal)

Exam / Certification Fees

Statutory fee set in the Ministry of Health fee schedule, payable through the government payments service at least 10 days before the examination

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

35%

Pharmacology, Pharmacokinetics & Clinical Therapeutics

Mechanisms of drug action, indications, contraindications, adverse drug reactions, therapeutic drug monitoring, clinical pharmacokinetics (clearance, volume of distribution, elimination half-life), and drug-drug interactions across major organ systems (cardiovascular, CNS, antimicrobial, endocrine, oncology, and respiratory).

20%

Pharmaceutics, Formulations & Compounding

Physicochemical principles of dosage forms (tablets, capsules, emulsions, suspensions, suppositories), drug release and dissolution mechanisms, accelerated and long-term stability testing, sterile compounding in laminar airflow hoods, cleanroom standards, sterilization validation, and excipient compatibility.

15%

Pharmaceutical Chemistry & Medicinal Chemistry

Structure-activity relationships (SAR) of major drug classes, chemical stability pathways (hydrolysis, oxidation, racemization), prodrug biotransformation mechanisms, acid-base dissociation constants (pKa), ionization fractions, and lipophilicity profiles (logP/logD).

15%

Pharmaceutical Calculations & Posology

Quantitative clinical and compounding calculations: electrolyte concentrations in milliequivalents (mEq) and millimoles (mmol), plasma and infusion osmolarity (mOsmol/L), alligation alternate for concentration adjustments, IV infusion drip rates and duration, renal clearance estimation using the Cockcroft-Gault equation, and pediatric dosing based on weight and body surface area (BSA).

15%

Israeli Pharmacy Law, Dangerous Drugs & Dispensing Ethics

Statutory mandates under the Pharmacists Ordinance [New Version] 5741-1981, Dangerous Drugs Ordinance [New Version] 5733-1973, prescription retention and validity periods, double-locked safe requirements for Schedule dangerous drugs, narcotic registry bookkeeping, dispensing error mitigation, pharmacist substitution protocols, and patient medical privacy.

Preparing for the Israel Pharmacist Licensing Exam Exam

What You Need to Know

  • Passing score: 60 (a failing score of 50-59 carries the right to inspect the paper and appeal)
  • Assessment: 120 multiple-choice ('American-style') questions over 3.5 hours with no break, sat on laptops at the International Convention Center (Binyanei Ha'uma), Jerusalem. Candidates may request a translation into English, Arabic, Russian, French or Spanish when they register, and approved candidates receive 25% extra time.
  • Time limit: 3.5 hours with no break
  • Exam / certification fees: Statutory fee set in the Ministry of Health fee schedule, payable through the government payments service at least 10 days before the examination Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

Israel Pharmacist Licensing Exam: Suggested Study Strategy

1Dedicate daily practice to multi-step posology math: commit the valence of divalent vs monovalent ions to memory for mEq calculations, and practice alligation alternate until fluent.
2Thoroughly memorize Israeli statutory timelines: 15-day validity for dangerous drug prescriptions, 1-year prescription archiving rules, and narcotic safe physical specifications.
3Focus heavily on high-yield drug classes in therapeutics: ACE inhibitors/ARBs, beta-blockers, DOACs, SGLT2 inhibitors, GLP-1 receptor agonists, and statin lipid guidelines.
4Understand the pharmacokinetic implications of renal and hepatic clearance: know when and how to calculate Cockcroft-Gault creatinine clearance to adjust narrow therapeutic index medications like vancomycin, aminoglycosides, and digoxin.
5Review the chemical mechanisms of drug instability, specifically ester/amide hydrolysis and beta-lactam ring opening in penicillins and cephalosporins.

Frequently Asked Questions

What is the format and passing score of the Israel Pharmacy Licensing Examination?

The paper has 120 multiple-choice questions and runs for 3.5 hours with no break. From the May 2026 sitting it is taken on laptops rather than on printed question and answer sheets; the Ministry states the structure itself is unchanged. The pass mark is 60, and candidates who fail with 50-59 may inspect their paper on the published review day and appeal within 10 days.

Who is required to take the Israeli Ministry of Health pharmacist licensing exam?

Graduates of recognised foreign pharmacy programmes who want an Israeli licence. Graduates of the Israeli pharmacy schools complete their internship within their degree and, since 16 January 2017, are exempt from the government licensing examinations in pharmacy.

What language is the official examination conducted in?

The examination is set in Hebrew and translated into English, Arabic, Russian, French or Spanish; the language must be chosen on the registration form. In exceptional cases the examination supervisor may permit the use of a dictionary. This practice bank is an independent English-language study adaptation by OpenExamPrep, not an official translation.

What are the rules regarding Dangerous Drugs (סמים מסוכנים) in an Israeli pharmacy?

Under the Dangerous Drugs Ordinance [New Version] 5733-1973 and Dangerous Drugs Regulations 5740-1979, all controlled substances listed in the First Schedule must be stored in an anchored, double-locked heavy steel safe. A dedicated registered pharmacist must maintain an official Dangerous Drugs Register (פנקס סמים מסוכנים), documenting every receipt, dispensing transaction, prescription number, patient ID, and remaining balance. Prescriptions for dangerous drugs are valid for only 15 days from the date of issuance.

What are the internship (סטאז') requirements for pharmacists in Israel?

Israeli pharmacy students complete their internship (סטאז') inside their university programme, and the faculty reports completion to the Ministry, which then issues a permanent licence without a temporary licence stage. Foreign graduates should confirm their own internship and recognition requirements directly with the Medical Professions Licensure Division, which assesses each file.

How often is the exam offered and what are the fees?

Twice a year. The published 2026 sittings are 13.05.2026 and 28.10.2026 at the International Convention Center (Binyanei Ha'uma) in Jerusalem, with registration closing two months before each date. The examination fee is set in the Ministry of Health fee schedule and must be paid through the government payments service at least 10 days before the examination.